Search PubMed⌕ Search

Biomedical subjects

S Constantini

Publications and source records attributed to S Constantini.

At least 73 records · Page 4Linked to original sources
PubMed1992

Cardiac vagal tone predicts outcome in neurosurgical patients.

OBJECTIVE: To evaluate the relationship between presurgical levels of cardiac vagal tone and outcome in neurosurgical patients. DESIGN: Prospective series. SETTING: Respiratory ICU in a university hospital. PATIENTS: Fifty-one adults admitted to the respiratory ICU between 1982 and 1985. Forty-two patients were scheduled for elective neurosurgery, and nine patients suffered from head trauma. INTERVENTIONS: Ten minutes of electrocardiographic (EKG) data were recorded before medical intervention. Neurosurgical patients scheduled for surgery had EKG data recorded 24 hrs before their operation. Trauma patients had EKG data recorded immediately after arrival in the respiratory ICU. MEASUREMENTS AND MAIN RESULTS: Cardiac vagal tone was evaluated using a vagal tone index, quantified from the EKG. Cardiac vagal tone monitored before surgical intervention significantly distinguished between the outcome groups only for the elective neurosurgical patients. Age, gender, heart rate, Glasgow Coma Scale scores, and tumor location, size, and malignancy were not related to outcome in the elective neurosurgery group. However, within the trauma group, low Glasgow Coma Scale scores were significantly related to poor outcome. CONCLUSIONS: Cardiac vagal tone may offer important predictive value by alerting the physician to the functional consequence of head injury. Information relating to autonomic nervous system functioning, such as the vagal tone index used in this study, may provide additional information that will complement the computed tomography scan results. This study demonstrates that the vagal tone index is a predictive factor that may be efficiently extracted from the heart rate pattern routinely monitored in ICUs.

Adolescent↗
PubMed1992

Severe limitation in mouth opening following transtemporal neurosurgical procedures: diagnosis, treatment, and prevention.

Five new patients and six previously described patients with severe limitation in maximum mouth opening following transtemporal neurosurgical procedures are described. Six patients underwent an operation for epidural hematoma and three for skull-base meningloma; two were treated with a pterional craniotomy for an aneurysm. Limited maximum mouth opening in these circumstances is caused by temporal muscle scarring and shortening. Aggressive physiotherapy is potentially beneficial if started early. If, however, diagnosis is delayed, the efficacy of physiotherapy declines, and surgical treatments such as temporal muscle detachment and coronoidectomy are fully indicated. The differential diagnosis, prevention, and treatment of limited maximum mouth opening following neurosurgical procedures are discussed.

Adult↗
PubMed1991

[CT-stereotactic determination of targets for thalamotomy for movement disorders].

The methodology of determining an invisible target by CT-stereotaxy, such as the ventrolateral nucleus of the thalamus, is described. This approach obviates the need for traditional ventriculographic determination of the third ventricle commissures and allows accurate measurement of third ventricular width. Morbidity and length of hospitalization are thereby reduced.

Adolescent↗
PubMed1991

Familial intracranial arachnoid cysts.

Three siblings with intracranial arachnoid cysts are described, two males and one female. One of the males has symmetric, bilateral, temporoparietal convexity cysts, and the others have singular, unilateral cysts. Three additional siblings in the family and other known relatives are clinically unaffected. As far as we know, this is the second reported case of familial intracranial arachnoid cysts and the first involving three siblings. The significance of these cysts and a review of the literature are presented.

Arachnoid Cysts↗
PubMed1991

Thromboembolic phenomena in neurosurgical patients operated upon for primary and metastatic brain tumors.

A retrospective study was designed to evaluate clinical thromboembolic phenomena (TEP) in patients operated upon for brain tumours. Among 492 patients treated surgically in the supratentorial area, the overall incidence of clinical TEP was 7%. There were 5% with deep vein thrombosis (DVT) and 4% with clinical pulmonary embolism (PE). Seven patients (1%) died from massive PE. Among 141 patients treated surgically in the infratentorial area there were no episodes of TEP. Significant risk factors for TEP development were operations in the supratentorial area, malignant gliomas (compared to meningiomas) and para- or hemiparesis. Age, sex and the specific location in the supratentorial area were not found to be statistically significant risk factors. Among 12 patients who presented initially with DVT two developed PE despite full heparinization. 7/19 patients with PE died within minutes to hours of the clinical episode despite full conservative measures. In 2/26 patients who were treated with full heparinization complications occurred. There was one case of diffuse subcutaneous bleeding and one case of tumour bed haematoma. The identification of risk factors for the development of TEP will allow the implementation of prophylactic measures in appropriate patients undergoing elective brain tumour surgery.

Adult↗
PubMed1991

The use of fibrin sealant in cerebrospinal fluid leakage.

Cerebrospinal fluid leakage is one of the central problems facing neurosurgeons, both due to its occasional difficulty in management and to the catastrophical significance of ensuing infection. An important tool emerging in the surgical management of CSF leakage is fibrin sealant, the natural coagulation product. Thirteen cases of CSF leakage, due to meningomyelocele, posttraumatic, and secondary to tumor, that were managed surgically with fibrin sealant are presented. Several of the cases were successfully operated upon following failure of conventional surgical techniques. Additional uses of fibrin sealant in neurosurgery are discussed.

Adenoma↗
PubMed1991

Hypertrophic spinal pachymeningitis: report of two cases and review of the literature.

The cases of two patients with idiopathic pachymeningitis hypertrophica that caused progressive paraparesis are presented. Gadolinium-enhanced magnetic resonance imaging was used to demonstrate this pathological entity in one patient, and myelography was used in the other. Decompressive surgery led to significant neurological improvement. The etiology, diagnosis, and management of this disease is discussed, and the literature is reviewed. To our knowledge, this is the first report to describe the features of this rare pathological entity on magnetic resonance imaging.

Aged↗
PubMed1991

Evaluation of an enzyme membrane immunoassay (Directigen RSV) for the rapid diagnosis of respiratory syncytial virus infections.

A rapid enzyme immunoassay (EIA) membrane test, the Directigen respiratory syncytial virus (Becton Dickinson), was compared with cell culture, an indirect immunofluorescence (IF) test, the Monofluokit respiratory syncytial virus (Diagnostics Pasteur), and a conventional enzyme immunoassay antigen test, the Abbott respiratory syncytial virus enzyme immunoassay in nasal aspirates specimens from children with suspected respiratory syncytial virus (RSV) bronchiolitis. The sensibility and specificity of the Directigen, respiratory syncytial virus were 91% and 98% respectively, as compared with those of culture, and of 93% and 86% as compared with the Monofluokit respiratory syncytial virus. In the comparison of the two enzyme immunoassays, Directigen respiratory syncytial virus detected more positive specimens: 68/127 than the other: 46/127. Directigen respiratory syncytial virus is a very rapid test, (15-min), sensitive and specific, which can be used as an alternative technique for detection of respiratory syncytial virus in nasal samples when viral isolation or immunofluorescence direct are not available.

Cells, Cultured↗
PubMed1990

[Surgery for craniopharyngioma].

We present a series of 20 patients (11 males) operated on for craniopharyngioma through a frontal craniotomy during an 11-year period. They ranged in age from 7 months to 58 years (mean 20 years). The most common symptoms were headaches, blurred vision and endocrine disorders. The perioperative mortality was 5% and morbidity 25%. 5 (25%) patients need reoperation; 13 (65%) received additional radiation therapy. In 94% visual function improved. 65% continued to have or developed endocrine problems, although all were well controlled with supplemental therapy. These results, similar to those reported from other centers, justify a combination of radical surgery and radiation therapy for this condition.

Adolescent↗
PubMed1990

[Interstitial radiotherapy for brain tumors].

Interstitial radiotherapy (brachytherapy) for brain tumors has radiobiological advantages over conventional teletherapy. With this method the tumor area can be exposed to effective, high dose irradiation with minimal damage to surrounding tissues.

Brachytherapy↗
PubMed1990

Nuclear magnetic resonance and lipids of the plasma from patients with intracranial tumours.

The plasma of fifteen patients with malignant primary intracranial central nervous system (CNS) neoplasms was examined using proton nuclear magnetic resonance (NMR) and lipid level analysis. Twenty-three benign intracranial neoplasms and twelve non-CNS, non-malignancy patients served as control. At 300 MHz the NMR mean line width of plasma with malignant tumours was (+/- 2 SE) 37.2 +/- 3.0 Hz and for benign tumours 33.5 +/- 3.0 Hz (P = 0.09). The mean plasma triglyceride level for the malignancy patients was 100 +/- 25 mg/decilitre and 173 +/- 74 mg/decilitre for the patients with benign tumours (P = 0.07). The mean plasma cholesterol was 182 +/- 42 mg/decilitre for the malignancy patients and for the patients with benign tumours 241 +/- 29 mg/decilitre (P = 0.03). Unfortunately overlaps of the values of the different groups, in spite of statistically significant differences, detracts from the clinical usefulness of these criteria. Attempts to combine these values and correct for tumour volume, as calculated from computerized tomography, did not improve the differentiation between these two groups. Although it has been reported that plasma NMR and lipid levels can differentiate between malignant and benign tumours in general and in the central nervous system, these criteria are not adequately sensitive and specific to replace histology for the definite diagnosis of central nervous system tumours.

Biomarkers, Tumor↗
PubMed1990

Delayed epidural hematoma without neurologic deficit.

Six patients with delayed epidural hematoma demonstrated by serial computed tomography scan are presented. Three of the patients had no neurologic deficit but suffered from severe headache. We suggest routinely performing repeat CT, before discharge, in patients having sustained head trauma with or without skull fracture, who suffer non-resolving headache, even when there is no neurologic deterioration. Serious symptomatology that may have occurred due to the development of delayed intracranial hematomas is thereby anticipated.

Adult↗
PubMed1989

[Corpus callosotomy in intractable epilepsy].

6 males and 3 females, 2-17 years old, underwent partial or complete corpus callosotomy as treatment for medically intractable epileptic seizures. All benefited from the procedure. Evidence for unilateral cerebral damage on computerized tomography or a nonlocalized focus with secondary contralateral spread were the criteria for patient selection. The best results were obtained in atonic seizures. Long term side effects were minor and were minimized by staging the callosal resection. If partial callosotomy is effective, complete resection is unnecessary.

Adolescent↗
PubMed1989

Pudenz antisiphon device tear as a cause of shunt malfunction.

Antisiphon device (ASD) tear was found in nine patients who underwent ventriculoperitoneal (VP) shunt revision of a Pudenz three-piece system. In six cases this was the only finding, in three, there was an associated distal malfunction. Repair of ASD tear constituted 27% of our shunt revision procedures. The locus minoris resistentia of the Pudenz ASD is the attachment of the diaphragm to the cylinder. ASD tear should be suspected whenever a noninflammatory fluid collection of a CSF leak are found at the proximal extracranial section of this system.

Cerebrospinal Fluid Shunts↗