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Purpose: The purpose of this study is to verify the safety of a new technique for a posterior arthroscopic approach to the ankle. This technique was recently described in literature. The technique uses a modified posteromedial portal, a different way of introducing the instruments into the portal, and the tendon of the flexor hallucis longus (FHL) as a landmark to work in the posterior compartment., Type of Study: Anatomic study., Methods: The technique was performed on 10 (4 fresh and 6 fresh-frozen) below-knee amputation specimens, which were then dissected. The instruments were left in place, and anatomic dissections were performed to determine the relationship to the surrounding neurovascular structures. Then the instruments were removed, and the distance of the neurovascular structures from the posteromedial portal was recorded. Another medial portal, 1 cm more proximal, was also created to measure the distance of this latter portal from the nervous structures., Results: None of the anatomic dissections showed injuries to the neurovascular bundle either during penetration of the instruments or during procedures in the posterior compartment laterally to the tendon of the FHL. This latter is the landmark to prevent damage to the more medially located nerves and vessels. The new posteromedial portal is located, on average, 13.3 mm (range, 11 to 17 mm) from the posterior tibial nerve, 14.7 mm (range, 8 to 20) from the calcaneal branch (which may be single or multiple, and may vary as needed the height of bifurcation from the posterior tibial nerve), and 17.3 mm (range, 15 to 21 mm) from the posterior tibial artery. A posteromedial portal located 1 cm more proximally is on average 2.9 mm closer to the nervous structures., Conclusions: Based on these anatomic data, there appears to be relatively little risk to the surrounding neurovascular structures with this new technique. Therefore, this technique appears to be relatively safe in the treatment of intra-articular and extra-articular pathology.

It is the purpose of this study to verify whether or not there is a correlation between some parameters for cartilaginous injury (width, depth, and type of injury), analyzed separately, and the medium to long-term prognosis of the same. Thus, the parameters were analyzed, correlating them individually with the results obtained when a self-evaluation form was used, and the Lysholm-Gillquist score system. The small number of patients (because of the strict criteria for inclusion) does not allow for a statistically valid analysis of the results obtained. At any rate, the following considerations may be made: the depth parameter for the injury may be a valid element alone in determining a medium- to long-term prognosis; this agrees with what is reported in the literature. The parameter for width of the injury, based on our results, does not appear to be a sufficient element to determine a correlation with future prognosis. As for the type of lesion parameter, this could be correlated with the prognosis. Studies conducted in this sense with higher numbers of patients could determine the type of injury with the worst prognosis.

The authors report the results of 18 hemiarthroplasties of the shoulder performed between 1990 and 1994 using the Neer II monoblock prosthesis, emphasizing the technical and surgical problems encountered. The patients treated numbered 13 for traumatic pathology (acute fractures: 7; sequelae of fracture of the proximal epiphysis of the humerus: 6), and 5 for degenerative lesions (arthrosis: 3; rheumatoid arthritis: 2). An evaluation of the results was based on the Constant method and isokinetic testing. Results based on follow-up obtained after 2 to 6 years were satisfactory in 83% of the cases.

A total of 100 cases surgically treated for rupture of the extra-rotator cuff were evaluated by isokinetic testing. Results were evaluated after a period of time ranging from 1 to 4 years, based on the Constant system, defining the type of lesion of the cuff based on the Snyder classification system, and measuring strength postsurgery using isokinetic testing after 3 and 6 months, and 1 year. Isokinetic testing made it possible to accurately evaluate which patients are capable of obtaining better recovery, and how much time is required for physiotherapy for postoperative rehabilitation, also allowing for correction on an individual basis of any muscular imbalance.

In this work we investigate techniques for embedding domain-specific spatial invariances into highly-constrained neural networks. This information is used to drastically reduce the number of weights which have to be determined during the learning phase, thus allowing us to apply artificial neural networks to problems characterized by a relatively small number of available examples. As an application of the proposed methodology, we study the problem of optical inspection of machined parts. More specifically, we have characterized the performance of a network created according to this strategy, which accepts images of parts under inspection at its input and issues a flag at its output which states whether the part is defective. The results obtained so far show that the proposed methodology provides a potentially relevant approach for the quality control of industrial parts, as it offers both accuracy and short software development time, when compared with a classifier implemented using a standard approach.

The authors present the results they obtained in the first 100 operations performed between January 1989 and November 1990 for the treatment of lumbar sciatic pain related to disc and/or bone compression: microsurgery according to the Caspar method was used. A total of 113 spaces were submitted to surgery; discectomy at two levels was performed in 13 patients. Nerve root compression observed was based on three causes: 1) pure disc hernia (57.5%), 2) pure lateral stenosis (15.9%), 3) combined pathology (hernia+stenosis) (25.6%). In one of the cases the pathology remained unknown. At an average two-year follow-up there were 94 excellent or good results, 2 fair results, and 4 poor results. Complications included dural lacerations in 3 cases, with no sequelae. Eight patients were submitted to further surgery for recurrence of symptoms; the final results after reintervention were excellent in 7 cases, and fair in 1. The authors emphasize the advantages to using microsurgery as compared to macrosurgery, and stress a frequent finding of pure lateral stenosis or associated with disc pathology (47 out of 113 levels operated, equal to 41%), as well as the reliability of CT scan when dealing with disc pathology (97% positive diagnosis) but its unreliability when diagnosis is lateral stenosis (19 out of 47, equal to 40%).

The authors report on a case of fracture of the coracoid process associated with fracture of the clavicle. Open reduction and internal fixation of the coracoid process lead to a good clinical and radiographic outcome.

The authors review eighty cases of pertrochanteric and subtrochanteric fractures of the femur treated surgically with the vitallium Jewett nail-plate between May 1975 and November 1977. They draw attention to the possibility offered by this fixation device of starting weight bearing at an early stage, a factor that is unanimously regarded as essential for rapid recovery in the elderly fracture patient. In fact, fifty-six patients commenced independent walking with some support within two weeks of operation. The fairly low incidence of complications (six in eighty operations), and the relative simplicity of the surgical technique, support the Jewett nail-plate as a suitable device for rigid fixation of trochanteric fractures of the neck of the femur.

A case of a 12 year old girl who presented tetralogy of Fallot (T. o F.) associated with Total Anomalous Pulmonary Venous Drainage (TAPVD) is described. This association is extremely rare, only four autopsied cases being reported in literature. TAPVD is associated with complex cyanotic congenital heart diseases in about one third of cases; asplenia or polysplenia are generally present. Double outlet right ventricle (DORV) is the commonest trunco-conal malformation associated with TAPVD; extremely rare is T. o F. Pulmonary outflow tract obstruction can avoid the haemodynamic consequences due to obstruction on the venous channel, or progression to pulmonary hypertension. The association of the two malformations can masquerade the clinical and Xray picture of TAPVD and make difficult the diagnosis during cardiac catheterization.

The history of antenatal diagnosis of congenital cardiac defects using ultrasound is briefly reviewed. A series of 277 pregnancies were prospectively examined; 203 were normal and 19 diagnosis of congenital heart disease were made. A correct diagnosis of the anomaly was made in 14 cases and the diagnosis was partially correct in 4 cases. There was 1 false-positive.

A case of the Holt-Oram syndrome is described, that is, the association of a skeletal anomaly of the superior limbs, with a constant involvment of the thumbs, and an ostium secundum defect with a prolonged P-R interval. The case presented has the peculiarity of being sporadic, while from the literature a familiarity is almost constant via an autosomic dominant hereditary transmission. The more common syndromes were an alteration of the superior limbs is associated with a congenital cardiopathy are schematically underlined. Finally, the embriological reasons of this not rare association are briefly discussed.

In a case of fetal heart failure caused by endocardial fibroelastosis, prenatal echocardiography clearly demonstrated a thickened endocardium. We therefore suggest that an abnormal endocardium may be detected in utero by ultrasound, thus representing an important clue in the differential diagnosis of fetal nonimmune hydrops and in the evaluation of pregnancies at risk for endocardial fibroelastosis.

The frequency of operations on the knee, particularly on the antero-medial aspect, involving damage or section of sensory nerves, prompted the authors to carry out an accurate research on the innervation of this region. This revealed many variations of the normal anatomy which have been classified and illustrated in detail.

The introduction of christiansen's prosthesis for the head of the femur has altered the balance between the two alternative surgical solutions for subcapital fractures of the neck of the femur (osteosynthesis and endoprosthesis). The writers report their results on the first forty-five patients treated surgically with the new prosthesis, illustrating its functional advantages as compared with the "single block" endoprosthesis. The risk of wear and tear of the acetabulum is practically abolished.

Infectious endocarditis involving intracardiac prosthesis continues to be a common and dangerous complication of cardiac surgery, but the incidence and severity of the disease are probably underestimated in this country. 14 cases of prosthetic endocarditis observed in a 5 years period are reported in this paper. 7 were early cases and 7 late cases. Etiology, clinical course, and pathological lesions, were similar in the two groups, while mortality was higher in the first group (100%) than in the second (85%). Delay in the diagnosis, negative blood cultures in a third of all cases, and doubts in indications for surgery, were the main reasons for a higher mortality than usual. Only one patient was reoperated on, unsuccessfully, but no patient who had not improved after two weeks of correct antibiotic treatment, survived; such cases, especially if diagnosis has been late and/or blood cultures negative, should be reoperated on without delay. The greatest efforts should be made in the prevention of the disease and, in particular, pre-operative and late post-operative prophylaxis should become more rigid and systematic.