Search

Since the introduction of more effective antiretroviral therapy in HIV treatment, an increase in survival and in the quality of patients' life has been observed, due to the dramatic reduction in commonly occurring opportunistic diseases. The appearance of new clinical cases has, however, been observed, previously unrecorded probably due to the quicker negative evolution of AIDS. Pathologies such as lypodistrophy, cardiomyopathy, immune disease, are extremely widespread and partly linked to the natural history of HIV infections, and partly to the side effects of the treatments. Among such diseases, femoral head necrosis seems to occur fairly frequently and is characterised by a quick evolution. The emergence of coxalgia in HIV patients requires an early diagnosis through NMR or bone scan. Given the usual evolution of this pathology and the problems related to antiviral treatment, conservative treatment seems to have little possibility of success. A surgical replacement becomes essential in cases of invalidating necrosis, but there are still unresolved questions as regards risks of infection, bone integration, as well as local and systemic reactions to the prosthetic debris.

Conventional radiography, ultrasound, Magnetic Resonance (MR), Arthrography Computed Tomography (Arthro-CT) and Arthrography Magnetic Resonance (Arthro-MR) are available for diagnosis of rotator cuff tears. Our purpose is to assess the specificity and sensitivity of these examinations and if they could give to the surgeon all the informations to select the more accurate treatment. We have evaluated retrospectively the images of 68 patients, 43 male and 25 female (average age 51 years), which then have been surgically treated for rotator cuff pathology. On the basis of our findings, we think that conventional radiography and ultrasound are excellent in a first evaluation. MR images, particularly in the coronal and sagittal oblique planes, are able to demonstrate partial or complete rotator cuff tears. The use of intra-articular contrast medium (arthro-CT, arthro-MR) should be reserved for partial lesions on specific cases.

Atrophy of infraspinatus muscle caused by suprascapular nerve entrapment is a typical disease of overhead sports such as volleyball, baseball and javelin. The chronic distress of suprascapular nerve infraspinatus branch may derive from nerve kinking and friction caused by an entrapment at the spino-glenoid notch, often repeated during external-rotation and abduction of shoulder. From 1999 to 2000 4 athletes, out of 143 professional baseball players, were found suffering from this disease. The diagnosis was confirmed by MNR and EMG, while a isokinetic test quantified a loss of strength in external-rotation and allowed a standard parameter for the treatment result evaluation. The 4 athletes were submitted to a non-invasive rehabilitation protocol, thanks to electrostimulation and isokinetic exercises, aiming at strengthening the extrarotator muscles and restoring a suited musclar balance. A subjective improvement was verified and confirmed by isokinetic test in all the players; moreover no surgery was needed.

The Authors relate their experience in 14 cases of prosthesis revision using a long stem implant by H. Wagner, performed in 12 cases with transfemoral approach. Notwithstanding the aggressive procedure, that consists of splitting the proximal extremity of the femur for a length of 16 cm to 25 cm, to perform the complete removal of the first implant and of all the cement, after a 2 year check-up, the Authors observed: the complete mechanical stability of the new implant, the rapid process of ossification replacing the surgical fractures and bone loss.