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Biomedical subjects

F Postacchini

Publications and source records attributed to F Postacchini.

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

Degenerative lumbar spondylolisthesis. Part I: Etiology, pathogenesis, pathomorphology, and clinical features.

The authors analyze the clinical features and the results of various imaging studies in 77 patients with degenerative lumbar spondylolisthesis. The most commonly olisthetic vertebra was L-4, followed by L-3. The extent of the olisthesis ranged from 8-43%. Forty-two percent of the patients with L-3 or L-4 olisthesis had reduced mobility of the underlying vertebra. Five different clinical pictures were present: no symptoms except occasional low back pain; chronic low back pain with no radicular symptoms; radicular symptoms and no signs of nerve root compression, with or without low back pain; radicular symptoms with neurologic deficit; intermittent claudication. Various pathological conditions were identified: slight narrowing of the central spinal canal without compression of neural structures; isolated stenosis of the nerve root canal; stenosis of both the nerve root canal and the central spinal canal. The onset of degenerative spondylolisthesis seems to be connected to excessive shear forces on the olisthetic vertebra. The extent of neural structure compression, and thus the clinical picture, depends on three factors: the primitive size of the spinal canal, the extent of degenerative changes in the zygapophyseal joints, and the extent of olisthesis.

Adult↗
PubMed1990

Pelvic stabilisation of a large chordoma of the sacrum. Description of a case.

Chordoma is a primary malignant bone tumour which derives form residue of the notochord. It constitutes 1.4% of all primary bone tumours, and in approximately half the cases it is localised in the sacrum. It is characterised by slow growth, but also by high local invasiveness, local recurrence and pulmonary metastasis. The literature reports many cases of chordoma of the sacrum, most of which do not extend beyond the second sacral metamere. The case presented here is a large chordoma which extended proximally as far as the 1st sacral metamere bilaterally, so that subtotal resection of the sacrum was required. There is very little data in the literature on the stability of the pelvis after such ample removal. Considering the young age of the patient we decided to stabilise the pelvis with Luque segmental instrumentation.

Adult↗
PubMed1989

The evolution of spondylolysis into spondylolisthesis during adult age.

Over a period of two and a half years 7 cases of isthmic spondylolisthesis in adults were observed. Radiographs which had been taken from 7 to 28 years previously, when the patients were aged 27 to 44 years, revealed a spondylolysis in which slipping was either absent or almost imperceptible. In 5 cases the radiographs revealed a gradual increase of vertebral slipping over the years and in all these cases the onset and progression of the listhesis was associated with a decrease in the height of the underlying disc. These observations do not support the widely held view that spondylolysis gradually evolves into spondylolisthesis only during childhood or adolescence. On the contrary, they indicate that it may be initiated and become progressive during adult age.

Adult↗
PubMed1989

Coracoacromial attrition syndrome. Anatomy, clinical aspects and surgical treatment.

Eighteen cases of coracoacromial attribution syndrome submitted to operative treatment over a 5-year period are analysed. Three types of syndrome were identified. The attrition manoeuvre was positive in all cases and, in 16, infiltration of local anaesthetic in the subacromial bursa abolished or considerably decreased the pain. The most frequent operative findings were excessive thickness of the acromion, sometimes associated with osteophytosis of the anterior margin of the bone, and inspissation of the subacromial bursa; in 3 cases there were fissures or lacerations of the bursal surface of the supraspinatus. In all patients the coracoacromial ligament was sectioned, horizontal osteotomy of the acromion performed and the subacromial bursa removed. When necessary, cheilotomy of the acromioclavicular joint was performed, and any partial lacerations of the cuff repaired. The results were satisfactory in 15 cases and fair in 3, and were directly related to the positivity of the attrition test and to the severity of the anatomical, coracoacromial and rotator cuff lesions observed at operation.

Adult↗
PubMed1988

Familial predisposition to discogenic low-back pain. An epidemiologic and immunogenetic study.

The first-degree relatives (parents, siblings and children) of 284 patients complaining of discogenic low-back pain (Group I), 114 patients who had undergone surgery for lumbar disc herniation (Group II), and 280 individuals who had never complained of low-back pain (Group III) were surveyed by self-completed questionnaires. Of the families in Group I and Group II, 35 and 37%, respectively, had at least one member with a history of discogenic back pain and 5 and 10%, respectively, had one or two members who had undergone disc surgery. Of the asymptomatic subjects in Group III, only 12% had at least one or more affected relatives and 1% had a relative who had undergone disc surgery; of the affected families, 41% had two or more members with a history of back pain. The proportion of symptomatic relatives in the affected families was higher among sedentary workers and motor vehicle drivers than among heavy or light manual workers. An immunogenetic study comparing the frequencies of HLA-A, B, and C antigens in 39 patients who had undergone lumbar disc surgery with those in 60 asymptomatic individuals showed no significant differences between the two groups. This study indicates that there is a strong familial predisposition to discogenic low-back pain, and suggests that the etiology of degenerative disc disease is related to both genetic factors, not linked to the HLA antigen system, and environmental factors.

Adult↗
PubMed1988

Anterior instability of the shoulder due to capsular laxity.

Thirty cases of anterior instability of the shoulder are reported where the only or pre-eminent pathological condition observed at operation was an abnormal laxity of the joint capsule. Four clinical pictures emerged - recurrent distortion, recurrent subluxation, recurrent dislocation, dislocation followed by recurrent subluxation - presumably due to increasing degrees of instability. In 13 cases, surgery consisted of stabilisation of the anterior joint capsule at the neck of the glenoid with a staple, and in 17 cases, capsulo-muscular plastic surgery with the aim of reducing the excessive width of the joint capsule and shortening the subscapularis. Satisfactory results were obtained in 90% of the cases. Although the quality of the results was not conditioned by the type of surgery used, capsulo-muscular plastic surgery appears to be the best method for the correction of the pathological condition responsible for the instability.

Adolescent↗
PubMed1988

Fractures of the humerus associated with paralysis of the radial nerve.

Forty-two cases of fracture of the humerus associated with paralysis of the radial nerve and treated over a period of 30 years were analysed. There was predilection for the mid-distal third, followed by the mid third and the supracondylar segment. Paralysis was complete in 39 cases and partial in 3. Treatment was conservative in 14 cases, early surgical in 18 (within 30 days), and late surgical in 10 (mean 4.7 months). The latter group involved cases where conservative treatment had not achieved recovery of neural function. Of the fractures treated conservatively, the diaphyseal fractures were slightly or moderately displaced, while supracondylar fractures were very displaced. Most of the fractures treated surgically were moderately or considerably displaced. Neurological recovery was satisfactory in 86% of the cases treated conservatively, in all those operated early, and in 50% of those operated late. The choice of treatment as between conservative or surgical must be on an individual basis, depending on the site and degree of displacement of the fracture, the extent of any exposure, and the degree of neurological deficit.

Adult↗
PubMed1987

Chemonucleolysis versus surgery in lumbar disc herniations: correlation of the results to preoperative clinical pattern and size of the herniation.

A prospective study was carried out on the results of chemonucleolysis or surgery in 156 patients who had lumbar disc herniations. All patients were considered as potentially good candidates for chemonucleolysis. Seventy-two received a chymopapain injection and 84 underwent surgery. Based on computerized tomography (CT) scan and/or myelography the herniations were distinguished as small, medium, and large. Also distinguished were three types of preoperative clinical patterns, Type A, Type B and Type C, corresponding to slight, moderate, and severe nerve root compression, respectively. Follow-up evaluations were made 1 month, 3 months, and an average of 2.8 years after treatment. The patients with a small disc herniation, who underwent chemonucleolysis, did slightly better as a group than those treated surgically. At 1 month, the proportions of satisfactory results were 75% in the chemonucleolysis group and 62% in the surgery series. At final follow-up, the proportions were 84% and 82%, respectively, but the ratio of excellent-to-good results was higher in the chemonucleolysis group. In the latter, most patients with satisfactory outcomes had a Type A or Type B clinical pattern. In medium-size herniations the results of surgery were slightly better than those of chemonucleolysis. At 1 month, 55% of patients in the chemonucleolysis group had satisfactory results compared with 74% of those in the surgery series; at final follow-up the proportions were, respectively, 76% and 86%. In the chemonucleolysis group most satisfactory outcomes were found in patients with a Type A or Type B clinical pattern. The results of chemonucleolysis in patients who had large herniations were significantly inferior to those of surgery: at final follow-up the results were satisfactory in 50% of patients in the chemonucleolysis group and 89% of those in the surgery series. Chemonucleolysis appears to be the treatment of choice in most patients with small disc herniations and an effective alternative to surgery in most patients with medium-size herniations when the preoperative clinical pattern indicates a slight or moderate nerve root compression. In all large herniations and in small- or medium-size herniations causing a severe nerve root impingement, surgery should be preferred to chemonucleolysis.

Adolescent↗
PubMed1987

The treatment of unreduced dislocation of the shoulder. A review of 12 cases.

The clinical and radiographic features and the results of treatment are analysed in 12 cases of shoulder dislocation (5 anterior and 7 posterior) in which the dislocation had been present for periods ranging from 3 weeks to 6 months. The follow-up ranged from 9 months to 16 years. Anterior dislocations are easily diagnosed on anteroposterior radiographs. Posterior dislocations may be suspected clinically because of the position of the limb in internal rotation and loss of external rotation, but can easily be missed on A.P. films, which show only a flattened appearance of the humeral head. A definite diagnosis is obtained only with a lateral (axillary) projection. All the anterior dislocations in our series were uncomplicated, but 4 of the posterior dislocations were associated with fractures of the humeral head and/or the greater tuberosity. Two of the 5 anterior dislocations were treated with physiotherapy and remedial exercises alone, while 2 were successfully reduced by manipulation; in the only patient submitted to surgery, ablation of the humeral head was performed. Results were excellent in one of the 2 patients treated with physiokinesitherapy where dislocation had been reduced spontaneously (the only such case described in the literature), and in one of the two cases submitted to nonoperative reduction of the dislocation. Results were good in the second patient subjected to nonoperative reduction and in the patient operated on. All 7 cases of posterior dislocation were treated surgically: in 3 cases the dislocation was reduced, in one the humeral head was removed, in one a partial shoulder prosthesis was applied, and in 2 cases the whole of the proximal extremity of the humerus was resected. In the latter 2 cases the results were poor and fair respectively, while in the remaining cases the results were good. The best surgical treatment of inveterate dislocations is reduction of the dislocation, which in the posterior forms requires a wide antero-supero-posterior approach. The alternative to surgical reduction is the application of a shoulder prosthesis, the result of which (as in resection of the humeral head) is related to the integrity of the greater tuberosity and the rotator cuff.

Adult↗
PubMed1986

Rupture of the rotator cuff of the shoulder associated with rupture of the tendon of the long head of the biceps.

Twenty cases of associated rupture of the rotator cuff and the tendon of the long head of the biceps were studied. This was out of a series of 54 patients referred to our unit with symptoms referable to the rotator cuff or to recent tendon rupture. In the majority of these patients there was marked loss of shoulder function due to rupture of the cuff. In 13 of 15 patients treated surgically the cuff lesion was either substantial or severe. The tendon lesion was partial in 3 cases and total in 12. In addition to repairing the cuff, the tendon was fixed in the bicipital groove in 7 of the 15 patients operated on. In 2 of 3 patients with partial rupture the tendon was not fixed but after several months the partial rupture became complete. The results in the 15 cases of associated ruptures treated surgically were satisfactory in 11 cases (73%) as determined by recovery of shoulder function. Fixation of the tendon was carried out in all the partial ruptures (13 cases), and in complete ruptures if they were recent or not more than 6 months duration in subjects of middle age or slightly more. Of the 12 complete ruptures fixation generally improved the power of elbow flexion and supination and reduced or diminished the cosmetic defect due to the bulge on the front of the arm which the biceps was contracted.

Adult↗
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↗
PubMed1985

The diagnosis of lumbar stenosis. Analysis of clinical and radiographic findings in 43 cases.

This study is based on 43 cases of lumbar spinal stenosis-37 involving the spinal canal and 6 involving isolated radicular canals. The clinical features are analysed, also the radiographic investigations currently used in the investigation of this pathological condition. Three distinct clinical syndromes are differentiated; continuous (acute or chronic), intermittent, combined. The last is the most frequent type. All the patients with stenosis of the canal showed significant radiographic changes, the most frequent being total or subtotal block on myelography with posterior impingement on the dural sac. In stenosis of the radicular canal the affected root was either displaced medially or cut off (amputated). Computerised tomography gives less precise results than radiculography.

Acute Disease↗
PubMed1985

The pathology of the rotator cuff of the shoulder.

The pathology of the rotator cuff of the shoulder, which is often regarded as synonymous with the condition known as peri-arthritis of the shoulder, comprises: calcified tendinopathy, tendinosis, the acromio-humeral friction syndrome and rupture of the rotator cuff tendons. The authors analyse the various aspects of these pathological conditions in the light of recent physiopathological and clinical findings.

Adult↗
PubMed1984

Morphologic changes in annulus fibrosus during aging. An ultrastructural study in rats.

Morphologic studies of annulus fibrosus of newborn, young, and old rats were carried out to determine the tissue changes occurring with aging. Newborn annulus consists of an inner portion containing chondroblast-like cells, a middle portion showing cells with intermediate features between chondroblasts and fibroblasts, and an outer portion containing fibroblast-like cells. The cells, arranged in rows, show a prominent ergastoplasm and are surrounded by pericellular lucunae. In the inner portion, the collagen fibers in the matrix are oriented randomly; in the middle and outer portions, the fibers between adjacent cell rows are arranged parallel, forming fibrous lamellae. The collagen fibers have fairly uniform diameters (average 510 nm), are strongly positive to the PASM reaction, and are surrounded by small proteoglycan granules. Both immature and mature elastic fibers are present. Young annulus consists of a transition zone, composed of large cells with no definite arrangement and bundles of collagen fibers oriented in various directions, and a lamellar zone consisting of fibrous lamellae separated by interlamellar septa containing the cells. These show intermediate features between chondrocytes and fibrocytes and well-developed ergastoplasm. The interlamellar septa consist of collagen fibrils and proteoglycans and contain few aggregates of electron dense material. The collagen fibers have highly variable diameters (average 740 nm). The larger fibers are scarcely periodate-silver-methenamine (PASM) positive. The proteoglycans are similar in size to those in the newborn. Few, mature elastic fibers are present. In old annulus, the transition zone is larger than in the young tissue. The cells are less numerous, and most of them show a sparse ergastoplasm.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗
PubMed1984

Chemonucleolysis in the treatment of prolapsed intervertebral disc. Early results.

The results of chemonucleolysis in 48 patients with protrusion of the annulus fibrosus or lumbar disc hernia treated over a period of two years are reported. The nucleolysis was performed under local anaesthesia at a single level in all cases, after the pathological state of the disc and nerve roots had been demonstrated by radiography. Satisfactory results, comparable with those following surgical treatment, were obtained in nearly all the patients with small disc herniae and in three-quarters of the patients with herniae of moderate dimensions. The pre-operative neurological defects showed regression in nearly all cases. The only complication was an infection of the disc in one case.

Adult↗
PubMed1984

Morphology of the cervical vertebrae in two caucasian ethnic groups.

A morphometric study of the cervical vertebrae was carried out on 63 Italian skeletons and 58 Asiatic Indian skeletons. The results indicate that there are considerable differences in the vertebral dimensions between ethnic groups of the same racial type. In a high proportion of both groups the mean sagittal diameter was less than 12 mm, which contradicts current opinion that this is the dividing line between the normal and the stenotic canal.

Adult↗