Biomedical subjects
Publications and source records attributed to L Ferrante.
A case of double unruptured intracranial aneurysm associated with aortic coarctation is presented. The main characteristics of the unusual association, the diagnostic criteria and the surgical strategies are reviewed.
Reporting 32 cases of medulloblastoma in patients aged 17 to 65 years and reviewing the major case-series in the literature, we analyze the clinicobiological and diagnostic features and treatment of this tumor in adulthood. We consider some factors that seem to have a favorable bearing on the prognosis: female sex, length of clinical history, tumor size, hemispheric site, and total removal followed by radiotherapy. We then discuss the differences in tumor behavior between adulthood and childhood that emerged from the comparative analysis.
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We use the term "occasionally-occurring familial brain tumours" (OFBT) to designate cases in which more than one member of a family presents a brain tumours outside the range of the clinical syndromes in which CNS cancer heredity is well established. We report our experience of OFBT and review the published work on such cases with special reference to some clinicobiological concordances among affected families. On the evidence we present and on that of several genetic and epidemiologico-statistical studies we are inclined to think that there are genetic factors predisposing to the onset of OFBT.
The incidence of neurological deficits in achondroplastic subject is by no means negligible. We considered the clinico-radiological and therapeutic data of 35 achondroplasic patients (5 personal cases and 30 published in the available literature) harbouring myelo-radicular deficits related to narrowing of thoraco-lumbar canal. There was no significant sex prevalence. The clinical symptoms appear most frequently in the III or IV decades of life. Actually morphological anomalies of the spinal canal are already present at birth in achondroplasic dwarfs, and signs of cervical cord involvement are not uncommon in achondroplasic children. The delayed occurrence of clinical symptoms related to narrow toracho-lumbar canal may be explained by the pathogenetic role of acquired cofactors as prolapse of intervertebral disks and for degenerative spondyloartrosis. The clinical history is usually of insidious onset. Most frequent symptoms are motor weakness of the lower limbs (82.8%) and low-back pain (77.1%). Sensory and/or sphincter disturbances appeared to be less frequent (about 40% of the examined subjects). Plain X-rays, myelography, CT, CT-myelography and MRI are the diagnostic examination of choice. Surgical treatment consists of anterior decompression with fusion, when thoraco-lumbar kyphosis is prevalent, and/or posterior decompression, when the symptoms are mainly caused by canal stenosis. From the prognostic point of view, two groups of patients are recognized, in relationship to the presence of marked dorsal kyphosis. Those with kyphosis showed almost invariably poor functional results. In the remaining ones the results were satisfactory, provided that the clinical history lasted less than 3 years and the symptomatology was not already too advanced.
The Authors present one case of choroid plexus papilloma localized in the third ventricle. This is in fact the only case in a series of about 4,000 patients operated on for brain tumors at the Neurosurgical Institute of the University of Rome. They consider 56 cases reported in the literature. Out of these, 43 are described and summarized in a table according to the clinical, radiological and surgical features. Twentyfive were the patients operated on, the average mortality in the cases which underwent indirect or not specified operation was 80%; that of patients submitted to a direct approach or to subtotal excision was 50%; and finally 3 patients out 13 (about 23%) who had total resection, died after surgery.
Arachnoidal diverticula are a rare complication of spinal surgery and occur most often at lumbar level, especially after discectomy. We report a case of lumbar arachnoidal diverticulum that arose two years after an L4-L5 discectomy and presented clinically with low back pain and sciatic pain and neurological deficits. We analyze the etiopathogenesis, clinical and radiological features and treatment.
The Authors report a case of intracranial meningioma in two sisters, with no evidence of neurofibromatosis. A study of the karyotype has been performed; in one patient we have found a pericentric inversion of one chromosome 9. The possible role of the genetical factors in the develop of familial meningiomas is discussed.
The Authors report 2 cases of recurrent cystic meningiomas among 22 cases operated on. After a review of the literature, the pathogenesis of the recurrences of these tumors is discussed, concluding that wrong interpretation of neuroradiological examination and/or incomplete extirpation of tumoral capsule are the main factors responsible of recurrences of cystic meningiomas.
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The authors report a case of two sisters affected of intracranial meningioma, with no evidence of von Recklinghausen's disease. A study of the karyotype has been performed in the patients and in their family; in one sister we have found a pericentric inversion of one chromosome 9. The possible role of the chromosomal abnormality in the develop of familial meningioma is discussed.
It has been reported a case of intraventricular cysticrecosis of the fourth ventricle. The Authors discuss the utility of CT iodoventriculography with reference to the diagnosis of such disease.
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The Authors report a case of acute, apoplectiform, multiple sclerosis, with right hemiparesis and severe motor dysphasia. The way undertaken to arrive to the diagnosis of demyelinating disease is discussed, with special attention to the importance of a multiple diagnostic approach, analysing the sensitivity and the limits of the instrumental methods actually available.
Six cases of Cortical Hyperostosis (C.H.) are presented. The clinical and laboratory features of the disease seem to be related to age at onset. In fact, our cases with a later onset (after the first year of life) are characterized by: a) a longer duration of the disease and a particularly high frequency of relapses; b) the absence of any sign of mandibular involvement; c) the presence of eosinophilia (700-1300/mm3). In two out of three cases having a later onset clinical and laboratory data suggest the hypotesis of a immunoallergic pathogenesis and particularly of cow's milk allergy. A review of the literature appears to confirm the differences between early and late onset forms of C.H. as for as the sites of skeletal involvement and the whole clinical course are concerned.
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