PubMed Health⌕ Search

Biomedical subjects

G Picetti

Publications and source records attributed to G Picetti.

8 recordsLinked to original sources
PubMed1995

Video-assisted thoracic surgery for the anterior approach to the thoracic spine.

Standard anterior approach to the thoracic spine is by a posterolateral thoracotomy. Because of the morbidity associated with this incision, video-assisted thoracic surgery (VATS) has been used as a less invasive approach for many intrathoracic disease processes. We have applied VATS for anterior access to the thoracic spine. From April 1991 to September 1994, 95 patients underwent thoracic spine procedures using thoracoscopy as the sole method of anterior approach. Procedures performed include discectomy for herniation (n = 57), multilevel discectomy for correction of spinal deformity (27), corpectomy (9), and drainage of intervertebral disc space abscess (2). All levels of the thoracic spine from the T2-T3 level to the T12-L1 interspace were approached. Forty-four procedures were performed through the left side of the chest and 41 through the right. The planned procedure was accomplished by VATS in all but 1 patient who required conversion to an open procedure because of scarring from a previous spine procedure. Mean operative time was 2 hours 24 minutes (range, 45 minutes to 5 hours 10 minutes). Average chest tube duration was 1.4 days, and mean length of stay was 4.82 days (range, 2 to 21 days). Complications included intercostal neuralgia (6), atelectasis (5), excessive epidural blood loss (2,500 mL; 2) and temporary paraparesis in a scoliosis patient related to operative positioning. We conclude that VATS offers a new, less morbid anterior approach to the thoracic spine. Although there is a significant learning period, most procedures requiring an anterior access can be performed safely by this technique. The VATS approach mandates an expanded role for the thoracic surgeon in operative spine disease.

Adolescent↗
PubMed1992

Clinical efficacy of spinal instrumentation in lumbar degenerative disc disease.

In review of 871 lumbar fusion procedures performed during the last 8 years, the theoretical advantages of lumbar spinal instrumentation are not borne out in simple discogenic disease. Four groups of 30-35 patients without previous surgery who underwent fusion by different techniques were matched for age, sex, length of follow-up, surgeons, number of levels fused, duration of preoperative symptoms, diagnosis, and type of third party payer. At least for the diagnoses of herniated disc with segmental instability and the instrumentation systems used in this study, results were superior with no internal fixation. This is in keeping with the higher complication rates and frequent need for implant removal reported by many authors.

Adult↗
PubMed1991

Diptheroids and associated infections as a cause of failed instrument stabilization procedures in the lumbar spine.

Between February 1985 and October 1987, the authors identified seven patients with occult lumbar spine infections associated with the presence of spinal fixation hardware. Six of these infections were with organisms of low virulence; four of the seven patients had polymicrobial infections. All of the polymicrobial infections contained a Diptheroid as one of the isolates. Two of the seven patients studied had normal sedimentation rates. All had white blood cell counts less than 12,000 cells. Imaging studies were not helpful with the exception of one case with a positive gallium scan. The diagnoses were supported by clinical presentation, pathologic tissue changes, positive cultures, and response to therapy. Successful therapy was obtained by removal of hardware and treatment with antibiotics.

Anti-Bacterial Agents↗
PubMed1989

Occult infections causing persistent low-back pain.

Occult infections caused by indolent organisms may produce persistent back pain that may be difficult to diagnose. The usual findings considered indicative of spinal infection are not reliable in these cases. The authors describe nine patients who presented with occult infections of the lumbar spine. Two of the nine had no antecedent lumbar surgeries nor open wounds. The predominant organisms were diptheroids and coagulase-negative staphylococci. The diagnosis was established by the clinical course, pathologic tissue changes at surgery, cultures, and response to antibiotic therapy. Normal Westergren sedimentation rates were noted in seven of nine patients, and normal white blood cell counts in six of nine patients. With the exception of two positive computed tomography (CT) scans, one positive gallium scan, and one positive magnetic resonance imaging (MRI) scan, all remaining imaging studies were negative for infection. In many cases, the infection neither was limited to nor involved the disc space.

Abscess↗
PubMed1988

Normal magnetic resonance imaging with abnormal discography.

In degenerative lumbar spine disease, recent studies have supported the clinical usefulness of discography, especially when used with computed tomography (CT) scanning. The role and capabilities of magnetic resonance imaging (MRI) scanning are currently evolving and being defined. This study reviews a series of patients with prolonged disabling symptoms who had normal MRI scans and abnormal discography. Discograms and discogram-CT scans may at times allow detection of clinically correlative and significant pathology (usually annular disruptions) not suggested by MRI scanning. This fact should be considered in patients with normal MRI scanning and continuing unexplained symptomatology.

Adult↗