Biomedical subjects

L Profeta

Publications and source records attributed to L Profeta.

7 recordsLinked to original sources

PubMed2004

Endoscope-assisted microneurosurgery for anterior circulation aneurysms using the angle-type rigid endoscope over a 3-year period.

INTRODUCTION: The use of the endoscope (fiberscope) to assist the microsurgical clipping of cerebral aneurysm was first reported by Fischer and Mustafa in 1994. The rigid endoscope has been increasingly used during aneurysm surgery in which structures around the aneurysm can be detected with high quality imaging. Our 3 years of its use now allows us to assess the endoscope's efficacy and limits in standard surgery with a pterional approach in aneurysms of the anterior circulation. The endoscope can carry out a supportive role in planning surgical manoeuvres and in verifying whether clipping has been performed correctly or not. In our view, among the aneurysms of the anterior circulation, the endoscope is particularly useful in those of the internal carotid and the anterior communicating arteries. In many cases of these aneurysms the posterior communicating artery, choroidal artery or one of the distal cerebral arteries is hidden behind the aneurysm dome. Dome retraction is often required in order to see these vascular structures with the microscope. Thus an endoscope with a 30 degrees view angle becomes very useful. The concealed areas are identified without retraction, which prevents the possibility of the aneurysm being ruptured and also reduces the use of temporary clipping. From its early use as a supportive measure that is sometimes useful in surgery for "easy" aneurysms, the endoscope has now become almost indispensable for the "difficult" aneurysms, including the large and giant ones before and after clipping. Thus, the endoscope should be kept ready for use in the operating theatre for any eventuality. OBJECTIVE: We assess the advantages and disadvantages of the use of the endoscope in the microsurgical treatment of intracranial aneurysms. METHODS: During our 3 years of experience, 52 patients with 48 ruptured and 10 unruptured aneurysms of the anterior circulation (including 6 cases of two-fold aneurysms) underwent clipping with endoscope support through a pterional approach. All ruptured aneurysms produced a Hunt and Hess Grade I or II subarachnoid haemorrhage. The endoscope was inserted before and after clipping in order to observe the conditions surrounding the aneurysm and to receive immediate confirmation that clipping had been performed correctly. RESULTS: In all cases general anatomy visualization was provided by the endoscope, and the correct clip positioning and vessel conditions were easily checked. In 4 cases the endoscope showed that the clip had been positioned incorrectly. Additional clipping was performed in these cases: in 2 cases the clip was re-applied correctly and in another case a clip was added. Only the fourth patient with a large communicating artery died (1.9%) of cerebral infarction. This was due to post-clipping stenosis of one distal cerebral artery in which it was not possible to re-position the clip correctly because of the presence of arteriosclerotic calcific plaque near the aneurysm neck. In 3 cases there was an intraoperative ruptured aneurysm dome that was not caused by the endoscope insertion. No further complications were caused by the endoscope. CONCLUSION: In certain cases endoscopic-assisted microsurgery is an exceptional aid to the surgeon and must become part of the operating theatre equipment and kept on hand ready for use. The endoscope is, in our opinion, particularly useful in certain aneurysm localisations (internal carotid artery-anterior communicating artery [ICA-ACOMA]).

Adult↗

PubMed2000

Preliminary experience with anterior cervical microdiscectomy and interbody titanium cage fusion (Novus CT-Ti) in patients with cervical disc disease.

BACKGROUND: Although the use of intervertebral fusion after anterior microdiscectomy in cervical disc disease remains controversial, a new surgical device is proposed for use in intervertebral fusion instead of bone graft. METHODS: This retrospective study at the Department of Neurosurgery, Cardarelli Hospital, Naples, from January 1993 to December 1998, compares the results of surgery on 58 patients with anterior microdiscectomy and intervertebral bone graft fusion (Group A) (ADIBG) with a group of 52 patients who underwent anterior microdiscectomy and intervertebral titanium cage fusion (Group B) (ADITC) in cervical radiculopathy and spondylotic myelopathy. In both groups a "radical discectomy" was performed under the operating microscope. In group A, interbody fusion was performed with autologous tricortical bone graft. In group B, a new type of titanium device (Novus CT-Ti) was used (Sofamor Danek Group). RESULTS: There was no collapse or extrusion of the device and no complications at the donor site (the bone fragments used to fill the cage were taken from osteophytes or vertebral body fragments). The use of this device provides immediate stabilization, reduces or eliminates pain, promotes bone fusion between the vertebrae adjacent to the cage by allowing bone growth through the cage, reestablishes and maintains the intervertebral space, reduces the average hospitalization time, and allows a quicker return to work. CONCLUSIONS: Patients who underwent ADITC did well and benefited from the surgery. Those who underwent ADITC did better than those who underwent ADIBG in regard to function, relief from pain, and complications. Early and good stability of the cervical spine seems to be the main advantage of using titanium cages.

Cervical Vertebrae↗

PubMed1998

[Reasons against lumbar puncture diagnosis with cerebrospinal fluid drainage in subarachnoid hemorrhage].

The necessity of cerebral angiography or angio-MRI was assessed in patients with thunderclap headache in whom subarachnoid haemorrhage had been ruled out on CT findings. In this cases the cerebrospinal fluid examination could be dangerous because could reduce the intracranial pressure with consequent risk of aneurysm rupture. CSF drainage, although, improves the clinical conditions and the symptoms of the patients, seems to not reduce the incidence of permanent neurological deficits caused by vasospasm; on the contrary, it increases the incidence of hydrocephalus requiring shunt procedures. We conclude that routine ventriculostomy with external ventricular drainage should be considered for all patients with altered sensorium and acute hyrocephalus following subarachnoid haemorrhage, with improvement in outcome.

Humans↗

PubMed1998

"Ultraearly" aneurysm surgery.

Three hundred and twenty-seven patients with intracranial aneurysm were managed at the Neurosurgical Division of Emergency Department of the Cardarelli Hospital of Naples. Of the 327 patient, 231 (70.6%), (I group), were operated on after 72 hours and 96 patients (29.4%), (II group), were operated on within 72 hours of subaracnoid hemorrhage. The patients operated on within 72 hours of hemorrhage (II group) were divided in two subgroups: 29 patients operated on within 72 hours formed the IIa group ("ultraearly" surgery) and 67 patients operated on between 24-72 hours formed the IIb group. Poor clinical grades (IV and V Hunt and Hess grades) were excluded from this study. Glasgow outcome scale (GOS), simplified in three grades was used to evaluate the results (GOS 1 good recovery; GOS 2 moderate or severe disability, and GOS 3 dead). The outcome was evaluated at the dimission and at 6 months. The best results seem to be for the patients in group IIb (24-72 hours), but if we consider that 31.2% of the patients operated on within 24 hours (IIa group) were in grade III of Hunt and Hess classification, also for these patients the surgical results seem to be good. The clinical presentation, treatment and outcome are discussed in this report.

Adult↗

PubMed1996

Surgical treatment of subdural empyema: a critical review.

Between 1990 and 1992 six cases of subdural empyema were surgically treated at the Neurosurgical Division of Emergency Department of Cardarelli Hospital in Naples. Three cases were associated with paranasal sinusitis and three cases with otitis media. Headache and fever were the presenting symptoms in all cases; in only two cases they were associated with seizures and altered mental status. CT scans showed convexity low density collections in five cases and multilocalized pus collection in one; concurrent paranasal or mastoid infections were visualized as well. The organisms responsible for the subdural empyema were Peptococcus in four cases, Streptococcus and anaerobius in the other two cases. In five cases surgical treatment consists in pus drainage by selective burr hole and placement of a subdural small silicon tube for local antibiotic therapy. In one case with a loculated diffuse empyema, craniotomy was performed in order to provide a better access to all the localizations. In all cases drainage of the wound and intravenous antibiotic therapy were used. Paranasal sinus drainage or mastoidectomy performed by the otolaryngologist when a localized collection of pus was present, grave a quicker regression of symptoms. A full recover of the original neurological status was achieved in all cases; a 20 months mean followup confirms the results.

Adolescent↗

PubMedDate not supplied

[Margagni-Larrey diaphragmatic hernia. Description of a clinical case].

A clinical case report of a Morgagni-Larrey hernia is presented. The finding was made at the age of four months by means of x-ray of the thorax, performed because of recurrent respiratory symptoms regressed after surgical intervention. The rarity of this type of hernia, without a herniary sac and accompanied by the late appearance of respiratory symptomatology, is stressed. It is suggested that x-ray of the thorax should be performed when recurrent respiratory disease is the presenting complaint, even in the first few months of life.

Bronchitis↗

PubMedDate not supplied

[Axial polydactyly: a clinical case].

After a short review of the normal embryonal development of lower limbs the authors describe a case of polydactyly associated with a 2nd-grade hypospadias observed in a 4-month-age patient. The authors, after the surgical treatment of both defects, have made the follow-up of the patient until six year age.

Humans↗