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PubMedDate not supplied

Anterior surgery of the upper cervical spine.

The authors report the results obtained in a series of more than 80 cases submitted to 76 operations of the upper cervical spine by transoral approach with a minimum follow-up of two years. The cases include: 15 unstable fractures or non-union of the odontoid processes; 28 cases of post-traumatic instability of C1-C2 level without fracture of the odontoid process; 13 cases of rheumatoid arthritis with instability at C1-C2; 14 cases of severe anomalies of the craniovertebral junction, often associated with basilar impression and spinal cord compression, of which 7 cases presented with tetraparesis; 6 malignant tumors. The method used involves an anterior transoral approach, more often without tracheotomy, and with exposure of the anterior aspect of the atlas and of the odontoid process by means of a midline incision of the posterior wall of the pharynx. When spinal cord lesion was present, decompression and reconstruction by bone grafts taken from the iliac crest were performed. In nearly all of the cases osteosynthesis with an anterior plate was used. Complications were mild. There were two cases of infection, observed at the onset of our experience, which were resolved after removal of the instrumentation. There was loosening of a screw in three cases; this was eliminated through the digestive tube with no consequences. There were no early intra- or postoperative deaths. Consolidation was obtained in most of the patients, and only in three cases did we observe a loss of postoperative reduction. Among patients affected with tetraparesis we observed many cases of neurological recovery.(ABSTRACT TRUNCATED AT 250 WORDS)

Cervical Vertebrae↗
PubMed1994

[Percutaneous gastrostomy. Personal experience in 137 cases].

Percutaneous gastrostomy is reported to be an effective alternative to total parenteral feeding or long-term nasogastric tube in the treatment of mechanical or functional dysphagia. The authors report their personal experience with 137 percutaneous gastrostomies performed on 98 men and 39 women from January 1986 through December 1993. All the maneuvers were performed under fluoroscopic guidance in the patients with head or neck cancer, neoplastic, vascular or post-traumatic neuropathy and upper GI tract cancer. To avoid left hepatic lobe trauma, percutaneous gastrostomy needs to be performed under US guidance. A 7F nasogastric tube is used to fill the stomach with air. After distending the gastric cavity, with the Seldinger technique under local anesthesia, fascial dilators of progressively increasing caliber are introduced into the gastric cavity and the final 12F gastrostomy catheter is positioned under fluoroscopic guidance. No major complications, such as hemorrhage or peritonitis, occurred. In one case, during the maneuver, the patient complained of severe epigastric pain which regressed with no further problems two hours later. In three cases the gastrostomy catheter fell out of place and was replaced by running the fistolous tract with a venous cannula and then a guidewire for gastrostomy repositioning. With this type of treatment, the patient can be given enteral feeding the following day. The maneuver requires approximately 10 minutes to perform and is well tolerated by the patient as it requires no general anesthesia. Percutaneous gastrostomy is more cost-effective than surgery or endoscopy and hospitalization is shorter. The only contraindications to this maneuver are hepatomegaly (because of the risk of liver trauma during percutaneous maneuvers), ascites (because of the risk of infection) and finally the complications resulting from gastric resection.

Adult↗
PubMed1998

Doppler ultrasound of the testis in azoospermic subjects as a parameter of testicular function.

Azoospermia frequently represents the end-point of different pathological conditions that cause important quantitative and qualitative alterations of both spermatogenesis and testicular structure, including intratesticular blood vessels. In this study we performed colour Doppler ultrasound of the testis in 12 azoospermic subjects affected by primary testicular pathology (four bilateral post-orchitis, four postradiotheraphy for cancer, four post-traumatic) aged 28.2+/-3.3 (mean+/-SD) years, in six subjects affected by obstructive azoospermia aged 29.7+/-2.4 years and in 20 age-matched fertile subjects (aged 28.6+/-2.5 years). The analysis of intratesticular vessels per organ was quantified using a semiquantitative score: category 0, no vessels visible; category 1, between one and three intratesticular vessels visible; and category 2, more than three vessels visible. In obstructive azoospermic patients and in fertile subjects there were always more than three intratesticular vessels. No intratesticular vessels were detected in eight testes (33.3%) and fewer than three vessels in 16 testes (66.6%) in subjects affected by primary testicular pathology. In azoospermic subjects the testicular structure of the testis was evaluated by diagnostic fine needle aspiration cytology (FNAC) performed in the middle portion of the testis. In non-obstructive azoospermic patients this procedure showed the presence of only Sertoli cells in all cases. When detectable vessels were present, a new aspiration was performed in these areas. In 12 out of 16 cases, spermatogenetic cells including mature spermatozoa, were found when the FNAC was performed in testicular regions showing the presence of blood vessels. These results indicate that colour Doppler sonography of the testis may be useful in the differential diagnosis of azoospermia and suggest the evaluation of the intratesticular blood vessel distribution before performing any method to retrieve intratesticular spermatozoa for intracytoplasmic sperm injection.

Adult↗
PubMedDate not supplied

Synovial metastasis of the shoulder detected by arthroscopy as the presenting manifestation of lung adenocarcinoma.

A case in which a post-traumatic shoulder impairment revealed the presence of the joint involvement by a metastatic localization of lung adenocarcinoma is presented. The patient was a 60-year-old white man, a smoker, in apparent healthy condition complaining of pain and stiffness from a 1-year-old traumatic accident to the right shoulder sustained during a tennis match. He had been unsuccessfully treated for 6 months with physical therapy. Because of the negativity of the usual imaging studies, a diagnostic arthroscopy was performed. It revealed the presence of a traumatic rupture of the glenoid labrum and of an atypical gelatinous synovial formation in the medial wall of the joint; it was histologically and immunohistochemically diagnosed as adenocarcinoma, probably originating in the lung or in the gastrointestinal tract. The pulmonary origin of the neoplasm was confirmed by computed tomography. The patient underwent chemotherapy and eventually died with contralateral lung and femur metastases 8 months after the diagnosis. The clinical importance of this rare observation is discussed.

Adenocarcinoma↗
PubMed1993

An unusual cause of benign paroxysmal positional vertigo.

Benign paroxysmal positional vertigo (BPPV) is a self-limiting condition characterized by vertigo and nystagmus induced by certain head positions. The most common causes of BPPV are post-traumatic following head injury and post-viral labyrinthitis. We present an interesting case of BPPV following an otherwise uneventful neurosurgical removal of a parietal osteoma using hammer and chisel. Caution should be exercised during such procedures as disabling vertigo can result for a considerable period of time.

Adult↗
PubMed1988

[Dynamics and pathogenesis of traumatic subdural hygroma].

Of 2005 patients, who had suffered blunt skull trauma, 108 developed post-traumatic subdural hygromas (TSH). CT was used to observe the course of subdural hygromas not treated surgically, with particular reference to the time of their appearance and regression. The relative incidence of TSH, and of the severity of head trauma quantified on a 5-grade scale was determined in different age groups. From the traumatic changes demonstrated on CT, some conclusions could be drawn regarding the pathogenesis. A hypothetical model has been developed which explains TSH as a result of shearing forces.

Brain Injuries↗
PubMed1986

Angiosarcomas in lymphedematous limbs.

The clinical and histopathological features of four cases of angiosarcoma in congenital, post-traumatic, and post-hysterectomy lymphedematous limbs are reported. A good correlation between histologic and ultrastructural findings and clinical course was observed.

Cell Transformation, Neoplastic↗
PubMed1991

Cone biopsy causes cervical endometriosis and tubo-endometrioid metaplasia.

Cervices from 42 hysterectomies performed from 1 to 91 months (mean 12.2) following conization were re-examined in order to assess the possible effects of post-traumatic regeneration on the endocervix. Twenty-nine (69%) showed a continuum of abnormalities in which the shared finding was the presence of tubo-endometrioid glands, accompanied in many cases by varying amounts of endometrial-type stroma. Thus, 18 post-conization cervices (43%) showed endometriosis, and a further 11 cases (26%) contained tubo-endometrioid glands without demonstrable endometrial-type stroma. These abnormalities were situated at the healed cone biopsy site, either superficially within the new transformation zone and/or within the cone biopsy scar. Post-conization cervical endometriosis occurred from 2 to 91 months (mean 17.8) and tubo-endometrioid metaplasia 2-24 months (mean 11.0) after the cone biopsy. It is concluded that cervical endometriosis and tubo-endometrioid metaplasia are common complications of conization, and that they represent aberrant differentiation following injury. The demonstration of endometriosis and tubo-endometrioid metaplasia in 69% of post-conization cervices has implications for the interpretation of cervical biopsies and smears from this group of women.

Adult↗
PubMed1975

Homovanillic acid and 5-hydroxyindole-acetic acid in the csf of patients after a severe head injury. II. Ventricular csf concentrations in acute brain post-traumatic syndromes.

Ventricular concentrations of homovanillic acid (HVA) and 5-hydroxyindole-acetic acid (5HIAA) were measured in 7 patients a few days after a severe traumatic brain injury. Both acid metabolites were elevated in respect to control patients values, however, the rise was more consistent for 5HIAA (258 +/- 86 ng/ml) with a 5HIAA/HVA ratio of 0.85 +/- 0.35. The data support previous hypothesis on the profound involvement of serotoninergic structures in the early stages of acute traumatic brain syndromes and on the role of 5HT in maintaining edema and vasospasm.

Adolescent↗
PubMed1991

[Post-traumatic hemoperitoneum: a rare complication of peritoneal splenosis].

Peritoneal splenosis is a frequent condition after traumatic spleen fracture, which, given that it is usually asymptomatic, is often not diagnosed unless a laparotomy is performed for some other reason. The case is presented of a 9 year old boy splenectomized a few years earlier because of traumatism, who again suffers abdominal injury with the development of hemoperitoneum, observing during surgery multiple splenosis foci disseminated all over the abdominal cavity, some of which present rupture and hemorrhage, constituting the cause of hemoperitoneum.

Abdominal Injuries↗
PubMed1987

[Post-traumatic astrocytoma].

A 25 year old woman developed a mixed pilocytic and fibrillary astrocytoma in scar tissue 20 years after the brain contusion. The case fulfilled the criteria of traumatic etiology of this brain tumor.

Adult↗
PubMed1985

[External immobilization of cervical spine with a halo vest--experience with 31 cases].

Post-traumatic or post-operative immobilization of cervical spine often requires long term bed-rest. But, bed-rest indeed gave discomfort to patients, nonetheless, sometimes complete external fixation cannot be gained. Since 1982, we have applied Halo vest to the patients who required external immobilization of cervical spine. In this paper, we reported our experiences with 31 cases who were treated by Halo vest. Thirty-one cases comprised 19 cases of cervical spinal trauma, 5 cases of atlanto-axial dislocation, 1 case of foramen magnum meningioma, and 6 cases of ossification of posterior longitudinal ligament (OPLL). In traumatic cases, Halo vest was used as external fixation of injured spine in 8 cases, and as an adjunct to surgical fusion in other cases. In case of atlanto-axial dislocation, 3 cases underwent posterior fusion, and 2 cases underwent anterior fusion. Anterior fusion of C1-2 was also done in case of foramen magnum meningioma after total excision of tumor. Six cases of OPLL underwent anterior decompression and anterior fusion. Mean immobilization time by Halo vest was as follows: 58 days (28-113) in case of cervical spinal trauma, 85 days (56-144) in case of atlanto-axial dislocation who underwent posterior fusion, 92 days (89-93) in case of atlanto-axial dislocation and foramen magnum meningioma who underwent anterior fusion, 59 days (54-70) in case of OPLL. Early ambulation was achieved in many cases. Good external fixation and result was obtained 27 cases out of 31 cases. Re-dislocation of cervical spine occurred in 1 case of cervical spinal trauma while he was in Halo vest.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1979

Microvascular surgery in maxillo-facial reconstruction.

The recent advances in microvascular surgery have been applied to maxillo-facial reconstruction in the area of the lower jaw and soft tissue of the face. Five cases are presented, demonstrating some of the techniques and results in patients suffering from congenital, post-traumatic and post-cancer resection deformities.

Adult↗
PubMed1984

Role of cholesterol and calcium bilirubinate crystals in acute postoperative acalculous cholecystitis.

Acute acalculous cholecystitis is rather unusual, but it is considered an increasing entity. Particularly interesting are the post-traumatic or post-operative forms of acute acalculous cholecystitis. Ischemia of the gallbladder and biliary stasis are the most likely pathogenetic factors. A case of acute acalculous cholecystitis after total gastrectomy for cancer is presented. Particular emphasis is put on the significance of cholesterol and calcium bilirubinate crystals findings in the bile of the gallbladder. The pathogenetic role of this microscopic form of lithiasis in post-operative acalculous cholecystitis is discussed. It is concluded that all surgeons should be aware of this pathology since it is becoming much more common to be faced with elderly patients having life-threatening post-operative gallbladder complications unrelated to macroscopic lithiasis.

Acute Disease↗
PubMed1981

[Desmoid fibroma of bone. An histoenzymological and ultrastructural study of the mandible in one case (author's transl)].

A case of post-traumatic desmoid tumor of the mandible is reported in a 4-year old girl. This tumor was considered typical clinically and by light microscopy. Four years later, the patient was symptomless, without evidence of recurrence. Histoenzymology showed a high level of leucine aminopeptidase activity. On electron microscopy, a part from a few primitive mesenchymal cells, abnormal fibroblasts represented the principal cellular component. These cells showed evidence of intracytoplasmic collagen fibers synthesis and of myoid differentiation (numerous filaments and endocytosis vacuoles). Myofibroblasts, with a microfibrillary network showing areas of dense osmiophilic condensation in the vicinity of cell membrane were also present. This atypical ultrastructural feature suggests, in this case, the non-neoplastic nature of this lesion. It seems to reflect an abnormal reaction to a traumatic aggression, characterized by proliferation of myofibroblasts (which normally disappear in the late stages of healing) and to have, thus, the signification of pathologic scar.

Child, Preschool↗
PubMed1995

[Filling of bone defects using biphasic macroporous calcium phosphate ceramic. Apropos of 23 cases].

PURPOSE OF THE STUDY: The authors report their experience with the use of a biphasic macroporous calcium phosphate bone substitute. MATERIALS AND METHODS: In 23 cases (22 patients) a biphasic macroporous calcium phosphate ceramic was used to fill a pathological bone defect. The ceramic used in this study was a macroporous (400 to 600 mu) component consisting of 60 per cent hydroxyapatite and 40 per cent beta-tricalcium phosphate. It was in the form of granules (2 to 3 mm), sticks (20 x 5 x 5 or 10 x 5 x 5 mm) or custom made blocks. In 6 cases, the ceramic was used alone; in 12 cases with autologous bone marrow and in 5 cases with autologous cancellous bone grafts. In 14 cases, the bone defect was due to conservative treatment of a benign tumor, in 3 cases due to aseptic post-traumatic non union, in 3 cases due to wide resection for malignant tumors of the pelvis and in 3 cases following osteotomy. Post operative assessment was made from clinical, radiographic and histological findings. RESULTS: 2 patients died 6 and 8 months post operatively and 2 were lost to follow up at 2 and 5 months with both having good clinical and radiographic results when last seen. For the remaining 19 cases, the average follow-up was 20 months (from 6 to 62 months). No local, regional or general deleterious effects were noted. Radiologically the bone ceramic junction healed in all cases except 2 within 3 months. In these last two cases, healing required 6 and 7 months. No radiolucent line appeared around the ceramic. No stress fractures occurred in the substitute. Histologically, 3 biopsies showed new bone formation throughout the ceramic with apposition of a well differentiated lamellar bone directly apposed to the ceramic. DISCUSSION: Animal experimentations have proven the interest of similar ceramics: macroporosity enhances bone rehabilitation and the biphasic characteristics associate the advantages of slow resorption of hydroxyapatite and more easily resorbed beta-calcium phosphate. No deleterious clinical, radiographical or histological effects were observed, confirming the biocompatibility of this substitute. Despite the poor mechanical properties of this macroporous ceramic before implantation, good clinical and radiographic results suggest improvement of these properties in the composite new formed bone-ceramic after implantation. CONCLUSION: We believe that macroporous biphasic ceramic is a good substitute for use in bone defects when good primary mechanical stability and contact with the host bone are present. Further clinical and experimental studies are necessary to determine the limits of such a substitute in terms of volume and to control its mechanical properties following implantation.

Adolescent↗
PubMed1995

[Post-traumatic hematoma of the adrenal gland. Apropos of a case and review of the literature].

The authors report a case of delayed diagnosis of traumatic haematoma of the right adrenal gland. Chronic unilateral haematomas are rare and their preoperative diagnosis is often difficult because of the long interval since trauma, which may be completely forgotten. This raises the problem of an adrenal mass whose origin is often only detected on histology of the operative specimen.

Adrenal Gland Diseases↗