Biomedical subjects
Publications and source records attributed to P Ciappetta.
The authors describe a case of functionless non-chromaffin paraganglioma of the retroperitoneal space, that invaded the spinal canal causing a cross section syndrome of the cauda equina. The case is described because of the unusual clinical evolution of the tumour in question, never previously described.
The authors describe a case of a post-traumatic subdural haematoma with an unusual evolution in two phases, one slow, the other very rapid. The rapidity of the evolution was caused by the rupture of a cortical dural artery, shown angiographically.
The authors report six cases of so-called spinal subdural arachnoid cysts, emphasizing the clinical and myelographic findings which, if not properly evaluated, may be misleading diagnostically. The literature of so-called perineural cysts and of extradural arachnoid cysts is likewise reviewed. Their clinical, roentgenological, and pathological features are examined. A common pathogenesis for all these lesions is proposed. It implies disruption and secondary proliferation of the arachnoid membrane. Hence, the term arachnoid diverticulum is advanced to include all lesions communicating with the subarachnoid space. Their varying relations with the subarachnoid space depend on the sites of the primary abnormalities and on hydrodynamic factors. Numerous observations of associated arachnoid diverticula, either perineural, subdural, or extradural, further favour a common pathogenesis.
A retrospective radiologic study of 40 non-neurologic thoracolumbar fractures allowed for the evaluation of the long-term results of surgical and conservative treatment in terms of correction of the post-traumatic deformity. The Magerl classification and the McCormack scale were used to select compressive type fractures (type A), and fractures characterized by comminution of the vertebral body without involvement of the posterior elements. Instability related to comminution and to considerable diastasis of the fragments is at the basis of failure of conservative (plaster brace) and surgical (short posterior fixation and posterolateral fusion) treatments. Severe type A fractures treated conservatively have, in fact, at follow-up shown significant residual deformity, while failure of the instrumentation or loss of correction in 40% of cases treated surgically has been revealed.
Primary bone location of hydatid disease is extremely rare. The clinical case herein reported represents a primitive bone location of echinococcus in the ileal and sacral area. The aspecific symptoms did not allow for a preoperative diagnosis. The latter was possible only after a CT scan performed for other reasons. The patient underwent a CT scan and MIR which showed a diffuse involvement of the ilium and sacrum along with the presence of two cysts (anterior and posterior). Surgery was performed through an anterolateral extraperitoneal and posterior access in the gluteal region. Asportation "en bloc" of the cysts was not possible. Therefore, they were opened, aspirated and washed with hypertonic solution (33% NaCl). Following surgery Albendazole was prescribed to the patient. At 22 days from surgery, a CT scan confirmed the disappearance of the cysts along with the presence of bone lesions.
Interhemispheric subdural hematoma (ISH) is a rare form of post-traumatic intracranial hemorrhage. The Authors report a further case and review the relevant literature. ISH most frequently gives a clinical picture corresponding to the falx syndrome. The possibility of an interhemispheric hematoma evolving into a chronic subdural hematoma of the convexity is considered together with both surgical and medical therapeutic indications.
The Authors report a case of intranasal cerebral ectopia; the problems concerning the nosographic and diagnostic definition of this condition as well as the differences from other similar pathologies with the same location (such as meningoencephalocele and nasal glioma) are discussed. Particular attention is payed to the various surgical techniques that can be used in these cases.
A description of two cases of intraspinal hemangiopericytoma is given, which join the 30 reported to date. The clinical features of this tumor rarely found in the CNS are compared with those of the same oncotype found at other sites. Surgical treatment is necessary, accompanied by radiotherapy. Spinal tumor embolization preoperatively is of benefit.
We report a case of neurological bladder (upper motor neuron type) which appeared after a few years after vertebral trauma with retrodislocation of C6. We presumed that there was a traumatic and spondylosic etiopathogenesis of the disturbance. Surgery was done following the surgical techniques used in spondylogenetic myelopathies and there was an immediate improvement of the urinary disturbance.
Brain tumors which manifest themselves neurologically in the first year of life can be declared "congenital". They are considered to be rare. Of a total of 440 central nervous system neoplasms in children, operated between 1951 and 1978, 24 (5,4%) congenital tumors were noted. The Authors report a clinical picture and the follow-up. The histology and topographical distribution of this series of tumors is compared to the literature data. The frequency of supratentorial tumors (15 cases; 62,5%) was much higher than that of infratentorial masses (9 cases); 37,5%). The high incidence of astrocytomas, choroid plexus papillomas and medulloblastomas is emphasized.
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