G. Volpentesta - Academia.edu (original) (raw)
Papers by G. Volpentesta
American Journal of Psychiatry, 2010
Brian is a 27-year-old Caucasian man who presents with signs and symptoms of a severe major depre... more Brian is a 27-year-old Caucasian man who presents with signs and symptoms of a severe major depressive episode, including depressed mood, profound anhedonia, decreased sleep with predominant late insomnia, decreased appetite, fatigue, significant psychomotor retardation, feelings of worthlessness and guilt, poor concentration, indecision, and frequent passive suicidal ideation without plan or intent. He denies any history of hypomania or mania. He denies psychotic symptoms. He reports significant somatic and psychic anxiety without any consistent focus. He does not meet criteria for any other major psychiatric illness, including substance use and personality disorder. He is otherwise healthy. This is Brian's fourth clear major depressive episode (by history), and it began approximately 3 years ago. Brian states that his first major depressive episode occurred "out of the blue" when he was 17 years old following an apparently "normal, happy" childhood and early adolescence. After 4-6 weeks of symptoms, he sought treatment and went into a full remission after 8 weeks of sertraline at 200 mg/day. He stayed on sertraline for 8-9 months, and then discontinued it after high school graduation. He remained well for about two and a half years but developed his second major depressive episode (again without any clear trigger) at age 20 in the fall of his junior year in college, where he was majoring in economics. He again sought treatment and achieved partial remission after about 4 months with a combination of sertraline (200 mg/day), clonazepam (1 mg at bedtime), and supportive psychotherapy. He continued to have residual difficulties with insomnia, mild anhedonia, and mild anxiety but was able to complete the school year without undue difficulty. He remained in combined treatment but developed a third major depressive episode at age 21 in the fall of his senior year. Bupropion was added to his medication regimen and titrated to 300 mg/day, and he was referred for cognitive-behavioral therapy. He achieved a significant reduction in symptoms, but not remission. Because of residual symptoms, he did not immediately pursue graduate studies and instead went to work for a local bank. Brian did reasonably well for about 3 years, with occasional worsening of depressive symptoms but generally with good functioning, when he developed his current major depressive episode.
Journal of neurosurgical sciences, 2004
Neurogenic low urinary tract dysfunctions unresponsive to medical and conservative therapy are di... more Neurogenic low urinary tract dysfunctions unresponsive to medical and conservative therapy are difficult to manage. Nowadays they can be treated with Sacral Nerve Stimulation (SNS), even if clinical experiences reported in literature are still limited. We performed SNS in 6 patients with neurogenic bladder: 3 patients had incontinence-urgency (1 myelitis, 1 multiple sclerosis, 1 autonomic polineuropathy) and 3 patients had urinary retention (1 incomplete spinal cord lesion, 1 operation for discal hernia T5-T6, 1 hysterectomy). Among cases with incontinence-urgency we achieved complete control of the bladder in 2 patients while in 1 patient the number of urinary losses was reduced of the 80%. In 2 patients with urinary retention we obtained complete recovery of the bladder function, while in 1 patient the number of cateterisms/die reduced of 50%, the urinary volume for micturion increased and residual urinary volume decreased. Results were unchanged during the follow-up (maximum 26 m...
Journal of neurosurgical sciences, 2003
Pathologica, 2000
A retrospective clinical-pathological review of 192 lumbar intervertebral discs removed via an in... more A retrospective clinical-pathological review of 192 lumbar intervertebral discs removed via an interlaminar approach or percutaneous nucleotomy from patients suffering from sciatic pain was carried out in order to assess if routine examination is useful. Only for a case of our series, which showed ill defined features at preoperative neuroradiologic imaging, an intraoperative pathologic examination was necessary. Immunohistochemical study was never required. A routine examination with a hematoxilin-eosin stain was sufficient also to recognize postoperative scar in patients reoperated. In conclusion we think that routine examination of the intervertebral disc is a procedure which is not expensive and useful to assess the nature of the lesion in reoperated patients and in rare cases showing unclear radiologic pattern.
La Chirurgia degli organi di movimento
Tubercular infection is a rare occurrence in the lower cervical spine. The isolated involvement o... more Tubercular infection is a rare occurrence in the lower cervical spine. The isolated involvement of the posterior arch is particularly rare, and the very few cases in which it is reported at the thoracic or lumbar levels were principally observed in immunodepressive patients. It is the purpose of this study to describe two cases of tuberculosis of the lower cervical spine with neurological deficit: one expansive neoformation at the level of the arch of C7, with saving of the vertebral body and the discs, and a spondylodiscitis at C4-C5, treated conservatively, the healing process of which was followed by MRI.
Minerva anestesiologica, 1987
Bollettino della Società italiana di biologia sperimentale, 1992
This report describes and illustrates the results of the histopathological and histochemical inve... more This report describes and illustrates the results of the histopathological and histochemical investigation on five slow-growing tumors of the central nervous system: four meningiomas and an ependymoma of the spinal cord. We have studied, by means of polarizing microscopy, sections stained with picro-sirius red F3BA that enhance the birefringence of collagen and reticulum fibres. The heterogeneous behaviour of the distribution of the collagen let us conclude that the fibrillar component of the extracellular matrix have a scarce importance for the speed of growth of these tumours.
Bollettino della Società italiana di biologia sperimentale, 1992
Quantitative determination of neuron-specific enolase in the serum was performed by RIA method in... more Quantitative determination of neuron-specific enolase in the serum was performed by RIA method in 18 neurological patients and in 22 patients with pulmonary diseases. The data confirmed that the specificity of this marker is not absolute for the detection both of the nature and of the seat of origin of the disease. Further problems are posed in patients which simultaneously suffer from endocrine, nervous and pulmonary abnormality.
Pediatric Neurogenic Bladder Dysfunction
Neuromodulation is an appealing new technique that can be proposed even to treat paediatric neuro... more Neuromodulation is an appealing new technique that can be proposed even to treat paediatric neurogenic bladder dysfunction in view of its usefulness and miniinvasiveness. Further technological improvements, including the production of miniaturized, more flexible and resistant electrodes, more stable and empowered integrated circuits and the application of telemetry for computerized setting of the stimulators and transfer of data, will likely broaden the indications of neuromodulation, which could become the standard treatment option for neurogenic bladder dysfunction.
Textbook of Cortical Brain Stimulation
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License.
Thrombosis Research, 1987
Using an end-to-side microanastomosis of the left common carotid into the right common carotid of... more Using an end-to-side microanastomosis of the left common carotid into the right common carotid of rats, implementing a potentially thrombogenic situation, we have investigated the possible antithrombotic effect of indobufen, a new antiplatelet drug. In eight of 15 untreated rats the anastomosis was totally obstructed by a single thrombus growing from the anastomotic wall. Indobufen treatment prevented thrombus formation completely in 14 of 15 rats (p less than 0.02). In treated animals indobufen also produced a statistically significant reduction of ADP-induced platelet aggregation relative to basal values. Platelet count were not influenced by drug treatment. Our experimental results suggest the potential usefulness of indobufen as an antithrombotic agent.
Neuromodulation: Technology at the Neural Interface, 2003
ABSTRACT New Treatments for Severe Intractable Dystonia: Intrathecal Baclofen Therapy (IBT) and D... more ABSTRACT New Treatments for Severe Intractable Dystonia: Intrathecal Baclofen Therapy (IBT) and Deep Brain Stimulation (DBS) of GPi Lavano A, Volpentesta G, Chirchiglia D, Signorelli F, Ferraro G, Veltri C, Aloisi M, Piragine G, Iorio L e Signorelli CD Cattedra—U.O. di Neurochirurgia (Dir. Prof C.D. Signorelli), Policlinico Mater Domini, Facoltà di Medicina e Chirurgia, Università degli Studi “Magna Graecia” di Catanzaro Dystonia is a clinical syndrome characterized by involuntary muscle contractions frequently causing repetitive, twisting movements or abnormal postures which are sometime painful. It is the third most common movement disorder after Parkinson’s Disease and Tremor, affecting more then 20,000 people in Italy. Dystonia is classified in three ways: by age of onset (childhood-onset, adolescence-onset and adult-onset), by body distribution of symptoms (focal, segmental, multifocal, generalized, and hemidystonia) and by etiology (primary hereditary or sporadic and secondary). Moreover, on the basis of involuntary movements types, we distinguish “mobile dystonia” (abnormal patterned or slow movements) from “fixed dystonia” (abnormal posture). The focal form of dystonia can be treated satisfactorily with botulinum toxin injections but, despite the notable exception of dopa-responsive dystonia, pharmacological treatment is, for the most part, ineffective in generalized dystonia or hemidystonia. Among the alternative solutions suggested in these forms of dystonia, the more promising therapies are Chronic Intrathecal Administration of Baclofen (IBT) and Deep Brain Stimulation of Gpi (DBS). Intrathecal Baclofen Baclofen is a muscle relaxant and antispastic agent with selective agonist action on GABA-B receptors which are distributed throughout the CNS. In the spinal cord these receptors are concentrated in superficial layers of the dorsal horn, lamina I, II, III, and IV while in the brain the highest concentrations of GABA-B receptors are within the substantia nigra and putamen. Intrathecal delivery of the gamma-aminobutyric acid (GABA) analog baclofen (beta-4chlorophenyl GABA) via an implanted pump, intrathecal baclofen therapy, (IBT) is a highly effective and reliable treatment for severe spasticity of cerebral and spinal origin. Oral baclofen has been used in generalized dystonia with a favorable response in up to 30% of the patients, but marked sedation often precludes the use of therapeutic doses. Therefore, the use of IBT in dystonia may be a logical application of this technique because it achieves higher cerebrospinal fluid concentrations and diminishes systemic side effects. In dystonia, the mechanism of action of baclofen remains speculative; at the central level, enhanced GABAergic output from the putamen may cause thalamocortical inhibition and at the spinal Abstracts � 213 level GABAergic receptor binding may decrease the release of neuroexcitatory transmitters (glutamate and aspartate). Patients selection for IBT, pump implantation Patients with severe forms of dystonia associated with significant potential for improvement in functional abilities, who have received extensive treatment with oral antidystonic and antispasticity medications including oral baclofen, without satisfactory control of symptoms or with unacceptable adverse effects, are considered candidates for IBT. After a positive trial of IBT utilizing an initial trial dose of intrathecal baclofen between 50 to 75 ug with dose increases of 25 ug after 24 hours to a maximum of 250 ugs, a pump for chronic intrathecal administration is implanted. A positive response is considered to be a reduction in symptoms lasting 4–8 hours as determined by both the patient and the physician. Reduction of symptoms may be “objective” (improvement in the BFM rating scale, Global Dystonia score and Disability score) or “subjective” (not measurable with scales but reported by patient). After pump implantation, the dose of intrathecal baclofen is increased in increments by 10% until either the patient reports dose-limiting adverse effects or improved spasticity control. Review of literature Clinical experiences reported in the literature with IBT in dystonic patients are limited. Many are merely descriptions of single cases (3,5,6,7,9,11,12,14,16). There are several series’ reports with intrathecal baclofen for dystonia including those of Albright (86 tests performed, 77 pumps implanted), Walker (21 tests performed, 14 pumps implanted), Ford (25 tests performed, 13 pumps implanted) and Hou (10 tests performed, 10 pumps implanted) (1,2,4,8,10,13,15). Up to present, there have been 164 tests performed and 134 pumps implanted with a response rate to IBT trial test of 81.6%. The mean dose used to produce a clinical response in dystonia during IBT testing is 126 ugs, which is a higher dose of IBT trial dose necessary to produce a clinical response in spasticity. Every form of the disease (multifocal/ segmental 24 cases, generalized 140 cases) and every…
Journal of Neurology, Neurosurgery & Psychiatry, 1997
Clinical Neurology and Neurosurgery, 1990
Surgical treatment of chronic subdural haematoma is varied and includes techniques such as cranie... more Surgical treatment of chronic subdural haematoma is varied and includes techniques such as craniectomy by means of a burr hole broadened by bone forceps, and formal craniotomyl-'. In most patients the mere evacuation of haematic collection is sufficient for a satisfactory recovery3,8T9; but in some cases, after surgery, neurologic conditions remain unchanged or worsen. Unsatisfactory results have been associated to precarious neurologic conditions before surgery, delay in the evacuation of haematoma, rapid decompression of the brain, failure of the brain to reexpand, bleeding of cortical vessels due to blood dyscrasias, anesthesiologic or surgical complications2*3v1@14. Another cause of neurologic deterioration is tension pneumocephalus, mainly in elderly patients15-18; the treatment of this uncommon complication is not well determined yet. In this study we describe 7 cases, admitted between January 1983 and September 1986, of symptomatic tension pneumocephalus following surgery of chronic subdural haematoma through the technique of burr hole broadened by bone forceps. Case reports Case 1 An 84-year-old-man with poor cardio-circulatory conditions, had a head trauma two months S-We present seven cases of tension pneumocephalus developing after burr hole evacuation of chronic subdural haematoma. After a carefull review of the literature we discuss the physiopathology, the diagnosis and the treatment of this complication of chronic subdural haematoma surgery.
British Journal of Neurosurgery, 1987
Two cases of postoperative intracerebral haemorrhages remote from the site of the initial craniot... more Two cases of postoperative intracerebral haemorrhages remote from the site of the initial craniotomy for saccular aneurysms are reported and the other cases from the literature are reviewed. Lack of a good postoperative recovery and the appearance of neurological signs not related to the site of the operation may suggest this complication, which is associated with high mortality and disability rate. The possible pathogeness of those postoperative haemorrhages is discussed.
Journal of Pigmentary Disorders, 2015
Jou rn a l o f Pi gmentar y D is o rd ers
Journal of neurosurgical sciences, 2003
Data reported in previous studies and our own previous experience have led us to explore the mech... more Data reported in previous studies and our own previous experience have led us to explore the mechanism of and the degree of protection afforded by Ginko Biloba in a model of cerebral ischemia in the Mongolian Gerbil evaluating histological and neurological effects in this rodent. Mongolian Gerbils were divided into experimental groups: Group A consisted of animals subjected only to experimental ischemia; 5 minutes occlusion of the carotid arteries. Group B consisted of animals subjected to experimental ischemia and to a dose of Ginko Biloba, given intraperitoneally immediately before the surgical procedure. Group C consisted of animals subjected to experimental ischemia and to a dose of Ginko Biloba, given intraperitoneally immediately after the surgical procedure. Group D consisted of animals subjected to experimental ischemia and to a dose of the caspase inhibitors z-VAD.FMK and z-DEVD.FMK injected intracerebroventricularly through the right hemisphere before the surgical procedur...
Journal of neurosurgical sciences, 2003
ABSTRACT Partial removal of nucleus pulposus with consequent reduction of intradiscal pressure ma... more ABSTRACT Partial removal of nucleus pulposus with consequent reduction of intradiscal pressure may be obtained with percutaneous intradiscal administration of chemical substances in the intervertebral disc. We used percutaneous intradiscal injection of radiopaque gelified ethanol (“Discogel”) in 72 patients (group 1) with conservative treatment resistant lumbar and radicular pain due to small and medium-size hernias of intervertebral disc to demonstrate its efficacy and safety vs. 72 subjects treated with intra-foraminal and intradiscal injections of a steroid and anesthetic (group 2 or control group). “Discogel” injection was performed with biplane fluoroscopy assistance and under local anesthesia with patient in lateral position on symptomatic side. Amount of “Discogel” injected ranged from 0.8 ml to 1.6 ml. We treated a total of 83 discs. We performed the procedure on one disc in 62 patients; in 9 patients two discs were treated in the same session and in 1 patient three levels were treated in two separate sessions. In group 1 patient “responders” were 65 (90.3%). Excellent and good results were obtained in 58 patients (80.4%), satisfactory results in 7 patients (9.8%) and poor results in 7 patients (9.8%); among “responders” pain control was quite immediate in 58 patients (89.3%) while in 7 patients (10.7%) there was a delay of 7-10 days. These values were significantly higher than in control group. Also the quality of life was significantly more sustained vs. control group, and this benefit was maintained over time. Concerning complications, in 3 cases (4.15%) we had transitory radicular irritation with neuropathic pain appearance immediately after the procedure and in 1 case (1.30%) transitory sensory-motor deficit due to diffusion of local anesthetic along the introducer needle. In conclusion intradiscal radiopaque gelified ethanol injection is minimally invasive, low cost, safe and effective procedure that may be considered in proper selected patients before recourse to surgery.
British Journal of Neurosurgery, 2014
Background. Cerebral aneurysms are relatively common in adults, with a prevalence ranging between... more Background. Cerebral aneurysms are relatively common in adults, with a prevalence ranging between 1% and 5%. Subarachnoid hemorrhage, following aneurismal rupture, is a major cause of death and disability in these patients. Matrix Metalloproteinases (MMPs) and Neutrophil Gelatinase-Associated Lipocalin (NGAL) seem to be involved in the pathogenesis and in the clinical course of aneurysms. In this study, we evaluated the relationship between tissue and plasma levels of MMP-9 and NGAL in patient with ruptured and unruptured middle cerebral artery aneurysms. Methods. An open label study was conducted on 7 patients with middle cerebral aneurysms. Three patients had ruptured aneurysms (Group I) and four patients had unruptured aneurysms (Group II). All patients underwent aneurysm clipping. Plasma levels of MMP-9 and NGAL were evaluated through ELISA Test. During the surgery, biopsies of the aneurysmatic arteries were taken and frozen (- 80°C) for Western blot evaluation of MMPs and NGAL expression. Four healthy volunteers (Group III) represented the control group for ELISA testing. Results. Both plasma MMP-9 and NGAL levels were significantly high in aneurysmatic patients respect to those of control patients, and these levels were higher (P < 0.01) in patients with ruptured aneurysms respect to patients with unruptured aneurysms (P < 0.01). The latest findings were similarly evident in tissue evaluation of MMP-9 and NGAL between ruptured and unruptured aneurysms. Conclusion. This study suggests that MMP-9 and NGAL plasma levels may be useful to predict the clinical course of a cerebral aneurysms in order to evaluate the progression of the disease and the tendency of an aneurysm to rupture.
American Journal of Psychiatry, 2010
Brian is a 27-year-old Caucasian man who presents with signs and symptoms of a severe major depre... more Brian is a 27-year-old Caucasian man who presents with signs and symptoms of a severe major depressive episode, including depressed mood, profound anhedonia, decreased sleep with predominant late insomnia, decreased appetite, fatigue, significant psychomotor retardation, feelings of worthlessness and guilt, poor concentration, indecision, and frequent passive suicidal ideation without plan or intent. He denies any history of hypomania or mania. He denies psychotic symptoms. He reports significant somatic and psychic anxiety without any consistent focus. He does not meet criteria for any other major psychiatric illness, including substance use and personality disorder. He is otherwise healthy. This is Brian's fourth clear major depressive episode (by history), and it began approximately 3 years ago. Brian states that his first major depressive episode occurred "out of the blue" when he was 17 years old following an apparently "normal, happy" childhood and early adolescence. After 4-6 weeks of symptoms, he sought treatment and went into a full remission after 8 weeks of sertraline at 200 mg/day. He stayed on sertraline for 8-9 months, and then discontinued it after high school graduation. He remained well for about two and a half years but developed his second major depressive episode (again without any clear trigger) at age 20 in the fall of his junior year in college, where he was majoring in economics. He again sought treatment and achieved partial remission after about 4 months with a combination of sertraline (200 mg/day), clonazepam (1 mg at bedtime), and supportive psychotherapy. He continued to have residual difficulties with insomnia, mild anhedonia, and mild anxiety but was able to complete the school year without undue difficulty. He remained in combined treatment but developed a third major depressive episode at age 21 in the fall of his senior year. Bupropion was added to his medication regimen and titrated to 300 mg/day, and he was referred for cognitive-behavioral therapy. He achieved a significant reduction in symptoms, but not remission. Because of residual symptoms, he did not immediately pursue graduate studies and instead went to work for a local bank. Brian did reasonably well for about 3 years, with occasional worsening of depressive symptoms but generally with good functioning, when he developed his current major depressive episode.
Journal of neurosurgical sciences, 2004
Neurogenic low urinary tract dysfunctions unresponsive to medical and conservative therapy are di... more Neurogenic low urinary tract dysfunctions unresponsive to medical and conservative therapy are difficult to manage. Nowadays they can be treated with Sacral Nerve Stimulation (SNS), even if clinical experiences reported in literature are still limited. We performed SNS in 6 patients with neurogenic bladder: 3 patients had incontinence-urgency (1 myelitis, 1 multiple sclerosis, 1 autonomic polineuropathy) and 3 patients had urinary retention (1 incomplete spinal cord lesion, 1 operation for discal hernia T5-T6, 1 hysterectomy). Among cases with incontinence-urgency we achieved complete control of the bladder in 2 patients while in 1 patient the number of urinary losses was reduced of the 80%. In 2 patients with urinary retention we obtained complete recovery of the bladder function, while in 1 patient the number of cateterisms/die reduced of 50%, the urinary volume for micturion increased and residual urinary volume decreased. Results were unchanged during the follow-up (maximum 26 m...
Journal of neurosurgical sciences, 2003
Pathologica, 2000
A retrospective clinical-pathological review of 192 lumbar intervertebral discs removed via an in... more A retrospective clinical-pathological review of 192 lumbar intervertebral discs removed via an interlaminar approach or percutaneous nucleotomy from patients suffering from sciatic pain was carried out in order to assess if routine examination is useful. Only for a case of our series, which showed ill defined features at preoperative neuroradiologic imaging, an intraoperative pathologic examination was necessary. Immunohistochemical study was never required. A routine examination with a hematoxilin-eosin stain was sufficient also to recognize postoperative scar in patients reoperated. In conclusion we think that routine examination of the intervertebral disc is a procedure which is not expensive and useful to assess the nature of the lesion in reoperated patients and in rare cases showing unclear radiologic pattern.
La Chirurgia degli organi di movimento
Tubercular infection is a rare occurrence in the lower cervical spine. The isolated involvement o... more Tubercular infection is a rare occurrence in the lower cervical spine. The isolated involvement of the posterior arch is particularly rare, and the very few cases in which it is reported at the thoracic or lumbar levels were principally observed in immunodepressive patients. It is the purpose of this study to describe two cases of tuberculosis of the lower cervical spine with neurological deficit: one expansive neoformation at the level of the arch of C7, with saving of the vertebral body and the discs, and a spondylodiscitis at C4-C5, treated conservatively, the healing process of which was followed by MRI.
Minerva anestesiologica, 1987
Bollettino della Società italiana di biologia sperimentale, 1992
This report describes and illustrates the results of the histopathological and histochemical inve... more This report describes and illustrates the results of the histopathological and histochemical investigation on five slow-growing tumors of the central nervous system: four meningiomas and an ependymoma of the spinal cord. We have studied, by means of polarizing microscopy, sections stained with picro-sirius red F3BA that enhance the birefringence of collagen and reticulum fibres. The heterogeneous behaviour of the distribution of the collagen let us conclude that the fibrillar component of the extracellular matrix have a scarce importance for the speed of growth of these tumours.
Bollettino della Società italiana di biologia sperimentale, 1992
Quantitative determination of neuron-specific enolase in the serum was performed by RIA method in... more Quantitative determination of neuron-specific enolase in the serum was performed by RIA method in 18 neurological patients and in 22 patients with pulmonary diseases. The data confirmed that the specificity of this marker is not absolute for the detection both of the nature and of the seat of origin of the disease. Further problems are posed in patients which simultaneously suffer from endocrine, nervous and pulmonary abnormality.
Pediatric Neurogenic Bladder Dysfunction
Neuromodulation is an appealing new technique that can be proposed even to treat paediatric neuro... more Neuromodulation is an appealing new technique that can be proposed even to treat paediatric neurogenic bladder dysfunction in view of its usefulness and miniinvasiveness. Further technological improvements, including the production of miniaturized, more flexible and resistant electrodes, more stable and empowered integrated circuits and the application of telemetry for computerized setting of the stimulators and transfer of data, will likely broaden the indications of neuromodulation, which could become the standard treatment option for neurogenic bladder dysfunction.
Textbook of Cortical Brain Stimulation
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License.
Thrombosis Research, 1987
Using an end-to-side microanastomosis of the left common carotid into the right common carotid of... more Using an end-to-side microanastomosis of the left common carotid into the right common carotid of rats, implementing a potentially thrombogenic situation, we have investigated the possible antithrombotic effect of indobufen, a new antiplatelet drug. In eight of 15 untreated rats the anastomosis was totally obstructed by a single thrombus growing from the anastomotic wall. Indobufen treatment prevented thrombus formation completely in 14 of 15 rats (p less than 0.02). In treated animals indobufen also produced a statistically significant reduction of ADP-induced platelet aggregation relative to basal values. Platelet count were not influenced by drug treatment. Our experimental results suggest the potential usefulness of indobufen as an antithrombotic agent.
Neuromodulation: Technology at the Neural Interface, 2003
ABSTRACT New Treatments for Severe Intractable Dystonia: Intrathecal Baclofen Therapy (IBT) and D... more ABSTRACT New Treatments for Severe Intractable Dystonia: Intrathecal Baclofen Therapy (IBT) and Deep Brain Stimulation (DBS) of GPi Lavano A, Volpentesta G, Chirchiglia D, Signorelli F, Ferraro G, Veltri C, Aloisi M, Piragine G, Iorio L e Signorelli CD Cattedra—U.O. di Neurochirurgia (Dir. Prof C.D. Signorelli), Policlinico Mater Domini, Facoltà di Medicina e Chirurgia, Università degli Studi “Magna Graecia” di Catanzaro Dystonia is a clinical syndrome characterized by involuntary muscle contractions frequently causing repetitive, twisting movements or abnormal postures which are sometime painful. It is the third most common movement disorder after Parkinson’s Disease and Tremor, affecting more then 20,000 people in Italy. Dystonia is classified in three ways: by age of onset (childhood-onset, adolescence-onset and adult-onset), by body distribution of symptoms (focal, segmental, multifocal, generalized, and hemidystonia) and by etiology (primary hereditary or sporadic and secondary). Moreover, on the basis of involuntary movements types, we distinguish “mobile dystonia” (abnormal patterned or slow movements) from “fixed dystonia” (abnormal posture). The focal form of dystonia can be treated satisfactorily with botulinum toxin injections but, despite the notable exception of dopa-responsive dystonia, pharmacological treatment is, for the most part, ineffective in generalized dystonia or hemidystonia. Among the alternative solutions suggested in these forms of dystonia, the more promising therapies are Chronic Intrathecal Administration of Baclofen (IBT) and Deep Brain Stimulation of Gpi (DBS). Intrathecal Baclofen Baclofen is a muscle relaxant and antispastic agent with selective agonist action on GABA-B receptors which are distributed throughout the CNS. In the spinal cord these receptors are concentrated in superficial layers of the dorsal horn, lamina I, II, III, and IV while in the brain the highest concentrations of GABA-B receptors are within the substantia nigra and putamen. Intrathecal delivery of the gamma-aminobutyric acid (GABA) analog baclofen (beta-4chlorophenyl GABA) via an implanted pump, intrathecal baclofen therapy, (IBT) is a highly effective and reliable treatment for severe spasticity of cerebral and spinal origin. Oral baclofen has been used in generalized dystonia with a favorable response in up to 30% of the patients, but marked sedation often precludes the use of therapeutic doses. Therefore, the use of IBT in dystonia may be a logical application of this technique because it achieves higher cerebrospinal fluid concentrations and diminishes systemic side effects. In dystonia, the mechanism of action of baclofen remains speculative; at the central level, enhanced GABAergic output from the putamen may cause thalamocortical inhibition and at the spinal Abstracts � 213 level GABAergic receptor binding may decrease the release of neuroexcitatory transmitters (glutamate and aspartate). Patients selection for IBT, pump implantation Patients with severe forms of dystonia associated with significant potential for improvement in functional abilities, who have received extensive treatment with oral antidystonic and antispasticity medications including oral baclofen, without satisfactory control of symptoms or with unacceptable adverse effects, are considered candidates for IBT. After a positive trial of IBT utilizing an initial trial dose of intrathecal baclofen between 50 to 75 ug with dose increases of 25 ug after 24 hours to a maximum of 250 ugs, a pump for chronic intrathecal administration is implanted. A positive response is considered to be a reduction in symptoms lasting 4–8 hours as determined by both the patient and the physician. Reduction of symptoms may be “objective” (improvement in the BFM rating scale, Global Dystonia score and Disability score) or “subjective” (not measurable with scales but reported by patient). After pump implantation, the dose of intrathecal baclofen is increased in increments by 10% until either the patient reports dose-limiting adverse effects or improved spasticity control. Review of literature Clinical experiences reported in the literature with IBT in dystonic patients are limited. Many are merely descriptions of single cases (3,5,6,7,9,11,12,14,16). There are several series’ reports with intrathecal baclofen for dystonia including those of Albright (86 tests performed, 77 pumps implanted), Walker (21 tests performed, 14 pumps implanted), Ford (25 tests performed, 13 pumps implanted) and Hou (10 tests performed, 10 pumps implanted) (1,2,4,8,10,13,15). Up to present, there have been 164 tests performed and 134 pumps implanted with a response rate to IBT trial test of 81.6%. The mean dose used to produce a clinical response in dystonia during IBT testing is 126 ugs, which is a higher dose of IBT trial dose necessary to produce a clinical response in spasticity. Every form of the disease (multifocal/ segmental 24 cases, generalized 140 cases) and every…
Journal of Neurology, Neurosurgery & Psychiatry, 1997
Clinical Neurology and Neurosurgery, 1990
Surgical treatment of chronic subdural haematoma is varied and includes techniques such as cranie... more Surgical treatment of chronic subdural haematoma is varied and includes techniques such as craniectomy by means of a burr hole broadened by bone forceps, and formal craniotomyl-'. In most patients the mere evacuation of haematic collection is sufficient for a satisfactory recovery3,8T9; but in some cases, after surgery, neurologic conditions remain unchanged or worsen. Unsatisfactory results have been associated to precarious neurologic conditions before surgery, delay in the evacuation of haematoma, rapid decompression of the brain, failure of the brain to reexpand, bleeding of cortical vessels due to blood dyscrasias, anesthesiologic or surgical complications2*3v1@14. Another cause of neurologic deterioration is tension pneumocephalus, mainly in elderly patients15-18; the treatment of this uncommon complication is not well determined yet. In this study we describe 7 cases, admitted between January 1983 and September 1986, of symptomatic tension pneumocephalus following surgery of chronic subdural haematoma through the technique of burr hole broadened by bone forceps. Case reports Case 1 An 84-year-old-man with poor cardio-circulatory conditions, had a head trauma two months S-We present seven cases of tension pneumocephalus developing after burr hole evacuation of chronic subdural haematoma. After a carefull review of the literature we discuss the physiopathology, the diagnosis and the treatment of this complication of chronic subdural haematoma surgery.
British Journal of Neurosurgery, 1987
Two cases of postoperative intracerebral haemorrhages remote from the site of the initial craniot... more Two cases of postoperative intracerebral haemorrhages remote from the site of the initial craniotomy for saccular aneurysms are reported and the other cases from the literature are reviewed. Lack of a good postoperative recovery and the appearance of neurological signs not related to the site of the operation may suggest this complication, which is associated with high mortality and disability rate. The possible pathogeness of those postoperative haemorrhages is discussed.
Journal of Pigmentary Disorders, 2015
Jou rn a l o f Pi gmentar y D is o rd ers
Journal of neurosurgical sciences, 2003
Data reported in previous studies and our own previous experience have led us to explore the mech... more Data reported in previous studies and our own previous experience have led us to explore the mechanism of and the degree of protection afforded by Ginko Biloba in a model of cerebral ischemia in the Mongolian Gerbil evaluating histological and neurological effects in this rodent. Mongolian Gerbils were divided into experimental groups: Group A consisted of animals subjected only to experimental ischemia; 5 minutes occlusion of the carotid arteries. Group B consisted of animals subjected to experimental ischemia and to a dose of Ginko Biloba, given intraperitoneally immediately before the surgical procedure. Group C consisted of animals subjected to experimental ischemia and to a dose of Ginko Biloba, given intraperitoneally immediately after the surgical procedure. Group D consisted of animals subjected to experimental ischemia and to a dose of the caspase inhibitors z-VAD.FMK and z-DEVD.FMK injected intracerebroventricularly through the right hemisphere before the surgical procedur...
Journal of neurosurgical sciences, 2003
ABSTRACT Partial removal of nucleus pulposus with consequent reduction of intradiscal pressure ma... more ABSTRACT Partial removal of nucleus pulposus with consequent reduction of intradiscal pressure may be obtained with percutaneous intradiscal administration of chemical substances in the intervertebral disc. We used percutaneous intradiscal injection of radiopaque gelified ethanol (“Discogel”) in 72 patients (group 1) with conservative treatment resistant lumbar and radicular pain due to small and medium-size hernias of intervertebral disc to demonstrate its efficacy and safety vs. 72 subjects treated with intra-foraminal and intradiscal injections of a steroid and anesthetic (group 2 or control group). “Discogel” injection was performed with biplane fluoroscopy assistance and under local anesthesia with patient in lateral position on symptomatic side. Amount of “Discogel” injected ranged from 0.8 ml to 1.6 ml. We treated a total of 83 discs. We performed the procedure on one disc in 62 patients; in 9 patients two discs were treated in the same session and in 1 patient three levels were treated in two separate sessions. In group 1 patient “responders” were 65 (90.3%). Excellent and good results were obtained in 58 patients (80.4%), satisfactory results in 7 patients (9.8%) and poor results in 7 patients (9.8%); among “responders” pain control was quite immediate in 58 patients (89.3%) while in 7 patients (10.7%) there was a delay of 7-10 days. These values were significantly higher than in control group. Also the quality of life was significantly more sustained vs. control group, and this benefit was maintained over time. Concerning complications, in 3 cases (4.15%) we had transitory radicular irritation with neuropathic pain appearance immediately after the procedure and in 1 case (1.30%) transitory sensory-motor deficit due to diffusion of local anesthetic along the introducer needle. In conclusion intradiscal radiopaque gelified ethanol injection is minimally invasive, low cost, safe and effective procedure that may be considered in proper selected patients before recourse to surgery.
British Journal of Neurosurgery, 2014
Background. Cerebral aneurysms are relatively common in adults, with a prevalence ranging between... more Background. Cerebral aneurysms are relatively common in adults, with a prevalence ranging between 1% and 5%. Subarachnoid hemorrhage, following aneurismal rupture, is a major cause of death and disability in these patients. Matrix Metalloproteinases (MMPs) and Neutrophil Gelatinase-Associated Lipocalin (NGAL) seem to be involved in the pathogenesis and in the clinical course of aneurysms. In this study, we evaluated the relationship between tissue and plasma levels of MMP-9 and NGAL in patient with ruptured and unruptured middle cerebral artery aneurysms. Methods. An open label study was conducted on 7 patients with middle cerebral aneurysms. Three patients had ruptured aneurysms (Group I) and four patients had unruptured aneurysms (Group II). All patients underwent aneurysm clipping. Plasma levels of MMP-9 and NGAL were evaluated through ELISA Test. During the surgery, biopsies of the aneurysmatic arteries were taken and frozen (- 80°C) for Western blot evaluation of MMPs and NGAL expression. Four healthy volunteers (Group III) represented the control group for ELISA testing. Results. Both plasma MMP-9 and NGAL levels were significantly high in aneurysmatic patients respect to those of control patients, and these levels were higher (P < 0.01) in patients with ruptured aneurysms respect to patients with unruptured aneurysms (P < 0.01). The latest findings were similarly evident in tissue evaluation of MMP-9 and NGAL between ruptured and unruptured aneurysms. Conclusion. This study suggests that MMP-9 and NGAL plasma levels may be useful to predict the clinical course of a cerebral aneurysms in order to evaluate the progression of the disease and the tendency of an aneurysm to rupture.