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Biomedical subjects

R Padua

Publications and source records attributed to R Padua.

At least 37 records · Page 2Linked to original sources
PubMed2001

Patient outcomes after Harrington instrumentation for idiopathic scoliosis: a 15- to 28-year evaluation.

STUDY DESIGN: A retrospective study was performed, using the Short Form-36 Health Survey and the Roland and Morris Disability Questionnaire, to investigate patient outcomes after fusion for adolescent idiopathic scoliosis using Harrington rod instrumentation. OBJECTIVE: To evaluate health-related quality of life and low back pain in a long-term follow-up study of surgery for adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: The commonly accepted surgical treatment for idiopathic evolutive scoliosis is vertebral fusion. It has been suggested that this procedure may cause low back pain and a poor quality of life over the long term. Outcome measures after surgery for adolescent idiopathic scoliosis have focused mainly on objective parameters such as radiographic measures. However, this information has proved to be correlated only weakly with outcomes that are more relevant to patients, such as functional status and symptoms. Until recently, only a few long-term outcome studies have used standardized and validated patient-oriented tools to evaluate surgically treated patients with scoliosis. METHODS: In this study, 70 patients treated with a standard Harrington technique were recontacted and evaluated by means of self-administered questionnaires (Short Form-36 Health Survey and Roland and Morris Disability, clinical examination, and radiographic analysis. Preoperative and follow-up radiographic findings were registered. Relations between radiographic and patient-oriented data were evaluated. RESULTS: A comparison between the current sample and the Italian age-matched normative data for the Short Form-36 Health Survey showed them to have a similar pattern. Findings showed the patient-oriented outcome to be correlated inversely with the extension of vertebral fusion and the preoperative Cobb angle. CONCLUSION: Long-term follow-up evaluation of Harrington rod fusion for adolescent idiopathic scoliosis showed no important impairment of health-related quality of life, as measured by patient-oriented evaluation.

Adult↗
PubMed2001

Health-related quality of life in type 1 diabetic patients and influence of peripheral nerve involvement.

We examined the relationships between diabetic peripheral nerve involvement and patients' own perception of quality of life in a multidimensional study based on outcome research recommendations. The study enrolled 50 consecutive outpatients with type 1 diabetes mellitus (23 men, 27 women; mean age, 40.1 years). The patients were evaluated with validated clinical tests (e. g. Semmes-Weinstein, vibration perception threshold, muscle strength), neurophysiological tests (sural, peroneal and ulnar nerves) and patient-oriented (SF-36 and NASS) questionnaires. Patient-oriented physical scores were significantly related with: (1) neurophysiological findings of the lower limbs; (2) conventional measurements of sensitivity. Conversely, patient-oriented mental scores were not related with these findings. The patient-oriented questionnaires provided an important perspective of the severity of the disease, often closely related with the biological parameters. They offered new interpretations to conventional biological measurements. In particular, the peripheral nerve picture was strictly related to the physical aspects of the patients' quality of life, and not with the mental aspects.

Adult↗
PubMed2001

Health-related quality of life in patients with myasthenia gravis and the relationship between patient-oriented assessment and conventional measurements.

We assessed the health-related quality of life (HRQoL) of patients with myasthenia gravis (MG) and correlated it with the physician's measurements of MG. Patients with MG were evaluated by means of (1) self-administered questionnaires, (2) clinical examination, (3) Osserman classification, (4) anti-AChR antibody, and (5) neurophysiology. Relationships between patient-oriented assessment and conventional clinical-neurophysiological and serological findings were evaluated. A total of 46 patients, inpatients and outpatients (mean age 50.7 years, range 11-77 years, 17 males, 29 females) with MG diagnosis were studied. The Osserman scale and clinical examination findings were significantly related to the physical aspects of HRQoL. Mental aspects of the quality of life were not progressively involved as muscle deficit progressed, but even in a mild clinical picture, the mental aspects were deteriorated. Patient-oriented measures proved that the patient's quality of life was impaired especially with regard to physical aspects. Our data demonstrated that clinical measurements are related to the HRQoL. The results may be useful in developing a disease-specific patient-oriented tool.

Activities of Daily Living↗
PubMed2001

Neurophysiological classification of ulnar entrapment across the elbow.

Ulnar nerve entrapment across the elbow (UAE), a common entrapment, requires neurophysiological evaluation for a diagnosis, but a standardised neurophysiological classification is not available. The aim of our study was to evaluate the validity of a neurophysiological classification of UAE, developed by us. To this end, we examined whether sensorimotor deficits, as observed by the physician and as referred by the patients, increased with the neurophysiological severity according to the classification. We performed a multiperspective assessment of 63 consecutive arms from 52 patients with a clinical diagnosis of UAE. Neurophysiological, clinical and patient-oriented validated measurements were used. The neurophysiological classification is based on the presence or absence of evoked responses and on the normality or abnormality of conduction findings. A strict relationship was observed between the degree of neurophysiological severity and the clinical findings (sensorimotor deficits). Moreover, a significant positive correlation between hand functional deficit and neurophysiological classification was observed. Conversely, a clear correlation between neurophysiological pattern and symptoms was not found. The neurophysiological classification is easy to use and reliable, but further multicentric studies should be performed.

Adult↗
PubMed2001

Clinical and neurophysiological outcome of surgery in extreme carpal tunnel syndrome.

INTRODUCTION: Surgical release is the most effective therapy for the symptoms of carpal tunnel syndrome (CTS). It is widely considered that surgery may be ineffective in 'extreme' cases (those with atrophy of the thenar eminence muscles and no sensory and motor response of the median nerve). OBJECTIVE: To report clinical and electrophysiological outcome of 10 subjects with 'extreme' CTS surgically treated. METHODS: Ten hands belonging to 10 patients (9 women and one man, mean age 65 years) underwent surgical release by the mini-incision of the palm technique. All showed atrophy of thenar eminence and absence of motor and sensory responses of the median nerve. The protocol consisted of clinical and electrophysiological evaluation, with the patient completing the self-administered Boston questionnaire (BQ) before the operation and one and 6 months after it. RESULTS: After surgical release, all patients reported an absence of pain and disappearance or reduction of paraesthesia. Six months after the operation, motor and sensory responses of the median nerve returned in 8 and 5 hands, respectively. The BQ showed a significant improvement in symptom and functional scores, although muscle atrophy remained unchanged. No correlation was found between the degree of clinical and electrical improvement and the age of the patients. CONCLUSION: It is possible to obtain good clinical and electrophysiological results even in extreme cases of CTS.

Aged↗
PubMed2001

Multiperspective assessment of peripheral nerve involvement in diabetic patients.

To assess the relationship between peripheral nerve involvement and the patient's perception of his own quality of life, we studied 36 consecutive out-patients affected by insulin-dependent diabetes mellitus without other diabetic complications other than neuropathy (20 men, 16 women; mean age 39.1 years). We used clinical (Semmes-Weinstein, vibration perception threshold, muscle strength, osteotendinous reflexes), neurophysiological (sural, peroneal and ulnar nerves), metabolic (glycosylated haemoglobin) and patient-oriented (SF-36 and NASS questionnaires) measurements. Patient-oriented physical scores were significantly related to: (1) neurophysiological findings of the inferior limbs; (2) conventional measurements of sensitivity; (3) metabolic assessment. Conversely, patient-oriented mental scores were significantly related only to metabolic assessment. The patient-oriented measure provided an important perspective of the severity of the disease often closely related with the biological parameters and suggested new ways of interpreting conventional biological measurements. In particular, the peripheral nerve picture appeared strictly related with the physical aspects of the patients' quality of life, while the metabolic picture appeared related with both the mental and physical aspects of the quality of life.

Adult↗
PubMed2000

Peroneal mononeuropathy: predisposing factors, and clinical and neurophysiological relationships.

The most common mononeuropathy in the lower extremity involves the nerve. We retrospectively evaluated the etiological predisposing factors and clinical-neurophysiological features of 36 patients affected by peroneal mononeuropathy (PM). In 30 patients, a clear predisposing factor was identified. PM was more frequently perioperative (11 cases), associated with axonal involvement. Unexpectedly, PM was not only due to surgery close to the peroneal region, but was mostly associated with hip surgery and, rarely, with thoracic-abdominal surgery. A postural predisposing factor of PM was also frequently observed, usually associated with a pure conduction block. Conversely, most patients with bedridden predisposing factor presented axonal involvement, which was rarely associated with conduction block. In 25 of 36 PM cases, a long-term follow-up lead to an improvement (12 cases) or to good recovery (13 cases) of PM. In conclusion, our study shows that: (1) in most PM cases it is possible to identify a predisposing factor; (2) there is a good correlation between predisposing factor and neurophysiological involvement, and (3) PM usually has usually a good prognosis.

Adolescent↗
PubMed1999

Multiperspective assessment of carpal tunnel syndrome: a multicenter study. Italian CTS Study Group.

OBJECTIVE: To assess the clinical and neurophysiologic dissociation often observed in clinical practice, and to improve patient evaluation for diagnosis of carpal tunnel syndrome (CTS). METHODS: The Italian CTS Study Group studied 1,123 idiopathic CTS hands with multiple measurements-clinical, neurophysiologic, and patient-oriented-of CTS. RESULTS: Clinical and neurophysiologic relationships were very strong when the clinical picture was evaluated by the hand functional measurements, with an exponential increase in functional impairment as the classification of neurophysiologic severity progressed. Conversely, symptoms and pain did not increase as the classification of neurophysiologic severity progressed: 1) A large part of the CTS population complained of severe symptoms, although minimal functional impairment and minimal or no electrophysiologic abnormalities were observed; and 2) symptoms improved in the patients with more severe neurophysiologic and clinical examination scenarios. CONCLUSIONS: Multiperspective and multimeasurement assessment, even when using a validated patient-oriented tool, provided interesting information that confirmed and clarified the clinical neurophysiologic dissociation often observed in carpal tunnel syndrome (CTS) patients. Furthermore, CTS appeared to be an ideal model for evaluating the importance of patient-oriented measurement.

Adult↗
PubMed1999

Ten- to 15-year outcome of surgery for lumbar disc herniation: radiographic instability and clinical findings.

The most appropriate treatment for radiculopathy associated with disc pathology is still controversial. Since 1934, surgical treatment has consisted of hemilaminectomy and removal of the herniated material. Many authors believe that these procedures may cause degenerative spondylosis and vertebral instability. Several surgical methods have been proposed, but the long-term effects are still being debated. In addition there appear to be few well-designed outcome studies on the management of this disease. In the present study, 150 patients were selected for surgery with strict criteria and all treated with the standard technique. The series was evaluated by subjective analyses (Roland questionnaire; 120 patients), objective examinations (68 patients - 56.6%) and radiographic studies including dynamic views (analyzed by the Taillard and Boxall methods) to establish the presence of vertebral instability (50 patients - 41.6%). The subjective and objective analyses showed a high rate of good results. Radiographic studies showed vertebral instability in 30 cases, but only 9 were symptomatic. Recurrences were not observed and only a few patients suffered from leg pain. The standard procedure for lumbar disc herniation showed good results at 10- and 15-year follow-up.

Adult↗
PubMed1999

Italian multicentre study of carpal tunnel syndrome: clinical-neurophysiological picture and diagnostic pathway in 461 patients and differences between the populations enrolled in the northern, central and southern centres. Italian CTS Study Group.

The economic trend in our country, as in other countries, now requires us to pay more attention to the social and economic aspects of health. Therefore, it is important to evaluate the diagnostic pathway and the socioeconomic aspects of pathologies. The Italian CTS Study Group performed a wide multicentre and multidimensional study (through a patient-, physician- and neurophysiologically oriented evaluation) on 461 idiopathic CTS patients to evaluate the clinical-neurophysiological picture and the diagnostic pathway. The whole population and the differences between the populations enrolled in the neurophysiological centres of the northern, central and southern parts of Italy were analysed. This study provided new and interesting information. As concerns the whole population, we observed different diagnostic pathways in relation to the level of schooling. As concerns the comparison of the populations, the southern centres have a population of CTS patients with higher frequency of hand stress and more severe nerve impairment.

Adult↗
PubMed1999

Usefulness of segmental and comparative tests in the electrodiagnosis of carpal tunnel syndrome: the Italian multicenter study. Italian CTS Study Group.

The Italian CTS Study Group performed a wide multicentric and multiparametric study to quantify the increase of electrodiagnostic sensitivity using an extended neurophysiological protocol and particularly segmental and comparative tests. The study also evaluated the clinical features of carpal tunnel syndrome (CTS) diagnosed by these tests, using validated physician- and patient-oriented measurements. The study group was composed of 740 patients for a total of 1123 idiopathic CTS hands. Overall, the sensitivity of standard tests (median digit-wrist sensory conduction velocity and wrist-thenar distal motor latency) was 83.5%. Comparative/segmental tests disclosed abnormal findings in a further 11.4% of cases, providing CTS electrodiagnosis in about 7 of 10 "standard negative" cases. The overall sensitivity of the electrodiagnostic protocol was 94.9%. The CTS population diagnosed by segmental/comparative tests had a clinical picture characterized by a high percentage of pain, and severe discomfort but no limitation in functional daily activity. Our data confirm the usefulness of a complete neurophysiological assessment by using segmental/comparative tests when standard tests yield normal results.

Adult↗
PubMed1999

Italian multicentre study of carpal tunnel syndrome. Differences in the clinical and neurophysiological features between male and female patients.

The Italian Carpal Tunnel Syndrome Study Group has carried out a multicentre study on 1123 hands with idiopathic carpal tunnel syndrome. We have compared the findings on clinical examination, the neurophysiological data and a patient-oriented assessment in men and women. The patient-oriented assessment showed that men complain of less discomfort than women; clinical examination was similar in the two populations and neurophysiological investigations showed greater changes in men.

Adult↗
PubMed1999

Bilateral congenital pseudarthrosis of the clavicle report of a case with clinical, radiological and neurophysiological evaluation.

Congenital pseudarthrosis of the clavicle is a rare condition. Bilateral involvement is extremely rare: only seven cases have been reported in the literature. Although the anatomy of the thoracic outlet can be markedly altered by the hypermobility of the shoulder and although few cases with mild symptoms suggesting brachial plexus impairment have been reported, the neurological status of the brachial plexus in congenital pseudarthrosis of the clavicle has not been well assessed. We report a case of bilateral congenital pseudarthrosis of the clavicle in which clinical, neurophysiological and radiological evaluations were performed.

Child, Preschool↗