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Biomedical subjects

A Spallone

Publications and source records attributed to A Spallone.

At least 73 records · Page 4Linked to original sources
PubMed1982

Meningioma as a sequel of radiotherapy for pituitary adenoma.

Two cases of meningioma developing after radiation therapy of pituitary adenoma were found among 180 verified adenomas irradiated pre- or post-operatively and followed up for at least five years. Only a few instances of association of meningioma and pituitary adenoma were found in the literature. In patients who did not receive X-ray treatment both tumours were simultaneously verified at operation and/or autopsy, whereas in those who were irradiated a definite time interval, ranging from 11 to 18 years, was present between surgical and/or radiotherapeutic treatment for pituitary adenoma and verification of meningioma. A possible role of radiation in the genesis of these meningiomas is postulated.

Adenoma, Acidophil↗
PubMed1982

The management of arteriovenous malformations of the corpus callosum.

A series of 15 arteriovenous malformations (AVMs) of the corpus callosum--9% of 170 intracranial AVMs admitted to the School of Medicine of the University of Rome during a 30-yr period--was studied. In all cases the lesion concerned mainly the corpus callosum, although in some it also involved the surrounding structures, such as septum pellucidum, tela choroidea, and the mesial hemisphere. These malformations are divided into three groups, namely, those involving mainly the genu, the truncus, or the splenium of the corpus callosum. The last predominated in the present series. Each type has a peculiar angiographic appearance. In general these lesions are fed by branches from the anterior cerebral and/or posterior cerebral arteries, although in some cases minor contributions from the middle cerebral artery may also be present. Vascularization is often bilateral. Venous drainage occurs through the inferior and/or superior sagittal sinuses and/or the Galen system. As to clinical presentation, Subarachnoid Hemorrhage (SAH) is the usual presenting symptom and tends to recur frequently. Neurological localizing symptoms are infrequent, as are seizures; psychological symptoms are an exception. Of the 4 cases managed conservatively, only one had no further episodes of bleeding and remained free of complaints. On the other hand, surgical results of the 11 operated patients were satisfactory, in the sense that no mortality and low morbidity were recorded. Accordingly, surgical treatment of AVMs of the corpus callosum is recommended as a rule.

Adolescent↗
PubMed1982

Spinal epidural abscesses. Surgical and parasurgical management.

42 cases of spinal epidural abscesses were operated on in the years 1957-1980, among approximately 8,000 spinal operations. Staphylococcus aureus was the microorganism most commonly isolated from infected material and the primary source of infection was in most cases cutaneous and/or subcutaneous lesions. Typical clinical history included back pain and fever, with progressive nerve root and spinal cord involvement. The cases were divided into three groups according to the operative findings: (a) acute abscesses; (b) chronic abscesses, and (c) mixed or subacute abscesses. These three groups differed as to duration of illness, incidence of meningeal signs, white blood cell concentration and lumbar puncture results. Plain X-rays were positive in 20% of cases. Myelography, whose indications were maximally restricted, gave in some instances inaccurate results. Treatment consisted of extensive laminectomy of all the affected spinal segments, and drainage of infected material. Local and systemic appropriate antibiotic therapy was also given. An average of 16 daily sessions of barotherapy, consisting of 1.7-2.0 atm given in 40-60 min, were administered in the last 9 cases. When compared with the patients to which barotherapy was not given, these cases showed a lower rate of permanent disability (11 vs. 21%), even if they were managed under less favorable clinical and neurological conditions. These results seem to support a favorable role of hyperbaric treatment in the management of spinal epidural abscesses. Early diagnosis and appropriate management remain essential in order to have satisfactory treatment results.

Abscess↗
PubMed1981

Benign intracranial hypertension vs. intracranial arteriovenous malformation: a possible CT dilemma.

A nine-year-old boy, presenting only with signs of increased ICP, underwent computerized tomography. This examination demonstrated no abnormalities in the precontrast scan. Following C. E., it showed scattered areas of blood-like density in both hemispheres, as well as a presumedly abnormal vessel in the left occipital region and dilated vein of Galen, sinus rectus, and tentorial veins. The presumptive diagnosis of left occipital AVM was not confirmed by angiography, which also ruled out obstructions of the intracranial sinuses. The possible mechanism responsible for this atypical CT picture is briefly discussed in the light of pertinent literature. It is suggested that careful consideration should be given to the indications for angiography in similar cases, in the presence of a "hypervascular" aspect of the postcontrast CT scan, particularly if a considerable amount of contrast medium has been used.

Cerebral Angiography↗
PubMed1981

Spinal osteochondroma diagnosed by computed tomography. Report of two cases and review of literature.

This paper reports two cases of spinal osteochondroma, in which preoperative diagnosis was greatly facilitated by CT scan examination. Moreover, by giving a precise indication of tumour extent, as well as of its relationships with the adjacent structures, CT was of great value also with regard to surgical treatment. Personal experience with the present cases, as well as a review of pertinent literature, suggests that the following CT scan findings may be considered as typical of spinal osteochondroma: a) roundish, sharply-outlined mass; b) bone-like density, with scattered calcifications; c) paraspinal, dump-bell, or eccentric intra-spinal location; d) osteosclerotic changes in neighbouring bone; e) lack of contrast enhancement. The value of CT scan examination in the diagnosis of vertebral tumours is stressed.

Adult↗
PubMed1981

The surgical treatment of choroid plexus papillomas: the results of 27 years experience.

This paper reports the results of 27 choroid plexus papillomas surgically treated, out of 28 cases observed in the authors institute during the period 1952-1978. These were divided into two groups: a) those operated on before 1969; b) those operated on in 1969 and the following years, when microsurgical facilities were routinely employed. As a rule, neither ventricular shunting nor radiation therapy were used preoperatively. A total removal was attempted in all cases, and performed in all but three. The second group (1969-1978) showed better results as regards the number of totally removed tumours (92% against 87%), surgical deaths (16% against 31%), and long-term good results (67% against 44%). Considering both groups together, long-term good results were achieved in 15 patients (55%), followed up from 2 to 27 years. Radical operation is the treatment of choice for choroid plexus papilloma. As indicated by the author's experience, this produces satisfactory long-term results, whilst surgical mortality can be held within acceptable limits, provided that modern techniques are used properly. The value of radiation therapy, which in any event should be restricted to malignant cases, remains questionable.

Adolescent↗
PubMed1981

Spontaneous cure of ruptured intracranial arterial aneurysms.

The case of a patient who had spontaneous cure of an intracranial saccular aneurysm, documented by angiography, is reported. This occurred in a 41-year-old patient, admitted four months after recurrent subarachnoid hemorrhage due to an angiographically verified supraclinoid internal carotid artery aneurysm. The relevant literature is reviewed, and the possible mechanism of spontaneous aneurysmal thrombosis is briefly discussed. It is concluded that repeating angiography is not without merit in patients with already documented cerebral aneurysms who are referred for surgical treatment some time after a subarachnoid hemorrhage.

Adult↗
PubMed1981

Minimosymptomatic occlusion of the middle cerebral artery.

Minimosymptomatic occlusion of the MCA before the origin of the perforating branches is an exceedingly rare occurrence. We report two cases of MCA occlusion at its origin, the second case proven by the CT scan in vivo. Published work rules out the possibility of a functionally effective deep collateral circulation in the distribution of the capsular rami of the MCA. In view of this we argue that there may be cases - admittedly very rare - in which, given the individual variability of the vascular supply, the MCA may be of negligible functional importance to the circulation of the internal capsule. In such cases occlusion of the MCA would be relatively well tolerated.

Adult↗
PubMed1981

The role of antifibrinolytic therapy in the preoperative management of recently ruptured intracranial aneurysms.

In a retrospective study of the use of antifibrinolytic therapy in a series of patients with recently ruptured intracranial aneurysms, 131 patients were selected based on the following criteria: commencement of therapy within 3 days of the last subarachnoid hemorrhage (SAH); continuation of therapy for at least 6 days; and apparently uncomplicated surgery. Two main modalities of antifibrinolytic therapy were used: Group A, tranexamic acid (AMCA) 3 gm daily plus aprotinin k.i.u. (kallikrein inactivating units) daily (82 cases); Group B, AMCA 6 gm daily (41 cases). The remaining 8 patients were treated with epsilon-aminocaproic acid alone or in combination with aprotinin and were not considered to constitute a large enough group for statistical comparison. The rest of the preoperative treatment consisted of bed rest; mild sedation; antihypertensives, if the blood pressure exceeded 160 mm Hg; and osmotic diuretics as needed. The mean interval between last SAH and operation was about 13 days in both groups. The rates of rebleeding and thromboembolism were similar in the two groups but the rates of ischemic complications and post-SAH hydrocephalus were higher in Group B. The difference in the rate of severe cerebral ischemic complications was statistically significant (11 of 82 in Group A versus 12 of 41 in Group B, p less than 0.02), and in the main they were present preoperatively. The rates of rebleeding (approximately 10%) and of death from rebleeding (approximately 5%) are lower than in other published series on the natural history of this condition. In cases in which antifibrinolytics are indicated, present evidence indicates that low-dose AMCA plus aprotinin seems to be a rational combination for lowering the rebleeding, ischemic complication, and post-SAH hydrocephalus rates.

Adult↗
PubMed1981

Occlusion of the internal carotid artery by intracranial tumors.

Occlusion of the internal carotid artery by an intracranial tumor occurs only rarely. Three such cases are reported here. All were parasellar tumors, 2 meningiomas and 1 pituitary adenoma. The occlusion was demonstrated by carotid angiography in all cases. The location of the tumor was demonstrated by a computerized tomographic (CT) scan in 1 case. These 3 cases were encountered in a neurosurgical series of over 4,500 brain tumors and 10,000 angiographic examinations during the period 1952 to 1979.

Adenoma↗
PubMed1981

The role of extracranial carotid abnormalities in the genesis of cerebral aneurysms.

The incidence of extracranial internal carotid artery (ICA) abnormalities, namely kinks, coils, and stenoses, was evaluated in a consecutive unselected series of 76 cases of single supratentorial saccular aneurysms submitted to bilateral carotid angiography. These patients were compared with a control group of 120 patients who had undergone either uni- or bilateral carotid angiography for causes other than cerebrovascular occlusive diseases or intracranial arterial aneurysms. Both groups had a total of 152 angiograms. Extracranial carotid abnormalities were significantly higher in aneurysm patients (p less than 0.001). Arterial kinks and coils were seen on 42 of 152 angiograms in the saccular aneurysm group and 17 of 152 in the control group (p less than 0.001); however, there was no significant difference regarding ICA stenoses (0.16 greater than p greater than 0.15). In the 76 aneurysm patients, abnormalities were mostly either located or more pronounced on the side opposite the aneurysm (in 22 as opposed to 11 on the same side, p less than 0.004). It is suggested that extracranial ICA anomalies have a role in the pathogenesis of intracranial arterial aneurysms, possibly by increasing the hemodynamic stress on the side opposite to the carotid lesion. The combination of the hydrodynamic theory, suggested by the present study, with other possible factors, might lead to a better understanding of the mechanism underlying development of human cerebral arterial aneurysms.

Adult↗
PubMed1980

Benign extramedullary foramen magnum tumors: diagnosis by computed tomography.

This paper reports two cases of benign extramedullary tumors of the foramen magnum studied by computed tomography (CT). The first case was a neurinoma; the second was a meningioma. Several different CT findings allowed a correct preoperative diagnosis of the location and nature of the tumors. In view of the invasiveness of traditional diagnostic methods and of the encouraging, although limited, experience of the present cases, the role of CT in the diagnosis of these lesions is promising.

Adult↗
PubMed1980

Nucleolar activity in differentiated cells after stimulation.

Initiation of nucleolar organizer region (NOR) activity was observed by using the silver staining method at various times after activation or stimulation of differentiated cells. Two methods were used: (1) activation of human lymphocytes by treatment with phytohemagglutinin (PHA), and (2) cell-cell fusion of chick erythrocytes with squirrel monkey cells. An increase in NOR activity in lymphocytes was seen as early as 4 h after PHA treatment and between 10 and 22 h in the chick erythrocytes after fusion. In both systems, as the size of the dormant cell nucleus increased, the amount of silver staining increased until the silver-stained area approached that of cycling cells.

Animals↗
PubMed1980

Giant cell tumors of the spine: a clinical study of six cases, with emphasis on the radiological features, treatment, and follow-up.

Six cases of giant cell tumor of the spine are reported. Based on cases reported in the literature and on their personal experience, the authors stress the difficulty of making a proper differential diagnosis between giant cell tumor and other giant cell variants (i.e., aneurysmal bone cyst and benign osteoblastoma) on the basis of the clinicoradiological findings alone. It is pointed out that the disappointing recurrence rate of about 50% for giant cell tumors in ordinary locations (such as the long bones) and in the sacrum is remarkably decreased when these tumors involve the movable part of the vertebral column; giant cell tumors above the level of the sacrum have a better prognosis. (Neurosurgery, 6: 29--34, 1980)]

Adolescent↗
PubMed1980

Benign extramedullary tumors of the foramen magnum.

This paper analyzes the clinical, diagnostic and surgical data of 18 benign extramedullary tumors at the foramen magnum extending into the posterior fossa and the spinal canal. These cases represent 30% of 60 foramen magnum tumors operated on between 1952 and 1978, among 4187 brain tumors and 587 tumors of the spinal cord. Foramen magnum meningiomas constitute 11 of this series (1.2% of 873 meningiomas, 113 of which were spinal). The considerable difficulty in early diagnosis is emphasized. However, in the present series, myelography showed positive findings in all cases, and angiography in most of them. CT scan, performed in one case, demonstrated the lesion. Surgical mortality was 11% (two deaths). On both patients who died after the operation, multiple surgical procedures had been performed because of erroneous diagnoses made in another unit. At the time of operation neurological symptoms were very advanced, and large tumors were located anteriorly. The review of the remaining patients showed a regression of preoperative symptoms with good to excellent results in all. No recurrences were recorded.

Adult↗
PubMed1979

Computed tomography in aneurysms of the vein of Galen.

Two cases of aneurysm of the great vein of Galen are reported. Diagnosis was made by means of computed tomography (CT) and confirmed by angiography. Surgical treatment was successful in one case; surgery was refused in the other case. The value of CT in the diagnosis of these malformations is stressed.

Brain↗