Biomedical subjects
Publications and source records attributed to M Scanarini.
The results of transsphenoidal microsurgery in treating 22 patients with pituitary microadenomas are reported. Histological and ultrastructural comparative studies were performed in attempting to obtain a more accurate morphological classification of pituitary microadenomas.
Four cases of growth-hormone-secreting pituitary adenoma, with associated aspects of acromegaly and gigantism, are reported in patients aged 12-26. All of the patients had macroadenomas and were treated surgically, three by the transsphenoidal approach and one with a transfrontal craniotomy. Histologic examination revealed eosinophilic adenomas in three of the cases and a mixed eosinophilic--chromophobe adenoma in one, all with cellular irregularities (mitosis and cellular and nuclear polymorphism), local invasivity, or both. Because surgical treatment did not produce complete normalization of growth hormone levels, radiotherapy followed the operations in all four cases. In our opinion, the treatment of acromegalic gigantism poses more therapeutic problems than that of simple acromegaly, with combined treatment (surgical, radiation, and medical) often being necessary.
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The occurrence of intracranial tumours of diverse histogenesis can be considered occasional. In a careful survey of the literature we have encountered 63 cases of concurrent intracranial tumours: we report five personal observations, too. This review raises the question as to whether the conjoint occurrence of two intracranial tumours is purely coincidental. The statistical analysis of the cases of concurrent intracranial tumours, and the comparison between the frequency found for each different tumour when it is solitary and when it is coincident in a same patient, suggests that a casual connection can be found between tumours of diverse histogenesis.
The authors clinical experience in the continuous subarachnoid monitoring of ICP (SaP) is reported. It is stressed that the outline and the absolute pressure values of the recordings are not significantly affected by CSF leakage. No complication was observed in any of the monitored cases.
Case histories are reported of 18 patients in whom the diagnosis of primary brain stem haematoma and brain stem haemorrhage was made by computed tomography (CT). The possibility of an early diagnosis of brain stem haematoma, and the differential diagnosis of brain stem haemorrhage by a combination of clinical and tomodensitometric criteria is emphasized. It is concluded that CT is a highly reliable method for the diagnosis, location, and management of brain stem haematoma.
A case of enlargement of a middle cerebral artery aneurysm is reported. Cerebral angiography demonstrated an increase in the size of this aneurysm. Possible factors causing aneurysmal enlargement are discussed.
Results of clinical, endocrinological, and ultrastructural studies of 60 cases of pituitary tumours are presented. A functional classification of such tumours that would: allow a clear correlation between clinical symptoms and the adenoma type, is discussed together with data available from the literature. A case of pituitary adenoma secreting more than two hormones is presented.
This study is based on 11 cases with pseudotumour cerebri. In each case a high dose of Escin was administered intravenously, and the drug effect during ICP recording was observed. In seven cases the drug manifested a significant hypotensive effect. In these cases the treatment with Escin (20 mg every 8 hours) was continued for 3 days; the control if ICP after this period showed a normal pressure in all cases. Oral treatment was continued at the same dosage for 20-30 days and the patient was then discharged. All patients presented complete remission of the clinical syndrome and fundus normalization. Follow-up after a year showed no recurrence. In three cases the treatment with Escin was unsuccessful; these patients were given dexamethasone, with normalization of the syndrome. Another case that presented with a severe picture of intracranial hypertension and visual impairment was treated with Escin and dexamethasone without positive results. The patient improved with external CSF drainage, and was treated by a shunt procedure that induced remission of the syndrome.
Two cases of pituitary abscess are reported. Bacteriological and histological findings of both cases are discussed, together with data available from the literature.
5 patients with gliomas of the anterior optic pathways, histologically assessed or with strong diagnostic evidence, who developed precocious or pseudoprecocious puberty (2 cases) before the operation or after radiation treatment, are presented. Only 2 patients presented familial and/or personal evidence of neurofibromatosis. The production mechanism of these sexual changes is discussed.
Two patients with angiographically proven longitudinal sinus thrombosis were studied from a coagulation point of view. In the first case, marked primary thrombocytosis was found. This patient was treated with aspirin, dipyridamole and radioactive phosphorus. In the second case, fibrinogen and whole blood plasma viscosity were elevated. This patient developed deep vein thrombosis of the left leg a few weeks after the cerebral episode and was treated with coumarin drugs. The importance of a coagulation study in every patient with cerebral vein thrombosis is emphasized.
Lumbar cerebrospinal fluid (CSF) pressure and ventricular size were determined in six patients with impairment of cerebral venous outflow caused by either sagittal sinus thrombosis or arteriovenous shunting into the sagittal sinus. None of the patients had enlargement of the ventricular system, but all six had elevated CSF pressure (mean, 30 mm Hg). At least two mechanisms sufficient to prevent ventricular enlargement and significant hydrocephalus are suggested by these cases: 1) intracranial pressure elevations that occur as a result of cerebral venous outflow impediment maintain a positive pressure gradient between the intracranial CSF and the sagittal sinus contents, thereby increasing bulk CSF outflow; 2) in adults, increased function of alternative CSF outflow pathways occurs secondary to sagittal sinus thrombosis across the arachnoid villi of other intracranial vascular structures and in the spine. These mechanisms may have general importance in the generation of hydrocephalus caused by other disease states in adults but not in children.
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The fine structure of human arachnoid villi obtained by surgical biopsy during operations for intracranial diseases was investigated by electron microscopy. The observation of the cerebrospinal fluid-blood interface, represented by the endothelial covering of arachnoid villi, provided ultrastructural evidence for both "closed" and "open" systems for CSF reabsorption. Ultrastructural findings such as micropinocytotic vesicles, giant intracellular vacuoles, gaps between endothelial cells and tubul-like endothelium-lined structures, previously identified in animals by other workers, were for the first time demonstrated in human specimens.