Biomedical subjects

C Alfonso

Publications and source records attributed to C Alfonso.

42 records · Page 3Linked to original sources

PubMedDate not supplied

Recurrent lumbar disc herniation: what recurs? (A morphological study of recurrent disc herniation).

A morphological study was conducted on disc material obtained during surgical discectomy in 20 patients. The series was divided into 4 groups. Group I: 3 patients who had never been operated on before; group II: 3 patients who had already been submitted to discectomy but at a level which differed from that of the disc examined; group III: 4 patients treated surgically for contralateral herniation; group IV: 10 patients with true recurrent disc herniation, that is, already submitted to surgery for the treatment of homolateral herniation of the same disc. All of the cases submitted to surgery had been operated on more than a year previously. Moreover, the disc material obtained during autopsy in a patient operated 15 years before for disc herniation was studied. A morphological study of the cases and the data reported in the literature reveals that the fibrocartilaginous tissue of recurrences differs from that of primary herniation because of the presence of large collagen bundles associated with fibrillar framework. This aspect suggests the hypothesis that is also supported by the autoptic material examined that recurrent disc herniation is formed by repair tissue that substitutes the part of the disc that is operated on, and that recurrent herniation is caused by mechanical collapse of the repair tissue. From a surgical point of view, a distinction may be made in terms of early recurrences, which appear within one year of surgery and are formed by disc tissue which is identical to that of primary herniation, and late recurrences, the subject of this morphological study.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

Anterior surgery of the upper part of the cervical spine by prevascular extraoral approach.

Anterior surgery of the upper part of the cervical spine, that is, proximal to C3, may be performed by transoral approach, possibly enlarged by glossomandibulotomy, by a retrovascular extraoral approach, or by a prevascular extraoral approach. The authors describe the surgical method of prevascular extraoral approach that allowed them to effectively treat osteoma localized at C2 and C3, post-laminectomy instability at C3 and C4, solitary metastasis at C3. As compared to transoral surgery the prevascular extraoral approach has the advantage of avoiding the risk of infection from germs in the oral cavity and of allowing for easier postoperative management, avoiding tracheotomy and/or prolonged dysphagia. As compared to a retrovascular approach the prevascular approach obtains a truly anterior exposure instead of an anterolateral one. Prevascular extraoral approach should thus be used whenever possible. Transoral surgery is indicated for decompression, of the brainstem and a bilateral retrovascular approach may be used to perform anterolateral fusion at C1-C2.

Aged↗

PubMedDate not supplied

Dysphagia due to cervical osteophytosis.

Cervical lesions caused by diffused idiopathic skeletal hyperostosis may cause compression of the upper respiratory and digestive paths. Horizontal anterior osteophytes that are not fused can cause dysphagia and dysphonia, large prevertebral ossifications extended or segmental may cause difficulty in breathing. A series of 6 cases with dysphagia, dysphonia, dyspnea due to duffused idiopathic skeletal hyperostosis, with cervical lesions is reported. In 3 cases, affected with moderate dysphagia, conservative treatment with anti-inflammatory drugs and a proper diet allowed for the symptoms to be controlled, and for spontaneous evolution of the lesions to occur, with fusion and remodeling of the compressive osteophytes. These patients continue to be asymptomatic 2-7 years after the first observation. In 3 cases affected with severe respiratory and/or nutrition deficit, the osteophytes and ossifications were surgically removed by prevascular extrapharyngeal approach, and rapid resolution of symptoms ensued. The follow-up 1-2 years after treatment showed that patients were asymptomatic and that radiographically there was no recurrence of lesions.

Aged↗

PubMedDate not supplied

Cyst of the medial meniscus: observation of two cases.

The authors report two cases of cyst of the medial meniscus. In both cases imaging diagnostics, CT scan, or MRI allowed us to reveal the characteristic horizontal meniscal lesion that would be the primary cause of cystic degeneration of the meniscus. The two cases were treated by selective resection of the meniscal lesion and arthroscopic decompression of the cyst.

Adult↗

PubMedDate not supplied

Anterior surgery in trauma of the cervical spine.

The study reports a series of 37 traumatic lesions of the cervical spine treated surgically by anterior approach. The series includes two IInd type fractures of the odontoid, treated by direct screwing, 32 recent fractures or fracture-dislocations of the lower cervical spine treated by decompression and anterior arthrodesis with a plate, 3 inveterate dislocations treated by anterior-posterior osteotomy in 2 cases, and decompression-arthrodesis in the third. One amyelic fracture of the odontoid healed in 4 months, the other patient, with Frankel C spinal cord lesion improved to D, but died 4 months later as a result of bronchial pneumonia ab ingestis. In all of the recent lower cervical lesions fusion was obtained in 3-12 months (mean 4.5 months). Eight incomplete spinal cord lesions improved by 2 Frankel classes in 3 cases and by 1 in 5. Six nerve root lesions healed with complete recovery. Three cases with no neurologic deficit remained unchanged as did 15 complete spinal cord lesions. In the 3 inveterate cases we obtained healing of a slow-developing myelopathy (Frankel D) after osteotomy, no improvement after osteotomy in the second case (Frankel B). In the case submitted to decompression and anterior fusion we obtained recovery from Frankel B to E in three months, but the patient then died as a result of pulmonary complications. Direct screwing of the odontoid allows us to obtain healing of the type II fractures without blocking C1-C2 movement with a posterior fusion. Anterior surgery in traumas of the lower cervical spine allows for anatomical decompression of the spinal cord and bone reconstruction with good results, avoiding the risk of neurologic progression caused by dragging of the disc material in the spinal canal, that may take place at the time of non-surgical reduction or by posterior approach of the dislocations. In our series complications included 2 infections, 1 that healed without sequelae and the other with kyphosis, and a fistula of the hypopharynx caused by fibrobronchoscopy 1 year after osteosynthesis, that healed after primary repair. For this latter complication anterior surgery can, at most, be considered a contributing cause, because of the deep scar.

Adolescent↗

PubMedDate not supplied

Intralesional surgery of primary tumors of the anterior cervical column.

The study involves a series of 10 primary neoplasms of the anterior cervical column (body and transverse processes) surgically treated by intralesional excision and followed-up after 2-10 years. The series included 6 benign and 4 malignant neoplasms. Among the benign tumors 4 cases were classified Enneking stage II (2 osteoid osteomas, 1 fibrous dysplasia, 1 osteoma): after simple excision none of the cases revealed symptoms or signs of recurrence at long-term follow-up. The other 2 benign forms were stage III (giant cell tumor and aneurysmal cyst): both of the cases were treated by extracapsular intralesional excision after selective arterial embolization and reconstruction with anterior fusion; the giant cell tumor was irradiated after surgery: at long-term follow-up the patients were asymptomatic and there were no signs of recurrence. The 4 malignant neoplasms (stage IIB) were 1 osteosarcoma and 3 solitary plasmacytomas with spinal cord compression. The osteosarcoma was treated by intralesional excision in 3 stages and radiation therapy, and there were no signs of disease 6 years after diagnosis. The cases of plasmocytoma were treated by intralesional excision and spinal cord decompression, anterior fusion with iliac graft and plate, radiation therapy, and chemotherapy, and they died after 2, 3 and 4 years with findings of multiple myeloma with no signs of disease at the level of the cervical vertebra treated.

Adolescent↗