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Biomedical subjects

D Donati

Publications and source records attributed to D Donati.

180 records · Page 10Linked to original sources
PubMedDate not supplied

Vertebral histiocytosis.

Thirty-five cases of vertebral histiocytosis are examined for a total of 52 vertebrae affected. The study is conducted on the radiographic picture at the onset and at long-term follow-up in 32 cases (24-223 months, average 45). Diagnosis may be based on radiology only in typical cases, otherwise there may be errors in differential diagnosis with malignant neoplastic lesions. Radiotherapy does not seem to influence the volumetric reconstruction of the vertebral body, which is inversely proportional to age. In those cases submitted to chemotherapy, the morphological results, in the absence of other types of local treatment, are often excellent. Orthesic or surgical treatment must be chosen based on the extent of the lesion and on its ability to progress; CT scan may be useful to this purpose, but initial orientation may be suggested by multiple adjacent lesions or by radiographic images such as osteolysis of the pedicles.

Adolescent↗
PubMedDate not supplied

The use of xenograft in young patients treated with Pemberton-Zanoli osteotomy.

Records and x-ray films of a group of 150 patients submitted to 193 operations involving Pemberton-Zanoli acetabulum osteotomy were reviewed. Follow-up ranged from 5 to 131 months (mean 57 months). In all of the cases cortico-cancellous calf rib grafts were used. In consideration of the special kind of operation performed, the authors observed valuable results due to the good mechanical and biological features of the graft. The most important feature of the method was the immediate stability of the press-fit graft, allowing for prompt rehabilitation and function.

Acetabulum↗
PubMedDate not supplied

A histomorphologic study of explants of massive allografts: preliminary results.

The authors report their experience in the histologic study of massive allografts, explanted as a result of oncological, mechanical or biological complications. The study was conducted according to the method of inclusion in methyl methacrylate that does not involve decalcification. A description is provided of all of the phases of fusion between graft and host bone in the site of the osteotomies, as well as distribution of revascularization and rehabilitation of the graft, attachment of the soft tissues, and finally, modifications in the joint cartilage of the osteoarticular grafts. The allograft must be considered to be osteoconductive, and is only weakly osteoinductive. Incorporation of the graft is a slow and incomplete process that follows sequential phases. The Volkmann's canals in the osteotomies constitute the preferred paths for rehabilitation of the graft that is on the order of millimeters on the surface and centimeters in the site of the osteotomies. The greatest modifications have been observed in the joint cartilage. The cartilaginous cells appear to be vital only from a morphological point of view.

Adolescent↗
PubMedDate not supplied

Arthrodesis of the knee after tumor resection: a comparison between autografts and allografts.

Cases of arthrodesis of the knee performed after bone tumor resection using autografts (Group I) and allografts (Group II) were compared (follow-up was comparable). The two groups show differences in type of pathology, treatment and length of resection. Nonetheless, the percentage of complications and the final results were similar. Despite the fact that arthrodesis of the knee is used less and less for reconstruction, it is our belief that the use of autografts should be substituted by allografts whenever possible.

Adolescent↗
PubMedDate not supplied

The use of massive bone allografts for intercalary reconstruction and arthrodeses after tumor resection. A multicentric European study.

A multicentric study was conducted by the European Musculoskeletal Oncology Society on 113 cases of resection for tumors of the major long bones and reconstruction with massive allografts, as intercalary diaphyseal or for arthrodesis. The follow-up was at least 12 months. There was a 14% incidence of infection, with a higher frequency (18.5%) in intercalary grafts as compared to arthrodeses (7%). Fracture of the graft occurred in 15.5% of the cases with a prevalence in the humerus (28.5%) as compared to the tibia (21.4%) and femur (14.7%). Fracture constantly occurred after osteosynthesis with screws, in 16% of the cases after osteosynthesis with a plate, and in 12.5% of the cases after osteosynthesis with an intramedullary nail. It was observed in 32% of the grafts preserved at -30 degrees, in 17% of those irradiated, and in 7% and 7.6% of those preserved at -180 degrees and -80 degrees, respectively. Delayed union and non-union was observed in 57% of the cases: 63% in intercalary grafts, 48% in arthrodeses. Final results after treatment of complications were excellent and good in 63% of the entire series. The results should, however, be evaluated after 3 years, as during this period of time important transformation phenomena of the graft occur. Complications are observed in 75% of the cases, but they may be reduced if planning is correct and surgery is accurate. Each complication may be dealt with and resolved without high risks for preservation of the limb.

Adolescent↗
PubMedDate not supplied

Reconstruction by Grosse-Kempf nailing in resections for bone tumor.

The authors report 38 reconstruction by Grosse-Kempf nailing for resection of bone tumor; there were: intercalar resections: 16; arthrodeses of the knee: 13; arthrodesis of the ankle joint: 5; gyroplasty: 4. Massive homoplastic bone graft was used in 26 cases, in 3 of which autoplastic grafting was associated; autoplastic grafts were used exclusively in 7 cases, and a cement spacer was used in 1. Twenty-nine patients (76%) obtained satisfactory final results, but in 10 cases secondary surgery was performed for a total of 14 operations, of which 7 major (1 nail substitution and 6 vascularized fibula operations). There were 7 failures: mechanical complications: 6; infection: 1. The highest number of non-unions were observed where massive homoplastic grafting was used: intercalar reconstruction: 11; arthrodesis of the knee: 7. The results were evidently better and the incidence of complications low in cases in which autoplastic grafting was used or where gyroplasty was performed. Absolute stiffness and best possible contact are difficult to obtain with blocked intramedullary nailing. On the contrary, when autoplastic grafts are used or when gyroplasty is performed micromovements allowed the instrumentation are compatible with good consolidation.

Adolescent↗
PubMedDate not supplied

The effect of intra-arterial versus intravenous cisplatinum in the neoadjuvant treatment of osteosarcoma of the limbs: the experience at the Rizzoli Institute.

The effect of intra-arterial versus intravenous infusion of cisplatinum on the histological response of osteosarcoma of the limbs was evaluated based on the results of three studies in which CDP was preoperatively associated with MTX and ADM (1st study), and with MTX, ADM, and IFO (2nd and 3rd studies). In the chemotherapeutic protocol that involved 3 drugs the percentage of "good histological responses to chemotherapy" (defined as tumor necrosis > 90%) was significantly higher in the 40 patients who were administered CDP by intra-arterial infusion as compared to that observed in the 39 patients treated with CDP by intravenous route (78% versus 46%: P .004). In the two sequential studies where 4 drugs were used, the percentage of good histological responses was essentially the same for patients treated with CDP administered intravenously, and for those treated with CDP administered intra-arterially (78% versus 84%). Regardless of the route of infusion used to administer cisplatinum the percentage of "good" histological responses was significantly higher in the 109 patients treated with the 4-drug protocol as compared to the 79 patients treated with the 3-drug protocol (82% vs 62%; P .04). This difference may essentially be attributed to the higher percentage of good responses observed in the 4-drug protocol in patients treated with CDP administered intravenously (78% vs 46% for patients treated i.v. with the 3-drug protocol; P .006). For the patients instead treated with CDP administered intra-arterially the percentage of good responses was essentially the same with the 4-drug protocol and with the 3-drug protocol (84% vs 78%; P ns). These data lead us to conclude that in the neoadjuvant treatment of osteosarcoma of the limbs a preoperative 4-drug protocol (MTX, CDP, ADM, IFO) is more effective than a 3-drug protocol (MTX, CDP, ADM), and that in a 4-drug preoperative chemotherapy protocol intra-arterial infusion of CDP does not offer particular advantages as compared to intravenous infusion.

Adolescent↗
PubMedDate not supplied

Clinical evaluation of patients treated by resection of bone tumor in the limbs with reconstruction.

A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal apparatus is presented. A total of 8 parameters from 0 to 5 were graded with points assigned. Each parameter has a number of functional criteria to better assess the result. The highest score allowed is 100. The system was developed to permit a simpler approach for the examiner, with less time needed to provide data, and yielding data that is more objective.

Arm↗
PubMedDate not supplied

[Local recurrence after surgical or surgical-chemotherapeutic treatment of osteosarcoma of the limbs. Incidence, risk factors and prognosis].

METHODS: Local recidivation (incidence, risk factors an prognosis) was analysed retrospectively in 765 patients with non-metastatic osteosarcoma of the extremities treated between 1972 and 1992 either with surgery alone (78 cases) or with surgery and associated adjuvant (258 cases) and neoadjuvant chemotherapy (429 cases). RESULTS: The local recurrence of the disease, which was documented in 26 patients (3.4%), was significantly related to the type of surgery performed (1.1% in 344 amputated patients vs 5.2% in 422 patients treated with resection; p < 0.003) and with surgical margins (0.6% in 700 radical or extensive operations vs 22.7% in 66 marginal or intralesional interventions; p = 0.0001). In patients treated with neoadjuvant chemotherapy, the incidence of local recidivation was also correlated with the type of histological response to chemotherapy (2.9% in 274 cases with a "good" response vs 8.4% in 154 cases with a "poor" response; p < 0.021). In all 26 patients local recidivation was associated with metastases occurring before (16 cases), after (3 cases) or in concomitance (7 cases) with the local recurrence of neoplasia. In spite of treatment performed at the start of recidivation, 25 patients (96.1%) died from the tumour whereas the mortality rate in those patients with metastases but no local recidivation was only 72.1% (261 out of 362 cases). This difference was also statistically significant (p < 0.01). CONCLUSIONS: The results obtained appear to justify the current trend of minimising demolitive surgery in osteosarcoma of the extremities. Surgery should only be performed in these patients by centres able to make an adequate evaluation of surgical margins and the histological response to preoperative chemotherapy. In view of the fatal prognosis linked to recidivation and the high probability of its onset in cases with inadequate surgical margins and a poor response to chemotherapy, the authors propose that subsequent amputation should be performed immediately in those patients undergoing resection who present both these conditions.

Bone Neoplasms↗
PubMedDate not supplied

Analysis of the distribution of human CD38 and of its ligand CD31 in normal tissues.

Human CD38 is a 45 kD ectoenzyme endowed with ADP-ribosyl cyclase and hydrolase activities. The molecule plays a central role in lymphocyte activation, proliferation and selectin-type adhesion with endothelial cells (HEC). A HEC surface molecule displaying all the features of a CD38L has been identified by means of a mAb (Moon-1), able to block CD38-mediated adhesion processes. The 130 kD molecule recognized by Moon-1 is CD31, a member of the Ig superfamily. This paper reports on the analysis of the surface expression of CD38 and CD38L in various human tissues of adult origin and compared in some instances to the fetal (9-14 weeks) counterparts. This was achieved by means of immunohistochemical techniques and analysis of purified cell populations. Among the specimens analyzed, CD38 is expressed by a vast array of cells of lymphatic origin as well as by the skeletal and cardiac muscle fibers, the bronchi (epithelial cells), the parotid gland (ductal epithelial cells) and hepatic sinusoids. On the contrary, CD31 proved constantly expressed by HEC at high levels, independent of the organ or tissue analyzed or of the kind of vessel. Other cells expressing CD38L were found in the lymphoid compartment (follicle mantle B cells and plasma cells), in the lungs (alveolar ducts, alveoli and lymphatic vessels) and in the kidney (glomerular cells). Interestingly, no fetal organ or tissue ever expressed CD38 and its ligand. The above results were enriched by the analysis of the expression of the two molecules on purified populations including mononuclear cells from the lamina propria of the gastro-intestinal tract and broncho-alveolar lavage lymphocytes.

ADP-ribosyl Cyclase↗