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Biomedical subjects

A Rosa

Publications and source records attributed to A Rosa.

At least 91 records · Page 5Linked to original sources
PubMed1991

Saccade deficits after a unilateral lesion affecting the superior colliculus.

A 70 year old patient with a small haematoma largely restricted to the area of the right superior and inferior colliculi is reported. Eye movements were electro-oculographically recorded 17 and 80 days after the onset of the haematoma. At the first examination, latency of lateral reflexive visually-guided saccades was asymmetrical, both in the gap task (central fixation point switched off 200 ms before the onset of the lateral target) and in the overlap task (central fixation point remaining switched on). Furthermore, latency of leftward saccades in the overlap task was increased, and accuracy of these saccades was impaired, at both examinations. In the immobility task (fixation straight ahead while lateral targets suddenly occurred) and in the anti-saccade task (saccade made away from the lateral target), the percentages of errors (saccades made to the target) were high at the first examination, and noticeably lower at the second. These results suggest that the superior colliculus plays an important role both in the triggering and inhibition of reflexive visually-guided saccades.

Aged↗
PubMed1991

[Heart arrhythmias in chronic respiratory failure due to chronic obstructive bronchopneumopathy: the incidence and correlations with nocturnal respiratory disorders].

The aim of this study was to assess: frequency and type of cardiac arrhythmias in patients with severe stable chronic obstructive lung disease (COLD) and chronic respiratory failure (CRF); diurnal or nocturnal predominance of the detected arrhythmias; prospective relationships between arrhythmias and nocturnal hypoxemic-hypercapnic episodes. All patients were examined with careful and complete medical history, chest roentgenogram, standard electrocardiogram, mono and bidimensional echocardiogram, respiratory function tests, arterial blood gases at rest, 24-hour dynamic electrocardiographic recording and, simultaneously, transcutaneous nocturnal monitoring of respiratory gases (TCNM). We studied 14 men: all complained of exercise-induced dyspnoea for 8 +/- 6 years; 10 of them reported usual nocturnal snoring. Respiratory function tests provided the following values (expressed in percentage compared with theoretical ones): vital capacity 58.6 +/- 15, forced expiratory volume/s 36 +/- 19, Tiffeneau index 60 +/- 19, Motley index 160 +/- 35, carbon monoxide diffusion capacity 48 +/- 26. Arterial blood gas analysis at rest resulted: PO2 47 +/- 4.5 mmHg, PCO2 49 +/- 7.9 mmHg, pH 7.38 +/- 0.3. Right ventricular diameter obtained with mono and bidimensional echocardiogram was 32 +/- 4.6 mm. Right pulmonary descending artery measured on chest roentgenogram was 23 +/- 3.8 mm. Nocturnal transcutaneous monitoring of respiratory gases showed mean PO2 of 40 +/- 9.7 mmHg and mean PCO2 of 75 +/- 19 mmHg. During night-time maximum percentage reductions of PO2 (36 +/- 17%) were measured.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

[Giant vertebro-basilar aneurysm. Frontal syndrome].

A 72-year-old man presented with an apparent frontal syndrome. He also had bilateral trigeminal neuralgia, a pyramidal syndrome of all 4 limbs, balance disturbances, a horizontal nystagmus when looking to the left and a right velopalatine paralysis. CT scan with contrast showed a hyperdense rounded lesion in the left cerebello-pontine angle. Cerebral angiography showed this to be a large aneurysm of the end of the vertebral arteries. The patient died suddenly. Autopsy confirmed the site and presence of the aneurysm. Balance disturbances, the pyramidal syndrome and velopalatine paralysis could all be explained by brain stem compression and the bilateral nature of the trigeminal neuralgia by compression of the trigemino-thalamic tract. The apparent frontal syndrome, the authors suggest could have resulted from subacute raised intracranial pressure.

Aged↗
PubMed1991

[Thrombolytic agents in cerebral infarctions].

Thrombolytic agents are aimed at restoring arterial patency thus reducing the risk of cerebral infarction in case of arterial occlusion by blood thrombus or embolus. A review of data from the literature is presented, and the authors have tried to answer the following questions: 1) What are the probabilities of early mortality (first 30 days) and of morbidity due to untreated or medically (thrombolysis excluded) treated cerebral infarction? 2) What are the morbidity and mortality rates after systemic thrombolysis or selective intraarterial thrombolysis? 3) Are the results of thrombolysis affected by the site of arterial occlusion (carotid or vertebrobasilar system)? 4) Does thrombolysis increase the risk of cerebral haemorrhage? 5) Can thrombolysis be regarded as an effective treatment and, if so, in which cases? This study of systemic thrombolysis yielded a mean mortality rate of 22.2%, with satisfactory functional outcome in 58.2% of the survivors. The corresponding figures for selective intraarterial thrombolysis were 29.7% and 84.5% respectively. However when the arterial territories occluded were taken into account, they became 10.4% and 84.4% respectively in the carotid system and 61.5% and 85.00% in the vertebrobasilar system. Comparisons between the natural history of cerebral infarctions, as far as it is known, and the results of thrombolysis suggest that thrombolytic agents are: 1) probably justified by the selective intraarterial route when the occlusion lies in the carotid system; 2) not indicated by the systemic route with urokinase or streptokinase but trials with tPA are being performed. These conclusions, however, must be interpreted with caution as they rest on general data leaving out a number of factors that are often neglected in reports particularly the exact site of arterial occlusion, chiefly in the vertebrobasilar system. From 3 limited cohorts it was possible to evaluate at about 14% the mortality rate in thrombolysis for basilar artery occlusion. This figure, compared with the 70-80% estimate found in the literature for untreated occlusions, suggests that the selective intraarterial thrombolysis may perhaps be indicated also in basilar artery occlusions. It must be noted that selective intraarterial thrombolysis is still an exceptional treatment which requires sophisticated techniques, highly qualified neuroradiologists and prompt application i.e. emergency stroke units.

Cerebral Infarction↗
PubMed1990

[Two-dimensional echocardiography in 100 cases of unexplained cerebral ischemic complications].

One-hundred patients with unexplained cerebral ischaemic events were explored by two-dimensional echocardiography. Thirty-nine patients showed abnormalities considered causative of embolic stroke. The most frequent cardiopathy found was mitral valve prolapse (38.5 per cent). This study suggests that unexplained cerebral ischaemic events should be evaluated by two-dimensional echocardiography and that the most frequent source of emboli to be expected is mitral valve prolapse.

Adolescent↗
PubMed1990

[Should certain carotid artery stenoses be surgically treated?].

Carotid endarterectomy is controverted. We present the available data and endeavour to answer the following questions: 1) what is the probability of morbidity and mortality from ipsilateral cerebral infarction due to asymptomatic or symptomatic extracranial carotid stenosis (transient or prolonged regressive ischaemic strokes) medically treated or untreated? 2) what is the peri-operative morbidity-mortality rate? 3) does the degree of stenosis affect the clinical course? 4) does the presence of ulcerations play a role? 5) what is the long-term probability of ipsilateral cerebral infarction when the stenosis has been operated with success? 6) should endarterectomy be regarded as an effective treatment? and if so, in which cases? Our study of asymptomatic stenoses has shown that the mean peri-operative morbidity-mortality rate was 4.22 percent and the long-term incidence of ipsilateral infarction was 0.34 percent/year for operated stenoses and 0.50 percent/year for all nonoperated stenoses; the latter figure rose to 1.18 percent/year in cases with severe stenosis and to more than 10 percent/year in cases with extensive and irregular ulcerations. In symptomatic stenoses, the cumulative peri-operative morbidity-mortality rate was 5.5 percent. The long-term annual incidence of ipsilateral cerebral infarction was 0.67 percent in patients operated upon and 2.70 percent in patients unoperated upon. A comparison of the natural history of asymptomatic carotid stenoses and of stenoses which were responsible for transient or prolonged regressive ischaemic strokes with the results of surgery showed that endarterectomy is: 1) probably justified in cases with deep and irregular ulcerations with or without symptoms and stenotic or nonstenotic; 2) perhaps justified in cases with symptomatic stenosis without ulcerations. These conclusions should be moderated as they rest on general data and do not take into account a number of factors that are often neglected in the literature, notably the quality of the results obtained by each individual surgeon.

Carotid Artery Diseases↗
PubMed1990

Early and unusual presentation of type I primary hyperoxaluria.

Oxalosis, the systemic deposition of calcium oxalate crystals, may occur in several hyperoxaluric states due to increased production or absorption of oxalate. Type I primary hyperoxaluria (PH I) is a rare autosomal recessive disease caused by deficiency of the peroxisomal enzyme alanine:glyoxylate aminotransferase. Most patients with this disorder are noticed in mid-childhood or even later due to symptoms related to urinary stone disease. In this paper, we report a patient with PH I with a rapid downhill progression to renal failure and death. Oxalosis was detected by renal biopsy, and the diagnosis of PH I was confirmed by increased urinary oxalate and glycolate levels.

Acute Kidney Injury↗
PubMed1989

[Focal motor crises: a transitory ischemic attack?].

A 65-year-old man with hypertension and coronary artery disease presented with a history of 6 tonic fits of right upper limb and 2 clonic fits of the right side of the face with language suspension, each lasting for only 2 to 3 minutes. CT with contrast showed a right occipital low density area, a probable old infarct, and left carotid angiography showed an ulcerated cervical stenosis. Based on reported experimental data, it is suggested that these paroxysmal manifestations are related to transient ischemic attacks, are of epileptic nature and due to an ischemic mechanism.

Aged↗
PubMed1987

[Non-traumatic spinal epidural hematomas (2 cases): contribution of the CT scanner].

Two cases of non-traumatic epidural hematoma are reported. The first case, a 76 year old woman receiving anticoagulant treatment, presented with paralysis of both lower limbs and right upper limb. Myelography and CT scan showed a widespread hematoma from C4 to T2. The second patient, a 63 year old hypertensive woman, developed flaccid paraparesis with urinary retention, myelography and CT scan showed an epidural hematoma extending from T12 to L2. In both cases, surgical evacuation was followed by a fair motor recovery. The 190 published cases of non-traumatic spinal epidural hematoma include 14 of precise etiology, 69 idiopathic and 107 associated with or 2 predisposing factors. Three mechanisms are proposed to explain the spontaneous cases: alteration of peridural veins; rupture of dural vascular clusters; minimal arterial injury. CT scan imaging shows a biconvex, hyperdense epidural image and is the investigation of choice for acute, hyperalgesic myelo-radicular compression syndromes.

Aged↗
PubMed1986

[Ocular bobbing. A new hypothesis].

Three of 4 patients with ocular bobbing were typical cases while in the last case the ocular disorder was asymmetric. A neuropathologic study was conducted in 2 cases. In both use, findings included variable degrees of pontine destruction without lesion of the medulla, with extension of the lesion into the mesencephalon in 1 case. The various physiopathogenic hypotheses put forward are reviewed but none appears satisfactory. A new hypothesis is proposed, based on available clinico-pathologic data (35 published and 2 personal cases) and recent experimental studies. Two centers, one mesencephalic, the other in the medulla, could exist that would generate saccadic movements downwards, and in the pons a center would provoke inhibition of saccadic movements. Destruction of the latter could activate spontaneous saccadic movements downwards (the only possible ones remaining) with the condition that the mesencephalic generating center and its pathways are intact.

Aged↗
PubMed1985

[Neuropathy and cerebellar syndrome induced by amiodarone].

A 62 year old man developed a neuropathy after several months of treatment with amiodarone. The clinical picture was atypical in that it associated a polyradiculoneuritis with cell-protein dissociation and an axial and peripheral cerebellar syndrome. Pathology of muscle and nerve showed dense inclusions in Schwann cell cytoplasm and in pericytes, highly suggestive of fat inclusions. Discontinuation of amiodarone therapy resulted in a slow regression of disorders. Diabetes mellitus developed. Several pathogenic hypotheses are proposed.

Amiodarone↗
PubMed1984

Inspiratory muscle strength and body composition in patients receiving total parenteral nutrition therapy.

We examined the relationship between inspiratory muscle strength and body composition in 59 patients receiving total parenteral nutrition (TPN). Inspiratory muscle strength was assessed by measuring maximal inspiratory pressure (Pm) after a tidal expiration, with the patient supine and the nose occluded. Body composition was determined by multiple isotope dilution. Body cell mass (BCM) and extracellular mass were estimated by measuring total exchangeable potassium (Ke) and total exchangeable sodium (Nae), respectively; Nae/Ke, an index of the nutritional state, was calculated from these values. The effect of changes in muscle mass was evaluated in 29 of the patients by simultaneous determination of Pm and body composition, prior to and at 2-wk intervals during TPN therapy. The Pm was lower (mean +/- 1 SE:33.5 +/- 2.8 cm H2O) in malnourished patients than in those who were in the normal Nae/Ke range (45.3 +/- 4.8 cm H2O, p less than 0.05). Loss of strength was related to reduction in muscle mass because BCM was also reduced in malnourished patients (15.6 +/- 0.8 kg) when compared to those with normal Nae/Ke (19.3 +/- 0.9 kg), (p less than 0.05), and Pm was positively correlated with BCM (r = 0.27, p less than 0.01). Changes in BCM were accompanied by appropriate changes in Pm during the study period (r = 0.44, p less than 0.01); the majority (21 patients) showed improvement in both BCM and Pm.(ABSTRACT TRUNCATED AT 250 WORDS)

Body Composition↗