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Biomedical subjects

A Bricolo

Publications and source records attributed to A Bricolo.

At least 73 records · Page 4Linked to original sources
PubMed1985

In vitro analysis of BCNU-sensitivity in human malignant gliomas. I. A model study with alkylating, cross-linking and carbamoylating agents in anaplastic astrocytomas of pediatric age.

Like all chloroethyl-nitrosoureas of major clinical use, 1,3 bis-(2-chloroethyl)-1-nitrosourea (BCNU) - which is one of the most effective chemotherapeutic agents for CNS malignancies - biologically degrades into active alkylating and carbamoylating moieties. Using a human brain tumor stem cell assay, we analyzed a series of anaplastic astrocytomas of pediatric age, characterized by different degrees of BCNU-resistance. Early (2-4) passage cultures from these tumors were treated in vitro with model drugs for alkylation (BCNU, CHLZ (2-[3-(2-chloroethyl)-3-nitrosoureido]-2-deoxy-D-glucopyranose), ENU (N-ethyl-N-nitrosourea), cross-linking (BCNU, CHLZ) and carbamoylation BHCNU (1,3 bis (trans-4-hydrocyclohexyl)-1-nitrosourea): dose-schedules were compatible with clinically achievable levels. Results of chemosensitivity tests confirmed that - as previously reported in malignant gliomas of the adult - cellular resistance to BCNU was closely related to the cross-linking activity of alkylating species. However, in pediatric gliomas the levels of cell kill after treatment with the purely carbamoylating agent BHCNU, even at the highest doses tested, were lower than expected.

Age Factors↗
PubMed1984

Review of 1,000 consecutive cases of severe head injury treated before the advent of CT scanning.

This is a review of 1,000 consecutive cases of severe head injury admitted to our Neurosurgical Department between January 1973 and August 1976, before the advent of CT scanning. All patients were comatose following head injury (GCS less than or equal to 8) and were treated homogeneously by the same neurosurgical team by a protocol that included immediate resuscitation on arrival, diagnosis of intracranial lesions by angiography, early surgery when needed, mechanical ventilation, steroids, and mannitol. Extracranial lesions, even if preponderant, were treated by various specialists in the Neurosurgical Department, which for all practical purposes operated as an Emergency Department. Admission criteria were very broad with no preadmission selection. The overall mortality for this series was 45%. A little less than half the patients made good recoveries or remained moderately disabled (47%); 6% were severely disabled, and 2% survived in a persistent vegetative state. More than two-thirds of the patients were brought to our Neurosurgical Department after a short stay at a general hospital; 72% were admitted within 6 hours of injury; 71% were traffic accident victims; and 34% had significant associated extracranial injuries. Carotid angiography was performed in 78% of the patients and indicated the presence of an intracranial haematoma requiring surgery in 36% of the whole series. Mortality was significantly higher in operated than in unoperated patients (56% versus 39%); those treated surgically, however, were older, in worse clinical condition, and showed a higher incidence of acute subdural haematomas associated with brain contusion. Carotid angiography proved very effective in revealing the presence of an expansive lesion but failed to reflect the severity of brain damage, since the group with "negative" angiograms showed a high mortality (52%). Patients with a lucid interval had a higher percentage of surgical lesions than those with immediate coma (58% versus 26%); but fully 42% of them did not require surgery, and 25% had negative angiograms. From the prognostic point of view the clinical data elicited after initial resuscitation were highly predictive of the outcome: some individual neurological signs, such as mydriasis, posturing and eye movements, were not inferior to the GCS score in that respect. Age also proved a strong predictor, since elderly patients are more likely to have severe subdural and parenchymal lesions and their clinical severity is accordingly greater.(ABSTRACT TRUNCATED AT 400 WORDS)

Accidents, Traffic↗
PubMed1984

CNS trauma: head injuries.

Head injuries are a common cause of death and permanent disability, particularly in the first decades of life. The high mortality and morbidity associated with head trauma is due mostly to the severity of the injury itself but also in part to the possible events that could aggravate the primary brain damage. This also occurs in patients with an initially mild head trauma. This article reviews imaging procedures, complications of head trauma, and the order of diagnostic evaluation.

Brain Concussion↗
PubMed1983

Choroid plexus papilloma of the cerebello-pontine angle.

The clinical symptoms, neuroradiological findings and post-operative course is described in four patients affected with a choroid plexus papilloma of the cerebello-pontine angle. Clinical criteria (such as the early onset of signs and symptoms of raised intracranial pressure, and the early impairment of the auditory function) and the neuroradiological pictures (the lack of bone lesions, the tumour appearance as a hypodense mass on CT scan, which is well-enhanced after contrast injection) help the neurosurgeon to predict the surgical findings, but they cannot be considered as definite. The prognosis of such tumours is related more to the difficulties of the surgical intervention than to the peculiar properties of the growth.

Adult↗
PubMed1981

Lumbar epidural Ewing sarcoma. Light and electron microscopic investigation.

The clinicopathological findings in a child with extraskeletal Ewing sarcoma are described. The patient complained of pain in the lower back and difficulty walking. An extraskeletal, epidural, friable tumor, 2-3 cm long was removed from the epidural space. It had no relationship with the bone structures. Light and electron microscopic examination of the tumor led to the diagnosis of Ewing sarcoma. The morphological aspects of this neoplasia and the problem of the differential diagnosis with other small cell tumors of the epidural space are discussed.

Adolescent↗
PubMed1980

Prolonged posttraumatic unconsciousness: therapeutic assets and liabilities.

Prolonged coma following severe head injury is a serious condition because it implies a poor prognosis. In order to assess the magnitude of this phenomenon, the authors have reviewed 135 cases of posttraumatic unconsciousness lasting more than 2 weeks, from among the entire propulation of patients with severe head injury managed in 10 years in their neurosurgical intensive care unit. The incidence of prolonged coma was 4% of all patients with acute traumatic coma, and 0.6% of all hospitalized patients with head injury. By 1 year after trauma, 30% of the patients had died, 8% survived in a vegetative state, 31% survived with severe disabilities, and 31% had made a satisfactory recovery. The early clinical picture of prolonged unconsciousness has no predictive value as to further evolution. Patients emerge from unconsciousness in consecutive steps representing the restoration of increasingly complex neurological functions; the timing of these steps is very variable and sometimes covers several months. The time distribution of recovery steps in individual cases is of limited predictive value as to outcome. The most frequent state during the recovery process is the condition of wakefulness without awareness, which should not be pronounced "permanent" earlier than 1 year after injury.

Brain Injuries↗
PubMed1978

Clinical application of compressed spectral array in long-term EEG monitoring of comatose patients.

To obtain continuous information about the cerebral electrical activity in the early course of coma, an apparatus was designed which included a small fast computer capable of calculating the Fourier transform. The practical application of this system of CSA to 123 comatose patients in a neurosurgical intensive care unit overcame the technical difficulties connected both with the patient's and environmental conditions. The advantages of such a technique are mainly due to its capacity of synthetising EEG signals and to its clarity of presentation, which is easily grasped even by people not specifically trained in electroencephalography. Hours of EEG activity are compressed into a pictorial and synoptic representation that shows in real time the distribution and temporal behaviour of frequencies as well as the intensity of total electrical activity. The immediate detection of these parameters permits evaluation of any worsening or improvement of cerebral electrogenesis, as well as of the inter-hemispheric asymmetries at their onset. EEG monitoring thus provides useful elements for assessing the comatose state in individual cases and for adjusting treatment. Finally, the spectrographic aspect of the first 48 h, as a whole, carries a great prognostic significance. The most striking finding from this study was the confirmation that the comatose states that, in their early course, show only a fixed slow-wave EEG activity are far more rare than those that display an electrical activity changing in time.

Adolescent↗
PubMed1977

Acute pontine syndromes following head injury.

Patients in the early stage of severe head injuries occasionally present with a clinical picture analogous to that in vascular or neoplastic pontine lesions and they can be identified by careful clinical examination and by repeated electroencephalography (E.E.G.). The commonest features in these cases were preservation of consciousness, constriction of the pupils, disturbances of reflex ocular motility, severe pyramidal deficits, decerebrate rigidity, myoclonic manifestations, irregular breathing, and cranial nerve palsies. An E.E.G. tracing similar to the normal pattern was a common finding. These observations suggest that pontine syndromes may be directly produceg a non-reacting, but conscious, patient for one who is deeply comatose.

Adolescent↗
PubMed1977

Decerebrate rigidity in acute head injury.

A comprehensive study of the motor patterns, usually grouped under the heading "decerebrate rigidity," was carried out in a series of 800 patients with severe head injuries. The incidence of these manifestations was 39.6%, and when they were present chances of survival were reduced from 79.4% to 28.1%. Clinical and electromyographic investigations revealed heterogeneous and unstable motor manifestations that did not fit into the classical groups of experimental models of decerebrate rigidity. Combinations of extensor and flexor attitudes and/or responses were frequently found in same patient, but could be separated into homogeneous groups. Each recognized postural pattern had its own distinct neurological signs and prognosis. Age did not significantly affect the outcome, however, intracranial exapnding lesions (73.5%), impairment of the brain-stem oculomotor system (49.8%), and deep coma (88.9%) all contributed to an unfavorable course. Surgical treatment was effective when performed for intracranial hematomas and in patients with incomplete extensor rigidity. Good recovery was achieved in 16% of decerebrate patients, while 12.1% survived in prolonged coma or with severe disabilities. All clinical and neuropathological data suggest that extensor motor abnormalities in the acute phase of cerebral traumatic disease do not always conclusively indicate structural brain-stem damage. A critical analysis of so-called "decerebrate rigidity" (rejecting in some instances its Sherringtonian implications) may allow for a more accurate clinical assessment of the severity of head injury.

Adolescent↗
PubMed1976

Local cooling in spinal cord injury.

Eight patients with acute spinal cord injury at different levels were treated by local cooling. Early laminectomy was performed and the subdural space was irrigated with saline at 5degreesC for about two hours. In addition to this treatment, five patients, after closure of the operative wound, received local epidural cooling that was prolonged for a few days. All patients before treatment had a complete loss of function of the spinal cord below the injured segment. Four of these regained some sensory and motor functions and two were able to walk. Somatosensory cortical evoked responses were consistent with the results obtained, thus demonstrating their prognostic value. The clinical application of local spinal cord hypothermia in order to minimize the catastrophic effects of spinal cord trauma is discussed. The results obtained in these eight patients agree with the several experimental observations and seem to justify the application of this procedure to human beings.

Adolescent↗