Biomedical subjects
Publications and source records attributed to D Fiore.
The authors expose the CT findings of primitive hepatic neoplasms. There are emphasized the usefulness of CT in detecting hepatic tumors and in the evaluation of its extension. The actual role of angiography in the evaluation of primitive hepatic diseases is stressed.
A retrospective appraisal of traditional neuroradiological techniques (such as direct röntgenograms, cerebral angiography RISA-cisternography, and pneumo-cisterno-encephalography, as opposed to the "new" technique of computer-assisted tomography) was carried out in a series of 82 cases of opto-chiasmatic arachnoiditis, all surgically verified. It is concluded that none of these examinations can provide a reliable diagnosis of opto-chiasmatic arachnoiditis, which preoperatively can only be a tentative diagnosis that becomes final only when confirmed by surgical findings. In the presence of certain progressive neuro-ophthalmological symptoms and signs, a negative neuro-radiological investigation should not deter the neurosurgeon from exploring the chiasmatic region. Computer-assisted tomography, of which the authors have no personal experience in these cases, may hold the future answer to the diagnostic problem.
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The so called colloid cyst of the third ventricle is believed to originate from the neuroepithelium in the diencephalic roof. The diagnosis is notoriously difficult and contributes significantly to the high mortality. A case in an eleven-year-old boy is reported. Computed tomography, also because not invasive, is chiefly indicative in this lesion, reducing the overall mortality.
Three cases of an infrequent cerebral vascular malformation, venous angioma, are reported. The first 2 of these cases, with the lesion in a supratentorial location, exhibited exophthalmos as a presenting symptom, together with palpebral or intraobital angiomatous formations, and also impairment of visual function. The first patient was operated upon and the "venous angioma" could be confirmed histologically. An angiographic follow-up of the same patient at an 18 year interval was also possible. The diagnostic work-up to be performed in cases of exophthalmos is discussed and the need for angiography is stressed.
The chest roentgenograms of 691 normal, arteriosclerotic and hypertensive patients have been reviewed for measurements of the aortic knob. There is a significant correlation between the width of the aorta and age, but no such correlation was found with the degree of hypertension. The comparison between average widths of the aorta in the 3 categories of subjects has shown its increase in arteriosclerotic and hypertensive patients.
A phonomecanocardiographic study in 33 patients who had undergone aortic valve replacement with a glutaraldehyde-preserved Hancock bioprosthesis, has been carried out 6 to 42 months after surgery. All xenografts were considered well functioning on the basis of clinical, electrocardiographic and radiographic evaluation. Typical phonocardiographic features of a well functioning porcine heterograft in aortic position were considered 1) an opening snap of variable intensity recorded in about 50% of the patients; 2) a normal closing sound; 3) a protosystolic ejection murmur which was always present and whose intensity was inversely related to the prosthesis size; and 4) the absence of a diastolic murmur. The anatomical and functional characteristics of the aortic valve of the pig are suggested to explain both the absence of a diastolic murmur and the pattern of the closing sound, which is undistinguishable from that of a normal aortic valve. Moreover, the reduced pliability of the right coronary cusp of the porcine valve, due to the muscular shelf at its base, with consequent limitation of the effective prosthetic orifice and relative stenosis of the device correlates well with both the opening snap and the sytolic ejection murmur.
Phonocardiographic examination was carried out in 40 patients who had undergone to aortic valve replacement with the Björk-Shiley prothesis. The regular function of the prothesis was evaluated on the basis of the physical, radiological and electrocardiographic data. In the majority of the cases the first sound was slight. The prosthetic closing sound was made of two components (a2, A2) and the opening sound by one or more components (C1, C2, C3). A sistolic aortic murmur was always present, and a diastolic murmur has been found in 20% of the cases.
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42 patients who had undergone aortic valve replacement with the Lillehei-Kaster prosthesis were studied. Phonocardiographic and physical examinations were carried out on these patients to determine the typical auscultatory pattern of this prosthesis. In the majority of the cases, the first sound was slight. The second sound was made up of two components, both produced by the artificial valve. A prosthetic opening sound was also detected. Moreover, a sistolic ejection murmur was present in all of the patients, and a diastolic murmur in 25%.
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Seven cases of adhesive arachnoiditis of the optochiasmatic cistern, verified surgically, with a history of head injury are presented. Neuroophthalmologic findings consisted of impairment of visual acuity and funduscopic atrophy rather than papilledema. The visual fields showed a damage of the periaxial rather than the axial type. Neuroradiologic examinations did not consistently give the findings considered classical of optochiasmatic arachnoiditis. Surgical lysis of the adhesions has given an improvement of the visual function, or at least an arrest in its impairment, in almost all cases. It is thought that these cases still present some valid indications for neurosurgical exploration of the optochiasmatic region.
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Only 9 oncocytic neoplasms of true adrenal origin have been described to date. It therefore seemed of interest to study the histochemical and ultrastructural features of a non-functioning monolateral adrenocortical oncocytoma which was incidentally detected by ultrasonography and magnetic resonance imaging in a 28-year-old woman. The tumor was round, well encapsulated and weighed 73 g. It consisted of islets of eosinophilic cells, and did not display any sign of necrosis. The proliferation rate (as evaluated by mitotic index and percentage of MIB-1 Ki67 positive cells) was low, and atypic mitoses were absent; some rare cells with nuclear atypias were observed and the capsule was focally invaded by oncocytes. Immunocytochemistry did not show expression of vimentin or cytokeratin. The oncocytes had an abundant cytoplasm packed with mitochondria containing plate-like cristae. Smooth endoplasmic reticulum was virtually absent, while rough endoplasmic reticulum cisternae and free ribosomes were abundant. Although the classic histological approach clearly indicates the benign nature of the tumor, the immunocytochemical and ultrastructural features of oncocytes may suggest their potential for malignant behavior.
The specific local and humoral immunological situation of the child, by permitting or not (+/- specific IgA-S) the passage of the Bordetella toxins to the bloodstream and the formation or not (+/- specific circulating IgG) of Circulating Immune Complexes (CIC), brings back to Type III Immunoreactions the pathogenesis of the pertussis encephalopathy and the reactions provoked by intramuscular vaccine. Since the antihistaminics and antiserotoninics can prevent the CIC precipitation, the Author believes that this would imply the indication to the usage of antihistaminics or antiserotoninics to prevent bot the neurologic complications of the illness and the systemic reactions to the intramuscular vaccine.