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Biomedical subjects

C Manelfe

Publications and source records attributed to C Manelfe.

At least 181 records · Page 10Linked to original sources
PubMedDate not supplied

Treatment with long acting repeatable bromocriptine (Parlodel-LAR*) in patients with macroprolactinomas: long-term study in 29 patients.

The aim of the study was to evaluate the short term and long-term effects of long acting repeatable bromocriptine (= Parlodel-LAR*) in patients with macroprolactinomas. Twenty-nine patients (15 men and 14 women) aged 42 +/- 2.7 (M +/- SEM) years were injected with Parlodel-LAR* every 4 weeks during 3.3 +/- 0.3 years. The starting dose was 50 mg/injection, then it was increased to 100 mg in 11 patients and 150 mg in 9 patients. PRL levels decreased in all but one patient 4 weeks after the first injection (270 +/- 59 vs 934 +/- 210 ng/ml, p < 0.001), then became less than 20 ng/ml in 20/29 (69%) patients and finally became undetectable or low in 13/29 (45%) patients. Visual field defects were present in 12/29 patients before treatment. In 11/12 patients, treatment with Parlodel-LAR* resulted in an improvement and complete correction of visual field defects was observed in 8/12 patients. Adenoma size (2.5 +/- 0.2 cm before treatment) was reduced by at least 20% in 24/29 (83%) patients. Disappearance of adenoma was observed on CT scan in 8/29 (28%) patients after 28.7 +/- 5.3 months of treatment. Minor side effects occurred in 20 patients after the first injection then disappeared in 18 patients within the following 6 months of treatment. One patient had rhinorrhea after 3 months of treatment. Treatment with Parlodel-LAR* results in beneficial short-term effects (with rapid correction of recent onset visual field defects) and long-term effects (which can include complete disappearance of adenoma on CT scan evaluation) in patients with macroprolactinomas.

Adult↗
PubMedDate not supplied

Cavernous hemangioma of the intracranial optic pathways: CT and MRI.

PURPOSE: The purpose of this work was to describe the CT and MR findings in three patients with cavernous hemangioma (CH) of the intracranial optic pathways. METHOD: CT and MR studies of three patients with CH of the optic chiasm were reviewed. All patients underwent MRI of the chiasmal area, with coronal T2- and T1-weighted studies as well as gadolinium-enhanced coronal and sagittal T1-weighted studies. RESULTS: The patients (mean age, 40 years) presented with chiasmal apoplexy (two cases) and progressive decrease of visual acuity (one case). In all cases, MRI showed regular enlargement of the optic chiasm, with extension to the optic nerve in one case and to the left optic tract in one case. The chiasmatic dimension was 2.5-3 cm in two cases and 1-1.5 cm in the other case. In all cases, MRI revealed an acute (isointense signal on T1-weighted and hypointense signal on T2-weighted sequences) or subacute (hyperintense signal on T1 - and T2-weighted sequences) hemorrhage with, adjacent to it, an area with signals of blood of different ages, highly suggestive of CH. CT showed, in chiasmatic CHs, a suprasellar mass spontaneously denser than adjacent brain parenchyma. In two cases, microcalcifications were associated. In two cases, CT and MRI revealed slight heterogeneous enhancement after contrast agent administration. In one case, no enhancement was observed. Two patients underwent surgery by frontopterional craniotomy. The optic chiasms were swollen with an intrinsic bluish mass. The cerebrospinal fluid was not xanthochromic. Microscope examination confirmed the diagnosis of CH. After 12 months, the operated patients had improved visual acuity and visual field but did not completely recover. The nonoperated patient (because of spontaneous rapid recovery of visual acuity) was followed clinically and on MRI over 18 months. CONCLUSION: CH in the optic chiasm must be suspected in the presence of an acute chiasmatic syndrome. MRI is the best imaging modality, showing either an acute or a subacute chiasmatic hemorrhage or the typical pattern of CH with heterogeneous alternation of foci of blood of different ages, with a central focus of methemoglobin, a peripheral rim of hemosiderin, adjacent foci of acute or subacute hemorrhage, and slight or no enhancement after gadolinium administration.

Adult↗
PubMedDate not supplied

Cerebral thrombophlebitis in three patients with probable multiple sclerosis. Role of lumbar puncture or intravenous corticosteroid treatment.

We report 3 cases of young patients, 2 women and 1 man, who presented a cerebral venous thrombosis following intravenous treatment with high doses of corticosteroids. All of them presented a probable multiple sclerosis according to clinical, biological (CSF) and MRI criteria and were treated for the first time by a bolus of 1,000 mg of methylprednisolone OD during 5 days. All the usual causes of cerebral venous thrombosis were systematically excluded in all of them. The role of corticosteroid treatment in cerebral thrombophlebitis is discussed. All of them underwent a lumbar puncture a few days before corticosteroid treatment and the relationship between lumbar puncture and cerebral thrombophlebitis is also discussed. Cerebral venous thrombosis associated with corticosteroid treatment has rarely been reported. The relationship between corticosteroids and venous thrombosis has already been suggested but has never been clearly understood.

Adult↗
PubMedDate not supplied

Pure motor hemiplegia: CT study of 30 cases.

Pure motor hemiplegia (PMH) is a well defined syndrome usually caused by ischemic lesions of lacunar type located either in the internal capsule or in the pons. Angiography and isotope scanning are usually normal. CT scan reveals small deep infarcts and appears to be the most reliable investigative method. The CT scan findings are described of thirty patients with PMH of rapid onset (less than 36 hours). In 29 of the 30 cases a lesion was found which could explain the PMH. Small hemorrhages (2 cm in diameter) in the posterior limb of the internal capsule were noted in two cases. Ischemic lesions were found in 27 patients, 22 patients had a single lesion (20 capsular and 2 pontine), while 5 patients had 2 lesions (2 bi-capsular, 3 capsular and pontine). Three varieties of ischemic capsular lesions were observed. We found in 15 cases a capsulo-putamine-caudate infarct (type I); in 8 cases a capsulo-pallidal infarct (type II); and in 2 cases an anterior capsulo-caudate infarct (type III). Type I corresponded to the area of the lateral lenticulostriate branches of the middle cerebral artery. Type II involved the territory of the perforating branches of the anterior choroidal artery. We suggest that type III involves the territory of the internal lenticulostriate branches of the anterior cerebral artery. Lacunes are generally linked to arterial systemic hypertension. However, only 16 of 30 patients in this series were chronically hypertensive.

Adolescent↗
PubMedDate not supplied

Preoperative embolization of intracranial meningiomas.

The goal of preoperative embolization of intracranial meningiomas is to facilitate their surgical removal by reducing tumor vascularity and decreasing blood loss during surgery. This study is based on personal experience with about 100 embolized meningiomas and on the experience of others. Embolization is performed during the same session as diagnostic angiography. The appropriate embolic materials (absorbable or nonabsorbable) are chosen according to the location of the tumor, the size of the feeding arteries, the blood flow, and the presence of any potentially dangerous vessels (dangerous anastomoses between external carotid artery and internal carotid or vertebral arteries, arteries supplying the cranial nerves). Preoperative embolization appeared to be very useful in large tumors with pure or predominant external carotid artery supply (convexity meningiomas), in skull-base meningiomas, and in middle fossa and paracavernous meningiomas. It was also useful in falx and parasagittal meningiomas receiving blood supply from the opposite side and in posterior fossa meningiomas. CT low densities demonstrated after embolization did not always correlate with necrosis on microscopic examination, and large areas of infarction could be found despite normal CT. Embolic material was found on pathologic examination in 10%-30% of cases; fresh or recent ischemic and/or hemorrhagic necrosis consistent with technically successful embolization was demonstrated in 40%-60% of cases. With careful technique complications are rare.

Embolization, Therapeutic↗
PubMedDate not supplied

[Computerized cisternography with metrizamide].

Metrizamide, a new water-soluble contrast medium with low toxicity, was used for cranial computed tomography (computerized cisternography) in 26 patients. When injected by lumbar puncture, the pericerebral cisterns (posterior fossa and sella turcica especially), can be visualized with much greater precision than with classical computed tomography. It also allows the normal and pathological circulation of the CSF to be studied. The authors report on 6 cases of tumours of the posterior fossa, 10 cases of pituitary tumours, 2 cases of "empty" sella, 2 cases of CSF rhinorrhoea, 2 cases of normal pressure hydrocephalus, and 2 cases of syringomyelia, studied by this method. The examination was normal in 3 cases. The authors stress the rapidity, reliability, and good tolerance of this new method.

Adenoma↗