New jet irrigation bipolar system.
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Catheterization↗
Biomedical subjects
A Brunori
Publications and source records attributed to A Brunori.
Non-acoustic neuroma tumor (NANT) of the cerebello-pontine angle: a 15-year experience.
Between 1980 and 1994, 145 patients affected by tumors of the CP angle underwent surgery at the Division of Neurosurgery of the San Camillo Hospital in Rome. The 56 (39%) "non-acoustic tumors" have been analyzed with regard to epidemiologic factors, clinical picture, neuroimaging findings in order to determine their distinctive diagnostic features. Moreover, the surgical outcome and follow-up results are presented and compared with those of the literature.
Adolescent↗
Spontaneous spinal epidural hematomas: is the role of dural arteriovenous malformations underestimated?
Two recent observations of spinal epidural hematomas (SEH) are presented: one of them was associated with iatrogenic coagulopathy, the other, apparently "spontaneous", required reoperation for early recurrence and was finally attributed to ruptured epidural arteriovenous malformation missed during the first procedure. Both patients underwent complete recovery. Although modern neuroimaging provides quick, noninvasive, and sensitive assessment of spinal epidural bleeding, we believe that preoperative spinal angiography is indicated in "spontaneous" SEH with subacute clinical course. Demonstration of underlying vascular anomaly would allow better surgical planning, complete obliteration of abnormal vessels, and prevention of recurrences. Essential epidemiological, pathogenetical, and clinical aspects of SEH are reviewed.
Arteriovenous Malformations↗
Life threatening intracranial complications of frontal sinus osteomas: report of two cases.
Paranasal sinuses osteomas are known as biological benign tumours. However, due to the peculiar anatomical relationships, patients harbouring an osteoma within the frontal sinus are exposed to serious orbital and intracranial complications. We report two unusual cases of intracranial mucocoeles associated with frontal osteomas. In one of them, a superposed tension aerocoele required emergency surgery. Although aggressive treatment of asymptomatic osteomas is not warranted, these lesions must be carefully observed and resected as soon as they show clinical and/or radiological signs of progression. The physiopathological and clinical aspects are discussed.
Bone Neoplasms↗
Cystic extra-axial cavernoma of the cerebellopontine angle.
Besides acoustic neuromas, the cerebellopontine angle harbors a wide variety of masses, named "nonacoustic neuroma tumors," as a whole. Although magnetic resonance imaging has much improved our ability to differentiate among posterior fossa lesions, misdiagnoses may still occur when facing rare, controversial cases.
Cerebellar Neoplasms↗
Surgical treatment of spasmodic torticollis: is there a role for microvascular decompression? With an illustrative case report.
Spasmodic torticollis (ST) is a puzzling movement disorder, characterized by involuntary tonic or clonic contractions of various neck muscles. From time to time, psychogenic, extrapyramidal and neuroperipheral origins have been postulated and reflecting the variety of theories proposed, as many different treatments have been attempted, none of which has shown absolute effectiveness. Surgery of ST classically includes destructive procedures such as myotomies, stereotactically placed lesions, rhizotomies and neurectomies. The recent application of the concept of "neurovascular conflict" to ST induced several authors to perform microvascular decompression (MVD) in these patients, with encouraging and in some cases long-lasting results. Our case report joins this group. From the analysis of pertinent literature we conclude that: a. Spasmodic torticollis is probably a collection of separate clinical entities; b. Even in the so-called "ST of neuroperipheral origin" some coexising central factor must be admitted; c. Neurovascular compression underlies at least some cases of ST. Historical, anatomical, physiopathological and clinical aspects of ST are extensively discussed.
Decompression, Surgical↗
Aneurysms of the sphenoid segment of the middle cerebral artery.
Aneurysms of the M1 segment of the middle cerebral artery are rare. Anatomically they are classified into a "temporal" variety, projecting supero-laterally and a "striate" variety projecting infero-laterally. Between 1960 and 1992, 13 such aneurysms were treated at our Institution. Among them, 11 underwent surgery: 8 (73%) had an excellent or good outcome, 1 (9%) a poor outcome and 2 (18%) died. Two patients treated conservatively carried thrombosed aneurysms: one was a giant unruptured aneurysm with complete occlusion of the parent vessel; the other one was found at autopsy following transsphenoidal surgery and unexplained SAH. All these cases were carefully reviewed with special reference to their clinical and anatomo-surgical features. Exact knowledge of the anatomy of lenticulostriate and temporal branches and awareness of all possible anatomical variants are crucial for correct opening of the Sylvian fissure and successful surgical approach to M1 segment aneurysms.
Adult↗
Acromegaly and pituitary tumors: early anatomoclinical observations.
The elucidation of pituitary physiopathology has been a major challenge for physicians since early ages. Due to the unawareness of the endocrine system, acromegaly, the most striking pituitary disorder, was commonly regarded as an intrinsic bone disease. Andrea Verga and Vincenzo Brigidi, Italian authors of the 19th century, reported the first macroscopic and microscopic descriptions of pituitary adenomas in acromegalic patients. Although far from providing a correct pathogenetic interpretation of the disease, they opened the way to forthcoming observations and discoveries. A short history of acromegaly and pituitary physiopathology is drawn.
Acromegaly↗
Frontoethmoidal osteoma complicated by intracranial mucocele and hypertensive pneumocephalus: case report.
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Brain Diseases↗
Celebrating the centennial (1894-1994): Leonardo Gigli and his wire saw.
In spite of the recent introduction of craniotomes in neurosurgical practice, the simple but brilliant wire saw invented by Leonardo Gigli still holds an important place in neurosurgical instrumentation. Born in Florence in 1863, Gigli was forced by circumstances to leave Italy soon after getting his medical degree. He first spent 2 years attending the most celebrated obstetrical clinics in Paris and London and then, in 1892, moved to Breslau where he worked with Fritsch and Mikulicz. During this successful and rewarding period, Gigli proposed the lateralized pubiotomy (Gigli's operation) for safe delivery in cases of maternal pelvic deformities and, inspired by the sight of a jagged knife during a country banquet, conceived his wire saw to simplify the procedure. In 1894, at Professor Obalinski's suggestion, he successfully tested a modified saw type with a whalebone guide for the preparation of osteoplastic cranial flaps. In spite of his great popularity and the high esteem in which he was held abroad, Gigli's aims were systematically belittled in Italy, where he never qualified for a university teaching position. He died in 1908, at age 44. Although the once celebrated Gigli's operation has merely historical interest today, the favorable features of his wire saw make it a safe and efficient tool in the hands of twentieth-century neurosurgeons worldwide.
History, 19th Century↗
Short report: imported mosquito: an uninvited guest.
Recently, the trend in the number of people traveling from the tropics to malaria-free areas has tremendously increased and this is paralleled by the number of imported malaria cases. Imported infected mosquitoes transmitting the infection to persons living or working nearby international airports have been reported. The possibility that mosquitoes may also reach areas far away from the landing area in the baggage of international travelers is indicated by two cases that are reported here. Malaria should be investigated in any case of unexplained fever even if no apparent risk factor for imported malaria is present, regardless of the distance from international airports.
Animals↗
Severe lumbar stenosis caused by chronic spinal epidural hematoma and multiple disk disease--case report and review of the literature.
We present a patient whose radicular syndrome resulted from combined compression by disk herniation and lumbar chronic spinal epidural hematoma (CSEH). The lesion was extensively studied by CT and MRI and the preoperative diagnosis confirmed by microscopic examination. CSEH is a rare entity, typical of elderly and invariably involving the lumbar canal: only 11 similar cases have been reported up to date. We propose that an undefined number of CSEH remains clinically silent, hidden in the roomy lumbar canal, displacing but not injuring the roots of the cauda. The routine use of Gd-DTPA MRI, even in emergency, will significantly decrease mistakes localization and will provide the correct differential diagnosis.
Aged↗
Intravenous immunoglobulin in two children with Guillain-Barré syndrome.
Two children with Guillain-Barrè syndrome were successfully treated with high-dose intravenous immunoglobulin (IVIG) and no relapses occurred over a 1 year follow up. No side-effects were observed. These data provide further evidence that IVIG may be safely and effectively employed in children with Guillain-Barrè syndrome.
Adolescent↗
Antonio Pacchioni (1665-1726): early studies of the dura mater.
The clustering of arachnoid villi along the sagittal sinus forms what is known as "Pacchioni granulations." These structures were first described in 1705 by Antonio Pacchioni, an Italian scientist. Pacchioni was born in Reggio Emilia, Italy, in 1665, and there he received his degree in medicine. Later he moved to Rome where he built a successful career dedicated to medical practice, research, and teaching. He became a friend of some of the leading scientists of his age: Lancisi, Malpighi, and Morgagni, among others. He devoted himself to elucidating the structure and function of dura mater, and in his studies often used the new technique of maceration of anatomical specimens in various fluids. Among Pacchioni's written works, the Dissertatio Epistolaris de Glandulis Conglobatis Durae Meningis Humanae (1705) deserves the greatest consideration as it contains the first description of arachnoid granulations. He compared dura to cardiac muscle and attributed to its "glandulae" (glands) the faculty of secreting lymph for lubrication of the sliding movements between meninges and brain during contractions. Three centuries after Pacchioni's death in Rome in 1726, the fine structure of arachnoid villi has not been fully elucidated; moreover, many questions related to mechanisms underlying cerebrospinal fluid absorption remain unanswered.
Arachnoid↗
Prevalence and significance of abdominal lymphadenopathy in patients with chronic liver disease: an ultrasound study.
Enlarged abdominal, mainly periportal, lymph nodes were detected by real time ultrasonography in 19% (42 of 227) of patients with chronic liver disease who had no evidence of tumor, upper gastrointestinal carcinoma, or lymphoproliferative disorder. Computed tomography, performed in 15 cases, always confirmed the sonographic findings. Lymph node biopsies from two patients showed reactive hyperplasia. Lymphadenopathy occurred more frequently in autoimmune (primary biliary cirrhosis, autoimmune, and liver-kidney microsomal antibody-positive chronic hepatitis: 33, 25, and 22% of cases, respectively) than nonautoimmune disease (cryptogenic, alcoholic, and hepatitis B virus-related chronic hepatitis: 16, 12, and 10% of cases, respectively) (p less than 0.005). Four of five patients with mixed polyclonal cryoglobulinemia or monoclonal gammopathy had lymphadenopathy. In 125 patients, including 25 with lymphadenopathy, who were monitored for a median period of 25 months, the ultrasonographic pattern remained unchanged. Abdominal, presumably benign, lymphadenopathy may accompany chronic liver disease, especially when prominent immunological features coexist. This should be kept in mind for the correct interpretation of such an ultrasound finding.
Abdomen↗
[Evaluation of a new ambulatory blood pressure measuring device, the Sandoz Pressure System].
The accuracy of "Sandoz Pressure System", in comparison with the mercury sphygmomanometer, was studied in 171 patients in 2 centers. The correlation, as estimated for 657 pairs of measurements, was excellent: systolic and diastolic coefficients were r = 0.986 and r = 0.940 respectively. The individual difference is less than or equal to 5 mm Hg for 90% of the systolic values and 82% of the diastolic values. The ambulatory reliability is demonstrated for 300 profiles, of which 279 (93%) are complete. Of 7902 determinations, 59 (0.75%) were deleted because considered to be incorrect.
Adolescent↗
Glial uptake of excitatory amino acids influences neuronal survival in cultures of mouse hippocampus.
Several reports have described apparently normal survival and development of hippocampal and spinal cord culture preparations grown in Ham's F-12 medium, which contains 100 microM each of L-glutamate and L-aspartate. As at this concentration these amino acids are neurotoxic, some adaptive mechanism must occur to allow neuronal survival. We have investigated the mechanism underlying such adaptation. Dissociated cultures of mouse hippocampal neurons were grown in either Eagle's minimum essential medium or Ham's F-12 medium, supplemented with 5% horse serum. Analysis of neuronal density in cultures stained for neuron-specific enolase showed that although large numbers of neurons were present in mature cultures grown in either medium, neuronal survival in cultures grown continuously in F-12 was reduced to 41% compared to controls grown in Eagle's minimum essential medium. Physiological studies showed that those neurons which survived in F-12 did not lose their sensitivity to excitatory amino acids. In addition, the acute application of fresh, serum-free F-12 to 10-14-day-old cultures grown in either minimum essential medium or F-12 was highly neurotoxic. Three lines of evidence suggest that glial uptake of amino acids, and reduction of the extracellular concentration of glutamate and aspartate below neurotoxic levels, rather than receptor desensitization underlies the adaptive mechanism allowing neuronal survival. First, application of fresh F-12 produced large depolarizations, and profound neuronal swelling in cultures grown in F-12; however, after several hours swelling reversed suggesting a slow onset of the adaptive process. Second, pressure application of conditioned F-12 obtained from sister cultures also elicited depolarizations in neurons grown in F-12, but the amplitude of the underlying inward current was 25-30% of that produced by fresh F-12, suggesting a loss of potency of F-12 exposed to prolonged contact with hippocampal cultures. Third, measurement by high performance liquid chromatography showed reduction of aspartate concentrations to around 10% of those present in fresh F-12, within 24 h after exposing glial cell cultures to fresh F-12. It is concluded that cellular uptake mechanisms for amino acids have a strong impact on excitotoxicity in vitro, and most likely play an important role in protecting neurons from the potentially damaging action of high concentrations of excitatory transmitters in vivo. In addition our experiments help to explain the mechanisms permitting neuronal survival in cultures grown in Ham's F-12 medium, which when applied acutely to mature cultures is strikingly neurotoxic.
Action Potentials↗