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Biomedical subjects

M Mariconda

Publications and source records attributed to M Mariconda.

17 recordsLinked to original sources

Minimum 20-year follow-up results of Harrington rod fusion for idiopathic scoliosis.

We evaluated the outcome of spinal fusion with a single Harrington distraction rod in patients with idiopathic scoliosis. At follow-up visits a minimum of 20 years post-surgery, we studied 24 patients who had been operated on by the same surgeon. The Scoliosis Research Society (SRS) Instrument and an additional questionnaire of our own, along with an invitation for a follow-up visit, were originally mailed to 28 consecutive patients of the surgeon. The SRS Instrument has seven domains dealing with back pain, general self-image, self-image after surgery, general function, function in terms of level of activity, function after surgery, and degree of satisfaction with the surgery. The length of time between surgery and the follow-up visit averaged 22.9 years (20.2-27.3). The mean age at surgery and follow-up were 15.8 (13-22) and 38.8 (35-48) years, respectively. Twenty-four patients sent back the completed questionnaires and 16 of them participated in the clinic and radiographic follow-up. To assess the meaning of the questionnaires' results, a control group of the same sex, age and geographic provenance was selected from our outpatients without scoliosis. The average follow-up score on the SRS Instrument for the patients was 100.8 (78-110). When we compared the study and control groups, no significant differences in the single SRS domain scores were observed. The mean Cobb angle and rib cage deformity before surgery were 70.46 degrees (40-120) and 36.4 mm (20-60 mm), respectively, whereas on follow-up they were 41.23 degrees (16-75) and 22.3 mm (5-50 mm), respectively. These long-term results lead us to consider Harrington fusion a procedure that produces a long-lasting high degree of self-reported post-operative satisfaction.

Adolescent↗

Quantitative ultrasound measurements of the calcaneus in the prediction of lumbar spine degeneration.

A cross-sectional study was conducted to evaluate the possible use of a low-cost radiation-free technique in the prediction of degenerative changes in the lumbar spine. Although an inverse correlation between osteoporosis and degenerative changes in the lumbar spine has been reported, no previous studies have asked whether there is a correlation between calcaneal quantitative ultrasound results and degenerative findings in the lumbar spine. In 117 patients with low back pain or pain in the lower limb, ultrasonographic parameters (speed of sound, broadband ultrasound attenuation, stiffness) of the calcaneus were correlated with evidence of degenerative changes and stenosis on magnetic resonance scans of the lumbar spine. Linear and logistic regression, as well as receiver operator characteristic curve analyses, were used to evaluate the correlation. Lumbar spine stenosis was associated with elevated calcaneal ultrasonographic parameters, particularly speed of sound. For the identification of a narrowing of the lumbar spinal canal below 100 mm(2) of dural sac cross-sectional area, speed of sound showed 89% sensitivity and 75% specificity in males older than 60 years. In male patients, we also found a significant positive correlation between ultrasonographic parameters and scores on a degenerative scale that primarily reflects intervertebral disc degeneration ( P=0.019 for speed of sound; P=0.039 for stiffness). In conclusion, calcaneal quantitative ultrasound is frequently used in elderly patients with low back pain as a diagnostic test for osteoporosis. The incidental finding of high values on ultrasonographic parameters in these subjects, particularly in males, is highly correlated with lumbar spine degeneration and stenosis, and can help to identify those symptomatic patients needing more extensive diagnostic testing.

Adult↗

Fracture of posterior-stablized tibial insert in a Genesis knee prosthesis.

We report a case of acute failure of a Genesis total knee arthroplasty (Smith and Nephew Orthopaedics, Memphis, TN) resulting from fracture of the eminence of the polyethylene posterior-stabilized tibial insert implanted in a revision procedure. A hyperflexion movement was responsible for shear stress on the insert with subsequent breakage. The correct diagnosis was obtained by arthroscopy, and the open substitution of the broken insert led to complete recovery of the prosthesis. This is the first report of mechanical breakage of a Genesis prosthesis.

Aged↗

Factors influencing the outcome of degenerative lumbar spinal stenosis.

The objective of this study was to evaluate the influence of decreased dural sac cross-sectional area and baseline clinical parameters on the outcome of patients treated surgically or conservatively for lumbar spinal stenosis. Computed tomography or magnetic resonance imaging scans of 37 patients were digitized and the dural sac cross-sectional area was calculated. This parameter and baseline clinical, socioeconomic, and anthropometric data of the patients were correlated with 1-year and 2-year follow-up data. The decrease in dural sac cross-sectional area negatively affected walking capacity on follow-up controls in patients treated conservatively, whereas such a relation was not observed among surgically treated patients. Female sex was the main parameter that worsened the global outcome of degenerative lumbar spinal stenosis, particularly after surgical treatment.

Dura Mater↗

[Villous-lipomatous proliferation of synovial membrane of the knee (lipoma arborescens). Magnetic resonance findings].

PURPOSE: We reviewed the imaging patterns of the villous-lipomatous proliferation of the knee synovial membrane (lipoma arborescens), with special reference to the role of MRI in the diagnosis of this rare condition. MATERIAL AND METHODS: 1994 to 1996, we examined four patients, none of them with a history of knee trauma. The clinical picture was characterized by moderate and painful suprapatellar swelling in three cases and by moderate suprapatellar swelling alone in one case. All patients were examined with conventional radiography and MRI; two were submitted to US and two to CT. The diagnosis of lipoma arborescens was suggested on the basis of imaging patterns and then confirmed by histologic findings. RESULTS: Conventional radiography showed a roughly oblong slim opacity in the suprapatellar recess in all cases; the joint space was always preserved. US showed a villous lesion surrounded by fluid, but provided no specific data on its nature. CT and MRI not only provided better location and morphologic detailing and showed the relationships with articular structures better, but also permitted the direct identification of the fat nodules within the abnormal synovial reaction. CONCLUSION: We stress the role of MRI in suggesting the correct diagnosis of lipoma arborescens, as it was subsequently confirmed in our series by histologic findings. In fact, fat-suppression sequences, after T1-weighted SE, can typify fat tissue.

Bone Neoplasms↗

Appendicular bone density, biochemical markers of bone turnover and lifestyle factors in female teachers of Southern Italy.

The present study was designed to investigate relationships between urinary free pyridinolines (F-Pyr), serum osteocalcin (OC) and appendicular bone mineral density (BMD). Furthermore, possible correlations between such variables and putative risk factors for low bone density were also analysed. We were not able to find any relationships between biochemical markers of bone turnover and appendicular BMD or putative risk factors for osteoporosis at multivariate analysis. Multivariate analysis showed a significant decrease of BMD when age increases (p < 0.001), with menopause and time since menopause (p < 0.001), while number of pregnancies (p = 0.018) was associated with a higher value of BMD. Age, menopause and time since menopause were significantly associated with urinary excretion of F-Pyr. Indeed age was an inverse effect modifier of the relationship between urinary excretion of F-Pyr and time since menopause.

Adult↗

[Bone metastasis of leiomyosarcoma. Apropos of a case].

INTRODUCTION: Bone leiomyosarcoma is a rare tumor, whether it may be primary or secondary. The authors report on the case of a woman, aged 67, admitted in January 1992 complaining of pain in the left hip and the upper end of the femur. CASE REPORT: In 1985 the patient underwent surgical excision of a soft tissue tumor in the right thigh, histologically diagnosed as a benign fibrous tumor. This lesion recurred locally four times and repeated excisions were performed throughout the years, always with a histological diagnosis of a benign lesion. On admission to hospital, the physical examination as well as laboratory data and plain roentgenograms were unremarkable. Both tomography and MRI showed a lesion in the upper end of the left femur. An isotopic bone scan showed marked increased uptake in the left hip extending to the femoral diaphysis. An open biopsy was performed for histology, immunohistochemistry and electron microscopy. A diagnosis of metastatic leiomyosarcoma was made. The retrospective histological examination of specimens of the soft tissue tumor excised in 1985 showed the same immunohistochemical features of the contralateral leiomyosarcoma. On this basis, one stage resection of the left hip and the upper end of the femur was performed and a Kotz modular prosthesis was inserted. Postoperative healing was achieved without any complications and the function of the operated limb was satisfactory. Three months after the operation pulmonary lesions were noted on chest radiographs and CT scan. The patient died two years after the first admission for widespread metastasis. DISCUSSION: In the reported case, the bony metastasis appeared to be the presenting finding of the soft tissue tumor of the contralateral thigh. This presentation is rare in previously published series. The misdiagnosis of the primary tumor had caused local recurrences, and an increased malignity occurred. According to the literature, a soft tissue leiomyosarcoma can be easily confused with other spindle cell lesions. Therefore an accurate histological and ultrastructural diagnosis is necessary for adequate surgical treatment.

Aged↗

Comparison of CT scan diagnosis and surgical findings in lumbar disk herniation.

The authors compare CT scan evidence with surgical findings in lumbar intervertebral disk disease. The results confirm the reliability of the CT scan for diagnosis of disk herniation, but find it somewhat less precise as far as diagnosis of disk degeneration. The authors emphasize the irreplaceability of the clinical examination in the preoperative assessment of lumbar disk disease as well as the important confirmation provided by the imaging studies.

Adult↗

An unusual finding in nerve root compression at L5 caused by herniated disc.

The authors describe the severe changes observed in the L5 nerve root in a patient aged 46 years with lumbar disc herniation at L4-L5. The lesions observed in the nerve root made it unrecognisable, thus we could not be certain that we were actually dealing with a nerve root until it was confirmed by histological examination. The severe macroscopic and microscopic changes observed had resulted in complete loss of function in the nerve root, so its removal did not cause any changes in the neurological, clinical or electromyographic pictures.

Electromyography↗

Intervertebral disc herniation at D3-4 Case report.

The authors report a case of intervertebral disc herniation at D3.4 which they removed surgically from a posterior approach. They emphasize the extreme rarity of this localisation. The hernia was calcified, extruded and displaced posterolaterally and medially, causing pressure on the anterior aspect of the spinal cord with neurological signs of the pareto-spastic type. The operation was successful, with relief of pain and regression of the neurological symptoms.

Adult↗

A computerised tomographic scan study of Luque loops and the progression of vertebral fusion in the surgical treatment of scoliosis.

The authors report the results of a study, using CT scan, on 15 patients with scoliosis treated by the Harrington-Luque method. The patients were monitored periodically from the 3rd to the 30th month after operation. Each patient was monitored only once in order to limit the risk of ionizing radiation. In all the follow-ups it was observed that the metallic loops were in close contact with the laminae, which did not show any signs of disturbances. The medullary canal appeared to be of normal dimensions. Vertebral fusion was evident at the first 3 months follow-up and at this time partial corticalization also commenced. In successive follow-ups, fusion progressed steadily, and after 8 months it was completely corticalized. This progression continued even after 18 months so that at 30 months the fusion was such that the distractor was completely surrounded.

Bone Wires↗

Serological markers of hepatitis B virus infection in healthy volunteer blood donors in Campania (Southern Italy).

The prevalence of hepatitis B virus (HBV) serological markers was determined in a prospective fashion by radioimmunoassay in 2,084 healthy volunteer blood donors. The results showed that 51.2% of the donors were positive for at least one marker, and the percentage of occurrence of each marker was: HBsAg 5.3, anti-HBs alone 1.7, anti-HBc alone 10.8, anti-HBs and anti-HBc 33.3. Because of the size of the problem this investigation strongly demands further studies on the potential role of blood positive for anti-HBc in transmitting HBV infection in our geographical area.

Adolescent↗

Synovial cyst in a posterior lumbar joint associated with sacralization at L5. Description of a case.

Synovial cysts may occasionally be localized in the facet joints of the lumbar spine. These lesions are usually secondary to interapophyseal arthritis or trauma, that may cause hypermobility of the facet joints. Given the frequent association with arthrosis, synovial cysts are more often observed at L4-L5, which represents the level of greater mobility in the lumbar spine, in subjects aged over 50 years. A rare case of synovial cyst of the posterior joint of L5-S1 associated with sacralization of L5, a congenital anomaly that determines considerable segmental mechanical stability, is described.

Adult↗

Tuberculosis of the lower cervical spine: a description of two cases.

Tubercular infection is a rare occurrence in the lower cervical spine. The isolated involvement of the posterior arch is particularly rare, and the very few cases in which it is reported at the thoracic or lumbar levels were principally observed in immunodepressive patients. It is the purpose of this study to describe two cases of tuberculosis of the lower cervical spine with neurological deficit: one expansive neoformation at the level of the arch of C7, with saving of the vertebral body and the discs, and a spondylodiscitis at C4-C5, treated conservatively, the healing process of which was followed by MRI.

Aged↗