Escleroterapia de las várices de los MI mediante espuma esclerosante fribro-vein con el método Tessari / Sclerotherapy of varices in lower limbs with fibro-vein sclerosing foam according to Tessari's method

Escleroterapia de las venas varicosas en miembros inferiores mediante espuma esclerosante de acuerdo a Tessari. Experiencia preliminar. El objetivo de este trabajo es evaluar la eficacia a corto plazo y la seguridad de la espuma esclerosante obtyenida del sulfato tetradecil-sódico (Fibro-Vein) con el método de Tessari en el tratamiento de telangiectasias y venas varicosas de miembros inferiores...Se obtuvo un alto porcentaje de éxito inmediato en el grupo tratado, con la rápida aparición del espasmo masivo en la mayoría de los casos y la obliteración de todos los 61 tramos venosos medianos y grandes observada 1 es después...La espuma esclerosante según Tessari basada en Fibro-Vein ha demostrado, en esta experiencia piloto, ser un trratamiento efectivo y seguro para venas varicosas de mediano y gran tamaño. Su papel en telangiectasias queda por definirse

Preliminary experience with a new sclerosing foam in the treatment of varicose veins.

BACKGROUND: Recently a new method of using a foam sclerosing agent for the treatment of leg veins has been described. We present a pilot study of a new technique for producing the sclerosing foam (Tessari's method) (SFT) and its use in sclerotherapy of major and minor varicosities. OBJECTIVE: A preliminary multicenter experience of sclerotherapy performed by means of this new kind of sclerosing foam made of purified sodium tetradecylsulfate is described. The authors evaluated the safety and efficacy of different doses and concentrations of the drug as well as different methods of preparing the foam in addition, the results of this technique were evaluated. METHODS: Over a 6-week period the three authors performed sclerotherapy or duplex-guided sclerotherapy using SFT, treating 77 patients. The SFT was formed using a three-way stopcock and two syringes, mixing air with liquid sodium tetradecylsulfate to create a foam. Each author used different concentrations (0.1-3%) and doses (2-8 ml) of SFT according to the size and number of the veins. Alternate methods of preparing the foam were examined as well. Seventy percent of the sclerotherapy sessions were performed on either the long or short saphenous veins, recurrent varices, or collaterals. Thirty percent of the treatments were for reticular varices and telangiectases. RESULTS: At 1-month follow-up, the vast majority of treated larger veins were either obliterated or showed a normal state of cephalad blood flow. Results for minor varicosities were good, but with related complications of hyperpigmentation and small areas of cutaneous necrosis. Two patients experienced transient scotomas and one patient developed segmental phlebitis of a collateral vein. The best foam was obtained by mixing one part liquid sodium tetradecylsulfate and four to five parts air, but the duration of the foam product was also related to several other factors. CONCLUSION: This preliminary pilot study demonstrates that the technique of producing sclerosing foam according to Tessari's method (three-way stopcock device) is very promising, especially for larger veins. No serious complications were reported, and further standardization of the method may improve the results and feasibility of this technique. Further studies are needed to validate this new technique.

Surgical treatment of far lateral lumbar disc herniation. Identification of compressed root and discectomy by lateral approach.

STUDY DESIGN: A new method is described of compressed root identification and discectomy for extraforaminal disc herniation, by a lateral intertransversalis approach. OBJECTIVES: To describe a safe surgical approach that does not require resection of adjacent bone structures during extraforaminal discectomy. SUMMARY OF BACKGROUND DATA: Most earlier series have reported approaches that damaged bordering bone structures with wide laminoarthrectomy. This is an attempt at a safer, simpler surgical approach. METHODS: Thirteen patients with lateral hernia have undergone this surgical procedure since 1995. Herniectomy was performed after identification of the compressed root within the iliopsoas muscle. RESULTS: All the patients resumed the upright position with the aid of semirigid brace 24 hours after surgery. Upon awakening from the anesthesia, no patient reported peripheral pain. Motor deficits resolved after physical rehabilitation in all but one patient. At a mean follow-up of 14 months, there was no report of back pain. CONCLUSION: The procedure described in this article offers a simple alternative to the valid procedures presently at hand. It offers the advantage of no bone resection and of minimizing nerve structures manipulation.

Early ultrasound diagnosis of developmental dysplasia of the hip.

The results of ultrasound diagnosis of developmental dysplasia of the hip (DDH) in several studies of 1,000 and 1,332 consecutive patients, performed according to Graf's method from 1984 to the present, are presented. Prior to 1984 the authors used radiography exclusively in suspected cases of DDH, however, the change from radiography to ultrasonography resulted in significant improvement in the ability to diagnose and treat DDH. Different standard methods of treatment have been developed for the management of each morphological type of the newborn's and infant's hip. Ultrasound is more sensitive than clinical assessment for diagnosing DDH since it detects the dysplastic morphology of the hip when Ortolani's test is negative. Instability can be demonstrated directly. The success of treatment of DDH depends on the time of diagnosis the early diagnosis obtained by ultrasound screening can significantly improve the results of treatment.

Diagnostic value of compression ultrasonography and fibrinogen-related parameters for the detection of postoperative deep vein thrombosis following elective hip replacement: a pilot study.

To determine their ability to diagnose postoperative deep vein thrombosis (DVT) D-dimer - by three methods -, fibrinogen degradation products (FgDP) and fibrinogen levels were measured in 68 consecutive patients before elective surgery for hip replacement and on postoperative day 1, 3, 6, and 10. All patients received prophylaxis and underwent compression real-time B-mode ultrasonography (C-US) on postoperative day 5 and 9, and bilateral ascending venography on day 10. Twenty-two out of 68 patients developed asymptomatic postoperative DVT, which was limited to the calf veins in 14 and involved the proximal veins in 8 patients. C-US was negative in all patients on day 5. On day 9, C-US sensitivity and specificity for proximal DVT were 63% (95% confidence interval: 26%-90% and 98% (89%-100%) respectively. Postoperative changes in the laboratory parameters evaluated were not different in patients with or without DVT until day 10. On day 10, mean D-dimer, FgDP and fibrinogen levels were significantly higher in patients with DVT than in those without DVT (p values between 0.006 and 0.032), but only D-dimer was higher with DVT involving two or more venous segments than with thrombosis involving one venous segment only (p < 0.05). Stepwise logistic regression analysis identified D-dimer and fibrinogen on day 10 as predictors of postoperative DVT. In a receiver operator curve and after weighing for the coefficients generated by logistic regression analysis, the combination of a latex photometric immuno-assay and of PT-derived fibrinogen yielded-at a cut-off value of 7.0 a sensitivity of 100% (73%-100%) and a specificity of 58% (39%-75%) for DVT, with a negative predictive value of 100% (78%-100%), a positive predictive value of 52% (32%-71%) and an overall accuracy of 71% (55%-83%). These results suggest that two simple, fast and reproducible tests may permit the identification of patients at low risk of having postoperative DVT and that a combination of sensitive laboratory assays and of the highly specific C-US may select patients requiring anticoagulant treatment. Efficacy and cost-effectiveness of this approach should be evaluated in large clinical management studies.

Early diagnosis of congenital dysplasia of the infant hip by means of ultrasound screening.

The authors present a study carried out in 1990 analyzing the results of ultrasound screening of the infant hip in order to evaluate possible dysplasia. They stress the already unquestionable role of ultrasound screening as a valid, sensitive and useful device in the diagnosis of congenital dysplasia of the hip and emphasize that the earlier the examination is carried out, the easier it is to begin suitable treatment rapidly and with positive results. They recommend that ultrasound screening should be carried out by an orthopaedist in order to further shorten diagnosis and treatment times.

Morphological or functional criteria in evaluation of the newborn hip?

Classifying the infant hip as normal or dysplastic before the stage of radiological significance, in other words during the first three months of life, has always been trusted to functional maneuvers causing clinical signs. From the results it is possible to deduce if the hip morphology is normal or somehow altered. In other words, because insufficient radiographic significance makes it impossible to directly assess the "morphological" criterion, diagnosis of the state of the hip is carried out using an indirect "functional" criterion. In contrast to radiographic imaging, ultrasound screening is already significant in the first weeks of life; it is therefore now possible to obtain real images of the infant hip earlier than it was possible using radiography. This eliminates the need for symptomatic evidence of dislocation. As a result, the "functional" indirect criterion used up till now for early diagnosis of infant hip can today be replaced by a direct "morphological" criterion. This innovation is not without epidemiological consequences, and this must be taken into account in order to rationalise between the opposing risks of over or under estimating the incidence of congenital hip dysplasia.

Intranasal and intramuscular human calcitonin in female osteoporosis and in Paget's disease of bones: a pilot study.

It has been shown that human calcitonin (hCT) is absorbed through the nasal mucosa when administered together with promoters like sodium glycocholate (SGC) or dihydrofusinate. The aim of this study was to compare the clinical and metabolic effect of intranasal (in) and intramuscular (im) hCT in patients with osteoporosis or with Paget's disease of bones. Fifteen women with postmenopausal or with senile osteoporosis entered a randomized six months trial with in hCT (plus SGC) or with im hCT 100 U on alternate days. Six women in each group were treated for 2 months, and only four women in each group continued treatment for an additional 4 months period. In hCT, but not im hCT, reduced subjective pain, while urinary cAMP increased to a similar extent in the 2 groups. Other metabolic indexes and bone mineral content (BMC) were unchanged, no new fractures took place, and side effects were fewer with in than with im hCT. To confirm the analgesic effect of in hCT, twelve patients with Paget's disease of bone were randomly treated for 20 days with in or im hCT 100 U/day: during the short period of treatment, pain was reduced by in, not by im hCT, and urinary cAMP excretion similarly increased in the two groups of patients.

Muscular contracture as a component of low back pain: evaluation criteria and significance of relaxant therapy.

The measurement of diastasis of the spinous processes and of muscular action potentials by means of bio-feedback equipment is a clinically valid means to evaluate the extent of reflex muscular contracture. The methods were used to study the relaxant effect of pridinol mesylate on the lumbar extensor muscles in subjects with acute low back pain. It was found that pridinol mesylate significantly reduced the contracture of the extensor lumbar muscles in low back pain when given per os or parenterally.

[A case of duodenal schwannoma (clinical study)]. / Su un caso di schwannoma duodenale (contributo clinico).

Taking a case of duodenal schwannoma, that they had observed, as a starting point, on the base of their experience and the data of literature, the authors discuss the epidemiological, of classification and anatomo-pathological aspects of this rare neoplastic form. They particularly outline the clinical aspect, the diagnostic pre-operating iter and the correct and radical surgical behaviour that must be practiced during laparatomy.

[Pharmacological and clinical aspects of S-adenosylmethionine (SAMe) in primary degenerative arthropathy (osteoarthrosis)]. / Aspetti farmacologici e clinici della solfo-adenosil-metionina (SAMe) nella artropatia degenerativa primaria (osteoartrosi)

After some preliminary remarks of a biochemical and pharmacological nature, the authors have started a clinical study to test the antiinflammatory activity of the S-adenosyl-methionine (SAMe). An open trial, carried out on 90 patients with severe degenerative arthropathies has shown that 30 mg SAMe intravenously twice a day for 14 days have a marked anti-inflammatory effect a rather term and no side-effects. In a "double-crossover" investigation, SAMe was next compared to indomethacin by i.m. administrations to 15 arthropathic patients. The therapeutic responses of the two drugs proved exactly alike, whereas the side-effects following indomethacin administration were not present after SAMe. In 9 patients affected with rheumatoid arthritis administrations of SAMe have proved less effective, although some clinical parameters showed improvements.