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Biomedical subjects

L Papavero

Publications and source records attributed to L Papavero.

17 recordsLinked to original sources
PubMed2005

[Treatment of traumatic rotatory atlanto-axial subluxation in childhood. Case report and literature review].

Cervical spine injuries are rare in children. They tend to occur predominantly in the region of atlanto-axial articulation. Even traumatic rotatory atlanto-axial subluxation (AAD) has been described in the literature, however, there is no consistent therapeutic protocol. We report on a 4 year old girl with an acute traumatic rotatory atlanto-axial subluxation treated with closed reduction and retention in a hard-collar. Control CT scans and physical examination after 6 weeks revealed an excellent outcome without any signs of recurrence. As there is a correlation between outcome and increasing length of the dislocation-therapy interval, optimal management of acute rotatory atlanto-axial subluxation depends on early diagnosis with plain radiography and CT scans. Timely diagnosed cases may be treated successfully with closed reduction and cervical immobilisation in a hard-collar. Failure to obtain reduction and recurrence are an appropriate indication for surgical intervention.

Acute Disease↗
PubMed1999

Anterior cervical plating for the treatment of neoplasms in the cervical vertebrae.

OBJECT: To assess clinical outcome and survival in patients with cervical vertebral spinal neoplasms after they have undergone anterior decompression and cervical plate stabilization (ACPS) by using either autologous bone graft or polymethylmethacrylate (PMMA) as the anterior load-bearing support structure. METHODS: This was a retrospective case study composed of 30 patients harboring cervical spinal vertebral neoplasms who underwent anterior cervical decompression and (ACPS) within a 7-year period. Postoperative immobilization included treatment in a halo brace in two cases and in a hard cervical collar for the remaining patients. Postoperatively most patients underwent radio- and/or chemotherapy. All patients except one benefited from a significantly improved quality of life with decreased pain and/or improved neurological status. The mean Kaplan-Meier survivoral estimate was 35.8 months (range 8 days-11.3 years, with 10 patients alive at most recent follow-up contact). Patients achieved long-term or lifelong mechanical stability in the cervical spine, and only one patient required a repeated posterior stabilization procedure. No hardware-related complications occurred. One patient died 8 days postoperatively of pneumonia. A nonsignificant difference in survival (p = 0.2164) was observed between patients harboring metastatic neoplasms (26.8 months) and those harboring lymphomatous and multiple myeloma neoplasms (54 months). CONCLUSIONS: Favorable clinical outcome of both neurological symptoms and pain can be achieved using ACPS after surgery for neoplasms in the cervical vertebrae. Furthermore, long-term or lifelong cervical spine mechanical stability with bone fusion is achieved using this technique even when radiation therapy is delivered to the site of the bone graft.

Adult↗
PubMed1994

Precise and limited decompression for lumbar spinal stenosis.

Fifty-eight consecutive patients with lumbosacral nerve root entrapment due to spinal stenosis were treated with modified microsurgical decompression. Only the clinically relevant sides and levels were decompressed while the spinous processes, the interspinous ligaments, the medial portion of ligamentum flavum and the functionally important parts of the facet joints were preserved. The reviewers rated recovery as good or excellent in 71% of patients while patient self-assessment indicated 76% good or excellent outcome. These data suggest that microsurgical decompression of spondyloarthritic changes can effectively relieve the signs and symptoms of nerve root compression and that with careful evaluation of all available data the number of nerve roots requiring decompression is often fewer than what is suggested by diagnostic images alone.

Adult↗
PubMed1988

The intraarterial route of drug delivery in the chemotherapy of malignant brain tumours.

This review is based on literature data and own experiences in 79 patients with malignant brain tumours using intraarterial delivery of cytostatic agents as adjuvant therapy. A survey is given of the pharmacological rationale of this therapeutic approach, of the drugs which have been used and of the related experimental and clinical experiences. Advantages and limitations are discussed and clinical conclusion drawn. Experience so far suggests that in anaplastic astrocytomas and oligodendrogliomas intraarterial ACNU might be as effective as intravenous BCNU against the tumours but causes less systemic side-effects.

Antineoplastic Agents↗
PubMed1988

Indications for extra-intracranial bypass surgery. New orientation after the Toronto Bypass Study based on angiographic and non-invasive ultrasound flow measurements.

UNLABELLED: Angiographic and flow measurement results in 18 cases, who underwent extra-intracranial bypass surgery, are presented. The method was the Mavis ultrasound technique. MAIN RESULT: Patients with unilateral internal carotid artery (ICA) occlusion and additional contralateral ICA stenosis or occlusion had a permanent cerebral blood flow (CBF) increase as a consequence of the anastomosis. On the contrary, patients without contralateral flow impairment or with good spontaneous extra-intracranial anastomosis did not have a real CBF improvement but only a temporary flow increase on the anastomotic side with comparable flow decrease in the contralateral ICA. The so-called Toronto Bypass Study was designed to evaluate the effectiveness of extra-intracranial bypass surgery for stroke prevention but it did not prove its effectiveness in this regard. Intentionally it did not put or answer the question of possible haemodynamic benefit for special subgroups of patients with cerebrovascular occlusive disease. Our results suggest such a haemodynamic benefit, and in consequence an indication for bypass treatment may be given in cases with ICA occlusion and additional contralateral flow impairment and without sufficient spontaneous collateralization. The question of a stroke preventing effect in this special subgroup should be answered by another controlled study. But this will be almost impossible to realize because--as a consequence of the Toronto study--at least in our country almost no further patients are transferred to the neurosurgeon for possible bypass surgery.

Arterial Occlusive Diseases↗
PubMed1987

Intracarotid infusion of ACNU and BCNU as adjuvant therapy of malignant gliomas. Clinical aspects and critical considerations.

Thirty patients with malignant gliomas were treated by operation, radiotherapy and additional intracarotid infusions of ACNU and BCNU. Positive results were obtained in the treatment of oligodendrogliomas and astrocytomas grade III and IV. On the contrary, the results in cases of glioblastoma multiforme were disappointing: neither survival time nor quality of life had been significantly improved. The protective effect of phenobarbitone against systemic toxicity by ACNU was not always confirmed in this study. Based on literature reports and our own experience the indications, technical aspects, unexpected complications and results of this therapeutic approach are discussed.

Astrocytoma↗
PubMed1985

[Differential diagnostic problems in the combination of infratentorial chronic epidural hematoma, empty sella syndrome and cerebrospinal rhinorrhea].

The chronic extradural haematoma rarely occurs after a head injury. This is particularly true, if we consider the localization in the posterior fossa. Posttraumatic rhinorrhea follows usually dural tearing after basal fractures of the skull, but in this case the cerebro-spinal fluid leakage was due to an empty sella. The case report shows how some diagnostical difficulties may occur in the daily neurotraumatological practice.

Atrophy↗
PubMed1980

Effect of omental transposition to the brain on protein synthesis in experimental cerebral ischaemia.

Occlusion of the middle cerebral artery severely affects the uptake of labelled leucine into various subcellular fractions from rabbit brain. Previous transposition of pedicled omentum to the cerebral surface maintains to a large extent the protein synthetic activity of the brain following arterial occlusion. The role of the transposed omentum in providing an effective collateral circulation and minimizing the occurrence of irreversible ischaemic lesions is stressed.

Animals↗
PubMed1980

Physiological function after middle cerebral artery occlusion in rabbits with neovascularization of the brain by transposed omentum.

The effect of brain neovascularization by omental transposition on somatosensory evoked potentials and on regional cerebral blood flow (rCBF) measured by hydrogen clearance was evaluated in rabbits exposed to experimental ischemia after occlusion of the middle cerebral artery (MCA). After MCA occlusion, the animals with brains neovascularized by transposed omentum showed a mild drop of rCBF accompanied by normal patterns of somatosensory evoked potentials elicited by sciatic stimulation. In the control animals, the evoked cortical electrical activity drastically decreased in amplitude immediately after arterial occlusion and fell to zero one-half hour later. The decay of bioelectrical activity in these rabbits was associated inevitably with a major drop in the rCBF. Morphological examination, as well as the functional data, indicate that omental transposition in animals exposed to experimental ischemia minimizes the occurrence of cerebral infarction because the neovascularization is capable of maintaining the local blood flow for at least 1 hour; therefore, the cortical electrical activity is preserved totally. In the light of these results, the authors suggest that this surgical technique can also be utilized in human beings who are affected by transient ischemic attacks to prevent more serious consequences.

Animals↗
PubMedDate not supplied

Local cerebral blood flow after middle cerebral artery occlusion in rabbits following transposition of omentum to the brain.

Transposition of pedicled omental grafts to the brain has been shown to minimize the effects of cerebral infarction in dogs and monkeys. An experimental study in which pedicled omental grafts and free non-revascularized omental grafts were placed on the brains of rabbits is reported. With the use of a modified inhaled hydrogen clearance technique to measure blood flow in the brain tissue, it was determined that the pedicled omental graft minimized the effects of middle cerebral artery occlusion by maintaining a collateral blood supply and limiting the decline of local cerebral flow. Super-position of free omental grafts on the brain had no effect on the threshold for infarction.

Animals↗
PubMedDate not supplied

Lumbar stenosis surgery: the experience of the neurosurgeon.

Even when multiple levels are affected, lumbar canal stenosis can be surgically treated using the microsurgical technique. This microapproach combines the advantage of an efficient decompression of the compromised neurostructures along with the preservation of the spinous processes the interspinous ligaments, the medial section of the yellow ligament as well as of the biomechanically relevant portion of the facet joints. Thus, due to minimal surgical trauma spinal stability is maintained, resulting in reduction of postoperative discomfort and a favorable clinical outcome. We report the results of 35 patients operated on consecutively using the microsurgical technique. Our study further shows that there is a remarkable discrepancy between radiological and clinical evidence of the levels of stenosis.

Follow-Up Studies↗
PubMedDate not supplied

The trapezial plate osteosynthesis: an advanced technology for anterior internal stabilization in cervical spine injuries and for the treatment of neck instability due to non traumatic causes.

The authors present a series of anterior fusion of the cervical spine using internal fixation by means of a screwed plate. After the description of the surgical technique utilized in 408 consecutive surgical procedures the authors report the results of 60 patients affected by traumatic lesions and followed up 1 to 3 years. In 27 cases a single-level fusion was performed; in 2 cases a two-level fusion; in 17 cases a subtotal corporectomy, and in 14 cases a total corporectomy. A good bony fusion was obtained in all 60 cases. All patients improved neurologically from incomplete cord and root lesions. None of the patients showed neurological worsening. Complications were rare and minor. Anterior fusion of the cervical spine with an osteosynthetic screwed plate is a surgical technique that is able to offer satisfying outcomes in cervical traumatic lesions and in non traumatic cervical pathology.

Bone Plates↗