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Biomedical subjects

L L Tosi

Publications and source records attributed to L L Tosi.

13 recordsLinked to original sources
PubMed2000

Women and the orthopaedic surgeon. Changing the relationship.

Women are disproportionately disabled by musculoskeletal conditions. For biologic and lifestyle reasons, musculoskeletal health is one of the areas of medicine in which the differences between men and women are most marked. Thus, an approach tailored to women, not just an approach based on what has worked for men, often is needed. How orthopaedists treat women will become an even more pressing issue in the years ahead. Demographic trends predict that the majority of senior citizens will be women in whom chronic conditions frequently involve a musculoskeletal problem. Even at earlier ages, women will present more frequently with musculoskeletal conditions because they participate in a broader range of sports and careers. The current study presents a lengthy list of action items that the orthopaedic surgeon should consider as he or she approaches the treatment of women. Many of these items involve anticipating musculoskeletal problems, and convincing patients to take appropriate preventive steps. Because so many patients are treated by physicians who are not orthopaedists for their musculoskeletal problems, a successful preventive approach presents orthopaedists with the opportunity to win the confidence and respect of a new generation of patients.

Adolescent↗
PubMed1998

Ensuring the success of women in academic orthopaedics.

In spring of 1995, the Academic Orthopaedic Society convened a panel of 21 female academic orthopaedists and 24 senior members of the society to discuss the challenges facing female orthopaedic residents and women in academic orthopaedics. Participants began by reviewing results of a 200 item mail survey of fulltime and parttime female academic orthopaedic surgeons. The survey had been conducted in early 1995. Using the Delphi technique, the panelists identified challenges facing women and ranked them in priority order. Although the challenges identified by survey respondents and panelists were similar, the priority assigned to them varied. Panel and survey findings pointed to a need for action in six areas: increasing mentoring; overcoming gender bias; reducing women's social and professional isolation; increasing attention to promotion and salary equity; providing greater accommodation for family responsibilities; and expanding recruitment efforts. This paper suggests actions that department chairpersons and the Academic Orthopaedic Society may take to attract more women to academic orthopaedics. Because many of the issues emerging from the survey and panel were not gender specific, implementation of the recommendations may benefit male and female orthopaedic residents and academic surgeons in general.

Career Choice↗
PubMed1997

Proposed curriculum model for resident education in pediatric orthopaedic surgery.

A curriculum developed for pediatric orthopaedic residency training is described. The curriculum is practice based, emphasizing those components thought to be necessary for orthopaedic practice. Highly technical or esoteric topics are deemphasized, because they are not relevant to practice capabilities at the end of residency training. The curriculum is designed to serve as a guide for educational direction in pediatric orthopaedic residency training, and not as a description of competency. Resource materials are being developed to provide the educator with relevant clinical material, objectives, and bibliography. The advantages of a practice based curriculum warrant further development of this model for other orthopaedic subspecialties.

Clinical Competence↗
PubMed1997

Osteogenesis imperfecta.

In the past 20 years, tremendous strides have been made in our understanding of the biochemical and genetic abnormalities associated with osteogenesis imperfecta (OI). Prenatal diagnostic techniques have allowed early detection of this disorder, particularly in families in which the actual molecular defect is already known. Although medical and surgical management of patients with OI continue to improve, the proper management of such problems as basilar impression still need to be determined. Progress in the treatment of OI at a molecular level is encouraging.

Bone Density↗
PubMed1996

Dislocation of hip in myelomeningocele. The McKay hip stabilization.

We reviewed the clinical and radiographic results of varus osteotomy of the proximal aspect of the femur and transfer of the adductor and external oblique muscles (the McKay procedure) in thirty-four children (sixty-six hips) who had an unstable hip secondary to a myelomeningocele at the middle or caudad lumbar level. the average age at the time of the operation was twenty months (range, seven to forty-two months). The average duration of follow-up was 10.9 years (range, 0.7 to 20.0 years). An open reduction was performed in ten hips. None of the children had had any previous operative treatment. The index operation helped to maintain the stability of thirty-seven of the fifty-one hips twenty-six children who remained neurologically stable: seventeen of nineteen hips that were at risk, two of three hips with acetabular dysplasia, fifteen of sixteen subluxated hips, one of three dislocated hips that had been previously reduced with a Pavlik harness, one of two dislocatable hips, and one of seven previously untreated dislocated hips. The index operation was not successful for one dislocated hip that had been treated with closed reduction and application of a spica cast. The operation was a success for eight of the fifteen hips in eight children who had a progressive loss of neurological function: three of five hips that were at risk, one hip with acetabular dysplasia, two of four subluxated hips, one of two that had been previously reduced with a Pavlik harness, and one dislocatable hip. Two dislocated hips redislocated. Initially the index operation was performed on all children who had a myelomeningocele at the third or fourth lumbar level. Recent data have shown that the hips in these children are not all at risk, and we now perform the operation only if there is documented instability of the hip.

Child, Preschool↗
PubMed1994

Percutaneous intramedullary fixation of long bone deformity in severe osteogenesis imperfecta.

Reported here are seven patients who had severe osteogenesis imperfecta, and who were extremely fragile, with three having cardiac disease. Their age ranged between 8 and 35 months. All seven patients had unbraceable deformities. Twenty five long bones, including 14 tibiae, 10 femora, and 1 ulna underwent percutaneous intramedullary fixation. Four patients had all four lower extremity long bones operated on simultaneously. Followup was 2 to 11 years. There were no neurologic or vascular complications, compartment syndromes, growth plate problems, or transfusion requirements. All bones healed. One patient had migration of a femoral pin into the knee joint. After bracing, all patients were able to sit; five were able to stand and eventually walk. All living patients were able to be sustained until successful definitive long bone fixation could be accomplished, approximately 2 years or longer after this initial procedure. With this safe, reproducible method, early stable fixation can be provided to patients too young and/or too sick for definitive or extensive open surgery. Future treatment regimens are not compromised.

Activities of Daily Living↗
PubMed1987

When does mass screening for open neural tube defects in low-risk pregnancies result in cost savings?

Using a decision analysis model, we estimated the savings that might be derived from a mass prenatal screening program aimed at detecting open neural tube defects (NTDs) in low-risk pregnancies. Our baseline analysis showed that screening v. no screening could be expected to save approximately $8 per pregnancy given a cost of $7.50 for the maternal serum alpha-feto-protein (MSAFP) test and a cost of $42,507 for hospital and rehabilitation services for the first 10 years of life for a child with spina bifida. When a more liberal estimate of the costs of caring for such a child was used, the savings with the screening program were more substantial. We performed extensive sensitivity analyses, which showed that the savings were somewhat sensitive to the cost of the MSAFP test and highly sensitive to the specificity (but not the sensitivity) of the test. A screening program for NTDs in low-risk pregnancies may result in substantial savings in direct health care costs if the screening protocol is followed rigorously and efficiently.

Computer Simulation↗
PubMedDate not supplied

Ligamentous instability of the knee in children sustaining fractures of the femur: a prospective study with knee examination under anesthesia.

Fifty-five children with 55 fractures of the femur were prospectively studied for the presence of ligamentous instability of the knee within 3 weeks from the time of injury. Two patients (4%) demonstrated instability on examination under anesthesia. A 9-year, 4-month-old boy sustained a second-degree injury to the lateral collateral ligament that healed after hip spica cast treatment. The other patient, a 12-year, 8-month-old boy, sustained an avulsion fracture of the posterior cruciate ligament from the tibial insertion with > 1 cm posterior displacement of the tibia on the posterior drawer test. After placement of an intramedullary rod, the avulsion fracture was treated with open reduction and internal fixation. Although the incidence of ligamentous instability of the knee in this study is less than that reported for adults with femur fractures, children should nevertheless have a thorough knee examination for ligamentous stability as well as radiographic evaluation of the knee.

Adolescent↗
PubMedDate not supplied

Latex allergy in spina bifida patients: prevalence and surgical implications.

We interviewed 93 consecutive children with spina bifida who were scheduled for operation to document (a) the prevalence of latex sensitivity, (b) predictors of anaphylactic reaction, and (c) the risk of type I hypersensitivity reaction perioperatively. Of these patients, 9.7% were clinically allergic. Radioallergosorbent testing (RAST) was 89% sensitive. All patients with known latex allergy were premedicated, and rigorous efforts were made to avoid latex exposure. No intraoperative anaphylactic reactions were noted. One postoperative reaction occurred in a history-positive, RAST-negative patient. We conclude that operation can be performed safely in patients with latex allergy.

Adolescent↗