86,786 research outputs found
Applicazioni medico-legali delle tavole di Ishihara in tema di idoneità al lavoro
No full textViene riferita una esperienza di impiego delle tavole di Ishihara in uno screening per la valutazione dell’idoneità al lavoro di elettricista.
Rilevata l’indispensabilità di una fine discriminazione cromatica per una tal genere di occupazione, vengono illustrati i risultati conseguiti nell’individuazione dei casi di discromatopsia
L’audiometria automatica Bekesy nella pratica medico-legale: alcune tecniche per la valutazione di simulazione di simulazione e dissimulazione
No full textGli AA. Segnalano l’interesse medico-legale assunto dall’audiometria automatica secondo Bekesy nella valutazione delle ipoacusie, per la possibilità di individuare artefatti dovuti a simulazione o dissimulazione .
Riferiscono sulla base della loro esperienza una metodologia di indagine audiometrica da impiegare per un dettagliato inquadramento della condizione uditiva studiata e quindi per una sua attendibile valutazione medico-legale
Efficacy of Hylan G-F 20 versus 6-methylprednisolone acetate in painful shoulder osteoarthritis: A retrospective controlled trial
No full textShoulder osteoarthritis affect about 32% of patients over 60 years. Conservative treatment are recommended to restore shoulder function while shoulder arthroplasty remains the standard treatment for severe osteoarthritis. When conservative therapies fail and surgical approach is precluded, viscosupplementation with HA may be the treatment of choice. Currently, there is minimal information available comparing the results of Hylan G-F 20 and corticosteroid injections for the treatment of shoulder osteoarthritis. Therefore, the purpose of this study was to examine the results of these two treatments at specific time points with validated outcome measurements. Retrospective comparative cohort study. The study population included 84 patients, 51 of whomtreated with Hylan G-F 20 and 33 with a corticosteroid. Gleno-humeral osteoarthritis was graded according to Samilson-Prieto classification and rotator cuff was assessed with MRI. Both groups received three injections 1 week apart and were evaluated using a Visual Analog Scale (VAS) for pain and satisfaction, the Shoulder Pain and Disability Index (SPADI) and the Constant-Murley scale. Outcomes were registered at 1, 3, and 6 months. The Hylan G-F 20 group showed a significant pain reduction (P<0.05), improvement in the Constant-Murley, SPADI scores (P<0.05), and satisfaction (P<0.01) at all three follow-up times. Pain, clinical scores, and subjective satisfaction in the corticosteroid group improved in the first post treatment month only (P<0.05) compared with the baseline. Overall, lower clinical advantages were found in patients with greater degree of osteoarthritis and rotator cuff tears. Intra-articular injections with Hylan G-F 20 are effective in reducing pain for up to 6 months in gleno-humeral osteoarthritis whereas corticosteroids injections resulte in improvement at 1 month only. In patients with severe osteoarthritis and/or full-thickness, RC tears results tended to be worse. © 2011 Springer-Verlag
Primi risultati di indagini cliniche e medico-legali in epatopazienti
No full textUna classificazione delle epatopatie costituisce un grosso problema, soprattutto sotto l’aspetto tassonomico.
Ai fini della clinica medico-legale, per le peculiarità metodologiche che le sono proprie, si è pensato di schematizzare le epatopatie nei seguenti tre gruppi, secondo i rilievi clinici e bioumorali dei soggetti esaminati:
-Gruppo A: Quadro clinico positivo per epatopatie;
-Gruppo B: Quadro umorale positivo per epatopatie;
-Gruppo C: Quadro umorale e quadro clinico positivo per epatopatie.
Nella valutazione medico-legale il gruppo A non ha significato; il gruppo B assuma significatività, quanto più marcate ed stese sono le alterazioni bioumorali.
In base a tale schema viene presentata la casistica dell’ambulatorio dell’Istituto di Medicina Legale e delle Assicurazioni della II Facoltà di Napoli e prospettato un nuovo protocollo da impiegarsi nella clinica medico-legale per ottenere una standardizzazione dei dati in sede valutativa e comparativa dei risultati
A Single-Center Experience With Phoenix Atherectomy System in Patients With Moderate to Heavily Calcified Femoropopliteal Lesions
No full textPurpose: To evaluate efficacy and safety of a new rotational atherectomy (RA), the Phoenix AtherectomyTM System, for the treatment of de novo and re-stenotic or occlusions atherosclerotic moderate-heavily lesions of the femoro-popliteal axis. Material and methods: From January 2015 to August 2017, 52 patients with heavily calcified femoro-popliteal lesions causing severe stenosis or occlusions were enrolled in our center to be treated using Phoenix catheters. Primary endpoints of this study were acute efficacy and safety at 30 days. Secondary endpoints were freedom from restenosis and target lesion revascularization (TLR)/target vessel revascularization (TVR) at 1-, 6- and 12- months. Results: The mean lesion length was 9.2 cm (range 5-23 cm). The lesions were located in superficial femoral artery (SFA) in 61.5% (Fig. 1-A), in popliteal artery in 21.1% and involved femoral-popliteal axis in 15.4%. A primary technical success was achieved in 51/52 patients, with an optimal working channel after RA alone. Using Kaplan-Meyer analysis, primary vessel patency rates at 1, 6 and 12 -months was 96.1%, 86.5% and 76.9% respectively. Assisted primary patency at 1, 6- and 12 -months was 100%, 90.3% and 86.5% respectively. Conclusions: Recanalisation with the Phoenix Atherectomy System is simple and safe, with a high technical success rate
Surgical approach to acute pectoralis major tendon rupture
No full textPectoralis major rupture is a very uncommon injury first time described by Patissier in 1822. Tears are classified on the type (partial and complete) or on the site (tendinous, myotendinous junction, intramuscular).
Ruptures are reported in young high-performance athletes as results of eccentric contractions of the musculotendinous unit. The most probable mechanism in elderly patients is a brisk tearing movement applied to stiff atrophic muscle. Injuries generally involve the sternal portion;
the localization to the clavicular portion is rare and can be misdiagnosed as muscle sprain. Preoperative planning include MRI as g old standard regarding operative versus non operative treatment decisions. Surgical repair is recommended in cases of complete tears because of loss of strenght in adduction, flexion and internal rotation.
Aim of the current study is to describe the surgical repair of acute pectoralis major tendon rupture in 5 patients. Surgery was performed through a modified delto-pectoral approach; pectoralis major tendon was attached at its anatomic insertion using two metallic anchors. The patient as been immobilized in a sling for 30 days and then assisted
physiotherapy begun; strenght exercises were allowed at 90 days. At a mean follow-up of 24 months results were excellent in all cases with restoration of strenght and coming back to previously sports activit
Co-analgesic therapy for arthroscopic supraspinatus tendon repair pain using a dietary supplement containing Boswellia serrata and Curcuma longa: a prospective randomized placebo-controlled study
No full textBackground: The cuff tendon that is most prone to full-thickness rotator cuff tears is the supraspinatus (SSP). Arthroscopic SSP repair ensures good to satisfactory mid- to long-term clinical outcomes. However, the intense postoperative pain reduces rehabilitation compliance and is cause of patient dissatisfaction. Many natural compounds act by inhibiting inflammatory pathways in a similar way to anti-inflammatory drugs Materials and methods: This was a prospective randomized trial designed to assess the analgesic effect of a dietary supplement (DS) containing Boswellia serrata and Curcuma longa in a population of subjects with full-thickness SSP tendon tear treated by arthroscopy. Three weeks before surgery, patients were randomized to receive Tendisulfur® (group T) or a placebo (group P) for 2 months. The primary outcome measure was subjective VAS pain. Secondary outcomes measures were Constant–Murley score simple shoulder test, and patient global assessment (PGA) scores. Patients were assessed immediately at baseline and subsequently at 1, 2, 4, 6, 8, 12, and 24 weeks. Results: Stratification of pain scores and subscores demonstrated significantly lower overall pain scores in group T versus group P at 1 week (p = 0.0477), and lower but not significantly different scores on week 2 (p = 0.0988); at subsequent time points, differences were not significant (p > 0.05). PGA scores were good in all subjects. Conclusions: In conclusion, this study provides objective data on the effect of a DS containing natural substances, added to standard analgesics, on postoperative RC pain. DS alleviated short and partially mid-term pain, while long-term pain was unchanged. This limitation can probably be addressed by a dosage increase over the first 4 weeks and by extending treatment by 1 or 2 months
Multichannel computed tomography (MCCT) analysis of glenoid erosion in shoulder hemiarthroplasty: Preliminary clinical applications
No full textGlenoid wear following shoulder hemiarthroplasty (HA) has been reported around 80% in long-term follow-up studies. Radiographic analysis is useful to depict glenoid erosion but does not evaluate accurately glenoid bone loss. Multichannel computed tomography (MCCT) allows scanning with submillimeter section thickness through dense areas of glenoid bone, despite the presence of metallic prostheses. In this preliminary study, we performed a MCCT analysis of glenoid erosion, in 15 patients with painful shoulder HA, at an average follow-up of 5.5 years. Clinical scores were retrospectively assessed at an early (1 year), medium (2.5 years), and late (5.5 years) follow-up. We analyzed the following glenoid features: articular line space (ALS), glenoid length (bone stock), glenoid version, morphology of erosion (concentric, superior ed inferior tilt), and gross bone defects. Glenoid was retroversed in 13 patients (minimum 0° maximum 8°), antiversed in 2 patients (2° and 6°). Erosion was described as concentric in 13 patients, eccentric ("superior tilt") in 1 patient, biconcave in another patient. The mean glenoid length was 19.7 mm (min 16.4 max 22.7). Gross bone defects were described in six patients. The scores registered at latest follow-up showed a significant decrease compared with the values at 1 year (P<0.001) and at 2.5 years (P<0.001). The patients with glenoid erosion associated with gross defects and ALS ≤1.2 mm had lower scores for pain and lower scores for ROM (P<0.01). Multidetector CT analysis establishes a new frontier in the postoperative management of shoulder arthroplasty, and its application in the glenoid analysis offers a significant contribution for the following reasons: qualitative and quantitative glenoid features are better seen because volume-rendering eliminates most streak artifacts and produces high-quality images; spatial information relative to the prosthetic devices and the relationship among hardware and bone can be better demonstrated; allows an accurate preoperative planning prior to starting with revision surgery. © 2010 Springer-Verlag
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