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The presence of conspecifics can affect alarm calls and in particular the signaller's behaviour. This study investigated the anti-predator response in males of a monogamous species, the red-legged partridge (Alectoris rufa), in relation to the audience. Aerial alarm calls and nonvocal behaviour were analyzed, in order to assess whether they were affected by the presence of an audience, and in particular by the audience's composition: unfamiliar males, unfamiliar females and signallers’ mates. Rate and spectrographic characteristics of the alarm calls, as well as behavioural responses to a dummy avian raptor, were analyzed in a sample of 18 farm-reared males. Our findings show that the presence of conspecifics was able to alter the number and structure of male alarm calls. In addition, the number of alarm calls drastically decreased when no audience was present: when the male was alone, it might even not vocalize, thus reducing predation risk. The audience composition was also important; the presence of the signaller's mate elicited more calls than that of an unfamiliar male. The spectrographic structure of alarm calls was affected by the audience, mainly in terms of peak frequency. This study shows that alarm calls of red-legged partridge males are influenced by the audience, and in particular by the presence of the signaller's mate: red-legged partridge males in presence of their mates not only warn them by increasing alarm calling rate, but also produce less detectable calls. [ABSTRACT FROM PUBLISHER]

This study is intended to investigate the differences in anti-predator behavioural and acoustic response to terrestrial and aerial predators as well as the behavioural differences between sexes in the red-legged partridge. To this aim we observed the response of 114 partridge (57 males and 57 females) to dummy terrestrial and aerial predators, a raptor and a fox. We divided behavioural responses to predators into four mutually exclusive categories: vigilance, freezing, escape and non-anti-predator behaviours. We also recorded and analysed the vocalizations emitted during tests. The animals reacted differently to aerial and terrestrial stimuli. The reactions elicited by the terrestrial predator were ranked as follows: vigilance, escape, non-anti-predator behaviours, and freezing. Those elicited by the aerial predator were ranked as follows: vigilance, freezing, escape and non-anti-predator behaviours. Vigilance and escape were elicited more frequently by the terrestrial predator than by the aerial predator (vigilance: p < 0.001; escape: p < 0.001). Freezing was the most frequent behaviour following the appearance of the aerial predator (p < 0.001). In fact, freezing may represent an effective strategy in an open space, combining camouflage from and detection by the predator. On the other hand, vigilance is an effective behaviour to detect and avoid a terrestrial predator hunting by ambush. We did not find clear-cut differences between sexes. The analysis of vocalizations revealed that the fox and the raptor elicited significantly different calls (p = 0.003); the fox evoked significantly more vocalizations than the raptor (p< 0.001), differing in addition in frequency parameters. Thus partridges not only discriminate between aerial and terrestrial predators and behave consequently, but are also able to tune alarm calls in relation to the context of predation. [ABSTRACT FROM AUTHOR]

A population pharmacokinetic analysis of dalbavancin was conducted in patients with different infection sites. Non-linear mixed effect modeling was used for pharmacokinetic analysis and covariate evaluation. Monte Carlo simulations assessed the probability of target attainment (PTA) of total dalbavancin concentration ≥ 8.04 mg/L over time (associated with ≥90% probability of optimal pharmacodynamic target attainment of fAUC24h/MIC > 111.1 against S. aureus) associated with a single or double dosage, one week apart, of 1000 or 1500 mg in patients with different classes of renal function. Sixty-nine patients with 289 concentrations were included. Most of them (53/69, 76.8%) had bone and joint infections. A two-compartment model adequately fitted dalbavancin concentration−time data. Creatinine clearance (CLCR) was the only covariate associated with dalbavancin clearance. Monte Carlo simulations showed that, in patients with severe renal dysfunction, the 1000 mg single or double one week apart dosage may ensure optimal PTAs of 2 and 5 weeks, respectively. In patients with preserved renal function, the 1500 mg single or double one-week apart dosage may ensure optimal PTAs of 2 and 4 to 6 weeks, respectively. Therapeutic drug monitoring should be considered mandatory for managing inter-individual variability and for supporting clinicians in long-term treatments of subacute and chronic infections.

Background: Scrub typhus is a vector-borne rickettsial infection, which can cause relevant morbidity and mortality. While the number of cases is around a million per year globally, the infection is seldom diagnosed in travellers from Europe., Methods: We herein report three cases diagnosed in Italian travellers and review the literature about imported cases in Europe in the last 60 years., Results: Three participants to the same hiking trip to the forest of northern Laos presented fever and other symptoms, including eschars (2 individuals) and skin rash (2 individuals). Overall, they didn't report complications, and recovered soon after doxycycline treatment. Diagnosis was retrospectively confirmed with PCR in one of them. The review collected data from 40 patients. Almost all of them (95%) presented fever, more than a half had headache, skin rash, eschars, arthromyalgias. 73% of them were hospitalized, and 16.2% needed intensive care. Diagnosis was confirmed by serology in almost all cases (94.6%). Most patients (88%) were treated with doxycycline. All patients survived, although one case resulted in incomplete tetraparesis., Conclusions: Scrub typhus should be considered in all travellers coming back from endemic areas and presenting with acute febrile illness. Laboratory diagnosis can be challenging, as specific tests are not widely available. In case of clinical suspicion, a prompt treatment with oral doxycycline could avoid severe complications., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

COVID-19 is characterized by a severe pulmonary disease due to severe acute respiratory syndrome (SARS)-CoV-2 infection. For clinicians involved in the management of patients with chronic autoimmune diseases the risk linked to the conditions itself and to drug-induced immunosuppression during the COVID-19 pandemic is a major topic. Pemphigus is a rare autoimmune blistering disease (AIBD) of the skin and mucous membranes caused by autoantibodies to desmosomal components, desmoglein 1 and 3. Among immunosuppressant therapies, rituximab (RTX) is considered a highly effective treatment with a favorable safety profile, but it induces a prolonged B-cell depletion that can lead to higher susceptibility to infections. For this reason, concerns about its use during the pandemic have been raised. We describe a case of a pemphigus patient in which RTX-induced B cell depletion led to the severe inflammatory phase, whereas corticosteroid treatment allowed a favorable outcome., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Sinagra, Vedovelli, Binazzi, Salemme, Moro, Mazzanti, Didona and Di Zenzo.)

We report a case of a woman who experienced psychiatric disorders after switching her antiretroviral therapy (c-ART) to dolutegravir (DTG). She is a 59-year-old HIV-1 positive woman with a recent story of cardiovascular disorders treated with beta-blockers, clopidogrel, and rosuvastatin. She underwent a c-ART switch from darunavir/cobicistat and maraviroc to emtricitabine/tenofovir alafenamide fumarate in association with dolutegravir due to drug-drug interactions. One week later, she started to show psychiatric symptoms that required admission to the psychiatric unit. These disorders resolved within a couple of days after DTG discontinuation to allow a regular discharge. With this case-report, we would like to analyse the possible correlation between integrase inhibitor and severe psychiatric disorders in order to confirm the evidences already published in literature., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2020 Daniele Mengato et al.)

Despite evidence supporting the effectiveness of best practices in infection prevention and management, many healthcare workers fail to implement them and evidence-based practices tend to be underused in routine practice. Prevention and management of infections across the surgical pathway should always focus on collaboration among all healthcare workers sharing knowledge of best practices. To clarify key issues in the prevention and management of infections across the surgical pathway, a multidisciplinary task force of experts convened in Ancona, Italy, on May 31, 2019, for a national meeting. This document represents the executive summary of the final statements approved by the expert panel.

Toxigenic Clostridium difficile is responsible for antibiotic-associated diarrhoea and other diseases. The increasing frequency and severity is attributed to highly-virulent ribotypes such as 027. The aim of the study was to collect epidemiological and molecular data for C. difficile isolates during 2009-2013 in the Central Hospital of Bolzano, Northern Italy. Stool samples from inpatients of the Bolzano Central Hospital were screened for toxins A and B, and C. difficile was cultured and tested for antibiotic susceptibility. PCRs were performed for genes of toxin A, toxin B, binary toxin and ribotyping. During the period 2009-13 from 320 patients (9% of patients tested) at least one stool sample proved positive for C. difficile toxins, and incidences for all hospital inpatients per 10,000 patient days (per 1,000 admissions) varied between 2.2 (1.5) and 4.3 (3.0). Out of 138 isolates (43% of total isolates were studied), 24 different ribotypes were identified. Isolates with ribotype 027 were predominant (38%), followed by 018 (13%) and 607 (10%). Whereas for ribotype 018 a significant decrease was seen during the five-year period, ribotype 027 increased significantly from 0% in 2009 to 64% in 2012, decreasing then to 10% in 2013. Isolates were sensitive to metronidazole and vancomycin, whereas isolates of the three major ribotypes were resistant to moxifloxacin. Our data indicates a significant change in C. difficile incidence rates and ribotype frequencies during the five-year period in the Central Hospital in Bolzano.

Background: Silicone implants have been successfully used for breast augmentation and reconstruction in millions of women worldwide. The reaction to the silicone implant is highly variable; it can lead to local inflammatory symptoms, and sometimes to systemic symptoms and disease. Over 80 cases of anaplastic lymphoma kinase-negative anaplastic large cell lymphoma have been reported in patients with silicone breast implants and have been accepted as a new clinical entity. To the best of our knowledge, an intravascular large B-cell lymphoma associated with a silicone breast implant has not been reported previously., Case Presentation: A 48-year-old Caucasian woman who presented with high fever was found to have splenomegaly on physical examination. A laboratory diagnosis revealed pancytopenia, hypertriglyceridemia, and hyperferritinemia. She developed signs of altered sensorium, hemiparesis, aphasia, and cauda equina syndrome. On further evaluation, she fulfilled the necessary five out of eight criteria for diagnosis of macrophage activation syndrome/hemophagocytic lymphohistiocytosis. Dexamethasone administration was followed by prompt improvement; however, 3 days later she again manifested high fever, which persisted despite administration of immunoglobulin and cyclosporine A. Her silicone breast implant was considered a possible contributor to her macrophage activation syndrome and was therefore removed. A histological examination of the capsule tissue showed an extensive lymphohistiocytic/giant cell foreign body reaction suggestive of autoimmune/inflammatory syndrome induced by adjuvants. However, the histological examination unexpectedly also revealed an intravascular large B-cell lymphoma., Conclusions: The genetic background of our patient with silicone breast implants might have predisposed her to three rare and difficult to diagnose syndromes/diseases: macrophage activation syndrome/hemophagocytic lymphohistiocytosis, autoimmune/inflammatory syndrome induced by adjuvants, and intravascular large B-cell lymphoma. The simultaneous manifestation of all three syndromes suggests causal interrelationships. Human leukocyte antigen testing in all women who undergo silicon breast implantation could in the future enable us to better evaluate the risk of potential side effects.

High developmental dysplasia of the hip is commonly treated with total hip arthroplasty and shortening osteotomy. We present a two stage technique, consisting of progressive femoral lowering followed by total hip arthroplasty. The clinico-radiographic results of eleven patients (twelve hips) who were operated on with the two-stage technique were evaluated at a mean follow-up of 11 ± 5 years. At the final follow-up, ten patients (eleven hips) had a mean Harris hip score of 85 ± 5 points with no implant loosening. One patient (one hip) was revised at 5 years due to infection. No neurovascular complications were observed in any patients. With this technique, we could place the cup in the anatomical position and obtain complete limb symmetry with excellent clinical results at long-term., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Leishmaniasis is spreading from mediterranean countries to the north of Europe. The Alps are not an endemic region and there are only few reports of sporadic cases. We report the case of a 72 year old male who presented after a syncope with fever, cough and a sacral skin rash. Clinical examination revealed splenomegaly, elevated liver enzymes and pancytopenia; differential diagnosis included myeloproliferative or lymphoproliferative disorders, infections and auto-immune conditions that cause enlargement of the spleen and liver diseases, however, all tests were negative. In (18)FDG PET computerized tomography, pathological and diffuse uptake in the spleen was seen, with mild and homogeneous FDG uptake in the bone marrow and normal tracer uptake elsewhere in the body. Bone marrow aspiration revealed the presence of numerous intra- and extracellular Leishmania amastigotes. Travel history indicated that he had been in Sardinia for a 7-day vacation several months ago. The patient promptly responded to treatment with liposomal amphotericin B. Imported visceral leishmaniasis is likely to be seen more frequently in non-endemic regions and fever, pancytopenia and splenomegaly are diagnostic clues, whereas diagnostic confirmation may be done by detection of Leishmania spp. amastigotes in the bone marrow.

The immune system protects the organism from foreign invaders and foreign substances and is involved in physiological functions that range from tissue repair to neurocognition. However, an excessive or dysregulated immune response can cause immunopathology and disease. A 39-year-old man was affected by severe hepatosplenic schistosomiasis mansoni and by amyotrophic lateral sclerosis. One question that arose was, whether there was a relation between the parasitic and the neurodegenerative disease. IL-17, a proinflammatory cytokine, is produced mainly by T helper-17 CD4 cells, a recently discovered new lineage of effector CD4 T cells. Experimental mouse models of schistosomiasis have shown that IL-17 is a key player in the immunopathology of schistosomiasis. There are also reports that suggest that IL-17 might have an important role in the pathogenesis of amyotrophic lateral sclerosis. It is hypothesized that the factors that might have led to increased IL-17 in the hepatosplenic schistosomiasis mansoni might also have contributed to the development of amyotrophic lateral sclerosis in the described patient. A multitude of environmental factors, including infections, xenobiotic substances, intestinal microbiota, and vitamin D deficiency, that are able to induce a proinflammatory immune response polarization, might favor the development of amyotrophic lateral sclerosis in predisposed individuals.

Purpose: Extrapulmonary tuberculosis (EPTB) is frequently seen in human immunodeficiency virus (HIV)-infected individuals in Sub-Saharan Africa and recent work has shown point-of-care (POC) ultrasound to be a diagnostic aid in the resource-limited, highly endemic setting. Its role in industrialized countries, however, has rarely been studied. With international migration, EPTB is increasingly seen in European hospitals. This study reports ultrasound findings and discusses the diagnostic relevance of EPTB in an industrialized country setting., Methods: In this retrospective study, we describe a cohort of 27 patients with a predominantly immigrant background diagnosed with HIV and EPTB in Northern Italy and evaluate the role of ultrasound in their clinical management. All inpatient files of HIV-positive individuals admitted to our hospital with culture-proven diagnosis of EPTB were reviewed, along with chest X-rays and ultrasound studies. The outcome and results of long-term follow-up were extracted., Results: A total of 243 HIV-positive inpatients were identified between January 2005 and November 2011. Twenty-seven of the patients [11.1 %, 95 % confidence interval (CI) 7.4-15.7] were diagnosed with EPTB. Ultrasound showed a typical pattern of enlarged abdominal lymph nodes and focal lesions in the spleen and liver in 22 patients (81.5 %, 95 % CI 7.4-15.7) and, thus, helped to raise the suspicion of mycobacterial infection., Conclusion: As disseminated mycobacterial infections in HIV-positive patients can be treated effectively if diagnosed early, and typical sonographic findings are seen in the majority of these patients, we suggest that POC ultrasound should be integrated in diagnostic and screening algorithms for EPTB in developed countries.

Background: Vancomycin is frequently used in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia; reduced susceptibility to vancomycin is therefore disturbing., Methods: molecular epidemiological analysis of 81 MRSA bacteraemia isolates collected during 2002-10 in the province of Bolzano, northern Italy was performed. MICs of a range of antimicrobials were determined by agar microdilution, screening for hGISA was by Macro-Etest and Etest GRD and confirmed by PAP-AUC with vancomycin and teicoplanin. All isolates were characterised by toxin gene profiling, agr, spa, and SCCmec-typing; MLST and PFGE were carried out on representative strains., Results: The dominant clones identified were ST8-MRSA-IVc (55%) and ST228- and ST111-MRSA-I (25%); most of the latter two lineages (19/20; 95%) were GISA or PAP-AUC confirmed hGISA. One ST8-MRSA-IVc isolate harboured ccrA2B2 together with ccrA4B4. The remainder were diverse genotypically and belonged to MLST clonal complexes 1, 22, 45 and 398., Conclusions: Diverse lineages of MRSA were identified as causing bacteraemia in a province in northern Italy. The association of a specific genotype with the hGISA and GISA phenotypes among representatives of the second most common lineage identified is of clinical concern.

We present a case of a young female athlete with chronic knee instability and constitutional varus limb, in which the failure of an initial stabilising operation required multiple operations to correct the unstable varus knee: in particular valgus osteotomy and ligament reconstruction using contralateral patellar tendon were performed in two staged operations in order to minimise surgical aggression, optimise rehabilitation and prevent postop complications. The final result is evaluated according to the IKDC chart as normal category A.

The B203.13 monoclonal antibody was developed by immunizing mice with the B/monocyte biphenotypic cell line B1b. During normal hematopoiesis B203.13 is expressed on a fraction of CD34+ cells, while on mature cells it is only present on B-lymphocytes. We tested this antibody as a marker of childhood B-acute lymphoblastic leukemia (B-ALL). Bone marrow aspirates from 139 cases of early B-ALL and 25 controls were studied. About 40% of the B-ALL patients expressed B203.13. In these patients, B203.13 was constantly co-expressed with CD10, but never co-expressed with CD20, contrary to the controls. The CD10(+)/B203.13(+) phenotype was specific to B-ALL, since CD10(+)/CD20(+) cells from common acute lymphoblastic leukemia (c-ALL) did not express B203.13. We concluded that the use of B203.13 in association with CD10 and CD20 provides meaningful information for distinguishing normal residual B-cells from leukemic B-lymphoblasts and that recurrence of a CD10(+)/B203.13(+) phenotype after transplantation may be a very early relapse indicator of early B-acute lymphoblastic leukemia.

Although TNF-related apoptosis-inducing ligand (TRAIL) usually induces cell death in tumor cells, there are some tumor cell types that are resistant to its apoptogenic effects. Some chemotherapeutic drugs, however, can sensitize resistant cancer cells to TRAIL by either upregulating surface TRAIL death receptor expression or by modulating intracellular signalling pathways emanating from TRAIL receptors. U2OS human osteosarcoma cells express TRAIL-R2 but are resistant to TRAIL-induced apoptosis. however, the genotoxic drugs, Doxorubicin and Cisplatin, are able to sensitize U2OS cells to TRAIL, without affecting their surface expression of either death or decoy TRAIL receptors. We demonstrate that Doxorubicin and Cisplatin downmodulate X-IAP, while not affecting FLIP levels in U2OS cells. Selective downmodulation of X-IAP protein synthesis by specific small interference RNA transfection induced a sensitization of U2OS cells to TRAIL comparable to that induced by pharmacological treatment with genotoxic drugs. TRAIL-R2 downmodulation by siRNAs completely abolished the TRAIL-induced apoptosis of genotoxin-treated U2OS cells. Our findings demonstrate that Doxorubicin and Cisplatin do not sensitize U2OS osteosarcoma cells to TRAIL by surface receptor modulation but rather by the removal of the intracellular signalling inhibition generated by X-IAP, suggesting a foreseeable relevant advantage to the therapy of these tumors by the combined regimen of genotoxin-based chemotherapy and TRAIL.

Fitek cementless cups have been adopted in our department in 1989. The first 100 consecutive Fitek implants were analyzed clinically (Harris hip score) and radiographically (anteroposterior and lateral x-rays) with a mean follow-up of 9.7 years. We did not have any case of cup loosening or any other problem requiring cup revision. In this series, we had 86 excellent, 10 good, 2 fair, and 2 poor results. The 2 poor results were because of 2 cases of aseptic loosening of the stem (1 cemented and 1 cementless). The x-rays showed an average angle of cup inclination of 36.5 degrees (range 16 degrees -54 degrees ) after surgery and no variations at the last follow-up. Bidimensional linear wear of the acetabular component showed 6 cases of measurable wear with an average wear rate per year of 0.265 mm. The overall wear rate per year was 0.02 mm. At the time of the last follow-up examination, we had 3 femoral osteolysis and no case of acetabular osteolysis. In our series, we observed "lack of contact" zones above the polar depression in 71 cases immediately after surgery. The average thickness of these lines was 1 (range 0.5-3.5) mm. Of these, at the last follow-up, 61 cases (86%) showed a complete "filling" of the "lack of contact," whereas in 10 (24%), the "filling" was incomplete (4 cases still showing a radiolucent line [

Background and Objectives: A retrospective analysis was performed to assess the efficacy of various treatments of non-Hodgkin's primary bone lymphomas (PBL)., Design and Methods: Fifty-two consecutive, previously untreated PBL patients were seen between the years 1982 and 1998. Information was obtained regarding each patient's presentation and clinical course. Histology was reviewed in all cases. Modern immunohistochemical stains were performed on each case., Results: Regarding therapeutic approach, we observed a complete response (CR) in 35/41 (85%) patients treated with chemotherapy with/without radiation therapy and in 7/11 (64%) patients who received radiation therapy alone. Relapses were observed in only 2/35 (6%) patients after chemotherapy (with/without radiation therapy), as compared with 4/7 (57%) patients after radiation therapy alone (p = 0.004); the relapse-free survival curves of these two subsets were significantly different. At both univariate and multivariate analysis only type of front-line therapeutic approach (chemotherapy with/without radiation therapy vs. radiation therapy alone) turned out to have a significant prognostic influence., Interpretation and Conclusions: Our data indicate that in PBL use of chemotherapy or combined-modality therapy seems to provide more durable CRs than radiation therapy alone.

The treatment of SL, especially in some cases, is mostly surgical. This lesion can be considered an extremely localised kyphosis (only two vertebrae) or a localized (sub-)luxation: at most hearetically pre-operative reduction should represent the first stage of the treatment, also because reduction makes further surgery easier and enables us to obtain the best results. After a glance at the various surgical techniques that have been used in the past, we describe our method of preoperative reduction in case of severe SL, an improvement of Scaglietti's original technique. According to the parameters taken into consideration, spondylolisthesis (SL) of the 4th and, above all, the 5th lumber vertebrae can be considered, especially in severe cases, as kyphosis or displacement (or even dislocation in the case of ptosis). In SL-kyphosis the antero posterior axes of the contiguous vertebral bodies are no longer parallel but tend to over-impose one to the other anteriorly forming an open posterior angle of varying degrees. It is an extremely short kyphosis (only two vertebrae) but from all points of view, even therapeutic, it reflects the characteristics of all types of vertebral kyphosis. SL-subluxation or SL-luxation (ptosis) is characterized by the respectively partial or total loss of normal alignment between the vertebrae involved. This can be explained by the fact that nearly all those who have dealt with the problem of treating SL, especially of L5, always ask themselves beforehand if it is possible and/or opportune to eliminate or improve the condition before surgery. In other words the question of reduction (pre or intraoperative, partial or total) of more or less severe L5 SL is always considered by all authors, even if their conclusions are often in disagreement.

An evaluation of total hip replacement patients requires objective criteria that allow for the measurement of any changes in the biomechanics of the prosthesis and the effects of these changes on clinical findings. An evaluation of loading and joint movement during walking in these patients has been dealt with by many authors. In this study 15 patients who had undergone total hip replacement for coxarthrosis primary or secondary to congenital dysplasia were examined by kinematic and kinetic gait analysis, clinical evaluation, and radiographic evaluation of the position of the neocenter of prosthetic joint rotation. The patients with prostheses in congenital dysplasia presented with a pattern of walking that was significantly modified. In agreement with what is reported in the literature proximal positioning had less influence on gait parameters as compared to lateral dislocation. Furthermore, changes in positioning observed did not seem to have negative effects on joint loading, measured indirectly by the calculation of joint moments.

With regard to increasing reservations as to homologous transfusions and the objective risks that they involve, since 1984 we have been using an autotransfusion technique in total hip arthroplasty constituting blood predeposit for hemodilution, and intra- and postoperative blood recovery. When this method was used postoperative complications were not very significant even when patients were high-risk (cardiopathic); furthermore, the use of homologous transfusions was required in 2.2% of the patients in 1994 as compared to 90% in 1985. The use of our orthopaedic protocol allows for rapid recovery of movement in the patient thus reducing time bed-ridden and related risks (DVT and/or PTE); the transfusion protocol allows for a return to normal of hemodynamic conditions a few days after surgery. Finally, the reduced incidence of complications caused by homologous transfusions (hepatitis, AIDS...) constitutes a financial saving for the government.

Indications for the surgical treatment of septic loosening of hip arthroplasty vary depending on different parameters. Explantation is indicated when patients are elderly, in generally poor condition, when there are veterate infections, particularly if these were caused by gram negative bacteria, and when there is severe skeletal injury. Reimplantation is instead indicated in patients whose general conditions are good, and who are young and motivated.

Reimplantation (when possible) represents today the method of choice when dealing with and attempting to resolve cases of deep infection in total hip arthroplasty. In recent years we have, however, had the chance to treat some cases of infection in cementless arthroplasty (without loosening) by conservative treatment: surgical debridement and specific antibiotic therapy (2 cases), or medical therapy alone (1 case), both associated with immobilization in a plaster cast for 2-3 weeks. The long-term results proved to be quite encouraging: none of the 3 patients treated conservatively showed (after 5-6 years) clinical-radiographic signs of recurrence of the infection.

The authors consider poor results in lumbar disc surgery to be commonly caused by the following conditions: 1) recurrence of the hernia; 2) postoperative instability; 3) scarring entrapment of the spinal nerve roots; 4) coexisting local or general pathology; 5) arachnoiditis; 6) psychological causes and those where insurance is involved. In particular patients with insurance-related motivations or those affected with depressive syndromes are frequently observed among those submitted to lumbar surgery. The only indications for surgery include recurrence of disc herniation and postoperative instability. In any of the other situations further surgery often results in worsening of the patient's conditions, or it at any rate does not guarantee improvement in the conditions of the patients.

The authors report the results obtained in 244 patients submitted to anterior interbody fusion. The method involves preoperative reduction in plaster (when necessary) and anterior surgical stabilization, facilitated by improvement in the anatomical and biomechanical conditions obtained with reduction. This method obtained excellent results in 85% of the cases, with fusion and absence of symptoms, and good results in 10% of the cases, with occasional symptoms and/or fibrous. Results were unsatisfactory in 5% of the cases because of residual radiculopathy (4 cases), non-union of the fusion (3 cases), retrograde ejaculation (2 cases), loosening of the graft (1 case) or unthreading of a screw (1 case). It is our opinion that anterior interbody fusion is the best surgical method for the stabilization of Meyerding grades III, IV and V spondylolisthesis. Posterolateral fusion is used to treat some cases with slippage equal to less than 25% (grade I) and cases where more than one level is involved.

The Osgood-Schlatter lesion is considered a traction apophysitis. Treatment is generally conservative, and only rarely does a surgical treatment become necessary for the persistence of pain and swelling over the tibial tubercle. The most widely used procedure consists of the excision of all intratendinous ossicles with or without removal of the prominent tibial tubercle. In 15 cases treated in this manner compared with 11 cases treated with various procedures before 1975, the results were clearly better with the former. There was only one fair and no poor results. Removal of all loose intratendinous ossicles associated with prominent tibial tubercles is the procedure of choice, both from the functional and the cosmetic point of view.

Fractures of the scapula from indirect trauma represent 0.01% of all skeletal fractures treated in our Institute. They are avulsion fractures that result from the violent pulling of the muscles, the ligaments, or both on their bony insertion. In our series of eight cases any possible direct trauma to the scapula was carefully excluded. In all patients treatment did not represent a particular problem and it was always conservative. Clinical results were always good, with excellent recovery of shoulder function except in one case with a circumflex nerve lesion leaving a deltoid muscle deficit.

A number of rating systems used to evaluate the results of total knee arthroplasty exist. Many of these systems are based on different concepts, and might be expected to give divergent results. To see if this was so, the authors examined a consecutive series of 235 posterior stabilized knee arthroplasties recording the results according to five rating systems: HSS (The Hospital for Special Surgery), Brigham, Freeman, BOA (British Orthopaedic Association), and the VENN diagram. In spite of their apparent differences, all point systems and the BOA gave almost identical results, while the VENN diagram proved to be the most stringent. The authors suggest that any of the current point systems may be used to "score" arthroplasties, but the results should also be rated with the VENN diagram in order to see the quality of the arthroplasty and a comparison between the different series.

Twenty-seven knees treated between 1974 and 1980 had a total condylar type knee arthroplasty without patellar resurfacing; the average follow-up period was 5.2 years. Compared with a previously reported group of 100 consecutive total condylar arthroplasties, the overall results in this series were very similar. However, there was a significant difference in stair-climbing ability, and one-third of the patients could not use the operated knee for this activity. In most knees the patella could be resurfaced. A working hypothesis assumes that the patellar button can be omitted in patients with relatively normal patellar cartilage, or relatively young, active, or obese patients who are considered a high risk for patellar bone fractures.

Nine total knee arthroplasties were performed in seven patients with the diagnosis of neuropathic arthropathy. The patients were divided into two groups, classical Charcot and Charcot-like. The histopathological findings in all of the knees, however, were essentially the same. These included hyperplastic synovium with bone and/or cartilage detritus, severe disorganization of the articular cartilage with invasion by a fibrous pannus, and hemosiderin deposits in synovial macrophages. Chronic inflammatory synovitis was noted in all cases. The results of total knee arthroplasty an average of three years after surgery (range, two to 4.25 years) were excellent in eight knees in six patients and good in one knee. Neuropathic knees can be treated by total joint arthroplasty if severe bone loss is corrected by either bone grafting or a custom-augmented prosthesis and if ligamentous balancing is adequately secured.