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Biomedical subjects

A Puca

Publications and source records attributed to A Puca.

33 records · Page 2Linked to original sources
PubMed1993

Thrombolysis in cerebral ischemia. A review of clinical and experimental data.

Thrombolytic therapy has been proposed in the treatment of cerebrovascular occlusive disease. Early clinical experiences with Urokinase and Streptokinase raised concern about the risk of hemorrhagic complications. More recently, tissue plasminogen activator (tPA) has been evaluated experimentally with promising results. Its clinical utilization has been recently initiated. A review of experimental and clinical data on thrombolysis in cerebral ischemia is presented. TPA treatment produced recanalization and clinical improvement in several patients. The rate of intracranial hemorrhagic complications is similar to the incidence of spontaneous hemorrhagic conversion of ischemic infarction. Nevertheless, large placebo-controlled clinical trials are necessary to further define the efficacy and the optimal modality of administration of tPA in thromboembolic stroke.

Animals↗
PubMed1992

Intracerebral injury following thermocoagulation of the trigeminal ganglion.

An unusual postoperative complication of percutaneous thermocoagulation of the gasserian ganglion is reported. Computed tomography and magnetic resonance imaging of the brain disclosed an intracerebral lesion following the surgical procedure. Some rare abnormalities of the skull base could increase the risk of such complications. A meticulous surgical technique with fluoroscopic and neurophysiological control is mandatory in any percutaneous procedure on the trigeminal ganglion.

Brain Injuries↗
PubMed1992

Spinal neurenteric cyst in association with syringomyelia: case report.

A case of spinal neurenteric cyst in association with Klippel-Feil deformity, spinal lipoma, and syringomyelia is presented. Neuroradiological evaluation was performed by means of magnetic resonance imaging of the spine and a computed tomography myelograph. The diagnosis of neurenteric cyst was established by histological and immunohistochemical studies. The pathogenesis of syringomyelia associated with an extramedullary mass lesion is discussed.

Adult↗
PubMed1991

Antinociceptive activity of intracerebroventricular lysine acetylsalicylate: an experimental study.

We investigated the antinociceptive activity of Lysine Acetylsalicylate (LAS) after intracerebroventricular (icv) injection in experimental animals. The effect on tonic pain was studied by means of the Formalin test on 140 male Swiss mice. In a first group of animals icv LAS was injected at different doses (0.25-0.5-1 mg in saline solution 5 microliters). A second group received icv morphine 1 microgram in 5 microliters saline, and finally a third control group received icv 5 microliters saline. The effect of the compounds on the Formalin test was evaluated under blind conditions. Icv LAS had no effect on the nociceptive behaviour at doses of 0.25 and 0.5 mg, while a reduction of the licking time was evident after the injection of 1 mg of the drug. The time course and the degree of the analgesic effect of icv LAS was investigated and compared to the effect of icv morphine.

Analgesics↗
PubMed1991

Cardiocirculatory arrest with hypothermia. Experimental study.

Direct surgical attack on intracranial malformations of great complexity may be facilitated by complete cardiocirculatory arrest under hypothermia. To improve the technical aspects of this procedure and to determine the optimum depth of hypothermia, the duration of arrest that can be tolerated, and the role of barbiturate brain protection, we conducted an experimental study on 11 baboons. Arrest lasted for 45 or 90 minutes at a brain temperature of 12 degrees C. The animals were assessed by clinical, neuroradiological and necropsy examination. All 4 animals subjected to 45 minutes arrest made a good clinical recovery while 3 of the 7 subjected to 90 minutes arrest presented thromboembolic complications. Strict heparinization in the last 2 animals solved these problems. The findings of this study may help to make the procedure safer for clinical use.

Animals↗
PubMed1991

Cerebrospinal fluid shunting for hydrocephalus in the adult: factors related to shunt revision.

Cerebrospinal fluid shunting procedures are widely employed in the treatment of hydrocephalus and other disturbances of the dynamics of cerebrospinal fluid. In spite of its popularity, this operation frequently requires surgical revision. A retrospective analysis of a series of 356 adults who underwent the insertion of a cerebrospinal fluid shunt between January 1970 and December 1988 was performed. The incidence of revision was analyzed, and an attempt was made to identify possible causal factors. The overall incidence of surgical revisions was 28.65%; the number of revisions in the same patient ranged between one and eight. The most frequent causes of revision were distal malposition, obstruction, and infection. A statistically significant difference (P less than 0.05) was found in both the risk of revision in patients who had undergone previous operations and those who had not and in the incidence of revision before and after January 1985. Meticulous surgical technique as well as perioperative antibiotic prophylaxis appear responsible for the latter. The differences in the incidence of revision among patients treated with different types of shunts and valves, though remarkable, is not statistically significant.

Adolescent↗
PubMed1990

Effect of intra-arterial tissue plasminogen activator and urokinase on autologous arterial emboli in the cerebral circulation of rabbits [corrected].

We conducted a randomized, blinded controlled trial to test the efficacy of fibrinolytic therapy with tissue plasminogen activator and urokinase in the treatment of acute embolic stroke. Embolic stroke was simulated in rabbits by injecting three 0.5 x 0.5 mm fragments of autologous arterial thrombus harvested from a traumatized auricular artery. Thirty minutes after embolization the rabbits were blindly treated with tissue plasminogen activator (n = 21), urokinase (n = 20), or 0.9% saline (n = 20). At 6 hours the rabbits were sacrificed, and the cerebral vasculature was inspected for the location and number of emboli. The brain was then cut into 0.5-cm-thick coronal sections and stained with triphenyltetrazolium chloride to define areas of infarction. Treatment with either tissue plasminogen activator or urokinase significantly reduced the number of emboli present in the cerebral circulation (p less than 0.05). The area of ischemic injury was also significantly reduced (p less than 0.05) by acute fibrinolytic therapy with either tissue plasminogen activator or urokinase. However, only treatment with tissue plasminogen activator significantly reduced (p less than 0.05) the incidence of infarction. There was no evidence of intracerebral hemorrhage in any rabbit. Early fibrinolytic therapy improved outcome in this model of acute embolic stroke.

Animals↗
PubMed1987

Neurological improvement in chronic ischemic stroke following surgical brain revascularization.

50 patients suffering from completed ischemic stroke in the carotid territory for at least two months (17 mild, 31 moderate, 2 severe strokes) underwent extra-intracranial arterial bypass surgery. Neurological improvement was obtained in 43 cases; it persisted in time in 40 cases. Quantitative evaluation of motor performance in 21 patients showed that the degree of improvement was highly significant. Several factors strongly indicate a causal relation between surgical revascularization and neurological restoration. The positive surgical result is strictly dependent on correct patient selection and, in particular: i) on the documentation of local hemodynamic insufficiency; ii) on the occurrence of transient neurological (and to a certain extent EEG) improvement following hyperbaric oxygenation. The latter can also provide reliable information on the minimum degree of improvement to be expected from surgery.

Adolescent↗
PubMed1987

Vasoconstriction of the basilar artery in rabbits: the vasoconstrictor activity of blood, CSF and blood-CSF mixtures incubated for varying periods of time.

After subarachnoid haemorrhage, the amount of blood in the subarachnoid space and the time elapsed since the haemorrhage seem important factors in predicting the occurrence of vasospasm. In this experiment we studied the responses of the rabbit basilar artery to acute topical application of samples of human cerebrospinal fluid (CSF), mixtures of blood and CSF incubated at 37 degrees C for 0 to 12 days. The degree and the duration of the vasoconstriction depended on the time of incubation and on the concentration of blood in the samples. Samples incubated for five and seven days caused severe and long-lasting vasoconstrictions. Samples incubated for 0, 1, 3, 8, 10 and 12 days caused slight or moderate and short-lasting vasoconstriction. Samples incubated for 5, 7, 8, and 10 days showed a linear relationship between the concentration of blood and the degree of constriction up to the blood-CSF ratio of 0.6 to 1 (blood content of 37.5%); further increases of blood concentration did not cause further vasoconstriction. This phenomenon may be related to the saturation of arterial receptors. The course of the vasoconstriction using samples with different blood concentrations suggests the existence of more vasoactive substances. This work seems to confirm the importance of blood concentration in the CSF and of time as factors governing the development of vasospasm.

Animals↗
PubMed1986

Total excision of spinal lipomas using CO2 laser at low power. Experimental and clinical observations.

Total excision of spinal lipomas (SL) is difficult because of the intimate adhesion between the fibro-adipose tissue and the neural structures. Radical surgery in SL can provoke nervous lesions; therefore many authors recommend only partial excision as a means of decompression. Nevertheless the role of traction or tethering of the spinal cord in all spinal disraphism, including SL, is known to be very important in determining the clinical picture. So partial removal of SL cannot be effective in releasing the tethered cord. The use of a CO2 laser at low power (3-5 W) permitted radical surgery without any neural damage and complications in 2 adult patients with large, not well capsulated SL. These patients were previously operated on by the same surgeon with conventional microsurgical techniques for partial excision. After CO2 laser surgery there was significant improvement of the clinical pictures, the follow-up being respectively 24 and 36 months. This clinical experience was performed after a CO2 laser had successfully been used in an experimental model in rats simulating a condition of SL. Using power of 3-5 W was not sufficient to attain an immediate vaporization, but the adipose tissue first changed into a transparent liquid across which it was possible to recognize the interfaces between the neural structures and the adipose tissue.

Adult↗
PubMed1984

Multiple spinal meningiomas in children.

A case of a girl with multiple spinal meningiomas, without evidence of neurofibromatosis, is described. The patient first underwent the complete removal of an intradural tumour at the lower lumbar level, at the age of eight year. A second intradural meningioma, located at the upper lumbar level, was surgically excised after a five year symptom-free period.

Adolescent↗
PubMed1984

Multiple intracranial metastases of malignant melanoma with long-term survival. Case report.

The authors present a case of multiple brain metastases and an extracranial secondary localization from malignant melanoma. The patient was operated on three times for the intracranial masses and had a 49-month survival with a good quality of life after the first of the three operations. She lived a total of 80 months from the time of diffusion of the primary tumor. The course of malignant melanoma is unpredictable, and long-term survival can be achieved in some cases, even in the presence of multiple brain metastases.

Adult↗
PubMed1983

Spontaneous thrombosis of an aneurysm of the great vein of Galen.

A case of a thrombosed aneurysm of the vein of Galen in a 9-year-old boy is reported. Previously, only ten clotted aneurysms of the vein of Galen have been described. In our case, thrombosis occurred spontaneously after birth. Clinical presentation was characterized by signs of hydrocephalus, with an abrupt deterioration after several years of satisfactory clinical evolution. The patient was successfully treated with a ventriculoperitoneal shunt.

Brain↗
PubMedDate not supplied

[Hydrocele and inguinal hernia after ventriculo-peritoneal shunt in childhood].

135 non tumoral hydrocephalic children have been operated on trough a V-P shunt in the period January 1975-June 1981. Of them, 10 (7.4%) presented an inguinal hernia or hydrocele in the postoperative period. Such complications required in 9 cases a specific surgical treatment, which was not followed by recurrence in any case; in one child the hydrocele subsided spontaneously. No relation was found with the type of shunt device inserted and the side of the operation.

Cerebrospinal Fluid Shunts↗