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Biomedical subjects

M Meglio

Publications and source records attributed to M Meglio.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Otogenic cerebral abscess: description of 3 cases, clinical and therapeutic considerations].

The authors use the 3 cases of otogenous cerebral abscess which came under observation as starting point for a discussion of the main etiopathogenetic, microbiological, clinical-diagnostic and therapeutic aspects of this disorder. After a brief presentation of the data regarding incidence, preferential localization and age of onset, they discuss the means for intracranial spread of infection and the related symptoms. As regards diagnosis, the authors assert that clinical examination and imaging techniques--CT and especially MRI--enable one to determine the dimension and site of the abscess cavity, differentiating it from other intracranial lesions and to monitor clinical evolution and response to therapy. After mentioning the principle bacteria involved in infection, they deal with the various means of treatment. The authors favor surgical removal of the auricular phlogistic focus and medical treatment of the intracranial abscess. They resort to neurosurgery only in those cases which do not respond to drug treatment or when the size and particular location of the abscess threaten the patient's life. In conclusion, the authors underline the problems seen today in diagnosis and therapy, comparing the quoad vitam and quoad valetudinem prognosis for the affected patients.

Adolescent↗
PubMed1997

Cervical cord compression due to atypical primary neuroectodermal tumor (PNET): one-stage removal and combined cervical spine stabilization. Case report.

INTRODUCTION: The neuroectodermal tumor of bone constitutes a recently isolated neoplasm, which morphologically resembles the peripheral neuroepithelioma of soft tissue. The diagnosis is made by excluding readily classified small round cell neoplasms and then demonstrating the neural origin of the tumor by means of ultrastructural or immunocytochemical studies. CLINICAL CASE: We report a case of a primary neuroectodermal tumor (PNET) with atypical findings (primary cervical location, massive vertebral body infiltration and isolated neurological symptomatology). Total tumor removal was achieved by means of a one-stage three-level laminectomy (partial C5, total C6-C7), C6 somatectomy, and combined anterior and posterior cervical spinal instrumentation and fusion. CONCLUSIONS: Our case presents three peculiar features: 1) isolated myelopathic symptomatology (first case described); 2) primary isolated massive vertebral cervical involvement with intraspinal epidural extension (first case described); 3) one-stage tumor resection, fusion and instrumentation. Since radiation therapy causes tumor shrinkage but is not curative, radical removal is mandatory even with complex instrumentation procedures.

Cervical Vertebrae↗
PubMed1996

Intracranial epithelioid hemangioendothelioma: case report.

We report the case of a 27-year-old man who underwent surgical excision of an intracranial extra-axial right temporal lesion. A preoperative embolization with the use of a mixture of N-butyl-cyanoacrylate, ultrafluid-lipiodol, and micronized tungsten was necessary to devascularize the tumor. The histological diagnosis was epithelioid hemangioendothelioma. The patient was neurologically intact and tumor-free 18 months after surgery. To our knowledge, this is the fifth patient reported with intracranial epithelioid hemangioendothelioma and the first adult patient for whom complete data are available.

Adult↗
PubMed1996

Cerebral blood flow velocities and trigeminal ganglion stimulation. A transcranial Doppler study.

Transcranial Doppler sonography (TCD) patterns of middle cerebral arteries (MCA) were recorded in 10 patients before and during unilateral trigeminal ganglion stimulation (TGS). During TGS, TCD flow velocity significantly decreases in all patients: on both sides in 2 patients, only ipsilaterally to the TGS in 7 patients, and only on the opposite side in the remaining patient. In 2 patients, a controlled progressive hypercapnia test was performed before and during TGS. An enhanced vascular response to increased CO2 concentrations was observed during TGS.

Blood Flow Velocity↗
PubMed1996

Cleidocranial dysplasia and syringomyelia. Case report.

cleidocranial dysplasia (CCD) is a dysmorphic syndrome characterized by delayed ossification of the cranial sutures, clavicular hypoplasia and dental dysplasia. We recently observed a 24-year old male patient with CCD and associated syringomyelia and Chiari I malformation (CMI). Only three cases with such an association had been described. The role of posterior fossa bone dysplasia in the pathogenesis of CMI and syringomyelia is discussed.

Adult↗
PubMed1995

"Filtering effect" of cerebrospinal fluid on spinal somatosensory evoked potentials: case report.

A 31-year-old man presented complaining of radicular (L4) pain. MRI and myelo-TC of the thoraco-lumbar spine showed the presence of an extradural CSF cyst extending from Th6 to L2, posterior to the cord. The patient underwent a Th12 laminectomy, the cyst was opened and drained. A recording electrode was placed epidurally, dorsal to the cyst, at the level of the Th12 vertebral body, and the potentials evoked by stimulation of the tibial and saphenous nerves were monitored during surgery. After cyst drainage the epidural potentials were significantly larger (x5) in amplitude and more defined in shape than those recorded in the presence of the cyst. Our case demonstrates the "filtering effect" of CSF on spinal somatosensory evoked potentials.

Adult↗
PubMed1995

Evaluation of fifth nerve dysfunction in 136 patients with middle and posterior cranial fossae tumors.

One-hundred thirty-six patients operated on for extra-axial tumors of the posterior and middle cranial fossae were retrospectively evaluated to define the relevance of trigeminal nerve dysfunction and to correlate clinical and surgical observations. The following data are reported: tumor types, presence of specific trigeminal symptoms and signs, mean duration of symptomatology, anatomical relation between tumor and fifth nerve. Trigeminal symptoms were present in 45 subjects (33.08%) with a mean duration of 23.56 months. Frequency of symptoms was different in various oncotypes. Fifth nerve disturbances were the symptom of onset in 18 subjects (13.23%). A tumoral involvement of the nerve was reported at surgery in 73 patients (53.67%) and was defined as contact, compression or infiltration. Postoperatively, 12 patients showed an improvement of fifth nerve disturbances. A statistically significant difference (p < 0.05) was found in: (1) the incidence of symptoms in patients with and in those without anatomical trigeminal involvement: (2) the incidence of signs in the same groups; (3) the incidence of postoperative relief in patients with fifth nerve compression compared to patients with different surgical findings; (4) the incidence of postoperative relief in patients with typical trigeminal neuralgia compared to those with other symptoms.

Adolescent↗
PubMed1995

Spinal cord stimulation in the treatment of paraplegic pain.

Twenty-five patients suffering from intractable pain due to a chronic spinal cord lesion underwent a percutaneous test of spinal cord stimulation. At the end of the test period, 40.9% of the patients reported a mean of 65% pain relief and these patients were selected for ongoing stimulation. At a mean follow-up time of 37.2 months the success rate, based on the number of patients with more than 50% pain relief, had fallen to 18.2%. Pain relief rates were analyzed in relation to quality of pain, neurological status, level and extent of the lesion, and electrode level to identify prognostic factors that could improve the clinical usefulness of spinal cord stimulation. Patients experiencing painful spasms or a constrictive type of pain and with incomplete thoracic lesions were found to be the best candidates for spinal cord stimulation.

Adult↗
PubMed1995

[The treatment of benign laryngeal pathologies using CO2 laser in direct microlaryngoscopy with propofol-induced endovenous anesthesia in spontaneous respiration without intubation].

Direct microlaryngoscopy is an endoscopic technique with considerable diagnostic and surgical potentialities, which are increased when carbon-dioxide Laser is used, but often limited by the anaesthesiologic methods employed. In fact, the traditional anaesthesiologic technique, which uses small bore oral-tracheal tubes and provides good ventilation, has significant disadvantages: the tube often impedes surgical activity especially in the posterior regions of the larynx; stenoses of the larynx impede oral-thacheal intubation and thus require pre-operatory thacheotomy; administration of succinylcholine often induces diffused myalgia in the following 12-24 hours; administration of traditional narcotics always requires hospitalization. Jet-ventilation used by the Freach School as an alterative, while offering a more ample operatory space, is also accompanied by many disadvantages: vocal cords vibration; spray expulsion of smoke, blood, etc.; as with the traditional method, it cannot be employed in cases of laryngeal stenoses; succinylcholine often induces diffused myalgia; it cannot be used on out-patients. Introduction of Propofol, a new endovenous anaesthetic, the anaesthetologic pratice has permitted total endovenous anaesthesia to be achieved, in spontaneous respiration, without intubation. This method is indicated even in cases where the previously mentioned approaches are shown to be inadequate or impracticable. Narcosis with Propofol was used in 70 patients with benign laryngeal pathologies, belonging to the ASA risk classes I-II who underwent surgery via CO2 Laser during Microlaryngoscopy. The pharmacologic protocol of this narcosis require intravenous premedication with atropine and phentanyl, induction and continuation with Propofol and pharyngolaryngeal local anaesthesia with lidocaine spray. The advantages offered by this method are considerable: a completely free operative space; the possibility of being used in cases of laryngeal stenosis; a rapid return to consciousness; the absence of myalgia after surgery; the possibility of treating the disease on an out-patient basis. The absence of significant complications and the good results obtained lead us to propose this anaesthesiologic method as a valid alternative to anaesthesia by the traditional oral-tracheal intubation and to Jet ventilation.

Adult↗
PubMed1994

Increase of cerebral blood flow and improvement of brain motor control following spinal cord stimulation in ischemic spastic hemiparesis.

A 64-year-old man had an ischemic stroke in the left parietotemporal cortical-subcortical areas. He developed a severe right spastic hemiparesis and dysphasia. An angiographic study showed left internal carotid artery occlusion and right internal carotid artery stenosis. A right internal endoarteriectomy was performed without any clinical improvement. After 1 year the patient was a candidate for cervical spinal cord stimulation (SCS) for the treatment of his spastic hemiparesis. An epidural electrode (Medtronic Sigma 3483) was positioned at the cervical level, mediodorsal to the cord. Clinical and neurophysiological studies (surface polyelectromyography, PEMG, for evaluation of brain motor control) were performed before and after 7 days of SCS (0.2 ms, 80 c/s, intensity for paresthesiae, continuous mode). A transcranial Doppler (TCD) study of both middle cerebral arteries (MCA) at rest and during SCS was performed on two occasions. SCS was followed by improvement of voluntary movement, decrease of spasticity and better endurance. The clinical findings were confirmed by the PEMG recordings. TCD examination showed an increase of flow velocities on both the right MCA (+43%) and the left MCA (+130%) during SCS. Such a TCD pattern, suggesting an increase of cerebral blood flow (CBF) during SCS, was reproducible. This case confirms efficacy of SCS in the treatment of ischemic hemiparesis and the increase of CBF following cervical SCS in man. The marked increase of CBF, particularly evident on the ischemic side, may play a role in mediating the improvement of motor control in our patient together with a possible arousal of the so-called 'sleeping neurons' of the penumbra zone.

Brain Ischemia↗
PubMed1994

Spinal cord stimulation and cerebral blood flow: an experimental study.

Spinal cord stimulation (SCS) affects peripheral, coronary and cerebral blood flow (CBF) in humans. In 1986 Meglio et al. [Appl Neurophysiol 1986;49:139-146] advocated a functional reversible sympathectomy as one of the mechanisms of SCS in man. An experimental animal model was developed to study SCS effects on CBF and to investigate the possible mechanisms. Twenty-one white New Zealand rabbits were anesthetized with Fluothane; spontaneous ventilation was permitted. A steady hemodynamic and metabolic state was maintained. A small cervical laminectomy was performed and an electrode (Medtronic Sigma 3483) was placed in the epidural space over the posterior spinal cord. Both common carotid arteries were exposed and external carotid arteries were ligated. In 3 animals, the cervical symapthetic trunk (CST) was exposed and wrapped with bipolar hook-stimulating electrodes. SCS was performed for 20 min with electrical square waves of 210 microseconds duration, 80 cycles/s, at 2/3 motor threshold intensity. CST stimulation was delivered for 1 min with the following parameters: 10 V, 10 cycles/s, 0.5 ms duration. CBF velocities of both internal carotid arteries were measured by using a CW Doppler (in all the animals) and electromagnetic flowmeter (in 2 animals), at rest, during sympathetic trunk stimulation, during SCS, during simultaneous SCS and CST stimulation. During SCS, an increase of CBF was detected in 11 rabbits (52.4%); a decrease was observed in two cases (9.5%). No change was detected in the remaining 8 animals (38%). CST stimulation induced a decrease of CBF in all animals. Electromagnetic flowmetry confirmed velocitometric findings in the 2 cases studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Spinal cord stimulation in low back and leg pain.

We have reviewed our experience with spinal cord stimulation (SCS) in patients with low back and leg pain. 33 patients complaining of leg and low back pain underwent percutaneous tests of SCS. 28 patients had failed back surgery syndromes, 1 patient had pain related to an L1 vertebral body fracture, another from Tarlow cysts and the remaining 3 patients had lumbosacral spondyloarthrosis and osteoporosis without radiological signs of root compression. 28 patients showed mono- or pluriradicular deficits. At the end of the test period (5-65 days), 21 patients (63.6%) reported more than 50% of pain relief (mean analgesia 75%) and were submitted to chronic stimulation. The mean follow-up was 45.5 months. At maximum available follow-up, 40% of the patients (13 out of the 33 initial patients) were successfully using the stimulator (mean analgesia 66.6%).

Chronic Disease↗
PubMed1993

Microvascular decompression for trigeminal neuralgia: prognostic factors.

A series of 66 patients with trigeminal neuralgia (TN) treated by microvascular decompression (MVD) is analyzed in order to define the importance of various prognostic factors. A typical pattern of pain, presence of facial hypaesthesia and previous ablative trigeminal procedures showed an unfavorable influence on the results of MVD. Duration of symptoms was longer in patients who failed to benefit from MVD. Pain distribution and the type of vascular compression did not influence the outcome.

Female↗
PubMed1993

Trigeminal involvement in intracranial tumours. Anatomical and clinical observations on 73 patients.

Neoplastic involvement of the trigeminal nerve was observed in 73 patients operated on in our institution for extra-axial tumours of the posterior and middle cranial fossae. It was defined as contact, compression, or infiltration. The nerve root was involved in 58 patients, the ganglion and/or the peripheral divisions in 9, all portions of the Vth nerve system in 6. A clinical trigeminal dysfunction was present in 44 patients (60%). Anatomico-surgical findings are correlated with clinical features and with tumour type. Typical trigeminal neuralgia was the complaint in 7 subjects; all of them presented an involvement of the sensory root. Post-operatively, 11 patients were relieved of their symptoms. The outcome is correlated with the anatomical findings and with the extent of surgical removal of the tumours. The importance of a careful evaluation of patients with trigeminal symptomatology is stressed.

Adolescent↗
PubMed1993

Typical trigeminal neuralgia associated with posterior cranial fossa tumors.

A clinical diagnosis of typical trigeminal neuralgia does not rule out the possibility of a space-occupying lesion compressing the nerve along its course from the brainstem to Meckel's cave. 4 cases of typical trigeminal neuralgia, treated medically for several years and seen here recently before a space-occupying lesion was found in the posterior cranial fossa, point up the need for thorough neurological and neuroradiological examination of all patients with the typical symptoms. Lesion removal resulted in total relief from pain in 3 patients. In the fourth patient the pain was controlled by percutaneous surgery with thermocoagulation of the gasserian ganglion.

Adult↗
PubMed1992

Intracerebral injury following thermocoagulation of the trigeminal ganglion.

An unusual postoperative complication of percutaneous thermocoagulation of the gasserian ganglion is reported. Computed tomography and magnetic resonance imaging of the brain disclosed an intracerebral lesion following the surgical procedure. Some rare abnormalities of the skull base could increase the risk of such complications. A meticulous surgical technique with fluoroscopic and neurophysiological control is mandatory in any percutaneous procedure on the trigeminal ganglion.

Brain Injuries↗
PubMed1992

Spinal neurenteric cyst in association with syringomyelia: case report.

A case of spinal neurenteric cyst in association with Klippel-Feil deformity, spinal lipoma, and syringomyelia is presented. Neuroradiological evaluation was performed by means of magnetic resonance imaging of the spine and a computed tomography myelograph. The diagnosis of neurenteric cyst was established by histological and immunohistochemical studies. The pathogenesis of syringomyelia associated with an extramedullary mass lesion is discussed.

Adult↗