Biomedical subjects
Publications and source records attributed to F Servadei.
The authors report the case of a patient with an apparently minor head injury in whom broader indications for computed tomographic (CT) scanning allowed the early detection and treatment of an acute bilateral extradural hematoma. CT scanning of adult patients with linear skull fractures should be done whenever possible.
Spontaneous epidural haematomas are rare at any level of the spinal canal. The radiological diagnosis is usually made by myelography and in a few reported cases by computed tomography (CT). We describe a patient in which the final diagnosis was possible only with Magnetic Resonance Imaging (MRI). Surgical evacuation resulted in partial recovery of an already four days existing complete paraplegia. It is stressed that MRI is the most useful examination to differentiate haematomas from other spinal epidural lesions and that an operative evacuation of a spinal epidural haematoma is indicated even if the patient comes after a complete paraplegia has developed.
Six cases of capillary haemangioblastoma involving the brain stem are presented. Some clinical and pathological peculiarities of this series are outlined. Four patients (two operated radically) showed good or excellent outcome, whereas two (one partial and one complete removal) died shortly after the operation. The chances of direct surgical approach in brain stem haemangioblastomas are considered and the pertinent literature summarized.
The authors present a series of 129 patients with "pure" traumatic cerebral lacerations, i.e. not associated with other intracranial lesions (especially haematomas) which by their presence alone can play a primary role in affecting clinical course and prognosis. Twenty per cent of the patients presented a lucid interval, thus confirming the nature of the laceration as a true expanding lesion, increasing in size in the post-traumatic period. Age, GCS score and neuroradiological findings were investigated in view of the eventual outcome. Follow-up examination confirmed that age and level of coma on admission, together with the degree of ventricular shift and presence of bilateral skull fractures, were all factors of statistical significance in affecting prognosis. Lacerations in the temporal area were associated with the poorest prognosis, and highest incidence of neurological focal deficits and residual parenchymal damage on CT control.
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The authors studied 24 patients affected by anaplastic gliomas in regard to the killer (Antibody-Dependent Cellular Cytotoxicity) and natural killer (Spontaneous Lymphocyte-Mediated Cytotoxicity) immunological functions, by counting the Cr51 release in Change liver and K 562 cell cultures, respectively. These parameters were also evaluated in 24 healthy donors as control, in 24 patients affected by bladder cancer and in nine cases of kidney cancer. Our data show, pre-operatively, a statistically significant impairment of ADCC and SLMC activity in glioma patients as compared both with controls, bladder and kidney cancer patients. The particular impairment of K and NK functions in gliomas is discussed with regard to the specific features of Central Nervous System malignancies. An improvement of ADCC activity was also found in the post-operative samples. This finding confirms other reports about partial restoring of altered immunocompetence after surgery, suggesting a link between extention of tumor mass and impaired immunological reactions.
A case of spinal meningocele is reported in which erosion of adjacent vertebral bodies and stretching of some roots coexisted. The neurological picture cleared after neurolysis and repair of the anterior thecal continuity.
The authors studied 24 patients affected by anaplastic gliomas, as regards immunology. In all of them the authors evaluated the lymphocyte subpopulation (B and T), firstly by simple lymphocyte count, secondly by studying the rosettes E-total and EAC, thirdly by stimulating the lymphocytes with mitogens phyto-haemoagglutinin-P (PHA), concanavalin A (Con A), and pokeweed mitogen (PWM), and lastly by counting the release of Cr51 in Chang liver cells culture in order to obtain antibody dependent cellular cytotoxicity (ADCC). The parameters were also evaluated after surgery and during conventional radio-chemotherapy with BCNU. Whereas the so-called B-pool seems to be unaffected, the preliminary results show that the T-pool (identified by the E-t rosettes and by responses to PHA, PWM, and ConA) is depressed to a statistically significant degree, if compared with a control group. This depression seems to be related to the tumoral mass, and it is not increased by radio-chemotherapy. In addition, ADCC also seems to be depressed in our glioma patients in comparison with a control group and witha group of bladder cancer patients.
A case of extrathecal cavernous hemangioma, a rare entity, is presented. Some clinical, radiological, and histological features of the lesion are discussed. The unusual dumbbell-like growth of the tumor through an intervertebral foramen is considered, as well as the potential effectiveness of radiation therapy. The literature dealing with spinal hemangiomas and hemangioblastomas is summarized.
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This paper describes two patients with traumatic aneurysms of the supraclinoid internal carotid artery, which occurred after a closed-head injury and without demonstrable basal skull fracture. In the first case, the traumatic origin of the aneurysm was demonstrated by repeat angiograms. The second case documents the formation of a giant, traumatic, true aneurysm of the supraclinoid carotid artery over a period of less than 2 months; there was an associated traumatic partial occlusion of the vessel proximal to the aneurysm. The mechanisms of injury of the supraclinoid carotid artery are discussed.
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An immunological study about the lymphocytes of nineteen patients affected by glioblastoma has been executed by using CML and ADCC tests. Eleven healthy subjects and nine ones affected by bladder carcinoma have been studied for control. The CML test has demonstrated an increase of citotoxic activity of lymphocytes in the totality of the patients affected by glioblastoma (37,09 +/- 3,67)% versus (4,00 +/- 1,78)% of controls. The ADCC test has demonstrated diminution of citotoxic activity of lymphocytes of the patients affected by glioblastoma in comparison with controls (20,57 +/- 9,77)% versus (29,18 +/- 6,67)% of the healthy controls versus (27,66 +/- 8,51)% of bearers of bladder carcinomas.
Two cases of recurrent anterior spinal meningocele are presented. Both cases were studied by CT. One of them was also investigated by ultrasonography. The value of these methods in the diagnosis of anterior spinal meningoceles is discussed.
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This report describes the evolution of techniques of spinal surgery developed for the treatment of spasticity of varied etiology and further describes application of a T-shaped dorsal longitudinal myelotomy to five patients. Additionally, a losenge-shaped griseotomy was performed on three patients. Both techniques led to the elimination of hypertonicity and painful spasms, without producing sensory deficits. Although all procedures are performed at lumbar levels, some patients showed reduced spasticity in the neck or upper extremities as well.
From January to June 1986, 158 patients with extradural haematoma were admitted to our neurosurgical unit. They were divided into four groups, reflecting their clinical features: A. 46 cases (GCS less than or equal to 12) in whom a condition of coma/stupor had occurred at the time of injury and persisted to the time of surgical decompression; B. 41 cases showing deterioration of consciousness (GCS less than or equal to 12) after a lucid interval; C. 46 cases of 'asymptomatic' patients (GCS consistently greater than or equal to 13, no neurological deficits, no signs of increased intracranial pressure); D. 25 cases arriving at our unit in a conscious state, but restless and/or with neurological deficits. The location of the haematoma (temporal in only 35%), the incidence of associated lesions such as cerebral lacerations and/or subdural effusion (30.3%), and the age of the patients (28.4 +/- 18.4 years were similar in the four groups. The size of the haematoma and the displacement of the midline structures were significantly greater in comatose/stuporose patients (groups A and B). The overall mortality was 12% (19 patients), with a morbidity of 14% (22 patients). Factors statistically significant in determining mortality and morbidity were: degree of coma as assessed by GCS; displacement of midline structures: age of the patient; size of the haematoma. There was no mortality or morbidity in those patients who remained conscious (groups C and D). A pronounced increase in the number of CT examinations performed in patients with head injury in our area of referral has caused profound changes in the population of patients admitted to our centre, resulting in a greater proportion of extradural haematomas detected in patients who are still conscious, and in whom operative mortality and morbidity are negligible. One further therapeutic implication of the increase in the number of patients with EDH admitted while asymptomatic may be the option of conservative management in those patients who remain in a good clinical condition, with haematomas of less than 1 cm in thickness and no displacement of midline structures.
A study of head injuried patients was carried out in the smallest nation in the world (Republic of San Marino) from January 1981 to December 1982. The results show an epidemiological incidence of 468 cases/10(5) population/year in regards to Hospital admissions, whereas the cases are 694/10(5) population/year when taking into account also patients seen only by Accident and Emergency Department. The consequences of the head injury (Post Traumatic Syndrome, PTS) were studied in 187 patients having comparable features on admission and discharge, and being all residents of the Republic of San Marino. Factors significant in determining a PTS seem to be a history of previous head injuries, the presence of previous neuropsychiatric disturbances and an abnormal E.E.G. on admission. The time of onset of the syndrome, associated with the above mentioned factors, can be important in determining whether the PTS is of neurotic or organic origin.