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Biomedical subjects

R Savini

Publications and source records attributed to R Savini.

At least 19 recordsLinked to original sources
PubMed1992

Implants of heterologous demineralized bone matrix for induction of posterior spinal fusion in rats.

The authors tested the osteoinductive capacity of powdered heterologous (bovine) demineralized bone matrix in rats. The first part of the study concerned a monolateral posterior spinal implant after decortication of three vertebrae, using as a control area the animal's contralateral side, in which neither bone graft nor any other material were placed. In another group of rats, a comparative evaluation was made of powdered heterologous demineralized bone matrix and fresh autologous bone. In the same animal, autologous bone was implanted to realize a thoracic posterior fusion and demineralized bone matrix, to induce a posterior fusion in the lumbar area. All data obtained suggested a good osteoinductive activity of heterologous powdered demineralized bone matrix. The two posterior spinal fusions done in the same animal with heterologous demineralized bone matrix or autologous bone, respectively, had similar callus development and required the same time for formation.

Animals↗
PubMed1992

Osteoblastoma of the spine.

Osteoid osteomas and osteoblastomas have similar histologic characteristics, although their clinical course in the spine may be significantly different. At the authors' institution, spinal osteoblastomas constituted 46% (30/65) of all osteoblastomas treated. Sixteen of the lesions occurred in the lumbar spine (53%), eight in the thoracic spine, and six in the cervical spine. In all regions of the spine, the posterior elements and pedicles were more frequently involved than the vertebral body. Twenty patients had pain or other symptoms for more than 12 months before diagnosis. Six of eight patients had thoracic lesions that demonstrated neurologic involvement. Twelve patients presented with painful scoliosis. Fourteen patients had lesions with well-circumscribed margins confined within the vertebral structure (Enneking Stage 2), and 16 had ill-defined margins with soft-tissue extension (Enneking Stage 3). Well-defined lesions were treated with curettage, with excellent results in 12 of 14 patients. The more extensive lesions were treated by intralesional excision (15/16) and adjuvant radiation therapy (9/16).

Adolescent↗
PubMed1991

Posterior lumbar apophyseal fractures.

From 1984 to 1987, nine patients with posterior lumbar apophyseal fracture underwent surgery. The clinical pattern was characterized by vertebral rigidity and leg pain in all cases, with associated nerve root deficit in three cases, neurogenic claudication in one, and paraparesis in one. In all patients, treatment consisted of removal of a bony and/or cartilaginous fragment. In eight patients, it was done through a posterior approach (unilateral laminotomy with partial facetectomy in six cases and bilateral laminectomy in two) and in one with paraparesis by means of hemicorporectomy followed by anterior fusion. At follow-up (minimum, 2 years), all patients showed complete regression of the painful symptoms, with a total recovery in cases with neurologic problems. The only complication was an incomplete cauda syndrome; this appeared immediately after the operation and regressed completely with conservative treatment after 6 months.

Adult↗
PubMed1991

Achondroplasia and lumbar spinal stenosis.

Achondroplasia is the most common type of rhizomelic dwarfism. The abnormal spinal development of the achondroplastic dwarf can result in neurologic damage due primarily to the following two syndromes: lumbar spinal canal stenosis and thoracolumbar kyphosis. The authors report the cases observed at their institution, discussing the diagnosis and operative treatment.

Achondroplasia↗
PubMed1991

The herniated lumbar intervertebral disc in children and adolescents. Long-term follow-up of 101 cases treated by surgery.

The authors review 101 cases of herniated lumbar intervertebral disc in children and adolescents treated by surgery. The most significant etiologic and pathogenetic factors in this series were early onset of disc degeneration, congenital lumbosacral malformations, and repeated trauma. The main clinical symptom was pain, usually sciatica, while neurological symptoms were less common than they are in adults. In all patients diagnosed correctly with the aid of appropriate imaging studies (myelography, CT scan, MRI), discectomy by means of conservative hemilaminectomy achieved satisfactory results, except in two cases of concomitant spinal instability due to spondylolysis and in one case of recurrence.

Adolescent↗
PubMed1991

[Osteoid osteoma of the spine. The experience of the Rizzoli Institute].

The authors report their experience at the Rizzoli Institute in treating osteoid osteomas localized to the spine (40 cases). This clinical study confirms that osteoid osteomas are tumors of adolescence, which are often diagnosed late due to their spinal localization. The role of additional investigations, dominated by bone scan and computed tomography is discussed. Their use should decrease the diagnosis delay. Mean follow-up in this series was 4 years, and confirmed that surgical excision had a favorable outcome. The outcome of associated scoliosis was also studied (8 cases). After tumor excision, there were 6 complete or partial corrections. Two cases remained unchanged. Curvature worsening after excision was not encountered.

Adolescent↗
PubMed1991

Surgical treatment of vertebral deformity due to myelomeningocele.

Surgical treatment of vertebral deformity due to myelomeningocele has always presented important technical problems. Many complications, the foremost of which pseudarthrosis and infection, are reported in the literature. The authors discuss 14 patients with vertebral deformity from myelomeningocele who were treated with different surgical methods and reviewed after an average of eight years. The only conclusion that can be drawn on the basis of both the literature and the present study is that posterior surgery alone is incapable of guaranteeing stable correction over time for severe deformity. Combined anterior and posterior surgery with spinal fusion up to the sacrum yields better results, and the patient is not required to wear a corset afterward.

Adolescent↗
PubMed1990

Late paraparesis due to pseudarthrosis after posterior spinal fusion.

The authors report three cases in which paraparesis related to a pseudarthrosis occurred several years after a posterior spinal fusion, but with a different mechanism (stretching of the spinal cord for progression of the deformity in kyphosis in two cases, and spinal cord compression for bone overgrowth within the canal in the site of pseudarthrosis in the third patient). Treatment was different. Partial correction of the deformity and stabilization of the spine by combined fusion (anterior and posterior) was sufficient in the first two cases for a complete neurological recovery. Posterior spinal cord decompression and stabilization of the spine by combined fusion was necessary for complete recovery in the third.

Adult↗
PubMed1989

Association of reduced factor VIII with impaired platelet reactivity to adrenalin and collagen after total thyroidectomy.

Twenty-one thyroprival patients, previously submitted to total thyroidectomy for tumours, were investigated during stabilized L-thyroxine supplementation and at the end of a 20-25 day "no-therapy" period, necessary for a 131I total body scintigraphy. During supplementation therapy a lower than normal mean beta-thromboglobulin (beta-TG) release level was found, the other blood clotting and platelet function tests being normal. After substitution therapy withdrawal, platelet function tests showed reduced adrenalin aggregation, increased collagen threshold aggregating concentrations, decreased beta-TG release values and reduced aggregation to ristocetin, whereas blood clotting tests showed prolonged aPTT values and reduced levels of factor VIII:C and vWf:Ag. We conclude that in acquired hypothyroidism the lowering of factor VIII:C and vWf:Ag (acquired von Willebrand disease) is associated with impaired platelet reactivity not only to ristocetin but also to collagen and especially adrenalin. In the patients investigated these changes were almost completely corrected by substitutive therapy with L-thyroxine at clinically effective doses.

Adult↗
PubMed1989

Scoliosis in spinal muscular atrophy: natural history and management.

This is a report on the natural history of 109 patients with infantile spinal muscular atrophy (SMA). All 18 children with the severe form died, as did five of the 52 with the intermediate form. Functional ability was more or less stable in the 47 living patients with the intermediate form, but 16 of the 39 with mild SMA lost the ability to walk. Ventilatory function was severely impaired in those with intermediate SMA: orthopaedic treatment for scoliosis in this group did not prevent the curves from worsening with age. Scoliosis was also severe in patients with mild SMA who had stopped walking: surgical treatment in six cases resulted in stable correction of the spine, with functional and cosmetic improvement and without impairment of respiratory function.

Adolescent↗
PubMed1988

Osteoid osteoma of the spine.

After reviewing the international literature the authors present three new cases of osteoid osteoma with vertebral body localisation, two in the lumbar region, and one in the cervical region. This rare localisation necessitates the use of accurate instrumental techniques, based on radiography, scintigraphy, and in particular, CT scanning, in order to arrive at a correct diagnosis as a prelude to the correct surgical treatment.

Adolescent↗
PubMed1988

Vertebral osteosarcoma.

A review of the total number of cases of osteosarcoma referred to the Tumour Centre at the Rizzoli Orthopaedic Institute between 1904 and 1986, revealed 11 cases of the disease localised in the vertebrae, 9 of which were fully documented. We excluded secondary forms of the disease due to irradiation or malignant degeneration in Paget's disease, also metastases from osteosarcoma of the limbs localised in the sacrum. It is extremely important to distinguish osteosarcoma from osteoblastoma; and this problem is even more highlighted by the statistical evidence that both neoplasms have an almost equal probability of being localised in the spine. Treatment has progressed from the initial purely palliative approach to a more aggressive type of surgery which, in association with modern chemotherapy, makes it a more reliable type of treatment from the oncological point of view. To this aim, we emphasize the importance of performing biopsy according to the required criteria.

Adolescent↗
PubMed1988

Cervical osteotomy by the Simmons method in the treatment of cervical kyphosis due to ankylosing spondylitis. Case report.

Ankylosing spondylitis can produce severe kyphosis in the spine. This is rarer in the cervical spine than in the thoracolumbar region, but it is also more invalidating as it may make it impossible for the patient to look forward as well as causing difficulty in mastication, swallowing and speaking. To correct cervical kyphosis, vertebral osteotomy is performed at the apex of the deformity. The authors present a case of cervical kyphosis due to ankylosing spondylitis successfully treated by the Simmons method.

Adult↗
PubMed1987

[Cardiological findings in acromegaly].

Acromegaly involves cardiovascular complications mostly due to the presence of hypertension, diabetes and atherosclerosis. However the appearance of cardiac decompensation and arrhythmias in the absence of predisposing factors tends to support the hypothesis of a specific myocardiopathy caused by excess GH. In order to assess the existence and course of subclinical cardiac alterations, 8 acromegaly patients were examined: 4 males and 4 females aged 31-56 with GH levels of 24-70 ng/ml (M + CD X 47 +/- 16) and no cardiovascular symptoms. One of the patients had moderate hypertension and 2 reduced glucose tolerance. The basal ECG showed sporadic ventricular extrasystoles in 2 cases and alterations compatible with left ventricular hypertrophy in another, while the effort ECG produced an asymptomatic depression of the ST segment in the hypertensive patient. The chest X-ray was normal in all cases. The echocardiography study investigated: the thickness of the interventricular septum (IVS = 13.9 +/- 2.8 mm), the thickness of the posterior wall of the left ventricle (LPW = 10.6 +/- 2.9 mm), the septum/posterior wall ratio (IVS/LPW = 1.3 +/- 0.2 the diastolic diameter (DD = 15.4 +/- 11.4 mm), the fraction of shortening (FS = 39.1 +/- 14.5%), the ejection fraction (EF = 64.1 +/- 18.4%) and revealed asymmetrical septal hypertrophy in 3 cases, concentric hypertrophy in another two. In two cases the DD and EF were distinctly altered. The patients were re-examined 2-4 years after surgical or radiation treatment. GH levels (M +/- SD = 10.3 +/- 10.1 ng/ml) were normal in 4 cases and still high, though lower in another two. The remaining two patients had borderline GH levels with high Sm-C. The ECG and chest X-ray were unchanged while echocardiography revealed a significant deterioration in heart function as far as DD (56.4 +/- 10.8 mm, p less than 0.05) were concerned with frankly pathological results in 4 and 3 cases respectively. These data confirm the view that most acromegalic patients present subclinical abnormalities in cardiac function and that the evolution of these is slightly influenced by the reduction in GH and Sm-C. levels. In fact, while the persistence of high GH and Sm-C. levels may explain the progression of cardiac alterations in some cases, it does not in others. It is also emphasised that echocardiography appears to be the most sensitive non-invasive technique for the diagnosis and follow-up of cardiac involvement in acromegaly.

Acromegaly↗
PubMed1987

The surgical treatment of late instability of flexion-rotation injuries in the lower cervical spine.

The authors reviewed 12 cases of anterior dislocation of the lower cervical spine due to flexion-rotation trauma, with late instability after closed treatment. The 12 patients were treated at the Instituto Ortopedico Rizzoli between 1977 and 1982. Epidemiology, causes, type of lesion, and associated complications were studied. After an average period of 3 years (range: 2-6), correction appeared stable in all of the patients. In 4 patients, posterior stabilization with plates was performed after presurgical correction in a halo-thoracic cast. In 4 patients, reduction with combined, treatment consisting of anterior release and posterior stabilization with plates was performed after failure of presurgical correction. Finally, in 4 patients, stabilization was obtained with anterior fusion alone without reduction of the dislocation.

Adolescent↗