Subarachnoid hemorrhage from ruptured intracranial aneurysms. Timing of pathophysiological events and surgery. A survey.
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Biomedical subjects
Publications and source records attributed to V Albanese.
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A case of a giant intracavernous carotid aneurysm, surgically treated by combined procedure of trapping and extra- intra-cranial arterial bypass, is reported. The authors reviewed the literature concerning the risks of immediate, early and late ischaemic complications related to carotid surgical occlusion. In agreement with other authors, the usefulness of extra- intra-cranial anastomosis in preventing cerebral ischaemia, in patients requiring surgical occlusion of main cerebral arteries, is suggested.
Hemangioblastomas are rarely seen in the supratentorial region, especially in childhood. The case of a 10-year-old boy with left parieto-occipital cystic hemangioblastoma is reported. The neoplasm was not attached to the dura, nor was it associated with von Hippel-Lindau syndrome or with erythrocythemia. Cerebral angiography showed no evidence of a vascularized tumor, whereas computerized tomography gave more accurate information. The gross and microscopic appearance of the lesion is described, and a review of similar cases previously reported in the literature is presented.
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A surgical procedure to bypass occlusive lesions of the proximal common carotid or vertebral artery is described. The case of a patient with recurrent cerebral ischemic episodes associated with proximal left common carotid stenosis is reported. A left transverse cervical-common carotid artery anastomosis was performed. It is suggested that this simple procedure may be useful in selected cases.
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Giant intracranial aneurysms containing a tortuous vascular channel appear, to some extent, different from other giant aneurysms. Their particular features are outlined in the present report which concerns a case of a small fusiform aneurysm of the posterior temporal branch of the middle cerebral artery evolving over five years into a giant serpentine aneurysm. Successful and complete removal of this lesion was achieved.
A case of fibromuscular dysplasia (FMD), mostly involving the basilar artery, associated with an intracranial aneurysm, is presented. Although the patient was symptomatic, the typical angiographic pattern is felt to be in this case an incidental finding. However the potential for FMD to produce severe neurological impairment is emphasized. The case is used as a basis for discussing shortly the incidence, the characteristic radiological appearance, the relationship with the presence of intracranial aneurysms and the therapeutic problems of FMD.
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The influence of age and other risk factors (history of hypertension and diabetes, cigarette smoking, dyslipidemia) on cerebral atherosclerosis was studied in 462 patients with RIA who had cerebral angiography. The degree of atherosclerosis was quantified using extracranial and intracranial cerebrovascular scores (ECS, ICS) based on the number and severity of the lesion in 11 extracranial and 21 intracranial arterial segments. Thirty-six percent of the patients under age 45 had a normal angiogram compared with 17% of the patients over 45. In the subgroup of patients with abnormal angiogram the mean ECS and ICS vascular scores were not significantly different in the two age groups. Cigarette smoking was the only risk factor to show a strong association with the extracranial score, and it was independent of the effect of age and other risk factors.
Utilizing the initial BP assessment in the 462 patients who entered the Italian Multicenter Study of reversible cerebral ischemia, an analysis of the effect of each BP component in respect of presence, extent and severity of atherosclerotic lesions, as displayed by angiography, was carried out separately for lesions located at either intra- or extracranial level. In a multivariate statistical model, among the following variables: sex, age, systolic BP, diastolic BP, cholesterol and smoking, systolic BP was found the best predictor of extent and severity of atherosclerotic lesions at extracranial level. None of the same variables was predictive of the severity of intracranial atherosclerosis. The results of this clinical study may confirm the indication, coming from physiopathologic observations, of a predominant role of systolic hypertension in the process of maintenance and acceleration of atherosclerosis in the large pre-cerebral arteries.
In this work the authors report a clinical case of Brunner's adenoma, which was responsible for the onset of other pathologies in the upper gastrointestinal tract, such as gastroesophageal reflux (GER), esophagitis and ulcerations of the antral mucosa. The preoperative diagnostic procedure (endoscopy, esophageal manometry, gastric emptying) and the follow-up at 3, 6 and 12 months from the surgery confirmed the relationship between the Brunner's adenoma and the alterations of the lower esophageal sphyncter (LES) tone and the gastric emptying. After a review of the international literature and a short analysis of the physiopathologic alterations, the authors point out the different therapeutical approach, in according to the size and implantation (sessile or peduncolated) of the lesion and to the related pathologies.
Varicocele is one of the main causes of male infertility. This pathology, in fact, is responsible for progressive anatomical and functional testicular damage. Constant monitoring of subjects suffering from varicocele is therefore necessary. In the present study, we evaluated the effect of varicocele surgical treatment on seminal parameters, testicular growth and pregnancy rate in patients with grade I varicocele. We operated on 47 patients with left grade I varicocele associated with sperm abnormalities and with testicular hypotrophy. A high ligation of the internal spermatic vein and all its collaterals was performed in all patients. The postoperative follow-up showed a significant improvement in seminal parameters (motility, morphology and sperm count) and in testicular volumes. Moreover, a pregnancy rate of 58% was observed. These results confirm the observations of other investigators and suggest that surgical therapy of varicocele is capable of improving seminal parameters, of reversing varicocele-related testicular hypotrophy and of achieving high pregnancy rates even in patients with grade I varicocele.
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