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Biomedical subjects

Paolo Cappabianca

Publications and source records attributed to Paolo Cappabianca.

At least 37 records · Page 2Linked to original sources
PubMed2005

Current state and future development of intracranial neuroendoscopic surgery.

Since the introduction of the modern, smaller endoscopes in the 1960s, neuroendoscopy has become an expanding field of neurosurgery. Neuroendoscopy reflects the tendency of modern neurosurgery to aim towards minimalism; that is, access and visualization through the narrowest practical corridor and maximum effective action at the target point with minimal disruption of normal tissue. Transventricular neuroendoscopy allows the treatment of several pathologies inside the ventricular system, such as obstructive hydrocephalus and intra-/paraventricular tumors or cysts, often avoiding the implantation of extracranial shunts or more invasive craniotomic approaches. Endoscopic endonasal transphenoidal surgery allows the treatment of pathologies of the sellar and parasellar region, with the advantage of a wider vision of the surgical field, less traumatism of the nasal structures, greater facility in the treatment of possible recurrences and reduced complications. However, an endoscope may be used to assist microsurgery in virtually any kind of neurosurgical procedures (endoscope-assisted microsurgery), particularly in aneurysm and tumor surgery. Basic principles of optical imaging and the physics of optic fibers are discussed, focusing on the neuroendoscope. The three main chapters of neuroendoscopy (transventricular, endonasal transphenoidal and endoscope-assisted microsurgery) are reviewed, concerning operative instruments, surgical procedures, main indications and results.

Brain↗
PubMed2004

Endoscopic endonasal transsphenoidal surgery: procedure, endoscopic equipment and instrumentation.

INTRODUCTION: In the last 10 years the endoscopic endonasal transsphenoidal approach has been proposed as a minimally invasive procedure for the treatment of pathologies of the sellar region. This procedure introduces various advantages compared with the transsphenoidal microsurgical approach such as a wider vision of the surgical field, less traumatism of the nasal structures, greater facility in the treatment of possible recurrences, and reduced complications. Nevertheless, as for any new procedure, there is an initial learning curve that is somewhat steep, due to the necessity of acquiring the specific endoscopic skills. It is equally essential to be supplied with dedicated endoscopic equipment and appropriate surgical instrumentation, in order to optimize the different stages of the operation. DISCUSSION: Therefore, after our extensive experience with over 250 patients treated by means of the endoscopic endonasal transsphenoidal approach for pathologies of the sellar region, we describe herein the characteristics of the proper endoscopic instrumentation, as well as a set of surgical instruments intentionally conceived to respond to the specific characteristics of this new procedure.

Endoscopy↗
PubMed2004

Surgical treatment of intracavernous trigeminal schwannomas via a fronto-temporal epidural approach.

The purpose of this study is to evaluate the efficacy of the fronto-temporal epidural approach in managing intracavernous trigeminal schwannomas. Five unselected patients harboring an intracavernous trigeminal schwannoma were operated on. Each of them was cured by a single craniotomy. In all cases the skull base approach described by Dolenc [Acta Neurochir. (Wien) 130 (1994) 55] was performed. The complete resection of the tumor and its capsule was gained in all five cases. There was no surgical mortality. No patient developed postoperative major complications. The fronto-temporal epidural approach can be applied for parasellar type trigeminal schwannomas, thus avoiding the exposure of the temporal lobe, and resulting in good chance for total excision of the tumor together with minimal surgical complications.

Cavernous Sinus↗
PubMed2004

Sellar repair with fibrin sealant and collagen fleece after endoscopic endonasal transsphenoidal surgery.

OBJECTIVE: To determine, in patients undergoing sellar repair after endoscopic endonasal transsphenoidal surgery, the clinical efficacy of a combination of fibrin sealant/collagen fleece compared to the use of fibrin sealant or collagen fleece alone, in preventing CSF-related (cerebrospinal fluid) postoperative complications. METHODS: From a retrospective analysis of our series of 242 consecutive endoscopic transsphenoidal procedures, in 56 out of the 90 cases in which the sella had been repaired, fibrin sealant and/or collagen fleece was employed, both in combination with one or multiple layers of other materials. The incidence of postoperative CSF leaks and the need for a postoperative lumbar drainage in the groups of fibrin sealant or collagen fleece treated patients were compared to the group of patients treated with the fibrin sealant/collagen fleece combination. RESULTS: In 2 out of 16 fibrin sealant treated patients a postoperative CSF leak presented, and in 6 out of these 16 subjects a postoperative lumbar drainage was necessary; patients who received a fibrin sealant/collagen fleece combination exhibited no detectable postoperative CSF leak, and no postoperative lumbar drainage was used. CONCLUSIONS: Closure of the sella turcica with fibrin sealant in combination with a collagen fleece is a safe and effective method to prevent CSF fistulas. When used in combination, the collagen fleece enhances the sealing and tissue regeneration properties of the fibrin sealant, thus reducing the incidence of postoperative CSF leaks, obviating the need for a lumbar drain placement.

Collagen↗
PubMed2004

Single brain metastases of carcinoid tumors.

Carcinoid tumors are one among the most uncommon source of metastatic lesion to the brain. Four cases of single brain metastases from carcinoid tumors operated upon and verified by both histology and immunohistochemical staining are reported. The site of the primary carcinoid tumor was the lung in two cases, ileum in one and the left colon in another. The location of the brain metastasis was supratentorial in two cases and cerebellar in two. A high vascular tumor with large blood channels was found at surgery. Immunohistochemical studies showed in all four cases positive staining for synaptophysin, neuron-specific enolase, chromogranine and cytocheratine and negative staining for S-100 and HMB-45. The postoperative survival time ranged from 5 to 18 months. The epidemiological, surgical and pathological features of brain metastases from carcinoid tumors are also discussed from the analysis of 44 well-documented cases reported in the literature.

Adult↗
PubMed2004

Dopamine receptor expression and function in clinically nonfunctioning pituitary tumors: comparison with the effectiveness of cabergoline treatment.

The aim of this study was to correlate dopamine receptors and D(2) isoform expression with the cabergoline effect on alpha-subunit secretion in vitro and tumor mass in vivo in clinically nonfunctioning pituitary tumors. Eighteen patients were subjected to neurosurgery, and a tumor sample was used for dopamine receptor and D(2) isoform expression evaluation by RT-PCR and the in vitro functional studies. After neurosurgery, nine of 18 patients with persistent tumor were treated with cabergoline and tumor mass was evaluated before and after 1 yr treatment. D(2) receptor was expressed in 67% of cases. D(2long) was found in 50%, D(2short) in 17%, and both D(2) isoforms in 33% of cases. D(4) receptor was also expressed in 17% of cases. The in vitro inhibition of alpha-subunit concentration was found in 56% of cases and was associated with D(2) expression (chi(2) = 5.6; P < 0.05). After 1 yr of cabergoline treatment, tumor shrinkage was evident in 56% of patients and was associated with D(2) expression (chi(2) = 5.6; P < 0.05). The expression of D(2short) rather than D(2long) isoform is associated with the most favorable response of the tumor to cabergoline treatment. In conclusion, this study demonstrates D(2) receptor expression and function in nearly 70% of cases, suggesting a role of this drug in the treatment schedule of clinically nonfunctioning pituitary tumors.

Adult↗
PubMed2004

Outcome of cabergoline treatment in men with prolactinoma: effects of a 24-month treatment on prolactin levels, tumor mass, recovery of pituitary function, and semen analysis.

The outcome of 24 months of cabergoline treatment on prolactin (PRL) normalization, tumor shrinkage, restoration of pituitary function, and semen alterations was prospectively investigated in 41 men with macro- (age 17-70 yr) and 10 with microprolactinoma (age 18-53 yr). Fifty-one age-matched men served as controls for semen analysis. At study entry, of the 41 patients with macroprolactinoma, 17 (41.4%) had visual field defects, 14 (34.1%) had headache, eight (19.5%) had galactorrhea, 22 (53.6%) had hypopituitarism apart from hypogonadism, and 30 (73.2%) had low testosterone levels; of the 10 patients with microprolactinoma, none had visual field defects, galactorrhea, or hypopituitarism apart from hypogonadism, two had headache (20%), and five had low testosterone levels (50%; P = 0.3). After 24 months of therapy, 1) PRL levels normalized in 31 patients with macro- (75.6%) and in eight with microprolactinoma (80%; P = 0.9), and galactorrhea disappeared in all patients; 2) maximal tumor diameter reduced by 73.7 +/- 22.6% in macro- and 72.8 +/- 28.3% in microprolactinomas (P = 0.91), and 15 macro- (30%) and seven microprolactinomas (46.7%; P = 0.37) disappeared; 3) visual field defects disappeared in 15 (75%) patients with macroprolactinoma, and headache disappeared in 15 (83%) patients with macro- and in one with microprolactinoma (50%); 4) GH secretion recovered in 62.5% and ACTH secretion in 60% of patients; 5) testosterone levels normalized in 25 patients with macro- (60.9%) and six with microprolactinoma (60%) after 6 months, and 20 patients required testosterone or gonadotropin replacement (in 14 or six patients, respectively); and 6) sperm volume and count normalized in all patients who normalized testosterone levels, whereas motility normalized in more than 80%. Cabergoline therapy was well tolerated; only 4.5% of patients had side effects at high doses. These data demonstrate that cabergoline treatment is as effective and safe in men as in women with prolactinoma and can be successfully used as primary therapy even in men bearing large macroprolactinomas.

Adolescent↗
PubMed2004

Endoscopy and transsphenoidal surgery.

ENDOSCOPY OFFERS INTERNAL visualization of many different cavities of the human body, with its specific vision inside the anatomy, close to the target area. The view of the surgical field in transsphenoidal surgery had been obtained with the naked eye from its beginning in 1907 up to the introduction of the operating microscope by Jules Hardy in the 1960s, which represented a great advance in terms of magnification and illumination. In the past decade, modern rigid endoscopes, with their wider view near the relevant anatomy, have permitted minimally traumatic transsphenoidal procedures in and around the sellar area, thus representing a "new wave" in transsphenoidal history. An overview of the evolution of the endoscope as a visualizing and operating instrument particularly related to the transsphenoidal approach is presented here. The current possibilities of transsphenoidal endoscopy, with its related advantages and limitations, are presented.

Endoscopes↗
PubMed2004

Endoscopic endonasal transsphenoidal surgery.

The endoscopic endonasal transsphenoidal approach is a minimally invasive surgical technique for the removal of sellar and parasellar lesions. The procedure is performed via an anterior sphenoidotomy. The two main characteristics of the endoscopic approach, when compared with the standard microsurgical operation, arise from the use of the endoscope as a unique optical device and from the absence of a transsphenoidal retractor. More convenient straight surgical instruments are employed, whereas bayonet-shaped tools are used in the microsurgical procedure, to avoid any interference with the light beam generated by the microscope. The standard surgical technique is composed of three main time phases: the nasal, sphenoid, and sellar phase. During the nasal phase, the scope is introduced through the chosen nostril and advanced up to the sphenoethmoid recess, where the sphenoidotomy is performed. The sphenoid phase consists of the detachment of the nasal septum from the sphenoid rostrum, the anterior sphenoidotomy, removal of the sphenoid septum or septa, and identification of the landmarks inside the sphenoid sinus. In the sellar phase, an opening of the sellar floor is performed for removal of the lesion. A wide view of the sellar environment is obtained through angled scopes to detect eventual tumor remnants. The procedure ends with the reconstruction of the sella and removal of the endoscope from the nostril, without any postoperative nasal packing.

Adenoma↗
PubMed2004

The "schola medica salernitana": the forerunner of the modern university medical schools.

The schola medica salernitana is considered the oldest medical school of modern civilization. Salerno's long medical tradition began during the Greco-Roman period in a Greek colony named Elea, where Parmenides decided to found a medical school. The fame of the school became more and more important during the 10th century, and it was best known in the 11th century. In the middle of 12th century, the school was at its apogee, and Salerno provided a notable contribution to the formulation of a medical curriculum for medieval universities. The most famous work of the Salernitan School was the Regimen Sanitatis Saleritanum, a Latin poem of rational, dietetic, and hygienic precepts, many of them still valid today. The school also produced a physician's reference book, with advice on how to treat a patient, a sort of code of conduct to help the physician to respect the patient and his or her relatives. The first science-based surgery appeared on the scene of the discredited medieval practice in Salerno, thanks to Roger of Salerno and his fellows. He wrote a book on surgery, called Rogerina or Post Mundi Fabricam, in which surgery from head to toe is described, with surprising originality. The important contribution to the School of Salerno made by women as female practitioners is outlined, and among them, Trotula de Ruggiero was the most renowned. The period when the School of Salerno, universally recognized as the forerunner of the modern universities, became a government academy was when Frederick II reigned over the Kingdom of the Two Sicilies, as Emperor of the Holy Roman Empire.

Female↗
PubMed2004

The legacy of Pompeii and its volcano.

On August 24, AD 79, a terrible eruption of Mount Vesuvius deranged life in beautiful Pompeii and killed thousands of men, women, and children. They were restored to us by the fact that Mount Vesuvius, with its rain of ashes, proved to be a skilled sculptor, preserving the shape and even the wrinkles in the clothes the Pompeians wore while trying to escape during the day of the tragedy. The detailed description of Plinius the Younger and modern static studies of the eruptive residues have made it possible to reconstruct with great accuracy the various phases of the eruption that took place 2000 years ago, including the hours and days during which the phenomena first became obvious. Today, almost 2000 years later, Pompeii has reawakened and risen from its sepulcher of ashes thanks to the excavations initiated under King Charles III of Bourbon in 1748. Excavations proceeded slowly under the Bourbons, with the aim of enriching the Bourbon Museum of Naples rather than of classifying the ruins and placing them into a historical context. Under Joachim Murat, interest in the town planning and architecture of the uncovered cities reemerged, especially with respect to Pompeii. In 1860, however, with the establishment of the Kingdom of Italy, the excavations, now under the direction of archaeologist Giuseppe Fiorelli, were provided new impetus and, finally, a scientific basis. Today, the excavations are giving us back extraordinary evidence concerning the culture, the everyday life, the habits, the architecture, and the wonderful frescoes of the Roman cities of southern Italy, making possible the statement that Pompeii is "the most alive of the dead cities."

History, 15th Century↗
PubMed2003

Withdrawal of long-term cabergoline therapy for tumoral and nontumoral hyperprolactinemia.

BACKGROUND: Whether the withdrawal of treatment in patients with nontumoral hyperprolactinemia, microprolactinomas, or macroprolactinomas is safe and effective has been unclear. We performed an observational, prospective study of cabergoline (a dopamine-receptor agonist) withdrawal in such patients. METHODS: The study population included 200 patients--25 patients with nontumoral hyperprolactinemia, 105 with microprolactinomas, and 70 with macroprolactinomas. Withdrawal of cabergoline was considered if prolactin levels were normal, magnetic resonance imaging (MRI) showed no tumor (or tumor reduction of 50 percent or more, with the tumor at a distance of more than 5 mm from the optic chiasm, and no invasion of the cavernous sinuses or other critical areas), and if follow-up after withdrawal could be continued for at least 24 months. RESULTS: Recurrence rates two to five years after the withdrawal of cabergoline were 24 percent in patients with nontumoral hyperprolactinemia, 31 percent in patients with microprolactinomas, and 36 percent in patients; with macroprolactinomas. Renewed tumor growth did not occur in any patient; in 10 female patients (22 percent) and 7 male patients (39 percent) with recurrent hyperprolactinemia, gonadal dysfunction redeveloped. In all diagnostic groups, prolactin levels at the time of recurrence were significantly lower than at diagnosis (P<0.001). The Kaplan-Meier estimated rate of recurrence at five years was higher among patients with macroprolactinomas and those with microprolactinomas who had small remnant tumors visible on MRI at the time of treatment withdrawal than among patients whose MRI scans showed no evidence of tumor at the time of withdrawal (patients with macroprolactinomas, 78 percent vs. 33 percent, P=0.001; patients with microprolactinomas, 42 percent vs. 26 percent, P=0.02). CONCLUSIONS: Cabergoline can be safely withdrawn in patients with normalized prolactin levels and no evidence of tumor. However, because the length of follow-up in our study was insufficient to rule out a delayed increase in the size of the tumor, we suggest that patients be closely monitored, particularly those with macroprolactinomas, in whom renewed growth of the tumor may compromise vision.

Adolescent↗
PubMed2003

Chondroma of the petrous apex.

The clinicopathological features of a chondroma of petrous apex area examined with magnetic resonance (MRI) are presented. The extreme rarity of the location, the MRI aspect, and the surgical strategy based upon MRI studies make this case noteworthy.

Aged↗
PubMed2003

Gender differences in the prevalence, clinical features and response to cabergoline in hyperprolactinemia.

BACKGROUND: Gender differences in tumor size are supposed to exist in hyperprolactinemia since microadenomas are more commonly found in women and macroadenomas in men. Whether this reflects only a delay in diagnosis in men or a true gender difference in tumor pathogenesis is still unclear. OBJECTIVE: To prospectively analyze gender differences in the presentation and response to cabergoline treatment in 219 consecutive newly diagnosed patients with hyperprolactinemia. DESIGN: An open prospective design. SUBJECTS: Of the 219 patients of which 145 were women; 107 patients had macroprolactinoma, 97 had microprolactinoma, and 15 had non-tumoral hyperprolactinemia. METHODS: Presenting clinical symptoms, prolactin levels and tumor size at magnetic resonance imaging were measured before and 3-6 Months after cabergoline therapy. RESULTS: Prevalence of microprolactinomas (56% vs 22%, P=<0.0001) and non-tumoral hyperprolactinemia (10% vs 0%, P=0.01) was higher in women than in men. Men and women were of similar age (median 32 vs 29 Years; P=0.2) and a similar number had gonadal/sexual dysfunction (85 vs 83%, P=0.6); weight gain (70 vs 46%; P=<0.0001) and galactorrhea (52 vs 19%; P=<0.0001) were more common in women. Prolactin levels were higher in men than in women, whether exhibiting macro- (2848+/-2954 vs 1132+/-2351 microg/l, P=<0.0001) or microadenomas (187.8+/-51.8 vs 135.4+/-60.5 microg/l, P=0.009) and the size of the adenoma was larger in men than in women irrespective of macro- (25.8+/-12.4 vs 17.2+/-7.2 mm, P=<0.0001) or microadenoma diagnosis (8.0+/-1.4 vs 7.1+/-1.6 mm, P=0.04). After treatment, prolactin levels decreased by 89.2-96.4% in all groups, and normalized more frequently in micro- than in macroadenoma patients (86 vs 64%, P<0.0001), regardless of gender (70% vs 69%, P=0.9). Menses resumed in 82% of women, libido disturbances improved in 57% of men. Tumor size was reduced by 45+/-25% and 52+/-24% in macroprolactinoma patients and by 44+/-31 and 38+/-29% in microprolactinoma patients in women and men respectively. Visual field defects disappeared in 61% of women and in 71% of men (P=0.6). CONCLUSIONS: Prevalence of macroprolactinomas was similar in men and women; microprolactinomas and non-tumoral hyperprolactinemia were more frequent in women. Clinical symptoms at presentation differed according to gender, with galactorrhea and weight gain more frequent in women. The successful response to cabergoline treatment for 6 Months was higher in micro- than in macroprolactinoma patients and was similar in women and men.

Adolescent↗