Infections in primary total ankle replacement: Anterior approach versus lateral transfibular approach

Background

Total ankle replacement (TAR) represents an alternative to fusion for the treatment of end-stage ankle osteoarthritis. The aim of the present study was to retrospectively assess the frequency of infections between TARs with anterior and lateral transfibular approach at 12-months follow-up.

A Novel Nomogram to Identify Candidates for Extended Pelvic Lymph Node Dissection Among Patients with Clinically Localized Prostate Cancer Diagnosed with Magnetic Resonance Imaging-targeted and Systematic Biopsies

Background

Available models for predicting lymph node invasion (LNI) in prostate cancer (PCa) patients undergoing radical prostatectomy (RP) might not be applicable to men diagnosed via magnetic resonance imaging (MRI)-targeted biopsies.

Angioplasty of the deep femoral artery using a semirigid PTFE prosthesis. Experimental studies

Underlining the importance of Profundus Femoral Artery and its capacity to make up for lower limb's haemodynamics during obliterative arteriopathy, the Authors conceive a funnel-shaped intravascular prosthesis, Goretex constructed (PTFE), to introduce, in case of obstruction, in the artery lumen with a suitable instrument. The research is performed through ten oldster dogs whose average weight is twenty-four kilograms. Isolated the deep Femoral Artery and carried out an arteriotomy of about two centimetres on the Common Femoral Artery, we bring the prothesis in Profundis Femoral Artery and we fix it to the wall of the Common Femoral Artery with 8/O microsurgical dots. After thirty days, the arteriographic test shows the patency of the endoprosthesis with normal peripheral flow in nine animals out of ten. By virtue of this preliminary experiment, the Authors point out the semplicity of this intervention, also feasible in local anaesthesia, the good tolerability of the prosthesis and its perfect integration with the surrounding arterious wall, without shifts or dissecting laminar flows between the external prosthesis wall and the vessel lumen of the animal.     

The antero-posterior diameter of the lumbar dural sac does not predict sensory levels of spinal anesthesia for Cesarean delivery

PURPOSE: The lumbosacral cerebrospinal fluid (CSF) volume, as assessed by magnetic resonance imaging, is a major determinant of the intrathecal spread of local anesthetics. Ultrasound imaging of the lumbar spine allows measurement of dural sac dimensions, which we hypothesize can be used to estimate CSF volume. The purpose of this study was to investigate whether the dural sac antero-posterior diameter correlates with sensory levels of spinal anesthesia during elective Cesarean delivery (CD). METHODS: After Research Ethics Board approval and informed consent, a prospective observational study enrolled 41 patients scheduled for elective CD under spinal anesthesia. With ultrasound imaging (transverse approach, 2-5 MHz curved array probe), we measured the antero-posterior diameter of the lumbar dural sac (dural sac diameter, DSD). Spinal anesthesia was administered with 0.75% hyperbaric bupivacaine 1.6 mL, fentanyl 10 microg and morphine 100 microg, with the patient in the sitting position. Sensory block levels were assessed with ice and pinprick every five minutes until peak sensory levels (PSL) were attained. Spearman's rank correlation was used to correlate DSD with PSL and time to attain PSL. RESULTS: There were no significant correlations between DSD and PSL assessed with ice (P = 0.474) or pinprick (P = 0.583). Similarly, there was no significant correlation between DSD and time to reach PSL, and between DSD and patient demographics. CONCLUSION: The lumbar DSD, as determined by ultrasound, is not a predictor of spinal anesthesia spread. Further research is necessary to understand if ultrasound findings can be used to predict intrathecal spread of local anesthetics.     

Motor unit function during evolution of proximal axonal swellings.

beta,beta'-Iminodipropionitrile (IDPN) impairs axonal transport of neurofilaments; their accumulation leads to the formation of proximal swellings in motor axons. Similar proximal swellings are a feature of some cases of motor neuron disease such as amyotrophic lateral sclerosis (ALS). Motor units in IDPN-treated animals were assessed to determine their relative susceptibilities to impaired function and whether the functional changes resulting from proximal axonal swellings share certain electromyographic features with ALS. Intrinsic properties of medial gastrocnemius motoneurones (MN) and contractile responses of their motor units were examined during the evolution of proximal axonal swellings in cats administered IDPN (50 mg/kg once weekly) for 7, 14 or 35 days. While conduction velocities were significantly decreased in all motor unit types by 35 days, the conduction slowing was greater in fast fatigable (types FF and FI) motor units than in fatigue resistant (types FR and S) motor units. Normal correlations between axonal conduction velocity and MN input resistance (Rin) and the inverse relationship between Rin and rheobase were lost with progression of the neuropathy. Twitch and maximum tetanic tension developed by fast-fatigable motor units declined early in the neuropathy, whereas fatigue-resistant units did not show similar changes until later stages of the intoxication. In some motor units, irregular and abnormal tetanic tensions were elicited by repetitive MN discharge. At 14 and 35 days, a novel, intermediate motor unit response classified as slow and fatigable (SF) was observed. Conduction block, characterized by repetitive MN firing without a corresponding contractile response, was observed in some type FF and S units by 35 days. Morphometric analysis of muscle fiber types showed significant atrophy, particularly in the type I fibers at 14-35 days; the atrophy reversed following cessation of IDPN administration. The influence of proximal axonal swellings on motor unit function in IDPN neuropathy is discussed in terms of reported electrophysiological alterations in motoneurone disease.     

Choline acetyltransferase activity in murine thymus.

Murine thymus has been demonstrated to contain both cholinergic receptors and acetylcholinesterase activity. In the present study we have investigated the presence of the enzyme choline acetyltransferase in this organ, which is responsible for the synthesis of acetylcholine. Results reported here demonstrate that (1) an appreciable amount of the enzyme is already present in the thymus on the day of birth; (2) its expression is developmentally regulated; and (3) thymic atrophy, induced in young (2-week-old) and adult (6-week-old) mice by i.p. injection of hydrocortisone for 2 days, is accompanied by significant reduction of choline acetyltransferase activity only in young mice. Altogether these results demonstrate the presence in the murine thymus of functionally relevant markers of the cholinergic system that might interface the interactions between the nervous and immune systems.     

Aseptic meningitis caused byLeptospira australis

Meningeal involvement in leptospiral infection is quite common, usually mild and often overlooked. In contrast, cases of isolated involvement of the central nervous system, including aseptic meningitis, have been reported only rarely. A case of a patient with acute aseptic meningitis caused byLeptospira australis serovarbratislava is reported. This is believed to be the first report of aseptic meningitis due toLeptospira australis. This case indicates the need to consider human leptospirosis in the differential diagnosis of aseptic meningitis.