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Biomedical subjects

A Tulli

Publications and source records attributed to A Tulli.

At least 19 recordsLinked to original sources
PubMed2006

Managing cardiovascular risk in menopausal women.

Blood pressure control and prevention of glucose intolerance are primary factors in overcoming the increased cardiovascular risks in menopausal women. This heightened risk may partially be explained by the metabolic syndrome - a precursor of type 2 diabetes - in which the renin-angiotensin-aldosterone system may play a pivotal role. Once diabetes occurs, the cardiovascular risk is considerably greater in postmenopausal women than in men - especially if hypertension is also present. An additional risk factor, weight gain, is common in postmenopausal women not treated with hormone replacement therapy. Rigorous control of blood pressure has been shown to be particularly beneficial in women with metabolic syndrome; a reduction in blood pressure can reduce the mortality rate of ischemic stroke. The administration of hormone replacement therapy can also reduce the likelihood of coronary heart disease in postmenopausal women; therefore therapy should be started early in the menopausal transition to maximize cardiovascular protection. As such, an ideal hormone replacement therapy that can overcome hypertension, prevent body weight gain and control serum triglycerides offers an important advance in cardiovascular risk management during the menopause.

Age Factors↗
PubMed2006

Vitiligo associated with other autoimmune diseases: polyglandular autoimmune syndrome types 3B+C and 4.

Vitiligo is a common skin disease characterized by depigmented maculae resulting from a reduction of the number and function of melanocytes. Many studies suggest that vitiligo might be an autoimmune disease. Vitiligo has been frequently described in association with other autoimmune diseases. Among the diseases described in association with vitiligo are the so-called autoimmune polyglandular syndromes (APS). Vitiligo can be present in all types of APS but the most frequent association appears to be in APS-3. APS-3 was defined as the association between autoimmune thyroiditis and another autoimmune disease. Here we report one patient with thyroiditis, vitiligo and autoimmune gastritis (APS-3B+C), one patient with chronic autoimmune thyroiditis, vitiligo and alopecia (APS-3C), and one case of a young patient with type 1 diabetes mellitus and vitiligo (APS-4), according to the newest classification. We stress the importance of a thorough assessment for autoimmune diseases in selected patients with vitiligo.

Adult↗
PubMed2003

The dorsal flap of the first web.

In the first web space region, there are communications between the dorsal arteries which arise from the dorsal branch of the radial artery and the digital arteries of the thumb and the index finger. These allow a distally based flap to be raised in the first dorsal intermetacarpal area. This flap has been used in 15 cases of soft-tissue loss from the thumb and index finger. The donor sites were closed primarily in all but two patients. There were no complications, and the results show that this flap is useful for soft-tissue defects on the tip and the palmar and dorsal surfaces of the thumb. Moreover, it may be used as a "cross-finger" flap.

Adolescent↗
PubMed2003

["Square sail" flap in median nerve lesions at the wrist. Anatomical elements and review of twenty operated cases].

INTRODUCTION: Following an anatomical study on the vascular supply of the upper limb, we propose a new adipo-fascial flap at the wrist. The fat pad of pronator quadratus lies over the muscle and is vascularised by a recurrent branch arising from the anastomotic "cross-road" of the anterior interosseous, radial and ulnar arteries, at the radio-carpal joint. The peripheral extensions of the adipose tissue have to be anchored to the palmar fascia of the muscle in order to hoist the flap as a "square sail". The flap is then distally rotated in order to cover the traumatized median nerve segment at the wrist, for 2.5-3 cm of length. METHODS: The authors present a review of the clinical applications (1995-2001) on painful neuromas of the median nerve at the wrist, where traumatic and iatrogenic injuries frequently occur. The surgical procedure consists of external neurolysis followed by coverage of the nerve using this vascularised flap. RESULTS: The results confirm the usefulness of vascularised fat flaps in creating an optimal perineural environment in terms of biological and mechanical quality. The advantage offered by this particular local flap is that it can be speedily raised. Because of its limited length the flap is only able to cover the median nerve at the level of the carpal tunnel: its indications are therefore very selective but not rare, due to the frequency of median nerve injuries at this level. DISCUSSION: Clinical results were very satisfactory: in the twenty cases reviewed, resolution of the symptoms of algodystrophy and causalgia was consistently observed, sometimes to an extraordinary degree, and associated with an improvement in the neurological deficit.

Adipose Tissue↗
PubMed2003

Lupus vulgaris developing at the site of misdiagnosed scrofuloderma.

Cutaneous tuberculosis is a rare form of extrapulmonary tuberculosis primarily occurring in developing countries. The recent increase in the incidence of tuberculosis, especially due to human immunodeficiency virus (HIV) infections, has led to a resurgence of extrapulmonary forms of this disease. We describe a case of lupus vulgaris in a 33-year-old woman who had a 5-year history of a slowly growing plaque on her neck. The lesion was located at the site of surgery repairing the scar resulting from the incision of a subcutaneous abscess during childhood. This lesion was misdiagnosed as bacterial abscess. Histopathologic examination of the plaque revealed non-caseating tuberculoid granulomas consisting of lymphocytes, epithelioid and giant cells. Staining for acid-fast bacilli and culture from biopsied tissue was negative. Polymerase chain reaction (PCR) for detection of Mycobacterium tuberculosis DNA, performed on a skin biopsy specimen, was positive. A diagnosis of lupus vulgaris developing at the site of a previous misdiagnosed scrofuloderma was made. Conventional antitubercular therapy with rifampicin, isoniazid and ethambutol was administered for 6 months, resulting in resolution of the lesion.

Adult↗
PubMed2002

Effect of subclinical hypothyroidism and obesity on whole-body and regional bone mineral content.

OBJECTIVE: The present investigation was aimed to evaluate the effect of subclinical hypothyroidism and obesity on bone mineral content (BMC) in different body segments. METHODS: Thirty-two premenopausal women (age: 37 +/- 9.9 years), with a wide range in body mass index (BMI), were studied. Subclinical hypothyroidism was defined by a basal TSH > or = 4 microU/l and/or a TRH-stimulated peak > or = 30 microU/l. For each subject, weight, height, BMI (weight/height(2)) and the waist/hip ratio were measured. Total BMC, total bone mineral density (BMD), leg BMC, leg BMD, trunk BMC, trunk BMD, arm BMC and arm BMD were determined using dual-energy X-ray absorptiometry. Thyroid function (basal and TRH-stimulated TSH, free T(3) and free T(4)) were determined from fasting blood samples for all subjects. RESULTS: Anova was conducted within all the groups to observe the effect of thyroid status and/or obesity on BMC and BMD. There was no statistical difference for age. Total BMC was affected by obesity (p < 0.05) but not by thyroid status, BMD of the legs was significantly influenced both by thyroid function and obesity (p < 0.01); total BMD was affected by hypothyroid status (p < 0.05). A direct relationship between leg BMD and TSH was demonstrated. CONCLUSION: Subclinical thyroid hypofunction and obesity seem to affect BMD differently in the body segments. An influence of gravitational force seems necessary in order to make evident the effect of subclinical hypothyroidism on bone. A condition of subclinical hypothyroidism should be considered when evaluating subjects for osteoporosis, since a BMD measured at the femoral neck may induce underestimation of initial osteoporosis.

Absorptiometry, Photon↗
PubMed2000

Huriez syndrome: case report with a detailed analysis of skin dendritic cells.

We report a 60-year-old man with familial scleroatrophic syndrome of Huriez who developed squamous cell carcinomas on the affected skin of the right palm. Immunohistochemical analysis showed a marked reduction in the number of CD1a+, Lag+ and S100+ epidermal Langerhans cells, but not of CD1b+ and factor XIIIa+ dermal dendritic cells, limited to palmoplantar skin. The Langerhans cell depletion was not associated with an abnormal skin content of mRNA for factors involved in Langerhans cell development or recruitment in the epidermis, including granulocyte/macrophage colony-stimulating factor, transforming growth factor-beta1 and macrophage inflammatory protein-3alpha. The results indicate that other as yet unknown mechanisms may account for the reduced number of Langerhans cells in the affected skin of such patients.

Carcinoma, Squamous Cell↗
PubMed1994

Fracture callus in osteopetrosis.

The histologic features of bone callus after a traumatic fracture in a patient with osteopetrosis are presented. The fracture callus develops in stages that are apparently normal. The tissue is initially rich in bone-forming cells and vessels. One year later, however, unlike mature osteopetrotic bone, the tissue shows no Haversian organization.

Adult↗
PubMed1994

[Heyman's operation for the treatment of congenital metatarsus varus].

The authors report their experience with the operation of Heyman, i.e. complete release of the tarsometatarsal and intermetatarsal joint for the treatment of congenital metatarsus varus. This operation of Heyman is capable of meeting the requirements of correction if the indications are precise and if the surgical technique is perfect. The operation is indicated in cases of varus over 15 degrees, passively reducible, with good axes of the hindfoot and without bony alterations of the Lisfranc joint, in children between 3 and 8 years old. There should be a dorsal and medial capsulotomy, with section of the medial 2/3 of the plantar aspects of tarsometatarsal and intermetatarsal capsules; the lateral portion, the lateral 1/3 of the capsule and the insertions of the fibularis brevis and tibialis anticus should be spared. A complete capsulotomy is not indicated owing to the risk of dislocation of the tarsometatarsal joint. The correction should be stabilized during the operation by Kirschner wires to avoid a loss of correction when putting the foot in plaster.

Bone Wires↗
PubMed1991

[Rare localization of a glomus tumor in the knee].

The glomus tumor, characterized by the classic trio of tumefaction, acute pain on palpation, and sensitivity to cold, is localized most commonly in the hand and quite rarely in the knee. It occurs most frequently in subjects between the ages of 20 and 40, and its cause is unknown. Masson divided glomus tumors into 4 main types: angiomatous, stromal, nervous, and myxoid, according to the histo-pathological features present. The authors believe that the histological appearance may be affected by the functional phase of the tumor at the moment of surgery: with sphincters closed, meaning very little dilatation of the venous collection areas, or with sphincters open, meaning considerable dilatation of the venous collection areas due to increased hematic flow.

Adult↗
PubMed1991

[The metatarsophalangeal articulation and the transverse metatarsal ligament: anatomical observations].

The authors conducted a macroscopic anatomical study of the metatarsophalangeal joints of the middle toes in order to add to our knowledge of the anatomy and physiology of this structure. Anatomical observations reveal the foot's lack of transverse ligamentous formations (as the sagittal bundle in the hand) connecting the extensor tendon to the glenoid plate. Consequently, the containment of the extensor tendon above the metatarsophalangeal joint is considerably less stable in the foot than in the hand, since it is entrusted to the posterior portion of the interossei muscles and the deep and superficial retinacula (all formations which run in a prevalently oblique direction). Hyperextension of the metatarsophalangeal joint causes the posterior portion of the interossei muscles, bound to the extensor tendon, to slide proximally, straightening the fibers and loosening the structures that stabilize the extensor tendon. The tendon can then easily shift in a lateral direction with respect to the rotation axis of the metatarsophalangeal joint, acquiring a valgus action. Even though the metatarsophalangeal joint is equipped with strong collateral ligaments, the valgus action of the extensor tendon eventually overcomes the resistance of both these and the weaker connections to the plantar aponeurosis of the foot and the extensor tendons. In conclusion, the lack of structures to provide passive stabilization of the extensor tendon in the metatarsophalangeal joints of the toes makes the foot particularly susceptible to multiple-toe deformity.

Humans↗
PubMed1991

[Morton's disease: optic and electron microscopy observations].

The authors performed an optic and electron-microscope investigation above the common digital nerve of the foot, whose fragments had been surgically removed from patients suffering from "Morton metatarsalgia" (neuroma). Histological sections were taken from pre-stenotic swelling in patients with clinical symptoms persisting for one year; perineural thickening without evidence of fibroblastic proliferation could be demonstrated, together with an intraneural deposition of an amorphous substance. In other patients suffering from Morton's disease for a longer time, a more pronounced epineural thickening in the pre-stenotic zone could be shown, with partial replacement of nerve fibers by amorphous substance. In the same patients endoneural fibrositis was seen at the level of the stenosis. Electron-microscopy in patients after one year showed an increase in collagenous endoneural fibers and microfibrils. These histopathological findings suggest a compressive mechanism in the pathogenesis of the damage to the common interdigital nerve in Morton's disease, caused by the extrinsic anatomical structures surrounding the nerve. The so-called "neuroma" can be identified with the pre-stenotic swelling.

Adult↗
PubMed1990

[The modality of endoconnective ossification on cartilaginous substrate: observations on the long bones in the embryo].

The authors conducted a histologic study on the modalities of ossification of the "diaphyseal osseous ferrule" in embryos between the sixth and eighth week of intrauterine life: the ossification of this "diaphyseal osseous ferrule" presents some peculiarities compared to that of other areas: it occurs with the modalities of periosteal ossification, exploiting, however, a cartilagenous substrate. In addition, the authors compared the ossification of the diaphyseal ferrule to that of the "perichondrial ferrule of the layer of ossification", examining histologic sections of embryos in the 25th week of intrauterine life.

Cartilage↗
PubMed1990

[The foot in rheumatoid arthritis].

Because of its high incidence of rheumatoid arthritis, the foot is probably the best place to study this pathology. Timely diagnosis is very important considering the high risk of disability. On the basis of both other studies and first-hand observations, the particular clinical and radiographic characteristics of rheumatoid arthritis of the foot are analyzed, differentiating it from the same disease in other joints. The research and comparison of these particular aspects helped with the overall clinical evaluation of early-diagnosed rheumatoid arthritis, that is before the development of reabsorption phenomena, bone damage, deformities, and ankylosis of the joints of the foot.

Ankylosis↗