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Biomedical subjects

L Tacconi

Publications and source records attributed to L Tacconi.

At least 19 recordsLinked to original sources
PubMed2006

Extracranial-intracranial bypass for the treatment of cavernous sinus aneurysms.

The optimal management of symptomatic cavernous sinus aneurysms remains controversial. Carotid occlusion is a simple procedure, but carries an ongoing risk of early and late stroke. Cerebral revascularisation is technically demanding and carries a risk of morbidity and mortality of around 10%. Eight patients treated with an extracranial-intracranial vascular bypass graft over a period of 44 months for symptomatic cavernous sinus aneurysms are reviewed. At a mean follow-up of 20 months, seven patients (87.5%) had an excellent outcome (Glasgow Outcome Score 5) while one patient suffered a perioperative stroke. In only one case, where the radial artery had been used, the graft became occluded. The results of this series seem to indicate that cerebral revascularisation is an effective treatment for patients with symptomatic cavernous sinus aneurysms.

Adult↗
PubMed2006

Orbito-cranial injuries caused by penetrating non-missile foreign bodies. Experience with eighteen patients.

BACKGROUND: Penetrating non-missile orbito-cranial injuries are uncommon civilian injuries which have some special features. Only limited case-reports are available in the international literature. METHOD: We present a retrospective review of 18 such in presumed trivial orbital injury. Early identification and removal of retained foreign body fragments was achieved within 36 hours. FINDINGS: Patients were operated on and followed up for at least of 3 years. The final clinical outcome was excellent: 16 had a Glasgow Outcome Scale (GOS) of 5 while in the remaining 2 it was 4. CONCLUSION: The present report indicates that good results, in managing such injuries, can be achieved by a high index of suspicion and early diagnosis of intracranial injury in presumed trivial wounds and by the removal of every possible retained foreign body.

Adolescent↗
PubMed2005

Cervicothoracolumbar pneumorachis. Case report and review of the literature.

BACKGROUND: Pneumorachis is a very rare entity to occur after a major trauma. It is even rarer when its occurrence is not associated with injuries in the skull base, chest, abdomen, pelvis, or spine. Pneumorachis extending through the entire spinal canal has never been reported. CASE DESCRIPTION: We report a case of traumatic air penetration into the spinal canal in a patient, involved in a road traffic accident, who had no apparent major bone and soft tissue injuries. The patient was conscious (Glasgow Coma Scale score of 15/15) upon admission. A cervical lateral x-ray taken the day after admission showed some air in the spinal canal. A subsequent computed tomography with reconstruction disclosed some subdural air extending from the cervical region to the lumbar region. The patient was successfully treated conservatively. The pathogenesis and rarity of this pathology are discussed along with the review of relevant literature. CONCLUSION: Any patient with spinal pneumorachis should be actively investigated to determine if a possible air fistula, which might increase causing spinal cord compression, is present. If a source is not found, a skull base fracture should be suspected.

Air Pressure↗
PubMed2002

Non-invasive assessment of extracranial-intracranial bypass grafts using advanced ultrasound technology.

There have been significant developments in ultrasound technology in the last few years which have resulted in an increase in the clinical value of this technique. An illustrative case is presented of how ultrasound technology has been used in the intraoperative and postoperative period to evaluate graft patency and function in patients undergoing extracranial-intracranial bypass graft surgery.

Cavernous Sinus↗
PubMed2000

Central neurocytoma: long-term follow-up of a paediatric case.

In order to gain a better understanding of the clinical and histological features of central neurocytoma and the role of radiotherapy in the treatment of these tumours, we present an unusual paediatric case and review the pertinent literature. Most patients present in the second and third decade of life, rarely in the teenage years and exceptionally in children. Our patient was treated by a combined surgical and radiation therapy treatment for a central neurocytoma at the age of 7 years, but the tumour had been diagnosed when she was 3 years old. At a 38-year follow-up, she is well with no evidence of tumour progression. This patient seems to be the youngest histologically proven case of central neurocytoma and with the longest recorded survival.

Brain Neoplasms↗
PubMed2000

Bilateral trigeminal neuralgia: a therapeutic dilemma.

In order to illustrate the inherent problems of managing bilateral trigeminal neuralgia a retrospective study of the 16 cases of bilateral trigeminal neuralgia, out of just over 300 cases of trigeminal neuralgia, treated over a 14-year period, has been performed. All the patients, presented with a typical history of trigeminal neuralgia and underwent surgical exploration. Pain relief was initially achieved in all cases; however, only four remained cured, three have become pain free after additional rhizotomy, a further one after peripheral cryotherapy and four with medical treatment. Four patients have had bilateral operations for trigeminal neuralgia, but in two cases the pain was relieved on one side only. Bilateral trigeminal neuralgia presents special problems of management with respect to underlying neuropathology (e.g. multiple sclerosis), the need for the limitation of the use of ablative techniques in order to minimise the disability of bilateral sensory and motor dysfunction, and the relatively poor response to microvascular decompression. These factors emphasize the multifactorial nature of the cause of trigeminal neuralgia. Magnetic resonance tomographic angiography is now available and is important in determining the range of therapeutic options for this group of patients.

Adult↗
PubMed1999

Peroxynitrite-mediated oxidation of fibrinogen inhibits clot formation.

The clotting activity of human fibrinogen was fully inhibited in vitro by peroxynitrite. The decrease of activity followed an exponential function and the concentration of peroxynitrite needed to inhibit 50% of fibrinogen clotting was 22 microM at 25 degrees C. The oxidative modification(s) induced by the peroxynitrite system (i.e. ONOO-, ONOOH and ONOOH*) appeared specifically to affect fibrin clot formation (through the inhibition of fibrinogen polymerization) since the interaction of peroxynitrite-modified fibrinogen with thrombin appeared to be unaffected. The addition of NaHCO3 decreased the peroxynitrite effect on fibrinogen clotting, suggesting that the reactive species formed by the reaction of CO2 with peroxynitrite are less efficient oxidants of peroxynitrite itself. Similar effects were observed after addition of bilirubin, which also exerted a significant protection against peroxynitrite-mediated modification of fibrinogen.

Bilirubin↗
PubMed1999

Mutation in the PTEN/MMAC1 gene in archival low grade and high grade gliomas.

The PTEN gene, located on 10q23.3, has recently been described as a candidate tumour suppressor gene that may be important in the development of advanced cancers, including gliomas. We have investigated mutation in the PTEN gene by direct sequence analysis of PCR products amplified from samples microdissected from 19 low grade (WHO Grade I and II) and 27 high grade (WHO grade III and IV) archival, formalin-fixed, paraffin-embedded gliomas. Eleven genetic variants in ten tumours have been identified. Eight of these are DNA sequence changes that could affect the encoded protein and were present in 0/2 pilocytic astrocytomas, 0/2 oligoastrocytomas, 0/1 oligodendroglioma, 0/14 astrocytomas, 3/13 (23%) anaplastic astrocytomas and 5/14 (36%) glioblastomas. PTEN mutations were found exclusively in high grade gliomas; this finding was statistically significant. Only two of the PTEN genetic variants have been reported in other studies; two of the genetic changes are in codons in which mutations have not been found previously. The results of this study indicate that mutation in the PTEN gene is present only in histologically more aggressive gliomas, may be associated with the transition from low histological grade to anaplasia, but is absent from the majority of high grade gliomas.

Adolescent↗
PubMed1999

Neurohypophyseal pilocytic astrocytoma invading the skull base.

We describe the clinical presentation, neuroradiological and histological findings of an unusual case of pilocytic astrocytoma of the neurohypophysis, and discuss the related surgical and prognostic issues of this neoplasm which invaded the skull base and the sphenoid sinus. Only four histologically proven cases of such a tumour have been reported in the English literature, and the pathological features and behaviour of this neoplasm still await definition.

Aged↗
PubMed1999

Multiple meningiomas in different neuraxial compartments. Report of two cases.

Multiple meningiomas in different neuraxial compartments are quite rare. The authors report two new cases of association between cranial and spinal meningiomas, one of them in a patient operated upon for multiple intracranial meningiomas. The first case was a 60-year-old woman with progressive paraparesis who had been operated on 13 years earlier for multiple intracranial meningiomas. A myelo-CT scan showed a block of contrast medium at T1-T2; the lesion was removed via a standard laminectomy. The second patient was a 76-year-old woman with a 6-month history of spastic paraparesis. MRI detected an extramedullary intradural lesion at T6-T7. A cerebral MRI, performed because of the onset of seizures, showed a right parietal lesion. Removal of the thoracic lesion was followed, 6 months later, by removal of the cerebral one. Both patients presented a progressive improvement of the paraparesis and returned to normal daily activities.

Aged↗
PubMed1998

Pathology of choroid plexus papillomas: a review.

Choroid plexus papillomas (CPPs) are rare, usually slow growing neoplasms. Their biological behaviour cannot be predicted in an individual case. Furthermore, the neuropathological diagnosis of these neoplasms is occasionally difficult because light and electron microscopical and immunohistochemical features may overlap with those of other neoplasms localising in the choroid plexus. The aim of this paper is to review the pathological literature (light and electron microscopy (EM) and immunocytochemistry), to provide guidance on current diagnostic tools and criteria and address the identification of 'atypical' CPPs, e.g. those CPPs with histological features indicative of aggressive behaviour, in an attempt to help bridge the diagnostic gap between benign CPPs on the one hand and choroid plexus carcinomas (CPCs) on the other.

Adenocarcinoma↗
PubMed1997

Cerebral meningioangiomatosis: case report.

We discuss the clinical, neuroradiologic and histopathologic features of a case not apparently associated with neurofibromatosis (type 2), reviewing the relevant literature.

Brain Neoplasms↗
PubMed1997

Central neurocytoma: a clinico-pathological study of five cases.

Central neurocytoma (CN) is a rare, benign tumour of neuronal differentiation which affects young patients and is generally found in the lateral or third ventricles. Its radiological features are non-specific and, in the past, these tumours were confused with other intraventricular lesions. Only recently, thanks to their characteristic features on immunohistochemistry and electron microscopy, have they been recognized as a separate entity. We present the clinico-pathological features of five cases of CN treated at our Institution between 1986 and 1994. The importance of diagnostic suspicion, total microsurgical excision and the role of radiotherapy is discussed.

Adult↗
PubMed1997

Outcome and prognostic factors in the surgical treatment of spinal dural arteriovenous fistulas. A long-term study.

From a total of 78 patients surgically treated for a spinal dural arteriovenous fistula, in whom long-term follow-up was available, 25 have been reviewed. Their outcome at different postoperative stages and the long-term prognostic factors is discussed. Excision or coagulation of the nidus, as well as disconnection of the draining vein offers better results in the long-term than clipping of the draining vein alone. Prolonged duration of symptoms and poor functional status before surgical treatment adversely affect the long-term outcome. Age at the time of surgery did not influence outcome in this study. In the long-term all patients tended to show a moderate, but definite functional decline. This is unlikely to be due entirely to recanalization and may represent a more generalized haemodynamic abnormality of the cord together with the effects of age on the original damage.

Adult↗
PubMed1996

Spinal epidural abscess--review of 10 cases.

Abscess formation in the spinal epidural space is a very rare lesion, occurring once in 10,000 admissions to a tertiary centre and often requiring emergency neurosurgical treatment commonly presenting late. We present our experience of ten cases of spinal epidural abscess treated at our institution between January 1984 and July 1994 and review the most recent literature.

Abscess↗