Biomedical subjects

R Rotini

Publications and source records attributed to R Rotini.

At least 19 recordsLinked to original sources

PubMed2006

Differences in ion release after ceramic-on-ceramic and metal-on-metal total hip replacement. Medium-term follow-up.

Modern metal-on-metal bearings produce less wear debris and osteolysis, but have the potential adverse effect of release of ions. Improved ceramic-on-ceramic bearings have the lowest wear of all, but the corrosion process has not been analysed. Our aim was to measure the serum ion release (ng/ml) in 23 patients having stable hip prostheses with a ceramic-on-ceramic coupling (group A) and to compare it with the release in 42 patients with a metal-on-metal bearing (group B) in the medium term. Reference values were obtained from a population of 47 healthy subjects (group C). The concentrations of chromium, cobalt, aluminium and titanium were measured. There was a significant increase of cobalt, chromium and aluminium levels (p < 0.05) in group B compared with groups A and C. Group A did not differ significantly from the control group. Despite the apparent advantage of a metal-on-metal coupling, especially in younger patients with a long life expectancy, a major concern arises regarding the extent and duration of ion exposure. For this reason, the low corrosion level in a ceramic-on-ceramic coupling could be advantageous.

Adult↗

PubMed2003

Ion release in stable hip arthroplasties using metal-on-metal articulating surfaces: a comparison between short- and medium-term results.

The use of metallic heads articulating with metallic cups could solve the problem of polyethylene (PE) wear in total hip replacement (THR) with metal-on-PE bearings. A conspicuous release of metal ions from new models of metal-on-metal bearings has been found in the short-term, but it is yet unclear whether the medium-term corrosion rate is high or, on the contrary, it becomes negligible, because of the continuous surface finishing. Our purpose was to compare the serum ion values (nanograms per milliliter) in 15 patients with metal-on-metal stable prosthesis (Group A), in the short-term (subgroup A(1); mean follow-up: 24 mo) and medium-term (subgroup A(2); mean follow-up: 52 mo), in order to determine whether the ion release decreased with time of implant. Chromium (Cr), cobalt (Co), molybdenum (Mo) and aluminum (Al) were analyzed. Twenty-two presurgical patients were used for comparison (Group B). The reference range was obtained from a population of 27 healthy subjects (Group C). Co and Cr levels in the medium-term (subgroup A(2)) were not decreased in comparison with the short-term values (subgroup A(1)) and were significantly higher (p < 0.001) than presurgical and reference values. Otherwise, Mo and Al concentrations were not significantly increased in comparison with reference values. In conclusion, despite the apparent advantage of metal-on-metal coupling, especially in younger patient populations, there is a major concern about the extent and duration of the relevant "internal" exposure to Cr and Co ions. This exposure should be carefully monitored, in order to clarify the biologic effects of ion dissemination and, consequently, to identify risks concerning long-term toxicity of metals.

Adult↗

PubMed2002

Ion release in patients with metal-on-metal hip bearings in total joint replacement: a comparison with metal-on-polyethylene bearings.

Polyethylene (PE) wear has been shown to be a problem in long-term joint replacement using metal-on-PE bearing. The use of metallic heads articulating with metallic cups could solve this problem: success will be enhanced if wear and corrosion of the articulating surfaces are maintained at a low level. New models with metal-on-metal bearing have been proposed, to be used mainly for young subjects: such coupling seems to have a reduced release, but it is unclear yet if the medium-term corrosion rate is really negligible or, on the contrary, it is significantly higher than in the metal-on-PE bearing. Aim of our study was the comparison of ion release in the serum of two groups of patients who had the same type of stable cementless prosthesis, but different bearing: twenty-six patients with metal-on-metal (Group A) and fifteen patients with metal-on-PE bearing (Group B) were examined. The follow-up was 14-38 months for group A and 18-34 months for group B. The serum concentration of chromium (Cr), cobalt (Co) and molybdenum (Mo) was measured. Twenty-two patients before surgery were used for comparison (Group C). The reference values were obtained from a population of twenty-two healthy subjects (Group D). Our findings indicate that metal-on-metal bearings produce a significantly higher systemic release of cobalt and chromium (ng/ml) when compared with levels found in metal-on-PE, pre-surgery and reference groups. Such a high release should induce to improve the bearing materials or, at least, to study the biologic fate of metal ions and consequently their long-term effects. In such a way a risk-to-benefit ratio for the patient could be established.

Adult↗

PubMed2002

Phalangeal ultrasonography in forearm fracture discrimination.

Over the last decade, the use of ultrasounds has been developed into an effective tool for investigating bone tissue and predicting the risk of fracture in osteoporosis. Studies have focused on hip and vertebral fractures while no information is available on the use of phalangeal ultrasonography to identify patients with forearm fractures. Thus, the current authors decided to compare 50 postmenopausal women with low energy forearm fractures (Fractured Group) with a control age-matched group of 94 women (Control Group). Measurements were taken at the distal metaphysis of the proximal phalanxes of the hand of the non-fractured arm using the DBM Sonic Bone Profiler. The reproducibility of the method was assessed by amplitude-dependent speed of sound (AD-SoS) CV% = 0.64 and by Ultrasound Bone Profiler Index (UBPI) CV% = 2.38. In the Control Group, the AD-SoS and UBPI mean values and standard deviations were significantly higher compared to the group with fractures (P < 0.0005). The receiver operating characteristic (ROC) curves were calculated and the areas under the curve (AUC) were 0.78 +/- 0.04 for AD-SoS and 0.77 +/- 0.05 for UBPI, respectively. Logistic regression analysis adjusted to age revealed that both AD-SoS (78.2%, ORAD-SoS = 12.03, P < 0.0005) and UBPI (76.0%, ORAD-SoS = 7.39, P < 0.0005) parameters discriminated correctly between fractured and non-fractured control women whereas the association of both parameters could not allow better discrimination. The present results showed that ultrasound investigation at the phalanxes is reproducible and efficiently discriminates between subjects with forearm fractures and those in the control subjects.

Aged↗

PubMed2000

Expression of the CD69 activation antigen on lymphocytes of patients with hip prosthesis.

The aim of the study was to evaluate the sensitization to metals in patients with Co-Cr hip prosthesis. Peripheral blood mononuclear cells (PBMC) were collected from 14 healthy donors and three groups of patients: 10 candidates for primary total joint replacements, 11 patients with well-fixed implant and 13 patients with aseptic loosening of the hip prosthesis. PBMCs were cultured with the metal ions employed for implant manufacturing and the expression of CD69 activation antigen on CD3/T lymphocytes was detected by flow cytometry. Chromium extract increased significantly the expression of CD3/CD69 phenotype in patients with loosening of hip prosthesis. The chromium-induced 'activation index' was higher in patients with loosening of hip prosthesis than in healthy donors and in pre-implant patients. The cobalt-stimulated PBMC of patients with either well-fixed or loosened prosthesis had an 'activation index' significantly higher than healthy donors. The activation index values were used to graduate the PBMC-response as 'normal' (> or = 0.9 and < 2), 'low' (< 0.9) and 'high' (> or = 2): an high-activation index was observed only in chromium-exposed PBMC of patients with prosthesis. Our data show that chromium released from orthopedic implants could be responsible for the lymphocyte sensitization and flow cytometry is an easy and reliable method for monitoring the hypersensitivity state in patients with metal prostheses. Activated lymphocytes in the peri-implant tissue are likely to elicit a localized immune response and contribute to maintain the inflammatory process evolving in the implant failure.

Aged↗

PubMed1999

Effects of metal ions on white blood cells of patients with failed total joint arthroplasties.

In this study twenty-two patients who had revision surgery for aseptic loosening of joint prostheses were examined. The concentration in serum of soluble products of corrosion from the implant, that is, chromium (Cr), cobalt (Co), and nickel (Ni) ions, and the number of white blood cells (leucocytes, myeloid cells, lymphocyte subpopulations) were measured. Twenty patients with no implants were used as controls. The patients who had revision surgery showed normal Ni concentration whereas by statistical analysis that same patient group was shown to have serum Cr and Co levels significantly higher than those of the control. By flow cytometry, a significant decrease of leucocytes, myeloid cells, lymphocytes, and CD16 populations as found in patients versus controls whereas CD3, CD4, CD8, and CD20 positive cells were decreased, but not significantly. In the arthroplasty patients the Cr concentrations were inversely correlated with some of the immunologic parameters while no significant correlation was found between Co levels and decreased lymphocyte subpopulations. Only in revision surgery patients with high Cr concentrations did we find a significant decrease of lymphocytes, namely of CD4 and CD16 positive cells; revision surgery patients with normal Cr concentrations did not show a significant decrease of lymphocyte subpopulations. These data suggest that the presence of metal ions, especially chromium, released from prosthesis components could be associated with changes of lymphocyte subpopulations in patients with loosening of joint prostheses.

Adult↗

PubMed1998

Bone-resorbing cytokines in serum of patients with aseptic loosening of hip prostheses.

Our aim was to determine if the serum levels of bone-resorbing cytokines (IL-1beta, TNF-alpha, IL-6, GM-CSF) are altered in patients with aseptic loosening of a total hip prosthesis, and if such levels are influenced by the type of implant. We determined cytokine levels in sera from 35 patients before revision for failed total hip arthroplasty and compared them with those in 25 healthy donors. We also assessed the soluble receptor of interleukin-2 (sIL-2r) in serum as an indication of a specific immune reaction against the implant. Our findings showed that the sIL-2r and TNF-alpha serum level did not change. The IL-6 level was not significantly altered, but was higher in patients with TiAIV prostheses than in those with a CrCoMo implant and in patients with cemented prostheses. The IL-1beta level was found to be higher in those with a TiAIV cemented prosthesis than in the control group (p=0.0001) and other groups of patients (p=0.003 v uncemented TiAIV, p=0.01 v cemented CrCoMo, p=0.001 v uncemented CrCoMo). The GM-CSF level significantly increased in patients compared with healthy subjects (p=0.008), and it was higher in those with cemented than with uncemented implants (p=0.01). Only patients with cementless CrCoMo prostheses had levels of GM-CSF similar to those of the control group. The highest GM-CSF concentrations were observed in patients treated with non-steroidal anti-inflammatory drugs (NSAIDs) in the last months before revision (p=0.04). In addition, when massive osteolysis was observed, the level of GM-CSF tended to decrease to that of the control group.

Acetabulum↗

PubMed1991

Snapping hip: a rare form with internal etiology.

"Internal" extraarticular snapping hip, rare and often misdiagnosed, can cause functional limitation of the hip and severe gait disturbances. It is provoked by the iliopsoas tendon which catches on the lesser trochanter or the iliopectineal eminence, as in the case described in this paper. Standard surgical treatment consists in lengthening the tendon, and the authors suggest an inguinal approach.

Adult↗

PubMed1991

Retention of the posterior cruciate ligament in total knee arthroplasty.

The importance of the preservation of the posterior cruciate ligament in total knee arthroplasty is analyzed from a biomechanical, clinical, and functional standpoint. Using clinical and radiographic criteria, the authors assess posterior cruciate ligament validity in a selected group of 31 of 45 total knee arthroplasties (PCA prosthesis) reviewed at least 18 months after the operation. Sixty-eight percent of the replaced knees, which were divided into two groups on the basis of preoperative deformity, had a functional posterior cruciate ligament. In view of these results the authors are satisfied with the prosthetic model they adopted, which was designed not only to preserve the posterior cruciate ligament, but also, by virtue of its special shape, to compensate in the event of ligament insufficiency.

Activities of Daily Living↗

PubMed1988

Total P.C.A. knee arthroprosthesis.

Between 1983 and 1986 the authors implanted 36 porous-coated P.C.A. total knee prostheses in 34 patients. Complications included two fatal cases of pulmonary embolism and one deep infection which healed within five months following removal of the prosthesis and arthrodesis. The results obtained in 23 patients after an average follow-up of 18 months were excellent in 87% and fair in 13% (according to the Hungerford evaluation system). Radiographic evaluation showed excellent prosthetic positioning in 70% of the cases, the presence of radiolucent lines in areas 5-6-7-8-11-15-19 (according to Hungerford) in 21% of the cases, and zonal bone resorption in areas 1-2-3-4 in 43% of the cases. The authors report their conclusions with reference to complications, the preservation of the posterior cruciate ligament, and problems related to positioning the prosthesis.

Aged↗

PubMed1988

Lumbosciatic pain due to sacral pathology.

Lesions of the sacrum are a possible, albeit infrequent, cause of low back pain and sciatica. The purpose of this paper is to draw attention to this possibility which, perhaps due to the rarity of sacral pathologies, is often overlooked in the investigation of lumbosciatic pain. This may influence the prognosis because of the consequent delay in diagnosis. Several cases are reported which were initially operated on for radicular disc syndromes with negative results, and only later correctly diagnosed as sacral lesions.

Adult↗

PubMed1988

The locked Grosse-Kempf intramedullary nail in the treatment of diaphyseal and metaphyseal fractures of the femur and tibia.

The Gross-Kempf locked intramedullary nail widens the indications for the traditional Küntscher nail in the treatment of diaphyseal and metaphyseal fractures of the lower limbs. The study includes 87 patients with a total of 93 closed fractures treated between 1981 and 1987. Osteosynthesis was carried out in 85 closed fractures and in 8 Grade 1 or 2 open fractures. Possible assemblies in relation to the level and type of fracture and the protocol for weightbearing are illustrated, with emphasis on the fact that dynamization of static assemblies is not always essential. The high percentage of positive results (86%) and the relatively small incidence of complications confirm the validity of this method. The only drawback is the fairly high dose of radiation absorbed by the surgeon during the operation.

Adult↗

PubMed1987

Vascular complications of detachment of the proximal tibial epiphysis. Report of 2 cases.

The authors describe two cases of proximal epiphyseal detachment of the tibia complicated by lesions of the popliteal artery. Following reduction and stabilization by Kirschner wires, vascular repair was done, in one case by the Fogarty method, and in the other by resection and substitution with a vein graft. The outcome was successful only in the second case. In the first case the vascular repair failed, with all the severe sequelae of ischaemic contractures in the ankle and foot. The need for early diagnosis of the arterial lesion is emphasized, as well as early and radical treatment (preferably by vein graft) if a good result is to be obtained. Failure results in severe and disabling contracture and stiffness of the ankle and foot.

Adolescent↗

PubMed1987

Chondrosarcoma of the bones of the hand.

The authors report two cases of phalangeal chondrosarcoma treated by carpometacarpal disarticulation of the affected finger. In both cases chondroma had been diagnosed histologically at previous operations consisting of curettage and homoplastic grafting. The cases subsequently came under our observation because of recurrences and an analysis of the clinical and radiographic course, together with a critical review of the previous histological preparation (in one case) led us to conclude that these neoplasms presented malignant features from the beginning and were not due to the sarcomatous degeneration of benign chondromas. The recent literature on this difficult differential diagnosis is reviewed.

Aged↗

PubMed1987

Segmental shortening and equalization for leg length discrepancies in adults.

The authors report 8 cases of leg length discrepancy in young adults, treated surgically by shortening or equalization techniques. The ages ranged from 16 to 35 years and the discrepancy from 2.5 to 12 cm. Three techniques were used; subtrochanteric femoral shortening (4 cases), equalization by shortening one femur and lengthening the other at the same operation (2 cases), diaphyseal "Z" osteotomy with shortening (2 cases - one femur, one tibia). The average time to consolidation was 3.4 months. Full weightbearing was allowed at 2 to 6 months depending on the method used. The only complication was one case of mild, transitory weakness of the extensors of the foot. The discrepancy was completely equalized in 2 cases; in the remainder the residual discrepancy was from 0.5 to 2 cm. The average shortening per case was 3.8 cm. There was secondary lumbar scoliosis in 5 cases; this improved by an average of 12 degrees after operation and lumbar pain was always relieved. All the patients declared themselves satisfied with the results.

Adolescent↗

PubMed1986

Slow healing fractures: can they be prevented? (Results of electrical stimulation in fibular osteotomies in rats and in diaphyseal fractures of the tibia in humans).

The purpose of the study was to evaluate the possibility of preventing delayed union in fractures by the use of low-frequency pulsing electromagnetic fields (PEMFs). The study was conducted in two parts, both with control groups. Fibular osteotomies in rats and diaphyseal fractures of the tibia in humans were treated with and without electrical stimulation (PEMF). The rats were sacrificed on the 8th and 23rd days respectively in order to evaluate the histological picture of the repair callus and its mechanical resistance. In the human subjects, the clinical and radiological follow-up took into account various factors known to affect the rate of union in the various fracture groups. The results obtained suggest that PEMF stimulation is capable of accelerating and modulating the physiological process of union by its favourable effect on osteogenesis.

Adolescent↗

PubMed1986

Carpal tunnel syndrome. Comparative study between normal and dialyzed patients.

The various theories of carpal tunnel syndrome (CTS) are reviewed. The clinical and other features are compared and the results of surgical decompression and neurolysis reported in two groups of patients; 65 operations in "classical" CTS and 11 operations in patients on renal dialysis ("dialytic CTS"). Relief of pain and recovery of normal sensation was achieved in a high percentage of cases in both groups. Recovery of motor function was markedly better and quicker in the "dialytic" group, probably because deterioration was more rapid and therefore surgical intervention was carried out earlier. The pathological anatomy showed no significant overall difference between the two groups, except that in two of the renal dialysis patients granular deposits of myeloid substances were observed in the flexor tendon sheaths and on the walls of the carpal tunnel.

Adult↗

PubMed1983

[Proglumetacin: a flexible and broad-spectrum antirheumatic agent].

Fifty-five patients with osteoarthritis, rheumatoid arthritis or spondyloarthritis, joint pain and other rheumatic-inflammatory disorders were treated with proglumetacin, at different doses, during 3-60 days. Assessment of therapeutic efficacy indicated 88.9% of good results. Joint pain progressively decreased during the whole period of observation. Tolerance was considered good or very good in 78% of patients.

Adolescent↗