[Prevention of infections caused by bladder catheterization].
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Biomedical subjects
Publications and source records attributed to M Ortolani.
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Modern technology has recently provided us with new resorbable suture material for use also in vascular surgery. Clinical use of these sutures has been impeded however by not little mistrust and by old dogmas without a rational experimental basis. We have therefore begun studies of two slowly resorbable materials, polyglactin 910 and polyglycolic acid, in comparison with two classic nonreabsorbable materials, nylon and polypropylene, used in experimental model of end-to-end anastomosis rats'infrarenal aorta, following up the healing process and its evolution after an interval. The results are discussed in relation to data collected from current literature.
Infant hips are classified, according to Graf, in 4 US types on the basis of the morphologic changes in both the cartilaginous and the bony roofs (type I, II, III, IV). Out of 6,000 examined hips, 170 (2.8%) were considered, which could be classified neither as type I (mature) nor as type II (delayed/immature ossification). These hips were called borderline hips. They exhibited some characteristic US features: good bone modeling, rounded cotyle, and alpha angle 60 degrees +/- 2. They were always observed during the first month of the patients' life. Anamnestic data were not specific (27.5% breech delivery, and 13% oligohydramnios); clinics sometimes overestimated the actual anatomic development (64/170 cases with positivity of Ortolani's sign and/or restricted abduction; 25% of patients presented with no suspicious signs). Dynamic hip examination showed only physiological cranial deflection of the cartilaginous roof. Finally, borderline hips developed into type I hips in 99% of cases, within the third month of the patients' life.
Neonatal hip sonography according to Graf employs a standardized image in a frontal section plane ("3-point system") and a good scanner adjustment (the femoral head must be anechoic, like the hyaline cartilage roof triangle). Pathologic conditions can change some of these parameters. The authors examined 6,000 neonatal hips in order to point out the commonest causes of diagnostic error. Two types of error were considered: method errors and interpretation errors. Method errors: they are due to the choice of transducer and frequency, to scanner adjustment and definition of the standard section plane. Their incidence was 2.25% and supported by an uncorrect definition of the standard section plane. Interpretation errors: they come from the wrong localization of some reference points--i.e., lower iliac margin, labrum--, uncorrect evaluation of increased echogenicity of the cartilaginous roof, infant age, application of radiographic criteria and uncorrect measurements of alpha and beta angles. Interpretation errors had 5.5% incidence; they were all due to the uncorrect measurement of alpha (3.18%) and beta (2.33%) angles, especially in pathological hips (68%). To reduce the number of errors, the authors suggest to strictly apply Graf's method, to make a diagnosis based on the morphological changes of the cartilaginous and osseous acetabular roof and, only later on, to measure alpha and beta angles to confirm the diagnosis or in the follow-up.
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In addition to the classical description of involvement of the cervical sympathetic in low root lesions (Claude Bernard-Horner syndrome), other sympathetic syndromes have been described accompanying the motor and sensory changes in obstetrical paralysis of the upper limb. Loss of sweat secretion can be deomonstrated by electrical skin resistance tests, and the authors describe their apparatus and method of investigating this in the newborn. Although sweat secretion is often scanty in the newborn, it can be enhanced with appropriate techniques, particularly in the areas richer in sweat glands. This method of investigating sympathetic nerve function has been used to clarify the location of the neurological damage and therefore it is of some value for the prognosis in obstetrical paralysis of the newborn.
Ortolani summarizes 40 years of experience with about 8,000 children with congenital hip dysplasia, treated from birth or at a very early age. All newborns should be screened and examined for congenital hip dysplasia and this exam should be repeated at one month and again in 3 months. The most reliable sign for the diagnosis of congenital hip dysplasia at birth is the "click" sign. The etiology of congenital hip dysplasia is in a localized fault in embryonic development. The treatment started just as early as the condition was suspected. Surgical treatment is recommended for all complete congenital hip dislocations not amenable to treatment by closed methods.
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Recent publications stress the importance of exogenous or environmental factors in the aetiology and pathogenesis of dysplasia of the hip. For this reason ante- and post-natal postures were studied in detail especially intra-uterine malposition and the so-called "forced" or "adaptation decubitus" (Zwangshaltung, Schrägseite-Lage Syndrome, Congenital pelvic obliquity). Even with the data obtained from very early (neonatal) diagnosis no distinction can as yet be made between dysplasic alterations of the hip which are sometimes associated with the above-mentioned anomalies and true congenital dysplasia. Furthermore, intra-uterine malposition and consequent breech presentation would seem to be a result rather than the cause of congenital dysplasia which only rarely occurs without underlying primary hip-joint pathology.
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