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Biomedical subjects

M Fornari

Publications and source records attributed to M Fornari.

At least 19 recordsLinked to original sources
PubMed2006

Biomechanics of the C5-C6 spinal unit before and after placement of a disc prosthesis.

The study consists of a biomechanical comparison between the intact C5-C6 spinal segment and the same segment implanted with the Bryan artificial disc prosthesis (Medtronic Ltd., Memphis, TN, USA), by the use of the finite element (FE) method. Our target is the prediction of the influence of prosthesis placement on the resulting mechanics of the C5-C6 spine unit. A FE model of the intact C5-C6 segment was built, employing realistic models of the vertebrae, disc and ligaments. Simulations were conducted imposing a compression preload combined to a flexion/extension moment, a pure lateral bending moment and a pure torsion moment, and the calculated results were compared to data from literature. The model was then modified to include the Bryan cervical disc prosthesis, and the simulations were repeated. The location of the instantaneous center of rotation (ICR) of C5 with respect to C6 throughout flexion/extension was calculated in both models. In general, the moment-rotation curves obtained from the disc prosthesis-implanted model were comparable to the curves obtained from the intact model, except for a slightly greater stiffness induced by the artificial disc. The position of the calculated ICRs was rather stable throughout flexion-extension and was generally confined to a small area, qualitatively matching the corresponding physiological region, in both models. These results imply that the Bryan disc prosthesis allows to correctly reproduce a physiological flexion/extension at the implanted level. The results of this study have quantified aspects that may assist in optimizing cervical disc replacement primarily from a biomechanical point of view.

Arthroplasty, Replacement↗
PubMed1999

Artificial lamina-assisted laminoplasty performed in seven cases.

OBJECT: The authors attempted to simplify the operative approach to severe multilevel cervical spondylotic myelopathy. Seven patients with progressive and severe myelopathy underwent modified double-door laminoplasty during a 5-month period. METHODS: The double-door laminoplasty procedure was modified by using two artificial titanium laminae obtained by simple surgical 0.5-mm Ti-mesh (rather than by bone graft or ceramic spacers). Preoperatively, gait disturbance was present in all patients with long-tract signs on neurological examination. In all cases the sagittal diameter of the cervical spinal canal was somewhat reduced (< 10 mm) by congenital stenosis, and further severe compression of the spinal cord resulted from osteophytic bars and calcified ligamenta flava at different levels. No abnormal alignment, pathological movements, or instability was present. Computerized tomography (CT) studies demonstrated severe multilevel cervical compression, and T2-weighted magnetic resonance (MR) imaging demonstrated pathological areas of hyperintensity within the spinal cord in all cases. In the initial follow-up study (range 8-12 months), the patients who underwent this procedure experienced marked improvement of gait disturbance without any significant incidence of morbidity or complications. Postoperative CT and MR imaging studies demonstrated complete spinal cord decompression and restoration of the patency of the subarachnoid spaces. CONCLUSIONS: The proposed procedure has the advantage of achieving both an immediate stabilization of the open laminae by means of a bridgelike mechanism and protection from the possible compression of the dural sac by paravertebral muscles.

Aged↗
PubMed1999

[Surgical treatment of internal duodenal diverticulum. Report of 2 clinical cases].

Internal duodenal diverticulum is a rare disease. Nowadays, less than 100 cases are reported in Western literature. Even if it is a pathology of malformative origin, the first clinical manifestations occur quite always during the III decade. Main symptom is a violent, suddenly arisen, abdominal colic, often associated with meals and with spontaneous remission. Frequency of accesses is variable in time; in most serious cases, colics are so close to cause a considerable reduction of nutrition. Among diagnostical means, very useful are Rx enema (that offers pathognomonical images) and endoscopy, by which the formation can be visualized directly and its connection with papilla can be delineated. In some rare cases, differential diagnosis has to be made with cystic dilatations of bile duct, and particularly with type III according to Alonso-Lej classification or choledochocele. When such a distinction is not possible, differential diagnosis will be made on the basis of histological examination of the type of mucosa present in the internal aspect of the diverticulum. Therapy of symptomatic forms is surgery. The technique of choice is transduodenal diverticulectomy. Cannulation of bile duct is a useful means to found the papilla during intervention, to protect duodenal suture in the postoperative period and to control it radiologically. Two cases of internal duodenal diverticulum operated on in the last 2 years are described and diagnostical and therapeutical items are discussed.

Adult↗
PubMed1998

Surgical management of giant anterior aneurysm.

BACKGROUND: Patients with intracranial anterior circulation aneurysms are subjected to surgical operation because of rupturing of the sac of the aneurysm leading to spontaneous subarachnoid hemorrhage (which occurs in most of the cases) or because of the neurological complaints caused by the mass or pulsation effect of the aneurysms against the surrounding brain structures. Direct surgical treatment of these giant aneurysms is always a challenging procedure but it makes feasible both the clipping of the neck of the aneurysm and the reduction of its mass effect. METHODS: A case series of 47 giant anterior circulation aneurysms, operated during a time span of 23 years (1972-1994) in our Institution is presented. RESULTS: In 31 cases the occlusion of the neck of the aneurysm could be achieved by applying single or multiple clips; in the remaining 16 cases the occlusion of the aneurysm was obtained by the aid of different methods. The operative mortality was 12.7%. CONCLUSIONS: Endovascular techniques for giant aneurysms occlusion are extremely useful in a combined approach. Due to their low morbidity these treatments can achieve a major role although some long term follow-up studies are still needed for a better understanding of their role.

Adolescent↗
PubMed1996

[The use of intraoperative topical bupivacaine in the control of postoperative pain following laparoscopic cholecystectomy].

Taking the starting point of a trial conducted on female patients who had undergone laparoscopic gynaecologic operations, which shows a good control of the postoperative pain through intraperitoneal infusion of local anaesthetic during the operation, the authors have proposed to reproduce the study on patients undergoing a laparoscopic cholecystectomy. The trial was conducted on two groups, a 50 patients each, undergoing an intraperitoneal infusion of local anaesthetic (bupivacaine) and placebo (physiologic solution) respectively. The results regarding the rate of patients who had felt postoperative pain (88% in the first group, 96% in the second group) and the different places of it, the pain in the right shoulder particularly (28% in the first group, 22% in the second), the intensity in the time and the different requests of analgesics new recorded. The results don't show statistically significant differences and they are different from the gynaecologic ones. The authors suggest, as reasons for these differences, the various moments of the liquid inoculation (at the beginning of the operation in gynaecology, at the end of it in cholecystectomy) and the Trendelemburg position of patients during the gynaecologic operation, on the contrary of cholecystectomy operations. They suggest, in the end, that the trials esecutions on numerically larger groups could bring more significant results.

Administration, Topical↗
PubMed1994

[Observations on dietary intake of iron in young adults of the city of Bologna and evaluation of the risk of iron deficiency].

The dietary iron intake was studied in 50 volunteers sample of young adults in Bologna neighbourhood; thirty men, mean age 28.9, and 20 women, mean age 30.4. A structured questionnaire was proposed individually by a skilled dietary interviewer. The mean dietary iron daily intake results similar to that found in western industrialised countries, as reported in previous studies, respectively 15.1 mg and 14.0 in men and women. This study reveals a lower percentage of animal origin dietary iron than in northern and central Europe in both sexes, as previously reported (male: 32.8%; female: 27.3%), furthermore the iron intake per kcal was markedly lower (male: 4.91/1000 kcal, female: 5.97) than the level of 7 mg/1000 kcal reported for those countries. The authors argue that the described dietary habit can lead to iron loss balance, mostly in women whose iron intake is far lower than one recommended by LARN (Recommended daily dietary allowances by National Nutrition Italian Institute). It is considered the increasing chance of iron therapy need in women, particularly during long-lasting hypocaloric diets.

Adult↗
PubMed1990

Surgical treatment of intracranial dermoid and epidermoid cysts in children.

Between 1956 and 1987 operations were performed on 36 patients below the age of 20 years for epidermoid and dermoid cysts of the central nervous system. Seventeen tumors were intracranial intradural lesions (47%): 12 were located in the supratentorial region (71%) and 5 were located in the infratentorial region (29%). Ten of these tumors (59%) were seated along the midline structures. The clinical presentation was consistent with the location of the tumors. The neuroradiological diagnosis was mostly made with the aid of pneumoencephalography, computed tomography (CT), nonionic contrast medium CT cisternography, and magnetic resonance imaging. Complete removal of the tumor contents was performed in all cases but one, although the completeness of removal of the tumor capsule could not be exactly estimated in some patients. At late follow-up only two tumor recurrences were observed. Radical removal of the tumor capsule of these congenital tumors, even when it is connected to vital neurovascular structures, seems advisable in patients who become symptomatic within the first two decades of life.

Adolescent↗
PubMed1990

Hemispheric cerebral tumors in children. Long-term prognosis concerning survival rate and quality of life--considerations on a series of 64 cases operated upon.

A series of 64 consecutive cases of children with neuroepthelial tumors of the cerebral hemispheres operated on from 1966 to 1983 is analyzed with regard to the long-term survival rate and the quality of life at late follow-up. At the time of the diagnosis the age of the patients ranged from 8 months to 15 years (mean age 7.6 years), and the relative incidence of these neoplasms was found to be about the same (37%) in the subgroups from 5 to 10 years and 11 to 15 years. It was only 9% in patients below 2 years of age. Tumor removal was radical in 84% and partial in 16% of the cases. The overall operative mortality was 14%, although it has been 4% since 1977. At histology, grade I and II lesions were found to account for 70% of the cases, and of the remaining 30% of the cases 8% were grade IV anaplastic lesions. The survival rate of the 55 survivors was calculated according to the actuarial life-table analysis. It was 62% at 5 years and 40% at 15 years. The survival rate at 5 years was 80% for low grade (I and II) tumors while it was 25% for high-grade malignancy (III-IV) tumors. The quality of life was assessed in all 29 patients with long-term survival (disease-free state lasting for at least 5 years) by adopting a specific protocol, which included repeated CT studies and neuropsychological evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Epilepsy course in cerebral gangliogliomas: a study of 16 cases.

From November 1979 to March 1988, 16 patients with cerebral gangliogliomas were investigated and underwent surgery at the Institute Neurologico "C. Besta" of Milan. Their age varied from 11 to 48 years. 15 of these patients presented with a seizure as the first and often the only neurological symptom. This report deals with the epileptologic and neuroradiologic features of these patients before and after surgical treatment.

Adolescent↗
PubMed1989

Surgical approach to pineal tumours.

During a period of 10 years (1977-1986) 40 cases of tumour of the pineal region have been treated at the Istituto Neurologico "C. Besta"-of Milan. Out of these 40 cases, 27 (67.5%) were in the paediatric (10-15 years) or juvenile (15-20 years) age at the time of operation. Since 1983 a specific diagnostic and therapeutic protocol has been adopted and thereafter direct surgical removal of the tumour was performed only when the neuroradiological investigations were highly suggestive of a benign extrinsic lesion. Sixteen cases in this series underwent direct surgical removal; in the remaining 24 cases stereotactic biopsy of the tumour was performed in the first instance. On the basis of the histological diagnosis obtained by this procedure surgical excision of the tumour (9 cases) or radiotherapy (15 cases) was then performed. 25 cases underwent surgical removal of the lesion. In all the cases the infratentorial supracerebellar approach as introduced by Krause and then modified by Stein was adopted. On analysis of the data of this series it was observed that in 25% of the cases completely benign resectable tumours were found; in 25% of the cases astrocytoma (grade I-II) which could be treated at least by partial removal were present; in 30% of the cases radiosensitive lesions were encountered. In the remaining 20% of the cases highly malignant tumours were found which should be treated only by radiotherapy and/or chemotherapy.

Adolescent↗
PubMed1989

Spinal meningiomas: review of 174 operated cases.

The long-term results obtained in a series of 174 patients operated on for spinal meningiomas are critically analyzed. This series was similar to those of other authors with regard to age, sex, location of the tumors, and clinical presentation. Before surgery, about 70% of the patients were included in Groups I and II (mild neurological impairment), and about 30% of the patients were classified in Groups III and IV (significant to severe neurological impairment, up to paraplegia). Complete tumor removal was achieved in 96.5% of the patients, and surgical mortality was about 1%. Microsurgical technique, which was adopted in the last 29 cases, proved to be very effective in reducing undue damage to the spinal cord and in minimizing the postoperative neurological deficits. Of the 174 patients who underwent surgery, 156 underwent late follow-up study for an average of 15 years (2 patients died in the immediate postoperative period, and 16 patients were lost to follow-up). Twenty-nine patients died of causes unrelated to the spinal meningioma; of the remaining 126 patients, 92% were categorized in Groups I and II, and only 8% in Groups III and IV. The rate of recurrence was 6% (9 patients) among the 150 patients who had complete tumor removal, and the rate of regrowth was 17% (1 patient with anaplastic meningioma) among the 6 patients treated by subtotal removal. The early diagnosis of the disease and the use of microsurgical technique appeared as the most relevant factors for further improvement of the surgical results.

Adolescent↗
PubMed1989

Natchev's auto-traction for lumbago-sciatica: effectiveness in lumbar disc herniation.

In Lind's auto-traction (LAT) for lumbago-sciatica, the patient provides traction force by pulling with the arms on a specially designed table, which also allows painless mobilization of the lumbar spine and passive traction. Two studies reported that one to 15 one-hour sessions on successive days might be sufficient to relieve pain in 25% to 90% of cases with verified lumbar disc herniation. Unfortunately, the technique imposes tiring manual efforts on the therapist and requires that the patient be transported by ambulance and confined to bed for a long time. These inconveniences were removed in a new version of the treatment proposed by Natchev. The effectiveness of Natchev's auto-traction (NAT) was evaluated in an open prospective trial on 77 patient with chronic lumbago-sciatica refractory to previous therapies, and herniation of one or more lumbar discs verified by computed tomography (CT) or myelography. Thirty-six of the 77 patients (47%) responded to the treatment in three to ten (median = 5) half-hour sessions. Pain intensity dropped to 27% (median) of the pretreatment intensity. Six months after treatment, 28 of the 36 responders were stable; only four had undergone surgery. By contrast, 20 of the 41 nonresponders had been operated on. The severity of either the radiologic or the neurologic picture was not predictive of the outcome. NAT was as effective as LAT: thus, due to its greater convenience it appears to be suitable as a routine approach in lumbar disc herniation and as a screening technique before surgery.

Adult↗
PubMed1988

Microsurgical treatment of intramedullary spinal cord tumours.

A series of 81 patients operated for intramedullary spinal cord tumours over a span of 12 years (1975-1986) is presented. The mean age of the patients was about 37 years and 9 patients were in the paediatric age (0-15 years). In 29 cases (36%) the tumours were located within the cervical region; in 34 cases the tumours were located in the thoracic region (42%) and in 18 cases the tumours were located within the medullary cone (22%). Ependymoma accounted for 52% of the cases (42 cases), astrocytoma for 20% (16 cases), lipoma for 7% (6 cases), hemangioblastoma for 6% (5 cases), metastatic tumours for 5% (4 cases); in the remaining 8 cases (10%) rare or very rare spinal tumours were found. The 9 patients in the paediatric age and 8 additional cases who had undergone previous surgery were then excluded from this review. In 59% of the patients with ependymoma and in 90% of the patients with astrocytoma severe neurological deficit were already present before the operation. Total tumour removal was accomplished in 81% of the cases with ependymoma, total or subtotal removal was achieved in 50% of the cases with astrocytoma. At long term follow-up study fair or good functional results were observed in 19 out of 41 cases of ependymoma (46%) and in 3 cases out of 10 of astrocytoma (30%). The surgical outcome was mostly related to the preoperative neurological conditions and to tumour malignancy grade.

Adolescent↗
PubMed1986

Intracranial repair of interrupted facial nerve in course of operation for acoustic neurinoma by microsurgical technique.

The microsurgical refinement of the lateral suboccipital approach is, in our opinion, the most satisfactory operative technique for achieving total removal of acoustic neurinomas of all sizes. In this series of 164 operated cases, large or very large tumours accounted for 64% of the cases (105 patients). The facial nerve was sacrificed in about 19% of the cases. In 81% of the cases the facial nerve was respected (65%) or repaired (16%) by direct intracranial suture performed immediately after tumour removal. Good or fair functional results were obtained in about 65% of the cases by this last procedure, which has to be considered as the treatment of choice for facial nerve repair. The results are compared with those of other series and with those obtained by different nerve substitution procedures.

Adult↗
PubMed1985

Urinary excretion of brush-border antigen revealed by monoclonal antibody: early indicator of toxic nephropathy.

Mouse monoclonal antibodies against brush-border antigens of the proximal tubule of human kidney were produced by the hybridisation technique. The urinary excretion of a brush-border protein with an apparent molecular weight of 50 000 (BB-50) was measured by a sandwich enzyme-linked immunosorbent assay with a mouse IgG1 against BB-50 and a polyclonal rabbit antiserum against human kidney as coating and second antibodies. The urinary excretion of BB-50 was fifty times higher in patients treated with cisplatin than in a matched control group and twice as high in workers occupationally exposed to water-soluble chromium(VI) compounds as in their matched controls. These findings suggest that the urinary excretion of kidney antigens revealed by monoclonal antibodies is a very sensitive and specific test for the assessment of toxic nephropathies.

Adolescent↗