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Biomedical subjects

F Grisoli

Publications and source records attributed to F Grisoli.

At least 55 records · Page 3Linked to original sources
PubMed2001

[Postural and locomotor evaluation of normal pressure hydrocephalus: a case report].

Generally, the diagnosis of idiopathic normal pressure hydrocephalus (NPH) is raised in elderly patients with an association of gait disturbances, cognitive impairment, urinary incontinence and widening of the ventricles. Gait disturbances appear as the predominant clinical symptom of NPH, and may precede other symptoms. The main objectives of this study were to determine the effect of ventriculoperitoneal shunt (VPS) on gait and to compare the results obtained in HPN with those obtained in Parkinson's disease (PD). The performance of a patient with NPH on specific postural and locomotion tasks was analyzed during three successive experimental sessions: the first one before VPS, the second one week after VPS and the third three months after VPS. The patient was instructed to walk at his natural speed and also to maintain postural control for one minute. Four gait parameters (mean velocity, stride length, cadency and step width) were calculated for each session to assess the subject's performance. In this NPH patient there was a significant improvement in gait performance before and after VPS. This improvement concerned mean velocity, stride length and step cadency but did not involve the width component which remained unchanged. Before VPS, the NPH patient walked slower and with a shorter stride length than a group of patients with PD. After VPS his performance was better than the PD group except for cadency. Step width remained longer for the HPH patient than in PD patients for all three sessions. From this study, it appears that gait in idiopathic NPH exhibits a specific temporospatial pattern distinct from that in PD or normal age-matched controls. Changes in gait can be evaluated shortly after treatment of NPH. Gait disorders, excepting dynamic balance, may normalize as soon as one week after surgery.

Aged↗
PubMed2000

Papillary glioneuronal tumour: clinicopathological and biochemical study of one case with 7-year follow up.

Among the mixed glioneuronal tumours, a new variant called papillary glioneuronal tumour has recently been delineated. A case occurring in a 23-year-old man is reported. The tumour was cystic with a mural nodule enhanced by gadolinium injection. It was located within the left parieto-occipital lobe. Surgical excision showed a greyish friable tumour with cystic areas. Histopathological examination revealed a pseudopapillary component comprising a single layer of regular cells, arranged around hyalinised vessels. These cells were immunoreactive with anti-glial fibrillary acidic protein and HNK1 antibodies. A neurocytoma-like component coexisted with round blind cells and focal fibrillary rosettes. These cells were immunostained by anti-neuron-specific enolase and anti-synaptophysin antibodies. Neither mitoses nor ganglioid cells were seen. HNK1, the three isoforms of NCAM, and the L1 adhesion molecule were detected by Western blot analysis. Ultrastructural study showed three different types of cells. The first contained gliofilaments, the second showed long processes with true synapses, and the third was poorly differentiated. However, all had identical nuclei and contained dense bodies. These findings suggest a common origin for the tumour cells derived from a bipotential neuroglial progenitor. As for other mature mixed neuroglial tumours, the prognosis is good. Our patient is free of disease 7 years after complete surgical treatment.

Adult↗
PubMed2000

Intracranial pseudolymphoma.

Intracranial pseudolymphoma is a rare tumor of the central nervous system. A 35-year-old woman presented with a frontal subcutaneous tumor. Magnetic resonance imaging revealed a left frontal meningeal tumor involving subcutaneous tissue without bone involvement. The mass was completely removed and the histological aspect of all tumor sections was that of a lymphoid hyperplasia with polyclonal proliferation. These findings were characteristic of pseudolymphoma defined as a hyperplasia of follicular and diffuse lymphoid type with assessment of its polyclonality by immunophenotyping on frozen sections, completed by molecular biology techniques.

Adult↗
PubMed2000

Centrifugal pumps and heparin-coated circuits in surgical treatment of giant cerebral aneurysms.

Giant cerebral aneurysms may be untreatable by conventional neurosurgical techniques. Early attempts to use circulatory assistance and deep hypothermia were abandoned due to hemorrhagic complications. More recently, interest in circulatory support for complex neurosurgical procedures has been renewed. A consecutive series of 8 patients were operated on for giant cerebral aneurysms with the combined use of deep hypothermia. The protocol included careful preoperative cardiovascular assessment, perfect intraoperative synergy between neurosurgical and cardiac teams, minimally invasive peripheral vascular access including two femoral vein (21 F) and single arterial (17 F) femoral cannulation, use of total Carmeda coating on BioMedicus pumps in closed circuits, and reduced heparinization without Protamine reversal. All cerebral aneurysms were successfully treated through deep hypothermia (15-18 degrees C) as assessed by intraoperative fluoroscopic controls and Doppler vascular assessment. Mean circulatory support time was 174.2 +/- 29.6 min. Circulatory arrest period was 20 +/- 12 min. All patients survived and were extubated within 48 h. No major deficit was observed clinically or on postoperative CT scan. No hemorrhagic complications occurred (mean transfusions was 2.2 blood units). This work supports an extensive use of heparin-coated surfaces for complex circulatory assist techniques, either for cardiac or extra cardiac complex procedures.

Adolescent↗
PubMed2000

Markers of tumor invasion are major predictive factors for the long-term outcome of corticotroph microadenomas treated by transsphenoidal adenomectomy.

OBJECTIVE: To assess the postsurgical outcome of patients with corticotroph microadenomas and to define predictors of the long-term outcome, with special emphasis on markers of tumor extension. DESIGN: Prospective study of 53 corticotroph microadenomas treated by enlarged adenomectomy. Patients followed for at least 2 years were classified into two groups: those in long-term remission and uncured patients (immediate failures and recurrences). Pre-, per- and postoperative parameters were analyzed as predictors of the long-term outcome. METHODS: Baseline hormone assessments were performed preoperatively, 8 days after surgery and every 6-12 months thereafter. Pituitary magnetic resonance imaging (MRI) allowed analysis of possible tumor extension to adjacent structures. Apparent completeness of the surgical removal was determined, and fragments labeled either 'tumor' or 'surrounding pituitary tissue' were submitted to serial sectioning. RESULTS: Immediate control of hypercortisolism was achieved in 43/53 patients (81%). However, later recurrences were observed in five patients (9%). Preoperative MRI showed tumor extension into adjacent structures with good specificity (91%) for prediction of surgical failure. Evidence of local invasion at surgery was also significantly predictive of the long-term outcome. A corticotroph adenoma was found at histological examination in 96% of the patients, and 26% had irregular limits, a feature significantly correlated with a poor outcome. Immediate postoperative plasma cortisol did not allow discrimination between long-term remissions and recurrences. CONCLUSION: Surgical failure was best predicted by signs of tumor 'invasiveness' at MRI, confirmed by peroperative examination and histology.

Adenoma↗
PubMed2000

Gamma knife radiosurgery as a primary treatment for prolactinomas.

OBJECT: The purpose of this study was to estimate the efficacy of gamma knife radiosurgery (GKS) in controlling tumor growth and endocrinopathy associated with prolactinomas. METHODS: Between 1993 and 1997, 164 of 469 patients with pituitary adenomas treated by GKS harbored prolactinomas. The dose to the tumor margin ranged from 9 to 35 Gy (mean 31.2 Gy), and the visual pathways were exposed to a dose of less than 10 Gy. The mean tumor diameter was 13.4 mm. The mean follow-up time for 128 cases was 33.2 months (range 6-72 months). Tumor control was observed in all but two patients who underwent surgery 18 and 36 months, respectively, after GKS. Clinical cure was achieved in 67 cases. Clinical improvement was noted with a decrease in the hyperprolactinemia after GKS. Nonetheless, in 31 (29%) of 108 patients who were followed for more than 2 years no improvement in serum prolactin levels was demonstrated, although this could be normalized by bromocriptine administration after treatment. Nine infertile women became pregnant 2 to 13 months after GKS and all gave birth to normal children. There was no visual deterioration related to GKS. Five women experienced premature menopause. In these patients there was subtotal disappearance of the tumor and an empty sella developed. CONCLUSIONS: Gamma knife radiosurgery as a primary treatment for prolactinomas can be safe and effective both for controlling tumor growth and for normalization of prolactin hypersecretion. A higher margin dose (> or = 30 Gy) seemed to be associated with a better clinical outcome. Gamma knife radiosurgery may make prolactinomas more sensitive to the bromocriptine.

Humans↗
PubMed2000

[Occipital condyle fractures and clivus epidural hematoma. Case report].

A 47-year-old woman presented with a rare case of epidural hematoma of the clivus. The patient had bilateral occipital condyle fractures (a comminuted fracture on the right side, an avulsion fracture on left side and a lower clivus fracture). On admission the patient was tetraparetic with left abducens palsy. Preoperative imaging showed no atlanto-axial or occipito-atlantal dislocation. The patient was operated with a posterior approach. An occipital craniectomy with C1 laminectomy was achieved without atlanto-occipital fusion. Two years after the trauma, the patient had mild left hemiparesis but was able to walk normally. Head motion was normal, but just mildly decreased by pain in flexion and extension. Imaging control did not show any occipito-atlantal instability. We describe the imaging features allowing precise diagnosis and discuss the management of a rare entity: bilateral occipital condyle fractures and epidural hematoma of the clivus.

Accidents, Traffic↗
PubMed1999

Neuropsychological follow-up of twenty two adult patients after surgery for craniopharyngioma.

The optimal management of craniopharyngioma today remains an unconcluded debate. This prospective study examines the cognitive status and quality of life of 22 patients one year after surgery for craniopharyngioma. Pterional approach (5 left, 15 right) was used in 20 patients (90%), whereas two were operated on using a rhinoseptal approach. Neuropsychological examination was performed twelve months after the operation. For twelve patients, neuropsychological examination was performed before operation. The preoperative evaluation revealed that six patients had impaired neuropsychological testing with memory and frontal dysfunction. Four of these patients have no postoperative neuropsychological defect. After surgery, there were 5 patients in whom abnormalities could be detected on the extended psychometric assessment: two were severe (a Korsakoff's syndrome and a memory defect associated with an intellectual deterioration), and three moderate (recent memory defects with frontal dysfunction, isolated learning defects). Four patients of the 22 were not able to return to their pre-illness activity. The present evaluation emphasizes that a good quality of life and neuropsychological performance were maintained in the majority of patients. Preoperative frontal dysfunction is probably correlated to tumour location, and precisely to the interruption of the direct efferent projections from the frontal cortex to the hypothalamus. Postoperative alterations of neuropsychological function were noticed only in patients with pterional approach. These patients had a poor surgical outcome, preoperative neuropsychological defects or treatment combined with radiotherapy. The two patients who were operated on using a rhinoseptal approach had no neuropsychological deficit. But this surgical approach is best reserved for patients with smaller intrasellar tumours. Further studies are needed to evaluate the neuropsychological advantage of these different approaches.

Activities of Daily Living↗
PubMed1999

Cytogenetic study of 33 ependymomas.

Ependymomas are glial tumors. They constitute approximately 5-10% of intracranial tumors. Ependymomas are tumors which can recur. Predictive factors of outcome in ependymomas are not well-established. Karyotypic studies on ependymomas are relatively scarce, and no specific chromosomal change has been described in these neoplasms. We performed a cytogenetic study of 33 ependymomas, of which eight were recurrent tumors, to determine the type and incidence of cytogenetic changes.

Adolescent↗
PubMed1999

Primary meningeal fibrosarcoma: a particular neuroradiological presentation.

Primary meningeal fibrosarcoma is a rare malignant tumor of the central nervous system. About seventeen cases have been reported in the literature since 1980. We present the case of a patient whose initial neuroradiological manifestation of primary meningeal fibrosarcoma was an en plaque meningioma. Fifteen months later, he developed a dramatic clinical deterioration and coma. CT scan revealed a large frontal lesion. The mass was completely removed and histological examination was characteristic of meningeal fibrosarcoma.

Adult↗
PubMed1999

Expression of the members of the Ptx family of transcription factors in human pituitary adenomas.

A number of putative transcription factors described in the pituitary have been implicated as key elements in the processes that direct pituitary development. Three recently described proteins, Ptx1, Ptx2, and Ptx3, define a new family of transcription factors, the Ptx subfamily, within the paired-like class of homeodomain factors. In mice, Ptx1 and Ptx2 gene expression has been detected in the area of the pituitary primordium and is maintained throughout development in Rathke pouch and adult pituitary. In the present study, the expression of the Ptx1, Ptx2, and Ptx3 genes was characterized in the normal human pituitary and in the different types of human pituitary adenomas. Although no Ptx3 gene expression could be detected in these tissues, Ptx1 presented with a quite ubiquitous pattern of distribution, being expressed at quite constant levels in normal tissues and in all 60 pituitary tumors analyzed. The pattern of expression of the Ptx2 gene among the different subsets of pituitary adenomas was even more varied. No Ptx2 expression could be detected in corticotroph tumors. In contrast, high levels of Ptx2 messenger ribonucleic acid were measured in the gonadotroph tumors, although no specific correlation to other markers of the gonadotroph lineage differentiation, such as alphaGsu, LHbeta, or FSHbeta, could be evidenced. Finally, Ptx2 was also expressed in pure lactotroph adenomas and not in somatotroph adenomas. Ptx2 is, therefore, the first paired homeodomain pituitary transcription factor differentially expressed in these two lineages, which derive from a common precursor. These results support a role for Ptx2 in the terminal differentiation of somatotroph and lactotroph cell phenotypes.

Adenoma↗
PubMed1999

An ultrarapid prognostic index in microprolactinoma surgery.

OBJECT: Prolactinomas account for approximately 40% of pituitary tumors. If the tumor does not exceed 10 mm at its largest diameter (microprolactinoma), the chances of definitive cure as a result of surgery alone vary from 62 to 89% depending on the series. Until now, however, there was no mechanism to predict whether total excision of a tumor had been accomplished. To improve the chances of total excision, we compared the peri- and postoperative kinetics of circulating prolactin (PRL) in patients judged to be cured and those not cured. METHODS: The pre-, peri-, and postoperative variations in blood PRL concentrations were determined using assays conducted at 10-minute intervals. Of the 36 patients included in the study, 27 were considered cured (resumption of a normal menstrual cycle within 6 months, PRL concentration at 9 days [mean +/- standard deviation 2.5+/-2.1 ng/ml] and 12 months [4.5+/-2.2 ng/ml] after the operation < 10 ng/ml and normally stimulated by metoclopramide and thyrotropin-releasing hormone [TRH]). Nine patients were not cured (PRL 20+/-15.7 ng/ml at 9 days after surgery, with no response to metoclopramide and TRH). The kinetics of PRL decrease in definitively cured patients were characterized by the following: 1) the initial slope of the curve decreased by at least 11% within the first 10 minutes after resection, and 2) immediate postoperative PRL concentrations were 20 ng/ml or less. CONCLUSIONS: The measurement of the kinetics of PRL decrease during surgery allows the chance of gross-total resection to be successfully predicted less than 25 minutes after excision of the adenoma. Provided an ultrarapid assay is available (the test used in the present study took < 15 minutes), this prognostic index would be useful to make a decision to continue the surgical procedure when the initial PRL slope is judged to be insufficient. Its use may also be extended to other pituitary tumors such as somatotropic adenoma and basophilic adenoma (Cushing's disease).

Adolescent↗
PubMed1999

[Pilocytic astrocytoma of the conus medullaris].

We report the case of a rare glial tumor of the conus medullaris classified as pilocytic astrocytoma in a young adult. This tumor is most commonly found in the brain. The imaging findings will be correlated with the findings at histology. The literature will also be reviewed.

Adult↗
PubMed1998

Are juvenile pilocytic astrocytomas benign tumors? A cytogenetic study in 24 cases.

We performed a cytogenetic study on 24 pilocytic astrocytomas: 23 in children and 1 in a young adult. We observed 12 normal karyotypes. In 12 karyotypes with structural and/or numerical abnormalities, chromosomes 7, 8, and 11 were most frequently involved. One case recurred and presented chromosomal abnormalities (hyperdiploidy) in the first tumor and additional structural abnormalities in the second tumor. We believe that chromosomal abnormalities in pilocytic astrocytomas are frequent and indicate tumoral progression.

Adolescent↗
PubMed1998

Gamma-knife surgery for secreting pituitary adenomas.

We report our preliminary results concerning 25 patients with secreting pituitary adenomas treated with stereotactic radiosurgery after partial transsphenoidal surgery and followed over a 6-36 month-period. Among the 15 acromegalic patients, a decrease of 65% in mean GH levels was achieved after 6 months and of 77% at 12 months after radiosurgery. Presently, only 3 patients (20%) are considered as in remission (mean GH and IGF1 level into the normal range). A decrease of 46% and 64% was observed at 6 and 12 months after radiosurgery in 4 patients with prolactinomas although no normalization of PRL levels occurred. Presently, 3/4 patients have individual PRL level slightly above the normal range. A normalization of Urinary Free Cortisol (UFC) was noticed in 4/6 (66%) patients with Cushing's disease within 6-12 months. No pituitary deficiency was noticed in this series with the exception of 4/25 patients (16%) who received subtotal or total pituitary irradiation for post-operative remnants of secreting adenomas poorly defined on MRI. One woman, who had undergone previously a conventional irradiation and presenting with a cavernous sinus adenoma reaching the optic nerve, developed an optic neuropathy. A second woman, with a cavernous sinus remnant, presented a cranial nerve palsy (VI) after the irradiation. We can conclude that radiosurgery using the Cobalt-60 Gamma-unit is, at least, as effective as conventional radiotherapy in the control of pituitary hormone hypersecretion from postoperative adenomas remnants with less adverse effects.

Acromegaly↗
PubMed1998

Anterior lumbosacral dislocation: case report and review of the literature.

BACKGROUND: Anterior lumbosacral dislocation is a rare traumatic anterior spondylolisthesis. METHODS: We report a new case surgically treated and review the eight cases previously reported. RESULTS: The mechanism of injury is hyperflexion-distraction. Neurological signs are inconsistent. Indirect radiological signs such as bilateral multiple transverse process fractures are strongly suggestive of the diagnosis. This complete soft tissue injury induces a definitive instability and requires an open reduction with posterior fixation. CONCLUSIONS: Suspicion of lumbosacral dislocation requires a computed tomography scan exploration with multiplanar reconstructions. Early reduction is associated with neurologic recovery. However, prognosis is correlated with the initial neurologic status and the severity of other associated injuries.

Adult↗