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Biomedical subjects

A Giunti

Publications and source records attributed to A Giunti.

At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

The Gamma nail, sliding-compression plate. A comparison between the long-term results obtained in two similar series.

The authors report the results they obtained in a retrospective comparative study conducted on two systems of osteosynthesis used to treat trochanteric fractures: the sliding-compression screw-plate (CHS), and the Gamma nail. Two series were included in the study, each of which was made up of 50 cases; these were comparable in terms of fracture type, age of the patients, associated pathologies, and minimum follow-ups of 6 months. The parameters compared were: surgical trauma, average amount of time before a standing position could be resumed, resumption of motor activity previous to trauma, mechanical behavior of the instrumentation. The results show that both of the means of synthesis are capable of effectively stabilizing pertrochanteric fractures, avoiding the mechanical complications instead observed when more dated instrumentation, such as the screw-plate or nail-plate, are used, systems which are not characterized by a sliding cervico-cephalic screw. The amount of time before walking is resumed is quicker when the Gamma nail is used. There was no significant difference in terms of resumption of motor activity. Surgical trauma was the same in both series when the instrumentation was applied after reduction of the fracture in closed surgery, while blood loss was greater when fracture reduction required by application of the plate was performed in open surgery.

Adult↗
PubMedDate not supplied

Traumatic injuries of the pelvis. SIOT paper 1967.

The paper that Prof. Campanacci read at the Annual Meeting of the Italian Society of Orthopaedics and Traumatology in 1967 was the product of vast research aimed at clarifying and classifying traumatic injuries of the pelvic girdle. The basic idea behind the study was that correct therapeutic conduct cannot neglect an in-depth knowledge of the pathologic anatomy and pathogenesis of the injury. What emerges, in addition to the knowledge of anatomopathology, is the continuing validity of the scientific method with which the problem was dealt with.

Biomedical Research↗
PubMedDate not supplied

Ceramic-ceramic coupling. Total hip arthroplasty in young patients.

Between 1994 and 2000 at the 7th Division of the Rizzoli Orthopaedic Institute a total of 123 total hip arthroplasties were implanted in 105 patients aged under 40 years (mean age 32 years). In most of the cases the patient was affected with osteoarthrosis secondary to congenital hip dysplasia (35%) or osteonecrosis (29%). In all of the cases the same type of cup was press-fitted with alumina on alumina bearing surfaces. The stem was cemented in 4 cases. Six of the patients were submitted to prosthetic revision surgery: 1 as a result of deep infection, 2 recurring dislocation, 3 aseptic loosening of one of the components. Radiographic evaluation did not reveal signs of periprosthetic osteolysis. We did not observe any cases of rupture of the alumina head or any problems related to the modularity of the implant. The authors wish to stress the reliability of using alumina on alumina in a population with high functional demand.

Adolescent↗
PubMedDate not supplied

MRI in diagnosis of osteoid osteoma of the proximal femur: a potentially deviating aspect. Description of a clinical case.

Osteoid osteoma constitutes 10-12% of all benign neoplasms of the bone. The tumor more frequently involves the male sex (male to female ratio 2.1:1) and it may be observed in all age groups, with evident predilection for the second decade of life. All of the skeletal segments may be affected, but the most frequent site is the long bones, in the diaphyseal, metaphyseal and more rarely epiphyseal regions. The lesion is characterized by an osteolytic area, the nidus, which is at times partially calcified, surrounded by an osteosclerotic zone that is more or less accentuated. Clinical suspicion and traditional radiography are essential in diagnostic orientation; usually, further imaging methods are also recommended, such as bone scan with Tc99, CT scan and MRI. This last method allows for easy localization of the lesion, although with a sensitivity that is less than that of the CT scan. Nonetheless, the finding, if not supported by clinical suspicion, may be dangerously deviating and it may orient diagnosis towards a more aggressive disease.

Adult↗
PubMedDate not supplied

Anterior surgery for the treatment of soft cervical disc herniation.

The authors present the results obtained in a series of 57 cases of soft cervical disc herniation submitted to anterior surgery. The cases included 52 radiculopathies and 5 myeloradiculopathies. Among the radiculopathies, 20 cases were treated by discectomy without magnification, and interbody fusion, and 32 by radical microdiscectomy, completed with interbody fusion in 19 cases and without fusion in 13. The 5 cases of myeloradiculopathy were all treated by microdiscectomy, with fusion in 2 cases and without fusion in 3. The results of treatment of the radiculopathies were evaluated as excellent or good in 80% of the cases treated by "macro" technique, and in 84% of those treated with "micro" technique; in the latter cases, more rapid and complete regression of pain, were always observed probably due to the more radical neurological compression obtained. The 5 cases of myeloradiculopathy obtained excellent results, with evident sensory and motor recovery. Long-term results for cases treated with or without fusion did not differ; the complications observed in the entire series may all be related to use of interbody grafting. The authors conclude that the method of choice in the surgical treatment of soft cervical herniation, with radicular or myeloradicular compression, is radical anterior microdiscectomy without interbody fusion.

Bone Transplantation↗
PubMedDate not supplied

Degenerative spondylolisthesis: lumbar stenosis and instability.

Degenerative spondylolisthesis may manifest itself with different clinical pictures depending on the phase of the spondylotic disease. Based on pathophysiological criteria 24 patients affected with degenerative spondylolisthesis were divided into three groups: group I: those with spondylotic instability; group II: those with lumbar stenosis and current or potential segmental instability; group III: those with lumbar stenosis and naturally stabilized spondylolisthesis. Group I was treated by posterolateral fusion; group II by laminectomy, removal of the medial portion of the facets and posterolateral fusion; group III by laminectomy and removal of the medial portion of the facets. Long-term results were positive in 100% of the cases in group I, 90% in group II and 83% in group III, with no statistically significant differences between groups, because of the limited series of cases. The authors conclude that surgery for the treatment of degenerative spondylolisthesis must be based on age, symptoms, and the phase of the disease, and that when these indications suited to the clinical-radiographic picture are taken into account, good results may be obtained with different operations.

Adult↗
PubMedDate not supplied

Complications in the surgical treatment of lumbar stenosis.

The authors analyze the complications which may occur in the surgical treatment of lumbar stenosis. They report 4 cases of cauda equina syndrome and 8 dural tears in 96 patients aged from 21 to 81 years submitted to multiple bilateral laminectomy. Based on a review of the patients some considerations on surgery for the treatment of lumbar stenosis are discussed. The advanced age of the patients, hypertension, diabetes, vasculopathies in general, severe neurological deficit dating back some time contraindicate surgery. When surgery is indicated a correct preoperative evaluation by MRI from T12 to the sacrum is required to determine the extent of the laminectomy and a safe and accurate intra- and postoperative bleeding control is mandatory. Dural laceration may be repaired by a thoracolumbar fascia patch.

Age Factors↗
PubMedDate not supplied

Bone with cement and antibiotic: antibiotic release in vitro.

It was the purpose of the study to evaluate morcellized bone with cement and antibiotic release mixed with vancomycin and methylmethacrylate cement (PMMA). The aim of the study is part of a wider one aimed at verifying the possibility of using this composite for the treatment of chronic septic pathologies of the bone. Five cylinders 1 cm in height by 1 cm in diameter, formed by morcellized bone with cement and vancomycin were immersed in plasma and 5 in physiological solution. Three cylinders equal in size but formed by cement and antibiotic alone were immersed in plasma and 3 in physiological solution. All of the cylinders remained in immersion for 28 days at a temperature of 37 degrees C. The immersion fluids were changed every day during the first week and on days 14, 21 and 28. The quantity of vancomycin released was dosed in each specimen. The greatest and most constant release of antibiotic took place in the cylinders of morcellized bone, cement and antibiotic immersed in plasma.

Anti-Bacterial Agents↗
PubMedDate not supplied

Tricalcium phosphate and hydroxyapatite ceramics in the surgery of bone tumors: preliminary results.

The authors report their preliminary experience in the use of substitutive bone compounds in order to fill the bone cavity after curettage. The material used is constituted by a biphasic compound, made up of tricalcium phosphate and hydroxyapatite. Twenty-one patients were submitted to surgery because of the presence of a benign or low-grade malignant tumor. After removing the neoplastic tissue the residual cavity was filled with: tricalcium phosphate/hydroxyapatite (5 cases); tricalcium phosphate/hydroxyapatite plus autogenous bone (8 cases); tricalcium phosphate/hydroxyapatite plus bone allografts (8 cases). A radiological evaluation obtained 12 months after treatment showed that the incorporation of the compound in granular form was nearly complete in most of the cases, while the blocks revealed partial remodelling which was more evident in the angles. Finally, bone resorption in the site of the compounds used was not observed.

Adolescent↗
PubMedDate not supplied

An evaluation of the "quoad vitam" prognosis in the elderly patient with medial fracture of the femoral neck.

The authors analyzed 425 consecutive cases of medial fracture of the femoral neck with the purpose of establishing a simple and practical system, and one which is easy to use, in order to evaluate this type of lesion and to compare different series of cases. Based on these criteria the death rate occurring intra-hospital and 6 months after trauma, the influence of the age factor, the type of anesthesia used and the type of treatment carried out, were evaluated. The results were as follows: The classification devised by the American Society of Anesthesiology continues to be an effective system for the evaluation of vital risk. The death rate was always directly related to age, and it was not influenced by either the type of anesthesia or the type of surgery used; however, it doubled when non-surgical treatment was used.

Aged↗
PubMedDate not supplied

Lumbosciatic pain and coagulopathies.

Three cases of nerve compression causing lumbosciatic pain and/or cruralgia due to hematoma secondary to coagulopathies of varying etiology are described. The cases involved a multiple nerve root syndrome of the cauda equina due to extradural hematoma in coagulopathy resulting from the administration of dicumarol drugs, a neuropathy of the crural nerve caused by hematoma of the iliopsoas muscle in hemophilia B, and a neuropathy of the sciatic nerve caused by hematoma in the gluteus and thigh in coagulopathy resulting from the administration of dicumarol drugs. In all three of the cases the clinical picture resembled that of lumbar disc herniation, but a careful evaluation of each patient's history, objective picture, and laboratory and radiological testing allowed us to make a correct diagnosis. Medical therapy is based on the correction of the coagulopathy by means of suitable drugs or hemoderivates. Surgical treatment is reserved for the most severe cases.

Acute Disease↗
PubMedDate not supplied

Bone scan in the evaluation of cementless hip prostheses.

The authors report the data obtained in a bone scan study conducted in 15 patients with cementless total hip arthroplasty. The study was conducted a minimum of 6 months and a maximum of 46 months postsurgery. Contrary to what occurs for cemented prostheses, we used bone scan not as a diagnostic aid for complications, but in order to evaluate the osteogenetic response of the bone to a cementless prosthetic implant. Zonal bone scan high uptake revealed specific areas of overloading, or, when localized in the para-articular region, they anticipated the presence of ossifications before they became visible radiographically. Bone scan was also useful in monitoring the incorporation and remodelling phases of the auto and/or homoplastic bone grafts used.

Aged↗
PubMedDate not supplied

Loosening of a hip prosthesis in a patient affected with tabetic disease.

The authors present a case of hip Charcot joint treated with cemented arthroplasty. Although there was only weak serological positiveness for lues and no neurological changes associated with the disease, three months after surgery there was dislocation and loosening of the prosthesis.

Aged↗
PubMedDate not supplied

An evaluation of the "in vivo" and "in vitro" biological reaction and mechanical features of carbon fibre composites.

Tissue reaction to an epoxy resin-carbon fibre composite was tested "in vivo" and "in vitro" in order to evaluate this material as an alternative to metal alloys for clinical use in orthopaedic surgery. While the "in vitro" tests suggest a mild toxic effect of the composite on cells, good biocompatibility "in vivo" was observed when debris are not generated. The mechanical tests compared the composite and stainless steel plates, confirming the expected values for static strength and elastic modulus, revealing, however, the formation of long needles of carbon fibre following breakage of the plate.

Animals↗
PubMedDate not supplied

Anatomical ceramic arthroplasty (AN.C.A.): preliminary experience with a new cementless prosthesis.

The study reports the results obtained in 100 hips operated with a new cementless arthroplasty (AN.C.A.) characterized by the anatomical shape of a stem coated with Al2O3 and by a spherical acetabulum in ceramic-titanium, stabilized to the acetabulum first by screwing of the titanium ring and then by bony ingrowth in the cupola covered with porous ceramic. The patients were followed-up after an average of 17.4 months (+/- 8 SD). The patients were clinically evaluated using on the Merle d'Aubigné system, with the following average values +/- SD: pain 5.51 +/- 1, walking 5.01 +/- 1.1, and range of motion 5.38 +/- 0.9. The radiographic stabilization of the prosthesis (considering the worst results of the acetabulum and/or of the stem) was bony (BS) in 83% of the case and fibrous (FS) in 11%; 6 cases (5 acetabulums and 1 stem) showed signs of radiographic instability. Of these, 2 were submitted to further surgery to substitute the acetabulum. Two other patients were also submitted to a second operation: 1 involved substitution of the fractured ceramic head, and the other involved substitution of the stem in a patient with progressive coxalgia and no radiographic signs of loosening. The method of radiographic evaluation was significantly correlated with pain (p = 0.0001) and with walking (p = 0.0095). Instead, there were no significant correlations between stabilization of the prosthesis and precision of the femoral fit (press-fit) of the stem, age, evaluation of preoperative mineralization of the bone, and length of the stem. 8% of the cases presented important radiographic signs of stress-shielding; while 16% presented hypertrophy of the femoral cortex. These radiographic findings were not correlated to clinical ones.

Adult↗