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Biomedical subjects

F de Peretti

Publications and source records attributed to F de Peretti.

31 records · Page 2Linked to original sources
PubMed1993

The vertebral foramen: a report concerning its contents.

Thirteen subjects were randomly selected and embalmed according to Winckler's technique. After removal of the vertebral column and the head in one block the specimens were frozen. Transverse transpedicular cuts were performed at C6, T1, T6, L1, L3, and L5. After enlargement photography, the surface area of the vertebral foramen and its various contents were measured on a computer using the Canvas programme and analysed using the Statview programme. The mean area of the vertebral foramen occupied by the cord was 30.5% at C6, 26.1% at T1, 21.4% at T6, 12.7% at L1, 0.08% at L3. The mean area occupied by the nerve roots was 3.9% at C6, 3.3% at T1, 1.6% at T6, 14.2% at L1, 17.5% at L3, 12.2% at L5. The mean area of all the nervous tissue was 34.4% at C6, 29.5% at T1, 23% at T6, 26.9% at L1, 18.9% at L3, 19.3% at L5. The cerebrospinal fluid occupied a mean area of 25.2% at C6, 30.7% at T1, 31.6% at T6, 43% at L1, 43.5% at L3, and 28.1% at L5. The total neural tissue did not occupy more than a third of the vertebral foramen. These facts should be considered by surgeons who perform laminectomy or decompression in cases of vertebral trauma or congenital and osteoarthritic stenoses.

Aged↗
PubMed1993

[Perilunar dislocations of the carpus. Value of surgical treatment].

Between 1980 and 1990, 60 patients presenting with 62 peri-lunar dislocations of the carpus have been surgically treated. One case was a subluxation of the scaphoid and 61 were posterior perilunar dislocations, among them were 32 grade I, 23 grade II, 4 grade III, 2 unknown grade according to the Witvoët and Allieu scale. In 36 cases the scaphoid was fractured in 5 were associated a fracture of the scaphoid and a scapho-lunar dislocation. 48 cases have been reviewed after a 31 month follow-up average. The result was satisfactory in 83 per cent of these cases, unsatisfactory results being observed in cases of delayed surgery or incomplete reduction. In 36 cases a dynamic radiological examination was available after a 36 month follow-up average. 27 wrists were stable, 9 were not (7 D.I.S.I., 2 V.I.S.I.) 8 of these were related to unsatisfactory reductions. Diagnosis was delayed in 10 cases which ended with less satisfactory results. The authors think that conservative treatment is not adequate, they propose different surgical procedures according to the possible association of a fracture of the scaphoid.

Adolescent↗
PubMed1993

[Flap coverage of open fractures of the leg by high energy].

This retrospective study has been made on 23 patients with open fractures of the tibia, type III or IV in Byrd's classification. Ten of these patients showed an aggravation of the soft tissue lesions after the initial treatment. At the beginning of our study, 22 patients had already achieved union and 1 had been amputated. All the patients have had a covering by one or several flaps. The analysis of the results concerns different types of fracture: the time interval between the accident and the first covering by flap, the type of the flap, the length of the hospitalization, the complications; the recovery of the function. First covering by flap has been made in the acute phase in 6 cases, in the sub-acute phase in 12 cases and in the chronic phase in 5 cases. The results of the patients covered in the acute phase were better, than those of the patients covered by flap in the sub-acute or the chronic phase. Early covering of the open fractures of the tibia is recommended. A classification of the open fractures, derived from the classification of Byrd is suggested. We included a type "O" for the fractures with potential aggravation. Different types of flap of the leg have been described. Our behaviour in high energy fractures of the tibia is determined by the necessity to look for a potential fracture aggravation and by the intention of an early covering of the open fracture.

Adolescent↗
PubMed1991

Anatomic and experimental basis for the insertion of a screw at the first sacral vertebra.

The authors present the anatomic and experimental basis of an original technique for screwing at the first sacral level employed in lumbosacral fusion. The anatomic studies were based on specimens from the anatomy museum, frozen sections of the sacrum and CT examinations with three-dimensional reconstruction and assessment of the density of the different structures of S1 in Hounsfield units (HU). The findings were that the ala and lateral portions of S1 contain yellow marrow forming what amounts to a fatty sphere bounded by the cortical bone of the sacroiliac joint, the linea terminalis and the spongy bone of the pedicles and of the body of S1. The experimental study was made by avulsion of sacral screws (system of Cotrel Dubousset), each of 7mm diameter. No screw perforated the sacral cortex. Three directions were tested. The insertion of a screw through the pedicle and body of S1 is advised, with the point of insertion below and lateral to the articular process of S1 and an oblique course forward and inward at an angle of 10 degrees to the sagittal plane. This internal obliquity is limited by the posterior prominence of the iliac ala.

Adult↗
PubMed1990

[Cross-forearm replantation in bilateral amputation].

We report the case of a 27-year-old patient who sustained a traumatic amputation of his 4 limbs. For the right upper limb, the site of amputation was at the level of the upper third of the forearm. For the left upper limb, the site of amputation was at the level of the Cower third of the forearm. In both cases, the loss of soft tissue was so extensive that hand replantation was impossible in the initial position. In such an unusual case, replantation of the right hand to the left side was attempted in this young patient. Osteosynthesis of the radius to the ulna in supination was performed, and arteries, veins, nerves and tendons were repaired. The other segments of amputated limbs were debrided and cleaned. Within a year, protective sensibility was restored in the replanted hand, but intrinsic muscles were paralysed. Secondarily, transfer of thumb opposition and capsulorrhaphy at the level of the metacarpophalangeal joints of long fingers were performed in order to provide a useful key-grip between the three first fingers.

Adult↗
PubMed1989

Biomechanics of the lumbar spinal nerve roots and the first sacral root within the intervertebral foramina.

This study consists of 3 sections: a descriptive study of the intervertebral foramen by dissection, supplemented by millimetric sections made with the cine-microabrasive apparatus (patented) on 12 specimens frozen with liquid nitrogen; a study of the attachments of the roots made during manipulations testing the resistance to avulsion of the rootlets, the roots, the dural sheath and the fibrous expansions at the periphery of the intervertebral foramen; and a study of the mobility of the roots in the foramina during movements effected within and outside the spine. We concluded that the classical description of an intervertebral foramen as occluded by a taut membrane like a drum-head is false as only perforated expansions attach the root to the foramen. Further, the points for attachment of the roots are the dura mater and the fibrous expansion passing from the foramen to the sheath of the spinal n. Finally, from the aspect of mobility, there are 2 distinct compartments and movements in one are not perceived in the other compartment if the attachments are unbroken. These attachments are a barrier interposed between the two compartments.

Biomechanical Phenomena↗
PubMed1989

[Fractures of the thoracic spine (T1-T10). Apropos of 105 cases].

Thoracic spine (T1-T10) fractures can be considered a specific entity owing to the anatomic features of the rib cage and the spinal canal. During a nine year period, the authors treated 105 such fractures. The thoracic spine fractures included 57 (54.2 per cent) compression fractures, 21 (20 per cent) comminuted (burst) fractures, 3 (2.8 per cent) flexion-distraction fractures, and 24 (23 per cent) fracture-dislocations. Five lesions, termed "fracture-dislocations by an oblique shearing force", were characterized by considerable displacement and the absence of neurologic injury. 35.2 per cent of the patients had injuries at multiple levels. The frequency of associated thoracic (26.5 per cent) and scapular injuries (20 per cent) reflected involvement of the entire thoracic cage. The frequency of neurologic impairment (30.4 per cent including 20 per cent complete paraplegia) reflects the particular vulnerability of the dorsal spinal cord. 32 per cent of the patients presented one or more thoracic effusions (hemomediastinum, hemothorax) related to parietal hematoma and/or hematoma at the fracture site. Functional management of 47 patients led to recovery of a painless spine without kyphotic deformity. Conservative treatment was often difficult because of associated parietal lesions; the 10 patients treated in this manner had only moderate reductions that maintained poorly in time, but had no major painful sequellae. A posterior approach was used for 42 patients with unstable or neurotoxic fractures because this permitted a complete decompression down to the posterior wall, when necessary by a "wide laminectomy". The anterior approach was reserved for purely anterior compression (3 cases) or residual compression after an initial posterior procedure (2 cases). Cotrel-Dubousset instrumentation (used in 7 cases) was particularly indicated because it offers the advantages of Harrington rods (31 cases) while providing better stabilization. This prevented later loss of reduction and obviated the need for a postoperative brace.

Adolescent↗
PubMed1989

[Vertebral hydatid cyst. Apropos of 2 cases].

The hydatid disease is rare in osseous locations, especially in our country (2.2 per cent). It has some particularities: clinical latency, diagnosis difficulties, surgical treatment often unsatisfactory because of the difficulty of total excision. Pain and sometimes deformity are often the only clinical features at the beginning of the disease. But, the evolution is unfavourable as soon as neurological symptoms appear. Multiple recurrences lead to unavoidable paraplegia. The antihelminthic drug (mebendazole) is disappointing in osseous location. Surgery is the only hope but the excision must be carcinologic. Spinal instrumentation can be improved by the use of acrylic cement whereas osseous grafts can be invaded by hydatidosis extension or recurrence. At present, the prognosis is still poor with constant apparition of cord compression. The authors report two cases of patients with osseous hydatidosis of the spine which illustrate these difficulties.

Adult↗
PubMed1988

Traumatic rotatory displacement of the lower cervical spine.

Traumatic rotatory displacement (TRD) are defined as all slight anterior corporeal displacements (less than 1/3 of the vertebral body) secondary to different vectors, but with a constant and dominant rotatory component. The authors report on 47 cases of TRD (35% of all severe lower cervical spine injuries) (follow-up: 6 months to 7 years). TRD occurs only when two lesions are present: an anterior lesion in the disk and ligaments, and a posterior lesion of the articular process, as the authors confirmed earlier in an experimental study on monkeys and specimens. Depending on the nature of the posterior lesions, three anatomoclinical types occur: 1) posterior capsular lesions cause unilateral facet dislocation (UFD): ten cases; 2) bony lesions of the articular process cause unilateral facet fracture (UFF): 28 cases; 3) double bony lesions, which can set free the articular facets, are called fracture separation of the articular pillar (FSAP): nine cases. The common radiographic characteristic of these three lesions is slight anterior displacement (or antero-listhesis), which is well seen on the lateral film; only tomograms or CT scans can show the posterior lesions. Instability, as defined by Roy-Camille, Denis and our experiments, was obvious on X-rays: soon after the injury, for UFD, and some time later, for 18 UFF and three FSAP. Statistically, 25% of all cases of TRD are associated with another traumatic lesion of the lower or upper cervical spine. Clinically, there is a 30% rate of radicular complications in TRD: this figure is higher than that of other injury types.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗