[Psychiatric aspects of infantile epilepsy and their relations with anomalies of behavior of the character type].
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Adolescent↗
Biomedical subjects
D Ferrari
Publications and source records attributed to D Ferrari.
Endoplasmic reticulum, Bcl-2 and Ca2+ handling in apoptosis.
In the complex signalling interplay that allows extracellular signals to be decoded into activation of apoptotic cell death, Ca(2+) plays a significant role. This is supported not only by evidence linking alterations in Ca(2+) homeostasis to the triggering of apoptotic (and in some cases necrotic) cell death, but also by recent data indicating that a key anti-apoptotic protein, Bcl-2, has a direct effect on ER Ca(2+) handling. We will briefly summarise the first aspect, and describe in more detail these new data, demonstrating that (i) Bcl-2 reduces the state of filling of the ER Ca(2+) store and (ii) this Ca(2+) signalling alteration renders the cells less sensitive to apoptotic stimuli. Overall, these results suggest that calcium homeostasis may represent a pharmacological target in the fundamental pathological process of apoptosis.
Animals↗
High-dose-rate brachytherapy at 14 Gy per hour to point A: preliminary results of a prospectively designed schedule for cancer of the cervix based on the linear-quadratic model.
The objective of this study was to describe the results and complications of a prospectively designed high-dose-rate (HDR) brachytherapy schedule for early-stage cancer of the cervix, at 14 Gy/h to point A, based on the linear-quadratic model and our clinical experience. We used a combination of brachytherapy and external beam pelvic and parametrial irradiation in 88 consecutively seen patients with stage IB1-IIB treated by irradiation alone (1995-1998). The modeled HDR schedule consisted of three insertions on three treatment days separated by 10 days, with six 7 Gy planned brachytherapy fractions to point A, at 14 Gy/h, two on each treatment day with an interfraction interval of 6 h, plus an 18 Gy external whole-pelvic dose followed by additional parametrial irradiation. The calculated biologically effective dose (BED) was 92 Gy10 for tumor and 110 Gy3 for the rectum, equivalent to 77 and 66 Gy in 2 Gy fractions, respectively. The median overall treatment time was 41 days. The actuarial 4-year central recurrence-free rate, pelvic control, and disease-free survival rate were 97%, 93%, and 88% for stages IB-IIA and 79%, 75%, and 75% for stage IIB. The actuarial 4-year late complication rate for grades 2-3 was 4.7% (scale 0-3). We conclude that preliminary results of this HDR brachytherapy schedule for early-stage disease at a median follow-up of 52 months are as effective as the previously used low dose rate (LDR) at 0.44 Gy/h at point A. They are also as effective as medium-dose-rate schedules (MDR) at 1.6-1.5 Gy/h at this institution and do not require a further increase in fractionation of intracavitary treatments or in the whole-pelvic external beam irradiation dose common to standard HDR schedules. In addition, more patients per machine can be treated per day compared with MDR. Longer follow-up is required for a complete assessment of late complications.
Adenocarcinoma↗
Corrective osteotomy for the treatment of genu procurvatun. Surgery.
The authors present the method known as proximal tibial osteotomy for the treatment of genu procurvatum. The importance of an accurate preoperative study, particularly aimed at avoiding negative repercussions on the position of the patella, and of a correct anatomical exposure with isolation of the peroneal nerve for any iatrogenic lesions, must be emphasized; a condylic plate was used to stabilize osteotomy was stabilized, adapting well to the anatomy of the region, and allowing us to obtain correction of any associated deformities on the frontal plane.
Adolescent↗
Supracondylar fracture of the femur following total knee arthroplasty. Description of two clinical cases.
The authors describe two cases of supracondylar fracture of the femur occurring following total knee arthroplasty. By reviewing the literature, they analyze causal factors indicating the constant presence, observed also in the cases presented, of an erroneous resection of the anterior cortex of the femur. In association with other predisposing factors, this condition favors an anomalous distribution of the load forces in this site, reducing torsion resistance of the femur by about 30%: what results is greater susceptibility for the risk of fracture for a long period of time, even for trauma of moderate entity.
Adult↗
Osteoid osteoma: diagnostic problems in joint and periarticular localizations.
The diagnosis of osteoid osteoma is usually not difficult. In typical forms of the disease, with diaphyseal localization, the clinical course and radiographic findings are so typical that diagnosis may be considered certain even when there is no histological confirmation. In some localizations, nonetheless, such as in the cancellous or short bones, or when the lesion involves a joint, diagnosis may be difficult, uncertain and late. Between January 1991 and April 1997 a total of 91 patients who had been diagnosed as having osteoid osteoma were submitted to computed tomography. Of these patients, there were 34 females, and 57 males, and age ranged from a minimum of 2 to a maximum of 69 years. Localizations are reported in Table I. For the purposes of our study, several cases with atypical features have been selected from these. We found it interesting to emphasize the importance of a correct diagnostic procedure with the purpose of accurately identifying the lesion.
Adolescent↗
The treatment of post-traumatic stiffness of the elbow.
The authors present the results observed in 12 patients affected with post-traumatic stiffness of the elbow treated by an external fixator in distraction to obtain functional recovery of range of movement; in all of the cases anterior and posterior release and resection of the apex of the olecranon was carried out, while in 2 cases interposition arthroplasty with freeze-dried dura madre was associated. The series includes 12 cases with a long-term follow-up that ranges from 8 to 33 months after surgery. The mean arch of movement during the preoperative phase was 35 degrees (minimum 0 degree-maximum 90 degrees) in flexion extension and 80 degrees (minimum 0 degree-maximum 150 degrees) in pronosupination. Recovery of mean joint excursion in flexion-extension was 91 degrees and in pronosupination it was 127 degrees. Complications included loosening of the nails in 2 cases, breakage of the nails in 1 case, and transitory deficit of the ulnar nerve in 4 cases. A total of 11 patients (91.66%) declared that they were satisfied with the considerable improvement in their ability to do daily activities. The results of arthroplasty in distraction in the elbow are satisfactory even if much attention must be paid to the selection of the patients because of the intense collaboration that is required during postoperative rehabilitation.
Adolescent↗
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↗
[The determination of serum amino-terminal procollagen type-III propeptide (PIIINP) in occupational exposure to rock wool fiber].
Fifty-six males workers exposed to rock wool during production, and 20 referents were examined. Exposure, evaluated by personal sampling, ranged from 0.05 to 0.74 fibres/ml (median 0.15). The subjects underwent a medical examination, chest X-ray according to ILO recommendations and pulmonary function tests. In all subjects the serum levels of type III procollagen N-terminal propeptide (PIIINPs) were determined. No evidence of pulmonary fibrosis, nor work-related lung diseases were observed. PIIINPs mean values in the exposed (9.8 ng/ml; 2.8 S.D.) were slightly higher, but not significantly different when compared to referents (8.5 ng/ml; 2.5 S.D.). No significant correlation between PIIINPs and rock wool exposure (both airborne levels and exposure duration) was observed. Furthermore, peptide levels were not related to pulmonary function test results. Our results suggest that occupational exposure to rock wool fibres lower than 0.75 fibres/ml for less than 20 years does not induce definite cases of pulmonary fibrosis nor an increase of type III collagen synthesis in the lung.
Air Pollutants, Occupational↗
[Ablative cesarean section and post-partum hysterectomy: review of 11 years of obstetric practice].
Obstetric hysterectomy is often performed as an emergency life-saving procedure. This retrospective report reviews the 11 years experience (1-1 1980 through 31-12-1990) at Mangiagalli Hospital, Milan. During this time 50 obstetric hysterectomies (incidence rate = 0.12%) were performed; cesarean hysterectomies were 30 (60%), hysterectomies after cesarean section 14 (28%) and after vaginal delivery 6 (12%). Its rate during or after cesarean section was 0.44% and after vaginal delivery was 0.02%. Thirty-six per cent of patients were nulliparous. Main indications were placental disorders, uterine atony with uncontrollable bleeding, disseminated intravascular coagulation (DIC). In 7 cases was performed an elective operation, in 4 cases for neoplasia and in 3 cases for myomata uteri. Maternal mortality rate was 2.04%, five patients (10%) developed hematomas and required further interventions.
Adult↗
[Determination of blood procollagen III peptide as an early indicator of pulmonary fibrosis in exposure to asbestos].
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Adult↗
[Juvenile neurosis and its bio-electric aspects].
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Adolescent↗
[Evaluation of professional student nurses].
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Clinical Competence↗
Lateral retrovascular approach to the upper cervical spine.
The authors describe the surgical anatomy of lateral approach to the upper cervical spine. The approach is retrovascular retropharyngeal extraoral allowing for anterolateral exposure of the upper cervical column, and it may be enlarged posteriorly on the homolateral posterior hemiarch of C1 and C2, and/or inferiorly on the lower cervical column. Absolute indications to this approach are anterolateral fusion with transarticular screws C1-C2 and excision of skeletal neoplasms adjacent to the vertebral artery. For other indications such as the treatment of anterior neoplasms and spinal cord decompression it is preferable to use pre-vascular extraoral approach or transoral approach.
Adolescent↗
Spondylometaphyseal dysplasia: description of a case.
The authors describe a case of a boy aged 15 who came to their observation for severe valgus of the knee, limping, and deficit in stature. The evaluation carried out led to a diagnosis of Kozlowski-type spondylometaphyseal dysplasia.
Adolescent↗
Caso quiz. Osteoma of the proximal femur.
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Adult↗
Failed back syndrome: a study on 95 patients submitted to reintervention after lumbar nerve root decompression for the treatment of spondylotic lesions.
The persistence of lumbar and nerve root pain after nerve root decompression surgery may be attributed to one of five causes; 1) progression of the spondylotic disease in the presence of peridural fibrosis; 2) recurrence of disc herniation or new hernia; 3) stenosis of the spinal or nerve root canal; 4) arachnoiditis; 5) vertebral instability. In most patients with peridural fibrosis and worsening of spondylotic lesions regression of nerve root symptoms was obtained after several months of conservative treatment, which continues to constitute essential treatment for most patients with recurrence of lumbar symptoms. The authors report the results obtained with the surgical treatment of 95 patients performed between 1981 and 1991 and divided into the categories listed above. Of these patients, 70 were submitted to further decompression surgery while 25 were submitted to posterolateral vertebral fusion. Reintervention obtained useful results in 83% of the cases where there had been recurrence of disc herniation; nerve root release obtained positive results in 100% of the cases where there was stenosis. Results obtained after wide decompression were poor in all of the cases with arachnoiditis; in these patients conservative treatment with T.E.N.S. can obtain a fair amount of control over pain. Positive results were obtained in 84% of the 25 patients submitted to posterolateral fusion for the treatment of vertebral instability, with fusion obtained in 96% of the cases. Surgical treatment is indicated for psychotic, neurotic patients or those with insurance-related motivations only when the organic cause of the symptoms is clearly evident.
Adolescent↗