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Application and results of the AO internal fixation system in nontraumatic indications.

The AO internal skeletal fixation system (ISFS) permits posterior spine fixation to be restricted to the vertebrae immediately adjacent to the lesion and allows manipulation of each instrumented vertebra in three planes. In a prospective study to assess the value of this fixation for adult spinal disorders, 68 patients were reviewed. The device was used in spondylolisthesis, postlaminectomy instability, post-traumatic kyphosis, degenerative scoliosis, spinal stenosis, tumors, and infections. A total of 322 transpedicular screws have been inserted without neurologic complication. Satisfactory results were achieved in 88% of the patients, and only four pseudarthroses (6%) occurred. The ISFS provides rigid stabilization to enhance bone graft consolidation and to allow rapid postoperative mobilization in a light external orthosis.

Bone Screws↗

[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↗

[Indications of prosthesis in the treatment of knee diseases].

Hinge prostheses of the knee expose to so many local or even systemic complications that they should be used only for reconstruction of the knee after tumoral excision. In all other indications, prosthesis of the knee must be semi-constrained or non-constrained. Moreover, it seems that it would be useful to choose the prosthesis that preserves the ligaments to the best, in order to reduce as much as possible the stress imposed on bone/prosthesis interfaces and to limit the size of the prosthesis that preserves the ligaments to the best, in order to reduce as much as possible the stress imposed on bone/prosthesis interfaces and to limit the size of the prosthesis on which depends the amount of bone removed and the risk of septic complications. In rheumatic diseases prosthesis of the knee is the only sensible surgical treatment. Since the inflammatory process involves all three compartments of the knee, the prosthesis must be of the three-compartment type. In degenerative (gonarthrosis) and post-traumatic diseases of the knee, prosthesis is needed only when conservative surgery (osteotomy for realignment or malunion) is inadequate, with global femorotibial or femoropatellar involvement and major laxity of the ligaments. In global femorotibial diseases the prosthesis utilized can only be three-compartmental; in one-compartment femorotibial diseases, one-compartment prosthesis is rational if there is no lesion of the capsule and ligaments. When anatomical conditions are still compatible with conservative surgery, prosthetic surgery will be preferred only when the patient's general condition requires prompt resumption of walking.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthritis, Rheumatoid↗

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↗

Post-traumatic squamous-cell carcinoma.

Between January 1, 1976, and January 1, 1986, we treated sixty-three patients who had histologically proved squamous-cell carcinoma that originated in a pre-existing scar or sinus of an extremity. In 49 per cent of the patients, metastases to regional lymph nodes either were present when the patient was first seen or subsequently developed. The age and sex of the patient, the etiology of the original scar, and the duration of illness bore no relationship to the result. The most significant factor in predicting the outcome was the grade of the tumor: for grade-I (low-grade) lesions, the incidence of metastasis was 10 per cent; for grade-II (moderately well differentiated) lesions, 59 per cent; and for grade-III (poorly differentiated) lesions, 86 per cent. Eleven patients had wide local excision of the lesion, which resulted in local recurrence in four patients and metastasis in three. Thirty patients had therapeutic amputation: one patient had recurrent disease and five patients had metastasis. Radical resection of lymph nodes after metastasis was uniformly unsuccessful in preventing additional metastasis. Ten patients who had a grade-II or grade-III tumor had prophylactic irradiation of the regional lymph nodes after the definitive operative treatment. At an average of thirty-seven months of follow-up, only one of them had metastasis. We recommend that well differentiated squamous-cell carcinoma be considered a low-grade tumor, according to the staging system for musculoskeletal neoplasms, and that more poorly differentiated squamous-cell carcinoma (grades II and III) be considered a high-grade lesion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

[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↗

[Initial epileptic crisis after the age of 60: etiology, clinical aspects and EEG].

We reviewed retrospectively a series of 100 inpatients with onset of epileptic seizure after the age of 60. All of them were investigated by EEG and 96 by CT scan. The most frequent cause of seizure was previous stroke, with 25 cerebral infarcts and 5 hemorrhages. Neoplastic lesions were present in 18 cases, with glioma (high grade), meningioma and metastases in the same proportion. Other etiologies included toxico-metabolic (18 cases), post-traumatic (9 cases), cerebral atrophy (4 cases) and miscellaneous (14 cases). The causes of seizure remained unknown in 7 patients, of whom 6 had focal signs in either clinical examination or EEG. Focal seizures (with or without secondary generalization) accounted for 65% of all cases and generalized seizures for 35%. The EEG was normal in 12 patients and abnormal in 88, with diffuse slowing in 55 patients and focal signs in 70 (some patients had both diffuse slowing and focal signs). Fourteen patients presented status epilepticus. Ten died during hospitalization. We conclude that epileptic seizure with onset after age 60 is nearly always symptomatic, and neuroradiologic investigations are necessary in the search for cerebral lesions. In our study, the prevalence of "idiopathic epilepsy" is lower than previously described.

Aged↗

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↗

Enhanced release of plasminogen activator inhibitor(s) but not of plasminogen activators by cultured rat glial cells treated with interleukin-1.

Astroglial cells are known to proliferate during development of the nervous system, as well as during post-traumatic gliosis. We have previously shown that the proliferation of cultured astrocytes can be stimulated by the urokinase-type (uPA) of plasminogen activator (PA) and that astrocytes are able to release such uPA upon stimulation with basic fibroblast growth factor, which is known to act as a mitogen for these cells. Here we report studies on the effects of human interleukin-1 (IL-1) on the release of PA activity by cultured newborn rat astroglial cells. Whereas there is controversy in the literature as to whether IL-1 stimulates multiplication of astroglial cells, we failed to observe such an effect in our system. We did observe, however, a dose-dependent decrease in PA activity in the supernatant of the IL-1 treated cultures. Further analysis revealed that this apparent decrease in PA release was in fact due to an increased release of plasminogen activator inhibitor (PAI). A similar IL-1 induced increase in PAI release was also found to occur in cultures of transformed astrocytes (human glioma LN18) and in cultured Schwann cells, but not in cultures of neurons or neuronal tumour cells. Since protease inhibitors are known to possess neuritogenic properties, our results suggest that IL-1, by its capacity to induce PAI, may promote neuritogenesis.

Adrenal Gland Neoplasms↗

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↗

Cone biopsy causes cervical endometriosis and tubo-endometrioid metaplasia.

Cervices from 42 hysterectomies performed from 1 to 91 months (mean 12.2) following conization were re-examined in order to assess the possible effects of post-traumatic regeneration on the endocervix. Twenty-nine (69%) showed a continuum of abnormalities in which the shared finding was the presence of tubo-endometrioid glands, accompanied in many cases by varying amounts of endometrial-type stroma. Thus, 18 post-conization cervices (43%) showed endometriosis, and a further 11 cases (26%) contained tubo-endometrioid glands without demonstrable endometrial-type stroma. These abnormalities were situated at the healed cone biopsy site, either superficially within the new transformation zone and/or within the cone biopsy scar. Post-conization cervical endometriosis occurred from 2 to 91 months (mean 17.8) and tubo-endometrioid metaplasia 2-24 months (mean 11.0) after the cone biopsy. It is concluded that cervical endometriosis and tubo-endometrioid metaplasia are common complications of conization, and that they represent aberrant differentiation following injury. The demonstration of endometriosis and tubo-endometrioid metaplasia in 69% of post-conization cervices has implications for the interpretation of cervical biopsies and smears from this group of women.

Adult↗

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↗