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Biomedical subjects

I Papo

Publications and source records attributed to I Papo.

At least 37 records · Page 2Linked to original sources
PubMed1989

Functions of the corpus callosum: observations from callosotomy performed for intractable epilepsy.

The effects of complete and partial corpus callosotomy in 6 patients are reported. Only the 2 cases undergoing total callosotomy showed evidence of impaired interhemispheric sensory transfer, related to sectioning of the splenium. Only mild long-lasting neuropsychological deficits were detected. Post-commissurotomy mutism and akinesia appeared in 4 cases, 2 with total, and 2 with partial anterior callosotomy. The short-and long-term effects of corpus callosotomy appear to be related to the extent of the section the creation of lesions during the surgical procedure, and a peculiar organization of cognitive functions in chronic epileptic patients.

Adult↗
PubMed1988

Neuropsychological changes after callosotomy in drug-resistant epilepsy: a study of the short-term evolution.

With the increasing interest in callosotomy as treatment for intractable epilepsy, it seems to be important to define the neuropsychological consequences of the related surgical operation. 8 patients suffering from drug-resistant seizures underwent section of the corpus callosum, 6 in the anterior part only and 2 undergoing complete two-stage commissurotomy including the posterior part. Before the callosotomy the patients were studied using a cognitive, affective and behavioural battery which was repeated 15 and 90-100 days after the operation. The patients with sufficient I.Q. were described in more detail using the cognitive parameters; the social and motor behaviour of Lennox-Gastaut subjects are accurately reported. No disconnection syndrome was ever observed after the partial commissurotomy while it occurred in one of the two complete callosotomies. The patients showed longer reaction times and a mild impairment of linguistic, praxic, memory and motor functions in the former evaluation (15 days), but there was consistent improvement in the latter check up. At the 90-100 day follow-up the Lennox-Gastaut patients responded more readily to the environmental stimulations and their postural, motor and behavioural functions were unchanged or improved, with respect to presurgical performances. The social and emotional behaviour of all the patients had always improved by the time the long-term evaluation (90 days) was performed. Finally, by limiting the callosotomy to the anterior part only, the neurological and psychological consequences seem to be limited.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Intracerebral haematomas from aneurysm rupture: their clinical significance.

Two series of patients (814 cases altogether) with ruptured intracranial aneurysms are analyzed in order to try to outline the clinical significance of space-occupying intracerebral haematomas (ICH) which may accompany SAH. In particular the question of whether intracerebral clots are or are not to be taken into account in planning emergency surgery is debated. From the reported series, it would appear that ICH after aneurysm rupture seldom lead to increasing intracranial hypertension warranting urgent surgery. This evolution was observed in approximately 5% of patients with expanding ICH. In 35% the intracerebral effusions were associated with irreversible lesions and in 20% the initial symptomatology definitely improved. Finally, in a relatively high percentage of cases (about 40%) ICH lacked of clinical significance.

Adult↗
PubMed1987

Commissurotomy in intractable epilepsy: clinical and surgical comment.

Two patients suffering from seizures unresponsive to medical treatment underwent two-stage "central" commissurotomy. In one patient anterior callostomy was carried out first; in the other the surgical procedure was performed in the reverse order. The clinical, EEG, and neuropsychological features of the two patients are reported before the operation, between stage 1 and stage 2 of the procedure, and after completion of the commissurotomy. The surgical aspects of the two different procedures and the related clinical pictures are described in detail.

Adult↗
PubMed1987

The limits of surgical management of traumatic coma.

It appears, on the whole, that the better results we are now able to attain in the treatment of traumatic coma are unrelated to a real improvement in surgical possibilities. The role of surgery seems, conversely, to be more limited than in previous times. Surgical intervention still keeps strictly mandatory whenever intracranial hypertension is related to extracranial effusions while, in brain contusion/lacerations, it is warranted only in selected cases.

Brain Concussion↗
PubMed1986

CT assessment of calcinosis in a patient with dermatomyositis.

A case of juvenile dermatomyositis developing intermuscular fascial plane calcification in the thighs early in the course of the disease is described. The use of CT was helpful in localizing the calcium deposits between the muscular layers before surgical removal of the calcification. These procedures may have prevented fistulization and development of contracture of the joints.

Adolescent↗
PubMed1985

Subarachnoid haemorrhage due to widely metastatising malignant ependymoma.

A case of a widely metastasing malignant ependymoma in a 35-year-old man is reported. The first and most impressive clinical feature was a massive subarachnoid bleed with rapidly developing spinal cord compression due to widespread metastases over the cord and the cauda equina. The cerebral ependymoma was finally shown on a CT scan. Subarachnoid haemorrhage caused by malignant spinal deposits seems to be exceedingly rare. Finally, some problems of classification concerning the malignant forms of ependymoma are discussed.

Adult↗
PubMed1984

[Hydrocephalus following subarachnoid hemorrhage].

Post-hemorrhagic hydrocephalus was studied in two homogeneous series including 410 patients, 320 of whom had ruptured intracranial aneurysms. Ventricular dilatation was more frequently observed in the patients with subarachnoid hemorrhage from ruptured aneurysm (44%) than in those in whom no vascular malformation was detected by the four vessel angiography (21%). Moreover, hydrocephalus was over twice as frequent in high grading (76-64%) than in low grade patients (31-35%). Ventricular dilatation was revealed in 58-52% of A.Co.A., in 39-30% of C.I.A. and in 20-21% of M.C.A. Altogether 51 patients underwent continuous ventricular drainage (EVD): 54% improved significantly, but fatal recurrent hemorrhage took place on drainage in half of them. On these grounds, it would appear that EVD may be indicated only in grade IV and, occasionally, in Grade III patients on condition that early radical surgery is carried out as soon as significant improvement is attained, without waiting for an entirely satisfactory grading. In this way, devastating hemorrhages on drainage could be prevented in the last patients of our series. Chronic disturbances of CSF dynamics calling for permanent shunting proved exceedingly rare in our patients.

Adult↗
PubMed1983

Intracranial meningiomas in the elderly in the CT scan era.

Intracranial meningiomas diagnosed and operated upon in similar five-year periods before and after CT scan are analysed. In the latter period the overall number of meningiomas and the average age of the patients have increased--tumours from 77 to 186, and average age from 50 to 56. All patients but one from the first group were operated on, while only 155 from the second group underwent surgery. Operation was rejected in 31 patients for different reasons. In the pre-CT scan epoch 25% of patients who were operated on were over 60 and 9% were over 65, whereas in the CT scan era these rates have risen to 35 and 21% respectively. Mortality and good recovery rate were the same in both groups up to 65 years of age. After 65, postoperative complications and mortality increased steeply: of the patients over 65 in whom the growth was excised 55% died. The radical surgery of intracranial meningiomas in geriatric patients over 65 still remains a tremendous challenge despite all the advances in operative technique, neuroanesthesia and intensive care. On these grounds, in such patients surgical indications should be carefully evaluated.

Adolescent↗
PubMed1982

Mass lesions of the frontal lobes in acute head injuries. A comparison with temporal lesions.

Contusions and lacerations of the frontal lobes are very frequent; 43.4% in the whole series of traumatic brain mass lesions. Clinical ICP, CT scan data and neuropathological findings in patients with such lesions are analysed and correlated. Moreover, the clinical features and the outcome of frontal masses undergoing surgery are also compared with similar lesions located in the temporal lobes. Frontal lesions cannot be differentiated on purely clinical grounds and the factors governing the outcome in both lactations are the same. On the whole, surgical indications nowadays seem to be rather rare; only lesions behaving truly as expanding lesions with obvious intracranial hypertension benefiting from surgery. Brain contusion-laceration syndromes in general can no longer be considered separate entities. Neither should they be included in the miscellaneous group of "traumatic intracranial mass lesions", since the pathophysiological significance of purely extracerebral effusions is entirely different. Traumatic contusions and lacerations and/or intracerebral haematomas, whether frontal or located elsewhere, should instead, be considered in the context of head injuries of a different degree of gravity, as having collateral features which, on occasion, may call for surgical management.

Adolescent↗
PubMed1982

Intracranial hypertension and prognosis of spontaneous intracerebral haematomas. A correlative study of 60 patients.

Intraventricular pressure was recorded in 60 patients with intracerebral haemorrhage, and correlated with their clinical conditions and prognosis. The results show that an evaluated intraventricular pressure is statistically linked with the most serious situations, and with the most severe prognosis. However, two thirds of the decreased patients had died with an almost normal pressure, suggesting that intracranial hypertension is not always the immediate cause of death, but only an aggravating factor. From these results, it is proposed that intracranial pressure should be monitored only in stuporous or comatose patients, and always compared with CT scan images, which give better information regarding the harmful effect of midline structure displacement.

Adult↗
PubMed1982

Surgical treatment of cardiac echinococcosis: report of nine cases.

We reviewed the results in eight patients followed from 10 months to 22 years after one-stage surgery for removal of primary and secondary myocardial and pericardial hydatid cysts. The results were satisfactory in eight patients who survived the operation. One patient, however, with recurrent myocardial echinococcosis, pulmonary embolization, and sepsis died at reoperation. The series was analyzed with reference to the surgical treatment and world-wide experience of complicated cardiac echinococcosis.

Journal Article↗
PubMed1982

External ventricular drainage in the management of posterior fossa tumors in children and adolescents.

External ventricular drainage (EVD) was used before and after posterior fossa operations in 62 children and adolescents. In all cases, the removal of the tumor (midline in 47 and laternal in 15) was attempted; total removal was achieved in 41. The overall mortality was 6.5% (4 patients). Only 25% of the survivors needed permanent cerebrospinal fluid (CSF) shunting. EVD seems, therefore, to be effective in controlling preoperative intracranial hypertension and in securing a smooth postoperative course. Preoperative CSF shunting seems to be necessary or advisable only in particular circumstances.

Adolescent↗
PubMed1982

[Surgery of heart myxoma].

Myxomas are the most common benign tumors of the heart. It is important that an exact diagnosis be made and radical surgical treatment effected. The clinical interest in them increased particularly in 1950 when Goldberg first established a diagnosis of intracardial myxoma by means of angiocardiography, and Grafford (1954) performed a successful operation in extracorporal blood flow. Our first successful operation was carried out in the above Clinic in 1961, and since then in about 4500 open heart operations 10 myxomas were extirpated.

Adult↗
PubMed1981

CSF withdrawal for the treatment of intracranial hypertension in acute head injuries.

Long-term ICP recording was carried out in 151 acute head injury patients- 131 comatose patients admitted to ICU, and 20 non-comatose patients harbouring intracerebral mass lesions (lacerations or haematomas) in whom a decision to operate was doubtful. CSF withdrawal was used in 39 cases: by intermittent subtraction in 23 patients, and by continuous ventricular drainage (VD) in the remainder. In the acute stage, within 72 hours or injury, CSF subtraction proved of little use in influencing ICP or clinical time course. Conversely, at a latter stage, CSF withdrawal either by repeated intermittent subtraction or by continuous VD could very often control raised ICP. However, some patients had to undergo permanent shunting eventually. Elevated ICP was also safely controlled in four out of eight patients with intracerebral mass lesions and stationary symptoms. Such patients recovered quickly, and operation was avoided.

Acute Disease↗