Biomedical subjects

T Vangelista

Publications and source records attributed to T Vangelista.

5 recordsLinked to original sources

PubMed1999

Delayed post-traumatic cervical instability.

BACKGROUND: Cervical spine instability is a clinical entity whose biomechanical and radiological features have been widely discussed by many authors. On the other hand, the subject of delayed post-traumatic cervical instability is often surrounded by confusion due to its difficult nosologic framing; the aim of this study is to contribute to the matter. METHODS: A cooperative study was organized by the Study Group for Spinal Surgery of the Italian Society of Neurosurgery to evaluate cervical trauma patients surgically treated more than 20 days after the traumatic event. From a total number of 172 patients, twenty-five were admitted to the study, because neuroradiological investigations performed during the acute phase had shown either an absence of traumatic lesions or only minimal lesions judged to be stable. For this reason these 25 patients had not been treated by either surgery or immobilization in a halo vest. Some time after trauma, this group of patients clearly demonstrated evidence of unstable lesions requiring surgical treatment, following the appearance of new clinical signs or on neuroradiological follow-up. RESULTS: Re-examination of the neuroradiological investigations performed during the acute phase made it possible to identify elements that might have led us to suspect the presence of ligamental lesions: microfractures, dislocations less than 3 mm, and inversion of physiological lordosis. CONCLUSIONS: This review clearly indicates that patients with even mild cervical trauma must be scrupulously evaluated during the acute phase and that in some cases it is advisable to perform a more detailed neuroradiological investigation.

Cervical Vertebrae↗

PubMed1999

Abducens nerve paresis as first symptom of trigeminal neurinoma. Report of two cases and review of the literature.

Two cases of neurinoma of the Gasserian ganglion with abducens nerve paresis as the first symptom are described and 27 cases culled from the literature are reviewed. The anatomo-surgical and clinical-radiological features of this pathology were re-assessed in an attempt to identify the pathogenetic mechanism responsible for a trigeminal neurinoma manifesting with VI cranial nerve palsy.

Abducens Nerve↗

PubMed1999

Surgical treatment of penetrating orbito-cranial injuries. Case report.

Penetrating orbital injuries are not frequent but neither are they rare. The various diagnostic and therapeutic problems are related to the nature of the penetrating object, its velocity, shape and size as well as the possibility that it may be partially or wholly retained within the orbit. The authors present another case with unusual characteristics and discuss the strategies available for the best possible treatment of this traumatic pathology in the light of the published data. The patient in this case was a young man involved in a road accident who presented orbito-cerebral penetration caused by a metal rod with a protective plastic cap. Following the accident, the plastic cap (2.5x2 cm) was partially retained in the orbit. At initial clinical examination, damage appeared to be exclusively ophthalmological. Subsequent CT scan demonstrated the degree of intracerebral involvement. The damaged cerebral tissue was removed together with bone fragments via a bifrontal craniotomy, the foreign body was extracted and the dura repaired. Postoperative recovery was normal and there were no neuro-ophthalmological deficits at long-term clinical assessment. Orbito-cranial penetration, which is generally associated with violent injuries caused by high-velocity missiles, may not be suspected in traumas produced by low-velocity objects. Diagnostic orientation largely depends on precise knowledge of the traumatic event and the object responsible. When penetration is suspected and/or the object responsible is inadequately identified, a CT scan is indicated. The type of procedure to adopt for extraction, depends on the size and nature of the retained object. Although the possibility of non-surgical extraction has been described, surgical removal is the safest form of treatment in cases with extensive laceration and brain contusion.

Adult↗

PubMed1998

Malignant cerebellar astrocytomas in childhood. Experience with four cases.

The most frequent type of cerebellar astrocytoma in children is the pilocytic variety, for which the treatment of choice and prognosis are now well established. In contrast, an anaplastic lesion in this site is extremely rare. The authors present four cases of high-grade astrocytoma in a cerebellar site. They discuss the best type of treatment for this pathology, with particular reference to postoperative radiotherapy and chemotherapy, in the light of their results.

Adolescent↗

PubMed1997

Effects of increasing doses of apomorphine during stereotaxic neurosurgery in Parkinson's disease: clinical score and internal globus pallidus activity. Short communication.

We analysed the firing activity of internal globus pallidus cells in two Parkinson's disease patients undergoing stereotaxic surgery. Both patients showed an advanced rigid-akinetic syndrome with disabling levodopa induced dyskinesias. Apomorphine, intraoperatively administered at doses (1-2 mg) inducing a short but clear clinical improvement without involuntary movements, reduced the pallidal discharge rate by > 50% in both patients. An higher apomorphine dose (2.5 mg), tested in one hemisphere, blocked the firing activity with a time course independent from the occurrence of dyskinesias. These finding suggest that the reduction of internal pallidus excitability is one of the mechanisms underlying the efficacy of dopaminergic therapy, but also that changes in other basal ganglia stations are likely to be involved in dyskinesias.

Antiparkinson Agents↗