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Background The relationship between Hyperuricemia and Cardiovascular risk has been established but whether or not a correlation between Serum Uric Acid (SUA) and Metabolic Syndrome (MS) exists is still a matter of debate. Indeed whether SUA level is part of MS diagnosis or just a pure marker of an unfavourable metabolic profile has not been demonstrated. Besides it’s unknown whether SUA’s addition to MS definition makes a difference in terms of prognosis. In our study we focused on evaluating in a group of hypertensive patients, the correlation between MS diagnosis and SUA defined with two different cut–off: 1) ≥6 mg/dL for women and ≥7 for men (classic cut–off); 2) >5.6 mg/dL for both sexes (recently proposed by the URRAH Project). Methods We enrolled 473 Hypertensive patients followed by the Hypertension Unit of San Gerardo Hospital (Monza, Italy), in which SUA was measured. Patients with Hyperuricemia were identified according to the two different thresholds. NCEP–ATP–III criteria were used for diagnosis of MS. Results MS was diagnosed in 33.6% while Hyperuricemia was found in 14.8% of subjects according to the traditional cut–off and 35.9% according to URRAH study’s cut–off. Hyperuricemia and MS coexist in 9.7% (traditional cut–off) and 17.3% (URRAH’s threshold) of the population. Hyperuricemia was more frequent in MS than in non–MS subjects (29 vs 7.6%, p–value Conclusions Hyperuricemia is related with MS diagnosis especially when defined by the recently defined cut–off of 5.6 mg/dL.

Background Metabolic Syndrome (MS) has been related to an impairment in arterial structural and functional properties with heterogeneous results. Purpose In this study we focused on the effects of MS on arterial carotid-femoral Pulse Wave Velocity (PWV) and common carotid Intima Media Thickness (IMT) in two different populations, one of hypertensive patients and one of healthy controls. Methods We enrolled 816 consecutive hypertensive (HT) and 536 healthy controls. Vascular structural (IMT) and functional (PWV) properties were evaluated. NCEP-ATP-III criteria were used for diagnosis of MS. Results MS was diagnosed in 26.9% and 6.9% in hypertensive and control subjects, respectively. PWV was similar in controls with and without MS (7.7±1.9 vs 7.6±1.1 m/s, p=0.69), while IMT was higher in controls with than those without MS (0.64±0.18 vs 0.57±0.13 mm, p=0.02). Hypertensives with MS were older (57.9±12.2 vs 52.7±14.1 years, p Conclusions The main finding of our work is that MS is a significant determinant of IMT while this is not the case for PWV. This result has been confirmed both in hypertensive subjects and in healthy controls. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): ASST Grande Ospedale Metropolitano Niguarda

The single-incision minimally invasive anterior approach to the hip with complete preservation of the musculotendinous structures offers excellent surgical exposure of both the acetabulum and the femur for the purpose of total hip replacement. Acetabular exposure corresponds to a modified and limited Smith-Petersen approach with intrinsic peculiarities. Femoral exposure in external rotation, adduction and extension of the leg is unusual for replacement purposes and is accomplished by the use of a traction table and a specially designed hook. Anterior single-incision exposure combines the advantage of intrinsic articular stability of anterior approaches with the advantages of preservation of lateral pelvitrochanteric and posterior myotendinous structures. An adequate learning curve must be overcome due to peculiar adaptations during the course of operation. A large variety of femoral components may be implanted by this approach; metaphyseal anchoring stems and femoral neck-preserving stems are particularly suited to this technique, combining both issues of minimally invasive surgery in total hip replacement: bone preservation and minimal surgical invasiveness. This article describes the surgical technique that we adopted in 2003 and compares it to other minimally invasive surgical techniques.

A modified and limited Smith Petersen approach was used for prosthetic hip replacement. The exposure of the proximal femur required the use of a traction table. We operated on 49 patients: 15 of them underwent cemented bipolar hemiarthroplasty, and 34 had a total hip arthroplasty. Skin incision ranged from 6 to 11 cm (average 7.8 cm). Patients subjective grading was evaluated according to a pain scale (0-10); early functional outcome was rated on postoperative days two, seven and 30 according to a functional scale of active flexion and abduction. Average active flexion on the second postoperative day was 68.4, and active abduction 14.7. Progressive increment of average active flexion and abduction was observed on day 7 (78.7 flexion - 22.3 abduction) and day 30 (88.4 flexion 29.2 abduction). All patients were allowed progressive weight-bearing depending on their postoperative pain. Most of them were fully weight bearing from the first day. This surgical approach, characterized by preservation of the muscular insertions, is associated with reduced postoperative pain and fast functional recovery. (Hip International 2004; 14: 233-8).

We are reporting on 46 patients who had suturing for chronic meniscal tears, 31 cases have been reviewed arthroscopically. The tears occurred both in the red-white zone (15 patients) as well as white-white zone (16 patients) ranging from isolated short peripheral tears up to complete and chronic dislocated bucket handle tears. Criteria of evaluation was the morphological appearance of the meniscus and stability at probing the site of tear. The follow up ranged from 26 to 48 months. Tears in the white-red zone were more likely to heal completely (80%) compared to tears in the white-white region (68.5%).

The young generation of orthopedic Surgeons, entering the sonographic era, are more aware of the importance of the early diagnosis of hip development dysplasia (D.D.H.).In time, probably during the next decades, D.D.H. sequelae will no longer be one of the most frequent reasons for surgical hip treatments.Early sonographic investigation indicates that about 41% of newborn hips still have not reached normal maturation at the time of birth (physiological immaturity) and 0.66% of dislocatable or dislocated hips elude pure clinical tests.Prevention and, when necessary, early treatment, which limit the suffering of both patients and parents, achieve first rate results and help contain costs for Society. However, for those cases detected later, either closed or open reposition-retention is still necessary.From the fundamental contributions of the past, we can now compare the results of the pre- and post-sonographic experience.

From August 1987 to the Ist of March 1993 1,477 RM.-isoelastic, uncemented cup components (257 HA, 1,220 Titanium coated) were inserted for T.H.R., matched with the RM- isoelastic and isotitan stem components. At a 4 year mean follow-up (7-1 years) 1,302 cups were clinically and radiographically assessed; 6.2% of cups could not be controlled, because at follow-up time the patients had died; 5.6% could not be traced. All the cups were fixed with 3.2 mm peripheral screws (mean number of screws: 6). The cups more than 60 mm in diameter were fixed with 2 additional cancellous (6.5 mm) screws. The Charnley score is: - 9 - (97.5%) - 8- (2.43%); 1 cup was removed because of infection (0.07%); 3 cups were revised because of malposition and reinserted in proper position. The results with a similar number of RM.-uncoated cups, fixed with only one or two screws from 1979 to 1985, at a mean 4 year follow-up were: 7% revision and 9% impending loosening. Even bone reaction at the bone-cup interface signifies no osteolisis, neither around the cup nor around the screws. The satisfactory clinical results suggest to proceed with the use of this cup

The new alpha 1-blocker alfuzosin was compared with propranolol as monotherapy for hypertension in a double-blind, parallel group study of 8-week duration in 40 patients with essential hypertension. The patients (11 males, 29 females; mean age 47.8 +/- 2.2 years in the alfuzosin group and 46.6 +/- 2.4 years in the propranolol group) randomly received either alfuzosin from 2.5 mg b.i.d. up to 10 mg b.i.d. or propranolol from 40 mg b.i.d. up to 160 mg b.i.d. according to an individualized dose-titration schedule. The two groups were comparable with respect to disease history, cardiovascular risk factors, concomitant diseases, previous treatments and end-placebo blood pressure and heart rate values. Four patients did not complete the study, two patients in the alfuzosin group: one patient because of postural hypotension and the second one because of breast cancer; and two patients in the propranolol group: one patient for inefficacy and the second one lost to follow-up. At the end of the 8-week trial the mean daily doses were 12.2 +/- 0.61 mg and 196 +/- 9.82 mg for alfuzosin and propranolol, respectively. The antihypertensive effects of the two drugs were comparable. Upright and supine blood pressures decreased significantly with both treatments from the second week on (P less than 0.001 for all BP values). At the end of the 8-week double-blind trial, 83% of alfuzosin patients and 67% of propranolol patients were normalized. The two treatments differed significantly with respect to their effect on heart rate. Alfuzosin did not induce marked changes in heart rate: only a slight increase was observed. In contrast, propranolol caused bradycardia, more marked in the upright position. Palpitations, headache, asthenia and orthostatic hypotension were reported in the alfuzosin group. Asthenia and decreased libido were reported in the propranolol group. These data prove that alfuzosin has antihypertensive effects equivalent to propranolol and it is an interesting agent for the therapy of essential hypertension. It can be used as a first agent at doses between 5 and 20 mg/day with satisfactory therapeutic response and without relevant side-effects.

A simple diagram of coronal plane forces about the hip is used to describe pathomechanics of coxa vara, coxa valga, coxarthrosis, femoral neck fracture, congenital coxa vara, slipped capital epiphysis, dislocation of the femoral head and acetabular loosening in total hip replacement. A common pattern of abnormality is seen to be excessive shear against a cranio-laterally oblique plane with consequent cranio-lateral migration of the structure distal to that plane. As soon as the plane is made horizontal with surgical treatment, the shearing forces disappear and the vertical compressive forces achieve healing.

Clinic blood pressure values are known to change according to seasonal influences. We therefore examined home and 24 h ambulatory blood pressure values to determine whether these measurements are also affected by the seasons.In 2051 subjects of the Pressione Arteriose Monitorate E Loro Associazioni (PAMELA) study, we measured clinic (sphygmomanometric measurements), home (semi-automatic device) and ambulatory (Spacelabs 90207) systolic blood pressure, diastolic blood pressure and heart rate. Because the overall sample was evenly distributed over each month (except August), we were able to make a cross-sectional determination of whether the values differed between seasons. The corresponding heart rates were also evaluated.As expected, summer was associated with the lowest clinic blood pressure and winter with the highest, and this was the case also for home and 24 h average blood pressure, although seasonal differences in the latter were less pronounced. Seasonal clinic, home and ambulatory blood pressure patterns were similar for normotensive subjects (n = 1152), untreated hypertensives (n = 540) and treated hypertensives (n = 359). Heart rate values did not differ by season.Seasonal influences on blood pressure are not limited to conventional measurements but characterize daily values as well. These effects are visible in both normal and elevated blood pressure values, regardless of the effect of antihypertensive drugs. This has implications both for the clinician and for studies aimed at evaluating the effects of antihypertensive treatment.

Die konservativen chirurgischen Eingriffe an einem dysplastischen, degenerativen oder posttraumatischen Huftgelenk mussen die Wiederherstellung einer moglichst anatomiegetreuen Situation zum Ziel haben. Sie ist Voraussetzung fur eine physiologische Beanspruchung des Gelenks. Das hier beschriebene Modell uber Funktion und Biomechanik eines normalen Huftgelenks und deren Umwandlungen unter pathologischen Bedingungen basiert auf der Interpretation von radiologisch sichtbaren Veranderungen im spongiosen Trabekel-werk des Beckens und des proximalen Femurendes. Das Modell visualisiert die mechanischen Krafte, die diesen biologischen Strukturveranderungen zugrundeliegen; es bildet die Basis fur das Verstandnis der biomechanischen Auswirkungen der gewohnlichen Korrektureingriffe am Huftgelenk. Daruber hinaus kann es die auf Operationen folgenden radiologischen Strukturveranderungen aus biomechanischer Sicht erklaren.

The results of a multicentric review are reported using the extensimetric instrumentation applied to the Ilizarov device. This clinical trial the follows same theoretical and experimental preliminary studies, outlines the advantages and current limits of the method, and sets the bases for further clinical and experimental research.

The new alpha 1-blocker alfuzosin was compared with propranolol as monotherapy for hypertension in a double-blind, parallel group study of 8-week duration in 40 patients with essential hypertension. The patients (11 males, 29 females; mean age 47.8 +/- 2.2 years in the alfuzosin group and 46.6 +/- 2.4 years in the propranolol group) randomly received either alfuzosin from 2.5 mg b.i.d. up to 10 mg b.i.d. or propranolol from 40 mg b.i.d. up to 160 mg b.i.d. according to an individualized dose-titration schedule. The two groups were comparable with respect to disease history, cardiovascular risk factors, concomitant diseases, previous treatments and end-placebo blood pressure and heart rate values. Four patients did not complete the study, two patients in the alfuzosin group: one patient because of postural hypotension and the second one because of breast cancer; and two patients in the propranolol group: one patient for inefficacy and the second one lost to follow-up. At the end of the 8-week trial the mean daily doses were 12.2 +/- 0.61 mg and 196 +/- 9.82 mg for alfuzosin and propranolol, respectively. The antihypertensive effects of the two drugs were comparable. Upright and supine blood pressures decreased significantly with both treatments from the second week on (P less than 0.001 for all BP values). At the end of the 8-week double-blind trial, 83% of alfuzosin patients and 67% of propranolol patients were normalized. The two treatments differed significantly with respect to their effect on heart rate. Alfuzosin did not induce marked changes in heart rate: only a slight increase was observed. In contrast, propranolol caused bradycardia, more marked in the upright position. Palpitations, headache, asthenia and orthostatic hypotension were reported in the alfuzosin group. Asthenia and decreased libido were reported in the propranolol group. These data prove that alfuzosin has antihypertensive effects equivalent to propranolol and it is an interesting agent for the therapy of essential hypertension. It can be used as a first agent at doses between 5 and 20 mg/day with satisfactory therapeutic response and without relevant side-effects.

We reviewed the results of 277 intertrochanteric valgus-extension osteotomies performed between 1973 and 1975 for primary or secondary osteoarthritis. The average age of the patients was 51 years and follow-up varied from 11 to 15 years. At the latest evaluation 67% of the hips were good or excellent on the Merle D'Aubigne scale. Better results were obtained in patients under 40 years of age with unilateral involvement and a mechanical (secondary) aetiology. An elliptical femoral head, minimal subluxation and an adequate pre-operative range of motion were also favourable. There was radiographic evidence of regression of the arthritic changes in 39% of the hips at final review. Valgus-extension osteotomy is effective for secondary osteoarthritis of the hip in selected younger patients, but not for those with primary hip disease or a poor range of movement.