Biomedical subjects
Publications and source records attributed to M Salvi.
A new method of treatment of dislocated fractures and apophyseal fractures, using direct traction by pins on the bone fragments, and cast is presented. The authors describe the technique employed and report the results of the 22 cases treated.
This is a retrospective study of 8 cases of instability of the C1-C2 segment caused by R.A. or non-union and treated by posterior stabilization with wire loops and bone grafts. The authors reported good results in patients with mild recent neurological involvement and/or radiographic instability of the segment (posterior subluxation of the dens greater than 1/3 of the A-P diameter of C1 or tilting of the dens greater than 30 degrees). The death of a patient with non-union of the dens and severe neurological involvement due to respiratory palsy leads the authors to regard severe long-term neurological involvement (quadriparesis) a contraindication for this type of procedure.
Fifty-three cases of chronic lesion of the anterior cruciate ligament were followed up clinically and radiographically, and treated consecutively with an artificial Dacron Stryker ligament. An average of 29 months (range 12-53) after surgery, the authors report a high incidence of residual laxity (70.5%) and a 13% incidence of complications. There were no cases of evident synovitis, even if the authors do report a high percentage (85%) of periligamentous femoral osteolysis. Based on the results obtained, the authors believe that the Dacron Stryker ligamentous prosthesis is only indicated in cases where a biological ligament fails in patients engaged in competitive sports who request immediate activity for a limited period of time.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Antibodies which are cytotoxic to human eye muscle cells and orbital fibroblasts in antibody dependent cell-mediated cytotoxicity (ADCC) are routinely detected in the serum of patients with thyroid-associated ophthalmopathy (TAO). In the present study sera from patients with TAO, most of which were shown to be positive in ADCC against eye muscle cell targets, were tested for complement-mediated antibody-dependent cytotoxicity (CMAC) against human and pig eye muscle cells, human (abdominal) skeletal muscle cells and human orbital fibroblasts, in 51Cr release assays. Several different assay protocols and complement sources were used and patient and age, sex matched normal sera compared. In preliminary studies tests were always negative when eye muscle cells, other skeletal muscle cells, or orbital fibroblasts were used as targets, regardless of the complement source, or concentration, or assay conditions used. When larger numbers of patients and normals were tested in a single assay mean (+/- SE) % specific lysis for patients with TAO was not significantly different from that for normals for either eye muscle cells or other skeletal muscle cells and taking the upper limit of normal as mean + 2 SD for the normals, tests were positive in no patient with either target. On the other hand ADCC tests were positive in 57% of the same sera tested with the same eye muscle cell targets. When human thyroid cells were used as targets, tests were positive in 10 of the 14 patients tested and monoclonal antibodies, in enzyme-linked immunosorbent assay, reactive with eye muscle antigens gave positive lysis of eye muscle cells.2+ t
In order to observe ultrastructural changes of the saphenous vein before implantation during coronary artery by-pass surgery, 58 fragments from a series of 29 consecutive patients, were studied by means of scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Two fragments were taken: the first just before the distal anastomosis; the second just before the last anastomosis on the aorta. The vein graft was kept in a finger solution of 10% nitroglycerin. Forced dilatation was avoided. The EM showed areas of early loss of the endothelial layer, not time-related, deposits of fibrin and blood corpuscular elements with muscular contraction in 75% of the examined grafts. From our experience and according to the literature, loss of the endothelial layer, spasm and early platelet and fibrin aggregation, are constant features of the explanted saphenous vein. In clinical practice, we emphasize, in addition to the "no touch technique", the early use of antiplatelet drugs during coronary artery by-pass coronary surgery.
In New Zealand rabbits subjected for a 2 month period to a 1% or 2% hypercholesterolic diet, larger intimal involvement and histologically heavier lesions were observed in the animals on a hypercholesterolic diet. The intimal involvement was larger in the aortic arch. In groups of rabbits simultaneously subjected to similar diets and to i.v. CDP-choline injections, the intimal involvement appeared reduced (p less than 0.01) both in the arch and in the descending tract of the thoracic aorta.
The authors present a cannulated guide with a rounded tip used to insert trans-skeletal wires for external circular fixators. Based on their experience, the authors confirm the effectiveness of the tool particularly in safeguarding vessels and nerves. The instrument is a definite aid to the surgeon, and does not penalize the time required for surgery.
Explore the source record for details and available documents.
The Toupet operation (270 degrees posterior fundoplication) has been performed in 99 patients suffering from symptoms of gastro-oesophageal reflux secondary to a hiatal hernia. To assess the effects of the Toupet antireflux procedure, we performed in 20 cases oesophageal manometry, intraoperatively and gastro-oesophageal scintiscan in the early postoperative period (3 months: 98 cases) and also later (5 years). For us gastro-oesophageal scintiscan is the ideal method of detecting reflux because it is a noninvasive technique as sensitive as the intra-oesophageal pH, is easy to perform and well-tolerated by the patient. Our long-term follow-up, with only 6% of poor results show that the Toupet operation like the Nissen fundoplication is the most effective surgical technique that can be used to correct gastro-oesophageal reflux and has an added advantage: the side effects, particularly the postfundoplication or gas-bloat syndrome are minimal. Additional follow-up after 10 years will be needed to establish the final outcome of the operation.
In the present retrospective study we examine the complications arising from simple goiter operations based on the analysis of 2,035 cases. The mortality rate is extremely low (0.3%). The most typical intraoperative complications - such as unilateral vocal cord paralysis (1.6%) and permanent parathyroprival hypocalcemia (0.4%) were observed to occur much more frequently in cases of subtotal thyroidectomy than in those of partial resection. - As a result of the introduction of synthetic reabsorbent sewing materials, healing problems have been drastically reduced (0.4%). Hypothyreosis and goiter recurrence can be avoided in cases of subtotal thyroidectomy by life-long and individually adjusted administration of thyroid hormones (rate of incidence in our study 3.1%). - In our view a subtotal thyroidectomy is indicate in cases where malignity is suspected (one or more cold nodules).
A 64 kDa protein has been identified in the membrane fraction of human eye muscle, orbital connective tissue and thyroid, by testing sera of patients with thyroid-associated ophthalmopathy in SDS-polyacrylamide gel electrophoresis and Western blotting. Antibodies to this membrane antigen seem characteristic of the early stage of ophthalmopathy. In the thyroid this newly recognized protein seems different from previously known membrane antigens. A thyroid antibody reactive with a 64 kDa membrane antigen in eye muscle could explain the very frequent association of ophthalmopathy with autoimmune thyroid disease.
We have evaluated three regimens for the rapid control (10 days' therapy) of thyrotoxicosis in hyperthyroid Graves' disease: methimazole (MMI, 40 mg/day), MMI and sodium ipodate (MMI + Na Ipodate, 1 g/day and MMI and saturated solution of potassium iodide (MMI + SSKI, 6 drops twice daily). When serum T4 and T3 concentrations were analysed as the percent change from pre-treatment values, the following results were observed. Serum T4 concentration decreased in the three treatment groups and the decrease was similar in the MMI and MMI + SSKI groups but significantly lower than in the MMI + Na ipodate group. The serum T3 concentration decreased to the normal range in all seven MMI + Na Ipodate treated patients by the fourth day of treatment and the per cent decrease in serum T3 from pre-treatment values was significantly greater than in the MMI and MMI + SSKI treated patients. The decrease in serum T3 was similar in the latter two groups. Heart rate decreased in all three groups, but the decrease was significantly more in the MMI + Na Ipodate-treated patients. The present findings suggest that the rapid control of hyperthyroid Graves' disease is similar in patients treated with MMI and MMI + SSKI and that the combination of MMI + Na Ipodate is more efficacious since the decrease in serum T3 concentrations and heart rate was significantly greater in the MMI + Na ipodate-treated patients.
This review has focused on the nature and significance of aAB detected in the serum of patients with EAD. Although many antibodies are characteristically detected in the serum of patients with such disorders, only a few are of known pathogenic significance. Antibodies that react with soluble cytoplasmic antigens are not expected to be harmful. On the other hand, membrane or cell surface-directed antibodies are likely to be damaging, either by lysis of the cell membrane, or by reaction with hormone or other surface receptors. Clinically, measurement of aAB has important diagnostic and management value. Moreover, detection of certain antibodies before the onset of disease raises hope that the corresponding disorders may be preventable, e.g. by specific immunosuppression of those subjects, or patients, with positive tests. The possible role of aAB in the association of organ-specific AID by cross-reacting with shared epitopes in various tissues has been highlighted by the recent finding, from the authors' laboratory, of antibodies reactive with a 64-kDa membrane protein found in several tissues, including thyroid, eye muscle, and pancreas, which are frequent sites for autoimmune inflammation. Study of such antibodies and the molecular characterization of the corresponding antigens in the various involved tissues should provide information concerning the role of cross-reactivity in autoimmunity as well as leading to the development of specific immunotherapeutic agents.
We characterized 22 human monoclonal antibodies (MCAB) reactive with human orbital antigens. Most of these monoclonal antibodies had variable degrees of reactivity with eye muscle, orbital connective tissue, thyroid, and extra-thyroid tissue preparations when tested in an enzyme-linked immunosorbent assay (ELISA). Eight of the MCABs, selected on the basis of their reactivity with human eye muscle or orbital connective tissue antigens, were used to affinity purify orbital membrane antigens. All purified fractions were tested in the ELISA for reactivity with the MCAB used for their purification. Four of the purified antigens with a high reactivity were not proteins. To increase the specificity of the reactivity of serum autoantibodies with affinity-purified antigens, we developed a competitive binding ELISA in which the MCAB-immunoglobulin was directly labeled with alkaline phosphatase. We tested the serum of 24 patients with Graves' ophthalmopathy, 10 patients with a history of Graves' hyperthyroidism and no eye disease, 14 patients with Hashimoto's thyroiditis without eye disease, 8 patients with other nonautoimmune thyroid disorders, and 20 normal subjects for reactivity with an affinity-purified nonprotein orbital antigen. The levels of serum autoantibodies against this antigen in patients with Graves' ophthalmopathy were significantly higher than those in normal subjects or patients with Graves' hyperthyroidism with no eye disease. Although unlikely to be of primary pathogenetic significance, it is possible that levels of this antibody in patients with Graves' ophthalmopathy may reflect the extent of orbital inflammation and, therefore, be useful as a clinical marker.
A hitherto unrecognized thyroid antibody, which reacts with a thyroid cell surface antigen expressed on passaged thyroid cells, was identified in serum from patients with thyroid-associated ophthalmopathy using antibody-dependent cell-mediated cytotoxicity (ADCC) tests. The antibody was detected in 14 of 23 patients with Graves' hyperthyroidism (Gh) and associated ophthalmopathy, in 3 of 4 patients with Hashimoto's thyroiditis (HT) and ophthalmopathy, but in only 1 of 16 patients with Gh without clinically evident eye disease and 4 of 37 patients with HT without eye disease. The ADCC test also was positive in 2 of 30 patients with thyroid cancer, both of whom had had Gh and ophthalmopathy in the past. There was no correlation, in patients with ophthalmopathy, between the levels of the antibody (expressed as percent specific lysis) and the titers of antithyroid microsomal antibody measured using a hemagglutination assay. Based on the results of blocking experiments using mouse monoclonal antibodies against human thyroid peroxidase, now known to be the thyroid microsomal antigen, the corresponding antigen was not thyroid peroxidase. Moreover, the new antigen was expressed on cultured and passaged thyroid cells which do not express the microsomal antigen. In patients with ophthalmopathy there was a close correlation between the degree of lysis of passaged thyroid cells and that of eye muscle cells, and ADCC activity against passaged thyroid cells was absorbed by preincubation of positive serum samples with eye muscle and thyroid cell, but not other cell, monolayers. The reaction of a newly identified cytotoxic thyroid antibody with a shared epitope on eye muscle cells thus appears to be a possible mechanism for the development of ophthalmopathy in patients with Gh and, less often, HT.