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Biomedical subjects

C A Pagni

Publications and source records attributed to C A Pagni.

At least 19 recordsLinked to original sources
PubMed2002

The important role of pain in neurorehabilitation. The neurosurgeon's approach or (neurorehabilitation: the neurosurgeon's role with special emphasis on pain and spasticity).

Pain syndromes due to peripheral or central nervous system damage, or both, may hinder neurorehabilitation. Control of pain may be obtained by ablative or augmentative procedures. Of the ablative modes only DREZ and Cordectomy are still being employed in cases of pain due to Brachial Plexus Avulsion and conus and cauda damage at T9-L1: in both pain is not simply due to "deafferentiation". The augmentative procedures include spinal cord, deep brain and cortical stimulation. Subarachnoid infusion of drugs (midazolam, clonidine, baclofen, etc.) is a new avenue open to control pain. Indications, results and mechanisms of action of those procedures in neuropathic pain are discussed on the basis of literature and personal experience.

Electric Stimulation Therapy↗
PubMed2002

Spinal meningioma during hydroxyurea therapy. A paradoxycal case report.

We report the case of a 65-year-old woman who developed symptoms of spinal cord compression due to a spinal meningioma after 10 years of treatment with hydroxyurea (1000 mg/day) for essential thrombocytemia. This case provides a paradigm for the occurrence of symptomatic meningioma in course of HU therapy.

Aged↗
PubMed2001

Nitric oxide synthase and cytochrome c oxidase changes in the tumoural and peritumoural cerebral cortex.

BACKGROUND: We analysed changes in nitric oxide synthase (NOS) and cytochrome oxidase (CO) activities in the tumoural and peritumoural cerebral cortex in order to investigate: a) the role of NO in tumourigenesis, in TBF regulation, and in vasogenetic PBE; b) the metabolic changes caused by the neoplasm in the surrounding tissues. METHOD: Intra-operative samples of cerebral cortex were studied by means of immunohistochemistry for nNOS and iNOS, and by histochemistry for NADPH-diaphorase (NADPH-d) and CO. FINDINGS: In contrast with normal cortex, reactive glial cells and the endothelium of small blood vessels displayed strong NADPH-d and iNOS activities in oedematous peritumoural tissue. In the tumoural cortex, NADPH-d and nNOS-positive neurones were reduced in number and their dendrites were thin and interrupted, and infiltrates of NADPH-d and iNOS-positive tumoural cells were frequent. CO activity was decreased in the deep layers of peritumoural cortex, and it was almost absent in the tumoural cortex. INTERPRETATION: In peritumoural and tumoural cortex changes in NOS and CO activities suggest that the coupling between neuronal activity and blood flow is impaired in the damaged cerebral cortex, and that the increase in NOS activity may play a role in tumour vascularization and progression.

Adenocarcinoma↗
PubMed2001

Sudden presentation of intracranial meningioma after elective general anesthesia.

A case of "silent" intracranial meningioma unmasked by narcosis is described. The diagnosis was made because of the patient's failure to wake up after elective general anesthesia for orthopaedic surgery. Factors leading to this complication and its management are discussed. Early computed tomography scan and antiedema therapy are strongly suggested for these patients.

Anesthesia, General↗
PubMed2000

De novo cavernoma case report and review of literature.

BACKGROUND: De novo cavernoma, reported with the familial form of disease, is rare in cases with a negative family history. Cranial radiation, coexistent vascular malformation, genetic and hormonal factors, previous surgery for intracranial lesions, or other apparently unrelated intracranial lesions have been reported as risk factors. METHODS: We report a case of de novo cavernoma without a family history and without previous irradiation or any other known risk factors. The genesis of this lesion is discussed. RESULTS: To our knowledge, this is the first case, based on two separate magnetic resonance imaging (MRI) studies, demonstrating evidence of de novo cavernous malformations in the absence of familial history, brain radiation therapy, or other apparently unrelated intracranial tissue lesions. Based on previous negative computed tomography scans, other cases have been presented as de novo cavernous angiomas; thus it is possible that the newly discovered cavernoma existed previously but had been missed on previous poorer quality or lower resolution imaging studies. CONCLUSIONS: Cavernoma can arise even without an associat family history; in our case, a previous head injury could have set off either a genetic cascade with attendant endothelial proliferation or a latent virus.

Adult↗
PubMed2000

Neuropsychological and neurophysiological evaluation after anterior communicating artery (ACoA) aneurysm surgery.

BACKGROUND: We evaluated high cerebral functions 6 months after surgery for bleeding ACoA aneurysms comparing neurophysiological and neuropsycological tests. METHODS: Twelve patients were chosen among a series of cases operated on in the first 48 hours after ACoA aneurysm bleeding. All of them were in Hunt-Hess grade I or II. We excluded patients over 65 years, or with intracranial haematomas, intraventricular haemorrhage, hydrocephalus, or with multiple or giant aneurysms. All of them underwent neurophysiological evaluation with recording and mapping of long latency (P300) auditory and visual event-related potentials (ERPs) and a neuropsychological assessment for memory, intelligence, frontal lobe functions and language. RESULTS: Neuropsychological assessment: All patients were severely damaged on phonemic fluency. In a first group (group A: 3 cases) tests were all in a normal range. In a second (group B: 3 cases) the tests showed severe impairment on learning and long term memory. In a third (group C: 6 cases) tests showed memory and "frontal lobe" deficits. Neurophysiological assessment: The whole group of patients showed significant delay in ERPs recordings compared to controls. ERPs of patients in group A and B showed no significant differences from controls, while being significantly delayed in 5 patients out of 6 of group C. CONCLUSIONS: All patients had difficulties in the phonemic task in which a notable cognitive effort is necessary, while intelligence, short term memory, attention and language were within normal limits. Patients in group C showed severe frontal lobe type cognitive impairment. Those ones in groups A and B did not present cognitive derangements (A) or only memory and learning impairment (B). ERPs may be an objective parameter in the follow-up of cases with cognitive impairment, even if neurophysiological tests cannot be replaced.

Event-Related Potentials, P300↗
PubMed2000

Peri- and postoperative pain valutation in carpal tunnel release of median nerve compression.

We analysed 108 patients, operated on day surgery, for carpal tunnel release of median nerve compression, to evaluate peri- and postoperative pain. We made in all cases a short intertenarian incision (25 mm) with microsurgical technique and local anaesthesia using mepivacaine 2% without vasoconstrictor. We evaluated pain for local anaesthetic infiltration as VRS (Verbal Rating Scale) 6,3 median-time to the first possible analgesic assumption (in all cases paracetamol 500 mg), total analgesic assumption, pressure algometry (to evaluate "allodiny") after the first 48 hours and subjective pain intensity by a numerical pain scale. Pain intensity on first drug assumption (after a mean time of 7 hours from the end of surgery) had a mean VAS value of 2,15; while after a second assumption of analgesic (after a mean time of 15 hours from surgery) had a mean VAS value of 2. Mean total analgesic assumption was 1,64 tablets of paracetamol 500 mg. From these data we may deduce that peri- and postoperative pain following median nerve decompression with this technique and anaesthesia, has a moderate intense peak of brief duration, for local anaesthetic infiltration (that seems to be the most painful event) and modest and not constant pain in the postoperative time (more evident 7 and 15 hours from the end of surgery). It may be useful association with mepivacaine bicarbonate solutions or injecting less painful local anaesthetic.

Anesthesia, Local↗
PubMed1998

[Therapeutic decisions and grading of subarachnoid hemorrhage].

Early admission and medical treatment can improve prognosis in patients with subarachnoid hemorrhage (SAH). In our Centre in 10 years, 595 patients with SAH have been treated: 422 were admitted within 24 hours (71%) and 498 (84%) within 72 hours. 374 underwent surgical treatment: 283 within 48 hours and 91 underwent late surgery. Thirty-three patients underwent emergency surgery for intracranial hematomas, with a mortality rate of 30%. One hundred eighty-one patients in Hunt-Hess grade I-II underwent early surgery. Mortality rate was 7%. Mortality rate for rebleeding, when surgery was delayed was more than 10%. Patients in Hunt-Hess grade III underwent early surgery in the majority of cases (68 out of 111). Only in 52% of cases surgical result was good. Thirty-four out of 108 in grade IV-V underwent early surgery, with a mortality rate of 45%. The analysis of general results shows that early surgery improves prognosis in Hunt-Hess grade III patients. Also patients in Hunt-Hess grade III-IV-V can take advantage of early surgery. Old age, arterial hypertension and angiographical vasospasm do not worsen prognosis even in patients operated on early. Endovascular treatment even in acute phase has improved results especially in cases of certain aneurysms types such as posterior circulation aneurysms.

Adult↗
PubMed1998

[Pharmacologic therapy of subarachnoid hemorrhage].

Medical treatment of subarachnoid haemorrhage, is focused on the prevention of rebleeding and vasospasm, of damages of oxitading products, and on the improvement of general conditions of the patient. Some authors consider use of antifibrinolytic usefull to reduce the risk of rebleeding, but the percentage of hydrocephalus and ischemia are increased. In our Centre combination of nimodipine-cloricromene and hemodilution is used for the prevention of vasospasm. We report conclusions about 216 patients in I-II-III grade of Hunt-Hess scale, treated before 48 hours from SAH. We obtained only 8% postspasm ischemias, with no neurological deficit, and only 23% of increased cerebral blood flow revealed by transcranial Doppler. Cloricromene is used only after aneurysm is occlused. It presents different action mechanisms. It is an inhibitor of platelet activation and aggregation, of cyclooxygenase and lipooxygenase activity, so reducing thromboxanes ratio. Phospholipase A2 inhibition it's possible but not demonstrated. It also interferes with phosphoinositoles path and so with proteinkinase C activity, and reduces hemostatic thrombotic balance activation and leukocyte endothelial adhesion and activation. It reduces, finally, the release of free radicals, cytokines inflammation amplyfing. The reduced damage to the endothelium allows the releasing of vasodilatatory agents like NO.

Humans↗
PubMed1997

Chronic triventricular hydrocephalus: morphological and functional study before and after ventriculoperitoneal shunting.

We have neuroradiologically and neuropsycho-physiologically studied a case of chronic hydrocephalus due to congenital acqueductal stenosis, before and after ventriculoperitoneal shunting. The aims of the study were: 1) to point out the correlation between neuroimaging (Computerized Tomography/Magnetic Resonance Imaging) and mapping of Computerized Spectral Analysis EEG (CSA-EEG); 2) to monitor evoked bioelectrical activity by neurophysiological evaluation of acoustic and visual N1 and P3. Both bioelectrical activity and neuroimaging evaluation showed a considerable recovery of the neurobiological substratum after neurosurgical shunting, while neuropsychological investigation showed a slight improvement in all cognitive tasks.

Adult↗
PubMed1995

Propofol analgesia in central pain: preliminary clinical observations.

Propofol, an intravenous general anaesthetic, has been reported to relieve some forms of pruritus at subhypnotic doses. We assessed its effectiveness in 32 patients with several kinds of non-malignant chronic pain, in a placebo-controlled, double-blind study. We found that central pain, but not neuropathic pain, is at least partially controlled by propofol at subhypnotic doses, without major side-effects. In particular, allodynia associated with central, but no neuropathic, pain has been completely controlled. Propofol analgesia leads to renormalization of brain metabolism as seen on single photon emission computed tomography. We conclude that propofol may help in the diagnosis of central pain, particularly in unclear cases, and also in treatment. Possible mechanisms of action are discussed.

Adult↗
PubMed1995

Primary diffuse leptomeningeal gliomatosis with anaplastic features.

A case of primary diffuse leptomeningeal gliomatosis with anaplastic features, diagnosed during life and confirmed at autopsy, is presented. The clinical, radiological and pathological features are compared with those of the very few cases reported in the literature. Early papilloedema and hydrocephalus were followed by spinal and cranial nerve palsies. The NMR images and the tissue biopsy turned out to be useful for reaching an in vivo diagnosis. While in the previously reported cases the glial proliferation was microscopically a slow growing astrocytoma, the present case was histologically malignant and had a high labelling index (LIs) for proliferation markers (PCNA and KI-67). The high growth rate and the wide diffusion of the tumour at presentation may account for the poor prognosis of diffuse leptomeningeal gliomatosis and the inefficacy of radiotherapy and chemotherapy. The presence of basal lamina arount tumour cells and the immunohistochemical distribution of the proliferation markers are consistent with the origin of primary leptomeningeal gliomatosis from ectopic glia.

Biomarkers, Tumor↗
PubMed1995

Functional thalamic depression in a case of reversible central pain due to a spinal intramedullary cyst. Case report.

In this report the authors discuss a case of central pain of spinal cord origin due to a spinal thoracic intramedullary cyst. Single-photon emission computerized tomography with technetium-99m hexamethylpropyleneamineoxime showed thalamic hypoperfusion contralateral to the affected leg. Surgical evacuation resulted in total relief of the pain and normalization of the thalamic alteration. The reader can infer from these findings that functional alterations in thalamic processing may be important in the genesis of central pain.

Cysts↗