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Biomedical subjects

E Scola

Publications and source records attributed to E Scola.

At least 19 recordsLinked to original sources
PubMed2002

[Dislocated supracondylar humerus fracture in the child. Surgical technique and outcome with dorsal approach].

Anatomical reduction and stabilization of displaced supracondylar humeral fractures in children is necessary to obtain good results. For most cases percutaneous crossed pinning is recommended. Sometimes open reduction is necessary but even in these cases neurological complications and varus deformities have been reported. So the technique of open pinning was modified. From 1995 to 1998 22 children were treated by a dorsolateral approach. The fracture was stabilized by crossed pinning: The proximal K-wire is drilled 10 degrees ascending to the dorsal humerus through the medial pillar into the ventral part of the medial epicondyle, after shortening it is not bent. The distal K-wire stabilizes the lateral pillar, after shortening its end is bent down. Immobilization for 3-4 weeks, mobilization is done by the patient. The implants are removed 2 weeks later. The follow up in 21 out of 22 patients (8-57 months, mean 35 months) according to Flynn's criteria showed 16 excellent, 4 good and 1 fair result. The fair result was due to valgus deformity. One patient has been reoperated due to displacement of K-wire. Neither iatrogenic nerve lesions nor varus deformities nor infections did occur. The dorsolateral approach combined with the above mentioned technique of pinning shows excellent and good results.

Bone Nails↗
PubMed2000

[Morphological changes in arterial ruptures].

The historical opinion that the intima layer of a ruptured artery of muscular type could stop bleeding by "rolling in" should be controlled experimentally. Five segments of human femoral/popliteal artery (3-4 cm long) were overstretched until complete rupture occurred. Furthermore a longitudinally split and a partially oblique incised segment were ruptured. As morphological finding a sandclock deformity was observed in the region of rupture. This phenomenon was induced by adventitia layer, which closed the ends of ruptured media layer like a Chinese finger trap. In the longitudinally split segment a transverse rupture of the media layer could be observed, while the fibers of adventitia layer were pulled out when the traction was continued. Neither macroscopical nor microscopical signs could be found for "rolling in" of intima or media layer. The reason for spontaneous hemostasis after arterial rupture is more likely the activation of platelets by collagenous fibers of adventitia layer than "rolling in" of intima or media layer. If there is no finger trap mechanism of adventitia layer like in shot- or stab wounds a massive blood loss must be expected.

Adolescent↗
PubMed1999

The Gregorio Marañón Hospital experience with vertical partial laryngectomies.

We present a retrospective study of 551 patients treated with conservative surgery for glottic carcinoma at the Gregorio Marañón Hospital between 1962 and 1996. In all, 12% of cases were locally advanced carcinomas. In early-stage carcinomas there were no statistical differences in 5-year survival between those treated by endoscopic laser resection, vertical hemilaryngectomy and radiotherapy. However, tumor recurrence after primary radiotherapy was higher (27%) than with conservative surgery (12%), while the voice preservation rate was significantly higher with surgery (83%) than with radiotherapy (72%). With locally advanced cancer, irradiated patients (to 60 Gy) had a 50% probability of recurrence with a very low chance for salvage by total laryngectomy (5-year survival rate, 38.5%). In contrast, partial laryngectomy could be performed on carefully selected patients, and the results for these patients were comparable to those for smaller lesions (with a 5-year survival rate of 81%).

Actuarial Analysis↗
PubMed1996

[Laryngeal vertical partial surgery. Surgical techniques. Oncological and functional results].

We present the results of a retrospective study of 467 patients treated with conservative surgery for glottic carcinomas at the ENT department of the "Gregorio Maranon" Hospital between 1962-1993. The disease was staged using the criteria set forth in 1988 by the AJCC, and 27.7% patients were intermediate to advanced stages. Our theoretic treatment protocol is presented. The 5 years uncorrected actuarial survival related to stage was 85.6%, 71.4% and 71% for stages I, II and III respectively. In stages I and II local failure occurred in 22.4% when patients were treated by laryngofisure and 10.8% when treated with hemilaryngectomy. The 5 years local control related to stage was 92.6%, 81.72% and 73.24% for stages I, II and III respectively. In stages I and II the 5 years survival with voice was 75.2% when the patients were treated with radiotherapy and 84.9% when treated with partial laryngectomy. Functional results have been evaluated according to a three grade scale. Good and fair results were 91.1% for the quality of voice, 99.7% for swallowing and 97.6% for respiration.

Carcinoma, Squamous Cell↗
PubMed1996

[Conservative surgery for supraglottic carcinoma. Surgical technique. Oncologic and functional results].

We present the results of a retrospective study of 817 patients treated with conservative surgery for carcinomas of the supraglottic larynx at ENT department of the Gregorio Maranón Hospital between 1962-1993. The disease was staged using the criteria set forth in 1988 by the AJCC, and 36,2% were stages III and IV. From the 817 patients treated with conservative surgery 230 were extended supraglottic laryngectomies. Our theoretic treatment protocol is presented. The 5 years actuarial uncorrected survival rate related to stage was 83,9%, 83,2%, 78,5% and 55,3% for stages I, II, III and IV respectively. Local-regional failure occurred in 32,9% patients overall, and the most common site for local-regional failure was the cervical nodes. The 5 years local control rate related to stage was 86,97%, 89,1%, 82,15% and 66,55% for stages I, II, III and IV respectively. In extended supraglottic laryngectomies the 5 years uncorrected survival rate was 62,6% in supraglottic laryngectomies (SL) extended to the base of the tongue, 62,5% in SL extended to the hypopharynx, 72,5% in SL extended to the arythenoyd and 79,4% in SL extended to the vocal chord. The 5 years local control rate was 87% in SL extended to the base of the tongue, 85,7% in SL extended to the hypopharynx, 97% in SL extended to the arythenoid and 90,8% in SL extended to the vocal chord. Functional results have been evaluated according to a three grade scale. Good and fair results were 97.6% for swallowing, 90% for respiration and 95.8% for the quality of voice.

Humans↗
PubMed1991

[Surgical treatment and late results of foot compartment syndrome].

From 1982 to 1988 a total of 29 patients with compartment syndrome of the foot were treated by fasciotomy. The most common causes were fracture dislocations of the Lisfranc (n = 14) and Chopart joints (n = 4). Since these injuries lead to a severe damage to soft tissue structures--joint capsules, ligaments, fasciae--the muscular compartments often communicate and decompression can be achieved by a longitudinal dorsal incision of the skin and fasciotomy of the fascia dorsalis pedis and the retinacula extensorum superior and inferior. Subsequent measurement of intracompartmental pressure dictates whether blunt dissection of the interosseous muscles and separate fasciotomy of the medial, lateral and plantar compartments have to be performed. Follow-up was possible in 18 patients: half had good results, while 9 patients had limited motion of their toes and/or paresthesia. It is impossible to know whether these negative findings are caused by the compartment syndrome itself or by the severe soft tissue damage resulting from the initial trauma.

Adolescent↗
PubMed1991

[Pathophysiology and pressure measurement in compartment syndrome].

Traumatic or ischemic damage of the musculature and soft tissue may cause compartment syndrome. In trauma, mechanical influences provoke humeral disorders and liberation of vasoactive substances with early onset of compartment syndrome, but isolated total ischemia of more than 6 h is commonly followed after revascularization by compartment syndrome caused by post-ischemic dilation of vessels. An understanding of the pathophysiology in compartment syndrome provides a better possibility of predicting this severe complication in trauma and vascular surgery patients. Several techniques are described for intracompartmental pressure monitoring. In normotensive patients, an intracompartmental pressure of more than 40 mmHg indicates "apparent" compartment syndrome, while pressures between 30 mmHg and 40 mmHg are interpreted as "imminent" compartment syndrome. In these cases therapeutic/prophylactic dermatofasciotomy is necessary. In hypotensive patients the lower limit for conducting a dermatofasciotomy must be reduced. According to the pathophysiology, an intracompartmental pressure of about 30 mmHg for more than 6 h duration must be treated by dermatofasciotomy.

Compartment Syndromes↗
PubMed1991

[Compartment syndrome in popliteal artery injury].

Between 1973 and 1988 50 patients with injuries of the popliteal artery were treated at the Medical School of Hannover University. While 26 patients with dislocations of the knee joint had mild soft tissue injuries, most of the 24 patients with periarticular fractures of the tibia and/or femur showed excessive soft tissue damage. In both groups 11 patients who were admitted with prolonged ischemia had to undergo amputations. Primary amputations were performed according to the recommendations of. The mean duration of ischemia was 5.5 h (range 2.2-9 h) in patients with knee dislocations (n = 21); fasciotomy was performed in 14 patients (67%). In patients with popliteal artery injuries combined with fractures (n = 18) the average duration of ischemia was 6.5 h (3-13.5 h); in 16 cases in this group (89%) fasciotomy had to be performed. Fasciotomy was always necessary in patients with combined injuries of the popliteal vein and artery. Moreover, all patients with ischemia of more than 6 h duration required fasciotomy. It can be concluded that fasciotomy will probably be necessary in patients with injuries of the popliteal artery and (a) severe soft tissue damage of the thigh and/or lower leg with compartment pressure of more than 30 mmHg; (b) ischemia of more than 6 h duration; (c) combined injuries of the popliteal vein and artery; (d) reconstruction of severely injured extremities. In general, fasciotomy should always be considered after reconstruction of the popliteal artery.

Amputation, Surgical↗
PubMed1990

[Significance of thrombocyte-collagen interaction in arterial laceration].

The interaction of platelets with the extracellular matrix (i.e., collagen) has been the subject of intensive research in the past 25 years. With today's knowledge it is possible to explain why blood loss is minimal in cases of arterial rupture. As discussed earlier, a direct interaction of platelets with collagen was suspected for cellular thrombogenesis in arterial injuries. The first step in this interaction is a loose adhesion of platelets onto mature collagen with activation of the platelets. This is followed by aggregation and activation of the platelets through adhesins, which interact with special glycoproteins of the platelet's surface. At the same time, fibrinogenesis is started and facilitated by expression of platelet-factor 3 from the membrane surface of the platelet, so the production of thrombin is acclerated. The activation of platelets induces mobilization of calcium from the dense tubular system, which is needed for almost all reactions in arterial thrombogenesis. Exogene and platelet-endogene factors are responsible for the platelet activation. The further activation of platelets is maintained by thromboxane A2 and thrombin. The regulation of platelet aggregation is controlled by cAMP and prostacyclin. These well-documented findings are the reason for the very rapid arterial thrombogenesis in cases of arterial rupture combined with a special "fingertrap mechanism" of the scissorlike structure of the adventitia. Therefore, severe hemorrhage is prevented. Even in microvascular lesions the platelet-collagen interaction will be found, so this mechanism must also be considered in the pathophysiology of traumatic compartment syndrome and lung contusion.

Animals↗
PubMed1990

[Pathological mechanism of spontaneous hemostasis in traumatic artery rupture].

In ruptures of arteries the spontaneous haemostasis was supposed to be induced by 'rolling' of the intima until now. Experiments with isolated arterial segments (human femoral artery) and in vivo with ovine femoral arteries could not show this mechanism as the reason for the spontaneous haemostasis. The structure of the adventitia and its typical behavior during rupture procedure explains better the 'sandglass formation' in arterial ruptures with fractures and dislocations. This is induced by a 'fingertrap'-mechanism of the adventitia. The adventitia is sealed by platelets, which show a direct interaction with the collagen fibers of the adventitia. The platelet thrombus is stabilized by fibrin.

Adult↗
PubMed1990

[Macroscopic and microscopic appearance of arterial stumps in limb segment amputation].

Until now, it has been assumed that in arterial lesions invagination of the intimal layer occurs. In a thigh and an upper-arm amputation this assumption was scrutinized. No hemorrhage or hypovolemic shock occurred in either case despite total amputation. The brachial and femoral arteries were closed and pulsed visibly within the soft tissue. Histology showed no invagination: the adventitial layer was drawn over the open lumen, which was filled with an extensive thrombus. Therefore, in these cases occlusion of the artery is presumed to occur by means of a fingertrap mechanism of the adventitia and the interaction of collagenous fibers with platelets. This hypothesis will be tested in an animal experiment.

Amputation, Traumatic↗
PubMed1990

[Experimental over-stretching of the femoral artery in the sheep in situ].

Arterial lesions associated with fractures or luxations are thought to be caused by an overstretching mechanism. In this paper we would like to elucidate this mechanism in an animal model. Eight sheep (mean age 1.7 years, mean weight 67 kg) were placed under general anesthesia and their femoral arteries prepared. Before stretching, a lesion was induced by crushing the artery with a blunt household wire clipper, so that the adventitial layer was not damaged. With a balloon catheter (inserted through a vessel branch) rupture of the intimal and medial layers was induced. The adventitia was lengthened in situ by tearing with the fingers until a sand-glass form occurred. Two to three minutes later the arteries were occluded proximally and distally so that traction could be stopped. After removal, the vessels were fixated immediately in formaldehyde and embedded in methylacrylate. Using the van Gieson elastica technique, 4- to 6-microns sections were stained. On histological examination of the proximal stump, a thrombus was located in the lumen surrounded by adventitial tissue, which was sheared off from the medial layer for some distance. There was no invagination of the medial layer. The histology of the distal arterial stump is shown in Fig. 6. The findings are similar to those in Fig. 5; in particular, the behavior of the adventitia can be seen here, the thrombus is enveloped by adventitial fibers. These findings can be explained by the three-dimensional network of the adventitia. With regard to the large amount of fibers, a direct platelet-collagen-interaction may be responsible for this thrombus.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Unicameral bone cysts--comparison between surgical and steroid injection treatment.

Two series of 20 patients each with unicameral bone cysts were compared, one treated before 1975 by curettage and bone grafting and the other treated after 1975 with methylprednisolone acetate (MPA) injections. At follow-up, the majority of patients were at the end of skeletal growth. In the MPA-treated series, the average age of the patients at diagnosis was 9.1 years, whereas the average age at follow-up was 16.7 years. The average follow-up interval was 7 years. The steroid-treated series had better radiographic final results than the surgically treated series, with a lower recurrence rate. The number of MPA injections required to heal the lesion ranged from one to six, with 70% of the patients requiring a maximum of three injections. Steroid injection treatment should be preferred to surgical treatment for the better final results, for the virtual absence of complications, and for the greater simplicity of execution and postoperative care.

Adolescent↗
PubMed1986

Transient osteoporosis of the hip.

The authors report 6 cases of transient osteoporosis of the hip. This is a rare disease but it should nevertheless be taken into account in the differential diagnosis with other inflammatory or neoplastic diseases of the hip. Even without treatment, it tends to regress spontaneously, but the pain can sometimes last for several months. Calcitonin is a reliable therapeutic agent and considerably shortens the natural course of the disease.

Adult↗
PubMed1986

Supracondylar fractures of the humerus in children. Analysis at maturity of fifty-three patients treated conservatively.

From a pool of 131 supracondylar fractures of the humerus in 131 patients who were treated conservatively, all of which healed in an average time of 4.5 weeks without complications related to the treatment itself, the cases of fifty-three patients were reviewed at maturity. The average age at follow-up was twenty-six years. Nine patients had unimportant limitation of elbow motion, and slight atrophy of the musculature of the arm or forearm, or of both, was present in six patients. Arm-length discrepancy was never observed. The carrying angle remained at about the same value that had been present at the time of fracture-healing in eighteen patients, decreased in twenty-two patients, and increased in thirteen. Malrotation of the distal fragment of the fracture only rarely caused medial tilting of the fragment with consequent cubitus varus. Varus deformity was present in four patients and valgus deformity, in three. None of the patients with valgus deformity had ulnar-nerve palsy. According to our results, varus and valgus deformities of the elbow after supracondylar fractures of the humerus seem to be caused either by growth imbalance of the growth plate of the distal end of the humerus (four patients) or by malreduction of the fracture (three patients). Twelve patients in the entire pool had neurological complications at the time of the fracture. Ten of those patients fully recovered from the deficit, whereas two--one with a radial-nerve deficit and the other with ulnar-nerve involvement--still had neurological impairment at follow-up.

Adolescent↗
PubMed1985

De Quervain's disease. An ultrastructural study.

The tendon sheaths of extensor pollicis brevis (EPB) and abductor pollicis longus (APL), obtained from four patients with de Quervain's disease were studied by light and electron microscopy. Three different layers were identified in the sheath which was much thicker than normal. Both the outer and the middle layers had thick bundles of collagen fibres with scattered fibroblasts. The inner layer was mainly formed by chondroid and myxomatous tissue. Collagen fibrils were thicker than normal, reaching 2100 nm in diameter. Numerous cells which resembled "myofibroblasts" were scattered throughout the whole thickness of the sheath. The results seem to indicate that thickening and hardening of the EPB and APL tendon sheaths in de Quervain's disease is caused by increased synthesis of the extracellular matrix, increased thickness of the collagen fibrils and areas of myxomatous and chondroid metaplasia.

Adult↗
PubMed1983

Replacement of femoral head endoprosthesis with total hip prosthesis. A report of five cases with problems of management.

Five cases who had endoprosthesis implanted for medial fracture of the neck of the femur are reported. All of them developed late complications that required replacements of endoprosthesis with total hip prosthesis. Complications included wearing of both joint cartilage and subchondral bone of the acetabulum, osteoporosis of the proximal end of the femur and fracture of the femur and the level of the endoprosthesis. Several problems of surgical management ensued. This experience strengthens the author's opinion that other forms of treatment--reduction in traction and nailing or total hip prosthesis--should be tried first also in particular cases of chronologically aged, but physically healthy patients with medial fractures of the neck of the femur.

Aged↗