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Biomedical subjects

S M Gaini

Publications and source records attributed to S M Gaini.

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

[Cerebral blood flow in subarachnoid hemorrhage].

Cerebral blood flow (CBF) following subarachnoid haemorrhage varies according to the time of sampling, with regard to the time of bleeding, to clinical conditions of patients and to any possible occurrence of vasospasm. CBF is proportionally reduced upon clinical conditions, involves the totality of patients and represents a diffuse bilateral phenomenon, not dependent on the location of the aneurysm. Following events, such as vasospasm, may deteriorate haemodynamic conditions, especially when unstable. Thus, CBF monitoring is necessary and useful in these patients. The evaluation of this parameter, according to the metabolic demands, appears rather fundamental. Besides, during the first two weeks, all the available therapeutic strategies have to employed in order to achieve the best optimization of the CBF so as to avoid the occurrence or at least minimising the extent of ischemic cerebral lesions.

Cerebrovascular Circulation↗
PubMed1998

[Surgical versus endovascular treatment in cerebral aneurysm. The opinion of a neurosurgeon].

The high risk of rebleeding of ruptured aneurysms imposes the need of their early exclusion from arterial circulation. The onset of endovascular technique of embolization gives a new chance, making, time by time, necessary the choice for the best treatment. The advantages and limits of surgical option are well known and consolidated. The results of endovascular technique are similar in the acute phase, but it lacks an adequate follow up and a clear definition of some technical knowledges. Clinical and anatomical data and a serious analysis of specific technical difficulties of both methods must condition the choice of treatment. Present experience allows us to give sure indications only for certain cases, whereas final landmarks are indisposable in many other situations. However, the team discussion between the neurosurgeon, the neuroradiologist and the neuroreanimator must be the crucial point of the decisional way in every single case.

Embolization, Therapeutic↗
PubMed1998

Dissecting vertebral aneurysm. Report of a case.

Aneurysms of the vertebral artery (VA) are relatively uncommon, accounting for less than 0.5-3.0% of all aneurysms and 20% of aneurysms originating in the posterior fossa. There are three distinct forms of aneurysms: saccular, fusiform and dissecting. The diagnosis of dissecting aneurysm is based on the findings of angiography, surgery and autopsy. Irregular fusiform appearance, intramural retention of contrast medium in the venous phase and alternating irregular stenotic and dilated segment (string and pearl sign) are the basal angiographic findings. Patients with dissection of VA often develop subarachnoid hemorrhages (SAHs), with the typical neck pain or suffer cerebral ischemia. Because of the high risk of rebleeding of dissecting aneurysms, they should be treated as soon as possible, with occlusion of the VA. Nowadays, both surgical and endovascular procedures allow the treatment of dissecting vertebral aneurysms. Anyway, one should be aware that vertebral occlusion performed proximal to PICA origin may be followed by ischemic complications. In this paper, we discuss the diagnostic and therapeutic difficulties associated with dissecting vertebral aneurysms on the basis of personal observation and a review of the literature.

Aortic Dissection↗
PubMed1997

Neurophysiological evaluation with multimodality evoked potentials in craniostenosis and craniofacial stenosis.

Multimodality evoked potentials (somatosensory and acoustic) have been recorded before surgery in children selected for surgical treatment for different kinds of craniostenosis and craniofacial stenosis. Evoked potentials were found to be deranged on at least one recording in 50% of cases, suggesting a significant incidence of neurophysiological alterations in these patients. No correlation was found between evoked potentials' derangements and clinical status, radiological findings, or different kinds of craniostenosis; moreover, a significant correlation was found between neurophysiological alterations and the age of the children. These preliminary data might define the possible role of neurophysiological tests in the presurgical evaluation of craniostenosis and craniofacial stenosis.

Aging↗
PubMed1997

A delayed complication with steel wire osteosynthesis.

We treated a 6-year-old child for hyperteleorbitism. We performed a facial bipartition steel wire osteosynthesis of the frontal bone. After 7 years we observed two episodes of pneumococcal meningitis, which were treated with intravenous antibiotic, resulting in a prompt recovery. The computed tomographic scan and nuclear magnetic resonance image showed the steel wire included in the frontal sinus and in contact with the dura mater. Removal of the wire and suture of the dura allowed prompt recovery.

Adolescent↗
PubMed1997

Incidence of asymptomatic berry aneurysms among patients undergoing carotid endarterectomy.

BACKGROUND: Scattered reports of literature suggest the hypothesis that patients suffering from a severe stenosis of extracranial carotid artery may present an increased rate of intracranial berry aneurysms caused by the hemodynamic stress on the side opposite to the stenosis, namely on physiological shunts. However, this hypothesis has never been verified upon a large and homogeneous series focused on the argument. MATERIALS AND METHODS: We reviewed a consecutive series of 405 patients submitted to carotid endarterectomy for stenosis greater or equal to 70%. RESULTS: Thirteen aneurysm were found in 11 patients (2.6%). Our patients showed a slight increase of incidence regards to general population (1%), maybe due to the large number of aged patients among our subpopulation. Preoperative TCD evaluation showed the presence of increased flow velocities in the physiological shunts, namely the anterior cerebral artery and the anterior communicating artery, in 65% of the patients, and angiography confirmed the redistribution of intracranial circulation. Nevertheless, according to aneurysm location, no statistically significant correlation (0.3 < p < 0.4) was found between the presence of an aneurysm and the values of velocity in these arteries. CONCLUSIONS: As regards the etiology of berry aneurysms, these data suggest that increased hemodynamic stress per se is not sufficient to cause the origin of berry aneurysms. Maybe, a role is possible only if either congenital, or acquired and age-related factor, peculiar of cerebral arteries, coexist.

Aged↗
PubMed1997

Acute pneumocephalus: an unusual complication of thoracotomy.

The authors describe a iatrogenic cerebrospinal fluid fistula into the pleural cavity, a rare and unusual complication of thoracic surgery. The importance of considering this diagnosis in patients who suffer from headache and altered mental status after thoracotomy and the early surgical repair of this potentially fatal complication are stressed.

Acute Disease↗
PubMed1996

Management of symptomatic carotid stenoses with coincidental intracranial aneurysms.

There are at present strong indications for surgery in patients suffering from symptomatic extracranial carotid stenoses of > 70%. Surgery of coincidental aneurysms is a still debated problem, but there is general agreement that it is indicated in selected cases according to the patient's life-expectancy and size and site of the aneurysm. The coexistence of these two lesions raises a decision-making problem. We reviewed 389 endarterectomies and found 12 intracranial berry aneurysms in 10 (2.6%) patients. All the 10 patients were harbouring a symptomatic carotid stenosis of > 70%. Since the correction of a stenosis increases blood flow to an aneurysm, our approach was to first operate on the intracranial lesion and then the stenosis in 7 patients harbouring aneurysms > 5 mm. Two patients affected by small aneurysms < 5 mm of an A2 azygos and left internal carotid artery underwent left endarterectomy only. The last patient was submitted first to percutaneous angioplasty of a left stenosis, then to open surgery of a contralateral middle cerebral aneurysm and finally to intravascular occlusion of a small aneurysm of the left internal carotid bifurcation by menas of a coil; this policy was adopted in order to restore normal haemodynamic conditions before the intracranial procedure. There was no mortality or permanent morbidity following surgery for aneurysm or endarterectomy. Transient morbidity occurred in 2 cases after clipping of aneurysms of the anterior communicating and middle cerebral arteries. Our results suggest that surgery of coincidental aneurysms may give good results even when there is a severe symptomatic stenosis in the neck. Moreover, the presence of a small intracranial aneurysm does not seem to be an additional risk factor for endarterectomy. When the lesions are on different sides, it may be better to treat the stenosis first if it decreases the ipsilateral cerebral blood flow.

Aged↗
PubMed1995

Long-term outcome in aqueductal stenosis.

In this study, 78 patients with aqueductal stenosis were submitted to detailed neurodevelopmental assessment with a follow-up of 5-25 years. Sixty-eight percent of patients were categorized as normal; they either attended normal school courses or had regular jobs. Among these, 34% had some motor abnormalities (ataxia, mild hemiparesis, visual disturbances). Twenty-four percent (19 cases) were moderately disabled (trainable retardation) and 8% (6 cases) were severely handicapped. Epilepsy was observed in 13% of the cases. Incidence of recurrent and generalized seizures paralleled neurodevelopmental outcome (5% in normal, 16% in moderately disabled and 50% in severely disabled patients). Endocrine dysfunctions were evident in 28% of the cases and were characterized by precocious or delayed puberty, amenorrhea and somatic underdevelopment. No patient with ventricular enlargement and a cortical mantle width below 20 mm showed a good outcome. Large ventricles were compatible with normal mental development when compensated with a corresponding cranial vault enlargement. In patients with normal mental status and motor abnormalities, long-term CT scan findings revealed the presence of focal brain abnormalities (poroencephaly, brain atrophy, calcifications, extracerebral collections).

Adolescent↗
PubMed1989

Benzodiazepine receptors and diazepam-binding inhibitor in human cerebral tumors.

Benzodiazepines can regulate neoplastic growth and immune response through specific peripheral benzodiazepine receptors. We investigated the presence of peripheral and classic central benzodiazepine receptors as well as diazepam-binding inhibitor, an endogenous ligand of both types of receptors, in different human cerebral tumors. Peripheral benzodiazepine receptors were present in all the tumor types studied, whereas central benzodiazepine receptors and diazepam-binding inhibitor were detectable in astrocytomas and glioblastomas and undetectable in meningiomas, neurinomas, and metastases. The role of diazepam-binding inhibitor and of the different benzodiazepine receptors in neoplastic cells is still to be defined.

Adolescent↗
PubMed1989

Primary intracranial rhabdomyosarcoma: report of two cases.

Primary intracranial rhabdomyosarcoma (RMS) is a rare tumor in infancy and childhood that is found in various locations in the central nervous system. The clinical course worsens rapidly, and the final outcome is poor, with a median survival time of 8-10 months. Invasion of the meninges, spontaneous intratumoral bleeding, spinal leptomeningeal CSF spreading of tumor cells, and early recurrence of the mass are the distinctive features of RMS. Diagnosis of RMS may be missed: immunohistochemical staining using specific markers (myoglobin, myosin, desmin, vimentin, enolase), along with ultrastructural studies, provide the basis for making the final diagnosis. Treatment of RMS includes surgical excision, craniospinal radiation therapy, and chemotherapy. We report two cases of primary RMS in the CNS located in the posterior fossa and frontotemporal area. Both children underwent total surgical removal of the mass. Early recurrence of the tumor mass was noticed in both patients 2 months after surgery. Both children died shortly thereafter.

Adolescent↗
PubMed1989

Clinicoradiological and therapeutic considerations in severe diffuse traumatic brain injury in children.

Forty-one children with severe head injuries and diffuse brain lesions were selected from a consecutive series of 62 children in traumatic coma (21 focal mass lesions) and studied. According to the CT pattern, two main types of intracranial lesions were considered: diffuse axonal injury (DAI) and diffuse brain swelling (DBS). High mortality, due to secondary increases of intracranial pressure (ICP), correlated well with the patterns of severe DBS, absence of perimesencephalic cisterns, and obliteration of the ventricles. However, children with normal CTs, and/or obvious shearing injuries indicative of DAI, had favorable outcomes; there was no mortality if increased ICP was not present. We conclude that although there does not seem to be any routine indications for ICP monitoring in children with pure DAI, early ICP monitoring and aggressive management of increasing ICP should be considered in comatose children with DBS, especially when associated with subarachnoid hemorrhage and respiratory or circulatory failure.

Adolescent↗
PubMed1988

Ganglioside content and composition in human gliomas.

Many alterations of ganglioside content and distribution have been described in human and experimental tumours. Our previous data showed the presence of lipid alterations in meningiomas, in particular an increased monosialylganglioside content. Therefore we analyzed the distribution and content of gangliosides in various gliomas. The data show that ganglioside content is inversely proportional to tissue malignancy and that the ganglioside pattern can be described as lacking of polysialylgangliosides with increased GD3 content. The amount of GD3 (as percent of total gangliosides sialic acid) increases from 15% in astrocytomas grade I to 60% in grade IV. The GD3 increase seems to be almost specific of glioma. Because anti-GD3 antibodies could be used to localize immunohistochemically the ganglioside and to help the tumour grading, we used a purified preparation of GD3 to produce monoclonal antibodies in balb/c mice. But because some clones did produce anti-GD3 antibodies the low yield requires further experiments to obtain an antibody useful for this purpose.

Adult↗
PubMed1987

Calmodulin content in human brain tumors.

Using a radioimmunoassay method, the particulate and soluble calmodulin levels were determined in biopsied specimens from normal human brain and from various human brain tumors. Both in normal and pathological tissues the major portion of calmodulin was revealed in the cytosol. The chromatographic elution profiles of calmodulin obtained from soluble and particulate fractions of the same specimen were identical, thus suggesting an identity of the supernatant and particulate form of calmodulin. In all the examined oncotypes, the calmodulin content was lower than in normal extracts and this biochemical feature could not have been correlated with the degree of malignancy of the neoplasia. Furthermore, the translocation of calmodulin from the particles to the cytoplasm, reported in other rapidly growing tumors, lacks in human cerebral ones. Our findings indicate that in human brain oncotypes the calmodulin distribution is quite different from that found in tumors taken from other tissues, where its level is increased and a positive correlation between calmodulin concentration and growth rate of neoplastic tissue has been revealed.

Adult↗