[Peripheral anesthesia techniques in surgery of the arm]. / Tecniche di anestesia periferica nella chirurgia dell'arto superiore.

BACKGROUND: This report deals with the techniques of peripheral anaesthesia used by the Authors for surgical treatment of lesions of the upper extremity. METHODS: Plexus brachial block anaesthesia using a supraclavicular approach was performed for arm, forearm and hand surgery, axillary block anaesthesia for forearm and hand surgery, while block anaesthesia was employed for wrist and hand injuries. Local anaesthetics as Bupivacaine 0.5% and Mepivacaine 2% without Epinephrine were used. RESULTS: In 95% of the cases the results were satisfactory, in 5% (not cooperating and young patients, long operations, incomplete block anaesthesia) it was necessary to perform a general anaesthesia. CONCLUSIONS: Surgeons and patients well accepted these techniques of anaesthesia because of: less bleeding during the operation, easy surgical performance, high percentage of success in reimplantations, absence of side effects due to narcosis, better recovery of psycho-physical conditions and long lasting postoperative analgesia.

[CT study of the carpal tunnel. The carpal tunnel syndrome]. / Studio TC del canale del carpo. La sindrome del canale del carpo.

The authors describe the CT aspects of carpal tunnel syndrome. Seventy-seven patients with signs and symptoms of carpal tunnel syndrome were studied, together with 28 postoperative controls (8 with and 20 without recurrence of symptoms) and 10 normal subjects. CT studies were carried out according to the conventional technique employing 3 high-definition axial slices respectively at the proximal end, in the middle and at the distal end of carpal tunnel. The patients affected with carpal tunnel syndrome presented changes in median nerve volume, in synovial sheet thickness, and in shape and density of the flexor tendons. Postoperative CT patterns of asymptomatic patients were similar to those of normal subjects. In the group of patients presenting postoperative recurrence of symptoms, 3 main findings were observed: incomplete surgery, newly formed cysts on the volar surface of the tunnel, and abnormal soft tissue interposed between the tendons. All the above findings were histologically confirmed during a second surgery. The authors believe CT to be a very useful tool in the evaluation of carpal tunnel syndrome, for both the first diagnosis and the demonstration of the causes of postoperative recurrences.

Carpal tunnel syndrome. Anatomical and clinical correlations and morphological and ultrastructural aspects of the tenosynovial sheath.

Specimens of tenosynovial sheath in 80 patients affected with carpal tunnel syndrome were studied histologically and by ultrastructural methods. The specimens were obtained from patients who had been submitted to decompression with neurolysis of the median nerve and synovectomy of the flexor tendons. They were divided into two groups. The first group, consisting of patients with irritative or compressive symptomatology of recent occurrence, presented thickened and oedematous synovial sheaths, with histological inflammatory features and deposits of Types 1 and 2 collagen in the perivascular and interstitial sites. Ultrastructural analysis revealed deficits in the synovial sheath cells in addition to interstitial collagen deposits. The second group of longstanding carpal tunnel syndrome with severe signs of compression presented diffuse thickening of the sheaths, with extensive fibrosis associated with hyalinosis, and Type 3 collagen deposit which at times was amyloid. It is suggested that thickening of the synovial sheaths in carpal tunnel syndrome occurs in successive stages of a proliferative nature and successively of a regressive type, with extensive fibro-hyalinosis.

[Dynamic study of the distal radioulnar joint with computerized tomography]. / Studio dinamico dell'articolazione radio-ulnare distale con Tomografia Computerizzata.

The authors describe a CT technique which allows the dynamic study of the inferior radioulnar joint. The examination consists of 4 CT slices, three of them acquired at the same level-i.e., the radioulnar joint- in the prone, intermediate and supine positions, respectively. The last slice is acquired, with the patient in the prone position, at the base of the styloid process where the triangular fibrocartilage is demonstrated. The distal radioulnar ligaments are not directly visible. Nineteen patients complaining of painfully impaired pronation and supination because of previous trauma (11 Colles fractures, 7 distortions and 1 Galeazzi lesion) were examined with this technique. In all patients, both wrists were studied to obtain normal parameters. The radioulnar joint was evaluated superimposing a draft on the dynamic images, which demonstrated that, in healthy limbs, during movement the ulnar epiphysis is always contained between two parallel lines drawn on the volar and dorsal surfaces of the radial epiphysis, respectively. It was also confirmed that supination is possible up to 110-135 degrees from the support plane. CT demonstrated different causes of impaired movements in the affected joints: in 12 cases some fibrous density tissue was seen at the ulnar epiphysis on the volar aspect and considered to be the evolution of a traumatic hematoma; 6 patients presented dorsal subluxation of the ulna during movement; finally, volar subluxation was detected only in one case. In 6 patients the triangular fibrocartilage was detached; in 1 patient an intraarticular fluid collection was demonstrated. In 3 patients CT detected no abnormalities. The fibrous tissue is responsible for impaired movements and causes the detached triangular fibrocartilage to shrink. The authors believe that this simple CT technique can yield useful pieces of information for accurate surgical planning.

[Experimental EMG-anatomopathological study of rabbits treated with Cialit grafts for the repair of sciatic nerve loss of substance]. / Studio sperimentale EMG-anatomo-patologico nel coniglio sottoposto ad innesto Cialit per colmare una perdita di sostanza del nervo sciatico.

The sciatic nerves of 10 rabbits of the New Zealand strain were cut and isolated in the latero-posterior region of the thigh under general anesthesia. Immediate homograft technique was used in animals. The maximal motor conduction velocity of the sciatic nerve was measured in all the animals before the cutting of the nerve. Long-term EMG and anatomo-pathological controls were carried out. The results obtained are discussed. Further research will be continued by applying new techniques and new EMG parameters as well as more sophisticated anatomo-pathological techniques.

[CT study of the carpal tunnel. Normal anatomy]. / Studio TC del canale del carpo. Anatomia normale.

The standard technique for CT investigation of the carpal tunnel and its normal anatomy were studied. Ten healthy asymptomatic volunteers, age 25-45, underwent wrist CT. The hand is placed in prone position with the third metacarpus in line with the radius. Digital radiograph and four axial CT scans are performed respectively: at the distal end of the radius, at the scaphoid tubercle level, at the hamate hook level and at the carpal-metacarpal joint. Standard carpal tunnel diameters are thus available with good reliability and repeatability when correct technique is adopted. The results permit a morphological description of the osseous walls, transverse ligament, flexor tendons with synovial sheets and median nerve. Gujon's canal and its content can also be investigated.

Medicina molecular: presente y futuro / Molecular medicine: present and future

The genetic background of individuals is recognized as an important clue in the analysis of classical hereditary and multifactorial acquired diseases. This new concept derives from the development and increasing use of molecular genetics in clinical medicine. The application of molecular biology techniques in biomedical investigation has encompassed the identification of the pathogenesis and etiology of diseases, prenatal diagnosis the production of new therapeutic agents, gene therapy and the development of pharmacogenetics. The impact on the fundamentals and practice of clinical medicine that will have the use of molecular biology is analyzed in this review

Biología molecular y medicina: conceptos básicos / Molecular biology and medicine: basic concepts

Through the advancements of molecular genetics, physicians and researchers are in an extraordinary period of study concerning the molecular basis of medicine. Molecular biology is making a tremendous impact on both diagnosis and treatment of diseases through the clinical introduction of molecular methods. These techniques, restricted for many years to basic biological research, include the polymerase chain reaction, DNA and protein electrophoresis, cloning of genes into viral or bacterial vectors and methods to rapidly sequence DNA and identify mutations. In this article the authors attempt to provide basic concepts on these themes for the non-trained physicians in order to help them to understand recent developments and foresee their future implications