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Biomedical subjects

S Duca

Publications and source records attributed to S Duca.

At least 19 recordsLinked to original sources
PubMed1994

Spinal intramedullary cavernous angiomas: a literature meta-analysis.

The present report reviews 57 (out of 65) cases of spinal intramedullary cavernomas collected from the literature, plus one personal patient. Almost 70% of all patients were women. Mean age at diagnosis for women was 36.4 years, with a peak in the third decade. More than three-fourths of all women became symptomatic between the second and fourth decades, with a peak in the fourth decade. Unlike in men, cervical and thoracic lesions are almost equally represented, generally involving 1-2 vertebral levels. Mean size at diagnosis is 1.7 cm; no enlargement over time was seen. Symptoms are more frequently acute; pain and sensorimotor deficits are the usual complaints, but the clinical picture may simulate that of multiple sclerosis. The duration of history was less than 5 years in more than 80% of women. Bleeding was seen in 60% of women, with a risk of 1.6%/person-year of exposure globally. Cervical lesions have both a shorter course and increased frequency of bleeding. If not immediately recognized, repeated cycles of bleeding are the norm, with a mean interval of 39.6 months between the first and second episodes. The preoperative status was the single most important factor bearing on outcome, whereas sex, age, size, location, duration of history and extent of removal were not. Magnetic resonance imaging was diagnostic in all cases, whereas angiography was 100% negative. Surgery should not be a necessary first option, as recovery from the first bleeding is apparently fairly frequent.

Adolescent↗
PubMed1993

The role of cortex in central pain syndromes: preliminary results of a long-term technetium-99 hexamethylpropyleneamineoxime single photon emission computed tomography study.

The role of the somatosensory cortex in central pain syndromes is widely questioned. Two recent position emission tomography studies detected a strong activation of the parietal and cingular cortices after brief nociceptive stimuli. On the other hand, a recent single photon emission computed tomography study found no cortical activation in five patients affected by central poststroke pain and algodystrophia. In this study, we present the single photon emission computed tomography findings in five patients suffering from central pain syndromes. Two of these, one with facial postrhizotomy anesthesia dolorosa and the other with central poststroke pain, showed a decrease of blood flow in the parietal lobe, further decreasing after stimulation by nonpainful maneuvers. Our results suggest that somatosensory cortical areas might be involved in the generation of anomalous pain states in some cases of central pain syndromes.

Adult↗
PubMed1993

[Study of spondylodiscitis with magnetic resonance. Use of gadolinium-DTPA].

Eighteen patients suffering from spondylodiscitis were examined with MRI and 22 pathologic levels were identified: 1 cervical, 6 thoracic and 15 lumbosacral. As for etiology, 4 cases were tubercular, 3 strepto-staphylococcal, 3 brucellar 1 strepto-bacteroides and 11 of unknown origin. Five patients underwent MR follow-up 4-9 months after the clinical onset. SE T1- and T2-weighed sequences were always performed and 11 patients, with 13 pathologic levels, also underwent SE T1-weighted sequences with i.v. Gd-DTPA administration. No correlation could be made between the signal intensity of the involved vertebral bodies and disks and etiology. On SE T1-weighted sequences 91% of the vertebral bodies were hypointense, whereas the intervertebral disks were hypointense in 55% of cases and isointense in 45%. On SE T2-weighted sequences, the vertebrae appeared hyperintense in 65% of the cases while the disks were hyperintense in 55% and isointense in 41%. After Gd-DTPA injection signal intensity increased in 100% of cases, both at the body and at the disk. In 6 cases an inflammatory infiltration of the intracanalar structures was found, whose identifications was possible, in 4 cases, only after contrast medium injection. In the follow-up of 5 cases at 4-9 months the vertebral bodies remained hypointense in 3 cases on T1-weighted sequences, while in 2 cases signal intensity tended to normalize. Signal normalized in 4 cases on T2-weighted sequences. In 2 follow-up examinations disk structures were never depicted, neither on T1- nor on T2-weighted sequences. To conclude, T1-weighted sequences appear to be more sensitive than T2-weighted sequences to demonstrate inflammatory processes in the vertebral bodies, while the two sequences are equivalent to evaluate the disks. Gadolinium-enhanced T1-weighted sequences were more sensitive than the T1- and T2-weighted ones, especially to assess the extent of inflammatory processes into the spinal canal and to evaluate their persistence. The authors suggest the use of unenhanced and enhanced SE T1-weighted sequences only at least in the follow-up of spondylodiscitis.

Adolescent↗
PubMed1992

Superficial siderosis of the central nervous system: neuroradiological evaluation of two cases.

We present 2 cases of superficial siderosis of the central nervous system secondary to chronic subarachnoid bleeding. The diagnosis was made with MR and cerebrospinal fluid (CSF) examination. MR showed, in T2-weighted images, superficial hypointensity of the cervical cord, brainstem, cerebellum, and basal cisterns due to hemosiderin deposits. CSF was xanthochromic, with increased protein content. In 1 of the 2 cases also the CT examination was positive, showing a hyperdense rim around the brainstem. A complete neuroradiological evaluation (MR, CT, angiography and myelography) did not permit to detect the source of the bleeding.

Central Nervous System Diseases↗
PubMed1992

[Late reinterventions after the surgical treatment of gastric and duodenal ulcer].

A number of 87 reinterventions performed during a 5-year-period for late complications of the gastric and duodenal ulcer surgery are analysed. In most of them (64 cases), the cause of the reintervention was a postoperative ulcer. A long afferent loop (6 cases), the dumping syndrome (4 cases), the stenosis of the anastomosis opening (6 cases) and the primitive neoplasm of the gastric stump (7 cases) represented other causes of reintervention. The immediate postoperative results were very good and good in 69 cases. The risks related to the specific character of this surgery materialized themselves in 14 postoperative complications (anastomotic fistulas, haemorrhages from the anastomosis, stress ulcers etc.), which required iterative operations; the postoperative death rate attained 3.4%. The analysis of these postgastrectomy syndromes is an opportunity to discuss about the failure factors in the surgery of the gastric and duodenal ulcer, the possibilities of exploration and the principles which should guide the reparative therapy.

Adult↗
PubMed1991

Comparative analysis between clinical requests and magnetic resonance imaging results in neurological diseases.

In order to rationalize the use of MR, which is a high cost technology and not widely available, we analysed comparatively the reasons of test requests and MR diagnosis. We selected three groups of motivations for requests: diagnosis, symptoms and aspecific symptoms: they all were related with MR results classifying concordance, negativity and discordance groups. The results were evaluated also considering whether the patients were hospitalized or outpatients and in relation to the brain, the cervical, thoracic and lumbar regions. Within the general group we found a negativity of 36%, which increases to 52.5% if the motivation of the exam was a symptom and to 88% if the symptom was aspecific, whereas it fell to 26% with the request belonging to the group diagnosis. Concordance was higher in the brain and in the cervical spine (62% and 61%) whereas it was 46% in thoracic and lumbar spine and higher, even if not statistically significative, in the group of hospitalized patients compared to the outpatients.

Adolescent↗
PubMed1991

[Cephalic duodenopancreatectomy with preservation of the pylorus in treating a malignant tumor of Vater's ampulla].

The paper reports on the clinical observation of a patient with mechanical jaundice in which the biliary obstruction was caused by an ampulla of Vater. Cephalic duodenopancreatectomy with preservation of the pylorus was used. Distally the duodenum was excised to its intersection with the mesenteric vessels. For recovery of the digestive circuits, a loop excluded "en Y" à la Roux ascending transmesocolically was used. The anastomoses had the following stages: choledochojejunostomy (T-T) the most proximal; pancreatic-jejunal anastomosis (T-L); and the most distal, the duodeno-jejunal one (T-L). After surgery, the evolution was good, and the patient left the hospital with the wound cured. Starting from this observation, the authors discuss aspects connected with the technique of cephalic duodenopancreatectomy with or without preservation of the pylorus.

Adenocarcinoma↗
PubMed1989

Sphincteroplasty of the sphincter of Oddi in the treatment of benign distal obstructions of the bile duct. A prospective study of 70 cases managed by a original surgical technique.

Seventy patients in whom sphincteroplasty was performed by an original technique are presented. In 65 cases the indication was stenosis of the sphincter of oddi, associated or not with cholelithiasis or hepatic hydatid disease. There were relative indications in another 5 patients. Sphincteroplasty was achieved with the aid of an original probe, and average length of the incision of the ampullary area was 28 mm. In the immediate postoperative period there was one case of acute postoperative pancreatitis, one duodenal fistula and an upper digestive haemorrhage; also a residual stone was detected. All these complications have responded favourably to conservative treatment. There was a single death in an old patient with bronchopneumonia. The late results were very good or good with the exception of two cases: one which presented with cholangitis episodes maintained by duodenal stasis, and one female patient, who after one year from sphincteroplasty had to be reoperated on for an hepatic abscess.

Adult↗