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Combined anteversion in total hip arthroplasty influences both dislocation risk and range of motion. One of its components, stem version (SV), could be dictated by many factors, from native femoral anatomy to stem geometry and surgeon's choice. In the present multicenter study, robotic technology was used to assess the influence of native femoral version on final SV and combined anteversion using a straight, uncemented stem.Three hundred sixty-two patients undergoing total hip arthroplasty were enrolled from 3 different orthopedic centers from 2012 and 2016. All patients underwent computed tomography planning with measurement of femoral neck version (FNV) and intraoperative measurement of stem version (SV), acetabular component version (AV), and combined version (CV) with robotic instrumentation.Mean FNV was 5.0° ± 9.6°, and SV was 6.4° ± 9.7°. The average difference between FNV and SV was 1.6° ± 9.8°. A moderate correlation was found between FNV and SV (R = 0.48, P.001). SV was between 5° and 20° in 174 patients (48%). Mean CV was 28.2° ± 7.9°. A strong correlation was found between SV and CV (R = 0.89, P.001). A significant difference in SV was found between the 3 centers (P .001). CV was25° in 109 patients (30.1%). Relative risk of CV25° was 8.6 times greater with SV 5° (P.001).With the use of an uncemented, single-wedge, straight stem, SV is highly variable. Despite being moderately correlated with native FNV, SV can be partially influenced by the surgeon. A low SV could be hardly corrected, bringing high risk of low CV.

Objectives The recent guideline for the evaluation and management of Chronic Kidney Disease recommends assessing GFR employing equations based on serum creatinine; despite this, creatinine clearance 24-hour urine collection is used routinely in many settings. In this study we compared the classification assessed from CrCl (creatinine clearance 24 h urine collection) and e-GFR calculated with CKD-EPI or MDRD formulas. Design and methods In this retrospective study we analyze consecutive laboratory data: creatinine clearance 24 h urine collection, serum creatinine and demographic data such as sex and age from 15,777 patients > 18 years of age collected from 2011 to 2013 in our laboratory at Careggi Hospital. The results were then compared to the estimated GFR calculated with the equations according to the recent treatment guidelines. Consecutive and retrospective laboratory data (creatinine clearance 24 h urine collection, serum creatinine and, demographic data such as sex and age) from 15,777 patients > 18 years of age seen at Careggi Hospital were collected. Results Comparison between e-GFR calculated with CKD-EPI or MDRD formulas and GFR according CrCl determinations and bias [95% CI] were 11.34 [− 47,4/70.1] and 11.4 [− 50.2/73] respectively. The concordance for 18/65 years aged group when compared with e-GFR classification between MDRD vs CKDEPI, MDRD vs CrCl and CKD-EPI vs CrCl were 0.78, 0.34, and 0.41 respectively, while in the 65/110 years aged group the concordance Kappas were 0.84, 0.38, and 0.36 respectively. Conclusions The use of CrCl provides a different classification than the estimation of GFR using a prediction equation. The CrCl is unreliable when it is necessary to identify CKD subjects with decrease of GFR of 5 ml/min/1.73 m 2 /year.

Surgical treatment of a unusual acetabular fracture is described. This fracture was characterized by impaction and breaking down of the posterior articular surface and comminution of lamina quadrilatera lower portion, without cortical fracture of both columns. The fracture was treated surgically through the Kocher–Langenbeck approach. A small hole was created in the acetabulum posterior wall, the impacted fragment was reduced, and the bone defect was filled with autologous bone from the greater trochanter. A plate was shaped in order to fix both bone graft and fractured fragment.

Concerns exist regarding prosthetic positioning and post-operative limb alignment in unicompartmental knee arthroplasty (UKA). In this study, we hypothesized deviations of the post-op anatomical femoro-tibial angle (aFTA) and the tibial component alignment to be factors influencing UKA survivorship. Moreover, by a comparison between all-poly and metal back UKAs, we hypothesized that prosthetic design plays a role in implant survivorship.One hundred ninety-five medial UKAs were performed on 176 patients by two experienced surgeons and one low-UKA user. One hundred and forty-seven UKAs were included in the study: 72 all-poly and 75 metal back. Measurements were performed on radiographs: mechanical femoro-tibial angle, Cartier angle, aFTA and tibial posterior slope (PS) on pre-op radiographs; femoral and tibial component varus/valgus, aFTA and tibial component PS on post-op radiographs.At an average follow-up of 61 months (min. 30, max. 107), 147 UKAs were evaluated: The reported survivorship rate was 93.1 %. Eleven implants underwent revision: ten all-poly and one metal back. No differences were reported between the two groups in the radiographic measurements. Significant radiographic differences were reported between revised and not revised UKAs: Revised UKAs were associated with overcorrection of the pre-op Cartier angle and under correction of pre-op aFTA. Most of revised UKAs were performed by the low-volume UKA surgeon.Surgeon's experience is essential to achieve good results in UKA: Preserving the tibial epiphyseal axis and avoiding excessive or insufficient corrections of the pre-operative limb alignment are predictor of successful replacement, while prosthetic designs, models and fixation geometry do not affect UKA outcome.IV.

In medical practice, the analysis of facial soft tissues often complement (or even supplement) the evaluation of the hard-tissue relationships. Current technology provides reference data in three dimensions, but clinical practice still uses two-dimensional photographs. In the current study, two-dimensional photographic and computerized, three-dimensional angles measured on the facial profile of children were compared.Two-dimensional angular measurements (facial convexity including/excluding the nose; maxillary prominence; nasal prominence; nasolabial; mentolabial; maxillo-labio-mandibular; interlabial) were obtained on the facial profile photographs of 55 boys and 31 girls aged 6; measurements were compared to three-dimensional computerized data collected on 27 boys and 28 girls of the same age and ethnic group.On average, in boys, only the angles of facial convexity including the nose, interlabial, nasolabial and maxillo-labio-mandibular showed differences between the means larger than 2 degrees (up to 2.5 degrees). Statistically significant differences (P0.05, Watson-Williams' test) were found for the angle of facial convexity including the nose and the maxillary prominence angle. In girls, differences between the two methods larger than 2 degrees were found for the interlabial, maxillo-labio-mandibular (statistically significant), and mentolabial angles (differences up to 7 degrees, corresponding to 4% of the relevant mean).The two-dimensional photographic and the three-dimensional computerized data compared in the current study, even not superimposable, seemed sufficiently interchangeable, at least from a clinical point of view. A particular attention should be given to the recording of lip position.

The distribution and appearance of secretory cells in the pituitary gland were investigated for the first time in a chondrostean species, Acipenser naccarii, from embryos to juveniles, by immunohistochemistry with mammalian and teleost hormone antisera. On 5.5 day post-fertilization (2.5 days pre-hatching), the pituitary of embryos appears as an oval cell mass with a narrow central cavity (hypophysial cleft), close to the ventral border of diencephalon under the third ventricle. At that time no neurohypophysis is observed, the adenohypophysis is not yet structurally divided into pars intermedia (PI) and pars distalis (PD) and only immunoreactive growth hormone cells are detectable. Seven days post-fertilization (1 day pre-hatching) the immunoreactive thyrotropic cells appear in the ventral region and the immunoreactive adrenocorticotropic cells in the posterior dorsal one. At hatching, some immunoreactive melanotropic (ir-MSH) cells are visible in the posterior dorsal region and some immunoreactive prolactin cells in the anterior one. Eight days later the immunoreactive somatolactin cells appear along the posterior dorsal border and the immunoreactive gonadotropic I (ir-GtH I) cells in the ventral region. Here, a few ir-GtH II cells finally appear in 76-86 day old juveniles. The gland elongates after hatching and in 8-day-old larvae two adenohypophysial regions are identified: a posterior (the presumptive PI) and an anterior one (the presumptive PD). In 156-166-day-old juveniles three regions (rostral and proximal pars distalis and pars intermedia) appear and a high number of ir-MSH cells are visible in the rostral region. The first protrusion of neurohypophysis into adenohypophysis is observed in 76-86-day-old juveniles and increases with age, branching into PI. The rostro-caudal distribution of the immunoreactive cells follows the spatial expression of the corresponding hormone gene families observed in zebra fish, suggesting similar differentiating mechanisms in teleosts and chondrosteans.

Management of a colostomy by irrigation is simple and effective. Five hundred and nine patients having a colostomy for rectal cancer during the last 10 years were assessed by our Rehabilitation Department as potential candidates for irrigation. Fifty-two patients were considered unsuitable and 40 refused to learn the technique. The remaining 417 (82%) patients adopted the irrigation method. Of these, 97% achieved full continence of periods of 24 to 48 h. There was no case of colonic perforation. The median duration of irrigation was 230 days; 31.6% had been irrigating from 1 to 5 years and 10.3% for more than 5 years. There was a reduction of more than 50%/24 h in the number of applicances used by patients. Irrigation is a simple, safe and cost-effective means of managing a colostomy. With careful selection of patients, irrigation should be recommended as a routine part of rehabilitation.

A series of 421 malignant pleural mesotheliomas, diagnosed in the Trieste-Monfalcone area, northeastern Italy, were reviewed. A large majority of the patients had been employed in "naval" work (shipbuilding, maritime trades, and dock work). Latency periods (time intervals between first exposure to asbestos and death), showed wide variations from one occupational category to another. Such variations were attributable, but only partly, to differences in the intensity of the exposure to asbestos. Various family cases were identified, including people with and without blood relationships. The data, obtained in the studies on Trieste-Monfalcone mesothelioma, suggest that interactions between asbestos and other factors play a considerable role in the pathogenesis of asbestos-related mesothelioma.

Latency periods (time intervals elapsing between first exposure to asbestos and death) were examined in 421 cases of malignant pleural mesothelioma, diagnosed in the Trieste-Monfalcone area, Italy. Occupational data were collected from the patients or from their relatives by personal or telephone interviews. Routine lung sections were examined for asbestos bodies in 370 cases. Latency periods, calculated in 312 cases, ranged from 14 to 72 years (mean 48.7, median 51). Latency periods differed significantly from one occupational group to another. Mean latency periods were 29.6 among insulators, 35.4 among dock workers, 43.7 in a heterogeneous group defined as various, 46.4 in non-shipbuilding industry workers, 49.4 in shipyard workers, 51.7 among women with a history of domestic exposure to asbestos, and 56.2 in people employed in maritime trades. The ANOVA test indicated a correlation between latency periods and occupational groups. Latency periods in people with asbestos bodies visible in routine lung sections did not differ from those seen in cases with no evidence of asbestos bodies. These data suggest that intensity of exposure is a relevant, but not the only, factor in determining the duration of latency periods.

The Authors describe a 53 year old patient, who, after suffering from asthma over the past 10 years, presented with abdominal pain, diarrhoea, dyspnea, petechias on lower limbs, and subsequently developed fever, polyneuritis, pericardial effusion and renal failure. Laboratory showed elevated IgE, presence of antinuclear antibodies to DNA, serum rheumatoid factor and peripheral eosinophilia. The clinical course was suggestive for systemic vasculitis; lung, skin biopsies and renal angiography confirmed this diagnosis: the association with asthma and eosinophilia fulfill the diagnosis of allergic angiitis and granulomatosis (Churg-Strauss syndrome).

We report three cases of brain metastases from malignant pleural mesothelioma that were seen at autopsy. We present a summarized review of 15 similar reports that were previously published. Our study included three aged male patients with a long occupational history of heavy asbestos exposure. In two patients, the metastases were discovered incidentally at autopsy, and there were no neurologic symptoms referred to before death. In the other patient, who had clinically occult mesothelioma, the intracranial tumor was discovered ante mortem: in this patient, the clinical features, as well as a computed tomographic scan, suggested a primary tumor of the brain. Interestingly, the histologic features of the latter case that were seen at autopsy depicted a spindle cell tumor that focally exhibited pseudopalisading, necrosis, vascular buds, which deceptively recalled a glioblastoma. All the three cases shared a basic sarcomatous pattern of malignant pleural mesothelioma in both primary and metastatic tumors. The immunohistochemical profile was consistent with such interpretation. It was concluded that metastases to the brain from malignant pleural mesothelioma, although rare, are not exceptional even if their clinical relevance is not prominent. They are seen concomitantly with high-grade tumors, and by mimicking a primary tumor on a clinical, instrumental, and histologic ground, they may occasionally represent a potential source of diagnostic pitfall.

Oral rehydration therapy has gained worldwide acceptance as the standard treatment for acute diarrhoeal diseases in infants and children. Besides the high sodium glucose-electrolyte solution based on the WHO/UNICEF recommendations, many diverse formulations of oral rehydration solutions (ORS) have withstood the trial of prolonged clinical use, their main differences concerning the concentration of sodium, the choice of the glycidic component, the use of bicarbonate as buffer or its substitution with acetate or citrate. It was recently hypothesized that glucose polymers-containing ORS markedly improve the intestinal sodium/glucose cotransport by delivering glucose at its critical site on the luminal villous membrane and therefore diminish stool output and duration of the diarrhoea. To investigate this hypothesis, the efficacies of two marketed ORS (table I), one containing sucrose and maltodextrin (solution A) and the other containing glucose (solution B) were compared. The study group comprised 13 infants and toddlers, 1 to 18 months old, who presented with acute diarrhea; 5 were males and 8 females; 7 were randomly allocated to receive solution A (Group A), 6 solution B (Group B). There were no significant differences between the groups in age, sex, causation of diarrhea or severity of dehydration before receiving ORS. Both groups showed a satisfactory response to 24 hours of treatment with either ORS, but a significantly lower stool output (number and global weight of stools) and higher blood glucose and bicarbonate levels were detected in group A (table II).(ABSTRACT TRUNCATED AT 250 WORDS)

Melanosis cerebelli (melanic pigmentation involving the dentate nuclei and the granular layer of the cerebellar cortex) is described in three patients, aged between 72 and 99 years. In two cases atrophic changes of the Alzheimer type co-existed in the cerebral cortex. One patient had a history of tremors, possibly cerebellar in origin.

Basal cell epithelioma of the lip. An analysis of 42 cases. The authors carried out a histopathological and epidemiological study of 42 basal cell epitheliomas of the lip. Both sexes were equally affected (male to female ratio 0.9:1) but the females were significantly older than the males (mean age: 70.7 years vs 62.3 years respectively). The incidence in the province of Trieste was 1.44%... for males and 1.46%... for females. More than 80% of the lesions (35 cases) consisted in solid forms, but there were also 4 cheratotic basal cell epitheliomas, 1 fibrosing epithelioma and 1 basosquamous epithelioma. In 2 of the males there was a recurrence a year after the surgical exeresis and in 6 cases another epithelioma was synchronous or metachronous to the lip epithelioma. Despite the fact that in 3 cases invasion of the muscular wall was noted and in another case the neoplasm had infiltrated and eroded the left nostril and the lower part of the septum, no patient died from the tumour nor were any metastasis observed.

The medical record and the lung sections were reviewed in 53 autoptic cases with pulmonary bone marrow embolism. In 31 cases the emboli could be ascribed to external cardiac massage, in one case to accident; in the other cases a definite aetiologic factor was lacking. The number of the emboli was largely variable from one section to another and sometimes very high (up to 16). The pulmonary bone marrow embolism has probably a clinical significance particularly when the underlying condition is severe.

The pathology of the optic nerve in the advanced elderly has been investigated at autopsy in a sample of 50 subjects (43 males, 7 females), aged 95-103 years. Septal fibrous thickness and slendering of nerve fibers were the most frequently encountered lesions as well as degenerative processes involving the cribriform lamina. Other significant features included gliosis, demyelination, and corpora amylacea. Complete arteriosclerotic disease was rarely observed. The results of the present study suggest that optic nerve pathology in aged people is almost the consequence of an inadequate blood supply; nevertheless, the degree of these lesions does not seem to parallel that usually observed in other sites particularly injured by ischemic disease.

The histochemical reaction for 3 beta-hydroxysteroid dehydrogenase was applied to glutaraldehyde fixed eel testis and successively processed for transmission electron microscopy. The reaction product was found only on the smooth endoplasmic reticulum and in the intermembrane space of mitochondria of the Leydig cells of hCG treated silver eels. The positive cytochemical reaction appears to be coupled with an enlargement of the Leydig cells and an increase of their smooth endoplasmic reticulum.

Summary From May 1988 to March 1990, 17 consecutive patients with histologically proven malignant mesothelioma were treated with epirubicin 75 mg/sqm i.v. on day 1 and ifosfamide 1.8 gr/sqm/day i.v. from day 1–5. Treatment was repeated every 3 weeks until progression. Fifty-three chemotherapy cycles were administered to the 17 patients treated (median, 3 cycles/patient). No complete responses, 1 partial response, 8 stable diseases and 8 progressions were noted. Toxocity was acceptable and no treatment-related deaths occurred. Actuarial median survival was 6 months. In this study, a combination of full doses of epirubicin and ifosfamide did not prove to be active in malignant mesothelioma.

Here, we show that an α-proteobacterium of the genus Asaia is stably associated with larvae and adults of Anopheles stephensi , an important mosquito vector of Plasmodium vivax , a main malaria agent in Asia. Asaia bacteria dominate mosquito-associated microbiota, as shown by 16S rRNA gene abundance, quantitative PCR, transmission electron microscopy and in situ -hybridization of 16S rRNA genes. In adult mosquitoes, Asaia sp. is present in high population density in the female gut and in the male reproductive tract. Asaia sp. from An. stephensi has been cultured in cell-free media and then transformed with foreign DNA. A green fluorescent protein-tagged Asaia sp. strain effectively lodged in the female gut and salivary glands, sites that are crucial for Plasmodium sp. development and transmission. The larval gut and the male reproductive system were also colonized by the transformed Asaia sp. strain. As an efficient inducible colonizer of mosquitoes that transmit Plasmodium sp., Asaia sp. may be a candidate for malaria control.

The term hallux rigidus is used to describe a condition characterized by pain and a reduction in the range of motion, especially dorsiflexion, at the first metatarsophalangeal joint1-3. According to the etiology, hallux rigidus can be classified as primary (hallux limitus) or secondary (Table I)1,2,4-8. View this table: TABLE I Etiology of Secondary Hallux Rigidus ### Functional Consequences With normal locomotion, the amount of hallux dorsiflexion during propulsion must approximate 65° to 75°9. With hallux rigidus, dorsiflexion of the first metatarsophalangeal joint is restricted9. As a consequence, during the propulsive phase of gait, functional limitation and pain lead to an internal rotation of the forefoot, reducing push-off and creating transfer metatarsalgia (Fig. 1)9,10. Fig. 1 During the propulsive phase of gait, the hallux is unable to dorsiflex adequately. As a consequence, the foot internally rotates, reducing push-off and causing transfer metatarsalgia of the lesser metatarsals. ### Indications for Surgery The indication for surgery is pain combined with degenerative changes of the first metatarsophalangeal joint. Because there is no correlation between reduction of dorsiflexion and radiographic findings in hallux rigidus, we believe that the most useful parameter for the choice of a specific surgical technique is the extent of arthritis of the metatarsophalangeal joint as seen radiographically with use of a classification system described by Coughlin and Shurnas11 and modified by us (Table II) (Fig. 2). View this table: TABLE II Classification of Arthritis of the Metatarsophalangeal Joint Associated with Hallux Rigidus Fig. 2 Radiographic classification of hallux rigidus. (See Table II for a description of the grades.) ### Patient Factors The surgical strategy has to be planned according to the arthritis classification and must include consideration of other patient factors (Table III). The goal of surgery is to relieve pain, improve function, reduce the progression of arthritis, and correct any …

Recently, inconclusive results have followed the early data on the possible association between multiple sclerosis (MS) and human T-cell lymphotropic virus type I (HTLV-I) infection. For this reason, we examined this hypothesis using the polymerase chain reaction (PCR) to study samples of differing origin from Italian MS patients. In particular, we developed a systematic analysis of paraffin-embedded brain white matter from histologically defined lesions of 14 MS patients using PCR and primer sets specific for HTLV-I sequences; additionally, cerebrospinal fluids (CSFs) from 12 patients and peripheral blood mononuclear cells (PBMCs) from subjects at the early and late phase of the disease were investigated for free HTLV-I virions and specific proviral sequences, respectively. In agreement with some groups who reported lack of HTLV-I sequences in PBMCs of MS patients but in clear contrast with others, we failed to detect specific viral sequences using this broad approach.