La nucleoaspirazione secondo Onik nel trattamento dell'ernia discale lombare analisi multicentrica dei primi risultati su oltre 650 trattamenti

Gli autori espongono i risultati ottenuti applicando la nucleotomia percutanea secondo Onik al trattamento dell'ernia discale lombare. Le casistiche sommate complessivamente ammontano a oltre 600 pazienti. Nel complesso i risultati sono buoni o ottimi nel 72% circa dei casi. I risultati insoddisfacenti, considerando globalmente i modest e gli invariati, corrispondonoal 26% circa. Eccezionali le complicanze (meno dell' 1 %): 1 discite (risolta con intervento chirurgico). La metodica di Onik può già essere serenamente considerata una possibilitanon trascurabile nel campo vasto e variegato dei trattamentidisponibili per l'ernia discale lombare

Seasonal and spatial variability of water quality parameters in the Port of Genoa, Italy, from 2000 to 2007

This paper presents the results of the statistical analysis of a set of physico-chemical and biological water quality parameters, monthly collected from 2000 to 2007 in the Genoa Harbour area (Ligurian Sea). We applied multivariate methods, such as principal component analysis (PCA) and dynamic factor analysis (DFA) for investigating the spatial and temporal variability and for providing important background information on pollution problems in the region. PCA evidenced the role of the sewage and river discharges and of the exchanges with the open sea in determining the harbour water quality. DFA was used to estimate underlying common trends in the time series. The DFA results partly show a general improvement of water quality over the 8-years period. However, in other areas, we found inter-annual variations but no significant multi-annual trend. Furthermore, we included meteorological variables in our statistical analyses because of their potential influence on the water quality parameters. These natural forcings explain part of the variability in water quality parameters that are superimposed on the dominating anthropogenic pollution factors.

Training resident anesthesiologists in adult challenging intubation comparing Truview EVO2 and Macintosh laryngoscope: a preliminary study

AIM

Teaching airway management continues to be of high importance to the anesthesiologist, since the care of each individual patient depends on the expertise, training and knowledge of the anesthetist with different airway devices, techniques and algorithms. The aim of our study was to compare intubation performed by resident anesthesiologists in training, under senior supervision, using Truview EVO2 (Group 1) or Macintosh blade (Group 2) in a group of adult patients undergoing elective surgery.

METHODS

This was a pilot prospective study. Thirty patients who were scheduled for surgery under general anesthesia were randomized into two groups. In Group 1, intubation was performed by using the Truview EVO2, and in Group 2 intubation was performed by using the Macintosh blade. Mallampati score, thyromental distance and neck mobility were recorded for each patient. The exclusion criteria included a Mallampati score =or<2 and a Patil distance >6 cm. The time of intubation and any occurrence of complications were recorded.

RESULTS

Intubation was always successful on the first attempt in Group 1, while it failed for 46.7% of patients in Group 2 (P=0.006). The time of intubation was not different between the two groups. No complications were recorded for Group 1 (Truview), while seven were reported in Group 2 (Macintosh) (P=0.003).

CONCLUSIONS

The resident managed to intubate all patients on the first attempt with the Truview, which led to a lower incidence of complications. Despite the exiguity of the population in the study, Truview EVO2 and other videolaryngoscopes can be considered to be useful tools in training resident anesthesiologists in elective intubation.

The toxic benthic dinoflagellate Ostreopsis ovata: quantification of proliferation along the coastline of Genoa, Italy

Toxic harmful algal bloom (HAB) occurrence is becoming more frequent and problematic in highly urbanized coastal zones. In summer 2005 along the urbanized Genoa coastline (Ligurian Sea, North western Mediterranean Sea), local first aid stations treated about 200 people, who all showed similar symptoms following exposure to marine aerosols. The link with proliferation of Ostreopsis ovata was made, and it highlighted for the first time, the risks that benthic HABs may represent in highly urbanised temperate areas. Subsequently, a specific monitoring plan was designed and implemented in the same area in July 2006, before the first signs of Ostreopsis proliferation were detected. Here we report on this quantification of an Ostreopsis ovata bloom in the Ligurian Sea. Cells were quantified both in the water column and in the epiphytic community on macrophytes. Our results suggest a role of sea water temperature and weather conditions in favouring bloom development.

Evaluation and comparison of two selective extraction procedures for heavy metal speciation in sediments

Two sequential extraction procedures (the former proposed by the Standard, Measurements and Testing-SM&T-program of European Union and the latter derived from those of Tessier and Forstner with various modifications) have been compared, by analyzing a reference material (CRM 601) certified for the content of heavy metals in the three solutions resulting from the SM&T procedure. Scanning electron microscopy-energy dispersive X-ray analysis (SEM-EDX) was used to evaluate the composition of the residues after various extractions. Reliable results, both in terms of precision and accuracy, were obtained for the first two steps of the SM&T scheme. As regards the third step, because it was modified during this work, a direct comparison of our results with those certified is not possible. SEM analysis confirmed that the scheme previously used in the laboratory was more aggressive compared to the SM&T procedure, which has also the advantage that the only CRM available for metal partitioning in sediments is certified using this method.

The surgical treatment of cervical metastases

Vertebral instability and the neuroaggressiveness produced by the occurrence of cervical metastasis in a neoplastic patient during remission or quiescence of the disease is rare, but it may negatively influence the prognosis of the patient and drastically reduce his or her life expectancy. The authors describe their experience with conservative or surgical treatment in 151 patients affected with cervical metastases.

Lumbar stenosis surgery: "recalibrage" according to Senegas

In the treatment of lumbar stenosis the method known as "recalibrage" proposed by Senegas is the most recent alternative to extended traditional laminectomy. Posterior decompression, which is obtained by removal of the cephalic half of the laminae, the yellow ligaments and the intraforaminal part of the facet joint, reduces the risk of postsurgical instability and makes it possible to proceed with fusion which is not just posterolateral. In cases where there is intersegmental instability we applied the Hartshill rectangle, proposed by Doce, stabilized to the residual laminar and associated with genous grafting. Our experience is based on 48 cases treated with this method over the last three years. In 19 cases Hartshill fixation was used to complete "recalibrage". Results are generally satisfactory, although follow-up is short. The "relative gain" method proposed by Lassale and Garcon was used for evaluation.

Complex fractures of the tibial plateau

Out of 142 consecutive cases of fracture of the tibial plateau 48 cases (34%) of complex fractures are taken into consideration. Surgical treatment is based on two types of osteosynthesis: 1) osteosynthesis "of election" with interfragmentary plates and screws, which was used in most of the cases; 2) minimal osteosynthesis with Barr or lag screws, when there are lesions of the soft tissue and capsuloligamentous lesions. A total of 69% of the results were satisfactory (good and excellent). The most unfavorable prognostic factors are comminution of the fracture and residual widening of the tibial plateau.

Automated percutaneous lumbar diskectomy according to the Onik method: conclusive considerations

The Onik method of automated percutaneous diskectomy in the treatment of the herniated lumbar disk offers undeniable advantages which we have already elaborated in our preliminary studies. Nevertheless, further experience with this technique has allowed us to pinpoint several aspects worthy of more attention: patient selection and long-term results. The patient selection procedure must follow Maroon and Onik's original protocol to the letter in order to single out those patients in whom contained disk herniation has caused actual sciatic pain and not merely low back pain. Imaging tests such as CT scan, MRI, and myelography have proved useful mainly in identifying contraindications for the technique, while only intraoperative diskography has been capable of diagnosing the contained status of the disk herniation, the basic criterion for selection. We reviewed 98 automated percutaneous lumbar diskectomies after a follow-up period ranging from 6 months to 2 1/2 years and found the results to be satisfactory, in spite of a slight deterioration of the good results at 6-9 months, following which there was no further change.

Vertebral artery release in vertebro-basilar insufficiency due to cervical uncoarthrosis

The authors report 31 cases submitted to transversectomy and uncosectomy according to the Jung and Kehr method for the treatment of vertebrobasilar insufficiency secondary to compression of the vertebral artery due to cervical uncoarthrosis. The results obtained were all classified as excellent or good. Emphasis is placed on several diagnostic aspects such as arteriographic investigation, and some details of the surgical technique used for the prevention of complications are discussed.

The role of osteotomy in the treatment of pseudarthrosis of the neck of the femur in younger patients

The authors discuss 34 cases of pseudarthrosis of the neck of the femur that were subjected to two different types of osteotomy, namely the support osteotomy of Putti and the valgising osteotomy of Pauwels. The following conclusions were reached: both methods produced good healing of the pseudarthrosis; with regard to the functional result, valgising osteotomy associated with a degree of lateralisation must be the operation of choice because it compensates for the shortening and prevents the Trendelenburg gait.

Arthroprosthesis in old unreduced congenital dislocation of the hip, using the "false" acetabulum. A study of 34 cases

In adult patients with considerable loss of function due to an unreduced congenital dislocation of the hip with a false acetabulum, the authors posed the question "Is it feasible, with a reasonable chance of success, to perform an arthroprosthesis in the "pathological" position, using the false acetabulum as a seating for the cup?" The aim of this study was to assess, in particular, the holding properties of the cup which has to be fitted after appropriate reaming, into this rather precarious false acetabulum. They define the indications for this procedure and describe their technique. The results of 34 operations, followed up for an average of 5 years, confirm the validity of this procedure.