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60-408: It is considered one of the best children's hospitals of Europe, it is known worldwide and in 1956 it was recognized as Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS). In 1931 Gerolamo Gaslini, together with his wife Lorenza, had the idea of building an institute for care and infancy named after his daughter Giannina, who died in 1917 at eleven years old, perhaps due to peritonitis which

120-655: A Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree. Subsequently, these medical school graduates undergo residency training in orthopedic surgery. The five-year residency is a categorical orthopedic surgery training. Selection for residency training in orthopedic surgery is very competitive. Roughly 700 physicians complete orthopedic residency training per year in the United States. About 10% of current orthopedic surgery residents are women; about 20% are members of minority groups. Around 20,400 actively practicing orthopedic surgeons and residents are in

180-463: A ruptured appendix or even a perforated gallbladder . Risk factors include ascites (the abnormal build-up of fluid in the abdomen) and peritoneal dialysis . Diagnosis is generally based on examination , blood tests , and medical imaging . Treatment often includes antibiotics , intravenous fluids , pain medication , and surgery. Other measures may include a nasogastric tube or blood transfusion . Without treatment death may occur within

240-462: A few days. About 20% of people with cirrhosis who are hospitalized have peritonitis. The main manifestations of peritonitis are acute abdominal pain , abdominal tenderness , abdominal guarding , rigidity , which are exacerbated by moving the peritoneum , e.g., coughing (forced cough may be used as a test), flexing one's hips, or eliciting the Blumberg's sign (meaning that pressing a hand on

300-590: A higher mortality rate. The term "peritonitis" comes from Greek περιτόναιον peritonaion " peritoneum , abdominal membrane" and -itis "inflammation". Orthopedics Orthopedic surgery or orthopedics ( alternative spelling orthopaedics ) is the branch of surgery concerned with conditions involving the musculoskeletal system . Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma , spine diseases , sports injuries , degenerative diseases , infections, tumors , and congenital disorders . Nicholas Andry coined

360-591: A mobile bearing system. External fixation of fractures was refined by American surgeons during the Vietnam War , but a major contribution was made by Gavril Abramovich Ilizarov in the USSR . He was sent, without much orthopedic training, to look after injured Russian soldiers in Siberia in the 1950s. With no equipment, he was confronted with crippling conditions of unhealed, infected, and misaligned fractures. With

420-470: A progressive increase in the volume of outpatient activities, day clinics, and day surgery provided in a structure called " Day Hospital ". In 2019, 538,704 outpatient services were provided, including 14,742 ordinary admissions and 14,696 cycles of Day Hospital and Day Surgery . Due to its nature as IRCCS, an important mission of the institute is scientific research, the results of which are published in prestigious international journals and aim to translate

480-448: A research component involved with the clinical and operative training. Examples of orthopedic subspecialty training in the United States are: These specialized areas of medicine are not exclusive to orthopedic surgery. For example, hand surgery is practiced by some plastic surgeons , and spine surgery is practiced by most neurosurgeons . Additionally, foot and ankle surgery is also practiced by doctors of podiatric medicine (DPM) in

540-491: A social point of view: Gerolamo Gaslini established that there had to be perfect equality of treatment between legitimate and illegitimate children because the right to assistance comes from the state of need and not from a social position. Furthermore, the institute has always set up a solidarity fund in favor of children and less wealthy families. The first management experience was of a consortium . Gaslini wanted to involve local, administrative, and scientific institutions in

600-548: A unitary organization in which experience, knowledge, and research would have found a ground for application. Gaslini, indeed, established the obligation for all healthcare professionals to carry out scientific research activities which, together with the use of modern techniques and machinery, would have kept the cultural infrastructure of the Institute always up-to-date. From that moment, the Gaslini Institute became

660-492: Is inflammation of the localized or generalized peritoneum , the lining of the inner wall of the abdomen and cover of the abdominal organs . Symptoms may include severe pain, swelling of the abdomen , fever, or weight loss. One part or the entire abdomen may be tender. Complications may include shock and acute respiratory distress syndrome . Causes include perforation of the intestinal tract , pancreatitis , pelvic inflammatory disease , stomach ulcer , cirrhosis ,

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720-417: Is considered diagnostic. In addition, Gram stain is almost always negative, whereas culture of the peritoneal fluid can determine the microorganism responsible and determine their sensitivity to antimicrobial agents. In normal conditions, the peritoneum appears greyish and glistening; it becomes dull 2–4 hours after the onset of peritonitis, initially with scarce serous or slightly turbid fluid. Later on,

780-409: Is often combined with meniscectomy or chondroplasty. The majority of upper-extremity outpatient orthopedic procedures are now performed arthroscopically. Arthroplasty is an orthopedic surgery where the articular surface of a musculoskeletal joint is replaced, remodeled, or realigned by osteotomy or some other procedure. It is an elective procedure that is done to relieve pain and restore function to

840-633: Is the Royal College of Physicians and Surgeons of Canada ; in Australia and New Zealand, it is the Royal Australasian College of Surgeons . In the United States, specialists in hand surgery and orthopedic sports medicine may obtain a certificate of added qualifications in addition to their board primary certification by successfully completing a separate standardized examination. No additional certification process exists for

900-405: Is under study and is likely to expand in the future. Computed tomography (CT or CAT scanning) may be useful in differentiating causes of abdominal pain. If reasonable doubt still persists, an exploratory peritoneal lavage or laparoscopy may be performed. In people with ascites , a diagnosis of peritonitis is made via paracentesis (abdominal tap): More than 250 polymorphonuclear cells per μL

960-409: Is wear of the bearing surfaces of components. This can lead to damage to the surrounding bone and contribute to eventual failure of the implant. The plastic chosen is usually ultra-high-molecular-weight polyethylene , which can also be altered in ways that may improve wear characteristics. The risk of revision surgery has also been shown to be associated with surgeon volume. Between 2001 and 2016,

1020-571: The American Academy of Orthopaedic Surgeons , still use the spelling with the digraph ae , though hospitals usually use the shortened form. Elsewhere, usage is not uniform; in Canada, both spellings are acceptable; "orthopaedics" is the normal spelling in the UK in line with other fields which retain "ae". Many developments in orthopedic surgery have resulted from experiences during wartime. On

1080-535: The American Association of Medical Colleges in 2021, the average work week of an orthopedic surgeon was 57 hours. This is a very low estimation however, as research derived from a 2013 survey of orthopedic surgeons who self identified as "highly successful" due to their prominent positions in the field indicated average work weeks of 70 hours or more. The use of arthroscopic techniques has been particularly important for injured patients. Arthroscopy

1140-493: The American Osteopathic Board of Orthopedic Surgery means that the orthopedic surgeon has met the specified educational, evaluation, and examination requirements of the board. The process requires successful completion of a standardized written examination followed by an oral examination focused on the surgeon's clinical and surgical performance over a 6-month period. In Canada, the certifying organization

1200-402: The exudate becomes creamy and evidently suppurative ; in people who are dehydrated, it also becomes very inspissated. The quantity of accumulated exudate varies widely. It may be spread to the whole peritoneum, or be walled off by the omentum and viscera . Inflammation features infiltration by neutrophils with fibrino-purulent exudation. Depending on the severity of the person's state,

1260-489: The Charnley low-friction arthroplasty and its derivative designs were the most-used systems in the world. This formed the basis for all modern hip implants. The Exeter hip replacement system (with a slightly different stem geometry) was developed at the same time. Since Charnley, improvements have been continuous in the design and technique of joint replacement (arthroplasty) with many contributors, including W. H. Harris,

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1320-491: The Gaslini Institute presents itself as a perfect combination of two essential elements: the Institute and the Foundation. The two institutions mutually provide each other, even remaining distinct. This guarantee system allowed the institute to achieve the best goals and to acquire prestige on a national and international level. The structure is organized in pavilions surrounded by the sea of Ligurian Riviera . The project

1380-521: The Gaslini has been the seat of the University of Genoa . On average there are a total of 516 beds, about 50 thousand admissions per year (between normal, day hospital, and outpatient treatment), with more than 40 thousand accesses to the emergency department in the 2nd quarter. There are about 600 foreign patients per year, on average from sixty countries of the world. Research is a strategic goal of

1440-808: The Institute and is primarily aimed at translating research findings into clinical practice. In 2007–2008, Gaslini Institute received the coveted accreditation recognition of Joint Commission International . In 2019, the agreement between the Giannina Gaslini Institute and the Italian Institute of Technology (IIT) will reach its operational conclusion, particularly in relation to the Joint Lab aspects of genomics, which are aspects of both high-value research and highly specialized complex diagnostics. The Institute shows an increasing number of admissions with appropriateness criteria and

1500-509: The United States. According to the latest Occupational Outlook Handbook (2011–2012) published by the United States Department of Labor , 3–4% of all practicing physicians are orthopedic surgeons. Many orthopedic surgeons elect to do further training, or fellowships, after completing their residency training. Fellowship training in an orthopedic sub-specialty is typically one year in duration (sometimes two) and sometimes has

1560-663: The United States. Some family practice physicians practice sports medicine , but their scope of practice is nonoperative. After completion of specialty residency or registrar training, an orthopedic surgeon is then eligible for board certification by the American Board of Medical Specialties or the American Osteopathic Association Bureau of Osteopathic Specialists . Certification by the American Board of Orthopedic Surgery or

1620-465: The abdomen elicits less pain than releasing the hand abruptly, which will aggravate the pain, as the peritoneum snaps back into place). Rigidity is highly specific for diagnosing peritonitis (specificity: 76–100%). The presence of these signs in a person is sometimes referred to as peritonism. The localization of these manifestations depends on whether peritonitis is localized (e.g., appendicitis or diverticulitis before perforation), or generalized to

1680-469: The battlefields of the Middle Ages , the injured were treated with bandages soaked in horses' blood, which dried to form a stiff, if unsanitary, splint. Originally, the term orthopedics meant the correcting of musculoskeletal deformities in children. Nicolas Andry , a professor of medicine at the University of Paris , coined the term in the first textbook written on the subject in 1741. He advocated

1740-725: The clinical manifestations described above. Rigidity (involuntary contraction of the abdominal muscles) is the most specific exam finding for diagnosing peritonitis. If focal peritonitis is detected, further work-up should be done. If diffuse peritonitis is detected, then urgent surgical consultation should be obtained, and may warrant surgery without further investigations. Leukocytosis , hypokalemia , hypernatremia , and acidosis may be present, but they are not specific findings. Abdominal X-rays may reveal dilated, edematous intestines, although such X-rays are mainly useful to look for pneumoperitoneum , an indicator of gastrointestinal perforation . The role of whole-abdomen ultrasound examination

1800-418: The club-foot shoe for children born with foot deformities and various methods to treat curvature of the spine. Advances made in surgical technique during the 18th century, such as John Hunter 's research on tendon healing and Percival Pott 's work on spinal deformity steadily increased the range of new methods available for effective treatment. Robert Chessher , a pioneering British orthopedist, invented

1860-553: The common home of all pediatricians in Italy. In 1956, thanks to the excellent research activity, the Giannina Gaslini Institute was recognized as IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) by the Ministry of Health. It was the first Italian pediatric hospital to have ever obtained this recognition. In 1964 Gerolamo Gaslini died and the presidency of the Foundation was assumed by his daughter Germana until 1981. Today

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1920-593: The construction of the Manchester Ship Canal in 1888. He was responsible for the injured among the 20,000 workers, and he organized the first comprehensive accident service in the world, dividing the 36-mile site into three sections, and establishing a hospital and a string of first-aid posts in each section. He had the medical personnel trained in fracture management. He personally managed 3,000 cases and performed 300 operations in his own hospital. This position enabled him to learn new techniques and improve

1980-563: The damage suffered by the institute, Gerolamo Gaslini undertakes to restore its functionality and expand its capabilities. In particular, it creates five new centers of clinical investigation, treatment, and assistance (immaturity, auxology, streptomycin, orthotics, anti-poliomyelitis); four new departments: experimental surgery, pathological anatomy and histology, physiotherapy and cardiac catheterization, three new hospital departments, and three clinics; it incorporates new university hospitals such as orthopedics and traumatology . The institute

2040-585: The distant 1917, in the middle of the war, in certainly not propitious conditions to such an initiative. " Gaslini sent a technical health commission across Europe to design and build a modern and cutting-edge institute. The construction of the Institute began in 1932 and lasted six years, until the start of the activities in March 1938. An estimate of the costs supported by Gaslini is around 55 million of Italian lire which correspond to several million euros . The institute has brought further innovations also from

2100-536: The double-inclined plane, used to treat lower-body bone fractures, in 1790. Antonius Mathijsen , a Dutch military surgeon, invented the plaster of Paris cast in 1851. Until the 1890s, though, orthopedics was still a study limited to the correction of deformity in children. One of the first surgical procedures developed was percutaneous tenotomy. This involved cutting a tendon, originally the Achilles tendon, to help treat deformities alongside bracing and exercises. In

2160-620: The femur and tibia was pioneered by Gerhard Küntscher of Germany. This made a noticeable difference to the speed of recovery of injured German soldiers during World War II and led to more widespread adoption of intramedullary fixation of fractures in the rest of the world. Traction was the standard method of treating thigh bone fractures until the late 1970s, though, when the Harborview Medical Center group in Seattle popularized intramedullary fixation without opening up

2220-474: The field into the general treatment of fracture and other musculoskeletal problems. He advocated enforced rest as the best remedy for fractures and tuberculosis , and created the so-called "Thomas splint" to stabilize a fractured femur and prevent infection. He is also responsible for numerous other medical innovations that all carry his name: Thomas's collar to treat tuberculosis of the cervical spine, Thomas's maneuvere, an orthopedic investigation for fracture of

2280-518: The fracture. The modern total hip replacement was pioneered by Sir John Charnley , expert in tribology at Wrightington Hospital , in England in the 1960s. He found that joint surfaces could be replaced by implants cemented to the bone. His design consisted of a stainless steel , one-piece femoral stem and head, and a polyethylene acetabular component, both of which were fixed to the bone using PMMA (acrylic) bone cement . For over two decades,

2340-472: The help of the local bicycle shop, he devised ring external fixators tensioned like the spokes of a bicycle. With this equipment, he achieved healing, realignment, and lengthening to a degree unheard of elsewhere. His Ilizarov apparatus is still used today as one of the distraction osteogenesis methods. Modern orthopedic surgery and musculoskeletal research have sought to make surgery less invasive and to make implanted components better and more durable. On

2400-622: The hip joint, the Thomas test , a method of detecting hip deformity by having the patient lying flat in bed, and Thomas's wrench for reducing fractures, as well as an osteoclast to break and reset bones. Thomas's work was not fully appreciated in his own lifetime. Only during the First World War did his techniques come to be used for injured soldiers on the battlefield . His nephew, Sir Robert Jones, had already made great advances in orthopedics in his position as surgeon-superintendent for

2460-464: The joint after damage by arthritis ( rheumasurgery ) or some other type of trauma. As well as the standard total knee replacement surgery, the unicompartmental knee replacement, in which only one weight-bearing surface of an arthritic knee is replaced, may be performed, but it bears a significant risk of revision surgery. Joint replacements are used for other joints, most commonly the hip or shoulder . A post-surgical concern with joint replacements

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2520-438: The late 1800s and first decades of the 1900s, significant controversy arose about whether orthopedics should include surgical procedures at all. Examples of people who aided the development of modern orthopedic surgery were Hugh Owen Thomas , a surgeon from Wales , and his nephew, Robert Jones . Thomas became interested in orthopedics and bone-setting at a young age, and after establishing his own practice, went on to expand

2580-453: The latest achievements in pediatrics and pediatric specialties into clinical application. The research activity is carried out within the 5 institutional research lines ( PNR 2018-2020 ): -Innovative Diagnostic Therapeutic Strategies and Rare Diseases. -Pediatric science, surgery, and neonatology -Rheumatology, Immunology, and Autoinflammatory Diseases -Hematology, oncology, and cell therapies -Muscular and neurological diseases Among

2640-405: The management of peritonitis may include: If properly treated, typical cases of surgically correctable peritonitis (e.g., perforated peptic ulcer, appendicitis, and diverticulitis) have a mortality rate of about <10% in otherwise healthy people. The mortality rate rises to 35% in peritonitis patients who develop sepsis, and patients who have underlying renal insufficiency and complications have

2700-545: The name implies, the discipline was initially developed with attention to children, but the correction of spinal and bone deformities in all stages of life eventually became the cornerstone of orthopedic practice. As with many words derived with the "æ" ligature , simplification to either "ae" or just "e" is common, especially in North America. In the US, the majority of college, university, and residency programmes, and even

2760-439: The other hand, since the emergence of the opioid epidemic, orthopedic surgeons have been identified as one of the highest prescribers of opioid medications. Decreasing prescription of opioids while still providing adequate pain control is a development in orthopedic surgery. In the United States, orthopedic surgeons have typically completed four years of undergraduate education and four years of medical school and earned either

2820-415: The other subspecialties. According to applications for board certification from 1999 to 2003, the top 25 most common procedures (in order) performed by orthopedic surgeons are: A typical schedule for a practicing orthopedic surgeon involves 50–55 hours of work per week divided among clinic, surgery, various administrative duties, and possibly teaching and/or research if in an academic setting. According to

2880-443: The outstanding results of Gaslini's research activity are first and foremost the research findings of high scientific value of a translational nature, which, thanks to early and more accurate diagnosis and innovative and very effective therapies, have enabled a real revolution in the treatment and prognosis of high-risk leukemia , disabling rheumatic diseases and severe nephropathies of the child. Peritonitis Peritonitis

2940-476: The prevalence of musculoskeletal procedures drastically increased in the U.S, from 17.9% to 24.2% of all operating-room (OR) procedures performed during hospital stays. In a study of hospitalizations in the United States in 2012, spine and joint procedures were common among all age groups except infants. Spinal fusion was one of the five most common OR procedures performed in every age group except infants younger than 1 year and adults 85 years and older. Laminectomy

3000-487: The son of R. I. Harris, whose team at Harvard pioneered uncemented arthroplasty techniques with the bone bonding directly to the implant. Knee replacements, using similar technology, were started by McIntosh in rheumatoid arthritis patients and later by Gunston and Marmor for osteoarthritis in the 1970s, developed by John Insall in New York using a fixed bearing system, and by Frederick Buechel and Michael Pappas using

3060-597: The standard of fracture management. Physicians from around the world came to Jones' clinic to learn his techniques. Along with Alfred Tubby, Jones founded the British Orthopedic Society in 1894. During the First World War, Jones served as a Territorial Army surgeon. He observed that treatment of fractures both, at the front and in hospitals at home, was inadequate, and his efforts led to the introduction of military orthopedic hospitals. He

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3120-489: The start of activities, thus he formed a consortium which he will have dissolved in 1946, assuming the administration of the Institute until 1960, when the first board of directors was settled. In 1949, Gerolamo Gaslini gave away all his possessions, making them flow into the homonymous foundation. The task of the Gaslini Foundation was to support over time the research and training of the Institute and to create

3180-428: The use of exercise, manipulation, and splinting to treat deformities in children. His book was directed towards parents, and while some topics would be familiar to orthopedists today, it also included 'excessive sweating of the palms' and freckles. Jean-André Venel established the first orthopedic institute in 1780, which was the first hospital dedicated to the treatment of children's skeletal deformities. He developed

3240-403: The whole abdomen . In either case, pain typically starts as a generalized abdominal pain (with involvement of poorly localizing visceral innervation of the visceral peritoneal layer ), and may become localized later (with involvement of the somatic innervation of the parietal peritoneal layer). Peritonitis is an example of an acute abdomen . A diagnosis of peritonitis is based primarily on

3300-711: The word in French as orthopédie , derived from the Ancient Greek words ὀρθός orthos ("correct", "straight") and παιδίον paidion ("child"), and published Orthopedie (translated as Orthopædia: Or the Art of Correcting and Preventing Deformities in Children ) in 1741. The word was assimilated into English as orthopædics ; the ligature æ was common in that era for ae in Greek- and Latin-based words. As

3360-524: Was appointed Inspector of Military Orthopedics, with responsibility for 30,000 beds. The hospital in Ducane Road, Hammersmith , became the model for both British and American military orthopedic hospitals. His advocacy of the use of Thomas splint for the initial treatment of femoral fractures reduced mortality of open fractures of the femur from 87% to less than 8% in the period from 1916 to 1918. The use of intramedullary rods to treat fractures of

3420-491: Was carried out by the architect Angelo Crippa and involved a huge complex of 20 buildings on a total plot of 73,000 square meters, including extensive gardens, internal roads, and access roads. After six years of construction, these buildings now house the clinics, the university, halls for the treatment of infectious diseases , the school for pediatric nurses, and the Institute of Mental and Moral Rehabilitation of Deficient and Abnormal Childhood. After World War II , following

3480-524: Was designed, built, and furnished entirely at the expense of Mr. and Mrs. Gaslini in memory of their daughter Giannina. The Gaslini Institute is the largest children's hospital in northern Italy and has extensive green areas on the coast, two-thirds of which are used as a park. The Gaslini employs over 2,000 staff including doctors, nurses, academics, and researchers. There are all pediatric specialties, numerous laboratories, and university chairs, many with corresponding professional schools. Since its foundation,

3540-484: Was not diagnosed in time. Gaslini did not accept the fact that children could die for lack of timely and adequate treatment, so he decided to create a pediatric hospital. " The thought of the conception and realization of the work that is identified in the Giannina Gaslini Institute, which is, at the same time, an instrument of good and an act of love towards my beloved, lost Creature, in the painful memory of her precocious maternal feeling, it arose and matured in my soul in

3600-430: Was pioneered in the early 1950s by Masaki Watanabe of Japan to perform minimally invasive cartilage surgery and reconstructions of torn ligaments. Arthroscopy allows patients to recover from the surgery in a matter of days, rather than the weeks to months required by conventional, "open" surgery; it is a very popular technique. Knee arthroscopy is one of the most common operations performed by orthopedic surgeons today, and

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