Search PubMed⌕ Search

Biomedical subjects

S Boriani

Publications and source records attributed to S Boriani.

At least 91 records · Page 5Linked to original sources
PubMed1978

Chondromas and chondromatosis (a study of 265 cases, 200 with long term follow up).

265 cases of solitary chondroma, multiple chondromas and chondromatosis were analysed. Two hundred cases had a long term follow up of 1-50 years (average ten years). Recurrence after surgical removal is rare. It is exceptional for malignancy to develop in chondromas of the hand. Malignant degeneration (chondrosarcoma, fibrosarcoma, etc.) was found in 12 per cent of the solitary chondromas and in 32 per cent of the multiple chondromas and chondromatosis involving the bones elsewhere than in the hand. The first of these figures is probably excessive, since many of the solitary chondromas elsewhere than in the hand remain asymptomatic and unrecognised; but the second figure is probably too low, since the risk of sarcomatous degeneration remains present throughout the patient's life.

Bone Neoplasms↗
PubMedDate not supplied

The treatment of thoracic and lumbar spine fractures: a study of 123 cases treated surgically in 101 patients.

For a total of 123 thoracolumbar traumatic lesions treated surgically in 101 patients over approximately 2 years (all monitored clinically and radiographically up to consolidation by follow-ups after from 6 to 26 months, mean 10 months) the technique used, complications and treatment are reported. The treatment procedure included: emergency surgery decompression, osteosynthesis, and fusion (posterior and possibly intersomatic); immediate recovery of function and loading; clinical and radiographic monitoring within 4-6 weeks, and possible anterior fusion in case of insufficient reconstruction of the anterior column. The complications observed out of 123 fractures were: collapse of the implant (4 cases), infection (5 cases), liquoral fistula (1 case), transitory paralysis of the abdominal muscles homolateral to the lombotomic incision (1 case), TVP (2 cases), bronchial pneumonia (2 cases), paralytic ileum (1 case). There was no sagittal deformity (secondary kyphosis) except for 5 cases of mechanical collapse that were resolved with a new operation. Neurologic deficit was caused by fracture in 49 patients (40% of the fractures or 48% of the patients). Six patients out of 30 affected with spinal cord lesion (20%) and 15 out of 19 affected with cone and/or cauda lesion (79%) improved. There was no progression of the neurologic findings after surgery. The authors conclude by proposing a protocol of posterior osteosynthesis for the use of a system in titanium made up of pedicle screws and hooks connected to a pair of cylindrical bars joined together.

Adolescent↗
PubMedDate not supplied

Hemorrhagic synovial lumbar cyst: a case report and review of the literature.

The authors report a case of an 81-year-old woman affected by a synovial cyst arising from the left facet joint of L3. The patient presented with severe pain and claudicatio spinalis. Diagnosis was based upon standard x-rays and MRI; the patient was operated on and the histology of the lesion confirmed the pre-operative diagnosis. On MRI images the lesion appeared as a roundish extradural mass arising from the left facet joint of L3, compressing the cauda equina posteriorly, and it appeared with an increased heterogeneous signal, consistent with a high quantity of fluid and hemosiderin within the cyst. A communication between the lesion and the joint space was evident on the MRI sagittal reconstruction. Grossly the cut surface of the mass had a cystic aspect, with some hemorrhagic areas between whitish myxoid tissue. Histologically the lesion was formed by fibrous connective tissue covered by synovium; focal inflammation and hemosiderin-laden macrophages were also present in some areas. At one year follow-up the patient is symptom-free.

Aged↗
PubMedDate not supplied

The use of the carbon-fiber reinforced modular implant for the reconstruction of the anterior column of the spine. A clinical and experimental study conducted on 42 cases.

The conservative treatment of neoplasms of the locomotor apparatus means the production of bone defects that may be filled with prostheses, bone grafts, systems of osteosynthesis. In the vertebral column, reconstruction of the resected elements--in the case of total vertebrectomy--requires the combination of anterior and posterior implants. It is the purpose of this study to analyze a group of 42 patients who, after accurate and uniform oncological (Enneking) and surgical (Weinstein-Boriani-Biagini) staging, were submitted to excision of one or more vertebral bodies for the treatment of neoplastic pathology, with reconstruction by prosthetic carbon fiber modular implant in order to obtain immediate stability, and to stimulate solid intervertebral fusion by bone grafts introduced inside the prosthesis. Thirty of the 42 patients presented with primary malignant tumor, 3 with benign tumor, 6 with solitary metastases, and 3 with plasmacytoma. In 32 cases, en bloc resection of the vertebral body was carried out (vertebrectomy) with combined anterior and posterior access in 29 patients (69.0%), and by posterior approach alone in 3 cases (7.1%). Ten intralesional corporectomies were carried out, 8 by anterior approach, 2 by posterior approach. The carbon prosthesis was filled with cortical and cancellous bone grafts in 38 cases. At a mean clinical and instrumental follow-up obtained 26 months after surgery for all of the patients, the use of a carbon prosthesis did not cause short- or long-term mechanical complications. The results of our study tend to affirm that the use of a carbon fiber modular implant may fill any loss of bone substance of the vertebral column, that it allows for immediate weight-bearing, and that if favors bone fusion. Some particular features of the carbon prosthesis favorably adapt to the surgical method of vertebrectomy: 1. The various components of the prosthesis may adapt to any type of bone resection of the vertebral body, even in unexpected situations; 2. Connection to posterior instrumentation in total vertebrectomies avoids the use of an anterior plate, thus reducing the time required for reconstruction of the anterior column, eliminating necessary surgical procedures in the segmental vascular structures. Finally, the radiolucency of the prosthesis allows for an easy evaluation of the formation of bone within and around the implant up to definitive anterior fusion and, of no less importance, early diagnosis of any local recurrence.

Adolescent↗
PubMedDate not supplied

Posterior lumbar interbody fusion a mid-term review of 60 cases.

It is the purpose of this study to evaluate the clinical and radiographic medium-term results of a series of 60 patients submitted to intersomatic lumbar fusion by posterior approach, using a system constituted by carbon wedges to be associated with bone grafts for intersomatic fusion, and by steel or titanium plates or bars used for posterior pedicle osteosynthesis. Satisfactory clinical results were obtained in 88.2% of cases and complete radiographic fusion in 91.4% of cases. Complications were generally observed in 8.3% of cases. In light of these results, we may consider intersomatic lumbar fusion by posterior approach a method that is perhaps aggressive, but effective in the treatment of severe lumbar spondylolysis. The use of carbon wedges brings several advantages that favor intersomatic fusion, its progressive control, and the restoration of normal lordosis of the lumbar spine.

Adult↗
PubMedDate not supplied

External fixation and sequential nailing in the treatment of open diaphyseal fractures of the tibia.

Between September 1996 and April 1998 a total of 26 open fractures of the tibia (Gustilo Anderson grade I in 4 cases, grade II in 3, grade IIIA in 8, grade IIIB in 11) were treated by debridement and monoaxial external fixation followed by locked intramedullary nailing after healing of the soft tissues had been observed. Nailing by reamed Grosse Kempf nail was carried out in all of the cases. The mean duration of external fixation was 50 days (with a minimum of 18 days and a maximum of 6 months). Upon removal of the external fixator intramedullary osteosynthesis was performed during the same surgical session in 25 cases. Nailing was carried out 45 days after removal of the external fixator in 1 case. Healing was obtained in all of the patients an average of 6 months after trauma, and 3 and 1/2 months after the second operation. There were two cases of infection, one deep (3.8%) and the other superficial (3.8%). No cases of chronic osteomyelitis were ever observed. Poor consolidation with valgus equal to 10 degrees and 15 degrees was observed in 2 patients. This method of treatment, based on our experience, allows for healing in some open fractures of the tibia in a relatively short amount of time and with an acceptable risk of complications.

Adolescent↗
PubMedDate not supplied

Symptomatic vertebral hemangioma: the treatment of 23 cases and a review of the literature.

It is the purpose of this study to analyze a group of 23 patients affected with hemangioma in one or more metameres of the vertebral column. On the basis of clinical examination and instrumental testing in time (minimum follow-up 12 months, maximum 217 months) the following treatment options are discussed: medical treatment and clinical monitoring closer in time; palliative surgical treatment whether or not associated with embolization of vascular afferences of the lesion and adjuvant treatment; intralesional surgical treatment whether or not associated with embolization of the vascular afferences of the lesion and adjuvant treatment. Skeletal hemangioma is a hamartomatous proliferation of vascular tissue, more precisely of endothelial tissue. This is demonstrated by its anatomical identity with other tissues and the existence of exceptional skeletal and multiple tissue hemangiomatosis that begin during childhood. Hemangioma is the benign tumor that is most frequently localized in the spine, involving about 10% of the world population, as reported in the literature on autoptic studies. It is often a solitary lesion, usually localized in the vertebral body, although it may extend to the posterior arch. There is predilection for the thoracic region of the spine, while it less frequently occurs in the cervical and lumbar spines. Generally, it remains asymptomatic throughout the entire life of the subject, so much so that it is often difficult to establish the onset of the lesion. Symptomatic hemangiomas (less than 1% of all hemangiomas) are those that are accidentally discovered via radiograms; they are most often observed during adult age. The most common treatment used for vertebral hemangioma associated with pain is radiotherapy, even if clinical observation represents a reasonable choice. Surgical treatment, preceded when possible by embolization of the vascular afferences of the lesion, is often associated with radiation therapy in cases where there is neurologic compression in addition to pain. It was the purpose of this study to analyze the long-term results obtained in a group of 23 patients affected with symptomatic vertebral hemangioma.

Adolescent↗
PubMedDate not supplied

Locked nailing in subtrochanteric fractures of the femur in the elderly patient.

Subtrochanteric fractures are a typical pathology in the elderly patient, they are not very common and they are difficult to treat. The general conditions of these patients, often at the limit of operability, are further compromised by surgery and time spent in bed, leading to the death of the patient in a high percentage of cases. The fracture is often spyroid, it has multiple fragments, with interruption of the medial cortical bone. The quality of the bone, because of the marked osteoporosis, does not guarantee the good hold of the means of fixation used. The use of intramedullary nailing is a safe method, that allows for stabilization of the fracture without excessive blood loss, it allows for early partial weight-bearing and it has a lower number of complications as compared to other methods. Between 1-1-97 and 31-12-00 a total of 59 persubtrochanteric fractures were treated; there were 15 males and 44 females. A Gamma Long nail was used in 46 cases, a Gamma Standard in 13. Eleven of the patients died within 6 months. A total of 27 patients aged an average of 78 years (minimum 65, maximum 87) were evaluated at a mean follow-up of 10 months (minimum 7, maximum 27). A Gamma Long nail had been used in 18 cases, and Gamma Standard in 8. Partial weight-bearing was allowed after a mean of 20 days (minimum 10, maximum 35), total weight-bearing after a mean of 60 days (minimum 40, maximum 75). Consolidation was obtained after a mean of 4 months (minimum 3, maximum 7). There were no significant complications.

Age Factors↗
PubMedDate not supplied

Conjoined fracture-dislocation of the forearm at the elbow.

Conjoined fracture-dislocation of the elbow were first described by Marotte in 1982. In this study, a total of 41 patients treated between 1975 and 1995 at the Rizzoli Orthopaedic Institute and 4 patients treated between 1997 and 2000 at the Division of Orthopaedics at the Maggiore Hospital are evaluated. Based on the Marotte classification, the patients are divided into 4 groups, by site of dislocation of the radial capitellum and amount of comminution of the fracture of the ulna. A clinical and radiographic evaluation was made after a mean follow-up of 5.3 years based on Anderson criteria. The results obtained were excellent in 17 patients (37.8%) satisfactory in 13 (28.9%), dissatisfactory in 12 (26.7%); 3 patients were considered to be failures (6.7%), the best results were obtained in type I anterior dislocations.

Adolescent↗
PubMedDate not supplied

Schwannoma of L3.

The authors report a case of large retroperitoneal schwannoma with osteolysis of the pedicle of L3, submitted to complete excision by partial vertebrectomy of L3 with a combined approach. Schwannoma is a hamartoma constituted by Schwann's cells, that causes non-specific clinical manifestations. Image diagnosis provides information as to the relationships that the neoformation contracts with the surrounding structures, but a definitive diagnosis is exclusively anatomopathologic. Retroperitoneal localization is rather rare (0.5-5% of cases). Treatment is represented by surgical excision. Because it is a benign, slow-growing neoplasm, when dealing with cases that are difficult to treat surgically or when complete excision means disabling neurovascular lesions, we may opt for the incomplete removal of the mass, as long as the case is carefully monitored over time.

Female↗
PubMedDate not supplied

The Fixion nail in the lower limb. Preliminary results.

The Fixion nail is an intramedullary nail made of stainless steel, that may be used to treat fractures of the humerus and in the lower limb. This nail is made up of a cylinder that has 4 longitudinal bars which, once inserted in the bone segment, expands via a pressure hydraulic system using physiological solution. The nail may be introduced without reaming and after its expansion it adheres to the bone walls producing stabilization of the fracture. In order to guarantee good stability, the apex of the nail must exceed the fracture line by 5 cm. Indications were initially limited to type 32 and 42 A1-2-3 fractures of the mid third of the lower limb, to then be expanded to type B1 fractures in the AO system. A total of 20 nails were used in 19 patients, with an average time of 7 days for partial weight-bearing and 40 days for total weight-bearing, achieving consolidation on day 18 after an average of 5 months in the femur and 4 months in the tibia. Reaming of the intramedullary canal was carried out in all of the cases.

Adolescent↗
PubMedDate not supplied

Osteoid osteoma of L4: excision by videoendoscopy.

It is the purpose of this study to demonstrate how in the surgical treatment of vertebral osteoid osteoma a video-aided mini-invasive method may be used as an alternative to modern percutaneous X-ray-CT-guided mini-invasive methods such as radiocoagulation, interstitial photocoagulation with laser injection. Reported here is the case of a female aged 13 years where instrumental testing showed the presence of an osteoid osteoma involving the internal surface of the lamina of L3 and spreading in the lumen of the vertebral canal. Once we established that it was impossible to carry out the aforementioned mini-invasive percutaneous treatment because of the closeness of the osteoid osteoma to the nervous structures, thus risking complications, the only procedure that could guarantee complete removal of the tumor was open aminarthrectomy. But to reduce surgical aggressiveness to a minimum, we decided to proceed by means of a video-aided mini-invasive method with the purpose of limiting hospitalization and recovery time in order to obtain economically favorable results.

Adolescent↗
PubMedDate not supplied

Vertebral localization of a brown tumor: description of a case and review of the literature.

The authors report a case of a female aged 45 years submitted to a long period of hemodialysis, affected with brown tumor of the lumbar spine. Brown tumor must be taken into consideration in the differential diagnosis of osteolytic lesions of the skeleton, particularly in young, nephropathic women undergoing hemodialysis. Brown tumor has a more favorable prognosis as compared to other lesions that have similar clinical and radiographic findings, such as metastatic lesions and giant cell tumors. In the case of brown tumor, in addition to treating lesion of the spine, treatment varying depending on neurological findings and biomechanical complications (structural collapse, segmental kyphosis, pathologic fracture, etc.), removal of the parathyroids and correction of the metabolic alterations is indispensable.

Adenoma↗
PubMedDate not supplied

Substitution in vertebral resections.

The authors discuss the reconstructive methods used after curettage and/or vertebral resection possibly associated with removal of surrounding muscular, visceral and nervous structures.

Adolescent↗