[Collaboration between occupational doctors in the public prevention services and qualified occupational doctors: description of an experience in the sandstone sector of Alto Mugello]. / Il rapporto tra medico del lavoro nei servizi pubblici di prevenzione e medico competente: descrizione di un'esperienza nel comparto lapideo dell'Alto Mugello.

BACKGROUND: The present course of work-related injuries imposes an effective collaboration among public service's doctors and qualified occupational doctors. We refer to a positive interaction in a prevention plan of hand-arm vibrations exposure during phases of dressing in the sandstone sector of Alto Mugello. METHODS: Both were acquired data on exposition (risk assessment, measures on tools, times and levels of exposition, etc.) and data on workers' health (an high number of workers showed suspect angioneurotic disorders). The symptomatic workers were subjected to a clinical-instrumental examination that highlighted a clear correlation between high hand-arm vibrations exposition and functional injury. RESULTS: Sharing informations is a precious tool both for Public Prevention Services, it enables in fact to realize an accurate representation of workers' health state, and for qualified occupational doctors to manage risk with employers and to carry out an effective health surveillance.

Soft tissue metastasis from carcinoma. A case report.

The authors report a case of a man who developed soft tissue metastasis to the thigh from pulmonary carcinoma. In the preoperative staging, computerized tomograms and magnetic resonance imaging allowed to identify and characterize the features of soft tissue masses; these studies, however, must be always completed with needle (tru-cut) or incisional biopsy.

Mucous cysts of the external popliteal sciatic nerve during childhood: presentation of two cases and a review of the literature.

Mucous cysts of the peroneal head constitute the most frequent cause of compression of the external popliteal sciatic nerve (EPS). Depending on the site in which it occurs, we distinguish between intranervous cysts, which are very rare, and extranervous ones, which are more frequent. The two varieties, which constitute anatomical variants of the same lesion and, probably, of a metaplasia of the connective tissue, are, from an anatomical point of view, true cysts, with their own connective walls, endothelial covering, and mucoid contents. Clinically, there is pain, paresthesia, a palpable mass, and motor deficit, all occurring at an early stage of the disease, depending on its site and size. At times, when there is no palpable mass, there may be problems with differential diagnosis with regard to disc compression. Ultrasound examination, electromyography, and, above all, MRI, have all proven to be useful in the study of the features of the neoformation; nonetheless, in our experience, they were not able to reveal either intra- or extranervous localization.

Glomus tumor in children (description of one case).

Glomus tumor is a lesion of the soft tissues which rarely occurs in children. One case of the disease characterized by deep localization and atypical radiographic symptoms and manifestations is described.

Agenesia of the pectoral muscle.

Two cases of agenesia of the pectoral muscle are presented. Clinical examination is sufficient for diagnosis. Nonetheless, dosage of LDH and CPK is needed in order to exclude primary myopathy. Surgery is rarely indicated in selected cases of female sex, for cosmetic purposes.

Retrograde intramedullary osteosynthesis in the surgical treatment of fractures of the radial capitellum during childhood.

The authors report 12 cases of fracture of the radial capitellum occurring during childhood, treated by retrograde intramedullary osteosynthesis. Preoperative assessment involved the four-stage "prognostic-therapeutic" radiographic method proposed by Métaizeau. The results were extremely encouraging, 92% excellent and good, particularly when there were no (except in one case) severe complications (necrosis of the head, pseudarthrosis, poor consolidation, synostosis) typical of these traumatic lesions. At the same time clinical data observed, in agreement with what is reported in the literature, confirmed that the principal prognostic factors are represented by the amount of traumatic lesion, and above all by epiphyseal dislocation, the quality of reduction obtained, and the age of the patient.

Osteosarcoma associated with Paget's disease: a description of a rare case.

Osteosarcoma associated with Paget's disease is very malignant and has an extremely severe prognosis. This is also related to the usually advanced age of the patient and to the consequent impossibility of carrying out suitable chemotherapy. The case presented here is exceptional because of the young age of the patient, which allowed us to use a neoadjuvant chemotherapy protocol.

The surgical treatment of Rockwood grade III acromioclavicular dislocations.

The conservative or surgical treatment of Rockwood grade III acromioclavicular dislocations continues to be a controversial subject. Thus, the authors report their experience with 52 cases; long-term follow-up was obtained for 40 of these, paying close attention to the preoperative clinical and radiographic evaluation and to the results obtained in order to ascertain whether or not surgical repair is required. The results of surgical treatment, however satisfactory (90% excellent or very good), are nearly the same as those obtained when non surgical treatment is used as reported in the international literature. The authors conclude that the use of surgical treatment must be limited to carefully selected cases, should prolonged conservative treatment fail. Of the three surgical techniques used, temporary stabilization of the acromioclavicular joint using AO wires associated with restoration of the coracoclavicular connections has proven to be more effective than Dall-Miles metal wiring and tangential resection, with a lower incidence of complication.

The anchor nail in osteosynthesis of fractures of the humerus.

Osteosynthesis with a humeral anchor nail may be listed along with other methods of intramedullary fixation for the treatment of diaphyseal fractures. The authors report their experience with 33 cases of humeral fractures treated between July 1987 and July 1991. Results were excellent in 61% of the cases, good in 24%, and fair in 15%; no particular complications were reported. The authors believe that the anchor nail constitutes a system of osteosynthesis involving only a small amount of trauma, and allowing for positive elastic stability for the consolidation of the fracture, as well as being a sufficiently safe system so that immobilization in plaster may be avoided. When compared with other systems of intramedullary fixation, the anchor nail is more effective than the Rush nail from a mechanical point of view, and the Kuntscher nail from a biological one.

Arthroplasty in the sequelae of congenital hip dysplasia.

The authors report their experience in the surgical treatment of the sequelae of congenital hip dysplasia, more specifically, 125 arthroplasties performed in 116 patients, with specific reference to the technical difficulties encountered and the various surgical methods used. This review suggests that prosthetization yields a high percentage of good results (77%) and constant remission of pain. Nonetheless, joint function, particularly when motion was severely compromised before surgery, or when dislocation was very severe (Crowe grades III and IV), is not always restored.

The echo-guided treatment of calcific tendinitis of the shoulder.

The authors report the results of percutaneous mini-invasive treatment of chronic calcific tendinitis of the rotator cuffs. A total of 39 patients have been treated by echo-guided injection under local anaesthesia since June 2000 with a follow-up of about 2 years. Considerable reduction in symptoms was obtained in 34 patients within a few days of treatment; improvement was moderate in 5 cases, there were no complications in any of the cases. Complete regression of calcification was observed in 21 patients, there was a more than 60% reduction in calcific deposits in 11 patients, there was little reduction in 5, and the calcification remained unchanged in 2. The method, based on our experience, proved to be simple to execute, low-cost and easily repeatable, offering good results from a symptomatological point of view as well. It is the purpose of this study to determine and maximize mini-invasive treatment that will allow for the elimination or reduction of calcifications by means of percutaneous and echo-guided access.

Acute external capsuloligamentous lesions of the knee.

The authors discuss 18 cases of acute capsuloligamentous lesions of the external compartment of the knee submitted to surgical treatment. The results obtained by separately studying the progression of the various types of anatomical lesions revealed a relationship between the entity of the lesion and the results. Positive results were as follows: 100% in isolated lesions of the EC, 70% in lesions of the EC and ACL, 40% in lesions of the EC + ACL + PCL. In grade I distorsion trauma surgery is not indicated; in grade II lesions treatment is based on an objective examination in narcosis, and surgery should be performed when dynamic tests are positive; in grade III lesions surgery is always indicated. An objective examination in narcosis (rarely arthroscopy) is thus of essential importance to therapeutic indications.