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Biomedical subjects

C Silvestro

Publications and source records attributed to C Silvestro.

At least 19 recordsLinked to original sources
PubMed2001

Delayed effects of a migrated foreign body (sewing needle) in the cervical spine: a case report.

STUDY DESIGN: A case report is presented. OBJECTIVE: This report documents one case of intraspinal migration of a metal foreign body. SUMMARY OF BACKGROUND DATA: The migration and penetration of foreign bodies into the spine have been described, but there are only three reports of a needle as the causative object. METHODS: This case report included a chart review, an examination of the patient, and a literature search. RESULTS: The patient successfully underwent surgery, in which the foreign body (a sewing needle) was removed. CONCLUSION: It is important to be aware of the possible delayed penetration of a foreign body into the spine even in patients with few or no symptoms.

Adult↗
PubMed2000

An evaluation of nurse rostering practices in the National Health Service.

An evaluation of nurse rostering practices in the National Health Service The scheduling of nursing time on hospital wards is critical to the delivery of patient care, resource utilization and employee satisfaction. Over the past decade many hospital wards in the United Kingdom (UK) have moved away from the traditional planning of rosters by a single manager, towards more participative processes known as self-rostering and team rostering. This paper tests the hypothesis, developed from the literature, that the three types of rostering approach may be positioned along a continuum. Self-rostering at one extreme, is conducive to staff empowerment, motivation and roster effectiveness, whilst departmental rostering, at the other, leads to perceived autocracy, reduced empowerment, lower levels of staff motivation and roster effectiveness. Team rostering is positioned mid-way on this continuum. This paper reports the findings of an empirical study of nurse rostering practices in the UK National Health Service (NHS), with a view to developing an understanding of the implications of implementing these three rostering approaches and testing the above hypothesis. The survey of rostering practices in 50 NHS wards, and in-depth case studies of seven wards, revealed that each of the three rostering approaches has benefits and limitations and a picture emerges quite different from that implied by the research hypothesis. Whilst the literature suggests that the choice of rostering approach determines the level of perceived autocracy, staff motivation and roster effectiveness, it is proposed in this paper that selection of rostering approach should be contingent upon operational context. The paper concludes with a framework which stipulates that the choice of rostering approach for a ward should be determined on the basis of four contingent variables, namely, ward size, demand variability, demand predictability, and complexity of skill mix. It is recommended that departmental rostering be applied in large wards with complex rostering problems, whilst team rostering is more appropriate for medium sized wards, and self-rostering appropriate for small wards.

Decision Making, Organizational↗
PubMed1994

Can lacerations of the thoraco-lumbar dura be predicted on the basis of radiological patterns of the spinal fractures?

Encroachment upon the spinal canal, separation of the pedicles, associated fractures of the laminae are assumed to be related to dural lacerations consequent to burst fractures of the thoracolumbar spine. Owing to the possible occurrence of early or delayed complications of meningeal discontinuations, the predictive value of these signs has been analyzed in a consecutive series of 50 patients, who were submitted to surgery. Dural tears were found to occur at a rate of 60%, without any statistically significant relation with any of the examined signs. The results were not consistent with the thesis that lacerations of the dura can be predicted on the basis of radiological signs.

Dura Mater↗
PubMed1994

Delayed worsening of the surgical correction of angular and axial deformity consequent to burst fractures of the thoracolumbar or lumbar spine.

Forty-one patients with burst fractures of the thoracolumbar junction, or the lumbar spine (T12 to L5), were followed for 6-48 months (mean follow-up = 19.9 months) after early surgery (usually within 24 hours). Preoperative, early postoperative, and late postoperative degrees of kyphosis, as well as percent reduction of the height of the vertebral body were calculated and compared. Early postoperative radiologic evaluations showed a statistically significant difference (p < 0.0001) between the mean values of both parameters calculated respectively before and after surgery. The decrease of the surgical correction, from the initial postoperative radiographs to follow-up, was statistically significant (p < 0.0001). However, the final values were better when compared with the preoperative features (p < 0.003 and p < 0.0001, respectively for degree of kyphosis and reduction in vertebral height.

Adolescent↗
PubMed1994

Spinal cord stimulation for the treatment of progressive systemic sclerosis and Raynaud's syndrome.

Progressive Systemic Scleroderma (PSS) is a generalized disease of connective tissue involving the skin, as well as other internal organs. The cutaneous signs are characterized by a progressive sclerosis and loss of function or dexterity in the hands. Between 1987 and 1992, 15 patients affected by scleroderma were treated by means of spinal cord stimulation (SCS) in order to reduce signs and symptoms related to vascular damage. The follow-up ranged from 12 months to 6 years. The study confirms that SCS is an effective therapy in patients with PSS and Raynaud's phenomenon because of its beneficial effects on the Raynaud episodes, ulcers, pain, vascular sclerosis and hand function. This method may have a primary role in the treatment of this chronic disorder because of the high probability of failure of other medical or surgical therapy.

Adult↗
PubMed1993

Giant fusiform aneurysm in middle cerebral artery branches: a report of two cases and a review of the literature.

Giant fusiform aneurysm (2.5 cm in length or more) is an unusual pathological entity typically described involving the main trunks of cerebral arteries and, rarely, cerebral artery branches. We are presenting two cases of middle cerebral artery branch giant fusiform aneurysm, one surgically and the other conservatively treated. We were unable to find in the literature reports of similar aneurysms at the same location. Clinical and pathological aspects, radiological findings, and treatment are discussed.

Cerebral Angiography↗
PubMed1993

Transpedicular decompression and stabilization of burst fractures of the lumbar spine.

Twenty-seven consecutive patients with neurological impairment due to burst fractures of the lumbar spine were operated upon, via the postero-lateral route, over a 38-month-period. Transpedicular fixation devices [posterior segmental fixator (PSF) or variable screw placement system (VSP)] were applied in all cases, in order to achieve short-segment fusion of the fractured spinal segment. Return to useful motor power or neurological normality (median follow-up: 18.7 months) occurred in 22 cases (81% of the whole series), with this outcome resulting in all but one of the cases with preoperative incomplete neurological deficit. Postoperative encroachment of the spinal canal, degree of kyphotic deformity, and reduction of the vertebral height showed statistically significant differences compared with the corresponding preoperative values.

Adolescent↗
PubMed1992

Near-anatomical reduction and stabilization of burst fractures of the lower thoracic or lumbar spine.

Thirty-one consecutive symptomatic patients with burst fractures of the lower thoracic or lumbar spine (T 11-L4) were treated by early surgery in a 36-month period, with near-anatomical reduction being achieved via the postero-lateral route. Fusion and reconstruction of the vertebral body was done by using autologous or processed bovine bone. Correction of the kyphotic deformity was obtained by using distraction rods or transpedicular devices. The post-operative mean degree of kyphosis, percent vertebral height, and percent canal stenosis showed statistically significant differences, compared with the corresponding pre-operative mean values. All but one of the 25 patients with incomplete paraplegia exhibited neurological improvement, with complete recovery occurring in 20 cases (median follow-up: 16 months) irrespective of the location of the lesion at the thoraco-lumbar junction (T 11-L1) or the lower lumbar segment (L2-L4). Out of the 6 patients with pre-operative complete paraplegia, useful motor power returned in one case with a lesion below L1. The results confirm the suitability of the postero-lateral route and are consistent with the assumption that early near-anatomical reduction and stabilization favours maximum neurological recovery in symptomatic patients.

Adolescent↗
PubMed1991

Spinal subarachnoid hematoma of unknown etiology. A case report.

A case of spinal subarachnoid hematoma at T3-T7 level is reported in a 60-year-old hunter, who developed progressive spinal cord impairment after receiving the recoil of his shotgun. Both clinical and neuroradiological investigations, including the selective spinal angiography, failed to demonstrate the origin of the bleeding. The combination of an apparently trivial spinal trauma with temporary increase of the intrathoracic pressure might be considered as possible etiologic factor.

Diagnosis, Differential↗
PubMed1991

Metoclopramide increases plasma but not cerebrospinal fluid vasopressin levels in man: study in hydrocephalic patients.

Arginine vasopressin (AVP) concentrations were determined in plasma and in cerebrospinal fluid (CSF) in 8 adult male patients suffering from hydrocephalus of various etiologies, before and after intravenous administration of 10 mg metoclopramide. Metoclopramide was able to increase the plasma (2.6 +/- 0.2 ng/l in basal conditions and 6.1 +/- 0.6 ng/l at 30 min) but not the CSF AVP levels. The results suggest that the neurons which secrete AVP into the CSF may be functionally different from those secreting into the peripheral circulation.

Adult↗
PubMed1991

On the predictive value of radiological signs for the presence of dural lacerations related to fractures of the lower thoracic or lumbar spine.

The predictive value of radiological signs for the presence of lacerations of the thoracolumbar dura in spine-injured patients could represent an important adjunct to the rationale for the optimal management, owing to the possible onset of early or delayed complications of these lesions. Occurrence of signs assumed to be related to dural tears, such as separation of the pedicles, fractures of the laminae, and encroachment of the spinal canal, was analyzed in a consecutive series of 25 patients submitted to surgical reduction and stabilization of the fractured lower thoracic or lumbar spine in a 24-month period. No statistically significant correlation was found between dural lacerations and any of the examined signs. Leaks of cerebrospinal fluid through traumatic breachs of the meninges were found in 16 of the 25 cases. The high rate of occurrence of dural lesions associated with fractures of the lower thoracic or lumbar spine adds a further argument to the aggressive approach to these injuries.

Adolescent↗
PubMed1990

Subarachnoid buprenorphine administered by implantable micropumps.

This report concerns 23 patients, the majority of whom are suffering from low back and chest pain caused by chest, urological or gynaecological cancer. These patients were treated with subarachnoid buprenorphine, administered in a single bolus or by slow infusion from micropumps, at a daily dose adapted to patients need (0.06-0.15 mg). The painful symptomatology was successfully controlled in all the cases treated, allowing the patients to live a virtually normal life. In no cases was respiratory depression or tolerance observed.

Adult↗
PubMed1987

Calcification and ossification of the spinal arachnoid after intrathecal administration of Depo-Medrol.

A woman 38-year-old, suffering for about ten years from multiple sclerosis and treated with repeated therapy cycles of intrathecal Depo-Medrol, developed a spastic paraparesis at the lower limbs. A lumbar myelography was carried out, and a dorsal block was demonstrated. The patient underwent a dorsal laminectomy, and arachnoidal calcification and ossification was find, but the removal of the bone plaques was ineffectual in order to the subsequent course of the neurological troubles. The results of the histological study and chemical tests are reported, and the etiology and the pathogenesis are discussed on the basis of the pertinent literature.

Adult↗
PubMed1985

Hematomyelia during anticoagulant therapy.

An unusual case of hematomyelia during anticoagulant therapy is reported in a patient after cardiac surgery. A review of the pertinent literature is presented. After medical and surgical treatment, the transverse symptoms largely subsided with rehabilitation of the patient.

Hemorrhage↗
PubMed1983

Correlates of adaptation to the sleep laboratory. Behavior, sleep organization, quantitative EEG.

The present study aims at establishing to what extent adaptation phenomena should be taken into consideration for the definition of an independent baseline in sleep research. To this purpose we have studied: (1) a standard battery of neuropsychological test evaluating performance, subjective assessments of moods and sleep quality; (2) classical sleep parameters; (3) data derived from quantitative analysis of sleep EEG. 19 young male volunteers have been recorded for consecutive nights; 7 of them underwent the recordings for 3, 8 for 6 and 4 for 10 nights. Results can be summarized as follows: (A) both interindividual and intraindividual variability show a progressively decreasing trend toward homogeneity for most of the explored parameters; (B) steady state is reached in different times for different groups of parameters; (C) an adequate group homogeneity was achieved from the 5th night onwards. Implications of these data in sleep studies, namely in sleep active drug research are discussed.

Adaptation, Psychological↗