Biomedical subjects
Publications and source records attributed to A Caroli.
Multiple exostoses syndrome is a rare autosomal dominant disorder that affects the enchondral skeleton during growth. The formation of numerous exostoses causes deformities of bones and joints. Degenerative malignant changes are described. A careful follow up during paediatric age is required. Three new cases in the same family are reported in this paper.
The authors present a case of ancient schwannoma of the motor branch of the median nerve. An accurate peroperative diagnosis was not possible despite the use of MRI. Sectioning of the nerve was required as the tumor could not be enucleated.
Anterior interosseous nerve syndrome is a rare occurrence. One particular case, in terms of its etiopathogenesis, and its clinical findings that involved isolated lesion of the long flexor muscle of the thumb is reported. Healing occurred after approximately 10 months. Medical and physiotherapeutic treatment were carried out.
AIMS AND BACKGROUND: The aim of this randomized controlled trial was to compare two methods for teaching breast self-examination: theoretical and practical session versus mailed material. METHODS: A random sample of women aged 20-64 years was drawn from the demographic file of the city of Faenza (Northern-Italy). Of 825 sampled eligible women, 168 declined participation, 657 were randomly assigned, after completing a pretest questionnaire aimed at evaluating practice and quality of breast self-examination. Individualised instruction was administered to the treatment group invited to be taught breast self-examination in a medical practice setting. The control group received mailed information about breast self-examination. One year later, 443 women completed the posttest questionnaire. RESULTS: As far as concerns the first outcome of the trial (change in practice of breast-self examination) our study showed, after adjusting for lost-to-follow-up, no difference between the treatment and the control group. The analysis performed to evaluate the second outcome (change in quality of breast self-examination practice) showed that women of the treatment group improved the quality of breast self-examination practice more than the control group (Wilcoxon test, z = 2.4, P < 0.01). The same results have been confirmed by multiple regression analyses taking into account all potential confounders. No selection bias affected these results. CONCLUSION: Theoretical and practical sessions resulted in an improved quality of examination technique than did mailed material.
The authors report their experience of 5 patients (4 males, 1 female) with a mean age of 36.4 years (min 25 years, max 45 years), undergoing triscaphoid arthrodesis between May 1989 and August 1993. The patients suffered from rotatory dislocation of the scaphoid (1 case) and stage 3A of Kienboeck's disease according to Lichtman's classification (4 cases). The paper describes the surgical technique used for partial arthrodesis of the wrist performed using plexual anesthesia. A dorsal access route is used through a curved longitudinal skin incision corresponding to the anatomical site of the scaphoid. The skin flaps are then peeled back revealing the surface veins and sensitive branches of the radial nerve which are isolated and conserved. Having cut through the retinaculum of the extensors, the extensor tendons are spread so as to reach the joint capsule which is sectioned crosswise. After the bone to be fused have been exposed, the cartilage is removed from the joint faces between the scaphoid, trapezium and trapezoid and, using a osteotribe, the subchondral bone is removed to reveal the spongy bone, leaving a space of approximately 6 mm between the spongy surface of the bones to be fused. Arthodesis is stabilised using Kirschner wires or metal minicambres enclosing scaphoid, trapezium and trapezoid. Spongy tissue is taken from the distal radial head and used as a graft to fill the spaces created between them which will consolidate over time. The wrist is immobilised in a plaster cast for 8 weeks before starting functional rehabilitation. Patients were checked both clinically and radiographically with a mean follow-up of 36.4 months (min 25, max 50 months). Using the assessment criteria proposed by Minami et al. excellent results were obtained in 4 patients (80%) with the disappearance of painful symptoms, joint excursion 50% greater than the normal wrist, and hand grip 70% greater than in the controlateral hand. There was good radiographical consolidation of the arthrodesis. Poor results were only recorded in one case (20%) with persisting pain and functional impotent. Radio-scaphoid arthrosis was observed radiographically consequent to hypercorrection of the scaphoid with a radio-scaphoid angle of less than 45 degrees. The authors underline the technical difficulty of this arthrodesis characterised by reduction of the scaphoid in a correct position in which the radio-scaphoid angle must be 45 degrees when measured from a lateral position. Lastly, the authors conclude that this from of arthrodesis may be used with good results to treat wrist pathologies such as rotatory scaphoid dislocation, triscaphoid arthrosis and Kien-boeck's disease at stage 3A according to Lichtman. They also affirm that arthrodesis limited to the wrist is preferable to total arthrodesis because it enables some joint movement to be conserved which is important for hand function.
The authors present the outcome of 42 patients operated at birth for closure of the spinal malformation. The age of patients at first observation ranged from 3 months to 21 years (mean 8.3 years); 7 patients (16.7%) had a close spina bifida, 35 (83.3%) had an open spina bifida and 30 (85.7%) of them developed hydrocephalus. The protocol included neurological evaluation, determination of development quotient using the Griffith's scale and intelligence quotient using the Wise-R scale. Adolescents underwent also the Blacky pictures test and Offer's interview. Verticalization and tutorial deambulation were achieved in 95.2% of patients; 76% of patients had a I.Q. > 90. The emotional situation was unsatisfactory in the majority of patients due to reduced autonomy and limited self-consideration.
Complex traumatic lesions of the hand constitute a frequent problem in surgical reconstruction. Often young subjects of full work age and with high functional requirements are affected. Thus, microsurgery has changed the quoad functionem prognosis of these lesions. In addition to presenting a modern definition of complex lesions, the authors expose and discuss a rational method of surgical treatment in light of the most recent possibilities of reconstruction offered by microsurgery of flaps and reimplantations. The conclusion is that only the constant presence of an expert microsurgical team permits a correct approach to this type of lesion.