Biomedical subjects

R Biagini

Publications and source records attributed to R Biagini.

At least 19 recordsLinked to original sources

PubMed2000

Chondrosarcoma of the mobile spine: report on 22 cases.

STUDY DESIGN: A retrospective review of 22 cases of chondrosarcoma arising from the mobile spine. OBJECTIVE: To evaluate the role of oncologic and surgical staging in correlating management and outcome of chondrosarcoma involving the spine. SUMMARY OF BACKGROUND DATA: Approximately 10% of chondrosarcomas arise from the mobile spine, occurring mainly in adults, particularly elderly men. The course of the disease depends on the aggressiveness of the tumor, but also is influenced by the management. Intralesional surgery is followed almost constantly by local recurrence even with adjuvant therapy. METHODS: All charts, radiographs, and images were reviewed. The composite information provided by this review allowed for oncologic and surgical staging of the reviewed cases. According to Enneking criteria, the surgical procedures were defined as curettage (piecemeal excision) or en blocexcision. The margins were submitted to histologic study and reported as intralesional, marginal, or wide. - As primary management, 10 intralesional curettages (follow-up period, 2-119 months; average, 61 months) and 12 en bloc excisions (follow-up period, 39-207 months; average, 97 months) were performed. A total of 33 procedures were performed, including the management of the recurrences (18 curettages and 15 en bloc excisions: one for soft tissue recurrence). A clinical and radiographic follow-up period of of 2 to 236 months (average, 81 months; minimal follow-up period for survivors, 30 months; average follow-up period for survivors, 115 months) was available for all the patients. RESULTS: Three recurrences occurred in 14 patients treated by en bloc excision at onset or for recurrence, two in cases of histologically proven contaminated or intralesional margins. All but one patient were alive at final follow-up evaluation. Conversely, all the patients treated by one or more curettages (with or without adjuvant radiation therapy) had at least one recurrence, and 8 of 10 of these patients died of the disease. At final follow-up evaluation, nine patients had died of the disease; nine were continuously disease free (but one had died of another unrelated malignancy); and four were symptom free after management for recurrences (one was found alive 155 months after a soft-tissue metastasis en-bloc excision). CONCLUSIONS: En bloc excision, with wide or marginal histologic margins, is the suggested management for chondrosarcomas of the spine. Early diagnosis and careful surgical staging and planning are necessary for conducting adequate management. However, tumor contamination of the specimen margins, even in a small area, or spreading of the tumor myxoid content can worsen the prognosis.

Adult↗

PubMed2000

Fast procedures for coincidence-summing correction in gamma-ray spectrometry

Simplified and fast procedures for coincidence-summing correction in gamma-ray spectrometry were investigated. These procedures are based on the usual theoretical expressions of the correction factors, but differ in the determination of the total efficiency curve based on the following approximations: (a) replacement, below the knee efficiency value, of the total efficiency by the full-energy peak efficiency; and (b) use of linear interpolations (in log-log plot) between only two experimental points above the knee efficiency value; or (c) assumption of a peak-to-total efficiency ratio independent on the counting geometry; or (d) assumption of a constant relation between the peak-to-total efficiency ratios and the photoelectric-to-total cross section ratios. The above approximations were separately assumed for determination of the coincidence-summing correction factors for nuclides with complex decay scheme (133Ba, 134Cs, 152Eu) and for 60Co and 88Y measured on a 15% relative efficiency p-type coaxial HPGe detector, for three source-detector geometries: point source placed on top of and at 10 cm from the detector window, and 1 l Marinelli beaker filled with aqueous solution. The results were compared with those based on more accurate experimental determinations of the total efficiency curve from measurements of standard sources of eight different single-gamma-ray emitters. The usefulness of each simplified procedure is evaluated with respect to its accuracy and to the reduction of the number of standard sources and measurement time.

Journal Article↗

PubMed2000

Comparative effects of levosulpiride and cisapride on gastric emptying and symptoms in patients with functional dyspepsia and gastroparesis.

BACKGROUND: The efficacy of several prokinetic drugs on dyspeptic symptoms and on gastric emptying rates are well-established in patients with functional dyspepsia, but formal studies comparing different prokinetic drugs are lacking. AIM: To compare the effects of chronic oral administration of cisapride and levosulpiride in patients with functional dyspepsia and delayed gastric emptying. METHODS: In a double-blind crossover comparison, the effects of a 4-week administration of levosulpiride (25 mg t.d.s.) and cisapride (10 mg t.d.s.) on the gastric emptying rate and on symptoms were evaluated in 30 dyspeptic patients with functional gastroparesis. At the beginning of the study and after levosulpiride or cisapride treatment, the gastric emptying time of a standard meal was measured by 13C-octanoic acid breath test. Gastrointestinal symptom scores were also evaluated. RESULTS: The efficacy of levosulpiride was similar to that of cisapride in significantly shortening (P < 0.001) the t1/2 of gastric emptying. No significant differences were observed between the two treatments with regards to improvements in total symptom scores. However, levosulpiride was significantly more effective (P < 0.01) than cisapride in improving the impact of symptoms on the patients' every-day activities and in improving individual symptoms such as nausea, vomiting and early postprandial satiety. CONCLUSION: The efficacy of levosulpiride and cisapride in reducing gastric emptying times with no relevant side-effects is similar. The impact of symptoms on patients' everyday activities and the improvement of some symptoms such as nausea, vomiting and early satiety was more evident with levosulpiride than cisapride.

Activities of Daily Living↗

PubMed1999

Osteolytic extra-axial sacral myxopapillary ependymoma.

The authors report an unusual case of sacral osteolytic myxopapillary ependymoma treated with curettage and radiotherapy. There is no evidence of recurrence 8 years after treatment. A review of the literature is presented on sacral ependymomas presenting with an osteolytic radiographic appearance (24 cases in 18 reports). The differential diagnosis with other sacral neoplasms is discussed.

Adult↗

PubMed1999

Optimal duration of therapy combining ranitidine bismuth citrate with clarithromycin and metronidazole in the eradication of Helicobacter pylori infection.

BACKGROUND: Ranitidine bismuth citrate (RBC) co-prescribed with clarithromycin and metronidazole for 1 week has been shown to be an effective eradicating regimen for Helicobacter pylori. AIM: To determine the optimal duration of this regimen. METHODS: A series of 165 dyspeptic patients were recruited for this randomized, open, parallel-group study. They were subdivided into three groups receiving RBC 400 mg b.d. plus clarithromycin 250 mg b.d. and metronidazole 500 mg b.d. for three different periods (4, 7 and 10 days). H. pylori infection was assessed by the concomitant positivity of CLO-test and histology performed at the pre-entry endoscopy. The bacterium was considered eradicated on the basis of a negative 13C-urea breath test performed at least 28 days after the completion of treatment. RESULTS: The three subgroups were well matched and 16 patients dropped out of the study for many reasons (six in the 4-day, five in the 7-day and five in the 10-day treatment regimens). Intention-to-treat cure rates were 60%, 84% and 85%, and the per-protocol rates 67%, 92% and 94% in the 4-day, 7-day and 10-day treatment regimens, respectively. There was a significant difference, P = 0.003-0.006 on intention-to-treat and P = 0.001-0. 002 on per protocol analysis between the 4-day and the 7-day and the 4-day and the 10-day periods, respectively. The 7-day and 10-day periods did not differ from each other. Side-effects were reported in 9%, 14% and 20% of the 4-, 7- and 10-day regimens. They led to stopping treatment in four cases (one in the 7-day and three in the 10-day period). There was no statistical difference among them. CONCLUSIONS: Reducing the duration of RBC-based triple therapy to 4 days provides a low and unacceptable rate of H. pylori eradication. As there is no difference between 7 and 10 days of treatment, 1 week represents the optimal time period for this kind of treatment, based on RBC plus two antibiotics.

Anti-Bacterial Agents↗

PubMed1998

The relationship between symptoms and IgG and IgE antibodies in an office environment.

Airborne fungi have been postulated as a cause of symptoms among office workers. Using the MAST chemiluminescent system, this study evaluated 36 IgG and 36 IgE antibody levels in 47 office workers from an area with elevated airborne fungal concentrations and 44 office workers from an otherwise similar area with lower airborne fungal exposure. No difference was found in IgG antibody to fungi between the lower and higher exposure areas, but high IgG antibody to one or more of the fungi studied was detected in 67% of all the workers tested. IgE antibody to one or more antigens was detected in 40% of the participants. Workers who reported atopic symptoms (sneezing, runny nose, and itchy eyes) or "sick building" symptoms (any three of the following temporally related to work: headache, fatigue, stuffy nose, irritated eyes, or sore throat) were more likely to have one positive IgE antibody test. Type I hypersensitivity to aeroallergens besides fungi may play a role in some symptoms reported by some participants in this office building.

Adult↗

PubMed1998

[Significance of computerized tomography in the diagnosis of post-traumatic proximal carpal instability].

INTRODUCTION: Proximal carpal instability is a painful condition characterized by early or late loss of radioulnar joint (RUJ) congruence not affecting the normal bone alignment of the two carpal rows. The joint incongruence or (incomplete) dislocation which leads to proximal instability is caused by many traumatic and nontraumatic events. The diagnosis of (incomplete) dislocation of the distal RUJ may be extremely difficult to make at conventional radiography because such injuries can be seen only when the lateral joint projection is perfect; otherwise the diagnosis is not reliable. CT is the only imaging tool diagnosing the grade of distal RUJ congruence independent of the examination technique. MATERIAL AND METHODS: We studied the radiocarpal complex conditions leading to proximal instability at the Rizzoli Orthopedic Institute from December, 1995, through December, 1997. In all, 389 cases were seen, 376 from trauma and 13 of nontraumatic origin. Each injury was studied with conventional radiography, CT, and MRI. Radiography was performed in two projections, namely the posteroanterior one with hand extension and the lateral one with the forearm in neutral position and the elbow bent at 90 degrees; the projections were repeated whenever a cast brace was applied. Unenhanced CT was performed for comparison with the patient prone and the forearm and wrist in prone and neutral position, as well as with the patient, forearm and wrist supine. Three criteria of electronic image processing were adopted for the RUJ studies in the 3 projections: radioulnar lines, congruence, and epicenter. MRI was always performed after conventional radiography and CT. Only the involved radiocarpal region was studied; coronal, axial and sagittal images were acquired with T2-weighted GE and T1-weighted SE sequences. RESULTS: Proximal instability was found in 17 of 389 patients; it was early in 13 and late in 4 of them. The comparison of radiographic and CT results showed that the former method is unreliable, with 53% false negatives. Pain, a cast brace, congenital or acquired deformities of distal radius and ulna and patient mispositioning by the radiology technician can change the rotation of the forearm, wrist and hand and make a perfect laterolateral projection in neutral position unfeasible, which affects the radiographic diagnosis. Conversely, CT showed its extreme efficacy in assessing the distal RUJ congruence with no false negatives independent of the RUJ rotation and of instability type and grade. CONCLUSIONS: Conventional radiography is a poorly reliable tool for the diagnosis of joint incongruence and its grade. In contrast, CT can diagnose a RUJ (incomplete) dislocation easily and unquestionably, thanks to its axial capabilities, even when adequate radiographic studies would be unfeasible. If the anteroposterior projection of the radiocarpal complex shows a congenital or acquired deformity of distal radius, the lateral projection can be skipped and a CT scan in prone, neutral and supine position performed. The 3 CT criteria quantify incongruence type and grade, and also demonstrate the position of maximum incongruence and its decrease by position. The comparative study of the radiocarpal region makes CT a very useful and valuable tool in congenital instability because its allows the assessment of contralateral radioulnar congruence too. MRI is very useful in the diagnosis of injury or degeneration of the fibrocartilage complex, namely in patients with no bone changes at conventional radiography.

Humans↗

PubMed1997

A system for surgical staging and management of spine tumors. A clinical outcome study of giant cell tumors of the spine.

STUDY DESIGN: This study developed and independently applied a spine tumor classification system, referred to as the Weinstein-Boriani-Biagini system, in a retrospective analysis of a series of patients with spinal giant cell tumors from three institutions. OBJECTIVE: To evaluate factors of potential prognostic significance for recurrence of spinal giant cell tumors. SUMMARY OF BACKGROUND DATA: No prior reviews of patients treated with modern surgical techniques are available. METHODS: Charts and radiographs for 36 cases of spinal giant cell tumors were reviewed by an independent investigator. All patients had had recent clinical follow-up examinations. All patients were classified according to the Enneking system. A subgroup of 24 patients for whom preoperative computed tomography scans were available were classified using the Weinstein-Boriani-Biagini staging system. Outcome measures included pain, neurologic status, and tumor recurrence. RESULTS: Recurrence rates were substantially higher among patients treated with attempted surgical excision before referral to a tertiary care center (83% vs. 18%). There was a higher recurrence rate for tumors that involved the vertebral body and posterior elements in comparison with lesions residing in only anterior elements (24% vs. 0%). Tumors that had extra-osseous extension into the canal and into the paraspinous musculature had a higher recurrence rate than tumors either confined to the osseous compartment or with extension either into the spinal canal or externally into paraspinous planes, but not both (21% vs. 10%). CONCLUSIONS: These results indicate that the Weinstein-Boriani-Biagini system may prove useful in developing treatment algorithms and in assessing outcome for these rare and difficult lesions. At least in the case of giant cell tumors, the musculoskeletal tumor staging system as developed by Enneking for long bones suggests the ideal surgical margin and may provide information relevant to tumor recurrence rates. Additional aspects of tumor extent and location, however, may berelevant to primary tumor recurrence rates when the selesions occur in the spine.

Adolescent↗

PubMed1997

Primary bone tumors of the spine. Terminology and surgical staging.

Appropriate application of an oncologic staging system is required to evaluate the relationship among histologic types, management, and outcome of primary bone tumors. A commonly accepted terminology for surgical procedures and for definition of tumor extent is needed for surgical planning and clinical reviews. The principles of the Enneking system for classifying stages of tumors are emphasized and applied to the spine using a practical approach for surgical staging.

Chondrosarcoma↗

PubMed1997

[Traditional radiology in the assessment of posttraumatic carpal instability].

INTRODUCTION: Carpal instability is a painful posttraumatic syndrome with early or late loss of the normal alignment of the carpal bones, which can be caused by a variety of injuries, from minor sprain to major fracture-dislocation of the carpal-wrist complex. If the trauma causing instability is a fracture, a severe dislocation or a fracture-dislocation, the radiographic diagnosis is not particularly difficult. The morphologic and dynamic complexity of the carpal region represents, instead, a major obstacle in the radiologic diagnosis of mild or moderate sprains because the morphologic alterations on standard static views are minimal or absent in these conditions. MATERIALS AND METHODS: We reviewed 214 injuries causing posttraumatic carpal instability including both the cases classified by the Data Analysis Center of the Istituto Ortopedico Rizzoli as carpal dislocations and fracture-dislocations from January, 1975, to July, 1996, and the more recent cases directly observed at our Casualty Clinic. In the former cases, we reviewed only the available images, while our patients were examined with comparative standard and under stress or dynamic views. RESULTS: Of 214 lesions causing posttraumatic carpal instability, 43 along the great arch were classified as severe because they were easily detectable on standard films and 171 along the small arch were classified as mild because slight/no abnormalities were detected on standard static views. Only dynamic imaging showed posttraumatic carpal instability demonstrating the integrity of the ligaments and of the carpal hinges, as well as gaps or asymmetry not detected on static views. CONCLUSIONS: We suggest the systematic use of dynamic imaging in the cases where static findings are negative or poor, in the patients with a painful wrist after an apparently minor sprain. Missed or delayed diagnoses are thus reduced, as well as the consequent joint incongruity and/or chronic subluxation which may severely impair these patients.

Carpal Bones↗

PubMed1996

En bloc resections of bone tumors of the thoracolumbar spine. A preliminary report on 29 patients.

STUDY DESIGN: Twenty-nine patients with primary bone tumors and solitary metastases of the thoracolumbar spine treated with en bloc resection are reviewed retrospectively. OBJECTIVE: To demonstrate the possibility to apply in the spine the same principles of surgical oncology adopted for primary bone tumors of the limbs. SUMMARY OF BACKGROUND DATA: The surgical oncologic staging systems currently applied in limb tumor surgery are difficult to apply to spinal tumors. The anatomic conditions make extralesional surgery difficult or impossible, which has restrained a more common use of resection surgery in the spine. Focus is put on a new surgical staging system and en bloc vertebral resection. METHODS: Twenty-five primary malignant and aggressive benign bone tumors and four solitary metastases were treated. The patients were submitted to oncologic and surgical staging for surgical planning. The primary tumors were classified according to Enneking system: three Stage IA, six Stage IB, eight Stage IIB, eight Stage 3 benign. Staging according to the Weinstein-Boriani-Biagini system was also done. Thirteen lesions involved the vertebral body; nine lesions developed in the posterior arch, or part of it, and seven lesions occupied part of the body and part of the arch. A careful anesthesiologic evaluation was performed as well as a continuous intraoperative on-line monitoring of the vital parameters. The en bloc resections (multisegmental in five patients) were performed in 10 thoracic, in 16 lumbar, in two thoracolumbar lesions, and in one lumbosacral lesion. Reconstruction was performed, aiming to replace the resected columns. The specimens were submitted to histologic study of the margins. All the patients were followed, and their status was defined on clinical and imaging studies. RESULTS: In 20 patients, a wide margin was achieved, in eight a marginal margin, in one an intralesional margin. The margin was contaminated in seven patients. Surgical time was 3-21 hours (average, 12 hours). No patient died during surgery or from surgical complications. Three mechanical failures of the implants required additional surgery. One deep infection arose. The only neurologic problems observed were related to the nerve roots sectioned for oncologic purpose. No local recurrence was found at follow-up evaluation after 6-134 months (average, 30 months). CONCLUSIONS: En bloc resection can be performed in selected tumors of the spine; the indication to such major surgery must be based on the oncologic stage, and the procedure must be carefully planned. For this purpose, the Weinstein-Boriani-Biagini system could be a helpful tool. Long-term results must be weighed before a definitive statement of the indications can be made.

Adolescent↗

PubMed1996

Chordoma of the spine above the sacrum. Treatment and outcome in 21 cases.

STUDY DESIGN: Twenty-one cases of chordoma arising in the mobile spine were retrospectively reviewed. OBJECTIVES: All the cases were submitted to oncologic and surgical staging to correlate treatment and outcome. SUMMARY OF BACKGROUND DATA: Excluding plasmacytomas, chordoma is the most frequent primary malignant tumor of the spine, occurring mainly in elderly men. The course of the disease is slow, metastases occur late, and death can result from complications related to local extension of the disease. Complete excision of the tumor according to oncologic criteria can be hampered by extension of the tumor and by anatomic constraints in the mobile spine. METHODS: All charts, radiographs, and images were reviewed. The composite information provided by this review allowed for oncologic and surgical staging of these cases. Treatment was defined according to Ennekings criteria. All the patients were followed for determination of their status clinically and radiographically. RESULTS: Ten patients died (1 to 137 months after treatment, mean 65 months); four patients are alive with the disease; only seven patients (33%) are symptom free at the final follow-up (39 to 112 months after treatment, mean 65 months). Conventional radiation therapy was not effective in eradicating the tumor, even if associated with palliative or debulking surgery: of 15 cases, 12 were associated with recurrence or progression. Intralesional surgery also was not effective (two recurrences in two cases, 18 to 41 months later). En bloc excision of the lesion, sometimes combined with radiation therapy as an adjuvant, obtained the best results (four patients disease free at 39 to 112 months, mean 77 months). CONCLUSIONS: En bloc excision--even if marginal--is the treatment of choice of chordomas of the spine. Early diagnosis and careful surgical staging and planning are necessary. Megavoltage radiation can be administered as an adjuvant.

Adult↗

PubMed1996

Health and immunology study following exposure to toxigenic fungi (Stachybotrys chartarum) in a water-damaged office environment.

There is growing concern about adverse health effects of fungal bio-aerosols on occupants of water-damaged buildings. Accidental, occupational exposure in a nonagricultural setting has not been investigated using modern immunological laboratory tests. The objective of this study was to evaluate the health status of office workers after exposure to fungal bio-aerosols, especially Stachybotrys chartarum (atra) (S. chartarum) and its toxigenic metabolites (satratoxins), and to study laboratory parameters or biomarkers related to allergic or toxic human health effects. Exposure characterization and quantification were performed using microscopic, culture, and chemical techniques. The study population (n = 53) consisted of 39 female and 14 male employees (mean age 34.8 years) who had worked for a mean of 3.1 years at a problem office site; a control group comprised 21 persons (mean age 37.5 years) without contact with the problem office site. Health complaints were surveyed with a 187-item standardized questionnaire. A comprehensive test battery was used to study the red and white blood cell system, serum chemistry, immunology/antibodies, lymphocyte enumeration and function. Widespread fungal contamination of water-damaged, primarily cellulose material with S. chartarum was found. S. chartarum produced a macrocyclic trichothecene, satratoxin H, and spirocyclic lactones. Strong associations with exposure indicators and significant differences between employees (n = 53) and controls (n = 21) were found for lower respiratory system symptoms, dermatological symptoms, eye symptoms, constitutional symptoms, chronic fatigue symptoms and several enumeration and function laboratory tests, mainly of the white blood cell system. The proportion of mature T-lymphocyte cells (CD3%) was lower in employees than in controls, and regression analyses showed significantly lower CD3% among those reporting a history of upper respiratory infections. Specific S. chartarum antibody tests (IgE and IgG) showed small differences (NS). It is concluded that prolonged and intense exposure to toxigenic S. chartarum and other atypical fungi was associated with reported disorders of the respiratory and central nervous systems, reported disorders of the mucous membranes and a few parameters pertaining to the cellular and humoral immune system, suggesting a possible immune competency dysfunction.

Adult↗

PubMed1995

Biological monitoring of commercial pesticide applicators for urine metabolites of the herbicide alachlor.

Alachlor (2-chloro-2',6'-diethyl-N-[methoxymethyl] acetanilide), the active ingredient in several trade name herbicides, is absorbed through the skin and readily excreted in the urine as conjugated metabolites. This paper presents the results of a study to measure alachlor metabolites in the urine of commercial pesticide applicators who were applying alachlor to corn and soybean crops under normal work conditions. Three spot urine samples, collected at the beginning and end of the work shift and the morning after the exposure survey, were collected from 20 applicators, 7 hauler-mixers, and 8 controls. Each sample was analyzed using both a competitive, solid-phase, enzyme-linked immunoassay (ELISA) and a high-performance liquid chromatography (HPLC) technique. Although the urine metabolite concentrations measured by ELISA were consistently higher than the respective HPLC measurements, a high correlation (r = 0.90) was observed between the ELISA and HPLC measurements. The controls, with little exposure to alachlor, had metabolite levels below or near the lower limits of detection for each analysis technique. Similar urine metabolite concentrations were observed for the applicators and hauler-mixers, suggesting similar work exposures. The average postexposure urine concentrations were not correlated with the amount of alachlor handled and applied, suggesting that other factors, such as work practices, are greater determinants of absorbed doses of alachlor.

Acetamides↗

PubMed1995

Exposure of commercial pesticide applicators to the herbicide alachlor.

Presented in this paper are the results of a pilot study to estimate the alachlor inhalation (2-chloro-2',6'-diethyl-N-[methoxymethyl] acetanilide) and skin exposures of commercial pesticide applicators, who apply a variety of herbicides and insecticides to crop land. Twenty applicators and seven hauler-mixers participated in the study. Inhalation exposures ranged from 0.32 to 6.4 micrograms/m3, with a geometric mean of 1.6 micrograms/m3. Alachlor deposition on clothing patches was highly variable, ranging from < 0.01 to 32.0 micrograms/cm2. The thigh patches generally received more deposition than patches in other areas. Surface-wipe and hand- and glove-wash samples also indicated that the hands frequently were exposed; alachlor concentrations in postshift handwash samples ranged from 3 to 324 micrograms/sample. The results of the study indicate that commercial pesticide applicators encounter substantial exposures to alachlor and that proper precautions for reducing exposures are not always followed. Practical steps, in particular the use of good work practices, may be taken to reduce exposures in this population.

Acetamides↗

PubMed1995

Primary bone tumors of the spine: a survey of the evaluation and treatment at the Istituto Ortopedico Rizzoli.

The experience at Istituto Rizzoli with 366 primary bone tumors of the spine focuses on the criteria for planning and treatment. An accurate preoperative evaluation by standard radiograph, computerized tomography scan, and magnetic resonance imaging allow the classification of benign lesions as latent (not requiring treatment), active (curettage), or aggressive (curettage plus adjuvants or marginal resection). The malignant lesions are classified as intracompartmental or extracompartmental (both low and high grade). Wide resection is attempted, but seldom is feasible. An angiographic study of the spinal cord is compulsory for lesions located in the thoracolumbar region. The value of embolization is enhanced, primarily in highly vascular lesions. An accurate preoperative study of the vital parameters of the patient, together with a continuous intraoperative monitoring, is mandatory.

Adult↗

PubMed1994

Two-level thoracic disc herniation.

STUDY DESIGN: A double, contiguous disc herniation in the thoracic spine (T7-T8, T8-T9) in a 44-year-old man is reported. The patient complained of intermittent episodes of weakness and numbness in the lower extremities, paraesthesias radiating to the anterior and medial surfaces of the thigh and the leg (mostly on the left side), and mild sexual and urinary dysfunction. OBJECTIVE: The treatment must achieve complete spinal cord decompression, prevent further herniation, and prevent iatrogenic vascular damage to the cord. A transthoracic approach seems to offer the largest surgical view. SUMMARY OF BACKGROUND DATA: Twenty-six other cases of two-level thoracic disc herniation were found in the literature, only five of which were treated with a transthoracic approach. METHODS: Treatment consisted of complete disc excision (T7-T8 and T8-T9) with a right anterior transthoracic approach. Complete and safe removal of the discs required hemicorporectomy of T8 and subsequent grafting and plating. Spinal cord angiography, showing the Adamkiewicz artery originating from the left T10, was performed before surgery. Computed tomography-guided methylene blue injection in the retropleural interspace of T7-T8 was done for intraoperative level localization. RESULTS: At 1 year follow-up, complete relief of neurologic symptoms was observed, as was solid interbody fusion. CONCLUSION: In this case, a transthoracic approach was safe and effective for disc excision and cord decompression via hemicorporectomy.

Adolescent↗

PubMed1994

Stimulatory effect on bone formation exerted by a modified chitosan.

A novel modified chitosan carrying covalently linked imidazole groups (average molecular weight 700,000, degree of substitution 0.28, degree of acetylation 0.08) was used to stimulate bone formation in an animal model. Lesions (7 mm diameter) were surgically made in the femoral condyle of sheep and treated with the modified chitosan. Within 40 d after surgery, the neoformed tissue occluded the surgical hole and assumed a trabecular structure in the peripheral area of the lesion, while looking like a mineralization nodule in the central part in association with a fibrous component. In the control, no sign of osteoinduction or reparative process was observed and bone marrow was rich in adipocytes.

Adipocytes↗