198,577 research outputs found
Irreducible Galeazzi Fracture-Dislocations
No full textBackground: Fractures of the radial shaft with disruption of the distal radial ulnar joint (DRUJ) or Galeazzi fractures are treated with reduction of the radius followed by stability assessment of the DRUJ. In rare instances, the reduction of the DRUJ is blocked by interposed structures requiring open reduction of this joint. The purpose of this study is to review all cases of irreducible Galeazzi fracture-dislocations reported in the literature to offer guidelines in the diagnosis and management of this rare injury. Methods: A search of the MEDLINE database, OVID database, and PubMed database was employed using the terms “Galeazzi” and “fracture.” Of the 124 articles the search produced, a total of 12 articles and 17 cases of irreducible Galeazzi fracture-dislocations were found. Results: The age range was 16 to 64 years (mean = 25 years). A high-energy mechanism of injury was the root cause in all cases. More than half of the irreducible DRUJ dislocations were not identified intraoperatively. In a dorsally dislocated DRUJ, a block to reduction in most cases (92.3%) was secondary to entrapment of one or more extensor tendons including the extensor carpi ulnaris, extensor digiti minimi, and extensor digitorum communis, with the remaining cases blocked by fracture fragments. Irreducible volar dislocations due to entrapment of the ulnar head occurred in 17.6% of cases with no tendon entrapment noted. Conclusions: In the presence of a Galeazzi fracture, a reduced/stable DRUJ needs to be critically assessed as more than half of irreducible DRUJs in a Galeazzi fracture-dislocation were missed either pre- or intraoperatively.</jats:p
A placebo-controlled study of the efficacy and tolerability of a nonsteroidal anti-inflammatory drug, DHEP plaster, in inflammatory peri- and extra-articular rheumatological diseases
No full textA double-blind, randomized, placebo-controlled study has been carried out in order to assess the effects of the new topical cutaneous formulation, diclofenac hydroxyethylpyrrolidine (DHEP) plaster. Sixty patients (10 M + 50 F, mean age 56.6 yrs) suffering from local inflammatory processes in peri-articular/tendinous and/or extra-articular sites were involved in this study and randomly given either DHEP plaster or placebo plaster. Plasters were applied and left on the site of inflammation b.i.d. (at 8 a.m. and 8 p.m.) for 14 days. Patients under stabilized systemic treatment with NSAIDs, glucocorticoids and/or basic therapy for over 2 months, maintained this treatment unchanged during the course of the study. Patients were examined on days 3, 5, 7 and 14. The effects of the treatments were assessed using subjective, semi-quantitative (provoked pain, peri-articular swelling, doctor-patient judgement, telethermographic index) and quantitative variables (spontaneous pain measured using a visual analogical scale). In the peri-articular pathologies, spontaneous and provoked pain decreased faster and in a clinically relevant manner in the group treated with DHEP plaster compared to the control group (p < 0.01). Local inflammation, objectively evaluated using the telethermographic index, showed consistent reduction during the study which was statistically significant from day 3 onwards and significantly different compared to the control group. Global assessment of efficacy, expressed by the investigator and the patients, was significantly better (good to excellent after only 7 days in 70% of the cases) in the DHEP group compared to the placebo group. In the extra-articular pathologies, results similar to those reported earlier were obtained.(ABSTRACT TRUNCATED AT 250 WORDS
Cartilage turnover markers are predictive of ACR70 response to anti-TNF alfa treatment in RA-patients
No full textBackground: Rheumatoid arthritis (RA) has a variable course with a wide range of potential outcomes, making it difficult to predict disease progression and magnitude of therapeutic response. The possibility to identify rapid versus slow responders at an early stage, has the potential to improve the care of the patients Objectives: To investigate in RA patients the possibility to apply a combination of markers reflecting different basic disease mechanisms to improve ability to predict rapid and sustained clinical response to anti-TFN treatment. Methods: 81 out of 85 consecutive RA patients were monitored in accordance with a structured protocol during three different anti-TNF therapies and were tested for serum Cartilage Oligomeric Matrix Protein (COMP) and C-Reactive protein (CRP) at baseline. 35 pts were treated with Adalimumab, 30 with Infliximab and 20 with Etanercept (4 serum samples were excluded because of incomplete data). The response to the therapy was evaluated by ACR20,50, 70. CRP was used to describe systemic inflammation and COMP to describe cartilage turnover. Levels of COMP were tested by using a commercial sandwich immunoassay (AnaMar Medical, Sweden) and levels below 10 U/L were considered as low cartilage turnover. CRP levels exceeding 10 ug/ml were considered as elevated. The outcome of the two markers was combined to investigate a possible synergy between the markers. Results: We could not find any difference in ACR20 between the two groups with low or elevated baseline COMP levels, at any time points. However, the percentage of ACR70 responders was significantly (p<0.005) higher in the group of patients with low COMP levels, at 3 months follow up. The percentage of ACR70 responders did not increase at 6 months for patients with low COMP at baseline in contrast to the patients with higher COMP. At 12 months there was no differences between the two groups. The percentage of ACR 70 responders in the group with normal cartilage turnover was high (38% at three months) but did not increase over time, in contrast to the group with elevated cartilage turnover that significantly (p<0.05) increased the percentage of ACR 70 response over time. The patient groups did not differ significantly in disease activity at baseline. Table 1. Comparison of percentage of ACR 70 responders at 3 months, at 6 months, at 12 months, in groups selected at baseline status of in vitro tests Group 3 months 6 months 12 months Mean value all patients (n=81) 20% 24% 31% COMP Normal (basal) (n=26) 38% ** 35% 42% COMP Elevated (basal) (n=55) 11% 18%* 27%* P-values are indicated by * for p<0.05 and ** for p<0.005 and shows the significance between groups with normal and elevated marker levels Conclusion: The results of the study suggest that the outcome of COMP may be helpful to the treating physician when considering continued observation or modification of the current treatment. References: G. Morozzi, F. Bellisai, M. Fabbroni, S. Cucini, M. R. Bacarelli, M. Galeazzi: Levels of circulating COMP and anti-CCP in RA patients treated with adalimumab: Ann Rheum Dis 2005; 64: 10
Insight into Galeazzi Fracture with Ulnar Nerve Compression
No full textInsight into Galeazzi Fracture with Ulnar Nerve Compression Pedro Jimenez, B.S.1, Diana N. Ghisa, B.S.1, Ivan Kliuikov, B.S.1, Nicholas Riemen, B.S.1, Gary Schwartz, M.D.2, Professor Mohammadali M. Shoja, M.D.2 1MS-II, Dr. Kiran C. Patel College of Allopathic Medicine 2Professor, Dr. Kiran C. Patel College of Allopathic Medicine Introduction. Galeazzi fractures are a well-documented orthopedic injury, involving a fracture of the distal third of the radius with a dislocation of the distal radioulnar joint (DRUJ). However, ulnar nerve compression associated with Galeazzi fractures is rare. This case report presents a 51-year-old female with a Galeazzi fracture following a motor vehicle accident, featuring a rare volar dislocation of the DRUJ and subsequent ulnar nerve compression. Case Description. The patient experienced significant wrist pain and weakness after the accident, and a clinical examination revealed a displaced fracture of the distal radius with volar DRUJ dislocation. The patient also exhibited symptoms of ulnar nerve compression, including numbness and weakness in the ulnar nerve distribution. Surgical treatment consisted of open reduction and internal fixation of the radius, reduction and stabilization of the DRUJ, and decompression of the ulnar nerve. Postoperative care included occupational therapy to improve digital range of motion and restore hand strength. Follow-up assessments monitored the long-term stability of the DRUJ and the recovery of motor and sensory function in the ulnar nerve distribution. Discussion. This case highlights the importance of recognizing and managing nerve involvement in Galeazzi fractures, particularly in rare presentations involving volar DRUJ dislocation and ulnar nerve compression. The successful outcome underscores the significance of timely surgical intervention and comprehensive postoperative rehabilitation in achieving favorable patient outcomes. This case contributes to the limited literature on nerve complications in Galeazzi fractures and emphasizes the need for continued research and clinical awareness in managing such complex cases
Recovery from Posttraumatic Stress Symptoms: A Qualitative Study of Attributions in Survivors of War
No full textThis study was funded by a grant from the European Commission, contract number INCO-CT-2004-50917
Laboratorio Sociale. Verso la definizione di nuovi modelli di gestione residenziale
No full textIl progetto del Laboratorio Sociale nasce dalla volontà di costruire un percorso di formazione e accompagnamento alla gestione sociale degli alloggi, rivolto ai gestori del patrimonio residenziale pubblico lombardo (Aler) e ai gestori dei nuovi interventi residenziali di housing sociale attivati all’interno del Fondo Immobiliare di Lombardia. Al tema della costruzione e riqualificazione degli immobili, fondamentale per garantire l’accesso a un alloggio adeguato, si affianca, quello della creazione di comunità solidali socialmente sostenibili e della necessità di definire e diffondere una nuova cultura dell’abitare. La risposta al disagio abitativo non può più essere univoca e standardizzata ma deve ricalcare la complessità della società contemporanea, ricercando risposte innovative per bisogni diversificati, fondando la costruzione e la gestione delle comunità su nuovi valori e proposte, sostenendo l’autorganizzazione e l’attivazione degli stessi abitanti. Si delinea così una nuova figura, quella del Gestore Sociale, che si differenzia da un normale gestore immobiliare per la centralità riservata all’inquilino e alla comunità. Alla consueta attività di gestione del patrimonio egli affianca la cura delle relazioni tra le persone che vi abitano.La pubblicazione è il racconto di questa esperienza e l'elaborazione dei contenuti ragionati emersi nel corso degli incontr
- …
