Biomedical subjects
Publications and source records attributed to R Manni.
A case of femoral neuropathy from iliac muscle hematoma occurring during heparin administration, successfully treated by early surgical decompression is reported. Following the evaluation of anatomy, possible pathogenesis and CT scanning findings, the role of early diagnosis is emphasized in the assessment of prognosis and for successful operative decompression.
A report of 3 cases of sodium valproate "encephalopathy". The addition of valproate to the treatment in 3 subjects, two adults and one child, all with generalised epilepsy, induced a worsening of the clinical and EEG pattern and in one case disturbances of vigilance as well. The occurrence of this complication in generalised epilepsy and the possibility that EEG alterations are its only manifestation are emphasised.
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Vertigo, vestibular function and the effect of labyrinthine stimulation on the EEG were studied in 29 epileptic patients. Vertigo has no distinguishing characteristics and the epileptic nature of this symptom can be only tentatively inferred from its chronological relationship with the other epileptic features. In a high percentage of epileptic subjects, especially those with focal seizures, abnormal vestibular responses can be observed. This finding may be ascribed to the existence of a common cerebral lesion responsible for both focal seizures and vestibular abnormalities, even though the data do not allow us to exclude the role played by antiepileptic treatment in modifying the vestibular response. Caloric labyrinthine stimulation in the method employed by us shows a limited activating effect on the EEG and clinical epileptic pattern. Even in the positive cases this method does not allow us to reach any precise anatomo-physiological conclusions.
The relationship between headache and epilepsy remains unresolved. We studied 3,600 patients affected by primary headache and 36 epileptic patients with a present or past history of headache. In the first group, no family history of epilepsy nor epileptiform EEG patterns were found. In the second group, there was no chronological relationship between epileptic seizure and headache attack in more than half of the patients; when found (46.1%) the relationship was neither precise nor specific. Taken as a whole, these data suggest the autonomous nature of epilepsy and headache.
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A retrospective study of the electroencephalographic patterns in 26 adults with chronic progressive external ophthalmoplegia. 12 of them presented EEG anomalies, all slight and aspecific. Of the various parameters considered (age, age at onset, duration of disease, CT, CSF findings, abnormalities of muscle mitochondria) the only two that seem to correlate are altered EEG patterns and severity of mitochondrial anomalies in skeletal muscle tissue.
We examined 148 EEG recordings from 118 patients affected with myasthenia gravis (35 males and 83 females, aged 17-82, with illness durations between 1 month and 24 years). The cases were clinically evaluated according to Ossermann's classification at the time of EEG recording. EEG patterns were subdivided into normal, diffuse or focal slow abnormalities, or epileptiform patterns. Of the 118 patients, 104 had normal EEG recordings and 14 had at least one abnormal recording (8 diffuse slow abnormalities, 6 focal slow abnormalities). The EEG findings were not correlated with clinical parameters (thymic pathology, respiratory incidents, drug treatment, etc.). One patient (whose EEG recordings were normal) showed an isolated epileptic fit and another patient was affected by epilepsy. A possible relationship between the two diseases is discussed.
EEG findings after sleep deprivation in 452 cases are reported. Effectiveness and specificity of this activating method in the field of epilepsy both in adult and in younger people are emphasized.
The comparative pharmacokinetics and pharmacodynamics of single oral doses of eterobarbital (N,N'-dimethoxymethylphenobarbital, DMMP, 400 mg) and phenobarbital (200 mg) were evaluated in a double-blind study in 8 normal volunteers. Following administration of DMMP, no unchanged drug could be detected in serum. The active monomethoxymethyl metabolite (MMP) appeared rapidly in the circulation but its concentration remained generally low and declined below the limit of detection (0.5 micrograms/ml) usually before 9.5 h. Serum levels of DMMP-derived PB increased slowly and reached a peak between 24 and 48 h in most cases. One subject showed an atypical pharmacokinetic profile, characterized by relatively high levels of MMP and a delayed appearance of low levels of PB. After administration of PB, serum drug levels peaked within 1.5 h and remained, at all sampling times, higher than those observed after intake of DMMP. Compared with DMMP, PB induced greater sedative effects as assessed by visual analogue rating scale, critical flicker fusion frequency and multiple sleep latency tests.
A night-time polygraphic sleep recording was performed in 14 patients with late onset partial epilepsy receiving chronic carbamazepine monotherapy. All patients had unstable nocturnal sleep patterns as indicated by significantly altered sleep continuity parameters compared with normal controls. Patients with poor seizure control tended to show greater alterations of sleep stability compared to patients in complete clinical remission but the difference failed to reach statistical significance. Epileptic patients also showed less REM sleep and longer REM latencies compared with normal controls, the most altered REM values being observed in patients with poor seizure control. These data confirm that polygraphic sleep alterations are seen in patients with symptomatic focal epilepsy and indicate that these abnormalities occur irrespective of seizure recurrence.
The efficacy and tolerability of vigabatrin (gamma-vinyl GABA, GVG), given as add-on therapy to 23 adult outpatients with severe drug-resistant epilepsy (17 with partial seizures), were studied using a double-blind, placebo-controlled, crossover design. The study consisted of two 7-week periods during which vigabatrin and placebo were administered in random sequence. Dosage was 1.0 g twice daily for patients weighing less than or equal to 65 kg and 1.5 g twice daily for patients weighing greater than 65 kg. Three patients were dropped from the study, two for reasons unrelated to treatment and one because of the appearance of vertigo, headache, dysarthria, and ataxia, which subsided rapidly when vigabatrin was stopped (3 g daily). Sixteen of the 20 patients available for analysis showed a decrease in the total number of seizures as compared with the placebo period. Of these, 12 showed a greater than 50% reduction in seizure frequency and 4 of the 12 showed a greater than 75% reduction. Both the total number of seizures and the number of partial seizures were significantly reduced by vigabatrin (p less than 0.01). Only in the patient who dropped out were severe adverse effects seen. The most frequently reported unwanted effect was mild drowsiness, which developed in seven patients on vigabatrin and in one on placebo. Positive effects, however, were also seen with six patients who reported an improved sense of well-being while receiving vigabatrin as compared with only 1 during the placebo period. No consistent changes in electrocardiogram (ECG), electroencephalogram (EEG), and visual-, auditory-, and somatosensory-evoked potentials were seen during the study.(ABSTRACT TRUNCATED AT 250 WORDS)
A rare case of an adrenal vascular cyst associated to an abdominal aorta aneurysm is reported. Adrenal cysts are an uncommon clinical finding, in most cases incidentally discovered for nonspecific abdominal pain, during US, TC or RM evaluation or at autopsy. Small adrenal mass are clinically silent. They may be symptomatic (lumbar tension, pain) for dimensions over 10 centimetres. Cysts of large size can cause displacement and compression of adjacent organs. They present a difficult problem of differentiation between benign and malignant lesions. Non-neoplastic adrenal cysts have been divided into four categories: parasitic (7%), epithelial (9%), endothelial (45%) and haemorrhagic or pseudocystic (39%). Vascular adrenal cysts may be a traumatic consequence of an hamartomatous vascular anomaly. The aim of this paper is to discuss, on the basis of the literature, the etiology, diagnosis and treatment of the adrenal mass. Surgical timing is discussed for the concomitant vascular lesion. The elective treatment was left adrenalectomy performed through transperitoneal approach. Surgery for abdominal aorta aneurysm was differed because the adrenal mass was suspected to be an infected neoplastic lesion and for the feasibility of endovascular procedure. The adrenal specimens contained a cystic structure with fluid blood, fibrin and calcifications. Normal adrenal cortical tissue was found in the cystic wall. This lesion (arising from vascular anomalies) require separation from haemorrhagic adrenal neoplasm. Awareness of adrenal pseudocysts and careful attention to the hystological features aids this distinction.
During the performance of 1018 thyroid operations, 1497 recurrent laryngeal nerves were identified and exposed. Of the 773 visualized nerves on the right side, 2 were found to be non recurrent (0.26%). This abnormality may represent a pitfall during thyroidectomy even for very experienced thyroid surgeons. We emphasize that the exposure and preservation of this vital structure is the standard of care and an essential component of routine dissection in thyroid surgery.
An EEG and CT study was carried out on 79 patients affected by dementia (24 SDAT and 55 MID). The EEG and CT patterns were compared with those of an age-matched control group. Statistical analysis of the CT findings between the demented and normal subjects showed significant differences only for severe atrophy. As far as EEG findings are concerned, no EEG pattern indicative of a specific type of dementia was observed even though a greater number of abnormal EEGs occurred in demented patients than in the control group. Finally, a poor EEG-CT correlation was found in demented patients.
A retrospective study was performed on 120 patients with cerebrovascular accidents in order to correlate EEG, CT and clinical data. A high degree of correlation was found between EEG and CT findings and between these laboratory tests and clinical picture in those subjects with ischemia in the carotid territory. Furthermore the combined use of EEG and CT testing improves the diagnostic validity of both methods.
The term "alcoholic epilepsy" has had controversial interpretations and has been applied to different alcohol syndromes. In the present study, a homogeneous population of alcohol abusers was retrospectively studied with the aim of clarifying the relationship between alcohol and epilepsy. If subjects who present with potentially epileptogenic lesions are excluded, strictly alcohol-related seizures seem to be withdrawal symptoms from a pathogenetic point of view. They, even if repeated, do not deserve the term "epilepsy" and probably should not be chronically treated with antiepileptic drugs. Finally, no characteristic interictal EEG pattern was found in alcoholics with seizures.