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Biomedical subjects

P Floridi

Publications and source records attributed to P Floridi.

10 recordsLinked to original sources

Acute sterile meningitis as a primary manifestation of pituitary apoplexy.

Pituitary apoplexy is a rare and underdiagnosed clinical syndrome. It results from hemorrhagic infarction of the pituitary gland. In its classical form it is characterized by acute headache, ophthalmoplegia, visual loss and pituitary insufficiency. Meningeal irritation signs, clinically indistinguishable from infectious meningitis, are considered rare and have not been reported as presenting signs. We report a 53-yr-old man who was admitted to hospital following acute headache, fever, neck stiffness and paresis of the left oculomotor and abducent nerves. A lumbar puncture revealed an increased number of polymorphs but with a sterile cerebral spinal fluid. Magnetic resonance imaging (MRI) showed an intrasellar mass with central necrosis in an enlarged sella. Endocrinological evaluation demonstrated insufficient thyroid, adrenocortical, and gonadal function. Necrosis within a chromophobe adenoma was found upon surgical decompression of the sella. After surgery anterior panhypopituitarism did not recover, while ophthalmoplegia subsided. The patient is now in good health under appropriate hormonal replacement therapy.

Acute Disease↗

Radiation-induced myelopathy in long-term surviving metastatic spinal cord compression patients after hypofractionated radiotherapy: a clinical and magnetic resonance imaging analysis.

BACKGROUND AND PURPOSE: Hypofractionated radiotherapy is often administered in metastatic spinal cord compression (MSCC), but no studies have been published on the incidence of radiation-induced myelopathy (RIM) in long-term surviving patients. Our report addresses this topic. PATIENTS AND METHODS: Of 465 consecutive MSCC patients submitted to radiotherapy between 1988 and 1997, 13 live patients (seven females, six males, median age 69 years, median follow-up 69 months) surviving for 2 years or more were retrospectively reviewed to evaluate RIM. All patients underwent radiotherapy. Eight patients underwent a short-course regimen of 8 Gy, with 7 days rest, and then another 8 Gy. Five patients underwent a split-course regimen of 5 Gy x 3, 4 days rest, and then 3 Gy x 5. Only one patient also underwent laminectomy. Full neurological examination and magnetic resonance imaging (MRI) were performed. RESULTS: Of 12 patients submitted to radiotherapy alone, 11 were ambulant (eight without support and three with support) with good bladder function. In nine of these 11 patients, MRI was negative; in one case MRI evidenced an in-field relapse 30 months after the end of radiotherapy, and in the other, two new MSCC foci outside the irradiated spine. In the remaining patient RIM was suspected at 18 months after radiotherapy when the patient became paraplegic and cystoplegic, and magnetic resonance images evidenced an ischemic injury in the irradiated area. The only patient treated with surgery plus postoperative radiotherapy worsened and remained paraparetic. Magnetic resonance images showed cord atrophy at the surgical level, explained as an ischemic necrosis due to surgery injury. CONCLUSIONS: On the grounds of our data regarding RIM in long-term surviving MSCC patients, we believe that a hypofractionated radiotherapy regimen can be used for the majority of patients. For a minority of patients, more protracted radiation regimens could be considered.

Aged↗

[Radiotherapy of the breast after conservative surgery for primary carcinoma. Irradiation technic with matched fields].

The authors report their technique for breast radiotherapy following conservative surgery (quadrantectomy + axillary dissection). The breast and chest wall are irradiated with photons from a 60Co unit through two fixed opposing tangential fields. The posterior field edges must be parallel and coplanar to the chest wall. A routine treatment plan using simulator, pantograph and computerized console is standardized by mathematical formulae elaborated from geometric breast measurement parameters. Gammagraphies acquired prior to and during therapy allow verification and control of treatment parameters. For 35 patients the therapy plan as described was compared with that obtained by CT images. Our procedure proved valid and an accurate treatment plan could be elaborated even without CT images. The use of wedges, half-field blocks and the dose scattered to the contralateral breast are also discussed.

Axilla↗

[Rare malformation of the anterior-inferior cerebellar artery. Cerebellar hemisphere angioma and aneurysm of the labyrinthine artery].

The AA relate a case of a complex malformation of the AICA characterized by aneurysm of the internal auditory artery developed inside the internal acoustic channel associated with an angioma fed by the cerebellar branch of the same artery. During a long period with dizziness, tinnitus, headache in the occipital region, mild sensoneural retrocochlear hearing loss a subarachnoid hemorrhage occurred. The vascular malformations were visualized by a vertebral angiography and the axial projection resulted to be the most important clue. The AA report the case for its rarity and emphasize the vascular origin of certain unexplained kinds of vestibular syndromes in young patients.

Aneurysm↗

[Sacroradiculo graphic and myelographic investigations with iopamidol: study of 610 examinations (author's transl)].

610 sacrorodiculographic and myelographic examinations were carried out injecting at lumbar level Iopamidol at 200, 300 and 370 mg I/ml concentrations. Immediate and early complications have been noticed in 18,52% of cases, i.e. sensation of pain during contrast injection, headache, nausea, vomit, neck stiffness, photophobia, epilepsy. In sacrorodiculographic examinations, side effects especially occurred by using 370 mg I/ml concentrations; in lumbar and thoracic myelographies, incidence of complications did not statistically differ by uing 300 or 370 mg I/ml concentrations. Side effects have occurred most frequently in cervical myelographies carried out with 370 mg I/ml concentration. Analysis of complications as well as radiographic results suggest to use Iopamidol at 300 mg I/ml concentration in sacrorodiculographics, in lower thoracic myelographies and in studies of narrowed, stenosed or obstructed canals; Iopamidol at 370 mg I/ml concentration may be used in upper thoracic studies and cervical myelographies.

Adult↗