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Biomedical subjects

C A Pagni

Publications and source records attributed to C A Pagni.

At least 19 recordsLinked to original sources
PubMed1995

Propofol analgesia in central pain: preliminary clinical observations.

Propofol, an intravenous general anaesthetic, has been reported to relieve some forms of pruritus at subhypnotic doses. We assessed its effectiveness in 32 patients with several kinds of non-malignant chronic pain, in a placebo-controlled, double-blind study. We found that central pain, but not neuropathic pain, is at least partially controlled by propofol at subhypnotic doses, without major side-effects. In particular, allodynia associated with central, but no neuropathic, pain has been completely controlled. Propofol analgesia leads to renormalization of brain metabolism as seen on single photon emission computed tomography. We conclude that propofol may help in the diagnosis of central pain, particularly in unclear cases, and also in treatment. Possible mechanisms of action are discussed.

Adult↗
PubMed1995

Primary diffuse leptomeningeal gliomatosis with anaplastic features.

A case of primary diffuse leptomeningeal gliomatosis with anaplastic features, diagnosed during life and confirmed at autopsy, is presented. The clinical, radiological and pathological features are compared with those of the very few cases reported in the literature. Early papilloedema and hydrocephalus were followed by spinal and cranial nerve palsies. The NMR images and the tissue biopsy turned out to be useful for reaching an in vivo diagnosis. While in the previously reported cases the glial proliferation was microscopically a slow growing astrocytoma, the present case was histologically malignant and had a high labelling index (LIs) for proliferation markers (PCNA and KI-67). The high growth rate and the wide diffusion of the tumour at presentation may account for the poor prognosis of diffuse leptomeningeal gliomatosis and the inefficacy of radiotherapy and chemotherapy. The presence of basal lamina arount tumour cells and the immunohistochemical distribution of the proliferation markers are consistent with the origin of primary leptomeningeal gliomatosis from ectopic glia.

Biomarkers, Tumor↗
PubMed1995

Functional thalamic depression in a case of reversible central pain due to a spinal intramedullary cyst. Case report.

In this report the authors discuss a case of central pain of spinal cord origin due to a spinal thoracic intramedullary cyst. Single-photon emission computerized tomography with technetium-99m hexamethylpropyleneamineoxime showed thalamic hypoperfusion contralateral to the affected leg. Surgical evacuation resulted in total relief of the pain and normalization of the thalamic alteration. The reader can infer from these findings that functional alterations in thalamic processing may be important in the genesis of central pain.

Cysts↗
PubMed1995

Cordomyelotomy in the treatment of paraplegia pain. Experience in two cases with long-term results.

A new operation is described for the treatment of central pain of cord origin. This is termed cordomyelotomy, and differs from cordectomy in that it aims at saving all descending neural transmission conveyed through the lateral columns. Three cases have been treated, two with excellent results after more than 10 years. Cordomyelotomy is indicated in cases of paraplegia pain in which the paroxysmal component is predominant and the patient is both paraplegic and without sphincteric control.

Adult↗
PubMed1994

Spinal intramedullary cavernous angiomas: a literature meta-analysis.

The present report reviews 57 (out of 65) cases of spinal intramedullary cavernomas collected from the literature, plus one personal patient. Almost 70% of all patients were women. Mean age at diagnosis for women was 36.4 years, with a peak in the third decade. More than three-fourths of all women became symptomatic between the second and fourth decades, with a peak in the fourth decade. Unlike in men, cervical and thoracic lesions are almost equally represented, generally involving 1-2 vertebral levels. Mean size at diagnosis is 1.7 cm; no enlargement over time was seen. Symptoms are more frequently acute; pain and sensorimotor deficits are the usual complaints, but the clinical picture may simulate that of multiple sclerosis. The duration of history was less than 5 years in more than 80% of women. Bleeding was seen in 60% of women, with a risk of 1.6%/person-year of exposure globally. Cervical lesions have both a shorter course and increased frequency of bleeding. If not immediately recognized, repeated cycles of bleeding are the norm, with a mean interval of 39.6 months between the first and second episodes. The preoperative status was the single most important factor bearing on outcome, whereas sex, age, size, location, duration of history and extent of removal were not. Magnetic resonance imaging was diagnostic in all cases, whereas angiography was 100% negative. Surgery should not be a necessary first option, as recovery from the first bleeding is apparently fairly frequent.

Adolescent↗
PubMed1994

Spinal dural arteriovenous fistulas: an underestimated cause of myelopathy.

13 patients with spinal dural arteriovenous fistulas (DAVF) diagnosed in our Institution have been the object of this study. The necessity to include the disease in the differential diagnosis with other pathologies affecting the lower thoracic cord, particularly in middle-aged and old males, is emphasized. Involvement of the spinal cord was always demonstrable on magnetic resonance studies, but pathologic vessels suggesting the possibility of DAVF were seldom recognizable. Myelography still remains an important complementary method. Spinal angiography is essential, taking into account that the fistula can be located far from the spinal cord. The therapy consisting in embolization in 7 cases and embolization associated with surgery in 6 cases led to improvement or stabilization of the disease in all cases. Our cases are discussed in comparison with the literature.

Adult↗
PubMed1993

Pain, muscle spasms and twitching fingers following brachial plexus avulsion. Report of three cases relieved by dorsal root entry zone coagulation.

Three patients who, following partial brachial plexus avulsion, experienced pain, involuntary finger twitching and muscular spasms are reported. Two exhibited cutaneous trigger zones, stimulation of which exacerbated their pain; changes in emotional tone aggravated both the pain and the spasms. Pain would appear to be due not only to deafferentation and scarring of the dorsal horn, but also to an afferent pathological barrage from partially damaged dorsal roots. The pathological sensory barrage may activate metameric interneuronal circuits and produce involuntary movements. Exacerbation of both the pain and the spasms can be explained on the basis of intrinsic properties of these ectopic pacemakers.

Adult↗
PubMed1993

Chromosome 22 monosomy in a radiation-induced meningioma.

We report for the first time on the cytogenetics of a radiation-induced meningioma, in a patient without neurofibromatosis. Chromosome 22 monosomy was found in more than 50% of the cells examined. These findings seem to suggest that the same kind of chromosomal aberrations are found in both "idiopathic" and radiation-induced meningiomas and that a common etiopathogenetic mechanism might be at work in meningiomas of whatever origin.

Chromosomes, Human, Pair 22↗
PubMed1993

The thalamocingular loop: recordings from the past.

It has been shown recently that a portion of the cingular cortex (area 24) is involved in the perception of pain. Older electrophysiological studies in neurosurgical patients, which could not be explained on the basis of previous anatomical data, support this notion.

Gyrus Cinguli↗
PubMed1993

The role of cortex in central pain syndromes: preliminary results of a long-term technetium-99 hexamethylpropyleneamineoxime single photon emission computed tomography study.

The role of the somatosensory cortex in central pain syndromes is widely questioned. Two recent position emission tomography studies detected a strong activation of the parietal and cingular cortices after brief nociceptive stimuli. On the other hand, a recent single photon emission computed tomography study found no cortical activation in five patients affected by central poststroke pain and algodystrophia. In this study, we present the single photon emission computed tomography findings in five patients suffering from central pain syndromes. Two of these, one with facial postrhizotomy anesthesia dolorosa and the other with central poststroke pain, showed a decrease of blood flow in the parietal lobe, further decreasing after stimulation by nonpainful maneuvers. Our results suggest that somatosensory cortical areas might be involved in the generation of anomalous pain states in some cases of central pain syndromes.

Adult↗
PubMed1993

The origin of tic douloureux: a unified view.

An hypothesis on the mechanism of pain attacks in trigeminal neuralgia is presented. It is based on the analysis of clinical characteristics and pathology of a series of 278 cases submitted to different methods of treatment, and on physiological data of the literature. The hypothesis is that trigeminal neuralgia is a sort of sensory reflex epilepsy. The posterior root, damaged and distorted by a vessel or compressed by other lesions shows demyelination, micro-neuromas, and so on. At the site of this chronic damage ectopic impulses and afterdischarges are generated; the gasserian ganglion cells too give rise to spontaneous impulse generation. Owing to this chronic anomalous afferent barrage, an epileptic subliminal focus is "kindled" in the trigeminal nucleus. The pain paroxysms develop when this subliminal activity is driven in prolonged seizure discharges by peripheral (trigger zone stimulation) or other (not perceived) afferences. Clinical characteristics of the attacks (triggering by innocuous stimulations; persistence of pain after stimulus stops; diffusion of pain outside the stimulated division; refractory period after each paroxysm; increase in frequency of the attacks up to an epileptic-like status; sensibility to carbamazepine and phenytoin) and recurrence following diverse procedures are discussed on the basis of experimental research in reflex epilepsy and "kindling". If this hypothesis is true, the treatment of choice of trigeminal neuralgia should be a direct approach to the posterior fossa in order to relieve neurovascular compression which, in more than 75% of the cases, is the causative factor of the disease.

Adolescent↗
PubMed1993

Selective expression of the Met/HGF receptor in human central nervous system microglia.

The c-MET proto-oncogene encodes the tyrosine kinase receptor for hepatocyte growth factor (HGF), also known as scatter factor, a powerful mitogen and motility factor for epithelial cells. We now show that the two previously described forms of the Met/HGF receptor, the intact p190MET and the truncated p140MET, are expressed in physiological conditions in the human central nervous system (CNS). The receptors were identified by Western blot analysis with monoclonal antibodies directed against different epitopes. By immunohistochemical staining the Met/HGF receptor was found to be expressed in a homogeneous cell population, equally distributed between the grey and the white matter, showing morphological features and immunochemical markers specific for the resident microglial cells. These data suggest a possible role for the c-MET proto-oncogene and HGF in microglial reactions to CNS injuries.

Antibodies, Monoclonal↗
PubMed1992

Spinal intramedullary subependymomas: case report and review of the literature.

A cervical spinal intramedullary subependymoma in a 53-year-old man is reported, and the relevant literature is reviewed. Spinal cord subependymomas seem to follow a benign course. Radiotherapy should not be administered to these patients. Magnetic resonance imaging, even with enhancement, is not able to distinguish between a subependymoma and the more common ependymoma.

Ependymoma↗