Biomedical subjects

A Giunti

Publications and source records attributed to A Giunti.

158 records · Page 9Linked to original sources

PubMedDate not supplied

Posterolateral spinal fusion: a study of 123 cases with a long-term follow-up.

A total of 123 patients submitted to posterolateral fusion according to the Wiltse method were followed-up after 2-10 years (mean 6 years and 2 months). The series included: isthmic spondylolisthesis: 80; degenerative spondylolisthesis: 18; failed back syndrome: 25. Good morphological fusion of the arthrodesis evaluated by conventional radiology and CT, was obtained in 87% of the entire series, while in 89% of the cases excellent or good clinical results were obtained according to the Friberg evaluation scale. Extent of the fusion to 1 or 2 intervertebral segments, or association of laminectomy did not influence the results. Clinical and radiographic results were maintained stable in time: in only 3 cases did we observe clinical deterioration due to degeneration of the segment located above the fusion 3-7 years after surgery. The only important complications observed were one cauda equina syndrome due to peridural hematoma after laminectomy-fusion, and one iliocaval venous thrombosis. The results of the series studied and the data reported in the literature show that posterolateral fusion is a method capable of providing a high percentage of good clinical and radiographic results, and it may be favorably compared with methods of interbody fusion and of pedicular fixation, compared to which it has the advantage of involving a minor number of complications. Anterior interbody fusion is however indicated for stabilization of the reduction of severe spondylolisthesis in the adolescent. Fusion with pedicular osteosynthesis is indicated for the treatment of macroscopic instability and in fusions which are extended to more than two intervertebral segments.

Adolescent↗

PubMedDate not supplied

Recurrent lumbar disc herniation: what recurs? (A morphological study of recurrent disc herniation).

A morphological study was conducted on disc material obtained during surgical discectomy in 20 patients. The series was divided into 4 groups. Group I: 3 patients who had never been operated on before; group II: 3 patients who had already been submitted to discectomy but at a level which differed from that of the disc examined; group III: 4 patients treated surgically for contralateral herniation; group IV: 10 patients with true recurrent disc herniation, that is, already submitted to surgery for the treatment of homolateral herniation of the same disc. All of the cases submitted to surgery had been operated on more than a year previously. Moreover, the disc material obtained during autopsy in a patient operated 15 years before for disc herniation was studied. A morphological study of the cases and the data reported in the literature reveals that the fibrocartilaginous tissue of recurrences differs from that of primary herniation because of the presence of large collagen bundles associated with fibrillar framework. This aspect suggests the hypothesis that is also supported by the autoptic material examined that recurrent disc herniation is formed by repair tissue that substitutes the part of the disc that is operated on, and that recurrent herniation is caused by mechanical collapse of the repair tissue. From a surgical point of view, a distinction may be made in terms of early recurrences, which appear within one year of surgery and are formed by disc tissue which is identical to that of primary herniation, and late recurrences, the subject of this morphological study.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

Anterior surgery of the upper part of the cervical spine by prevascular extraoral approach.

Anterior surgery of the upper part of the cervical spine, that is, proximal to C3, may be performed by transoral approach, possibly enlarged by glossomandibulotomy, by a retrovascular extraoral approach, or by a prevascular extraoral approach. The authors describe the surgical method of prevascular extraoral approach that allowed them to effectively treat osteoma localized at C2 and C3, post-laminectomy instability at C3 and C4, solitary metastasis at C3. As compared to transoral surgery the prevascular extraoral approach has the advantage of avoiding the risk of infection from germs in the oral cavity and of allowing for easier postoperative management, avoiding tracheotomy and/or prolonged dysphagia. As compared to a retrovascular approach the prevascular approach obtains a truly anterior exposure instead of an anterolateral one. Prevascular extraoral approach should thus be used whenever possible. Transoral surgery is indicated for decompression, of the brainstem and a bilateral retrovascular approach may be used to perform anterolateral fusion at C1-C2.

Aged↗

PubMedDate not supplied

Dysphagia due to cervical osteophytosis.

Cervical lesions caused by diffused idiopathic skeletal hyperostosis may cause compression of the upper respiratory and digestive paths. Horizontal anterior osteophytes that are not fused can cause dysphagia and dysphonia, large prevertebral ossifications extended or segmental may cause difficulty in breathing. A series of 6 cases with dysphagia, dysphonia, dyspnea due to duffused idiopathic skeletal hyperostosis, with cervical lesions is reported. In 3 cases, affected with moderate dysphagia, conservative treatment with anti-inflammatory drugs and a proper diet allowed for the symptoms to be controlled, and for spontaneous evolution of the lesions to occur, with fusion and remodeling of the compressive osteophytes. These patients continue to be asymptomatic 2-7 years after the first observation. In 3 cases affected with severe respiratory and/or nutrition deficit, the osteophytes and ossifications were surgically removed by prevascular extrapharyngeal approach, and rapid resolution of symptoms ensued. The follow-up 1-2 years after treatment showed that patients were asymptomatic and that radiographically there was no recurrence of lesions.

Aged↗

PubMedDate not supplied

Fracture of the ceramic epiphysis in hip arthroplasty.

Between November 1985 and October 1993, a total of 694 ceramic-ceramic hip arthroplasties were implanted; up until 1987 the alumina used in the first 82 cases was Ostalox, produced by IMEC of Caravaggio, characterized by poor control of the size of the crystals; after 1987 Biolox alumina of the Feldmhule company was used in 612 cases. Fracture of the ceramic head occurred in 2 cases; in both patients ceramic was of the Ostalox type, meaning a 2.4% incidence of fracture; up until the present none of the 612 Biolox heads has presented this complication.

Aluminum↗

PubMedDate not supplied

The use of cobalt therapy to prevent heterotopic ossification after total hip arthroplasty.

The occurrence of heterotopic ossification after total hip arthroplasty may be prevented by radiation or medical therapy. The authors report the results obtained in 96 cases treated by cobalt therapy: the occurrence of high grade ossification (Brooker III and IV) is equal to 1% in cases treated, as compared to 9% in cases not treated. Male patients of advanced age and who are characterized by primary arthrosis are more at risk for ossification.

Adult↗

PubMedDate not supplied

Wear of the epiphysis-acetabulum in total hip arthroplasty: a review of the literature.

Problems related to the use of total hip arthroplasty and the properties of the materials used to make prostheses have encouraged wear phenomena of the epiphysis-acetabulum combination of international importance and acknowledgement. Based on a review of the literature, the authors analyze the most recent years of study of wear phenomena and discuss the choice of materials to be used in total hip arthroplasty implant, with particular interest in any potential defects.

Acetabulum↗

PubMedDate not supplied

Removal of heterotopic ossifications followed by cobalt therapy after hip arthroplasty.

The authors report 7 cases in which removal of high grade ossification which developed after hip arthroplasty was performed: all of the patients were treated postoperatively by radiation therapy with the purpose of preventing recurrence of ossification. After surgery ossification was present, but to a moderate degree, in 6 out of 7 cases examined; movement had clearly improved. The results obtained show that removal surgery is justified if movement of the hip is considerably impaired (ankylosis) and that prevention plays an essential role and must be carried out every time that the patient risks the development of ossification.

Aged↗

PubMedDate not supplied

Hydroxyapatite as metallic prosthesis coating: preliminary clinical experience.

The authors report the radiographic results of 65 An. C.A. prosthetic stems coated with hydroxyapatite and followed-up at least 24 months after implantation. A comparison with a homogeneous group of aluminum-coated An.C.A. stems showed that hydroxyapatite-coated stems are characterized by better osteointegration, with a clearly inferior incidence of radiolucent lines at the bone/prosthesis interface. Macroscopic observation and histologic examination carried out on two stems removed because of persistent pain to the thigh revealed partial resorption and fragmentation of the coating. The authors believe that this phenomenon, the object of other observations reported in the literature, may indicate the reduced stability of the coating in the long run, and as such further in-depth study is required.

Aluminum↗

PubMedDate not supplied

Anterior surgery in trauma of the cervical spine.

The study reports a series of 37 traumatic lesions of the cervical spine treated surgically by anterior approach. The series includes two IInd type fractures of the odontoid, treated by direct screwing, 32 recent fractures or fracture-dislocations of the lower cervical spine treated by decompression and anterior arthrodesis with a plate, 3 inveterate dislocations treated by anterior-posterior osteotomy in 2 cases, and decompression-arthrodesis in the third. One amyelic fracture of the odontoid healed in 4 months, the other patient, with Frankel C spinal cord lesion improved to D, but died 4 months later as a result of bronchial pneumonia ab ingestis. In all of the recent lower cervical lesions fusion was obtained in 3-12 months (mean 4.5 months). Eight incomplete spinal cord lesions improved by 2 Frankel classes in 3 cases and by 1 in 5. Six nerve root lesions healed with complete recovery. Three cases with no neurologic deficit remained unchanged as did 15 complete spinal cord lesions. In the 3 inveterate cases we obtained healing of a slow-developing myelopathy (Frankel D) after osteotomy, no improvement after osteotomy in the second case (Frankel B). In the case submitted to decompression and anterior fusion we obtained recovery from Frankel B to E in three months, but the patient then died as a result of pulmonary complications. Direct screwing of the odontoid allows us to obtain healing of the type II fractures without blocking C1-C2 movement with a posterior fusion. Anterior surgery in traumas of the lower cervical spine allows for anatomical decompression of the spinal cord and bone reconstruction with good results, avoiding the risk of neurologic progression caused by dragging of the disc material in the spinal canal, that may take place at the time of non-surgical reduction or by posterior approach of the dislocations. In our series complications included 2 infections, 1 that healed without sequelae and the other with kyphosis, and a fistula of the hypopharynx caused by fibrobronchoscopy 1 year after osteosynthesis, that healed after primary repair. For this latter complication anterior surgery can, at most, be considered a contributing cause, because of the deep scar.

Adolescent↗

PubMedDate not supplied

Antibiotic and antithromboembolic prophylaxis in hip arthroplasty (a review of 700 primary implants).

The authors report the results obtained with antibiotic and antithromboembolic prophylaxis used in 700 consecutive primary total hip arthroplasties. As for antibiotic prophylaxis (5 cases of infection: 0.7%) the various types of antibiotic used always kept the infection rate under 1%, confirming the effectiveness of the preventive use of antibioticotherapy. The incidence of deep venous thrombosis and pulmonary embolia were 3.7% and 0.7%, respectively (26 cases of DVT and 5 of PET). The incidence of DVT rose to 34.4% in a selected group of cases in which phlebography had been carried out even in the absence of symptoms of DVT. This confirms that the routine use of this method would without a doubt be useful in preventing complications with a high risk for the life of the patient (pulmonary embolia). As for pharmacological prophylaxis, indobufene and calcium heparin were the drugs used most: their effectiveness was nearly similar, despite the fact that the use of calcium heparin in patients considered to be at a higher risk for thromboembolic complications should be made clear.

Adult↗

PubMedDate not supplied

Peripheral aneurysms in the differential diagnosis of soft tissue sarcomas.

The authors present four cases of peripheral aneurysm: 1 true aneurysm towards the superficial femoral artery, and 3 aneurysms of the popliteal artery, 1 of which true and 2 false. The criteria used for differential diagnosis with soft tissue sarcomas is analyzed and the importance of a complete diagnosis before planning incisional biopsy is emphasized.

Adult↗

PubMedDate not supplied

Hip arthroplasty in the elderly patient: is it a correct indication?

The authors report the results of 54 primary hip arthroplasty implants performed in patients aged over 75 years. The cases examined demonstrated that this type of surgery is not contraindicated in elderly patients as the occurrence of complications and perioperative risks are not higher if compared with a "younger" population. Preoperative anesthesiological evaluation that is extremely accurate is required.

Age Factors↗

PubMedDate not supplied

Intraoperative fractures of the femur in prosthetic hip reimplantations.

A total of 19 cases of intraoperative fractures of the femoral diaphysis occurring during prosthetic hip reimplantation are described. Incidence, predisposing factors, treatment, and influence on long-term results are discussed. The pre-existence of osteolysis or narrowing of the femoral cortex, often associated with primary cemented implantation with a metal-polyethylene combination, constitutes a factor that predisposes the patient to fracture. Fracture consolidation occurs in most cases with minimum treatment, at times without instrumentation; fracture, however, always means a delay in weight-bearing and a slowing down in recovery times. Long-term clinical evaluation shows functional results that are worse for reimplantations complicated by fracture as compared to those where there are no complications. The differences in the radiographic results instead do not reveal statistical significance.

Aged↗