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Biomedical subjects

F Postacchini

Publications and source records attributed to F Postacchini.

At least 37 records · Page 2Linked to original sources
PubMed1995

Early fracture callus in the diaphysis of human long bones. Histologic and ultrastructural study.

The medullary callus and the periosteal callus of fractured long bones were studied in 26 adults undergoing open reduction and internal fixation of closed diaphyseal fractures that occurred 1 to 21 days before surgery. In the 1st week after fracture, a progressive increase was observed in the number of polymorphic mesenchymal cells in the medullary callus and of fibroblast-like cells in the periosteum, where the first calcification foci were seen 7 days after injury. In the 2nd week after fracture, the medullary callus presented numerous mesenchymal cells, fibroblasts, and newly formed capillaries, whereas the inner periosteal layer showed many osteoblast-like cells. New bone trabeculae were first seen in the periosteal callus 12 days after injury. In the 3rd week after fracture, new trabecular bone appeared in the medullary callus. Cartilage also became apparent in the medullary and periosteal callus but remained limited in amount. Calcification within cartilage was first observed in the periosteum 18 days after fracture. The process of fracture healing in long bones in humans is similar, though not identical, to that described for long bones in laboratory animals.

Adult↗
PubMed1994

Ligamenta flava in lumbar disc herniation and spinal stenosis. Light and electron microscopic morphology.

METHODS: Ligamenta flava obtained from nine patients with lumbar disc herniation and ten patients with lumbar stenosis were studied at histologic, histochemical, and ultrastructural levels. Lumbar ligamenta flava removed from six patients who underwent surgeries for thoracolumbar fractures were used as controls. RESULTS: Ligamenta flava from control subjects consisted of large elastic fibers, thin bundles of collagen fibers, and few spindle-shaped fibroblasts. In proximity to the laminal insertion, the ligaments had fibrocartilagineous features. In the control subjects who were age 50 or older, the cells decreased in number and areas that had fewer and thinner elastic fibers and a more abundant collagen component were visible occasionally. In patients with disc herniation, the ligaments had similar morphologic features to those of the controls of similar ages. The ligamenta flava from patients with lumbar stenosis showed areas of fibrosis in which the cells were often represented by actively synthesizing fibroblasts and areas of chondroid metaplasia. Degenerating elastic fibers were seen occasionally, while calcified areas were observed often. CONCLUSIONS: Ligamenta flava undergo slight fibrotic and chondrometaplastic changes with aging. No peculiar changes occur in patients with disc herniation. In spinal stenosis, fibrotic changes, chondroid metaplasia, and calcification reduce the elasticity of the ligaments, which may thus bulge into the spinal canal in the standing position even if they are normal in thickness.

Adult↗
PubMed1994

Lumbar spinal stenosis and diabetes. Outcome of surgical decompression.

We reviewed 25 diabetic (mean age 68 years) and 25 non-diabetic patients (mean age 71 years) who had undergone decompression for lumbar spinal stenosis at a mean of 3.4 years after operation to determine whether diabetes affected the outcome of surgery. The preoperative symptoms were similar in the two groups except that an abrupt onset of symptoms, the presence of night pain and the absence of any posture-related pain relief were recorded only by diabetic patients. Nerve-conduction velocity was slowed in 80% of the diabetic and in 25% of the non-diabetic patients. Peripheral vascular deficiency was diagnosed in 20% of patients with diabetes and in 4% of non-diabetics. The outcome of surgery was similarly successful in the two groups. Mistaken preoperative diagnosis was the cause of failure in three diabetic patients, two with diabetic neuropathy and one with diabetic angiopathy.

Adult↗
PubMed1993

The surgical treatment of central lumbar stenosis. Multiple laminotomy compared with total laminectomy.

We assigned 67 patients with central lumbar stenosis alternately to either multiple laminotomy or total laminectomy. The protocol, however, allowed multiple laminotomy to be changed to total laminectomy if it was thought that the former procedure might not give adequate neural decompression. There were therefore three treatment groups: group I consisting of 26 patients submitted to multiple laminotomy; group II, 9 patients scheduled for laminotomy but submitted to laminectomy; and group III, 32 patients scheduled for, and submitted to, laminectomy. The mean follow-up was 3.7 years. Bilateral laminotomy at two or three levels required a longer mean operating time than total laminectomy at an equal number of levels. The mean blood loss at surgery and the clinical results did not differ in the three groups. The mean subjective improvement score for low back pain was higher in group I but there was also a higher incidence of neural complications in this group. No patient in group I had postoperative vertebral instability, whereas this occurred in three patients in groups II and III, who had lumbar scoliosis or degenerative spondylolisthesis preoperatively. Multiple laminotomy is recommended for all patients with developmental stenosis and for those with mild to moderate degenerative stenosis or degenerative spondylolisthesis. Total laminectomy is to be preferred for patients with severe degenerative stenosis or marked degenerative spondylolisthesis.

Adult↗
PubMed1993

Acromioclavicular joint cyst associated with rotator cuff tear. A report of three cases.

Acromioclavicular joint cyst (AJC) is a rare condition, usually occurring in the presence of a wide communication between glenohumeral and acromioclavicular joints in patients with a massive rotator cuff tear. In the presence of AJC, accurate evaluation of the status of the rotator cuff should always be made. Removal of the cyst only must be avoided because the condition tends to recur if the cuff tear is not repaired. When the tear is so large that it cannot be repaired, excision of the cyst should be associated with a resection of the lateral end of the clavicle.

Acromioclavicular Joint↗
PubMed1993

Post-operative intervertebral discitis. Evaluation of 12 cases and study of ESR in the normal postoperative period.

Twelve cases of intervertebral discitis following lumbar discectomy were evaluated and ESR was assessed in 70 patients operated on and without evidence of postoperative infection. Six of the intervertebral discitis patients were studied retrospectively and 6 prospectively. In the retrospective group, patients reported that symptoms appeared on average 15 days after the operation. Antibiotic treatment generally began 31 days after the operation and lasted 62 days; symptoms regressed after 3.9 months. All patients showed long-term radiographic vertebral changes and osteolysis in the cases treated later. In the prospective group, the first symptoms appeared on average 5 days after the operation, treatment started after 8 days and lasted 41 days. Symptoms regressed after 1.8 months. There were only 3 cases of vertebral radiographic changes. In both groups, ESR was always more than 70. The most useful diagnostic imaging tests were conventional tomography and MRI. Needle biopsy had no effect on the length of treatment. In 14% of patients without infective complications, ESR increased noticeably a week after the operation but, in contrast to the intervertebral discitis patients, it did not then continue to increase. Close post-operative observation permitted early detection of intervertebral discitis. Early and high-dose antibiotic treatment, even if unspecific, can resolve this infection in a few weeks.

Adult↗
PubMed1992

Bone regrowth after surgical decompression for lumbar spinal stenosis.

We reviewed 40 patients treated surgically for lumbar stenosis at an average time of 8.6 years after operation. In 32, total laminectomy had been performed and in eight bilateral laminotomy, both at one or more levels. Of the 16 patients with degenerative spondylolisthesis, ten had had a concomitant spinal fusion. Patients were assigned to one of four groups according to the amount of bone regrowth: group 0 had no regrowth and groups I, II, and III, had mild, moderate or marked regrowth, respectively. Only 12% of the patients showed no bone regrowth; 48% were assigned to group I, 28% to group II and 12% to group III. Imaging studies showed varying degrees of recurrent stenosis in patients with moderate or marked bone regrowth. All patients with degenerative spondylolisthesis showed bone regrowth, which was more severe in those who had not had a fusion. The clinical results were satisfactory in most of the patients with mild or no bone regrowth and significantly less good in those with moderate or marked regrowth. In the group with degenerative spondylolisthesis, the proportion of satisfactory results was significantly higher in patients who had had spinal fusion. The long-term results of surgery for lumbar stenosis depend both upon the amount of bone regrowth and the degree of postoperative vertebral stability.

Adult↗
PubMed1992

Rotator cuff tears. Results of surgical repair.

A prospective study was done on 73 patients who underwent surgical repair of a rotator cuff tear. The patients were divided into four groups according to the active shoulder flexion and the trophism of the rotator cuff muscles: group A--range of motion > 100 degrees; group B--ROM 60-100 degrees; group C--ROM < 60 degrees; group D--ROM < 100 degrees and significant muscle hypotrophy. The rotator cuff tears were classified into four groups at surgery according to size: grade I measured < 2 cm; grade II measured 2-4 cm, grade III measured > 4 cm but was reparable; and grade IV was irreparable. The results were evaluated after an average follow-up of 2.3 years and correlated to several factors including the preoperative clinical assessment, the size of the lesion, the type of lesion (tear or detachment), and the mechanism of injury (traumatic or atraumatic). Seventy-three percent of the cases had satisfactory results. The preoperative clinical assessment and the size of the tear were the most important indicators of the final outcome. The proportion of satisfactory results underwent a progressive decline from group A (88%) to group D (14%) and from grades I and II (88% and 89%, respectively) to grade III (56%) and grade IV (none). Rotator cuff repair is almost always successful in patients with more than 60 degrees of active arm flexion and either small or medium-size tears. Less than two-thirds of the patients with major tears and less than 60 degrees of motion achieve satisfactory results. Failure is highly probable in irreparable tears and in the presence of significant hypotrophy of the rotator cuff muscles.

Adult↗
PubMed1992

Radial head fracture treated by resection. Long-term results.

Thirty-one patients who underwent resection of the radial head for fracture of the radial head were reviewed after an average of 17 years. These patients were divided into three groups according to the type of fracture and treatment: group 1 had undergone complete resection due to isolated radial head fracture, group 2 partial resection due to isolated fracture, and group 3 complete resection due to radial head fracture associated with other lesions in the same arm. The clinical results were satisfactory in 72% of the group 1 patients, none of the group 2 patients, and 60% of the group 3 patients. In 55% of the patients an increase in the valgus angulation of the elbow was observed, modest in most instances. In almost half of the patients, all of which had full range of elbow motion, a new radial head had formed. Eighty percent of the patients had clinically asymptomatic distal subluxation of the radioulnar joint. In most cases of isolated radial head fracture, complete resection yields satisfactory long-term results. Partial resection, on the other hand, has a high incidence of failure. The presence of other osteoarticular lesions in the same arm significantly reduces the chances of success.

Adult↗
PubMed1992

Measurement of extensor hallucis longus power in patients with hallux valgus. Is the Dandy sign reliable in cases of hallux valgus?

The authors took manual and dynamometric measurements of the power of the extensor hallucis longus (EHL) muscle in 100 patients with juvenile hallux valgus and 141 normal patients. Three degrees of valgus deformation were recognized: mild (15-25 degrees), moderate (26-35 degrees), and severe (> 35 degrees). Neither the manual nor the dynamometric measurements showed any difference in EHL power between the normal patients and those with mild valgus deformity. In the patients with moderate valgus deformity, the manual measurement usually showed the EHL force to be the same as that of the normal patients, while the dynamometric measurement gave a lower value. The patients with severe valgus deformation were shown to have a slight to moderate loss of power on manual measurement and a greater loss of power on dynamometric evaluation. Both methods of measurement are equally reliable. When the valgus deformation is mild to moderate, any loss of EHL power must be attributed to another cause; when the valgus deformation is severe, however, it by itself provokes a significant loss of EHL power. The Dandy maneuver is unreliable only in cases of severe hallux valgus.

Adult↗
PubMed1992

Microdiscectomy in treatment of herniated lumbar disc.

The authors studied 122 patients who had undergone microsurgery for herniated lumbar disc or isolated nerve root canal stenosis. The patients were reviewed one month and three months after surgery and then returned for a final evaluation after an average of 1.4 years. Intraoperative or postoperative complications occurred in 13 cases and consisted of misdiagnosis (discovered intraoperatively) of the level of the herniated disc (7 cases), dural laceration (3 cases), and discitis (3 cases). Limited discectomy was performed in 16 cases and complete discectomy in the others. Two patients who had undergone limited discectomy experienced recurrence; this did not occur when complete discectomy was performed. Discitis occurred in patients who had undergone complete discectomy. Most of the patients who underwent operation for disc herniation at one lumbar level with no complications began walking within 24 hours, and 72% were discharged within 36 hours. Eighty-five percent of the patients had a satisfactory result one month after surgery, and 91% had a satisfactory result at the final follow-up. There was no significant difference between patients with protruded herniation and patients with sequestered herniation. In the patients with nerve root canal stenosis the proportion of satisfactory results was 72% at one month and 88% at the final follow-up. The main advantage of microsurgery is the full illumination of the operative field, and this technique is strongly indicated in cases of single-level herniated disc. Over the short-term, microdiscectomy achieves a higher proportion of satisfactory results, requires a shorter hospitalization period, and allows an earlier return to work than traditional surgery. However, no significant difference was found between microsurgery and traditional surgery over the long-term.

Adolescent↗
PubMed1991

Magnetic resonance imaging in the diagnosis of lumbar spinal canal stenosis.

Twenty-two patients with clinical symptoms suggesting lumbar spinal canal stenosis underwent myelography, computed tomography (CT), and magnetic resonance imaging (MRI). Patients were divided into two groups according to myelographic findings. Group I included 19 cases in which myelograms showed spinal canal stenosis, and group II consisted of 3 patients with myelograms negative for this condition. MRI showed uniform narrowing of the dural sac, indentations on the posterior aspect, or interruption of the outline of the sac in the sagittal scans and reduced area of the sac in the transverse scans. In group I patients, the diagnostic accuracy of MRI was greater than that of CT and myelography. In Group II patients, all of whom had moderate or severe lumbar scoliosis, MRI suggested spinal canal stenosis in contrast with myelography. In spinal canal stenosis surgery may be planned on the basis of MRI findings alone, except in scoliotic patients.

Aged↗
PubMed1991

Degenerative lumbar spondylolisthesis. II. Surgical treatment.

The authors analyze the results of operative treatment in 32 cases of degenerative spondylolisthesis with various degrees of compression of the nervous structures. Five types of surgery were performed: unilateral laminotomy; bilateral laminotomy with or without transverse process fusion; bilateral laminectomy with or without spinal fusion; and laminectomy, spinal fusion, and interspinous wiring. Satisfactory results were achieved in 84% of the cases. Seventy-six percent of the patients had further vertebral displacement, and 81% showed varying degrees of articular process regeneration more than two years after surgery; these findings concern both patients who had been treated with spinal fusion and those who had not. Bilateral laminotomy is indicated in patients with isolated nerve root canal stenosis; as the olisthesis is mild and lateral flexion-extension radiographs show no vertebral hypermobility, spinal fusion is not necessary. When central spinal canal stenosis is present, bilateral laminectomy, extensive lateral decompression, and spinal fusion are recommended. Interspinous wiring may be useful for immediate vertebral stabilization.

Aged↗