Biomedical subjects
Publications and source records attributed to G Gaist.
We reviewed the cases of 16 patients with primary intracranial lymphomas. The clinical and radiological data proved to be helpful in suggesting the diagnosis, but only tumoral biopsy provided unequivocal diagnosis. In our cases radiotherapy proved to be the most effective treatment.
The authors present a series of 129 patients with "pure" traumatic cerebral lacerations, i.e. not associated with other intracranial lesions (especially haematomas) which by their presence alone can play a primary role in affecting clinical course and prognosis. Twenty per cent of the patients presented a lucid interval, thus confirming the nature of the laceration as a true expanding lesion, increasing in size in the post-traumatic period. Age, GCS score and neuroradiological findings were investigated in view of the eventual outcome. Follow-up examination confirmed that age and level of coma on admission, together with the degree of ventricular shift and presence of bilateral skull fractures, were all factors of statistical significance in affecting prognosis. Lacerations in the temporal area were associated with the poorest prognosis, and highest incidence of neurological focal deficits and residual parenchymal damage on CT control.
A case of carpal tunnel syndrome caused by a posttraumatic neuroma-in-continuity of the median nerve is reported. Such a cause of median nerve compression is rare.
The infratentorial compartment represents the second most common location of arachnoid malformations. Ten arachnoid cysts of the posterior fossa, operated on between 1970 and 1983, are reviewed. These lesions, although congenital and developmental in nature, may present at any age, and males are more frequently affected. A high rate of birth-related trauma (50% in this series) is conceivably due to fetal macrocranium, and the enlarged head and psychomotor retardation prevail in infancy and childhood. In arachnoid cysts occurring during adulthood, symptoms and signs more clearly indicate a dysfunction of the posterior fossa. Besides computerized tomography, pneumoencephalography and metrizamide techniques are recommended to rule out a Dandy-Walker syndrome in doubtful cases, and to obtain information about the cerebrospinal fluid (CSF) circulation. It is particularly important to establish the presence and type of communication of cysts with the CSF pathways. Although infratentorial cysts often communicate, they can be space-occupying masses because of increasing CSF retention, which may be due to a ball-valve mechanism or to inadequate communication. The frequently associated hydrocephalus (seven of the 10 cases in this series had hydrocephalus) seemed to be dependent mainly upon mechanical factors. The authors discuss the indications for intracranial surgery versus shunting procedures and report the results achieved by direct cyst excision.
Extraneural metastases from primary pineal tumors are extremely rare: only 15 such cases could be found in th literature. Another case is presented of a 10-year-old boy who developed multiple pulmonary and skeletal metastases from a presumed primary pineal germinoma. The incidence and pathogenesis of distant dissemination in the different types of pineal tumors are discussed, with special comment on the controversial role of the direct surgical approach and shunting of cerebrospinal fluid.
The authors studied 24 patients affected by anaplastic gliomas in regard to the killer (Antibody-Dependent Cellular Cytotoxicity) and natural killer (Spontaneous Lymphocyte-Mediated Cytotoxicity) immunological functions, by counting the Cr51 release in Change liver and K 562 cell cultures, respectively. These parameters were also evaluated in 24 healthy donors as control, in 24 patients affected by bladder cancer and in nine cases of kidney cancer. Our data show, pre-operatively, a statistically significant impairment of ADCC and SLMC activity in glioma patients as compared both with controls, bladder and kidney cancer patients. The particular impairment of K and NK functions in gliomas is discussed with regard to the specific features of Central Nervous System malignancies. An improvement of ADCC activity was also found in the post-operative samples. This finding confirms other reports about partial restoring of altered immunocompetence after surgery, suggesting a link between extention of tumor mass and impaired immunological reactions.
Fifty-eight patients suffering from intractable pain in the trigeminal distribution due to neoplasms of the intracranial or facial regions underwent controlled percutaneous coagulation of the Gasserian ganglion (trigeminal thermorhizotomy). Of them, 35 were evaluated at varying time intervals from the intervention (mean: 7 months). While pain was completely relieved in 71 per cent of cases at discharge, the follow-up examination was consistent with 49 per cent of analgesias. The rationale of percutaneous thermocoagulation in malignant facial pain is given and the pertinent literature summarized.
A case of spinal meningocele is reported in which erosion of adjacent vertebral bodies and stretching of some roots coexisted. The neurological picture cleared after neurolysis and repair of the anterior thecal continuity.
The authors report a case of brain abscess which occurred as a possible complication of a mycotic aneurysm. Inadequate antibiotic treatment given at the time of a febrile illness in a patient with rheumatic heart disease seems to be the most likely cause of this unusual complication. The effects of inadequate antibiotic treatment on the pathogenesis are briefly discussed.
Acute bilateral extradural hematomas occurred after apparently trivial trauma in a patient suffering from osteogenesis imperfecta congenita. Factors influencing the development of this dramatic complication are peculiar to this rare disorder of bone and connective tissue development and include bony weakness, increased vascular fragility, and possible coagulopathies.
This 9-year-old boy had two circular areas of aplasia congenita of the scalp in the territory of the first division of the trigeminal nerve and an ipsilateral parieto-occipital leptomeningeal capillary venous angioma. He had an associated giant aneurysm of the distal posterior cerebral artery on the same side as the vascular malformation. The patient had a long history of seizures and presented with intracerebral bleeding. This case may be considered as a variant of Sturge-Weber syndrome. Further observations must be added to consider this entity as a separate neurocutaneous disease.
The opportunity of stereotactic biopsy for the histological diagnosis of brain tumors, the radiobiologic bases, clinical implications and technical possibilities of interstitial radiation therapy are discussed. The results of 9 cases, out of 14 treated to-date over 20 months, with a minimum follow-up of 4 months, are presented.
The authors studied 24 patients affected by anaplastic gliomas, as regards immunology. In all of them the authors evaluated the lymphocyte subpopulation (B and T), firstly by simple lymphocyte count, secondly by studying the rosettes E-total and EAC, thirdly by stimulating the lymphocytes with mitogens phyto-haemoagglutinin-P (PHA), concanavalin A (Con A), and pokeweed mitogen (PWM), and lastly by counting the release of Cr51 in Chang liver cells culture in order to obtain antibody dependent cellular cytotoxicity (ADCC). The parameters were also evaluated after surgery and during conventional radio-chemotherapy with BCNU. Whereas the so-called B-pool seems to be unaffected, the preliminary results show that the T-pool (identified by the E-t rosettes and by responses to PHA, PWM, and ConA) is depressed to a statistically significant degree, if compared with a control group. This depression seems to be related to the tumoral mass, and it is not increased by radio-chemotherapy. In addition, ADCC also seems to be depressed in our glioma patients in comparison with a control group and witha group of bladder cancer patients.
Thirty-one cases of arachnoid cysts of the middle cranial fossa were investigated by CT scan, 7 of them undergoing additional metrizamide CT cisternography. In this paper we analyze and correlate the different findings from these two examinations and propose a classification of arachnoid cysts of the middle cranial fossa into three basic types. Pathophysiological and surgical implications are discussed.
Two cases of traumatic interhemispheric subdural hematoma are reported. The first patient had combined convexity and parasagittal subdural hematomas; the second patient had an interhemispheric subdural hematoma which extended over the tentorium. Although most reported cases have followed a subacute clinical course with characteristic lower-extremity monoparesis, both our patients deteriorated rapidly 24 and 48 hours after the injury without warning neurologic signs and died in spite of prompt surgical treatment. Both cases were diagnosed with computerized axial tomography (CT). This examination is particularly valuable in defining the extent of the hematoma and its possible association with other lesions.
The authors describe an unusual and unique case of a giant capillary telangiectasis of the right frontal lobe encountered in a 10-month-old child. The patient presented with progressive neurologic symptoms mimicking a brain tumor. The lesions was resected in toto with good clinical results.
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