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We sought to conduct the largest retrospective study to date of open tibia fractures and describe the incidence of complications and evaluate the potential predictive risk factors for complications. Patients with open tibia fractures treated with reamed intramedullary nail (IMN) across a 10-year period were evaluated. Patient charts were reviewed for demographics, type of open fracture (T), comorbidities, and postoperative complications. A multivariate model was conducted to determine the risk factors for each type of complication. Of the 486 patients with open tibia fractures, 13 % (n = 64) had infections, 12 % (n = 56) had nonunions, and 1 % (n = 7) had amputations. TIII fractures had much higher rates of each complication than TI and TII fractures. Fracture type was the only significant risk factor for both nonunion and infection. Our study found that the Gustilo grade of open tibia fracture is by far the greatest predictor of nonunion and infection.

Studies comparing open reduction internal fixation (ORIF) vs. intramedullary nailing (IMN) for distal tibia shaft fractures focus upon closed injuries containing small patient series with open fractures. As such, complication rates for open fractures are unknown. To characterize complications associated with ORIF vs. IMN, we compared complications based on surgical approach in a large patient series of open distal tibia shaft fractures. Through retrospective analysis at an urban level I trauma center, 180 IMN and 36 ORIF patients with open distal tibia fractures from 2002 to 2012 were evaluated. Patient charts were reviewed to identify patient demographics, fracture grade (G), patient comorbidities, and postoperative complications including nonunion, malunion, infection, hardware-related pain, and wound dehiscence. Fisher’s exact tests compared complications between ORIF and IMN groups. Multivariate regression identified risk factors with statistical significance for the development of a postoperative complication. One hundred and eighty IMN (G1 22, G2 79, and G3 79) and 36 ORIF (G1 10, G2 16, and G3 10) patients were included for analysis. ORIF patients had a higher rate of nonunion (25.0 %, n = 9) compared with IMN patients (10.6 %, n = 20, p = 0.03). No additional complication had a significant statistical difference between groups. Multivariable analysis shows only surgical method influenced the development of complications: ORIF patients had 2.52 greater odds of developing complications compared with IMN patients (95 % CI 1.05–6.02; p = 0.04). ORIF leads to higher rates of nonunion and significantly increases the odds of developing a complication compared with IMN for open distal tibia fractures. This is the first study investigating complication rates based on surgical approach in a large cohort of patients with exclusively open distal tibia fractures.

Buckwheat (Fagopyrum esculentum Moench) is mainly used as human food and its by-product could be fruitfully used in animal nutrition thanks to its chemical composition. For this reason the aim of this study was to evaluate the partial substitution of corn and soybean meal with buckwheat bran in the diet for low-producing hens. Experimental diet was prepared by incorporating buckwheat bran at a level of 30% in a corn-soy based laying-hen diet as partial substitution of corn (20%) and soybean (10%). Sixteen low-producing I SA-Brown hens, 74 weeks of age, were transferred in couple wire cages, 16 L:8D and tested during two experimental period with 14 days adaptation and 14 days performance and shifting the treatments in the second period. Egg production, egg mass and egg quality (shell: thickness and weight; albumen: Haugh units and weight; yolk: colour and weight) were daily measured; feed intake (g/hen d), feed conversion and body weight were recorded per period. Faecal and feed samples were also collected to evaluate digestibility by the natural-marker technique (acid-insoluble ashes). Results showed that, after the adapting phase, egg production rate increased in the group fed buckwheat (43.3% vs. 50.5% in Control and Buckwheat, respectively; P < 0.05). The feed intake also increased (78.3 ± 0.68 g/hen d vs. 87.8 ± 0.68 g/hen d; P < 0.05) but no significant difference was reached in the feed conversion efficiency between the two diets (control diet 3.0 ± 0.42 vs. experimental diet 3.4 ± 0.42; P = 0.52). Egg quality traits did not differ between treatments; improvement trend was observed for albumen Haugh units in the group fed buckwheat (89 ± 1.2 vs. 92 ± 1.1; P = 0.12). Nutrient balance confirmed that Apparent Metabolisable Energy (AMEn) of diet was deeply lowered by the buckwheat bran use (6.5 MJ/kg vs. 10.1 MJ/kg), due to the high fibre content of buckwheat bran (263 g/kg). Buckwheat bran can be used as an ingredient feed for low-producing laying hen; it induces a feed-intake increase partially balanced by improved egg-production rates and a tendency to better albumen Haugh units.

A new mesalazine rectal gel preparation (without propellant gas) has been recently developed to improve topical treatment in distal ulcerative colitis.To evaluate the efficacy, safety and patient tolerability of mesalazine gel enema compared with mesalazine foam enema in the treatment of patients with acute left-sided ulcerative colitis.In a randomized multicentre investigator-blind parallel group trial, 103 patients with mild to moderate left-sided colitis or proctosigmoiditis were randomly allocated to mesalazine 2 g gel enema (n = 50 evaluable patients) and mesalazine 2 g foam enema (n = 53 evaluable patients) for 4 weeks. Clinical symptoms, endoscopic and histological findings were assessed at entry, 2 and 4 weeks. Patients' evaluation of treatment tolerability and acceptability was assessed at 2 and 4 weeks.After 4 weeks of treatment, clinical remission was achieved by 76% of mesalazine gel enema-treated patients and 69% of patients treated with mesalazine foam enema (P = 0.608). Endoscopic remission rates at week 4 were 51 and 52% for the mesalazine gel and foam enemas, respectively (P = 0.925). Histological remission was achieved by 30% of patients in both groups. Patients reported that the new mesalazine gel preparation was significantly better tolerated than the foam enema. Patients in the foam group had significantly more difficulty in retention (25% vs. 6%, P0.05), abdominal bloating (50% vs. 26%, P0.005) and discomfort during administration (48% vs. 26%, P0.05).The new mesalazine gel enema is efficacious and significantly better tolerated than the mesalazine foam enema.

Helicobacter pylori eradication therapy can be unsuccessful in 5 to 20% of patients.To investigate the validity of a strategy using triple therapies for the retreatment of patients with eradication failure, avoiding retreatment with antibiotics prone to induce resistance after use in the first treatment.From a consecutive sampling of 108 patients still Helicobacter pylori-positive after a first course of antibiotic-based treatment, 74 (68.5%) agreed to a second course of triple therapy. Group 1 (N = 17): treatment failures on an imidazole (1)-based therapy were retreated with clarithromycin (C)-based regimen; Group 2 (N = 28): failures on a C-based therapy with an I-based regimen; Group 3 (N = 7): failures on an IC-based therapy using an I-based regimen and Group 4 (N = 22): failures on a non-I/non-C based therapy with either an I-based, C-based or IC-based regimen. The presence of Helicobacter pylori was assessed by histology and the CLO-test at study entry and two months after stopping therapy.Nine patients were withdrawn from the study (12.2%) due to a lack of end point endoscopy. Helicobacter pylori was cured after the second course of therapy in all but seven patients [10.7% failure by Per Protocol analysis, 21.6% by Intention-To-Treat analysis]. No statistically significant differences were found between the four groups (Group 1: 92.9% PP, 76.5% ITT; Group 2: 90.9% PP, 71.4% ITT; Group 3: PP and ITT 85.7%; Group 4: PP and ITT 86.4%). Minor adverse events were experienced in nine, none of whom required withdrawal from the drug therapy.A second course of triple therapy with alternate antibiotics effectively eradicated Helicobacter pylori, with only very few treatment failures. This suggests that the therapeutic strategy employed may be recommended.

Helicobacter pylori (Hp) is connected with active/chronic gastritis, gastric gastric and duodenal ulcer. It is not known whether exogenous factors are involved in Hp infection. The aim of this prospective study, performed on 286 consecutive subjects undergoing upper gastrointestinal endoscopy, was to evaluate the influence of smoking and alcohol consumption on Hp infection. For each patient the following parameters were taken into account: sex, age, smoking (no,10,10 cig/day) and alcohol (no,40,40 g ethanol/day) intake, antiulcer therapy (no, H2-blockers, omeprazole, sucralfate), presence of gastric or duodenal ulcer (DU). At least two biopsies from both the antrum and the corpus were obtained for histological examination; the gastritis was classified and scored according to the Sydney system.chi-squared test (corrected), Fisher's exact test.43 pts had Hp (27M, 16F; age 57.8 yrs, range 23-91), 47 Hp ++ (25M, 22F; age 61.1, range 19-86), 81 Hp + (48H, 33F; age 56, range 16-84), 115 Hp- (75M, 40F; age 57.8, range 19-84). Hp infection was found to be significantly correlated with presence of ulcer symptoms, gastritis, lymphoid follicles and, among DU patients, with active DU. The other parameters considered did not influence Hp infection. In conclusion smoking habits and alcohol consumption do not affect Hp infection of the stomach.

The case is described of a 56 year old patient admitted to hospital with rhabdomyolysis without myoglobinuria and caused by hypokalaemia following the ingestion of liquorice. The patient was treated with L. Carnitine chloride and KCl.