18 research outputs found
PEEK versus metal cages in posterior lumbar interbody fusion: a clinical and radiological comparative study
No full textLow back pain and sciatica represent a common disabling condition with a significant impact on the social, working and economic lives of patients. Transforaminal lumbar interbody fusion (TLIF) is a surgical procedure used in degenerative spine conditions. Several types of cages were used in the TLIF procedure
The role of six biomarkers in diagnosis of hemophilic arthropathy: review of the literature
No full textThe aim of our narrative review of the literature is to identify the role of six important biomarkers: synovial fluid thrombomodulin, fibroblast-like synoviocytes, synovial tissue growth factor , vascular endothelial growth factor in synovium and peripheral blood, urinary C-terminal telopeptide of type II collagen, and synovial fluid tumor necrosis factor alpha. These urinary, serum and synovial biomarkers illustrated should be evaluated in patients with hemophilic arthropathy for early diagnosis of hemophilic arthropathy, because they have important implications in the development of arthrofibrosis, altered inflammatory response and bleeding. Moreover, better knowledge of their biological activity is important to identify possible new biological treatment options
Aggressive hemangioma starting from l5 body, treated with mass embolization and radiation therapy with protons: a case report
No full text: A hemangioma is a benign tumor of endothelial cells, multiplying into the medullary spaces of the cancellous bone. This tumor is in most cases not symptomatic, and in this case, they do not require any specific treatment. Pain and neurological symptoms derived from hemangiomas as shown in 2-11% of the cases. The 55% of these cases presents low back pain, while the 45% presents neurological deficit from compression of the spinal cord, peripheral nerves or both. We present a clinical case report of a young woman, affected by aggressive L5 hemangioma causing a spinal canal stenosis with associated sciatalgic symptoms. We performed a review of the current literature on the treatment options, giving the rationale of our treatment choice (mass embolization and radiation therapy with protons)
The role of the anterolateral ligament in knee’s biomechanics: a case–control retrospective study
No full textPurpose: The aim of this study was to assess the functional and clinical results of patients who underwent ACL reconstruction surgery and were divided into subpopulations related to ACL-associated lesions and focused on ALL-associated lesion. Methods: Our retrospective analysis included 62 patients who underwent standard ACL reconstruction surgery in our hospital from 2014 to 2016. The mean follow-up period was 21 months (range 11–35). We divided the sample into two subpopulations due to the presence or absence of ALL tear at the preoperative MRI. In 42 patients out of 62 (68%), ALL lesion was evident. We evaluated in both subpopulations the ACL failure rate, the functional outcomes rated with IKDC, KOOS, Lysholm scores and the clinical assessment of anteroposterior and rotatory instability with the Lachman test and pivot-shift test. Results: The overall re-injury rate in our cohort of patients was 4.8% with a smaller but not a significant difference between the two groups. A statistically significant difference was observed for the three functional scores, favoring the isolated ACL-lesion group (p < 0.05). Similarly, a better Lachman score was observed in the isolated ACL-lesion group, without statistical significance (p = 0.77); overall, the rate of positive test was lower in the isolated ACL-lesion group. We observed a significant difference of residual rotatory instability (positive pivot-shift test) in the two subpopulations (p = 0.036), and 9% of patients in the ACL + ALL lesion group showed residual jerk or subluxation. Conclusion: The additional ALL reconstruction/repair surgery should always be considered in patients with evident ALL tear at the preoperative MRI
Aggressive hemangioma starting from l5 body, treated with mass embolization and radiation therapy with protons: a case report
No full text: A hemangioma is a benign tumor of endothelial cells, multiplying into the medullary spaces of the cancellous bone. This tumor is in most cases not symptomatic, and in this case, they do not require any specific treatment. Pain and neurological symptoms derived from hemangiomas as shown in 2-11% of the cases. The 55% of these cases presents low back pain, while the 45% presents neurological deficit from compression of the spinal cord, peripheral nerves or both. We present a clinical case report of a young woman, affected by aggressive L5 hemangioma causing a spinal canal stenosis with associated sciatalgic symptoms. We performed a review of the current literature on the treatment options, giving the rationale of our treatment choice (mass embolization and radiation therapy with protons)
Fractures in Patients with COVID-19 Infection: Early Prognosis and Management. A Case Series of 20 Patients in a Single Institution in Lombardy, Northern Italy
No full textFifty-eight percent of the total infections in Italy of COVID-19 were found in northern Italy, in particular, Lombardy. From February 21, 2020, to March 23, 2020, 20 patients with a fracture and a diagnosis of COVID-19 were hospitalized. Demographic data, COVID-19 symptoms, laboratory and radiographic examinations, and treatment methods were recorded. At 1-month follow-up, patients were assessed with the SF-36 score. This case series includes 20 patients (16 women and 4 men), with an average age of 82.35 years (range 59-95). Eleven patients (55%) had a femur fracture. Fourteen patients (70%) had 3 or more comorbidities or previous pathologies. Three patients with severe comorbidities died during the hospitalization. Thirteen patients (65%) had fever, 18 patients (90%) asthenia, and 17 patients (85%) dyspnea. All patients (100%) were given antibiotic therapy, whereas 16 patients (80%) underwent hydroxychloroquine therapy and 8 (40%) were treated with corticosteroids. Eighteen patients (90%) underwent antithromboembolic prophylaxis. Eighteen patients (90%) had lymphopenia. All 20 patients (100%) required noninvasive mechanical ventilation. High D-dimer and polymerase chain reaction values were found in all patients (100%), whereas lactate dehydrogenase was increased in 18 patients (90%). Patients with fractures, especially in the lower limbs, frequently require hospitalization, making these patients more subjected to the risk of COVID-19 infection. COVID-19 infection therefore does not seem to influence the fracture pattern in the elderly population but can lead to health deterioration with increased mortality. The typical symptoms of COVID-19 disease have not changed when associated with a fracture or trauma. Laboratory data are in line with what is reported in recent studies, whereas a more invasive assisted ventilation is associated with a poor prognosis. Finally, analyzing the data obtained from the SF-36 score, significantly lower values emerged when compared with those reported in the literature.Level of Evidence:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence
Acute treatment of medial collateral ligament tears: short to mid-term results
No full text: The aim of this study is to describe the results of a consecutive set of patients treated in acute for the surgical repair of medial collateral ligament (MCL) tears with a mean follow up of 63.78±43.25 months (4- 136). This is a retrospective observational study. From January 2011 to December 2016, 56 patients within the average of 31.75±13.27 (13-55) years old at the time of injury underwent medial compartment repair in an acute setting. The sample size of our study is therefore made up of 26 patients. Patients have been evaluated with functional scores: IKDC (international knee documentation committee evaluation form), the KOOS (Knee injury and osteoarthritis outcome score) and clinical assessment. The Tegner Activity Score was evaluated retrospectively at the 12 months follow-up. The mean KOOS value at the final follow-up were 91.25±9.65 (72-100) for pain, 85.68 ± 12.34 (57-100) for the symptoms category, 94.5±8,07 (75-100) for the activity of daily life, 71.87±22.86 (35-100) for the sport category and 76.37±18.55 (38-100) for the quality of life. At the last follow up the mean IKCD value was 77.68±15.95 (55-98). The mean difference in the Tegner Activity Score between the preoperative time and the postoperative time was 1.06±1.12 with a 95% Confidence Interval 0.46-1.66. The functional outcomes underline how the surgical approach to the medial capsule-ligament compartment of the knee is a reliable treatment to restore excellent joint function. Level of evidence III retrospective observational study
MPFL reconstruction and tibial tuberosity transposition in patients with patellar instability: May it troubleshots also trochlear dysplasia?
No full textAbstract Purpose This study aimed to highlight short‐ and medium‐term outcomes of combined medial patello‐femoral ligament (MPFL) reconstruction and anterior tibial tuberosity (ATT) transposition surgery in patients with recurrent patellar instability and different degrees of trochlear dysplasia. Methods Between January 2014 and May 2019, 25 patients with patellar instability underwent a surgical procedure combining the lowering/transposition of the ATT and the MPFL reconstruction. Each patient were preoperative assessed by Kujala score, International Knee Documentation Committee (IKDC), Tegner activity level scale. The assessment of instability predisposing factors was carried out with patellar height, tibial tuberosity‐trochlear groove (TT‐TG) distance, trochlear dysplasia, sulcus angle, patellar tilt and MPFL injuries. Functional outcomes were evaluated with Kujala, IKDC and Tegner scores at 3, 6 and 12 months after surgery. Results The average age of the patients was 20 years (range 13–43 years). Pre‐ operative Caton–Deschamps index was pathological in 10 (40%). Sulcus angle was elevated in 13 patients (52%) and TT‐TG distance was irregular in 17 patients (68%). Trochlear dysplasia was present in 13 patients (9 type A, 3 type B, 1 type C according to Dejour’s Classification). No re‐dislocation occurred during the follow‐up. There was a significant increase in the Kujala, IKDC and Lysholm scores after 3, 6 and 12 months, and the results were compared for the different follow‐up times and patient’s trochlear dysplasia degree. Conclusion This prospective observational longitudinal study identified good clinical outcomes in patients who underwent MPFL reconstruction and ATT transposition for patellar instability. Finally, the different risk factors for patellar instability examined, particularly the presence of trochlear dysplasia, did not significantly influence the final functional results, which range from good to excellent without re‐dislocation episodes
The story, of Nair: a study on the origins of symbolisation in light of an alleged case of psychosis or autism
No full textEste trabalho tem por objetivo verificar a procedência de uma hipótese sobre a origem da simbolização à luz dos dados do caso clínico de Nair, considerada como psicótica e autista em situações escolares e clínicas anteriores ao tratamento que embasou a tese. Segundo esta hipótese, o sujeito constitui o objeto antes de se auto-constituir como eu. A primeira parte do trabalho resume o caso clínico-institucional de Hermes, abordado anteriormente no mestrado, a partir de cuja reflexão surgiu a hipótese que se busca verificar à luz do caso clínico de Nair. Após contrastar detalhadamente a teoria lacaniana do simbólico e a ciência aristotélica do universal com a teoria espinosana da essência singular, o estudo volta-se à apresentação de um apanhado das sessões constitutivas do caso clínico de Nair. Na seqüência, o trabalho procede a reflexão teórica e metapsicológica sobre a condição psíquica singular revelada pela paciente, no contexto da psicanálise freudiana. É também considerado o psiquismo do analista, tal como se revelou na interação com a paciente. Finalmente, no último capítulo, procura-se refletir sobre o significado e a função metapsicológica dos instrumentos teóricos e técnicos acionados ao longo do tratamento de Nair. Tais instrumentos constituíram-se a partir de dois conceitos colhidos junto a filosofia de Merleau-Ponty. Concernentes a uma fundamentação corporal da intersubjetividade, as noções de co-percepção e reflexão em ordem, apropriados técnica eteoricamente ao contexto da prática psicanalítica do autor, tomam parte, no último capítulo, de Lima reflexão sobre a física da luz pressuposta na holografia. ) A conclusão da tese é a de que a hipótese de que o sujeito constitui o objeto antes de se auto-constituir como eu pode ser plenamente confirmada à luz do caso clínico e, além disso, ampliada em sua significação gnoseológica e ontológica, no campo teórico formado pela confluência entre a física da luz (ou óptica) e a psicologia profunda (ou metapsicologia). O campo teórico e prático assim configurado, o autor chamou de Psicologramática, vindo a propô-lo como um novo campo científicoThis thesis aims to verify a hypothesis about the origins of symbolization through clinical data obtained from case of Nair. Nair was diagnosed as psychotic and autist in school and clinical settings before starting the treatment that originated the present thesis. According to this hypothesis, the subject constitutes the object before constituting itself as an I. The first part of the thesis summarises the institutional and clinical case of Hermes (Calderoni, 1994) from where the hypothesis being presently investigated was derived. A detailed review of Aristotle\'s science of the universal, Lacan\'s theory of the symbolic and Spinoza\'s theory of singular essence is followed by the presentation of a sample of clinical sessions constitutive of Nair\'s case. The theoretical and metapsychological reflection on the unique psychological condition expressed by Nair is then developed in the context of Freudian psychoanalysis. The psyche of the analyst, as it was revealed in the interaction with the patient, is also considered. The last chapter reflects on the meaning and metapsychological function of the theoretical and technical tools used along the treatment of Nair. Such tools find their origins in two concepts found in the philosophy of Merleau-Ponty. Referring to the corporeal underpinnings of intersubjectivity, the notions of co-perception and reflection in the other were appropriated theoretically in tire context of the psychoanalytical practice of the author andused in a reflection about the physics of light embedded in holography. The thesis concludes by showing that the clinical case of Nair confines the hypothesis that the subject constitutes the object before constituting itself as an I. It also shows that this hypothesis can be extended in its epistemological and ontological meaning in the theoretical field formed by the confluence of optics (the physics of light) and depth psychology (or metapsychology). The thesis proposes that this theoretical and practical field should be called psychologrammatic and, as such, it constitutes a new scientific fiel
The story, of Nair: a study on the origins of symbolisation in light of an alleged case of psychosis or autism
No full textEste trabalho tem por objetivo verificar a procedência de uma hipótese sobre a origem da simbolização à luz dos dados do caso clínico de Nair, considerada como psicótica e autista em situações escolares e clínicas anteriores ao tratamento que embasou a tese. Segundo esta hipótese, o sujeito constitui o objeto antes de se auto-constituir como eu. A primeira parte do trabalho resume o caso clínico-institucional de Hermes, abordado anteriormente no mestrado, a partir de cuja reflexão surgiu a hipótese que se busca verificar à luz do caso clínico de Nair. Após contrastar detalhadamente a teoria lacaniana do simbólico e a ciência aristotélica do universal com a teoria espinosana da essência singular, o estudo volta-se à apresentação de um apanhado das sessões constitutivas do caso clínico de Nair. Na seqüência, o trabalho procede a reflexão teórica e metapsicológica sobre a condição psíquica singular revelada pela paciente, no contexto da psicanálise freudiana. É também considerado o psiquismo do analista, tal como se revelou na interação com a paciente. Finalmente, no último capítulo, procura-se refletir sobre o significado e a função metapsicológica dos instrumentos teóricos e técnicos acionados ao longo do tratamento de Nair. Tais instrumentos constituíram-se a partir de dois conceitos colhidos junto a filosofia de Merleau-Ponty. Concernentes a uma fundamentação corporal da intersubjetividade, as noções de co-percepção e reflexão em ordem, apropriados técnica eteoricamente ao contexto da prática psicanalítica do autor, tomam parte, no último capítulo, de Lima reflexão sobre a física da luz pressuposta na holografia. ) A conclusão da tese é a de que a hipótese de que o sujeito constitui o objeto antes de se auto-constituir como eu pode ser plenamente confirmada à luz do caso clínico e, além disso, ampliada em sua significação gnoseológica e ontológica, no campo teórico formado pela confluência entre a física da luz (ou óptica) e a psicologia profunda (ou metapsicologia). O campo teórico e prático assim configurado, o autor chamou de Psicologramática, vindo a propô-lo como um novo campo científicoThis thesis aims to verify a hypothesis about the origins of symbolization through clinical data obtained from case of Nair. Nair was diagnosed as psychotic and autist in school and clinical settings before starting the treatment that originated the present thesis. According to this hypothesis, the subject constitutes the object before constituting itself as an I. The first part of the thesis summarises the institutional and clinical case of Hermes (Calderoni, 1994) from where the hypothesis being presently investigated was derived. A detailed review of Aristotle\'s science of the universal, Lacan\'s theory of the symbolic and Spinoza\'s theory of singular essence is followed by the presentation of a sample of clinical sessions constitutive of Nair\'s case. The theoretical and metapsychological reflection on the unique psychological condition expressed by Nair is then developed in the context of Freudian psychoanalysis. The psyche of the analyst, as it was revealed in the interaction with the patient, is also considered. The last chapter reflects on the meaning and metapsychological function of the theoretical and technical tools used along the treatment of Nair. Such tools find their origins in two concepts found in the philosophy of Merleau-Ponty. Referring to the corporeal underpinnings of intersubjectivity, the notions of co-perception and reflection in the other were appropriated theoretically in tire context of the psychoanalytical practice of the author andused in a reflection about the physics of light embedded in holography. The thesis concludes by showing that the clinical case of Nair confines the hypothesis that the subject constitutes the object before constituting itself as an I. It also shows that this hypothesis can be extended in its epistemological and ontological meaning in the theoretical field formed by the confluence of optics (the physics of light) and depth psychology (or metapsychology). The thesis proposes that this theoretical and practical field should be called psychologrammatic and, as such, it constitutes a new scientific fiel
