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Biomedical subjects

G Brunelli

Publications and source records attributed to G Brunelli.

At least 19 recordsLinked to original sources
PubMed1992

Acute cholecystitis: ultrasonographic staging and percutaneous cholecystostomy.

Experience in the treatment of acute cholecystitis with percutaneous cholecystostomy in 29 high-risk and elderly patients is reported. The treatment group included 14 men and 15 women, 21 of whom were over 70 years of age. The suspected clinical diagnosis of acute cholecystitis was confirmed in all cases by ultrasonography (accuracy: 95.6%). The percutaneous cholecystostomy was successful in 27 of 29 cases and these patients had a sudden improvement in their clinical condition; failure of the procedure was due in one patient to dislodgement of the catheter and in another patient to the guide-wire slipping out of the gallbladder. Six patients complained of pain radiating to the right shoulder which disappeared within 30-60 minutes after the procedure. Twenty-three of the 27 patients subsequently underwent elective cholecystectomy. In 22 patients the ultrasonographic findings were compared with the histology; thus enabling us to establish an ultrasonographic staging of acute cholecystitis related to the seriousness of the disease. Percutaneous cholecystostomy is the treatment of choice in high-risk patients, in the elderly, as well as in young patients with impending perforation.

Acute Disease↗
PubMed1992

[Sensory retraining of the hand using gnosis rings].

Sensory reeducation is very important. Many methods are used but it is difficult to assess their efficiency. Besides the routine methods we are using the gnostic rings which have on their periphery 5 symbols: a letter = A, a number = 3, a geometrical figure = a circle, a rough surface and a smooth convex surface. The symbols of the rings are in 3 different sizes (1.5 - 1 and 0.5 cm). The gnostic rings have 3 advantages: 1) they allow a precise evaluation in percentage. 2) they require an important brain effort, 3) they may be kept in the pocket and used several times during the day.

Equipment Design↗
PubMed1992

Gnostic rings: usefulness in sensibility evaluation and sensory reeducation.

The benefit of additional clinical tools for quantifying patients' ability to recognize objects is clear, as well as its correlation with the moving two-point discrimination test. The recognition of letters is such a tool. The authors describe gnostic rings, an additional technique, that is useful for clinical sensibility testing, as well as for sensory reeducation.

Discrimination, Psychological↗
PubMed1992

Diagnostic criteria for migraine and psychogenic headache in children.

The headache histories obtained from 214 children were analysed by computer to see whether it was possible to identify and classify migraine, and to distinguish children with psychogenic headache. During headache attacks, most children had no or very few associated symptoms. For classification, 175 patients were divided into four homogeneous groups; the remaining 39 could not be grouped. An overlap between the different groups was found. Psychogenic headache emerged as a clearly definable syndrome, characterised by psychological problems and daily headache for a period of at least one month (10 patients). When the 214 patients were grouped according to the classification of the Headache Classification Committee of the International Headache Society, distinguishing those children with psychogenic headache was no longer possible.

Age Factors↗
PubMed1992

The effects of lengthening on nerves.

Use of external fixators in limb lengthening and skin expanders in plastic surgery are well-known operative techniques. In some cases neurologic complications arise due to distraction which is either excessive or too fast. What happens to the nerve in these cases has not yet been thoroughly investigated. We therefore conducted an experiment on the sciatic nerve of rats. In one group of animals the nerve was studied after lengthening the femur, and in the other group after lengthening the nerve itself with a skin expander. Electrophysiologic and histologic studies (optic microscopy and axon teasing) were used to examine the effects of tension on the sciatic nerve. The results suggest that if distraction is performed gradually, the nerve does not undergo any electrophysiologic functional changes. It does, however, undergo some morphologic changes, such as a decrease in both the areas of the axons and the myelin sheaths, an increase in the distances between the nodes, and proliferation of Schwann cells.

Animals↗
PubMed1992

[The treatment of acute cholecystitis by percutaneous cholecystostomy].

The authors report on their personal experience with percutaneous cholecystostomy (PC) in 36 cases of acute cholecystitis (AC). PC was successful in 34 cases, improving the clinical condition of the patients within the first hour following treatment and normalizing the laboratory data within 24-48 hours. Twenty-seven patients with calculous AC underwent cholecystectomy within 4-15 days. In 6 cases (3 calculous and 3 acalculous ACs) PC was the only treatment performed; in one case (calculous AC) PC was combined with lithotomy, the stone fragments being extracted via the cholecystostomy. According to literature reports, to date PC has been performed mainly--as an alternative to surgical cholecystostomy--on the patients unsuitable for cholecystectomy due to their age or to severe impairment of their conditions. In our experience, the procedure can be performed on a wider range of patients as a final (notably in acalculous AC) or temporary step (notably in calculous AC where it may allow cholecystectomy to be delayed and thus performed under better clinical conditions, with decreased morbidity and mortality risks).

Acute Disease↗
PubMed1991

Compartmental syndrome due to viper bite.

The case is reported of a young girl who was bitten on the hand by a viper and developed compartment syndrome of the intrinsic muscles more than 24 h later. Multiple dorsal and volar fasciotomies resolved the acute episode with complete restitutio ad integrum. The clinical case is discussed in detail and the literature on these rare complications of snake bites in European countries reviewed.

Acute Disease↗
PubMed1991

Free microvascular fibular transfer for idiopathic femoral head necrosis: long-term follow-up.

The authors discuss free microvascular bone transfers in general, and propose a new classification for idiopathic femoral head necrosis. They then present a technique they have been using for 11 years, with the goals of providing both mechanical support and an improved blood supply to the femoral head. This technique involves clearing the necrotic area of the femoral head, filling the area with cancellous bone taken from the greater and lesser trochanters, and transferring a fibular microvascular graft. The approach is transtrochanteric and spares the capsule. Vascular anastomosis is done with the lateral branches of the deep femoral artery, sparing the anterior circumflex artery which is important to the blood supply of the femoral head. Forty-five cases have been surgically managed over 11 years. Eighteen cases with follow-up longer than five years were analyzed, providing an 84 percent successful outcome with both very good and good results.

Adult↗
PubMed1990

Experimental investigation of cross-nerve transfers relating to repair of brachial plexus avulsion injuries.

There is a lack of agreement regarding the potential for peripheral nerve cells with short axons to regenerate and innervate the terminal end organs of nerve cells with long axons. We designed a study to evaluate experimentally the possibility of neurons to reconstitute much longer axonal segments. Twenty Wistar rats were used. The brachial plexus was isolated and the radial nerve transected immediately after its origin. The proximal end of the axillary nerve (previously cut) then was coapted tot he distal stump of the radial nerve. In 10 other rats, the cut radial nerve was simply recoapted to itself without involvement of the axillary nerve; these animals served as controls. Finally, in 10 rats, nerves were cut without repair to evaluate the degenerative changes. After 90 days, the distal part of the radial nerve was examined by light microscopy, calculating the number and area of regenerated axons. We also checked the motor end-plates of reinnervated muscles. In the nerve-transferred group, good axonal regeneration with good reinnervation of the muscles was seen. In this way, we have experimentally demonstrated a plasticity of regeneration in peripheral nerves. This suggests that the surgeon may use nerves connected to proximal muscles to neurotize avulsed nerves of distal muscles.

Animals↗
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

[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↗
PubMed1989

Bradykinin and substance P potentiate acetylcholine-induced bronchospasm in guinea-pig.

The interaction of threshold doses of bradykinin (BK) and substance P (SP) with acetylcholine (ACh)-induced bronchospasm was investigated in anaesthetized guinea-pigs. The two peptides potentiated the ACh-induced bronchospasm, an effect which did not seem to depend on prostaglandin release. On the other hand, vagotomy abolished the capacity of BK and SP to potentiate the ACh-induced bronchospasm. The present data suggest a possible involvement of BK and SP in the genesis of airway hyperreactivity.

Acetylcholine↗
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

[Proposal for a global medico-legal functional evaluation of disabilities of the hand].

The present evaluations of hand invalidity are based on parameters that can give correct assessment for amputations or for single stiffness, but these parameters are not able to evaluate the majority of lesions. A nerve lesion does not repair at 100% or at 0%; all degrees are possible. The same is true for vascular, tendon and muscular lesions. We studied a new global evaluation on a large number of patients and we compared it with the tables in use today. The assessed parameters are: the active and passive movement, ability of the hand, strength, duration of the effort or of the fatigue, trophism, sensibility, pain, aesthetics.

Disability Evaluation↗