Edoardo Carlo Marinoni

Sympathetic Modulation of Radial Artery Compliance in Congestive Heart Failure

Animal studies have suggested that arterial compliance can be modulated by adrenergic influences. Whether this adrenergic modulation also occurs in humans is still a matter of debate. In the present article we address this issue by examining the relationships between sympathetic tone and arterial compliance in a variety of physiological and pathophysiological conditions. We have found that cigarette smoking, ie, an action that produces a marked sympathetic activation, causes a significant reduction in radial artery compliance, as measured by an echotracking device capable of providing continuous beat-to-beat evaluation of this hemodynamic variable. When expressed as compliance index, ie, as the ratio between the area under the compliance-pressure curve and pulse pressure, the reduction amounted to 35.7 +/- 4.8% (mean +/- SEM) and was independent of the smoking-related blood pressure increase. Furthermore, pharmacological stimulation of adrenergic receptors located in the arterial wall was also shown to affect arterial compliance because the radial artery compliance index was markedly reduced (- 29.5 +/- 3.9%) during phenylephrine infusion in the brachial artery at doses devoid of any systemic blood pressure effect. Evidence was also obtained that the relationship between sympathetic activation and arterial compliance has pathophysiological relevance, because in 17 patients with congestive heart failure (New York Heart Association classes II through IV) there was a significant inverse correlation (r = .62, P < .01) between muscle sympathetic nerve activity (directly measured by microneurography in the peroneal nerve) and radial artery compliance.(ABSTRACT TRUNCATED AT 250 WORDS)

Regional Migratory Osteoporosis: A Pathogenetic Hypothesis based on Three Cases and a Review of the Literature

Abstract: Regional migratory osteoporosis (RMO) is a migrating arthralgia of the weight-bearing joints of the lower limb which mainly affects middle-aged males. Its aetiology is unknown. The association of RMO with generalised osteoporosis has recently been reported. A concurrent systemic osteoporosis was also reported in some cases of transient osteoporosis of the hip (TOH), a disorder closely related to RMO. In its turn, TOH is considered a reversible stage of avascular necrosis of the hip (AVN), and the aetiopathogenesis of both of them remains strongly debated. We report three cases of RMO associated with generalised severe idiopathic osteoporosis. Three men, in the fourth and fifth decades of life, complained of at least four episodes of arthralgia in the lower limbs, with a migratory pattern, radiographic focal osteoporosis and final clinical resolution. The most striking common feature of these patients was the presence of a severe systemic osteoporosis with a prevailing trabecular involvement. We suggest that a prolonged or exaggerated activation of regional acceleratory phenomena (RAP) is the cause of transient osteoporosis. Bone tissue microdamage due to osteoporosis may be the most frequent noxious stimulus that turns RAP on, and, bone tissue microfracture is the most prevalent consequence. When this pathogenetic pathway is activated, the progression from focal osteoporosis and bone marrow oedema to avascular necrosis is associated with the amount of structural damage.

Periprosthetic bone density around fully hydroxyapatite coated femoral stem

In this study, periprosthetic bone mineral density was measured at scheduled time intervals after surgery by dual energy xray absorptiometry in 21 patients to assess the history of bone density redistribution after femoral stem insertion. Measurements of changes in bone density with time were obtained for the regions of the greater trochanter, the lateral cortex, the tip, the medial cortex, and the calcar. In all regions, bone density decreased during the first 3 months after surgery; this was followed by a prolonged period of 18 to 30 months of bone gain, a subsequent period of steady state, and the final resumption of bone aging processes after the third postoperative year. The greatest loss was observed in the calcar region after 6 months (greater than 50%). The characteristic pattern of time related bone density changes obtained in this study may make it possible to compare other pathologic, design, or stiffness related patterns. This could have clinical relevance in the early diagnosis of pathologic processes and as a means of evaluating prosthetic designs.

BONE ASSESSMENT AFTER TOTAL KNEE ARTHROPLASTY BY DUAL-ENERGY X-RAY ABSORPTIOMETRY : ANALYSIS PROTOCOL AND REPRODUCIBILITY

Abstract. Bone quality is important for the success of joint prostheses implantation, and the assessment of bone density after total knee arthroplasty by means of dual-energy X-ray absorptiometry may be useful for monitoring implant stability. The aim of this study is to suggest a validated analysis protocol for the assessment of bone status after total knee arthroplasty. A dedicated densitometric analysis protocol of five regions of interest was designed, and 10 subjects who had received an uncemented knee prosthesis (8 females and 2 males, aged 55–74 years) underwent three consecutive scans in posteroanterior and lateral projections, with repositioning after each scan to test the suitability and reproducibility of the protocol. The reproducibility of the measurement of bone mineral content and density in the femoral and tibial regions ranged, respectively, from 2.1% to 4.1%, from 0.9% to 2.6% for the posteroanterior scans, and from 2.7% to 5.6% and from 2.3% to 4.7% for the lateral scans, depending on the considered region. Our results confirm that the suggested protocol allows precise assessment of bone mineral content and density, and that dual-energy X-ray absorptiometry is reliable for the evaluation of bone mass around prosthetic implants.

Shoulder evaluation with isokinetic strength testing after arthroscopic rotator cuff repairs.

HYPOTHESIS The purpose of this study was to evaluate, with isokinetic testing, the recovery of strength in patients with rotator cuff tears treated with two different arthroscopic repair techniques. MATERIALS AND METHODS From September 2004 to September 2006, patients with a full-thickness supraspinatus tear were randomized to two different groups. Patients in group 1 underwent side-to-side repair with permanent sutures, whereas those in group 2 underwent tendon-to-bone fixation with 1 metal suture anchor loaded with double sutures. The same independent examiner evaluated the outcomes using the Constant score and isokinetic strength testing preoperatively and at 3, 6, and 12 months postoperatively. Data analysis was also performed in three subgroups: small, medium, and large tears. RESULTS Constant scores improved from preoperatively to 12 months postoperatively. In group 1, the mean Constant score was 32 points before surgery and 78 points at 12 months postoperatively. In group 2, the mean Constant score was 30 points before surgery and 88 points at 12 months after surgery. Strength increased gradually during the first postoperative year. In group 1, preoperative mean peak torque was 34% and 39% in internal rotation and external rotation, respectively. After repair, it decreased to 17% and 21%, respectively, at 12 months. In group 2, preoperative mean peak torque was 32% and 37% in internal rotation and external rotation, respectively; after surgery, it decreased to 9% and 12%, respectively, at 12 months. Data analysis showed that the difference in improvement in Constant scores and in strength recovery from preoperatively to postoperatively in groups 1 and 2 was statistically significant (p < .05). CONCLUSION We showed a strength difference between patients with side-to-side repairs and those with tendon-to-bone repairs. LEVEL OF EVIDENCE Level 1; Prospective randomized study.

Rapidly destructive bilateral hip disease: a case report and review of the literature

We describe the case of an elderly woman with rapid destruction of the right hip followed by the same involvement of her left hip 10 months later. The clinical history, the physical examination and radiographic images suggested the diagnosis of rapidly destructive hip disease. This disease is a distinct entity, unilateral in 80%–90% of cases, which requires extensive investigation and special efforts for its identification. Essential elements for the differential diagnosis are discussed.

Changes in bone mineral density following total knee arthroplasty: a 1-year follow-up study by dual energy X-ray absorptiometry

Abstract The assessment of bone density by means of dual energy Xray absorptiometry is a valid option for monitoring bone changes. In this study, time-related bone changes after total knee arthroplasty implantation were assessed in eight postmenopausal women (aged 62–72 years) up to one year from surgery. The pattern of bone changes followed a well-known design: an initial phase of accelerated bone loss and a subsequent phase of partial bone recovery. The greatest bone loss was observed at 2 months after surgery: 5.0% for the whole periprosthetic bone in the AP projection and 11.5% for the bone in the LL projection. In the following ten months the bone loss in the AP projection was completely recovered while the periprosthetic bone evaluated in the LL projection showed a residual bone loss of 9.0%. At 12 months from surgery, the distal femur in LL projection showed the greatest bone loss: 20.0% for the anterior region of interest and 17.0% for the posterior one. A significant correlation was found between the maximum postoperative bone loss and the residual bone loss at 12 months. These results suggest that pharmacological and rehabilitative strategies may be useful for the conservation of bone stock.

Titanium Hydroxilapatite Coated Metacarpo-Phalangeal and Interphalangeal Implant

At present, the artificial replacement of the metacarpo-phalangeal or interphalangeal joints is still an unsolved problem. Clinical experiences have releaved the limits of cemented prostheses (Flatt’s prosthesis, Schultz’s prosthesis and Biomeric) and also of articular spacers (Swanson’s implant, Niebauer’s prosthesis, Swanson’s-gromets implant). So we have planned an uncemented implant, a titanium Dac Blu hydroxilapatite coated prosthesis.