348 research outputs found
Cello techniques and performing practices in the nineteenth and early twentieth centuries
No full textThis thesis comprises a study of cello performance practices throughout the nineteenth century and into the early decades of the twentieth. It is organised in terms of the increasing complexity of the concepts which it examines, as they are to be found in printed and manuscript music, instrumental methods and larger treatises, early recordings, concert reviews and pictures. Basic posture is considered along with different ways of holding the
bow. The development of the tail-pin shows that even when it was widely used, the older posture was still referred to as a model. Some implications for tone quality and tonal
projection are considered in the light of the shape of the arms. Some connections between the cellist's posture and that recommended by etiquette books are explored. The
functionality of the left hand and arm, and the development of modem scale fingerings, show that there was a considerable period of overlap between newer and older practices, with modern scale fingerings evolving over a long period of time. Similarly, views on the function of the right wrist in bowing are shown to change gradually, moving towards a more active upper arm movement with less extreme flexibility of the wrist. Two central expressive techniques especially associated with string playing arc considered in the context of the cello, namely vibrato and portamento. These topics are examined in the light of written indications in music, recommendations in cello treatises, and the practices evidenced in early recordings. The sources for this study can be brought into an overall
framework of a constant dialogue between `theory', as expressed in verbal instructions to the learner, or general a priori reflections about the cello, and `practice', manifested in performing editions and early recordings, or in individual acts of reception. A wide divergence is noted, both between theory and practice in general, and in terms of different styles of playing observable at any one time. It is suggested that tensions between practice
and critical disapproval can be resolved in terms of Lacanian discourse. Several test cases are used in order to compare several different recordings of the same works. The question of the musical character of the cello is discussed in terms of widespread assumptions about its gendered identity. A wide range of sources suggest that this moved from a straightforwardly `masculine' identity expressed through a controlling, elevated eloquence to a less clearly defined one, incorporating the 'feminine', with a greater stress on uninhibited emotional expression. Some performance implications for this change of view are pursued with respect to specific repertoires. Broad conclusions stress the importance of the diversity of performance practices as opposed to unifying generalisations
BUB ‘N’ ROLL TECHNIQUE A novel approach to harvesting the Descemet-endothelium complex in DMEK surgery
No full textBUB ‘N’ ROLL TECHNIQUE
A novel approach to harvesting the Descemet-endothelium complex in DMEK surgery
Background: Fuchs endothelial corneal dystrophy (FECD) is a leading cause of corneal transplantation, often treated with Descemet membrane endothelial keratoplasty (DMEK). Current DMEK techniques require precise harvesting of the Descemet membrane and endothelium complex, and this step can be technically challenging. This study investigates a novel, simplified technique called "Bub 'n' Roll" for preparing donor tissue for DMEK, with the goal of improving reproducibility and minimizing endothelial cell loss.
Methods and Materials: Forty-one corneal tissues were prepared using the Bub 'n' Roll technique. This hydrodissection method involves injecting a preservation fluid to create a Type 1 or Type 2 bubble, facilitating separation and spontaneous rolling of the Descemet membrane and endothelium. Surgical dissection time, endothelial cell density (ECD) of the harvested tissue, and post-operative outcomes (rebubbling rates, best corrected visual acuity (BCVA), and central corneal thickness (CCT)) were retrospectively analyzed. Tissues were preserved in EUSOL-C (Alchemy) cold storage fluid at +4°C until the endothelial descemetic 'roll' was set up and then in TISSUE-C (Alchemy) until the DMEK transplantation surgical procedure. The procedure is performed bimanually under an optical biomicroscope at 10x magnification.
Results: The study included 41 patients (61% female, mean age 69.2 years). Average donor age was 63.3 years (51% female). Average surgical duration was 318.62 ± 69.94 seconds for Type 1 bubbles and 377 ± 63.95 for Type 2 (p=0.0237). Rebubbling was necessary in 24% and 25% of cases. The Cellular Density significantly reduced over time after Bub'n'roll (p < 0.001). At 3 months the 1 type lost 30.2 + 6% of endothelial cells, at 24 months lost 40 +- 4.5 % compared with the type 2 bubbles 19 +-5% at 3 months and a 33 +-3% at 24 months .There was a correlation between duration and loss of endothelial cells in type 1. At the last follow-up, the average BVCA was 0.17 ± 0.07 with significance (p< 0.001).
Conclusion: The Bub 'n' Roll technique appears to offer a viable and simplified approach to DMEK donor tissue preparation. The technique reduces intraoperative manipulation, is readily reproducible and allows excellent control of surgical steps. However, limitations of this single-surgeon, retrospective study include a relatively small sample size and limited follow-up. Further multi-center, longer-term, and controlled studies are warranted to determine the long-term efficacy and benefits of this technique in a broader surgical community and compare its advantages against existing methods
Delayed facial palsy after vestibular schwannoma resection: clinical data and prognosis.
No full textTUMORI MALIGNI METACRONI DELLE GHIANDOLE SALIVARI DI DIFFERENTE TIPO NELLO STESSO PAZIENTE
No full textLinfoadenopatie ascellari monolaterali da granulomi di tipo sarcoidosico: malattia granulomatosa idiopatica o sarcoidosi? Caso clinico
No full textLa presenza di granulomi di tipo sarcoidosico nei linfonodi periferici, in assenza di altre alterazioni cliniche e/o radiologiche suggestive, non è di per sé sufficiente a porre diagnosi di sarcoidosi. Per definizione, infatti, la sarcoidosi è una malattia sistemica e per una diagnosi
certa è pertanto necessario dimostrare il coinvolgimento di due o più organi che però può rendersi evidente a distanza di anni dall’esordio della malattia, ponendo così il medico di fronte a un difficile quesito diagnostico.
In assenza di altre localizzazioni di malattia, viene posta diagnosi di “malattia granulomatosa idiopatica” dei linfonodi periferici. I pazienti vanno comunque sottoposti ad un accurato follow-up a lungo termine per evidenziare eventuali variazioni del quadro clinico-strumentale,
che rendano certa la diagnosi.
Prendendo spunto da un caso di malattia granulomatosa idiopatica a localizzazione ascellare monolaterale, gli Autori effettuano una revisione della letteratura sulla sarcoidosi e sulla presentazione extrapolmonare
della malattia, evidenziando come questa vada tenuta presente nella diagnostica differenziale delle linfoadenopati
Aortic arch pseudoaneurysm on penetrating ulcer: delayed closure after endovascular treatment
No full textStandard open repair of true or false aneurysms of the aortic arch usually require cardiopulmonary bypass, hypothermia and circulatory arrest, associated with increased mortality and morbidity rates. Thus, an alternative strategy that avoids cardiopulmonary bypass (CPB) and hypothermic circulatory arrest would benefit the patient. Endovascular stent-grafting has developed as a safe and effective treatment for descending aortic pathologies.5,6
We share our experience with the endovascular approach to pseudoaneurysm of the aortic arch in a patient with high risk for aortic arch replacement under extracorporal circulatio
Early diagnosis of endolymphatic hydrops with distortion. Product otoacoustic emissions.
No full textThe present investigation was specifically designed to evaluate the ability of the glycerol test combined with pure-tone audiometry, distortion-product otoacoustic emissions (DPOAEs) to diagnose endolymphatic hydrops early and to identify patients who may evolve toward Meniere's disease. This investigation consisted of 43 consecutive patients with daily episodes of tinnitus with duration exceeding few hours or with continuous tinnitus who received no treatment. These were the unique symptoms reported by the patients. Each patient underwent glycerol testing measured with conventional pure tone audiometry and with distortion product otoacoustic emissions (DPOAEs). For the traditional pure-tone glycerol test a hearing improvement of at least 10 dB, at the lower two or three frequencies (125,250 and 500 Hz) was judged as positive result. For the DPOAEs glycerol testing, a smaller positive difference (5 dB) for at least three frequencies was interpreted as a significant fluctuation. Twenty four patients showed negative glycerol test both with pure tone audiometry and DPOAEs. In 7 cases the improvement was concurrently observed. In 9 patients post-glycerol changes appeared only in the DPOAEs outcomes. Finally the remaining three patients had two different patterns. Two had different ameliorations of the DPOAEs and pure-audiometry on the left and right sides respectively, and in the last one only post-glycerol, audiograms recovered. The present study re-confirms the potentiality of DPOAEs associated with glycerol test in diagnosing endolymphatic hydrops precociously. The possibility of these patients degenerating into Meniere's disease should not be underestimated
Studio morfodinamico della deglutizione dopo laringectomia sub-totale
No full textL’obiettivo principale della chirurgia laringea sub totale è la creazione di una neolaringe che permette il ripristino sia della fonazione che della funzione deglutito ria e respiratoria. Lo scopo di questo lavoro è di valutare attraverso la video fluoroscopia l’efficienza del ripristino della deglutirne nei soggetti sottoposti a laringectomia sub-totale. Vnegono riportati i risultati dello studio videofluoroscopico condotto su 59 pazienti selezionato, sulla base di diversi criteri, da un gruppo di 312 sottoposti a laringectomia subtotale tra il 1984 ed il 2004 nel nostro Dipartimento di Otorinolaingoiatria. Con la Videofluoroscopia si è valutato il tempo di transito orale ed il tempo di transito faringeo. Il tempo di permanenza del sondino naso gastrico e della cannula tracheale sono stati utilizzati come parametri di valutazione del recupero della funzionalità deglutito ria. I risultati mostrano come, a distanza da un anno dall’intervento, i tempi di deglutizione siano al di sotto del secondo come in un soggetto sano. I dati ottenuti dalla video fluoroscopia a 12 mesi dall’intervento non hanno evidenziato sostanziali differenze qualitative tra CHP e CHEP nel ripristino di una adeguata attività deglutito ria
Incidence of Surgical Site Infections: Our Experience
No full textISE.334
Incidence of Surgical Site Infections: Our Experience
L. Izzo. M. Caputo, P. Meloni, A. Bolognese, P. Di Cello, P. Izzo, R. Buffone, I. D'Angeli, F. Bisogno, D. Pietrasanta. Policlinic Umberto I - University Hospital, Rome, Italy
Background: The aim of this study is to determine surgical wound infection (SWI) rates in surgical patients using the National nosocomial Infections Surveillance system (NNIS), to monitor current surgical antimicrobial prophylaxis, and to identify possible modifiable risk factors for SWI.
Materials and Methods: Main criteria for hospital wards inclusion were: more than 20 surgical procedures per week, and use amoxycillin/clavulanate (Augmentin) among prophylactic options. Each patient operated from December 1st 2005 to July 31th 2006 was surveyed for 30 days after surgery. SWI cumulative incidence rates and 95% confidence intervals (95%CI) were calculated.
Results: During the study period, 2068 surgical procedures were performed in 2050 patients. A total of 147 SWI were diagnosed in 142 patients: 82 (57.7"/o) were at superficial incision, 31 (21 .8%) were 81 deep incision and 42 (29.6%) were at organ-space site. Incidence cl SWI every 100 operations was 6.4%. About 86.5% of the operated patients received antimicrobial prophylaxis, mainly with amoxicillin clavulanate (Augmentin) (28.3%) or with imipenem/cilastatin (Tienam) (11.4%). Pre-operative hospital stay> or== 48 h, diabetes, obesity, and HIV/AIDS infection were statistically significantly associated with increased risk of SWI.
Conclusions: The SWI rates found are comparable with European studies and can be a benchmark for national incidence data and for inter- and intra-hospital SWI rate comparisons
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