124 research outputs found
Good long-term outcomes of the hip Chiari osteotomy in adolescents and adults with hip dysplasia: a systematic review
No full textBACKGROUND AND PURPOSE: The Chiari osteotomy was a regular treatment for developmental hip dysplasia before it became mostly reserved as a salvage therapy. However, the long-term survival of the Chiari osteotomy has not been systematically investigated. We investigated the survival time of the Chiari osteotomy until conversion to total hip arthroplasty (THA) in patients with primary hip dysplasia, and factors which correlated with survival, complications, and the improvement measured in radiographic parameters. PATIENTS AND METHODS: Studies were included when describing patients (> 16 years) with primary hip dysplasia treated with a Chiari osteotomy procedure with 8 years' follow-up. Data on patient characteristics, indications, complications, radiographic parameters, and survival time (endpoint: conversion to THA) were extracted. RESULTS: 8 studies were included. The average postoperative center-edge angle, acetabular head index, and Sharp angle were generally restored within the target range. 3 studies reported Kaplan-Meier survival rates varying from 96% at 10 years to 72% at 20 years' follow-up. Negative survival factors were high age at intervention and pre-existing advanced preoperative osteoarthritis. Moreover, reported complications ranged between 0% and 28.3 %. INTERPRETATION: The Chiari osteotomy has high reported survival rates and is capable of restoring radiographic hip parameters to healthy values. When carefully selected by young age, and a low osteoarthritis score, patients benefit from the Chiari osteotomy with satisfactory survival rates. The position of the Chiari osteotomy in relation to the periacetabular osteotomies should be further (re-)explored.Biomaterials & Tissue Biomechanic
Ridondanza e linguaggio. Un principio costitutivo delle lingue
No full textChe cos'è la ridondanza e come si manifesta nel linguaggio e nelle diverse semiotiche' Come si lega alla prevedibilità, alla possibilità di anticipare e correggere l'errore, alla sin-cronizzazione tra gli utenti di un linguaggio, alla possibilità di realizzare produzioni “im-perfette”' Quali tipi di ridondanza esistono' In quali livelli dell'analisi delle lingue naturali possiamo individuarla' Può essere misurata o calcolata' Su tali questioni, centrali sia per la teoria linguistica che per la filosofia del linguaggio, ci si interroga in questo libro. Ripercorrendo la genesi della nozione di ridondanza nella teo-ria dell'informazione e soffermandosi sulle sue prime applicazioni linguistiche, l'autrice ne propone una nuova definizione, evidenziando i nodi cruciali per la comprensione del fun-zionamento delle lingue e fornendo metodi di misurazione e valutazione di alcuni tipi di ridondanza delle lingue storico-naturali.La ridondanza si configura così come un principio costitutivo e ineliminabile di ogni se-miotica, poich direttamente dipendente dalla finitezza psico-biologica dei suoi utenti; e a un tempo si impone come principio regolativo cui, attraverso diversi equilibri, tende ogni forma di comunicazione.What is redundancy and how it is manifests itself in language and other semiotic codes. 'How does it relate to the predictability, the ability to anticipate and correct the error, the synchronization between the users of a language, the ability to realize production" "'What kinds of redundancy exist' in which levels of analysis of natural languages, we can locate it and measure it or calculate it'. The book addresses these issues, central to linguistic theory and philosophy of language. Tracing the genesis of the concept of redundancy in information theory and focusing on his first language applications, the author proposes a new definition, highlighting the crucial for understanding the functioning of languages and providing methods of measurement and evaluation of some types of redundancy of languages
Our experience in surgical treatment of chiari type 1 malformations
No full textIntroduction: There are four types of Chiari malformations described in the literature. Due to the fact that it is a common finding in the general population (true Chiari being present in 0,75% of the population), Chiari 1 malformation was also called Chiari anomaly.Material and methods: In the last 5 years 17 patients with Chiari I malformation have been treated in our clinic. There were 12 women and 5 men. The mean age was 43 years (between 21 and 60 years). The symptoms were grouped in 6 syndromes: brain stem and bulbar palsy syndrome, cerebellar syndrome, central cord syndrome, paroxysmal intracranial hypertension, scoliosis, pyramidal syndrome.Surgical treatment: According to recent literature patients respond best when operated within 2 years from the onset of symptoms. We recommend early surgery for symptomatic patients. Surgical treatment of Chiari I malformation should accomplish several golds. First of all, there is the obvious need to decompress the lower part of the cerebellum. Chiari I malformation being related to a small posterior fossa, the surgical treatment should realise enlargement of the total volume of the posterior fossa(7, 12). In the author’s opinion the key point in surgical treatment of Chiari 1 malformation should be to reestablish the CSF flow at the level of the foramen of Magendie and foramen magnum. Various approaches were used in the last five years in our clinic for the treatment of symptomatic patients: only osseous decompression in 2 patients; osseus decompression with dural grafting and intradural dissection of adhesions in 4 patients; osseous decompression with dural grafting, intradural dissection, and tonsillar coagulation in 11 patientsResults: The long-term (6 months postoperative) surgery-related result was considered excellent if symptoms resolved (7 patients). The result was considered good if the patient experienced significant improvement but also residual symptoms (8 patients). A poor result indicated no change in symptoms (2 patients). As for the surgical technique used, the vast majority of patients with good or excellent outcome at 6 months underwent osseous decompression with dural grafting, intradural dissection, and tonsillar coagulationConclusions: Regarding Chiari I malformations, the author considers that a proper patient selection is critical to prevent unnecessary procedures and maximize the outcome. In light of this study results and recent literature, the author considers that the surgical gold standard consists in three key steps: posterior fossa craniectomy followed by durotomy and subarachnoid decompression of CSF flow and last duroplasty
JAK2V617F and prothrombin G20210A gene mutations in a patient with Budd-Chiari syndrome and essential thrombocythemia
No full textMyeloproliferative disorders and the inherited thrombophilias have been described as the main causes underlying the Budd-Chiari syndrome. Moreover, the presence of the JAK2V617F was associated with a higher frequency of Budd-Chiari syndrome in patients who have overt or even latent myeloproliferative disorder. We herein describe a 28-year-old woman who was diagnosed with Budd-Chiari syndrome and later developed an overt myeloproliferative disorder. The patient was found to carry both the JAK2V617F and the prothrombin G20210A mutation in the heterozygous form. The significance of the chronology of diagnosis is highlighted. © 2010 The Author(s).Baxter EJ, 2005, LANCET, V365, P1054, DOI 10.1016-S0140-6736(05)71142-9; Colaizzo D, 2007, J THROMB HAEMOST, V5, P55, DOI 10.1111-j.1538-7836.2006.02277.x; Denninger MH, 2000, HEPATOLOGY, V31, P587, DOI 10.1002-hep.510310307; Franchini M, 2006, CRIT REV CL LAB SCI, V43, P249, DOI 10.1080-10408360600552678; Janssen HLA, 2000, BLOOD, V96, P2364; Kralovics R, 2005, NEW ENGL J MED, V352, P1779, DOI 10.1056-NEJMoa051113; Menon KVN, 2004, NEW ENGL J MED, V350, P578, DOI 10.1056-NEJMra020282; Patel RK, 2006, GASTROENTEROLOGY, V130, P2031, DOI 10.1053-j.gastro.2006.04.008; Schafer AI, 2006, BLOOD, V107, P4214, DOI 10.1182-blood-2005-08-3526; Vardiman JW, 2002, BLOOD, V100, P2292, DOI 10.1182-blood-2002-04-11990
Machine Learning Models for Predicting Short-Long Length of Stay of COVID-19 Patients
No full textDuring 2020 and 2021, managing limited healthcare resources and hospital beds has been a fundamental aspect of the fight against the COVID-19 pandemic. Predicting in advance the length of stay, and in particular identifying whether a patient is going to stay in the hospital longer or less than a week, can provide important support in handling resources allocation. However, there have been significant changes in terms of containment measures, virus diffusion, new treatments, vaccines, and new variants of SARS-CoV-2 during the last period. These changes pose several conceptual drift issues that can limit the usefulness of machine learning in this context. In this work, we present a machine learning system trained and tested using data from more than 6000 hospitalised patients in northern Italy, distributed over almost two years of pandemic. We show how machine learning can be effective even by analysing data over this long period of time, also exploiting a model that predicts the patient's outcome in terms of discharge or death. Furthermore, learning from data that also consider deceased patients is a common issue in predicting the length of stay because they have severe conditions similar to patients with a long stay period, but may actually have a very short duration of hospitalisation. For this purpose, we present a method for handling data from alive and deceased patients, exploiting more patient records, increasing the robustness of the model and its performance in this task. Finally, we investigate the features that are most relevant to the prediction of the simplified length of stay
Monitoring of cerebrospinal fluid flow by intraoperative ultrasound in patients with Chiari I malformation
No full textObjective: To investigate the feasibility of intraoperative ultrasound (IOUS) for monitoring cerebrospinal fluid (CSF) flow in patients with Chiari I malformation. Methods: Twenty patients with Chiari I were scanned by IOUS with color Doppler flow imaging (CDFI). CSF flow status and flow velocity were monitored at different times during the surgery. Results: CSF flow was detected in all 20 cases by IOUS-CDFI in real time. CSF flow was extremely slow or even ceased following bony decompression (craniectomy + laminectomy) in 19 patients; however, bidirectional flow was observed in the systolic phase and cranially directed flow in the diastolic phase. The maximum flow rate ranged from 4 to 13 cm/s after duraplasty, and this varied with respiratory rhythm. Only 1 patient showed typical CSF flow after craniectomy, suggesting sufficient decompression, and without further duraplasty. All surgeries were terminated when bi-directional CSF flow was observed using IOUS-CDFI. With the exception of 1 patient, all the patients' symptoms were significantly relieved. Conclusion: IOUS-CDFI can monitor CSF flow during posterior fossa decompression, provide information about the re-circulation of CSF flow, and objectively evaluate the efficacy of surgery. (C) 2010 Elsevier B.V. All rights reserved.Clinical NeurologySurgerySCI(E)PubMed4ARTICLE3173-17611
Alveolite allergica estrinseca cronica o fibrosi polmonare idiopatica? Ruolo della TC con elevata risoluzione (HRTC)
No full textElectroconvulsive therapy and type 1 Chiari malformation
No full textCrown Copyright © 2018 Published by Elsevier B.V. All rights reserved. This manuscript version is made available under the CC-BY-NC-ND 4.0 license:http://creativecommons.org/licenses/by-nc-nd/4.0/
This author accepted manuscript is made available following 12 month embargo from date of publication (March 2018) in accordance with the publisher’s archiving policyType 1 Chiari Malformation (T1CM) refers to a congenital herniation of the cerebellar tonsils though the foramen magnum of ≥5 mm (Pickard et al., 2012). Total prevalence in normal adults is almost 1%, yet only 0.01–0.04% of the population are symptomatic (Tubbs, 2013). The ectopic tonsils may cause obstruction of cerebrospinal fluid (CSF) flow through the subarachnoid space at the craniocervial junction (Pickard et al., 2012). Patients may be asymptomatic, or display varied symptoms due to brainstem compression, cerebellar displacement, traction on cranial nerves or interference with CSF flow. Transiently elevated intracranial pressure (ICP) due to trapped cerebrospinal fluid causes the most common symptom, headaches, in 81% of patients (Fischbein et al., 2015). 10% of patients have associated hydrocephalus (Tubbs, 2013), and an unknown percentage have idiopathic intracranial hypertension
Syringomyelia with irreducible atlantoaxial dislocation, basilar invagination and Chiari I malformation
No full textA 27-year-old woman presented with bilateral weakness of her all extremities for 5 years. She had a spastic gait and was unable to ambulate without assistance. Neurologic examination revealed increased deep tendon reflexes and positive pathologic reflexes. Radiographs showed occipitalization of the atlas, C2-C3 congenital fusion and fixed atlantoaxial dislocation with an atlanto-dental interval of 10 mm. MRI demonstrated cervicomedullary junction (CMJ) compression from the odontoid, a Chiari type I malformation, and syringomyelia extending from the foramen magnum to C5. The patient underwent transoral atlantoaxial release followed by posterior internal fixation from the occiput to the axis, which resulted in a significant improvement in motor function in all extremities. Post-operative images showed anatomical reduction of the atlantoaxial joint. However, an MRI performed 8 days following surgery showed a new retro-odontoid pannus had developed that was compressing the spinal cord at CMJ. A follow-up CT scan performed at 6 months post-operatively demonstrated a solid bony fusion between the occiput and C2, while an MRI at that time showed complete resolution of the retro-odontoid soft tissue mass with correction of the Chiari I malformation, and resolution of the syringomyelia. Final follow-up at 2-years revealed an excellent clinical outcome.Clinical NeurologyOrthopedicsSCI(E)PubMed7ARTICLE3361-3661
Transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome: A comprehensive review
No full textBudd-Chiari syndrome (BCS) is a relatively rare clinical condition with a wide range of symptomatology, caused by the obstruction of the hepatic venous outflow. If left untreated, it has got an high mortality rate. Its management is based on a step-wise approach, depending on the clinical presentation, and includes different treatment from anticoagulation therapy up to Interventional Radiology techniques, such as transjugular intrahepatic portosystemic shunt (TIPS). TIPS is today considered a safe and highly effective treatment and should be recommended for BCS patients, including those awaiting orthotopic liver transplantation. In this review the pathophysiology, diagnosis and treatment options of BCS are presented, with a special focus on published data regarding the techniques and outcomes of TIPS for the treatment of BCS. Moreover, unresolved issues and future research will be discussed. © The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved
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