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Biomedical subjects

A Bollati

Publications and source records attributed to A Bollati.

At least 37 records · Page 2Linked to original sources

Free thyroid hormones in evaluating persistently elevated thyrotropin levels in children with congenital hypothyroidism on replacement therapy.

Some children with congenital hypothyroidism receiving L-T4 therapy have elevated serum TSH levels despite having normal serum T4 concentrations, suggesting that they have a higher threshold for the feedback regulation of TSH release. To further study this possibility, we determined serum free T4 (FT4) and T3 (FT3) concentrations in two groups of L-T4-treated hypothyroid children. Group A consisted of 10 patients with high serum TSH levels; group B consisted of 10 patients with normal TSH levels. All patients were clinically euthyroid, and serum total T4 and T3 concentrations were similar in the two groups. A third (control) group (C) consisted of randomly selected normal children. The three groups were age matched. Serum FT3 and FT4 were significantly lower in group A compared to group B. Serum FT4 and T4 were higher and TSH was lower in group B compared to group C. The T4/T3 ratio wash higher in both groups of children with hypothyroidism than in group C. We conclude that in most patients a high serum TSH was due to inadequate L-T4 therapy, as shown by free hormone concentrations (low) but not by total hormone levels (normal). This suggests that L-T4 therapy should be monitored by measurement of TSH and free hormone concentrations. The latter also can be used to indicate moderate overdosage, not clinically detectable, as shown by the comparison between groups B and C. Measurement of serum total T4, as indicated by the lack of difference between groups A and B and also by T4/T3 ratio, cannot be considered a reliable index of therapeutic adequacy in such children.

Child↗

Microsurgical anterior cervical disk removal without interbody infusion.

A series of 57 patients with root syndromes or compressive myelopathy were operated upon by a modified Cloward technique. No bone grafts were used. The patients were observed for 6 months to 5 years after surgery. Of the 47 patients with radiculopathy, 44 were cured and three complained of minor pains in their arms. Of the 10 patients with myelopathy, three were greatly improved, five were slightly improved, and two remained unchanged. In 100% of these cases, immobilization of the involved interspace occurred within a year. The surgical technique is discussed.

Humans↗

Carcinoma associated with lipomeningocele: case report.

We report the case of a 41-year-old man with an epidermoid carcinoma that had developed on a meningocele with a fistulous tract that chronically drained cerebrospinal fluid. After a review of the literature, we discuss the cause of this rare occurrence. We think that the recurrent discharge of spinal fluid (never complicated by meningitis) may have caused a chronic irritation of the tissues and then the delayed development of a carcinoma, which is similar to a case found in the literature. In our case there was a "flow" of carcinomatous cells along the fistula, which entered the meningocele, invading the subdural space as far as the peduncle. Our patient, who had a benign lesion (meningocele), came under neurosurgical care only after the lesion had degenerated. The malignant degeneration of such a benign lesion emphasizes the need for surgical treatment as soon as possible.

Adult↗

Tension pneumocephalus after transsphenoidal surgery for acromegaly.

The Authors report the case of a 27-year-old man who developed intraventricular and subarachnoid tension pneumocephalus after removal of a large pituitary adenoma via the transnasal approach. This exceptional complication was probably caused by the combined action of a cerebrospinal fluid fistula plus an external lumbar subarachnoid drain, and resolved after removal of the spinal catheter. Such a conservative treatment was allowed in this case by the absence of a shift of midline structures due to bilateral intraventricular air collection. Usually, however, tension pneumocephalus is a life-threatening condition that requires prompt intervention. Meticulous attention to the cerebrospinal fluid draining system is needed in patients with a fistula to avoid the development of this unusual complication.

Acromegaly↗

Third ventricle intrinsic craniopharingioma. Case report.

A case of craniopharingioma developed and situated in the cavity of the third ventricle with no connections with the base of the skull is reported. The patient was a thirty-year-old man, who within a few months had developed a diencephalic syndrome followed by psychic disorders and intracranial hypertension. Cerebral scan: large area of accumulation in the supra and retrosellar region. Bilateral carotid angiogram: no pathological staining but the venous angle and the internal cerebral vein were elevated and shifted posteriorly. Pneumoencephalogram: free and normal basal cisterns; the third ventrical is almost totally filled by a mass; small dilatation of the lateral ventricles. Operation: right trans ventricular approach to the third ventricle. The tumour was the size of an apricot encapsulated with a smooth surface, and adherent to the wall of the third ventricle only in the region of the infundibulum. There was little bleeding and no cystic component. Total removal was performed except for a few millimeters of capsule in the infundibular region. The postoperative course was complicated by an irreversible diencephalic insufficiency with death on the 27th postoperative day. Autopsy clearly showed that the inferior surface of the brain in the diencephalic region was not involved by the mass which hystologically was doubtless a craniopharingioma. Only two other cases of craniopharingioma of the third ventricle were so far reported in the literature by Cashion and Young in 1971.

Adult↗