Search PubMed⌕ Search

Biomedical subjects

D Zerbi

Publications and source records attributed to D Zerbi.

At least 19 recordsLinked to original sources
PubMed2001

Spinal subarachnoid bleeding of unknown etiology. Case reports.

Spinal subarachnoid bleeding of unknown etiology is extremely rare. It has been suggested that these lesions have to be divided into two subtypes with different behaviour and prognosis according to their location around the spinal cord. The dorsally located bleeding would invariably cause severe spinal cord compression while the ventral lesions would have a very benign course in the absence of remarkable neurological deficit. We observed two patients with spontaneous spinal subarachnoid bleeding of unknown etiology. In both cases the disease was revealed by the sudden onset of severe back pain without subsequent signs of spinal cord compression. In one case the bleeding was ventral to the spinal cord while in the other it was located dorsally. The patients were evaluated with panspinal MRI and selective spinal angiography. They were treated conservatively and follow-up examinations at 18 and 24 months show they are neurologically intact in the absence of rebleeding episodes. We think the diagnosis of spontaneous subarachnoid bleeding of unknown etiology cannot be achieved without a panspinal MRI and a selective angiography have ruled out any other causes. We suggest their incidence is more prevalent than reported due to the difficulty/reluctance to employ MR in the presence of only minor symptoms. Our cases also show that these lesions may have a benign course independently from their location around the spinal cord.

Hematoma↗
PubMed1999

Local versus central assessment of venographies in a multicenter trial on the prevention of deep vein thrombosis in neurosurgery.

Venography is the diagnostic method of choice for end-point measurement in multicenter trials on the prevention of postoperative deep vein thrombosis (DVT). The aim of the study was to determine the inter-observer agreement between the local and central assessment of venographies in a multicenter trial comparing enoxaparin and placebo in the prevention of DVT after elective neurosurgery. The study was run in seven centers experienced in venography trials on DVT prevention. The central and local adjudication panels were both blind with respect to the assigned treatment. The central panel was unaware of the local adjudication. Venographies were adjudicated as positive, negative or inadequate for adjudication and positive venographies as proximal or distal DVT. Inter-observer agreement was assessed according to the Cohen's inter-observer variability index (K index). All 266 venographies (8 monolateral) were considered adequate for adjudication by both the central and local panels. A disagreement was found in 25 cases; K index = 0.75. Fourteen venographies adjudicated as negative centrally were considered positive locally (3 were proximal DVT). Eleven venographies adjudicated as positive centrally (1 was a proximal DVT) were considered negative locally. Enoxaparin was found to be more effective than placebo according to both the central and local adjudication: 16.9% versus 32.6% (Relative risk, RR = 0.52; CI 95% 0.33-0.82) according to central adjudication; 18.5% versus 33.3% (RR = 0.56; CI 95% 0.36-0.87) according to local adjudication. We conclude that a good inter-observer agreement in the assessment of venography was observed between the central and local adjudication in a study on DVT prevention run in a restricted experienced study framework. The cost and work overloading of central assessment of venographies in this study framework seems not to be justified.

Anticoagulants↗
PubMed1998

High prevalence of antiphosphatidylinositol antibodies in young patients with cerebral ischemia of undetermined cause.

BACKGROUND AND PURPOSE: Anticardiolipin antibodies (aCL) are associated with thrombotic phenomena including cerebral ischemia in young adults. Although aCL are directed to a neoepitope formed by phospholipid and beta2-glycoprotein I (beta2-GPI), immunoassays based on cardiolipin as target antigen are widely used. We previously demonstrated that 47% of aCL-negative systemic lupus erythematosus (SLE) patients had antiphospholipid antibodies (aPL) to epitopes other than cardiolipin, and we found an association between aPL to noncardiolipin antigens and thrombosis. We now assess the prevalence and clinical significance of noncardiolipin aPL in young adults with cerebrovascular disease of undetermined etiology. METHODS: Seventy-seven non-SLE patients, aged <51 years, with cerebral ischemia were studied. Specificity of aPL were characterized by ELISAs using 7 different phospholipids: cardiolipin (CL), phosphatidylserine (PS), phosphatidylinositol (PI), phosphatidylglycerol (PG), phosphatidic acid (PA), phosphatidylcholine, and phosphatidylethanolamine. RESULTS: Thirty-four patients (44.1%), had aPL to 1 or more of the following antigens: 23.4% to CL, 18.2% to PS, 15.6% to PG, 14.3% to PA, and 28.6% to PI. Fifty-nine patients (76.6%) were aCL negative. Of these subjects 23.4% showed aPL to noncardiolipin epitopes. PI was the specificity with highest prevalence in all subgroups, and in 6 patients anti-PI antibodies were the only detectable aPL. The binding of aPL to the different antigens was beta2-GPI dependent. CONCLUSIONS: Our data demonstrate a high prevalence of aPL in young adults with cerebral ischemia of undetermined cause. PI was the specificity with highest prevalence, suggesting that anti-PI antibodies may be an immunological marker in young patients with cerebrovascular disease.

Adult↗
PubMed1996

Special types of periodic lateralized epileptiform discharges associated with confusional state in cerebral circulation insufficiency.

A peculiar type of periodic lateralized epileptiform discharges (PLEDs) was recorded on 22 EEGs performed in 11 patients. They were characterized by bursts of sinusoid activity around 7-9 Hz, usually followed by a slow wave, lasting less than 500 ms, with a period less than 2 s, and these sequences could be continuous over several days. We propose to name this pattern 'periodic sinusoid paroxysmal activity' (PSPA). PSPA was recorded mainly over both parieto-temporo-occipital regions, although asymetrically. Sensory stimulations and anticonvulsants had no effect on PSPA. In three cases, mobilization of the head blocked PSPA. The spontaneous disappearance of PSPA was sometimes followed by classical PLEDs. PSPA was always associated with a confusional state and behavioural disturbances, and erratic distal clonic movements were seen in 6 cases. These symptoms disappeared as soon as PSPA ceased. Patients had either vascular risk factors or a previous cerebrovascular insult. The confusional state was associated with either lowered carotidian bloodflow or probable global cerebral hypoperfusion due to a systemic pathology. A vascular origin of PSPA is likely, due to the presence of vascular risk factors, to the morphology of PSPA and to the provoking and inhibiting factors.

Aged↗
PubMed1991

Brain stem abscess treated successfully by medical therapy.

A case of a solitary brain stem abscess in a 55-year-old man is presented. The computed tomographic scan and clinical picture allowed the presumptive diagnosis to be made. The abscess resolved completely after treatment with chloramphenicol, vancomycin, and ceftazidime administered intravenously. Medical therapy should be considered as an effective treatment of a brain stem abscess, provided the antibiotic therapy is administered under close clinical and computed tomographic monitoring.

Brain Abscess↗
PubMed1985

A critical approach to therapeutic apheresis in the management of inflammatory dysimmune polyneuropathies.

Data concerning 37 patients with inflammatory dysimmune polyneuropathy treated by discontinuous flow centrifugation, membrane plasma separation and cascade filtration are presented. Plasmapheresis was combined with immunosuppressants in patients with chronic or relapsing neuropathy (8 patients), cryoglobulinemic (6 patients) and paraneoplastic disease (2 patients), whereas 21 patients with acute Guillain-Barré syndrome (GBS) underwent exclusively plasmapheresis. Most patients were treated during the onset or progression of their disease and excellent or satisfactory clinical results were obtained in 18 patients with GBS, 6 with cryoglobulinemia, 2 with paraneoplastic disease and 4 with chronic relapsing polyneuropathy. Prior to therapy, 34 patients had high levels of immune complexes (CIC); this level was clearly reduced by plasmapheresis and clinical results correlated well with this removal. 3 patients with chronic dysimmune polyneuropathy, without any evidence of CIC, were completely unaffected by treatment. The possible role of CIC in demyelinating polyneuropathies is discussed on the basis of information given by cascade filtration treatment of 7 patients.

Chronic Disease↗
PubMed1984

Plasmapheresis combined with lymphocytapheresis and cytotoxic drugs as a therapeutic modality in neuroimmunological diseases.

Rebound after plasmapheresis is thought to be due to enhanced antibody and/or immune complex production. To prevent rebound a combination of steroids and immunosuppressive drugs has been used: lymphocytapheresis was employed in most patients, for not more than 10 sessions. 50 patients with myasthenia gravis, inflammatory myopathy, chronic dysimmune polyneuropathy and immune complex polyneuropathy have been treated and long-lasting benefits obtained in 35 patients. Rebound effects were observed only when cytotoxic drugs were not given or discontinued too soon. 8 patients who had been treated by plasmapheresis combined with steroids alone, after some recurrences of their disease, were switched to cytotoxic drugs, steroids and lymphocytapheresis combined with plasma exchange: in this group 7 patients eventually gained long lasting remissions. Our clinical experience strongly supports the hypothesis of a synergy between plasmapheresis and immuno-suppressive measures.

Autoimmune Diseases↗
PubMed1982

Plasma exchange combined with cytotoxic drugs and lymphocytapheresis for myasthenia gravis.

20 patients with myasthenia gravis (MG), refractory to anticholinesterase and steroid therapy, underwent plasma exchange therapy combined with immunosuppressive drugs and lymphocytapheresis. In all these patients an apparent clinical improvement was obtained since their first exchange session. During a follow-up of 8-18.5 months, a long-lasting benefit was achieved in 16 patients even though 6 of these had a single recurrence shortly after their first apheretic cycle. 3 patients who achieved substantial improvement of their symptoms during plasmapheresis showed recurrence of weakness after each apheretic course was stopped. However, their clinical response to therapy tended to improve with the following courses, which would be consistent with the effects of immunosuppression. This study strongly suggests that plasma exchange combined with immunosuppressive drugs and lymphocytapheresis can bring about dramatic and sustained improvement of MG and may alter its natural history.

Azathioprine↗
PubMed1981

Plasma exchange in the management of patients with multiple sclerosis: preliminary observations.

Since humoral factors have been implicated in the pathogenesis of multiple sclerosis (MS) and previous attempts at therapeutic intervention have not met with uniform success, plasma exchange (PE) was recently proposed for the management of this disease. We are currently investigating the possible effectiveness of PE in the treatment of MS, and to date 6 patients have been entered into the study. At least 4 of our patients who did not respond to conventional therapy have shown unequivocal, moderate to marked improvement following the first session of PE. At the time of treatment, these patients had an acute exacerbation of their disease. We found no correlation between clinical improvement and the serum immune complex levels, suggesting that other poorly known mechanisms were operative. Based on our preliminary results, we feel that PE may be efficacious in treating exacerbations of MS. More evidence is needed on the effects of PE in the chronic stage of the disease.

Adult↗
PubMed1981

Plasma exchange as a therapy for Guillain-Barré syndrome with immune complexes.

Small volume plasma exchange (PE) was evaluated in 6 patients with acute Guillain-Barré syndrome (GBS) and in 1 with its chronic relapsing type. Patients were treated during the onset or progression of their neurologic involvement and no other combined therapy was provided. 6 of our patients had clear benefit following the first session. Two procedures on alternate days were carried out in 4 patients while a third procedure was performed in 3 due to insufficient exchange or to equivocal improvement. After PE, patients showed moderate to marked improvement in motor strength, in their ventilatory function and in their sensory symptoms, which improved definitely but more slowly than motility. Each patient showed, prior to therapy, high levels of immune complexes; their level was clearly reduced by PE and clinical results correlated with this removal. No relapse was observed during 5-15 months of appropriate follow-up.

Adult↗
PubMed1981

[The predictive value of serial scintigraphy and computerized tomography in the diagnosis of brain lesions (author's transl)].

Six characteristic initial clinical neurological patterns were defined and their incidence was determined in one year caselist of patients hospitalized in the Neurology Department of the General Hospital of Saronno. Since the predictive value of a diagnostic procedure depends not only on sensitivity and specificity but also on the prevalence of disease in the population sampled, the prevalence of surgical brain lesions was evaluated retrospectively in this caselist for each of the clinical patterns previously defined, in order to evaluate the predictive value of serial brain scintigraphy and of brain computerized tomography. In this caselist the most frequent clinical patterns (stroke, skull trauma) show a low prevalence of surgical lesions, unlike it happens in the Neurosurgery Department of another hospital chosen as reference. It follows that in the sample of population constituted by the patients hospitalized for "stroke" in the Neurology Department of this hospital the Bayes' theorem yields a predictive value of brain scintigraphy not significantly inferior in respect of computerized brain tomography. In addition a review of the positive scans of patients with cerebral infarction has shown the possibility of a correct diagnosis in 95%. Therefore the serial scintigraphy is thought to keep a high value as a screening tool in this kind of patients where, after a simple clinical selection, the prevalence of brain lesions needing of surgery is low.

Brain Injuries↗
PubMed1981

Plasmapheresis in the treatment of four cases of Guillain-Barré syndrome (acute form).

Four patients with GBs were treated by PE. In all cases the treatment was successful in that it halted the progression of the disease, induced regression of the signs of bulbar impairment, ventilatory failure and cranial nerve paralysis and improved motility. In all instances the response was quicker for the nerves affected last. Our results confirm that PE is probably the only pathogenetic therapy that can be offered to GBs patients, especially since it can halt the progression of the disease and dramatically shorten its course. It is noteworthy that clinical benefit correlates strongly with removal of large quantities of circulating immune complexes.

Acute Disease↗
PubMed1980

Successful treatment by plasma exchange in Guillain-Barré syndrome with immune complexes.

A 18-year-old woman in the 7th month of pregnancy had a mild enteritis followed within 8 days by a typical Guillain-Barré syndrome with respiratory failure requiring ventilatory support and bulbar palsy. After induction of delivery and discouraging results with steroid therapy, she was treated by plasma exchange. After 2 sessions on alternate days, a recovery of motility was observed and respiratory failure was abolished. It is pointed out that the most significant improvement was recorded immediately after the plasma exchanges, and that this correlated with the removal of immune complexes.

Adolescent↗
PubMed1970

[Not Available].

Explore the source record for details and available documents.

Diagnosis↗