[Graphic representation of physiologic parameters on digital computers].
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Biomedical subjects
Publications and source records attributed to B Perin.
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Osteonecrosis is a disease characterized by the death of marrow and bone tissues. All bones may be affected, most commonly those of the hip, knee, shoulder, ankle as well as the small bones of the hands and feet. When the disease involves a weight-bearing joint there is a significant risk that subarticular fracture may develop leading to disabling arthrosis and requiring, therefore, arthroplasty surgery. Osteonecrosis typically affects patients in their third, fourth and fifth decades of life and is associated with many factors including other diseases and co-morbidities. Multifocal osteonecrosis is defined according to the involvement of at least three separated anatomic sites. We describe the case of a young man with osteonecrosis of the shoulder and hip joints which required total arthroplasty. Among biochemical investigations, an increase in the plasminogen activator inhibitor type 1 (PAI-1) levels associated with mild hyperhomocysteinemia was present. Another finding was the HLA B27, without signs of spondyloarthropathies. In patients with osteonecrosis, especially if multifocal, a careful medical history, a complete physical examination and some biochemical investigations, particularly those related to thrombophilia and hypofibrinolysis, should be performed.
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The authors report their experience of benign urethral stricture dilatation by balloon catheter in 11 male patients. Ten posterior and 2 anterior urethral strictures were treated; in 1 patient several narrowings coexisted at various levels. Etiology was inflammatory in 4 cases, iatrogen in 3, post-traumatic in 2, and equivocal in 2. The patients were studied both before and soon after dilatation by means of retrograde and voiding cystourethrogram and uroflowgraphy; the follow-up (2-14 months) was performed by urodynamics alone. In all cases, dilatation was followed by the restoration of urethral gauge, together with prompt functional improvement of urodynamic parameters. The latter result subsisted in time in 9 patients. In 2 cases recurrences were observed, demonstrated at once by clinics and urodynamics. Both lesions were successfully re-treated. Neither early nor late complications occurred. In spite of the limited material, the valuable results obtained, together with the absence of complications, the peculiar morphology of recurrences, and the chance of repeating it make the procedure advisible as a valid alternative to conventional techniques for these pathologies.
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Posttraumatic acute articular blocks of the knee may be caused by "mechanical" factors, such as the interposition of some osteochondral, meniscal or ligamentous fragments between condyles and tibial plateau or by non-mechanical ("functional") factors, such as the pain associated with capsular-ligamentous structure injuries or with intraosseous bruises involving the synovia. From January, 1994, to January, 1996, we examined 751 patients for posttraumatic knee injuries. The patients were submitted to MRI with a dedicated unit and we selected 86 of them who had an acute articular block as the major symptom. The block had a mechanical cause in 36 patients of the selected group (41.8%), as confirmed at arthroscopy, while the other 50 patients (58.2%) had a functional block. Fifteen of the latter patients had only intraosseous bruising, with no ligament or meniscus damage, while the other 35 had isolated or variously associated menisco-ligamentous injuries, as confirmed at arthroscopy. All the patients also had some intraosseous bruises which were clearly depicted at MRI. This study demonstrates that MRI is an extremely valuable tool in assessing the cause of articular blocks, allowing a prompt appropriate choice to be made between therapeutic arthroscopy and weight-free limb immobilization.