Combining nerve and tendon transfers in tetraplegia: a proposal of a new surgical strategy based on literature review

European Journal of Orthopaedic Surgery & Traumatology - Spinal cord injury (SCI) is very common, most frequently resulting from motor vehicle accidents and falling from a height. Often, SCI...     

Survival and Prognostic Factors of Cirrhotic Patients with Ascites: A Study of 134 Outpatients

Ascites is a complication of chronic liver disease that is associated with decreased survival. The purpose of the present study was to identify some prognostic factors easily obtainable by the clinician in a large group of cirrhotic patients with ascites, possibly useful for first screening of outpatients as candidates for liver transplantation. We studied 134 ambulatory patients with cirrhosis who came to our outpatient clinic between July 1983 and March 1989 because of an episode of ascites. These patients were then followed up for an average period of 31 ± 23 months and survival was determined. Thirty-one variables determined at the time of inclusion were analyzed with a Cox proportional hazards model to identify predictors of mortality. Cumulative mortality as of June 30, 1991, was 59%. Factors independently correlated with death were: refractory ascites (relative risk, 4.78), low albumin levels (3.77), high Child-Pugh score (3.31), encephalopathy (2.71), high bilirubin levels (2.03), high γ-glutamyl-transferase levels (1.87), and old age (1.57). The results show that 1 ) the occurrence of refractory ascites has a prognostic value superior to those of other variables, and 2 ) simple clinical and biochemical parameters, most of them components of the Child-Pugh score, are useful for a first screening of ascitic cirrhotic patients as candidates for liver transplantation.     

Association Between Haptoglobin Phenotype and Microvascular Obstruction in Patients With STEMI: A Cardiac Magnetic Resonance Study

ObjectivesThis study aimed to evaluate the correlation between different haptoglobin (Hp) phenotypes and myocardial infarction characteristics as detected by cardiac magnetic resonance (CMR) in consecutive patients after ST-segment elevation myocardial infarction (STEMI).BackgroundHp is a plasma protein that prevents iron-mediated oxidative tissue damage. CMR has emerged as the gold standard technique to detect left ventricular ejection fraction (LVEF), extent of scar with late gadolinium enhancement (LGE) technique, microvascular obstruction (MVO), and myocardial hemorrhage (MH) in patients with STEMI treated by primary percutaneous coronary intervention (pPCI).MethodsA total of 145 consecutive STEMI patients (mean age 62.2 ± 10.3 years; 78% men) were prospectively enrolled and underwent Hp phenotyping and CMR assessment within 1 week after STEMI.ResultsCMR showed an area at risk (AAR) involving 26.6 ± 19.1% of left ventricular (LV) mass with a late LGE extent of 15.2 ± 13.1% of LV mass. MVO and MH occurred in 38 (26%) and 12 (8%) patients, respectively. Hp phenotypes 1-1, 2-1, 2-2 were observed in 15 (10%), 62 (43%), and 68 (47%), respectively. Multivariable analysis demonstrated that body mass index, Hp2-2, diabetes, and peak troponin I were independent predictors of MVO with Hp2-2 associated with the highest odds ratio (OR) (OR: 5.5 [95% confidence interval [CI]: 2.1 to 14.3; p < 0.001]). Hp2-2 significantly predicted both the presence (area under the curve [AUC]: 0.63 [95% CI: 0.53 to 0.72; p = 0.008]) and extent of MVO (AUC: 0.63 [95% CI: 0.54 to 0.72; p = 0.007]).ConclusionsHp phenotype is an independent predictor of MVO. Therefore, Hp phenotyping could be used for risk stratification and may be useful in assessing new therapies to reduce myocardial reperfusion injury in patients with STEMI.     

Sarcopenia in distal radius fractures: systematic review of the literature and current findings

European Journal of Orthopaedic Surgery & Traumatology - Sarcopenia is a clinical syndrome characterized by the reduction in muscle mass, strength and physical ability. Although proximal femur...     

Three-Dimensional Echocardiography: Advancements in Qualitative and Quantitative Analyses of Mitral Valve Morphology in Mitral Valve Prolapse

Degenerative mitral valve disease (MVD) is the leading cause of organic mitral regurgitation (MR), one of the most common valvular heart disease in western countries. Substantial progresses in the surgical treatment of degenerative MVD have improved life expectancy of patients with significant MR. However, prognosis, surgical decision and timing of surgery strongly depend on the accurate characterization of mitral valve (MV) anatomy and pathology and on the precise quantification of MR. Three-dimensional (3D) echocardiography, a major technological breakthrough in the field of cardiovascular imaging, provides several advantages over two-dimensional (2D) imaging in the qualitative and quantitative evaluations of MV apparatus. In this review, we focus on the contribution of this new modality to the diagnosis of degenerative MVD, the quantitative assessment of MR severity, the selection and monitoring of surgical and percutaneous procedures, the evaluation of procedural outcomes. The results of a systematic and exhaustive search of the existing literature, restricted to real-time 3D echocardiography in adults, are here reported.