Metopic synostosis is a relatively simple form of craniosynostosis, resulting from premature fusion of the metopic suture. In this pathology different degrees of dysmorphia of the anterior cranial fossa and the presence of associated anomalies of the skull might enable specific subgroups to be identified. Since most functional and cosmetic anomalies benefit from early surgical treatment, over the last few years neurosurgeons have been forced to elaborate less drastic, but nonetheless effective, surgical techniques. In the present report we analyze the surgical results obtained in a series of 62 infants with trigonocephaly operated on within their 1st year of life. Patients were subdivided into two groups (group I: 8 patients; group II: 54 patients) according to the specific dysmorphic characteristics of the frontal bone and anterior cranial fossa, and the presence of compensatory deformities affecting the anterior cranial base and temporo-parietal region. All the patients were treated using one of two relatively simple surgical techniques (procedure A: inversion of two hemifrontal bone flaps--48 cases; procedure B: the "shell" operation--14 cases). Both surgical procedures appeared to be effective, allowing adequate functional and cosmetic correction of the cranial deformity. In patients operated on following procedure B surgical time and blood loss were dramatically reduced. Long-term outcomes were satisfactory in all cases, irrespective of the surgical technique used. In the group II patients, however, progressive normalization of the interorbital distance was constantly observed, suggesting a different degree of stenotic involvement at the level of the anterior cranial base in these patients.

The purpose of this study was to evaluate 54 “Conus” uncemented stems both clinically and radiologically. The radiological evaluation was carried out to verify the stability of this rounded cross-section stem in terms of bone ingrowth and axial subsidence. Clinically, 39 hips (72%) were rated excellent, 13 (24%) were rated good, 2 (4%) were rated fair or poor. The average Harris Hip Score increased from 53 before operation to 93 at the time of the last follow-up (average FU 22.5 months). None was reoperated. Radiologically, 13 stems (24%) were judged to have subsided using a method described by Loudon and Charnley (6). Calcar modification, observed in 22 hips (41%), consisted of a slight rounding off of the proximal medial edge at the cut femoral neck. These results encourage the use of this versatile stem which revealed good primary and secondary stability, with good load distribution along the femur.

A 33-year-old patient with cranial epidural tuberculoma without history of tuberculosis is described. CT and MR imaging showed a lesion located on both sides of a right frontotemporal bone destruction with epidural extent. Except for a small necrotic core, the lesion enhanced intensely after contrast medium administration. Osteitis and subgaleal abscess were associated. The displaced dura mater delineated the epidural tuberculoma. Diagnosis was verified by histology and identification of Mycobacterium tuberculosis. After removal of the tuberculoma and combination therapy, there was a complete regression of abnormalities. Differential diagnoses are dural tuberculoma, focal tuberculous pachymeningitis and tuberculous epidural empyema.

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Purpose Metal ion release may cause local and systemic effects and induce hypersensitivity reactions. The aim of our study is first to determine if implant-related hypersensitivity correlates to patient symptoms or not; second, to assess the rate of hypersensitivity and allergies in shoulder arthroplasty. Methods Forty patients with shoulder replacements performed between 2015 and 2017 were studied with minimum 2-year follow-up; no patient had prior metal implants. Each patient underwent radiographic and clinical evaluation using the Constant-Murley Score (CMS), 22 metal and cement haptens patch testing, serum and urine tests to evaluate 12 metals concentration, and a personal occupational medicine interview. Results At follow-up (average 45 ± 10.7 months), the mean CMS was 76 ± 15.9; no clinical complications or radiographic signs of loosening were detected; two nickel sulfate (5%), 1 benzoyl peroxide (2.5%) and 1 potassium dichromate (2.5%) positive findings were found, but all these patients were asymptomatic. There was an increase in serum aluminum, urinary aluminum and urinary chromium levels of 1.74, 3.40 and 1.83 times the baseline, respectively. No significant difference in metal ion concentrations were found when patients were stratified according to gender, date of surgery, type of surgery, and type of implant. Conclusions Shoulder arthroplasty is a source of metal ion release and might act as a sensitizing exposure. However, patch test positivity does not seem to correlate to hypersensitivity cutaneous manifestations or poor clinical results. Laboratory data showed small constant ion release over time, regardless of gender, type of shoulder replacement and implant used. Levels of evidence Level II.