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Biomedical subjects

J J Livio

Publications and source records attributed to J J Livio.

At least 19 recordsLinked to original sources
PubMed2000

Prevention of recurrent hip fracture.

Our objective was to describe the interventions aimed at preventing a recurrent hip fracture, and other injurious falls, which were provided during hospitalization for a first hip fracture and during the two following years. A secondary objective was to study some potential determinants of these preventive interventions. The design of the study was an observational, two-year follow-up of patients hospitalized for a first hip fracture at the University Hospital of Lausanne, Switzerland. The participants were 163 patients (median age 82 years, 83% women) hospitalized in 1991 for a first hip fracture, among 263 consecutively admitted patients (84 did not meet inclusion criteria, e.g., age>50, no cancer, no high energy trauma, and 16 refused to participate). Preventive interventions included: medical investigations performed during the first hospitalization and aimed at revealing modifiable pathologies that raise the risk of injurious falls; use of medications acting on the risk of falls and fractures; preventive recommendations given by medical staff; suppression of environmental hazards; and use of home assistance services. The information was obtained from a baseline questionnaire, the medical record filled during the index hospitalization, and an interview conducted 2 years after the fracture. Potential predictors of the use of preventive interventions were: age; gender; destination after discharge from hospital; comorbidity; cognitive functioning; and activities of daily living. Bi- and multivariate associations between the preventive interventions and the potential predictors were measured. In hospital investigations to rule out medical pathologies raising the risk of fracture were performed in only 20 patients (12%). Drugs raising the risk of falls were reduced in only 17 patients (16%). Preventive procedures not requiring active collaboration by the patient (e.g., modifications of the environment) were applied in 68 patients (42%), and home assistance was provided to 67 patients (85% of the patients living at home). Bivariate analyses indicated that prevention was less often provided to patients in poor general conditions, but no ascertainment of this association was found in multivariate analyses. In conclusion, this study indicates that, in the study setting, measures aimed at preventing recurrent falls and injuries were rarely provided to patients hospitalized for a first hip fracture at the time of the study. Tertiary prevention could be improved if a comprehensive geriatric assessment were systematically provided to the elderly patient hospitalized for a first hip fracture, and passive preventive measures implemented.

Aged↗
PubMed1993

Treatment of large bone defects with the Ilizarov technique.

Between 1985 and 1990 we treated 11 large segmental bone defects (average 6.7 cm) in ten patients with the Ilizarov technique. Open fractures, type III according to Gustilo, represented the largest group (8 of 11 cases). The average delay before the Ilizarov technique was initiated was 8.9 months. The external fixator was usually maintained for 1 year. Bone regeneration was obtained in every case. Consolidation was not fulfilled with this technique in three cases. The complications observed were one refracture, four leg-length discrepancies (average 1.5 cm), and five axial deformities exceeding 5 degrees. No pin-track infection was observed. In our limited series of four type IIIC open fractures treated by the Ilizarov technique, no patients required amputation. The Ilizarov technique is particularly useful in the treatment of large bone defects, without major complications, especially if there is an adequate initial debridement.

Adolescent↗
PubMed1993

[Urethral trauma: retrospective study of 15 years].

In urethral traumas are included pendulous, bulbar and prostatomembranous injuries generally associated with a pelvic fracture or a symphysis diastasis. Because of the possible sequelae concerning potency and urethral stricture of prostatomembranous disruptions in peculiar, treatment remains controversial. Authors present a retrospective series of 27 patients (26 males, 1 female) treated during these last 15 years to try to modify or redefine their strategy and to choose the harmless method of treatment by a multidisciplinary approach between the anaesthesiologist, the traumatologist and the urologist.

Adolescent↗
PubMed1993

[Prospective surveillance of nosocomial infections in a traumatology and orthopedics service].

From May 1989 to February 1990, 1164 patients were followed in the Service of Orthopaedic Surgery and Traumatology at the CHUV, for the development of nosocomial infections (N.I.), in particular postoperative wound infections. Among them, 439 patients were treated conservatively and 725 underwent 833 operations. The global incidence of N.I. was 7.7/100 admissions. Urinary tract infections represented 57% of all N.I., postoperative wound infections represented 21% (with 12% superficial and 9% deep infections), pneumonias represented 20% (5 deaths), bacteriemias represented 2% (1 death) of the cases. The rate of infections was 1.1% for clean surgical interventions (n = 549), 0% for clean-contaminated operations (n = 87), 7.5% for contaminated operations (n = 40), 22.8% for dirty operations and 1.6% for unclassified operations (n = 122). Among the 19 postoperative wound infections, 6 were diagnosed after the patients were discharged. In conclusion, postoperative wound infections constituted only 20% of all N.I. observed in the Service of Orthopaedic Surgery and Traumatology and the rates of infection according to the types of interventions were low. On the other hand, 80% of the N.I. were observed at sites other then the wounds and were associated with a 0.5% mortality rate.

Cross Infection↗
PubMed1992

[Progressive correction of an ulnar deviation of the hand following defective healing of the 2 forearm bones and probable sequellae of a Volkmann contracture].

The authors describe the progressive correction of a deformed forearm and an ulnar deviation of the hand as a result of a bullet wound. The injury comprised a fracture of the two bones of the forearm, with deformed callus and after effects of a probable Volkmann syndrome. The correction was obtained after 10 months. This report illustrates the interest and the difficulty presented by osteogenesis by distraction and osteotomy with a minimal cutaneous wound. This allows the reduction of risk to the cutaneum and vessels involved in extemporaneous corrections.

Adolescent↗
PubMed1990

[Pertrochanteric fracture in elderly subjects. Prospective non-randomized studies].

During a two-year period 237 patients were admitted for intertrochanteric fracture of the femur. 196 patients were included in this study with an average age of 79 years. Surgery comprised 163 nailings (Ender-Kempf), 31 blade plates and 2 prostheses. In this study the mortality rate and general complications were essentially related to the age and general condition of the patient; the general complications did not differ between methods. Walking ability at 6 months chiefly depended on the patient's general condition before the fall. The techniques allowing immediate weight-bearing diminished the length of hospitalization. Reoperation was required in 4% of nailings and 6.5% of blade plates.

Aged↗
PubMed1990

[Atypical osteogenesis following multiple sequestrectomies for infected open fracture of the femur: a case].

The authors present the case of an open fracture of femur Cauchoix type II with an infection due to Escherichia coli, Clostridium perfringens, Enterococcus and Aspergillus fumigatus. After several sequestrectomies and five hyperbaric sessions, apyrexia was attained at the end of the third month, the femur having been stabilised with an external fixator. The 15 cm gap due to loss of bone substance, filled at each dressing with an antiseptic iodine based ointment, closed itself finishing as continuous bone five months after the accident, the granulation tissue having been recovered by thin skin grafts. A repeated fracture occurring forty-eight hours after the removal of the Hoffmann frame was treated by fitting an Ilizarov fixator arriving at consolidation in seven months. The authors examine different possibilities of accelerating osteogenesis and highlight the potential role of iodine ointment as inductive to osteogenesis stemming from a periosteal layer seemingly held in place.

Adult↗
PubMed1989

[Pancoast's tumor: multi-disciplinary treatment and combined cervico-thoracic approach].

Five patients were treated from May 1987 to April 1988 in CHUV, Lausanne, for a superior sulcus tumor (3 epidermoid, 2 undifferentiated carcinomas). Treatment consisted of preoperative radiotherapy (3000 cGy)-surgery-postoperative radiotherapy (1500-2500 cGy). Two patients died from metastases. Only one patient presented with a local recurrence. Surgical resection was carried out by combined cervical and thoracic exposure. The cervical approach allows separation of the tumor from the subclavian artery, brachial plexus and vertebrae. Then, by thoracotomy, the superior lobe with tumor and thoracic wall is removed. Technical aspects of the procedure are described.

Carcinoma↗
PubMed1987

[L4/L5 spondylolisthesis following reduction and stabilization by anterior and posterolateral graft of L5/S1 spondylolisthesis with major displacement].

40 children and adolescents, recurrence of a spondylolisthesis after posterior or even postero-lateral fusion is a well known fact. Anterior fusion added to the posterior graft is said to prevent such and occurrence. We report a case of a L4/L5 listhesis which followed near complete reduction of a 70% L5/S1 slip fixed by a combined approach. We think this is due to the persisting lumbo-sacral postural abnormalities and that while reducing and fixing the spondylolisthesis one should restore physiological posture to prevent this recurrence at the same level or at a higher one.

Child↗