[Pre- and postoperative color Doppler ultrasonography of myocutaneous flaps in reconstructive surgery of the breast]. / L'eco color-Doppler nello studio pre e postoperatorio dei lembi miocutanei in chirurgia ricostruttiva della mammella.

The authors present their experience in the study of blood supply of flaps. The machine used to study both pre and postoperatively the myocutaneous flap is the echo-color Doppler, a brand new device which has recently been used in investigating the morphology and the blood supply. The use of such method has provided us with the following information: detailed ultrasound structure of the skin, subcutaneous and muscular tissues of the examined flap; localization of vessels within the flap; size of the vessel in its whole length; quality and speed of both the arterial and venous flow. Such information is very important for the surgeon to plan in detail the reconstruction by knowing the blood supply of myocutaneous flap.

Acute appendicitis. How many uncorrect diagnosis? A clinical and histological evaluation of 124 cases treated with emergency procedure.

Acute appendicitis is a very common disease in western countries, affecting the entire population with higher prevalence in younger people. The diagnosis of the disease is still basically performed through the clinical evaluation of the patient, while peripheral White Cell Count or imaging techniques such as ultrasonography are poorly helpful. Therefore, a great number of patients is operated without finding a severe involvement of the appendix at intraoperative observation. To evaluate the rate of false acute appendicitis and to correlate the histological involvement with the clinical behavior of the disease the Authors carried a prospective study during a period of 28 months on 124 patients with a diagnosis of acute appendicitis treated on emergency basis.

Ulnar nerve compression at the elbow level.

The long-term results are reported (average 9 years) of anterior transposition of the ulnar nerve into a muscular groove in the treatment of ulnar nerve compression at the elbow level. The series of 27 elbows consisted mostly of patients with muscle deficit. The results were examined in relation to the preoperative duration of symptoms, particularly weakness and wasting of muscles, and were satisfactory in 78% of cases in that recovery of the muscle deficit was either complete or showed marked improvement. When the duration of symptoms exceeded one year, the results were less satisfactory.

Is double contrast arthrography of any value in lesions of the anterior cruciate ligament?

The clinical diagnosis of lesions of the anterior cruciate ligament may be difficult. It would be useful to have available an arthrographic method by means of which the clinical diagnosis could be confirmed. The results obtained with three different techniques using double contrast arthrography were studied in 150 cases, of which eighty-one were submitted to surgery. The anterior cruciate ligament was abnormal at operation in twenty-three of these eight-one cases. The level of accuracy using the technique described by Pavlov and Torg was approximately 85 per cent. Provided careful attention is paid to technical details, and the operator has some experience in the interpretation of arthrographic results, we would recommend this modification as being rapid, simple and free from risk.

Survival and quality of recovery of patients with pertrochanteric fractures of the femur.

The authors have reviewed two consecutive groups of 100 patients with pertrochanteric fractures of the femur. The first were treated conservatively and the second surgically. The subsequent results were subjected to statistical analysis. There was a statistically significant difference between the mortality rates in relation to treatment in the two groups but not in relation to age. A history of previous pathological disorders was found to exert a negative influence only in the conservatively treated cases. Fifty four per cent of the cases treated conservatively and 70 per cent of those treated by operation were able to lead completely independent lives. This was unfavourably affected by the age and preoperative pathological state of the patients only in the cases treated conservatively.