Biomedical subjects
Publications and source records attributed to L Palma.
Seventy-eight cases of late cerebral radionecrosis gathered from the literature are reviewed and three personal cases reported. The difficulties in making pre-and intra-operative diagnoses, the efficacy of surgical treatment in cases of circumscribed lesions, and the very poor prognosis of diffuse lesions are emphasized.
Ten cases of the empty sella syndrome are presented. In four a pituitary adenoma had been treated by surgery with or without radiotherapy. In three women there was a close relation pregnancy, and two boys had congenital malformations. Five cases presented with appearances of pseudotomour, and the remainder had cerebrospinal fluid (CSF) fistula. Four fistulas were spontaneous, one was post-traumatic aggravated by the intrasellar implantation of YT-90. Two were occult CSF fistulas causing recurrent meningitis. Gamma cisternography and iodocisternography proved to be good diagnostic tests, both for the empty sella and for CSF fistulas. Nine cases were operated on. In four na intrasellar cyst was present. In the other five an empty sella with deficient or absent diaphragm was found. Treatment of most cases consisted of covering the floor of the sella with lyophilized dura, which was fixed in place with biological glue.
A series of 200 patients operated on at the Rome University Neurosurgical Clinic for primary glioblastoma is analyzed. Eight of these patients (4%) survived for over four years. The histological preparations showed more or less heavy perivascular lymphocytic infiltration in six of these cases. Since such infiltrations in malignant tumours of other organs are recognized as having an immune function, expressing the host's resistance to his tumour, the longer survival of the cases considered may well denote an immune defensive mechanism.
The presence of lysozyme in the CSF is considered with regard to its value in the early diagnosis of primary or secondary CNS Tumours. Since the appearance of this enzyme in the CSF is secondary to the increase of protein in the fluid, the search for lysozyme in the CSF is of no practical help in the diagnosis of CNS tumours.
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Four cases of spinal cysts lined by simple columnar epithelium of endodermal origin, without associated vertebral or other congenital anomalies, are reported. Pathology, pathogenesis and nomenclature of such cysts are discussed. Misplacement of endodermal cells is though to be the common developmental error leading to the formation of such cysts, as well as of those replicating intestinal wall or containing other endodermal derivatives such as bronchial tissue.
A surgical series of 346 children with nontumoral hydrocephalus shunted in the period January 1957 to December 1973 is presented. The etiological factors, preoperative clinical and anatomical status of the patients, their surgical career, the reasons for revision operations and causes of death, are analyzed and discussed in relation to each of the four groups constituting the series: tetraventricular communicating hydrocephalus, triventricular hydrocephalus, obstructive hydrocephalus from ventriculocisternal block and postmeningocele or postmyelomeningocele hydrocephalus. 141 patients required 218 revision operations. 16 patients died after the first operation, 27 on revision and 38 sometime later. 41 patients were lost to follow-up. A recent clinical and instrumental review of the physical, neurological and mental status of the remaining 224 patients showed that 136 (60.7%) are well or very well, 68 (30.3%) have residual deficits likely to regress with treatment and 20 (8.9%) are severely handicapped. These long-term results and the surgical aspects of the problem are discussed in the light of the literature.
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PURPOSE: To determine the incidence of atherosclerotic coronary artery disease (CAD) and or myocardial ischemia in patients (pt) with abnormal ST segments restrict to recovery phase (RRAST) of exercise testing (ET). MATERIAL AND METHOD: Retrospective study in 19 non consecutive pt with RRAST, related to coronary arteriography or exercise planar scyntillography (18 men, 58 +/- 9 years, 18 asymptomatic). RESULTS: RRAST corresponded to ST segment depression from 1 to 4 mm, with T inversion during early recovery (2 pt); late (14 pt) or both (4 pt). It was documented CAD (14 pt and 9) with artery-by-pass surgery); hypertensive myocardiopathy with normal coronary (3 pt), and mitral prolapse valve (1 pt). In 13 pt with coronary arteriography or exercise scyntillography, within the first 6 months from exercise testing, myocardial ischemia was confirmed in 8 pt in 3 pt, successive exercise testing showed RRAST reproductive in 2 cases. CONCLUSION: The authors report the high incidence of CAD and or transitory hypoperfusion during myocardial scyntillography in symptomatic men with middle age with RRAST during exercise testing.
BACKGROUND: Evaluation of circulating anti-p53 antibodies is an easy-to-perform, widely employed, procedure to assess the p53 status in cancer patients. MATERIALS AND METHODS: Levels of circulating anti-p53 antibodies in patients affected either by oral SCC or by pre- malignant oral lesions were assayed using a commercial ELISA kit. Autoantibody titers to Hsp60 and Hsp72 were determined by conventional ELISA. RESULTS: Anti-p53 antibodies were detected in 3 out of 16 SCC-bearing patients (18.7%) and in 9 out of 13 patients suffering from pre-malignant oral lesions (69.2%). High titers of anti-Hsp60 autoantibodies were detected in 3 out of 29 patients (10.3%), while in all patients anti-Hsp72 titers were in the normal range. CONCLUSION: The presence of anti-p53 antibodies in both SCC-bearing patients and in patients with pre-malignant lesions support the notion that p53 gene mutation is an early event in oral tumorigenesis and suggest that this assay could be useful for diagnostic screening of pre-neoplastic lesions at high risk of recurrence and/or transition towards overt malignancy.
Spinal cord compression is a rare presentation of non-Hodgkin lymphoma. Extradural location at onset is a rare but devastating event in pediatric oncology. The authors describe a girl with acute spinal cord compression due to epidural non-Hodgkin lymphoma, emphasizing the encouraging perspective for a complete recovery in children with this condition. A 5-year-old girl presented with pain followed by progressive hyposthenia and paraplegia after a trauma. CT scan and MRI showed homogeneous tissue extending from T2 to L4, occupying the entire vertebral canal and extending to the para- and peri-vertebral soft parts. Emergency surgical debulking was carried out through T6-L1 laminectomy. The patient began chemotherapy (LMB 89 Protocol) and the tumor quickly disappeared. The patient is maintaining a complete remission 42 months after diagnosis. Significant results may be obtained with the chemotherapy treatment of epidural non-Hodgkin lymphoma when the disease is promptly diagnosed. Considering the effectiveness of chemotherapy, the authors believe that a neuro-surgical approach should be employed only when rapid worsening of symptoms is observed or for diagnostic purpose.
Two unusual cases of perforating oculocerebral trauma by foreign bodies treated surgically are reported. Both were caused by industrial accidents. In the first a nail shot from a nail gun ricocheted off the target and crossed the right eyeball and the posterior wall of the orbit, lodging in the homolateral temporal lobe. In the second case a metal fragment expelled by an agricultural machine penetrated the left maxillary sinus, crossed the floor of the orbit, the eyeball and the roof of the orbit and lodged in the homolateral frontal lobe. After accurate neuroradiological examination the patients were operated using simultaneous transcranial and transorbital access. In our opinion this is the only approach which can minimize the risk of infection which is so dangerous in this type of trauma. The functional and aesthetic results, which were very satisfactory in both cases, seem to confirm the correctness of this approach.
The authors found in literature the description of 124 cases of intra-orbital primitive meningiomas; they illustrate their clinico-surgical aspects as well as the differential features on the ground of their point of origin: 90 meningiomas of the (dural) sheath of the optic nerve (23 intraforaminal ones and 67 extraforaminal ones), 34 extradural meningiomas; they present 4 original cases, 3 extradural ones and 1 of the sheath of the optic nerve. After describing the elements of differential diagnosis with the most common intra-orbital expansive lesions (gliomas, sarcomas, angiomas, psuedotumors or orbital granulomas) the authors end by stating that total extirpation must be always carried out including, if necessary, the optic nerve and the ocular globe when it is invaded.
A surgical series of 144 infantile triventricular hydrocephalus (from nontumoral aqueductal stenosis) operated on in the period 1957-1982 is presented. The etiological factors, preoperative clinical and anatomical status of the patients are summarized. Their surgical career, the reasons, for revision operations and causes of death are analyzed in relation to each of the four operations performed: ventriculocisternostomies according to Stookey-Scharff or Torkildsen, extrathecal shunts (VA or VP). 46 patients required 72 revision operations, but 23 more patients were lost to follow-up after the first operation. 3 patients (2.0%) died after the first operation, 7 (4.8%) on revision and 18 (12.5%) sometime later. A recent clinical and instrumental review of the physical, neurological and mental status of the remaining 93 patients (64.5% of the total series) has showed that 50 (34.8%) are well or very well; 35 (24.3%) have residual deficits, and 8 (5.4%) are severely handicapped.