Biomedical subjects
Publications and source records attributed to F Faccioli.
Leiomyoma of the urethra is a small, benign and extremely rare tumor of mesenchymal origin. To date, about thirty cases have been reported in the literature. A case of leiomyoma of the urethral meatus that had been incidentally discovered is described. The anatomopathological aspects are presented and the clinical and therapeutic problems are discussed.
Spontaneous electrical activity (EEG) and event-related computer averaged brain electrical potentials (EPs) are becoming an integral part of CNS function monitoring in neurological intensive care patients. EEG monitoring using the compressed spectral array (CSA) computer analysis offers continuous information about cerebral electrical activity, permitting an accurate definition of the severity of brain injury, forecasting patient's course, and early detection of secondary intracranial changes. It offers more precise indications for treatment and prognosis. Combining EEG with multimodality EPs permits a finer diagnosis of the location and extent of CNS damage and contributes information, not otherwise obtainable, on the integrity of CNS pathways. Changes is electrophysiological patterns are often related to changes in other physiological parameters or events affecting the patient. Consequently, it appears advantageous to monitor simultaneously other CNS and body functions and record, process and display the data obtained in the patient care area. To make this comprehensive monitoring system reliable and useful, a wise application of advanced computer technology and a high degree of understanding of intracranial dynamics are required.
The cervical laminectomy is usually applied in the treatment of cervical myelopathy caused by cervical canal stenosis and multiple spondylosis. Nevertheless, late complications are often reported, especially scar formation, the so-called laminectomy membrane, between the dura and overlying paraspinal muscles, which, compressing the cord, reduces until to abolish the favourable effects of the previous laminectomy; moreover, malalignment of the cervical spine with secondary kyphosis may follow an expansive laminectomy. In order to avoid these complications, in 1977 Hirabayashi introduced a new surgical technique, the "expansive open-door laminoplasty", which permits the enlargement of the spinal canal over multiple segments by completely incising the laminae laterally on one side and partially on the opposite: elevation with tilting of the laminae upward in the incised side, allows enlargement of the canal. The Authors describe in detail the operative procedure and report their experience in 10 patients.
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To obtain continuous information about the cerebral electrical activity in the early course of coma, an apparatus was designed which included a small fast computer capable of calculating the Fourier transform. The practical application of this system of CSA to 123 comatose patients in a neurosurgical intensive care unit overcame the technical difficulties connected both with the patient's and environmental conditions. The advantages of such a technique are mainly due to its capacity of synthetising EEG signals and to its clarity of presentation, which is easily grasped even by people not specifically trained in electroencephalography. Hours of EEG activity are compressed into a pictorial and synoptic representation that shows in real time the distribution and temporal behaviour of frequencies as well as the intensity of total electrical activity. The immediate detection of these parameters permits evaluation of any worsening or improvement of cerebral electrogenesis, as well as of the inter-hemispheric asymmetries at their onset. EEG monitoring thus provides useful elements for assessing the comatose state in individual cases and for adjusting treatment. Finally, the spectrographic aspect of the first 48 h, as a whole, carries a great prognostic significance. The most striking finding from this study was the confirmation that the comatose states that, in their early course, show only a fixed slow-wave EEG activity are far more rare than those that display an electrical activity changing in time.
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Eight patients with acute spinal cord injury at different levels were treated by local cooling. Early laminectomy was performed and the subdural space was irrigated with saline at 5degreesC for about two hours. In addition to this treatment, five patients, after closure of the operative wound, received local epidural cooling that was prolonged for a few days. All patients before treatment had a complete loss of function of the spinal cord below the injured segment. Four of these regained some sensory and motor functions and two were able to walk. Somatosensory cortical evoked responses were consistent with the results obtained, thus demonstrating their prognostic value. The clinical application of local spinal cord hypothermia in order to minimize the catastrophic effects of spinal cord trauma is discussed. The results obtained in these eight patients agree with the several experimental observations and seem to justify the application of this procedure to human beings.
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This study concerns 1600 post-traumatic acute comas, who underwent combined clinical and EEG examinations. The EEG has been recorded accurately bedside several times a day throughout the acute stage. The obtained EEG patterns, generally considered to be polimorphous and extremely variable, can be classified into five basic groups corresponding to progressive deterioration of the cerebral electrogenesis: borderline, changeable, sleep-like, monotonous and silent. Borderline, sleep-like and changeable patterns, even though they indicate a varying degree of impairment of cerebral electrogenesis, prove nevertheless that the brain is capable of elaborating physiological rhythms and of modifying its activity in a spontaneous or evoked manner. True slow monotonous activity indicates an extreme degree of cerebral impairment; flattening, up to EEG silence, indicates the onset of brain death. Focal slowing and/or flattening, which often lacks surgical significance, is not considered in this classification. Focal or generalized irritative activity in the early stages, however, indicates a more severe condition. EEG has often proved to be an useful means supporting the diagnostic and prognostic value of clinical examination.
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Nowadays, extradural vertebral neoplasms which compress the spinal cord are being diagnosed earlier and therefore laminectomy for decompression relieves many patients of their neurological deficits before permanent cord damage has set in. In addition, radiotherapy and oncological treatment have prolonged life expectancy as well as the quality of life in these patients. As the indications for surgery have grown, the problem of spinal instability resulting from direct involvement of the supporting structures of the spine or due to the surgical procedure per se, must be considered. Many of these patients would rapidly return to leading their normal activities if not confined to bed rest or uncomfortable orthopedic devices. The Authors present 9 patients with extradural vertebral lesions: 4 plasmacytomas, 3 metastatic carcinomas, 1 malignant lymphoma and 1 aggressive osteoblastoma treated by simultaneous decompression and stabilization of the spine. All patients showed remarkable improvement of neurological symptoms except in one case where massive pulmonary embolism caused death a few hours after surgery. This surgical treatment offers the advantages of performing wider and better decompressive maneuvers and, at the same time, assuring fast mobilization of the patient after surgery who is often in poor general conditions, thus reducing post-operative complications due to delayed physical therapy and bed confinement.
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