Congress presentation in Milan SICVE 2009: ENDOLEAK TYPE II PREVENTION
Presentazione al congresso di MIlano SICVE 2009: PREVENZIONE ENDOLEAK DI TIPO II
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
Trattamento dell'artrosi trapezio-metacarpale con 1/2 FCR "annodato" (2014)Alberto Mantovani
TRATTAMENTO DELL’ARTROSI TRAPEZIO-METACARPALE
CON TRAPEZIECTOMIA, LIGAMENTOPLASTICA E
INTERPOSIZIONE DI METÀ TENDINE FLEXOR CARPI
RADIALIS “ANNODATO”
Alberto Mantovani, Carmen Girardelli, Michele Trevisan, Daniele Carletti, Marco Cassini
UOC Ortopedia e Traumatologia, ULSS n. 21 Regione Veneto, Ospedale Mater Salutis, Legnago (VR)
L'uso delle protesi LRE nelle patologie degenerative e post-traumatiche del g...Alberto Mantovani
Summary. “Use of the LRE prosthesis for degenerative and inflammatory conditions of the elbow”. The authors
present their experience in the use of the LRE Biomet® prosthesis for lateral unicompartmental joint replacement
for the treatment of arthritis as well as fractures of the lateral condyle of the humerus. This is a series
of 7 patients, 3 of whom were women. Their ages ranged from 46 to 73 years.In 2 cases, only the humeral
component was inserted as the articular surface of the head of the radius was intact. The follow-up
ranged from 6-36 months. The results were evaluated using the Mayo Elbow Performance Score (MEPS).
The final score was excellent in 3 patients, good in 3 cases and there was one fair result. The best scores were
noted in the patients in whom both components were used and at longer periods of follow-up. The indications
and advantages of this implant will be discussed.The consistent good results and absence of complications
appear to validate the use of this prosthesis and should open the door to future expansion of indications
for partial joint replacement in the elbow.
La pseudoartrosi congenita dell’apofisiunciforme dell’osso uncinato: descrizi...Alberto Mantovani
SUMMARY
Congenital pseudarthrosis of the hook of the hamate has been described in the literature as "os hamuli proprium." However, its existence has never been correlated with other pathological conditions. We report two cases in which this congenital anomaly became symptomatic due to two different disorders related to it. In the first case, the congenital pseudarthrosis of the hook of the hamate produced a pathological rupture of the flexor profundus tendon to the little finger in a 54 years old farmer. In the second case, it resulted in carpal tunnel syndrome in a 35 years old lady who was employed as mechanic worker. The first patient was treated in the emergency and the flexor digitorum superficialis tendon to the ring finger was sutured to the distal stump of the ruptured flexor profundus tendon to the little finger. The second patient was advised surgery for decompression of the median nerve but she has refused to undergo the operation. In our opinion, the pathological symptoms in both patients (ruptured flexor profundus tendon and carpal tunnel syndrome) were directly related to the congenital pseudarthrosis of the hook of the hamate. We have described the diagnostic protocol adopted in the two patients and the radiological study performed in the other members of their families. The latter study revealed an asymptomatic congenital pseudarthrosis of the hook of the hamate in a sister of the first patient. We have also discussed the differential diagnoses and the other possible modalities of treatment that could be utilized in these and other cases.
TRAPEZIECTOMIA E TENOARTROPLASTICA CON ½ FCR “ANNODATO” (relazione SICM 2013)Alberto Mantovani
Relazione al "51° Congresso Nazionale della Società Italiana di Chirurgia della Mano" Rimini 03 - 05 ottobre 2013
RIASSUNTO
Scopo: Lo scopo di questo studio è di presentare e valutare in modo retrospettivo una tecnica di trattamento dell’artrosi trapezio metacarpale (TM) utilizzata dal 1995. Si tratta di un intervento di trapeziectomia, ligamentoplastica e interposizione tendinea con metà del tendine flexor carpi radialis (FCR), che viene prima bloccato in un tunnel osseo nella base del primo metacarpo e poi interposto e più volte annodato nel nuovo spazio scafo metacarpale, fino a colmarlo stabilmente. Dimostriamo inoltre che il muscolo abductor digastricus (ABD.D.) è una costante anatomica utilizzabile per la via chirurgica di accesso al trapezio.
Materiali e metodi: Sono stati valutati 78 pazienti operati dal 1995 al 2012, da 51 a 86 anni, di cui 72 donne e 6 uomini, con un follow up da 1 a 17 anni. Per la valutazione clinica abbiamo usato il Mayo Wrist Score (MWS) “adattato” per il pollice. La distanza scafo metacarpale è stata misurata all’RX di controllo del follow up ed è stata definita: invariata o ridotta di ± ½ confrontandola con l’RX postoperatorio.
Risultati: I risultati clinici con il MWS adattato al pollice sono stati: ottimi in 53 casi, buoni in 15 casi, discreti in 6 casi e negativi in 4 casi: 2 di questi sono stati rioperati dopo 1 e 2 anni rispettivamente, per dolore persistente. Il tempo medio di ripresa funzionale per il lavoro è stato di 2 mesi (range da 1 a 6 mesi) . La distanza scafo metacarpale è risultata costantemente diminuita ma non ha mai superato il valore di – ½ rispetto all’RX post operatorio e senza correlazione con il risultato clinico. Non sono state registrate complicanze.
Discussione: La tecnica descritta è risultata efficace e riproducibile. Associando la stabilizzazione metacarpale mediante plastica legamentosa con metà del tendine FCR e l’interposizione e annodamento dello stesso tendine nel nuovo spazio scafo metacarpale, si può ridurre il tempo di immobilizzazione post operatoria e anticipare il recupero funzionale del pollice. Si tratta di una tenoartroplastica biologica ottenuta solo con strutture del paziente e non richiede perciò costi aggiuntivi di altri materiali. Viene anche segnalato l’interesse chirurgico della via di accesso anteriore al trapezio, sezionando costantemente il tendine del muscolo ABD.D..
O documento discute os avanços nos dispositivos para correção da insuficiência mitral percutânea, incluindo anuloplastia, reparo dos folhetos e implante valvar. Múltiplos dispositivos como MitraClip, CARILLON e implantes de cordas já mostraram bons resultados clínicos. Contudo, desafios permanecem como a anatomia assimétrica da valva mitral e a necessidade de imagens avançadas.
Congress presentation in Milan SICVE 2009: ENDOLEAK TYPE II PREVENTION
Presentazione al congresso di MIlano SICVE 2009: PREVENZIONE ENDOLEAK DI TIPO II
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
Trattamento dell'artrosi trapezio-metacarpale con 1/2 FCR "annodato" (2014)Alberto Mantovani
TRATTAMENTO DELL’ARTROSI TRAPEZIO-METACARPALE
CON TRAPEZIECTOMIA, LIGAMENTOPLASTICA E
INTERPOSIZIONE DI METÀ TENDINE FLEXOR CARPI
RADIALIS “ANNODATO”
Alberto Mantovani, Carmen Girardelli, Michele Trevisan, Daniele Carletti, Marco Cassini
UOC Ortopedia e Traumatologia, ULSS n. 21 Regione Veneto, Ospedale Mater Salutis, Legnago (VR)
L'uso delle protesi LRE nelle patologie degenerative e post-traumatiche del g...Alberto Mantovani
Summary. “Use of the LRE prosthesis for degenerative and inflammatory conditions of the elbow”. The authors
present their experience in the use of the LRE Biomet® prosthesis for lateral unicompartmental joint replacement
for the treatment of arthritis as well as fractures of the lateral condyle of the humerus. This is a series
of 7 patients, 3 of whom were women. Their ages ranged from 46 to 73 years.In 2 cases, only the humeral
component was inserted as the articular surface of the head of the radius was intact. The follow-up
ranged from 6-36 months. The results were evaluated using the Mayo Elbow Performance Score (MEPS).
The final score was excellent in 3 patients, good in 3 cases and there was one fair result. The best scores were
noted in the patients in whom both components were used and at longer periods of follow-up. The indications
and advantages of this implant will be discussed.The consistent good results and absence of complications
appear to validate the use of this prosthesis and should open the door to future expansion of indications
for partial joint replacement in the elbow.
La pseudoartrosi congenita dell’apofisiunciforme dell’osso uncinato: descrizi...Alberto Mantovani
SUMMARY
Congenital pseudarthrosis of the hook of the hamate has been described in the literature as "os hamuli proprium." However, its existence has never been correlated with other pathological conditions. We report two cases in which this congenital anomaly became symptomatic due to two different disorders related to it. In the first case, the congenital pseudarthrosis of the hook of the hamate produced a pathological rupture of the flexor profundus tendon to the little finger in a 54 years old farmer. In the second case, it resulted in carpal tunnel syndrome in a 35 years old lady who was employed as mechanic worker. The first patient was treated in the emergency and the flexor digitorum superficialis tendon to the ring finger was sutured to the distal stump of the ruptured flexor profundus tendon to the little finger. The second patient was advised surgery for decompression of the median nerve but she has refused to undergo the operation. In our opinion, the pathological symptoms in both patients (ruptured flexor profundus tendon and carpal tunnel syndrome) were directly related to the congenital pseudarthrosis of the hook of the hamate. We have described the diagnostic protocol adopted in the two patients and the radiological study performed in the other members of their families. The latter study revealed an asymptomatic congenital pseudarthrosis of the hook of the hamate in a sister of the first patient. We have also discussed the differential diagnoses and the other possible modalities of treatment that could be utilized in these and other cases.
TRAPEZIECTOMIA E TENOARTROPLASTICA CON ½ FCR “ANNODATO” (relazione SICM 2013)Alberto Mantovani
Relazione al "51° Congresso Nazionale della Società Italiana di Chirurgia della Mano" Rimini 03 - 05 ottobre 2013
RIASSUNTO
Scopo: Lo scopo di questo studio è di presentare e valutare in modo retrospettivo una tecnica di trattamento dell’artrosi trapezio metacarpale (TM) utilizzata dal 1995. Si tratta di un intervento di trapeziectomia, ligamentoplastica e interposizione tendinea con metà del tendine flexor carpi radialis (FCR), che viene prima bloccato in un tunnel osseo nella base del primo metacarpo e poi interposto e più volte annodato nel nuovo spazio scafo metacarpale, fino a colmarlo stabilmente. Dimostriamo inoltre che il muscolo abductor digastricus (ABD.D.) è una costante anatomica utilizzabile per la via chirurgica di accesso al trapezio.
Materiali e metodi: Sono stati valutati 78 pazienti operati dal 1995 al 2012, da 51 a 86 anni, di cui 72 donne e 6 uomini, con un follow up da 1 a 17 anni. Per la valutazione clinica abbiamo usato il Mayo Wrist Score (MWS) “adattato” per il pollice. La distanza scafo metacarpale è stata misurata all’RX di controllo del follow up ed è stata definita: invariata o ridotta di ± ½ confrontandola con l’RX postoperatorio.
Risultati: I risultati clinici con il MWS adattato al pollice sono stati: ottimi in 53 casi, buoni in 15 casi, discreti in 6 casi e negativi in 4 casi: 2 di questi sono stati rioperati dopo 1 e 2 anni rispettivamente, per dolore persistente. Il tempo medio di ripresa funzionale per il lavoro è stato di 2 mesi (range da 1 a 6 mesi) . La distanza scafo metacarpale è risultata costantemente diminuita ma non ha mai superato il valore di – ½ rispetto all’RX post operatorio e senza correlazione con il risultato clinico. Non sono state registrate complicanze.
Discussione: La tecnica descritta è risultata efficace e riproducibile. Associando la stabilizzazione metacarpale mediante plastica legamentosa con metà del tendine FCR e l’interposizione e annodamento dello stesso tendine nel nuovo spazio scafo metacarpale, si può ridurre il tempo di immobilizzazione post operatoria e anticipare il recupero funzionale del pollice. Si tratta di una tenoartroplastica biologica ottenuta solo con strutture del paziente e non richiede perciò costi aggiuntivi di altri materiali. Viene anche segnalato l’interesse chirurgico della via di accesso anteriore al trapezio, sezionando costantemente il tendine del muscolo ABD.D..
O documento discute os avanços nos dispositivos para correção da insuficiência mitral percutânea, incluindo anuloplastia, reparo dos folhetos e implante valvar. Múltiplos dispositivos como MitraClip, CARILLON e implantes de cordas já mostraram bons resultados clínicos. Contudo, desafios permanecem como a anatomia assimétrica da valva mitral e a necessidade de imagens avançadas.
This document summarizes the current status of surgical and transcatheter mitral valve repair. It notes that mitral valve repair surgery has low risks and good outcomes when appropriate procedures are used. However, around 50% of symptomatic patients with severe mitral regurgitation are denied surgery. New transcatheter techniques are being developed as alternatives to surgery, including the MitraClip edge-to-edge repair device, annuloplasty devices, and future prospects for transcatheter mitral valve replacement. Early experiences with MitraClip show it reduces mitral regurgitation in many patients but long-term outcomes need further study. An individualized approach is needed to determine the best repair option based on a patient's anatomy,
new technologies for Mitral regurgitationdrmaisano
This document discusses potential treatments for mitral regurgitation beyond the MitraClip procedure. It notes that while the MitraClip is effective for selected patients, other options are needed to treat a wider range of patients. These include open heart surgery, combining approaches synergistically, and new technologies such as annuloplasty, neochordae implantation, and mitral valve replacement. Several new transcatheter techniques are discussed such as devices to implant neochordae or reshape the coronary sinus. The document emphasizes tailoring the treatment approach to each individual patient based on their anatomy, comorbidities, and goals of care.
percutaneous therapies for mitral regurgitationRavi Kanth
This document discusses mitral regurgitation (MR) and percutaneous approaches to mitral valve repair. It provides background on the anatomy of the mitral valve and the types of MR. Surgical repair or replacement is the standard treatment for MR but percutaneous options are being developed to provide less invasive alternatives for high-risk patients. The MitraClip procedure has been used successfully in humans and involves deploying a clip to grasp and oppose the mitral valve leaflets, reducing regurgitation. Indications, outcomes, limitations, and components of the MitraClip system are described.
- The EVEREST trial compared outcomes of the MitraClip percutaneous mitral valve repair device versus surgical repair in 279 patients with moderate to severe mitral regurgitation.
- At 12 months, freedom from death, surgery for valve dysfunction, and severe mitral regurgitation was significantly better in the surgery group compared to the percutaneous group.
- However, safety outcomes like adverse events at 30 days were significantly reduced with MitraClip due primarily to fewer blood transfusions. Similar results were seen at the 2-year follow up.
A 66 year old male with a history of cardiomyopathy, myocardial infarction, and congestive heart failure underwent a MitraClip procedure to treat functional mitral regurgitation. The procedure was performed using echocardiography guidance to place clips on the mitral valve to reduce regurgitation. In the days following the procedure, the patient's condition improved and he was discharged from the hospital. At a 3 month follow up, the mitral regurgitation was still mildly reduced and the patient's heart function and symptoms had improved.
This document discusses proposed criteria for patient selection for transcatheter mitral valve repair using the MitraClip device. It outlines anatomical and clinical considerations for both degenerative and functional mitral regurgitation. Experience from high-volume centers indicates MitraClip can be effective for selected patients at high risk for surgery, though longer-term data is still needed, especially for functional MR. A multidisciplinary team approach is important to thoroughly evaluate each patient's suitability and discuss risks versus benefits of MitraClip versus surgery.
This document provides specifications and pricing for computer components for building a desktop PC, including:
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The document describes geological features observed around the Kaweah River area in California. It summarizes that the Kaweah River and its tributaries were formed over millions of years by erosion of the Sierra Nevada mountains. Various rock formations in the area like granite and gneiss were also formed by this erosion. Plant life native to the region like cocklebur and morning glory are also described.
This document discusses learning about different parts of England and some strange things encountered. It covers the topic being discussed, different parts of England explored, what was learned, and some strange things found in England.
The document outlines the official basketball rules as approved by FIBA for 2010, including rules related to the court, teams, playing regulations, violations, fouls, general provisions, and duties of officials. It provides definitions for key terms and outlines rules for areas like equipment, substitutions, timeouts, scoring goals, violations like traveling and 24 second shots, and different types of fouls. The rules were valid starting October 1, 2010 according to the document.
The document describes different teenage tribes or subcultures that exist in the UK. It provides details about the fashion styles, music preferences, and characteristics of 9 different tribes: Goths, Nu-Metallers, Soulstrels, Indie Kids, Pop Princesses, Clubbers, Grungers, Skaters, and Townies/Chavs. It includes a matching exercise and questions for students to test their understanding of the information about each tribe.
CUORE E TECNOLOGIE: EVOLUZIONE DELLA CARDIOLOGIA INTERVENTISTICA CHIUSURA DEL...Maurizio Gentile
The document discusses surgical closure of the left atrial appendage (LAA). It notes that LAA ligation during mitral valve surgery is associated with a reduction in risk of embolism. However, surgical techniques for LAA closure are often incomplete, resulting in blood stasis and potential clot formation. Newer clipping devices allow for atraumatic, complete exclusion of the LAA via various access methods and may help prevent stroke in atrial fibrillation patients when performed during concomitant cardiac surgery or as a standalone procedure.
12. TIPO I:
MOVIMENTO LEMBI
NORMALE
TIPO II:
MOVIMENTO LEMBI
AUMENTATO
(PROLASSO)
TIPO III:
MOVIMENTO LEMBI
RESTRITTIVO
CLASSIFICAZIONE FUNZIONALECLASSIFICAZIONE FUNZIONALE
13. TIPO ITIPO I
• Normale movimento dei
lembi
– Dilatazione Anello
(funzionale)
– Perforazione lembo
(endocardite)
CLASSIFICAZIONE FUNZIONALECLASSIFICAZIONE FUNZIONALE
16. “Surgeons are not basically concerned
with lesions. We care more about
function. Therefore one may define the
aim of a valve reconstruction as
restoring normal leaflet function rather
than normal valve anatomy”
The French Correction.
Journal of Thorac and Cardiovascular Surgery 1983; 86: 323 –
337.
Alain Carpentier
The « functional approach »
17. Tre opzioniTre opzioni
- Sostituzione senza preservazione dell’apparato sottovalvolare:Sostituzione senza preservazione dell’apparato sottovalvolare:
porta ad incremento della sfericità post-chirurgica del ventricolo sinistroporta ad incremento della sfericità post-chirurgica del ventricolo sinistro
con decremento della frazione di eiezione post-operatoria;con decremento della frazione di eiezione post-operatoria;
- Sostituzione con preservazione dell’apparato sottovalvolare:- Sostituzione con preservazione dell’apparato sottovalvolare:
migliora la funzionalità ventricolare postoperatoria tramite lamigliora la funzionalità ventricolare postoperatoria tramite la
preservazione dell’apparato subvalvolare; non evita la terapiapreservazione dell’apparato subvalvolare; non evita la terapia
anticoagulante e i rischi relativi alla protesi;anticoagulante e i rischi relativi alla protesi;
- Riparazione:Riparazione: migliora la funzionalità ventricolare postoperatoria tramitemigliora la funzionalità ventricolare postoperatoria tramite
la preservazione dell’apparato sottovalvolare; evita inoltre la terapiala preservazione dell’apparato sottovalvolare; evita inoltre la terapia
anticoagulante postoperatoria con le relative complicanze;anticoagulante postoperatoria con le relative complicanze;
TRATTAMENTO CHIRURGICOTRATTAMENTO CHIRURGICO
18. Tecniche ChirurgicheTecniche Chirurgiche
AnnuloplasticaAnnuloplastica mediante suture (DeVega, etc)mediante suture (DeVega, etc)
mediante ring protesici (anellimediante ring protesici (anelli
rigidi,rigidi,
semirigidi, flessibili, parziali, asemirigidi, flessibili, parziali, a
struttura disomogenea)struttura disomogenea)
mediante strip in pericardiomediante strip in pericardio
Altre plasticheAltre plastiche plastica dei lembi valvolariplastica dei lembi valvolari
plastica delle corde tendineeplastica delle corde tendinee
plastica dei muscoli papillariplastica dei muscoli papillari
plastica del ventricolo sinistroplastica del ventricolo sinistro
Obiettivo finaleObiettivo finale
recuperare una buona superficie di coaptazione tra i due lembirecuperare una buona superficie di coaptazione tra i due lembi
TECNICHE CHIRURGICHETECNICHE CHIRURGICHE