Posterior Subtalar Dislocation

A subtalar dislocation of the foot is an uncommon injury, and cases of posterior subtalar dislocation are even rarer. This injury is characterized by a simultaneous dislocation of talocalcaneal and talonavicular joints while tibiotalar and calcaneocuboid articulations remain intact. Subtalar dislocation is commonly accompanied by fractures of the malleoli, talus, or fifth metatarsal and by a rotational component of the subtalar joint. Subtalar dislocation can occur in any direction and produces significant deformity. This article presents a case of pure posterior subtalar dislocation in an 80-year-old man who presented with pain and deformity in his left ankle following a motorcycle accident. Radiographs demonstrated dislocation of both the talonavicular and talocalcaneal joints. The calcaneus was displaced posteriorly without medial or lateral displacement. No rotational component of the calcaneus was noted, suggesting the trauma was in pure hyperplantar flexion. We hypothesize that pure hyperplantar flexion could lead to a progressive subtalar ligament weakening that may result in a complete ligament rupture if the plantar flexion force is prolonged. This could be observed in the presence of good bone quality and if the force is applied distally at the navicular bone

EVOLUTION AND HEALING OF FRAGILITY FRACTURES OF THE PROXIMAL FEMUR

After a traumatic fracture a physiological process begins to heal the fracture. The steps of the process are inflammation, granulation, formation of fibrous callus and finally bone. There are many factors that may influence the healing of the fracture: adequate blood supply, good contact between bone fragments, good stability of the fracture, general health, age, smoking, related pathology, use of drugs, etc. In elderly patients the variations in bone structure and healing processes have a negative influence on fracture healing. Fragility fractures require careful placement of the implants to reduce the risk of failure of osteosynthesis. Appropriate surgical devices and facilitation factors must be used to allow bone healing

Case report: laser Nd:YAG e rieducazione funzionale nella sindrome del piriforme

La sindrome del piriforme \ue8 caratterizzata da una lombalgia con interessamento del gluteo e con possibile irradiazione all'arto inferiore; pu\uf2 essere definita come una patologia dovuta ad intrappolamento, compressione o irritazione del nervo sciatico a livello del muscolo piriforme con o senza deficit neurologici. In questo studio \ue8 stata valutata l'efficacia della sinergia terapeutica tra laser Neodimio:YAG e rieducazione funzionale nella riduzione del dolore e nel miglioramento dell'indipendenza funzionale in una paziente affetta da sindrome del piriforme

Service level Indication: A proposal for QoS monitoring in SLA -based multidomain networks

The offering of QoS based communication services has to face several challenges. Among these, the provisioning of an open and formalised framework for the collection and interchange of monitoring and performance data is feit as one of the most important issues to be solved. Indeed, this is true in seenarios where multiple providers are teaming (intentionally or not) for the construction of a complex service to be sold to a final user, like in the case of the creation of a virtual private network spanning multiple network Operators and infrastructures. In this case, failures in providing certain required Ievels in the quality parameters should be dealt with an immediate attribution of responsibility across the different entities involved in the end-to-end provisioning of the service. But also in cases apparently much simpler, for example when an user requires a video strearning service across a single operator network infrastructure, there is a demand for mechanisms for the measurement of the received quality of service across all the elements involved in the service provisioning: the server system, the network infrastructure, the dient terminal and the user application. lt is clear that this is a complex problem, involving different technologies, disciplines and research areas. In this paper, starting from the ongoing work in the definition of standard interfaces for the Quality of Service negotiation (Service Level Agreements) and control (Service Level Specifications), as weil as from the work ongoing in the IPFIX and IPPM working groups from the IETF, we introduce a new document specifically for delivering monitoring information to user applications. We called such a document Service Level Indication. We here aim at sketching a possible starting point for a research discussion. © 2003 by Springer Science+Business Media Dordrecht

Oral beclometasone dipropionate in the treatment of extensive and left-sided active ulcerative colitis: a multicentre randomised study.

AIM: To explore the efficacy and safety of the topically acting steroid beclometasone dipropionate (BDP) in an oral controlled release formulation in the treatment of extensive or left-sided ulcerative colitis. METHODS: In a multicentre, randomised, parallel-group, single-blind study, patients with active mild to moderate ulcerative colitis were randomised to a 4-week treatment with BDP 5 mg/day o.d. vs. 5-ASA 0.8 g t.d.s. The primary efficacy variable was the decrease of Disease Activity Index (DAI) (clinical symptoms and endoscopic appearance of mucosa). Safety was evaluated by monitoring adverse events, vital signs, haematochemical parameters and adrenal function