Stereotactic technique for percutaneous biopsy of deep brain lesions.
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Biomedical subjects
Publications and source records attributed to R Spaziante.
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Because of the variability of the structural features of cerebral tumors, the characteristics observed in biopsy samples may not be representative of the whole neoplasm. The reliability of cerebral stereotactic biopsy is therefore greatly debated. In order to test the value of diagnoses based on biopsy samples, the authors compared histological and cytological data obtained from a small fragment of a tumor with the definitive diagnosis obtained from surgical or necropsy specimens. An analysis of 64 cases is reported, where a correct diagnosis from the biopsy sample was achieved in 92.2% of the cases. Neuroglial tumors were more difficult to characterize than other types of intracranial tumors, with an accuracy of 81.5%.
This study examines the accuracy of ultrasonic scanning in the recognition of malignancy in 103 "cold" thyroid nodules. All nodules underwent to surgical ablation and to histopathological examination. 10 nodules were cistic, 72 solid and 21 mixed cistic-solid on echography. None of the cistic nodules showed malignant disease while six carcinomas were present in solid nodules and one (a papillary cancer) in a mixed cistic-solid lesion. However we were unable to find echographic abnormalities pathognomonic for malignancy. Only in one case (an undifferentiated carcinoma which involved adjacent blood vessels) the diagnosis of malignant tumour was made before operation; in the other cases the echo patterns of the carcinomatous nodules were similar to those observed in benign nodules. Similar ultrasonic findings were also seen in the various types of thyroid cancer (3 follicular, 2 papillary, 1 medullary, 1 undifferentiated) a part the papillary carcinoma which appeared as cistic-solid lesion. Our data seem to limit the diagnostic value of echography in the detection of malignant thyroid nodules, nevertheless they confirm the benignancy of echografically cistic nodules.
The authors report a case of a Grade 2 astrocytoma with pan-medullary extension, from C1 to L2, in a little girl aged 12. It was successfully operated on. The clinical picture showed an initial acute paraplegia which suddenly turned into tetraplegia with respiratory insufficiency and second degree coma. Besides the rarity of the case, some atypical aspects are pointed out, such as the patient's youth and the partially aggressive character of the neoplasm. The surgical implications of such pan-medullary tumours are discussed, the authors emphasize the aspects that in their opinion indicate exploratory surgery and, when possible, total removal of the tumours.
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Two variations on the currently most commonly used technical method for phlebography are described. The first variation involves an original method for visualizing the dorsolumbosacral epidural plexus via the retrograde route from the azygos vein. If necessary this can be associated with catheterization and simultaneous injection into an ascending lumbar vein or into a lateral sacral vein. This method permits exploration from T7 to S1 and provides phlebograms of excellent quality, owing to the reduction in the flow caused by countercurrent injection. The second variation involves visualizing the epidural venous plexus by means of double percutaneous transfemoral catheterization of the hypogastric veins, using balloon catheters. This method is performed easily and rapidly. Preferential flow is obtained via the epidural plexus, and there is less diversion of the contrast medium through anastomoses and less filling of the vena cava. The specific indications for these methods are described. The availability of alternative methods beyond the traditional one renders epidural phlebography more reliable and more manageable, and it ensures certainty of diagnosis.
The data from 55 patients with empty sellae seen during the past five years are examined. The clinical and radiological features most helpful in defining and classifying each case are identified. The most frequent and most serious complications and the warning signs useful in diagnosis are discussed. The indications for and the results of surgical treatment are reviewed.
Four cases of benign intrasellar cysts are reported. Three of these were treated surgically. Their origin and typical clinical features are discussed, in particular the altered pituitary function and visual disturbances. Computerized tomography has many advantages over traditional neuroradiological tools in reaching a diagnosis. The indication for active treatment and the surgical techniques and the methods used in the prevention of complications are outlined.
The study of pituitary diseases is described, with visualization of the cavernous and intercavernous sinuses accomplished through percutaneous, transfemoral catheterization, using special methods to ensure its reliability. The most characteristic normal and pathological findings are described. The value of this method and the indications for its use in diagnosis are discussed. The possibility of combining morphological investigations with regional functional studies of pituitary hormones by selective blood sampling is suggested. This technical development opens new prospects for the future and further broadens the indications for use of this procedure.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
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A rare instance of pituitary invasive adenoma in a child has been reported; the unusual age of the patient and then the rarity of the orbit invasion has been emphasized. It has been further pointed out the histologically benign nature of the neoplasm, which on contrast behaves like a malignant adenoma, according to its rapid and serious anatomo-clinical evolution.
The author's experience in the surgical treatment of lumbar disc lesions is reported. The following technical devices have been adopted: -- curved unilateral incision into deep fascia --interlaminar space widening by chisels and gouges, avoiding the use of rongeurs -- sodium succinate methylprednisolone injection into dural sac. -- early ambulation (within the first 18 hours). Benefits obtained by these procedures are: -- earlier disappearance of pain -- remarkable reduction of stay in hospital -- earlier and more complete recovery.