[Carotid endarterectomy with placement of a PUR (polyurethane) patch]. / La TEA carotidea con posizionamento di patch in PUR.

In this study, 40 patients who underwent surgery for cerebro-vascular insufficiency were considered. Carotid endarterectomy was the procedure of choice in all of the patients; the arteriotomy was always closed using a PUR patch, a new material that, for its chemical and physical characteristics seems to be a good alternative to PTFE. All of the patients underwent surgery under loco-regional anesthesia, allowing a perioperative monitoring of the neurological status through the patient's active collaboration. During the postoperative period, non local or systemic pathology related to the use of the patch has been observed. During the short and half term follow-up, the patients underwent echo-Doppler of the supra-aortic trunks that didn't show either false aneurysms or thrombosis on the patch surface.

The tarsal tunnel syndrome: a report of eight cases.

The authors report eight cases of tarsal tunnel syndrome, pointing out the difficulty of a differential diagnosis and the possibility of a complete restoration to normality by surgery in those cases which were resistant to local conservative treatment. Tight laciniate ligament, varices, exostosis, and adhesions were noted as the causative factors.

The treatment of relapsing clubfoot by tibialis anterior transfer underneath the extensor retinaculum.

Nineteen patients with 22 relapsing clubfeet were treated by tibialis anterior transfer underneath the extensor retinaculum. This operation is indicated in cases of relapse in which the clubfoot is still supple. It is not indicated in cases with subtalar rigidity. The results were excellent in 19 cases, fair in 2 and poor in one. The fair and poor results were attributable to faulty technique or errors of indication.

The treatment of diaphyseal fractures by functional bracing. Results in 36 cases.

The results of 36 diaphyseal fractures (14 humerus, 22 tibia) treated by functional bracing are reported. These are very encouraging, with consolidation and complete functional recovery in all cases.

Congenital clubfoot: results of treatment of 54 cases.

Fifty-four patients with congenital clubfoot (total: 82 club feet) were observed at the 2nd Department of Orthopaedic Surgery of Rome University from 1970 to 1980. The conclusions of this study were the following: The patients with congenital clubfoot who had a uniform treatment from the beginning at the same hospital obtained better results than those who received previous treatments at other hospitals. A relapse was considered as a recurrence of the initial deformity after complete recovery and not as an incompletely corrected congenital clubfoot. In many of the patients with clubfoot who were treated, no direct correlations existed between the radiographic and clinical results. Of the patients with clubfoot who received an early treatment by posterior release, 89% had excellent and good results. One- or two-stage posteromedial releases did not prevent relapses, even though those done in one stage obtained better results. The transfer of the anterior tibial tendon to the third cuneiform proved to be the most effective procedure to prevent and correct relapses.

Köhler's disease of the tarsal navicular: long-term follow-up of 12 cases.

Twelve patients with Köhler's disease of the tarsal navicular were reviewed at follow-up averaging 33 years after diagnosis. All patients were asymptomatic. Neither alteration of the navicular shape nor osteoarthritis was observed radiographically. The type of treatment did not affect the time required for bone restoration, which took an average of 8 months. Weightbearing plaster casts for 3 months rendered the patients pain-free, whereas arch supports only decreased local pain, which lasted for an average of 7 months.

Invasive retrocalcaneal bursitis: a report of three cases.

The authors describe three cases of retrocalcaneal bursitis, characterized by considerable local clinical symptomatology. The diagnosis was made clinically and confirmed histopathologically. In none of these cases, even after several years, did systemic rheumatic disease develop. Removal of the bursa brought about clinical cure.

An ultrastructural study of recurrent disc herniation: a preliminary report.

One early and two late recurrent herniations located at the same interspace as the original prolapse were studied by light and electron microscopy. In the early recurrent herniation, most chondrocytes appeared to be actively engaged in protein synthesis, and the intercellular matrix contained densely packed collagen fibers, numerous matrix vesicles, and abundant electron-dense amorphous material. In late recurrent herniations, chondrocytes had scant endoplasmic reticulum and extensive cytoplasmic filaments, and the intercellular matrix showed intermediate features between fibrocartilage and fibrous connective tissue. On the basis of these morphologic characteristics, it seems reasonable to assume that the newly formed disc tissue arose mainly from remnants of the original herniation in the early recurrent prolapse and from the annulus fibrous and the granulation tissue invading the disc space after discectomy in the late recurrent herniations.

Chondrolysis of the hip (idiopathic and secondary forms).

The writers describe one case of idiopathic chondrolysis of the hip and four cases of chondrolysis secondary to slipped upper femoral epiphysis, all followed up from two to six years. So far as the writers know, idiopathic chondrolysis has not previously been reported in the literature in a male of the white race after the end of skeletal growth. In this case biopsy disclosed necrosis and fibrosis of the articular cartilage with extensive infiltration of lymphocytes and plasma cells in the synovial membrane and in the subchondral medullary spaces. In all the cases described there was gradual regression of pain and improvement in the radiographic appearances within about one year. Moderate limitation of movement persisted, however, especially internal and external rotation. In all cases the treatment consisted of protected weight bearing and physiotherapy.

Rupture of the short head tendon of the biceps brachii.

Subcutaneous rupture of the short head tendon of the biceps brachii is a very rare lesion, with only five cases previously reported. The case of a 67-year-old farmer whose tendon ruptured following a mild muscle effort is presented. The degenerative changes revealed by histological examination of the injured tendon were so severe as to lead to the conclusion that its tensile strength must have fallen considerably prior to rupture. The most characteristic clinical signs of this rupture are a sizeable bulge in the middle third of the injured arm, and a hollow in the site normally occupied by the short head of the biceps. Suture of the ruptured tendon to that of the coracobrachialis led to full functional recovery.

Biochemical variations in the matrix of human tendons in relation to age and pathological conditions.

With increasing age, the human tendon shows an increase of collagen and a diminution of mucopolysaccharides and glycoproteins. Similar findings have recently been reported by other authors in the tendons of mammals. Fragments of tendon affected by tendinosis, obtained dlring suture and tenoplasty operations, were also examined. Marked diminution of collagen and an increase of acid mucopolysaccharides and structural glycoproteins were found as compared with the control tendon.