Biomedical subjects
Publications and source records attributed to F Tomasello.
Giant intracranial aneurysms containing a tortuous vascular channel appear, to some extent, different from other giant aneurysms. Their particular features are outlined in the present report which concerns a case of a small fusiform aneurysm of the posterior temporal branch of the middle cerebral artery evolving over five years into a giant serpentine aneurysm. Successful and complete removal of this lesion was achieved.
A case of fibromuscular dysplasia (FMD), mostly involving the basilar artery, associated with an intracranial aneurysm, is presented. Although the patient was symptomatic, the typical angiographic pattern is felt to be in this case an incidental finding. However the potential for FMD to produce severe neurological impairment is emphasized. The case is used as a basis for discussing shortly the incidence, the characteristic radiological appearance, the relationship with the presence of intracranial aneurysms and the therapeutic problems of FMD.
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A standardized protocol was used for duplicate examination by two neurologists of the clinical history and neurological signs in 55 patients with reversible cerebral ischemia. One trained examiner from each of eight clinical centres involved in the Italian Cooperative Study on reversible cerebral ischemia participated in this research. Duplicate examination were compared in order to evaluate the percentage of agreement achieved in the responses. Several discrepancies relating to either historical data or neurological signs were detected. Possible causes of this disagreement are discussed. The inter-observer differences appear to be an important problem to be faced in cooperative studies on reversible ischemic attacks. The purpose of the study was to estimate these differences in the attempt to increase the degree of agreement by repeated training sessions and discussion between the different examiners. These efforts are needed to improve the quality of clinical investigations on reversible cerebral ischemia and to increase the validity of their results.
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BACKGROUND: The telomeric-repeat binding factor (TRF1) participates in a physiological homeostatic mechanism controlling telomere shortening by inhibiting telomerase activity: down-regulation of TRF1 expression results in telomere elongation and may be involved in cell immortalization. PATIENTS AND METHODS: To determine the TRF1 expression by immunohistochemistry (IHC) in human brain tumors, a cohort of 20 consecutive flash-frozen surgical specimens (14 meningiomas and 6 anaplastic astrocytomas (AA)) were collected. RESULTS: Variable levels of TRF1 expression in 12 out of the 14 (87.5%) meningioma samples were observed. By contrast, no expression of TRF1 in tissue samples from AA (p = 0.008) was detected. Positive TRF1 cells were usually more differentiated (less atypical features) and Ki67 negative (inverse statistical association, chi2 = p < 0.001). CONCLUSION: We demonstrated, for the first time, that routine IHC techniques are capable of identifying TRF1 expression in intracranial tumors, which is heterogeneously expressed in meningiomas, but absent in AA. Although these preliminary observations need confirmation from larger studies, the TRF1 status in intracranial tumors might become of prognostic value.
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The incidence of kinking and coiling of the internal carotid artery in an unselected series of 1,010 angiographies is reported. The angiographies of patients with cerebrovascular insufficiency and those of patients with other brain diseases were separately reviewed. On the basis of a statistical comparison, the finding of kinks and coils appears significantly higher in "vascular" than in "non-vascular" patients. The greater difference concerns age subgroups up to 50 years. These data give support to the assumption that both kinking and coiling of the internal carotid artery may play a role in determining cerebral ischemic attacks. Surgical experience concerns a series of 19 patients operated by various corrective procedures, including resection of the internal carotid artery and end-to-end anastomosis. It is felt that surgery, performed in appropriately selected cases, can afford significant benefits to cerebrovascular patients, especially those presenting recurrent ischemic episodes.
Four main models of vascular microsurgical anastomoses in rabbits are described with reference to revascularization procedures in man. Some technical expedients designed to improve the patency rate, are outlined. This preliminary report emphasizes the value of laboratory training to achieve successful results with microneurosurgical treatment of cerebral ischemia.
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A new model of spinal cord compression is presented. Forty-two New Zealand albino rabbits weighing between 1.2 and 1.5 kg were submitted to spinal cord compression to about half of its normal diameter by vascular Sugita's clip to different compression time (sham, 5-10-20 minutes e 1-6-12 hours) and sacrified after 72 hours. The consequent neurological dysfunction size of lesion was graded by Tarlov's scale for voluntar motility. Ultrastructural and morphometrical studies were carried out to evaluate changes in shape, perimeters, axonal and myelin areas of the lateral and the posterior tract of spinal cord. A 10 minute decrease of 50% of the transverse diameter of the spinal cord causes a defined damage. The swelling of myelin is a useful index of the importance of the damage.
A comparative study on surgical versus conservative brain metastases treatment has been carried out. Patients have been divided in seven groups by means of treatment modalities. Follow-up, has been carried out taking into consideration mean survival time and quality life in particular, evaluated by means of Order's classes. Anaesthesiological management problems were discussed also. From data analysis, it follows that untreated patients, (group 1) had a lower mean survival time than that of the other patients. Thirty days after first evaluation, 85% of these patients had a very poor quality life. Patients who underwent surgery associated to radio and chemotherapy (group 2) have had better recovery of functional autonomy and longest mean survival time. Among these, thirty days after treatment only 3% had a very poor quality life, while 67% had the better quality life. Patients who underwent others treatment modalities had intermediate results.
A simple and safe procedure is proposed to manage cases of "empty sella" complicated by rhinorrhea. It is performed under fluoroscopic control only by introducing a needle in the sphenoid sinus via a transnasal route and by injecting fibrin glue into the sinusal cavity. This procedure requires a short hospitalization and it allows to avoid the compliances of other techniques.