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Biomedical subjects

R Da Pian

Publications and source records attributed to R Da Pian.

At least 55 records · Page 3Linked to original sources
PubMedDate not supplied

Microsurgical treatment of ten arteriovenous malformations in critical areas of the cerebrum.

Ten cases of arteriovenous malformations located in critical areas of the cerebrum, i.e., motor and speech areas, the insular cortex, the corpus callosum, and the basal ganglia, were treated surgically by radical removal of the lesion. In four of the cases a neurologic examination before surgery was negative; five cases exhibited only mild hemiparesis or dysphasia; only one exhibited hemiplegia and stupor. There were no postoperative deaths and a residual permanent deficit was noted in only one patient. Postoperative control angiograms failed to show any filling of the arteriovenous malformations in any of the cases. Recovery of the ability to work was achieved in all of the patients. The operating microscope and controlled hypotension made possible a precise resection at the edges of the lesion, and damage to surrounding important cerebral structures was thus avoided. Based on these results, microsurgery should be considered as an elective therapy for these kinds of arteriovenous malformations, even when preoperative symptoms are minimal.

Adolescent↗
PubMedDate not supplied

Preoperative embolization of arteriovenous malformations with polylene threads: techniques with wing microcatheter and pathologic results.

The technique with a wing microcatheter system and the pathologic aspects of 11 cerebral arteriovenous malformations (AVMs) surgically resected after embolization with polylene threads are reported. Embolization was performed once in eight patients and twice in three patients. Resected AVMs were submitted both to routine hematoxylineosin examination and to immunohistochemical workup in order to detect the type of immunologic response to thread emboli. In nine cases, 50% or more of the nidus was obliterated by the embolization. After embolization two patients developed reversible neurologic deficits. Pathologic specimens of resected AVMs demonstrated no vascular necrosis; however, a moderate inflammatory response could be seen, characterized by the presence of both mononuclear cells and foreign-body giant cells, associated with the absence of polymorphonuclear infiltrates. A granulomatous fibrotic process was identified that was present from the first month after embolization. Immunohistochemistry indicated that the immunologic response to thread emboli was cell-mediated, not humoral. Embolization with the wing microcatheter with the use of polylene threads proved to be a safe and efficient system of embolization, as a preoperative procedure. Polylene threads are a nontoxic and biocompatible material that can be used as an embolic agent for brain AVMs.

Adult↗
PubMedDate not supplied

Patient characteristics and pre-operative therapeutic modalities.

The International Cooperative Study on the Timing of Aneurysm Surgery included 68 participating centers from 16 different countries. Eight Italian neurosurgical units participated in the Study: Bellaria Hospital, Bologna; Neurological Institute of Milan, Milan; University Hospital, Brescia; University of Milan, Milan; University of Padova, Padova; University of Rome, Rome; Civil Hospital, Verona; and Civil Hospital, Vicenza. The overall case contribution from the Italian centers was 485 cases, 14.1% of the total study population. As compared to the other centers included in the Study, the Italian centers exhibited a higher percentage of patients with impaired consciousness; a later interval of planned surgery from SAH; frequent use of preoperative lumbar drainage, as well as antihypertensives, anticonvulsants, antifibrinolytics, steroids, diuretics and LMW dextran; and less frequent use of sedatives and narcotics. The individual Italian centers differed significantly in regard to patient characteristics and preoperative therapeutic modalities. There was a relatively high number of stuporous or comatose patients admitted to Centers 1, 7 and 8, very few admitted to Centers 5 and 6, and none admitted to Center 2. The different distribution of key prognostic factors prevents a direct comparison of the overall management results of the centers. A stratification of the patients according to a risk scale and/or a prognostic model is required for comparison of the management results.

Female↗
PubMedDate not supplied

Surgical findings and postoperative therapeutic modalities.

The 8 Italian centers participating in the International Cooperative Study on Timing of Aneurysm Surgery operated upon 68% of their patients eligible for the study. This low operative rate is mainly explained by the prevailing use of a delayed surgical policy. Only 28% of cases were operated on within 3 days of hemorrhage. Although early surgery was applied in more than 50% of patients from Centers 2, 6 and 7, most other centers operated on approximately 10% of patients within this time interval. Italian centers exhibited a wide variation in planned and actual surgery interval, with only 48% of their patients eventually operated on at the planned time. Differences from planned and actual timing of surgery were less consistent in the units performing early surgery. Preoperative conditions were different between the individual centers. The percent of patients alert at the time of surgery varied from approximately 50% in Centers 3 and 7 to 90% in Center 5. Centers 2 and 6 never operated on comatose patients and rarely stuporous patients. During surgery, induced hypotension was used in 67% of Italian patients. The brain was tight at exposure in 42% of patients from Italian centers; the difference from the other study centers was very significant (p = 0.0009). Consequently major brain resection was more frequently performed in Italy than in the other centers. Brain conditions depended mainly upon timing of surgery and preoperative grade (except for comatose patients) and varied accordingly between the individual centers. Temporary arterial occlusion was rarely used in Italian centers. Intraoperative bleeding from the aneurysm was slightly more frequent than in the other centers. The overall incidence of intraoperative complications was unremarkable. There were significant differences between the Italian and the other centers regarding the use of postoperative routines and medications. In Italian centers ventricular CSF drainage, shunt insertion, ICP monitoring, sedatives and analgesics were less frequently used; lumbar CSF drainage, anticonvulsants, steroids, and diuretics were applied more frequently. In the individual centers the major differences were in the use of antihypertensives, vasopressor agents, diuretics, hypervolemia, and low-molecular weight dextran.

Humans↗
PubMedDate not supplied

Results of treatment.

Overall results of management in patients admitted to the 8 Italian centers participating in the International Cooperative Study on Timing of Aneurysm Surgery were rather unsatisfactory, with good recovery in only 42% of patients, and death in 45% of patients. As compared to the other centers included in the Study, Italian centers exhibited a significantly lower recovery rate and a significantly higher mortality rate. There were significant differences also between the individual Italian centers; independently of admission neurological status and timing of surgery, the outcome was better in centers 2 and 6 (a mortality rate under 20%) and worse in centers 1 and 8 (a mortality rate around 60%). Using prognostic factor models, higher than expected mortality rates were observed in 4 centers, and lower than expected good recovery rates in 3 centers. In Italian centers vasospasm accounted for the highest morbidity and mortality rate; the difference in mortality rate from vasospasm between Italian and other centers was very significant. Other important causes of death and disability were constituted by direct effect of the initial bleed and by recurrent hemorrhage. Patients operated on in Italian centers exhibited a good recovery in 57% of cases; the mortality was 27%. Differences from the other centers were less marked than for the overall management results. Mortality rates from vasospasm and from surgical complications were significantly higher in Italian than in the other study centers. Between the individual Italian centers, vasospasm accounted for the highest mortality rate in centers 7 and 8 (17% and 28% respectively). Postoperative pneumonia was significantly more frequent in Italian than in the other centers. In regard to timing of surgery, the differences in results between Italian and other centers were less marked when surgery was performed after 10 days from hemorrhage. In Italian centers as a whole, a delayed operation was linked with a better outcome than an early or subacute operation. The lowest recovery rate was observed in drowsy patients operated on between 4 and 10 days from the hemorrhage. Focal ischemic deficits and pneumonia were prevalent after an operation within 3 days of hemorrhage, while postoperative brain swelling was most frequent in patients operated on between 4 and 10 days from hemorrhage. The differences in results between Italian and other centers and among the individual Italian centers are widely discussed; possible explanations include inadequate modalities of treatment (especially inadequate management of vasospasm) and structural deficiencies of intensive care management in seriously ill patients.

Humans↗
PubMedDate not supplied

Deep controlled hypotension with sodium nitroprusside in the surgical treatment of intracranial arterial aneurysms.

The authors report 73 cases of intracranial arterial aneurysms operated on under deep controlled hypotension--i.e. hypotension below 60 mmHg of systolic arterial pressure (s.a.p.)--. Deep hypotension was induced by Sodium Nitroprusside (SNP). No problems were encountered in order to reach or to maintain deep hypotension. SNP showed to be an easy hypotensive agent, without toxicity at the recommended dosage. Fifty-nine patients were operated on between 40 and 25 mmHg of s.a.p. In 55 patients deep hypotension lasted for 30 minutes or more, reaching 2 hours in 3 patients. Surgical results were excellent, in regard either to the control of bleeding, either to the dissection of the aneurysm. Clinical results were evaluated by comparison with 146 patients operated on under normal pressure (group of control); no complications were clearly related to deep hypotension per se. However, the authors stress the risks of deep hypotension in early surgery, due to the possible association to vascular spasm.

Blood Pressure↗
PubMedDate not supplied

Giant unruptured aneurysm of the middle cerebral artery manifesting with epilepsy: successful surgical treatment.

A case of a giant aneurysm of the middle cerebral artery (M.C.A.), presenting with history of visual hallucinations, is described. The aneurysm was successfully excised, with disappearance of previous symptoms. The interest of the case is constituted by the very unfrequent location for an aneurysm over 3 cm in diameter, by the occurrence of epilepsy as the first symptom and by the excellent response to surgical therapy. The morphology and location of giant aneurysms, their surgical treatment and especially the problem of aneurysm-induced epilepsy are discussed.

Adult↗