Biomedical subjects
Publications and source records attributed to D Riva.
The theoretical advantages of microsurgery guided by volumetric reconstruction of anatomy in stereotactic space, compared to traditional technique are discussed. Preliminary clinical results in 30 cases and technical considerations, concerning future developments, are presented.
8 long-surviving children, treated for medulloblastoma with combination radiotherapy and chemotherapy after surgery were examined in order to assess general intelligence, immediate attention and prolonged attention. Their siblings or first cousins were selected as controls. The children with medulloblastoma performed significantly worse than their peers, both in intelligence tests and attention tests. A trend towards a positive correlation between age at the start of treatment and IQs was confirmed in our study, while there was no evidence of a correlation between IQs and time elapsed from therapy. The role of chemotherapy, radiotherapy and their combination effect in producing neuropsychological sequelae is discussed.
Neuropsychological impairment after removal of posterior fossa tumors is a recurrent issue in child neuropsychology and neurosurgery. The aim of this study was to assess verbal and performance intelligence, as well as immediate and sustained attention, in children with medulloblastoma or astrocytoma operated on for total removal of the lesion. Surgical treatment of medulloblastoma was always followed by chemoradiotherapy. Siblings of both tumor groups (without a history of neurological disease, even suspected) were examined as controls. The results were as follows: the cognitive performances were significantly poorer than the controls in both groups; the children with medulloblastoma scored below normal. Attention deficits were present in both groups as well when the usual clinical tests were used. When assessed by means of computerized methodology, the same function was normal. Considering that both groups of children underwent the same surgical treatment and all had hydrocephalus, the severe intellectual impairment reported only in patients with medulloblastoma can be ascribed to chemoradiotherapy. In contrast, the attention deficits present in both groups could be ascribed to the proximity of lesions to the ascending activating system. Malfunctioning of the activating system seems to be bypassed by the computerized administration of stimuli, which supplies motivation and kindles attention.
Forty-eight children with unilateral cerebral lesions, incurred before or after the first year of life, were given the Wechsler Intelligence Scale for Children, with an average delays of 4 and 8 1/2 yr for the late and early injuries, respectively. Thirty-one of their siblings were chosen as controls. Results are as follows: early and late right-hemisphere lesions significantly lower only Performance IQ. Early left lesions impair equally Verbal and Performance IQ, while late left-hemisphere lesions do not significantly affect Verbal or Performance IQ relative to controls.
208 children, male and female, aged 6 to 12 years, grouped in 6-month steps, were tested for three spatial skills: two basic abilities, recognition of two lines of differing slope and of one line of differing slope in a frame and with no frame, and one more complex skill, route-finding by means of maps. The results support the hypotheses of neuropsychological development according to which the hemisphere strategies used in the course of cognitive development for the handling of spatial tasks differ by sex and may change before and after the age of ten.
The Authors carried out a random double-blind trial on 30 patients affected by idiopathic urge incontinence with oxybutynin chloride (15 mg/die) and placebo for two 20 day therapeutical cycles. The 24 patients who completed the trial oxybutynin chloride induced statistically significant effects--compared to placebo too--both on the subjective symptoms (reduction or disappearance of the urgency in 14 cases - 60.8% - and of urge incontinence in 16 cases - 76.1%) and on the objective symptoms showed by cystomanometry (increased bladder capacity at the FD and VSD in 14 and 15 cases, respectively; absence of involuntary contraction in 9 cases and normal or reduced detrusor pressure at the VSD in 13 out of 16 cases). Improvements, though less significant, were also obtained with the placebo.
Cerebral commissurotomy is a well established procedure in the treatment of epileptics refractory to drug therapy. Breeching of the ventricles in complete commissurotomy carries a certain morbidity. This has led others to perform operations in which the entire corpus callosum or only its anterior portion with or without the anterior commissure were sectioned. Sectioning of the anterior corpus callosum alone is justified by: a) frequent appearance in patients of seizures attributable to a frontal focus, b) clinical and experimental evidence that frontal discharges spread across the corpus callosum leading to subsequent generalized its, c) the attempt to understand the mechanisms involved in generalized seizures, d) even further reduced surgical morbidity and neuropsychological disability. Five epileptics were submitted to anterior callosotomy. The seizures in all of them suggested a frontal focus and consisted of absences, adversive, tonic, atonic, and tonic-clonic attacks. All patients were incapacitated by the frequency of seizures. Their EEGs showed paroxysms of bilateral synchronous slow spike and wave with uni-, or multiple (including bilateral symmetrical) focal accentuation. In two patients there were additional independent temporal lobe discharges. Neuropsychological evaluation showed cognitive deficits caused by inattention paroxysms and absences. After anterior callosotomy there was marked reduction in frequency of all types of seizures, the greatest improvement being in the reduction of frequency of absences. There was a marked decrease in physical, social and neuropsychological disabilities.
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We report a case of Lennox-Gastaut-type epilepsy that was followed for 3 years. The patient showed typical EEG findings and later a parietotemporal astrocytoma (type II) on the left. Removal of the tumor was followed by recovery of the child and disappearance of EEG epileptic elements.
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