Biomedical subjects
Publications and source records attributed to A Benedetti.
General remarks on carotid-ophthalmic aneurysms are followed by the description of a personal case in which direct closure of an "inoperable" aneurysm was successful. The surgical treatment of these malformations is discussed.
Fifty patients undergoing cesarean section with spinal anaesthesia received hyperbaric 1% bupivacaine at the L1-L2-, L2-L3 or L3-L4 interspace. Intrathecal injection was performed with a 24 gauge Sprotte needle in 35 patients and a 25 gauge Whitacre needle in 15. Successful anaesthesia was obtained in 49 patients (98%). Fluid loading with 1 litre of crystalloid before spinal block was used for prophylaxis of hypotension. 36 patients (72%) received ephedrine iv after spinal injection. All newborns were in good condition (Apgar score greater than or equal to 9). No post-spinal headache was reported. Our experience confirms the smaller incidence of headache with the pencil point needles compared with conventional needles, the effectiveness of the method and the pleasurableness of the procedure for the mothers.
Hepatic fibrosis and cirrhosis represent the main consequence of chronic liver diseases of different origin. Therefore, the clinical assessment of disease severity is a must in the management of patients with chronic liver damage. Although liver biopsy may be associated with sampling error, interobserver variability and potential complications, it still remains the gold standard for establishing the severity of hepatic necroinflammation and fibrosis. In the last years, several non-invasive tests for the assessment of disease activity and stage have been proposed. However, at present all these tests are not totally accurate and reliable and need further evaluation.
NAFLD is considered to be the most common cause of liver test abnormalities among adults, up to the 10-24% of the general population being affected by NAFLD, with a prevalence rising up to the 50-90% among obese. These data determined a significant interest in the scientific communities. The publications regarding NAFLD increased of 3 folds between 1987 and 1990, of 4,5 folds between 1991 and 1993, of 6,5 folds between 1994 and 1996, of 20 folds between 1997 and 1999 and of 63 and 67 folds in the 2000-2002 and 2002-2004 periods. Approximately the 60% of the published papers appeared in gastroenterological journals, while the 25% of the papers were published on diabetologic journals and the 10% on cardiovascular disease journals. This growing interest has led the most important international scientific associations to organize monotematic conferences specifically on NAFLD and NASH.
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Fractures of the occipital condyle occur very rarely. Plain cervical spine films are not able to detect them. Tomography and CT scan of atlanto-occipital joint are, in these cases, very important. The Authors report a case of a young girl who had a head trauma associated to a fracture of the right occipital condyle. The value of CT and tomography are emphasized.
The International Cooperative Study on the Timing of Aneurysm Surgery included 68 participating centers from 16 different countries. Eight Italian neurosurgical units participated in the Study: Bellaria Hospital, Bologna; Neurological Institute of Milan, Milan; University Hospital, Brescia; University of Milan, Milan; University of Padova, Padova; University of Rome, Rome; Civil Hospital, Verona; and Civil Hospital, Vicenza. The overall case contribution from the Italian centers was 485 cases, 14.1% of the total study population. As compared to the other centers included in the Study, the Italian centers exhibited a higher percentage of patients with impaired consciousness; a later interval of planned surgery from SAH; frequent use of preoperative lumbar drainage, as well as antihypertensives, anticonvulsants, antifibrinolytics, steroids, diuretics and LMW dextran; and less frequent use of sedatives and narcotics. The individual Italian centers differed significantly in regard to patient characteristics and preoperative therapeutic modalities. There was a relatively high number of stuporous or comatose patients admitted to Centers 1, 7 and 8, very few admitted to Centers 5 and 6, and none admitted to Center 2. The different distribution of key prognostic factors prevents a direct comparison of the overall management results of the centers. A stratification of the patients according to a risk scale and/or a prognostic model is required for comparison of the management results.
The 8 Italian centers participating in the International Cooperative Study on Timing of Aneurysm Surgery operated upon 68% of their patients eligible for the study. This low operative rate is mainly explained by the prevailing use of a delayed surgical policy. Only 28% of cases were operated on within 3 days of hemorrhage. Although early surgery was applied in more than 50% of patients from Centers 2, 6 and 7, most other centers operated on approximately 10% of patients within this time interval. Italian centers exhibited a wide variation in planned and actual surgery interval, with only 48% of their patients eventually operated on at the planned time. Differences from planned and actual timing of surgery were less consistent in the units performing early surgery. Preoperative conditions were different between the individual centers. The percent of patients alert at the time of surgery varied from approximately 50% in Centers 3 and 7 to 90% in Center 5. Centers 2 and 6 never operated on comatose patients and rarely stuporous patients. During surgery, induced hypotension was used in 67% of Italian patients. The brain was tight at exposure in 42% of patients from Italian centers; the difference from the other study centers was very significant (p = 0.0009). Consequently major brain resection was more frequently performed in Italy than in the other centers. Brain conditions depended mainly upon timing of surgery and preoperative grade (except for comatose patients) and varied accordingly between the individual centers. Temporary arterial occlusion was rarely used in Italian centers. Intraoperative bleeding from the aneurysm was slightly more frequent than in the other centers. The overall incidence of intraoperative complications was unremarkable. There were significant differences between the Italian and the other centers regarding the use of postoperative routines and medications. In Italian centers ventricular CSF drainage, shunt insertion, ICP monitoring, sedatives and analgesics were less frequently used; lumbar CSF drainage, anticonvulsants, steroids, and diuretics were applied more frequently. In the individual centers the major differences were in the use of antihypertensives, vasopressor agents, diuretics, hypervolemia, and low-molecular weight dextran.
Overall results of management in patients admitted to the 8 Italian centers participating in the International Cooperative Study on Timing of Aneurysm Surgery were rather unsatisfactory, with good recovery in only 42% of patients, and death in 45% of patients. As compared to the other centers included in the Study, Italian centers exhibited a significantly lower recovery rate and a significantly higher mortality rate. There were significant differences also between the individual Italian centers; independently of admission neurological status and timing of surgery, the outcome was better in centers 2 and 6 (a mortality rate under 20%) and worse in centers 1 and 8 (a mortality rate around 60%). Using prognostic factor models, higher than expected mortality rates were observed in 4 centers, and lower than expected good recovery rates in 3 centers. In Italian centers vasospasm accounted for the highest morbidity and mortality rate; the difference in mortality rate from vasospasm between Italian and other centers was very significant. Other important causes of death and disability were constituted by direct effect of the initial bleed and by recurrent hemorrhage. Patients operated on in Italian centers exhibited a good recovery in 57% of cases; the mortality was 27%. Differences from the other centers were less marked than for the overall management results. Mortality rates from vasospasm and from surgical complications were significantly higher in Italian than in the other study centers. Between the individual Italian centers, vasospasm accounted for the highest mortality rate in centers 7 and 8 (17% and 28% respectively). Postoperative pneumonia was significantly more frequent in Italian than in the other centers. In regard to timing of surgery, the differences in results between Italian and other centers were less marked when surgery was performed after 10 days from hemorrhage. In Italian centers as a whole, a delayed operation was linked with a better outcome than an early or subacute operation. The lowest recovery rate was observed in drowsy patients operated on between 4 and 10 days from the hemorrhage. Focal ischemic deficits and pneumonia were prevalent after an operation within 3 days of hemorrhage, while postoperative brain swelling was most frequent in patients operated on between 4 and 10 days from hemorrhage. The differences in results between Italian and other centers and among the individual Italian centers are widely discussed; possible explanations include inadequate modalities of treatment (especially inadequate management of vasospasm) and structural deficiencies of intensive care management in seriously ill patients.
The posterior approach to cervical rizopathy is a widely acquired technique; however only recently it encountered more favorable consideration. After a brief review of the literature, the Authors present some details of surgical approach, discuss its value and its limits with a comment on their own series.
Craniobasal tumors affecting the middle cranial fossa are rarely treated radically; the main problem to solve is the presence of important nervous and vascular structures in this region. The Authors report a case of complete removal of a malignant tumor involving the temporal bone and the middle cranial fossa. Surgery was performed by the cooperation of the neurosurgical and the ENT teams.
Stereotactic biopsy was used to sample a hypodense lesion of the left temporo-occipital lobes in a 32-year-old female with a history of grand mal seizures. Although the intraoperative cytologic examination showed a picture suggestive of malignancy, including giant cells and atypical mitotic figures, the clinical and radiologic history militated against a malignant nature for the lesion, which was thus classified as a low-grade giant-cell astrocytoma. This case emphasizes both the utility of intraoperative cytologic examination of stereotactic biopsy specimens and the need to consider the cytologic and histologic evidence in light of the clinical and radiologic findings.
The Authors have developed an original stereotactic technique by which the radiation dose erogated by a 4 MV linear accelerator is focused into the target volume with a steep dose gradient at its borders. The technique has been employed in a series of 30 patients affected by deep seated brain tumors and AVMs. The paper deals with the preliminary results obtained in a series of 10 patients in pediatric age.
Two cases of an unusual complication in ventriculo-peritoneal shunt for childhood's hydrocephalus are described. Migration of the distal part of shunt into peritoneal cavity was observed. Symptomatology, diagnostic and treatment are reported.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.