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A spectrum of application of autogenous costochondral grafts.

Autogenous costochondral grafts have found application in 26 variegated cases of congenital dysplasia, ankylosis, neoplastic disease, osteoarthritis, and post-traumatic dysfunction. The authors' experience with the grafting procedure has been generally favourable, but various difficulties have also arisen. There is a cursory discussion on the physiological superiority of rib cartilage grafts over those of other autogenous joints in reconstruction of the temporomandibular articulation.

Adolescent↗

[Peri-orbital surgical approaches].

After having made a definitive diagnosis in patients with orbito-frontal pathology, the choice of incision is an important factor to achieve good intra-operative exposure of the region, as well as to obtain a good functional and aesthetic result. In the majority of cases we prefer to utilize the incisions commonly used for blepharoplasty, especially the transconjunctival approach popularized by Tessier. Other more classic accesses such as the superolateral, infra-orbital and intra-oral incisions, are reserved for treatment of cases of orbitomalar (communition) fractures. We feel there are limited indications for use of incisions through the eyebrows with medial extensions for exposure of isolated lesions of the medial orbital wall, orbital roof, and the anterior wall of the frontal sinus. However they may become very useful as the primary incisions in the treatment of open fractures of the orbital region. The bicoronal incision, a classical approach in neurosurgery, is also being used by us in cases of tumors and complicated middle face fractures which appear to extend to the orbito-frontobasal region in 40% of our patients. In addition it provides excellent access for post-traumatic reconstruction of orbito-frontal bone defects and impacted fractures. A combination of different incisions: bicoronal, peri-orbital and intra-oral, may be indicated for the correction of syndromal anomalies such as Treacher-Collins, for treatment of complicated facial fractures, or for pure aesthetic surgery procedures, such as the "mask-lift" introduced by Tessier.

Humans↗

[Role of angiography in studying posttraumatic abdominal masses in pediatric patients].

In infancy and neonatal period, post-traumatic space-occupying masses often can be associated to malignant, clinically not identified, lesions. Radiodiagnostic non-invasive techniques cannot, in many cases, demonstrate extension, nature and localization of such a lesion, when angiography, in personal experience, shows quite even malignancy and extension without false negatives, and is essential, in our opinion, for evaluation of therapeutic policy and follow-up.

Abdominal Injuries↗

Immunoimaging of choroidal melanoma: assessment of its diagnostic accuracy and limitations in 101 cases.

Immunoscintigraphy (IS) was performed on 101 patients with space occupying intraocular lesions including choroidal melanomas (85), choroidal naevi (11), non-melanoma metastases (three), and other melanoma simulating lesions (two). Scintigraphic images with conventional and emission computer tomography techniques were obtained after the intravenous injection of 99mTc-labelled F(ab')2 fragments of monoclonal antibody (MoAb) 225.28S directed against the high molecular weight-melanoma associated antigen (HMW-MAA). Immunohistochemistry was performed on sections of four out of 10 melanoma-containing eyes to confirm MoAb binding. IS demonstrated positive scans in 66 out of 85 choroidal melanomas, offering a sensitivity of 78%. Sensitivity was dependent on the lesion size. True negative results were obtained in 15 out of 16 non-melanoma lesions (specificity 94%). False positive antibody accumulation was found in one patient with a post-traumatic subretinal haemorrhage. Immunohistochemistry demonstrated positive MoAb 225.28S binding in all melanoma sections. In summary IS offered substantial sensitivity and specificity in the differentiation of intraocular lesions, particularly choroidal melanomas, naevi, and metastases. In combination with other diagnostic procedures such as ultrasound echography and fluorescein angiography IS proved to be a valuable method in the diagnosis of choroidal melanoma.

Choroid↗

Multidisciplinary approaches to complicated vascular lesions of the orbit.

BACKGROUND: Hemodynamically active vascular lesions of the orbit are often clinically challenging to treat, both because of the complexity of the vascular anatomy and the delicacy of the cardinal structures that are involved and vulnerable to damage. Attempts to achieve complete embolization of such vascular lesions may result in damage to vital visual structures. Conversely, incomplete closure of the feeders or vascular shunts will usually result in recanalization and, therefore, recurrence of such lesions. METHODS: Surgical excision after selective optimal embolizations may convert dynamic lesions into static ones with controlled surgical risks and could provide a solution to these problems. Cyanoacrylic polymerization was used to embolize the lesions, which were then excised with careful microsurgical and microvascular techniques. RESULTS: The authors present four cases of different hemodynamically active orbital vascular lesions (a post-traumatic arteriovenous fistula, a complex venous anomaly, a cavernous hemangioma of bone, and an arteriovenous malformation), which were treated successfully with the combination of presurgical embolization and surgery. CONCLUSION: The authors believe that, from their experience with these cases, a multidisciplinary approach to complicated orbital vascular lesions is ideal and practical.

Adult↗

[Pomade crust of the scalp simulating cornu cutaneum].

A 63-year-old woman with a history of exaggerated use of topical skin care products of post-traumatic scarring alopecia presented with a monstrous cutaneous horn-like pomade crust of the scalp hidden beneath a wig. The crust consisted of corneocytes and bacterial debris. Pomade crusts have not been described previously in this localization. They are usually found in the inguinal or gluteal folds of infants, and occasionally in other body regions, e.g., on the face of adults.

Alopecia↗

[Diagnosis of skeletal metastases in prostatic cancer using gamma camera (author's transl)].

On 170 patients with histologically proven carcinoma of the prostate scintigraphic studies of the skeleton using gamma camera and follow-up examinations were performed and compared with x-ray as well as serum alkaline and acid phosphatase. Osseous metastases in 47% had no radiological evidence and were only scintigraphically detectable. Positive scans were registered in 48% of the patients with prostatic cancer, 20% of them were positive due to metastases and 28% were false positive caused by osteoarthrotic and arthritic changes, sporadically by post-traumatic lesions and in 3 cases by Paget's disease. At the time of the initial diagnosis of prostatic cancer 21% of 159 patients studied scintigraphically had radiological or scan evidence of osseous metastases. Analyses corresponding stages of tumor revealed an unequivocal dependance of the frequency of metastases upon the extent of the primary tumor. The successful treatment is characterized by the decreased uptake of radioactivity primarily accumulated in skeletal metastases.

Aged↗

[Idiopathic facial paralysis and magnetic resonance tomography (MRT)].

We investigated 15 patients with unilateral facial paralysis using gadolinium(Gd)-DTPA (diethylenetriamine pentaacetic acid) enhanced (magnetic resonance imaging (MRI). Eleven were idiopathic and 1 each was due to basal skill trauma, Lyme's disease, Foville's syndrome and herpes zoster oticus. Ten of 11 Bell's palsies showed a significant enhancement of the facial nerve on the paralysed side. In all cases enhancement was shown in the labyrinthine segment, in 9 in the meatal segment, in 8 in the mastoid segment and in 7 in the tympanic segment also. Follow-up Gd-enhanced MRI investigation was performed 3-11 months later in 8 patients. In 1 case with incomplete return of function after 3 months MRI enhancement was decreased. We could not find any correlation between the intensity of the Gd enhancement and the course, severity or outcome of Bell's palsy, or stapedius reflex audiometry. The mechanisms and aetiology of the Gd enhancement in Bell's palsy seem to be non-specific phenomena which are also found in post-traumatic facial lesions, for instance. Nevertheless, the ability to image the facial nerve in Bell's palsy provides a new means of examination in this disorder. In our opinion Gd-enhanced MRI is recommended in cases of recurrent or "atypical" Bell's palsy and in cases with total loss of electrical excitability, to exclude tumours. It is further suggested that MRI may provide valuable information concerning areas which may require surgical exploration or decompression.

Adolescent↗

The role of the radiologist in the management of the child with a suspected bone tumor.

The radiologist's most important task in evaluating lesions of the skeleton is to recognize with a great degree of certainty the post-traumatic and the self-limiting and healing tumorous conditions which require neither biopsy nor other surgical treatment. The group of lesions that will need biopsy ranges from those that cannot be absolutely classified in the above group to frankly malignant-appearing tumors. The radiologic differential diagnosis of malignant tumors is of lesser importance because this will be performed by the pathologist. Examples are illustrated and discussed. The importance of consultation among surgeon, radiologists, and pathologist is emphasized, particularly to avoid the possibility of misinterpreting immature callus formation as ostegenic sarcoma.

Adolescent↗

[Post-traumatic osteoid osteoma. Apropos of 2 cases and review of the literature].

Two cases of osteoid osteoma which became clinically apparent after a prolonged silent period are reported. One was located in the tibia in a 30-year-old female and the other in the femur in a 26-year-old male. Both developed after a surgical procedure, at the site of the operation; one was located on the track of an internal fixation screw. Diagnosis was delayed despite the suggestive timing of the pain; isotopic scanning, CT scan and angiography provided suggestive data and diagnosis was confirmed by histologic studies. A review of the literature found 13 other cases meeting the following criteria: initial trauma, silent period, suggestive pain, discovery of an osteoid osteoma at the site of the trauma, and recovery following surgical treatment. The role of the trauma is discussed.

Adult↗

The empty sella syndrome analysis of 10 cases.

Ten cases of the empty sella syndrome are presented. In four a pituitary adenoma had been treated by surgery with or without radiotherapy. In three women there was a close relation pregnancy, and two boys had congenital malformations. Five cases presented with appearances of pseudotomour, and the remainder had cerebrospinal fluid (CSF) fistula. Four fistulas were spontaneous, one was post-traumatic aggravated by the intrasellar implantation of YT-90. Two were occult CSF fistulas causing recurrent meningitis. Gamma cisternography and iodocisternography proved to be good diagnostic tests, both for the empty sella and for CSF fistulas. Nine cases were operated on. In four na intrasellar cyst was present. In the other five an empty sella with deficient or absent diaphragm was found. Treatment of most cases consisted of covering the floor of the sella with lyophilized dura, which was fixed in place with biological glue.

Adenoma↗

[Radiographic and scintigraphic studies of cranial bones].

The authors described 9 cases of pathological changes in cranial bones of the type of osteolytic foci of changed osseous structure, post-traumatic lesions and postoperative changes of cranial bones as well as fibrous degeneration of bones which were found during routine scintigraphic investigations of the brain with 99mTc. In 7 cases it was possible to obtain the correct diagnosis after comparing with plain skull films, in 2 cases scintigraphy had to be supplemented with angiography (in one case it was necessary for ruling out paracerebral haematoma in presence of skull fracture, in the other case it was done for demonstrating the vessels supplying frontal bone haemangioma). In none of these cases it was necessary to supplement this investigation with administration of radioisotope markers accumulating selectively in bones.

Brain Diseases↗

[Cold lymphocytotoxins: their relationship with various physiological and pathological conditions].

The significance of cold lymphocytotoxins, observed at 15 degreesC, is not clearly understood at the present time. The frequency of their appearance has been studied in normal subjects (blood donors, aged people, vaccinated subjects, post-traumatic splenectomy) and in patients with a neurologic disease (multiple sclerosis), a neoplasic disease (breast cancer)and hematologic diseases (thrombocytopenia, acute leukemia, chronic lymphatic leukemia, Hodgkin disease and systemic lupus erythematosus). There are no antibodies found in the geriatric group; they are found only in 3,9 % of blood donors and in 18 % of the subjects after vaccinations. A range of 17 to 30 % is found in subjects with breast cancer or multiple sclerosis. More than 50 % of the individuals with Hodgkin disease or lupus erythematosus produce these antibodies (52 % and 73 % respectively). In acute leukemias and chronic lymphatic leukemias, lymphocytotoxic antibodies sometimes appear at 37 degrees, reacting with autologous cells and having no HL-A specificity.

Acute Disease↗

[Morphological aspects (optical and ultrastructural) of hypertrophy of the olivary bulb].

The present paper is an anatomical study of 3 cases which evolved with hypertrophy of the inferior olives: a case of zoster encephalitis, a multifocal leucoencephalopathy and a post-traumatic encephalopathy. In all three cases a relationship was demonstrated between the dentate nucleus and dento-olivary pathway - a relation of topical order in some instances - and the hypertrophic lesion of the inferior olive. Examination in the electron microscope revealed in the hypertrophic olivary cell not only dystrophic lesions but also progressive intracellular phenomena, such as maintenance of the Nissl bodies, multiplication of the mitochondria and especially marked proliferation of the neuro-filaments. This shows that, at least in some of the evolutive phases, hypertrophy of the inferior olives is based upon a real hypertrophy of the olivary cell. In addition, lesions of the glial system of the hypertrophic inferior olives were noted with the presence of osmiophil degeneration whose morphology clearly differed from that of Rosenthal's fibres.

Adult↗

Papillary and cystic tumor of the pancreas possibly concealed within a pseudocyst.

A 17 year old girl, with a papillary and cystic tumor of the pancreas, probably concealed within a previous post-traumatic pseudocyst of the pancreas is described. At 10 years of age, she had received a drainage procedure for a pancreatic pseudocyst, following a blunt abdominal trauma. The histological examination of the cyst wall did not show an epithelial lining. Seven years after that, she developed anemia and a computer tomography and ultrasonography of abdomen revealed a 10 cm x 9 cm x 8 cm, cystic, multilocular pancreatic mass with solid parts. On operation, a fist-sized, solid and multilocular cystic tumor, located in the body and tail of the pancreas, and infiltrating into the colonic serosa but with no metastasis, was found and completely excised. Histologic and electron microscopic examination revealed the characteristic features of a papillary and cystic tumor of the pancreas. This report suggests that cystic lesions of the pancreas should be carefully checked to decide the best surgical therapy.

Abdominal Injuries↗

Anterior surgery of the upper cervical spine.

The authors report the results obtained in a series of more than 80 cases submitted to 76 operations of the upper cervical spine by transoral approach with a minimum follow-up of two years. The cases include: 15 unstable fractures or non-union of the odontoid processes; 28 cases of post-traumatic instability of C1-C2 level without fracture of the odontoid process; 13 cases of rheumatoid arthritis with instability at C1-C2; 14 cases of severe anomalies of the craniovertebral junction, often associated with basilar impression and spinal cord compression, of which 7 cases presented with tetraparesis; 6 malignant tumors. The method used involves an anterior transoral approach, more often without tracheotomy, and with exposure of the anterior aspect of the atlas and of the odontoid process by means of a midline incision of the posterior wall of the pharynx. When spinal cord lesion was present, decompression and reconstruction by bone grafts taken from the iliac crest were performed. In nearly all of the cases osteosynthesis with an anterior plate was used. Complications were mild. There were two cases of infection, observed at the onset of our experience, which were resolved after removal of the instrumentation. There was loosening of a screw in three cases; this was eliminated through the digestive tube with no consequences. There were no early intra- or postoperative deaths. Consolidation was obtained in most of the patients, and only in three cases did we observe a loss of postoperative reduction. Among patients affected with tetraparesis we observed many cases of neurological recovery.(ABSTRACT TRUNCATED AT 250 WORDS)

Cervical Vertebrae↗

Homovanillic acid and 5-hydroxyindole-acetic acid in the csf of patients after a severe head injury. II. Ventricular csf concentrations in acute brain post-traumatic syndromes.

Ventricular concentrations of homovanillic acid (HVA) and 5-hydroxyindole-acetic acid (5HIAA) were measured in 7 patients a few days after a severe traumatic brain injury. Both acid metabolites were elevated in respect to control patients values, however, the rise was more consistent for 5HIAA (258 +/- 86 ng/ml) with a 5HIAA/HVA ratio of 0.85 +/- 0.35. The data support previous hypothesis on the profound involvement of serotoninergic structures in the early stages of acute traumatic brain syndromes and on the role of 5HT in maintaining edema and vasospasm.

Adolescent↗

[Post-traumatic hemoperitoneum: a rare complication of peritoneal splenosis].

Peritoneal splenosis is a frequent condition after traumatic spleen fracture, which, given that it is usually asymptomatic, is often not diagnosed unless a laparotomy is performed for some other reason. The case is presented of a 9 year old boy splenectomized a few years earlier because of traumatism, who again suffers abdominal injury with the development of hemoperitoneum, observing during surgery multiple splenosis foci disseminated all over the abdominal cavity, some of which present rupture and hemorrhage, constituting the cause of hemoperitoneum.

Abdominal Injuries↗