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Biomedical subjects

F Brunelli

Publications and source records attributed to F Brunelli.

At least 55 records · Page 3Linked to original sources
PubMed1991

[Presentation of a new homodigital, countercurrent sensitive island flap].

The authors present new sensitive homodigital island flap which can be used to cover large finger pulp defects when classical techniques cannot be applied. An anatomical study consisting of the meticulous dissection of the branches and anastomoses of the digital arteries formed the basis for this new flap. The precise but safe surgical technique is described with the presentation of the first five clinical cases. The authors consider the following advantages of this flap: unrestricted coverage of large pulp defects, the flap is innervated after repair of the transposed digital nerve, tension is avoided allowing immediate mobilization. They also consider the disadvantages related to the necessary section of the digital nerve and artery. However the authors consider that the benefits outweight the disadvantages when compared with conventional techniques.

Adult↗
PubMed1991

Gastric emptying and interdigestive antroduodenal motility in patients with esophageal scleroderma.

The study was carried out on two groups of patients with esophageal scleroderma (LES pressure less than 5 mm Hg and amplitude of smooth muscle pressure waves less than 10 mm Hg): one group included patients with mild (group M) and the other severe (group S) gastroesophageal reflux (GER) diagnosed by ambulatory esophageal pH monitoring. Nine normal subjects were used as controls. Antroduodenal motility was recorded by means of manometry for 200-300 min after an overnight fast and the gastric emptying (T1/2) of a semisolid meal was measured utilizing a scintigraphic method. Patients of group S showed a significantly lower incidence of migrating motor complex activity fronts, as well as a more delayed gastric emptying, compared with those of group M. The reason that patients with the same degree of esophageal motor impairment have different degrees of GER may lie in the fact that the concomitant impairment of gastrointestinal interdigestive cyclic clearing activity and the delay in gastric emptying may allow a larger quantity of material to remain stagnant in the gastric lumen, readily available for gastroesophageal reflux.

Adult↗
PubMed1990

Strategy and timing of peripheral nerve surgery.

The authors review the latest theories of peripheral nerve regeneration and repair. They present their research on nerve regeneration including the alterations in the mother cell body, and in the distal part of the axon, and the time required to reach the best production of amino acids for cytoskeleton reconstruction. Other research of particular interest which is presented regards the chemotactic arrangement of motor and sensory axons inside a vein. This research has shown that the axons are able to find their way to the appropriate (sensory or motor) distal endoneural tubes. Adoption phenomena are also presented. The discussion of surgery includes the type (suture, glueing, grafts, tubulization) and the time of surgical repair. Timing and repair strategies are related to the site of the lesion (which can require that a greater or smaller amount of cytoskeleton be reconstructed), the type of the injury, the state of surrounding tissues, the age of the patients, injuries to muscles, tendons, bones, vessels and skin. A scheme of strategy is proposed.

Endothelium, Vascular↗
PubMed1990

[Direct muscular neurotization].

The authors present a technique of direct muscular neurotization consisting of re-innervation by direct implantation of a nerve into one or several muscles in cases of avulsion of the nerve supplying the muscle or traumatic or surgical avulsion of the neural part of the muscle. The biological basis for this operation is that a denervated muscle can accept a new innervation by a foreign nerve even in an aneural zone because its sensitivity to acetylcholine is present throughout the muscle, while, in a normally innervated muscle, sensitivity to acetylcholine is confined to the motor endplates. The results of 47 cases are presented: 42 of them obtained good or very good results.

Animals↗
PubMed1990

[The Bentall technique for the treatment of aortic aneurysms and acute aortic dissections: our experience with 24 cases].

Authors report their experience between 1981 and 1989 in the surgical treatment of 24 patients, aged 11 to 68 years, with chronic aneurysm of the ascending aorta (14 cases) or acute aortic dissection (10 cases), 7 of them being in cardiogenic shock with cardiac tamponade. In 7 patients the classic Bentall technique was employed, in 7 a modified Bentall technique and in 10 cases reimplantation of the coronary arteries was performed. In 2 cases a coronary artery by-pass, by saphenous vein graft, was placed on the right coronary artery, which was involved in the dissection. Valved dacron conduits were always employed. Two patients died after the operation whereas no late deaths were recorded in a follow-up interval ranging from 3 months to 7 years. The modifications of the classic surgical technique described in 1968 by Bentall-De Bono are of primary importance in diminishing the operative mortality and the incidence of early and late complications in these patients, whose disease nonetheless remains a surgical challenge.

Acute Disease↗
PubMed1990

[Supraventricular aortic stenosis. A different surgical approach].

A 15-year old female with William's syndrome became symptomatic for congenital supravalvular aortic stenosis. Surgery was carried out using an unpublished technique which consisted in a symmetrical enlargement of the aortic root by inserting three triangular patches of autologous pericardium. This method has the advantage of restoring normal valvular competence while respecting coronary orifices .

Adolescent↗
PubMed1990

[Arthrodesis of the wrist in cases of hand paralysis (personal technique)].

Arthrodesis of the wrist in cases of paralysis of the upper limb, although rejected by certain authors, is a valid operation provided it is confined to certain indications such as paralyses requiring minimal muscle transfers. Arthrodesis of the wrist is particularly useful in the sequelae of brachial plexus lesions with dissociated paralysis and in total paralysis of the radial nerve with hand drop and preservation of the wrist flexors. Numerous techniques of arthrodesis have been proposed. Over the last 27 years, the authors use a technique with a direct dorsal incision. The first row of carpal bones and the radius are roughened with chisel. A cortico-cancellus graft is then raised from the dorsal surface of the radius, leaving a distal cortical bridge. The graft is slid under this bridge, placed onto the roughened surface of the carpus and pushed under the operculum raised at the base of the 2nd and 3rd metacarpals. The arthrodesis is fixed with two Kirschner pins and a plaster for 3 months. We have used this technique in 31 patients with nerve paralyses since 1971 and have obtained complete consolidation with total patient satisfaction in all but one case.

Activities of Daily Living↗
PubMed1990

The esophagus as a possible cause of chest pain in patients with and without angina pectoris.

In a series of 18 patients with angina pectoris, in whom treatment over at least 3 years with nitroderivatives and Ca-antagonists had become partially ineffective on chest pain, and in 18 patients with angina-like non-cardiac chest pain, the following examinations were carried out: upper gut x-ray and endoscopy, acid perfusion test, esophageal manometry, 24-hour esophageal pH monitoring associated with Holter recording. The presence or absence of coronary insufficiency was established by means of scintigraphic and ECG tests, Holter monitoring and coronary arteriography. In both groups the majority of patients had abnormal esophageal function, but in patients with angina pectoris treated for a long period of time the motility changes were prevalently reflux-related. With respect to the origin of chest pain, the esophagus was found to be the likely cause in 4 patients with angina pectoris, and the probable cause in another 10 of the same group; it was the likely cause in 7 patients without angina pectoris, and the probable cause in another 7 of the same group. As nitroderivatives and Ca-antagonists decrease the LES tone and the amplitude of esophageal pressure waves, long-term treatment with these drugs may be taken into account in the genesis of gastro-esophageal reflux and related changes, including esophageal pain.

Angina Pectoris↗
PubMed1989

Stabilisation of the trapezio-metacarpal joint.

A new technique of trapezio-metacarpal stabilisation is described which uses the abductor pollicis longus tendon passed through the bases of the first and second metacarpals to fasten the base of the thumb. A biomechanical rationale is presented, as well as the surgical technique and 12 results at follow-up one to six years later.

Adult↗
PubMed1989

[Repair of cutaneous tissue loss of the arm. Development of the principles and technics].

Few sectors of reconstructive surgery have evolved as quickly over the past few years as the use of skin flaps, especially those used to cover losses of substance in the upper limb. This development is due to the increasing concern of surgeons about: 1) ensuring selective coverage of higher quality (the teguments used for the hand must be supple, thin and sensitive); 2) having reliable techniques; 3) reducing operating times and the duration of treatment.

Arm↗
PubMed1988

Neurolized nerve padding in actinic lesions: omentum versus muscle use. An experimental study.

Free microvascular greater omentum flap to pad brachial plexus after neurolysis for actinic lesions is a major operation. Thus several authors have suggested a simple padding by means of traditional muscle flaps. As contouring the brachial plexus elements is difficult using muscle, we wished to evaluate the formation of perineural fibrosis with either omentum or muscle, following neurolysis. An experimental model in rats was set up, dividing the two femoral nerves and wrapping one of them with the greater omentum and the other with abdominal muscles. The degree of perineural fibrosis at light microscopy observation was fivefold greater when muscle, rather than omentum, was used.

Animals↗
PubMed1988

The treatment of acromio-clavicular dislocation by transfer of the short head of biceps.

A follow-up of 78 patients with acromio-clavicular dislocation who have been operated on since 1956 is reported. The tendon of the short head of the biceps is transferred to the clavicle to obtain, and maintain, reduction. The site of transfer in the last 51 cases has been to a point on the clavicle immediately above the coracoid process. The acromio-clavicular joint is only opened when an obstruction to reduction is present. The functional results in this group of patients are very good.

Acromioclavicular Joint↗
PubMed1988

Traumatic aneurysms of two proper digital arteries in the same patient: a case report.

Aneurysms in the hand are infrequent and aneurysms of the proper digital arteries are particularly rare, only 11 cases having been reported in the literature. The authors describe the case of a patient operated on for two traumatic false aneurysms of the ulnar digital arteries of the middle and ring fingers. Arterial aneurysms should be carefully evaluated to exclude other lesions such as cysts, abscesses, neuromas. The choice between ligation and resection or reconstruction of the vessel should be based on pre-operative and intra-operative evaluation of circulation.

Adult↗
PubMed1988

Fontan repair for tricuspid atresia: experience with 50 consecutive patients.

From April, 1975, to October, 1985, 50 patients (mean age, 5.3 years; range, 2.5 to 14 years) underwent a Fontan repair for tricuspid atresia or severe tricuspid stenosis. Fifty-six palliative operations had been performed previously in 43 patients. Twenty-nine patients received an atriopulmonary connection by direct anastomosis [19], interposition of an aortic homograft [7], or a porcine heterograft [3]. An atrium-subpulmonary chamber connection was performed in 21 patients (Björk modification, 10; Dacron tube, 10; valved conduit, 1). Eleven patients (22%) died early, 6 of whom did not meet the established criteria for a Fontan operation. One patient died 6 months postoperatively of superior vena cava thrombosis. Four patients were reoperated on successfully. At a mean follow-up of 28.8 months, 28 patients are in New York Heart Association Functional Class I and 9 are in Class II; 1 patient was lost to follow-up. Thirteen patients underwent control catheterization fifteen days to four years postoperatively (median right atrial pressure, 14 mm Hg). Exercise testing in 9 asymptomatic patients, performed after a mean interval of 33 months, showed a moderate impairment of cardiac performance. We conclude that in select patients, a Fontan repair appears to be a reliable procedure at medium-term follow-up.

Adolescent↗
PubMed1988

The subcutaneous overturned skin flap in continuity according to the "double door" technique.

Loss of skin substance with exposure of the bone may be repaired with adjacent or distal flaps, pedunculated or free. For the more distal areas of the limbs it is difficult to find adjacent flaps which do not leave considerable defects at the donor site. To overcome this and also to avoid lengthy major surgery, the author has developed the overturned subcutaneous or fascial flap, raised by using the "double door" method prepared like Colson greffe flaps. The subcutaneous flap may be axiated or random and is covered with a mesh-graft while the "double doors" are sutured to close the donor site. The method is described and the first cases are presented.

Fractures, Open↗