Neurocysticercosis: surgical treatment of an autochthonous case in a non-endemic region.

OBJECTIVE AND IMPORTANCE: This study describes a case of autochthonous neurocysticercosis in a non endemic region where a differential diagnosis with more frequent single parenchymal lesions must be carried out. CLINICAL PRESENTATION: The patient presenting generalized seizures and coma status under the suspicion of cerebral neoplasia was admitted to the neurosurgery division. MRI showed the presence of an ovoidal cystic lesion in right-frontotemporal region. INTERVENTION: After right fronto-temporal osteoplastic bone flap elevation and usual dural tacking and opening, trans-scissural subaracnoid access was made possible by microsurgical strumentation in right Sylvian fissure. A cystic, translucid lesion was identified in the deep Sylvian fissure, involving the distal segment of the fissure and the frontal lobe, the cystic lesion was removed surgically. Pathological examination showed a typical picture of neurocysticercosis. CONCLUSIONS: After both surgical and chemotherapeutic treatment with albendazole the outcome was successful. The diagnosis of neurocysticercosis should be taken into account in the presence of generalized seizures possibly due to single parenchymal lesions, even in non-endemic regions for this parasitic infection.

Quercetin inhibits the sulfation of r(-)-apomorphine in human brain.

The first aim of this investigation was to study the sulfation of R(-)-apomorphine in human brain. The second aim was to investigate the inhibition of R(-)-apomorphine sulfation by quercetin in human brain. R(-)-apomorphine is hereafter referred to as apomorphine. Apomorphine sulfation was measured in 5 brain specimens; 3 derived from the frontal cortex and 2 derived from the temporal cortex. The rate of apomorphine sulfation was 5.6 +/- 4.3 pmol/min/mg. The activities of SULT1A1 and SULT1A3, which were also measured in these samples, were 11 +/- 9.1 and 2.6 +/- 1.7 pmol/min/mg, respectively. The rate of apomorphine sulfation correlated with the activity of SULT1A1 (r = 0.989; p = 0.002) and SULT1A3 (r = 0.973; p = 0.005). Apomorphine sulfotransferase followed Michaelis-Menten kinetics, the Km (mean +/- SD) and Vmax values (mean +/- SD) of which, measured in 5 brain samples, were 32 +/- 7.3 microM and 8.9 +/- 7.9 pmol/min/mg, respectively. Quercetin was a potent inhibitor of apomorphine sulfation with an IC50 value, measured in 5 brain samples, of 16 +/- 2.3 nM. The inhibition mechanism of quercetin using apomorphine sulfation in 5 brain samples was mixed, non-competitive with a Ki and Kies (mean +/- SD) of 16 +/- 4.1 and 87 +/- 37 nM, respectively (p = 0.008). The intrinsic clearance value of apomorphine (mean +/- SD) was 247 +/- 170 ml/min/mg(-1) and was decreased to 100 +/- 85 ml/min/mg(-1) (p < 0.01) in the presence of 25 nM quercetin. In conclusion, apomorphine is sulfated in human brain. Sulfation might reduce the level of apomorphine in human brain and be a factor limiting the effect of this drug. Quercetin is a potent inhibitor of apomorphine sulfation and may inhibit the sulfation of apomorphine in human brain in vivo.

[Mixed neuroglial tumor: description of a case]. / Tumore misto neurogliale: descrizione di un caso.

A case of neuroglial tumor in a 18-year-old man is presented. The neoplasm was composed by two cell types. One type showed features typical of neuronal cells, while the other resembled glial cells. The diagnosis was confirmed by immunohistochemistry results.

The gln-Arg192 polymorphism of human paraoxonase gene is not associated with coronary artery disease in italian patients.

Serum paraoxonase (PON) is an HDL-bound enzyme protecting LDL from oxidation. A common polymorphism of the paraoxonase gene (PON1) involving a Gln-to-Arg interchange at position 192 has been demonstrated to modulate PON activity toward paraoxon, a nonphysiological substrate; Arg192 (allele B) is associated with higher activity than Gln192 (allele A). This polymorphism has been proposed as a genetic marker of risk for coronary artery disease (CAD). However, the relationships between codon 192 PON1 genotypes, coronary atherosclerosis, and the occurrence of myocardial infarction (MI) are still controversial. PON1 genotypes were determined in 472 consecutive subjects (>40 years old) who underwent coronary angiography. CAD (>50% stenosis) was detected in 310 subjects (CAD+); 162 subjects with <10% stenosis served as controls (CAD-). We also evaluated 204 randomly selected individuals as population controls. PON1 genotypes were determined by PCR and AlwI restriction enzyme digestion. Frequencies of alleles A and B were 0. 70 and 0.30 in angiographically assessed subjects and 0.73 and 0.27 in population controls, respectively (chi2=2.0; P<0.3). Distribution of PON1 genotypes in CAD+ were not significantly different from those in CAD- (chi2=2.10; P<0.3). Similarly, no differences were observed in the subgroup of CAD+ with MI nor in that at higher oxidative risk (smokers and/or diabetics). After controlling for other coronary risk factors, no association was found between PON1 alleles and the presence of CAD. PON1 AA genotype was associated with reduced concentration of apolipoprotein B-containing triglyceride-rich lipoproteins. This study did not provide evidence of a significant association between codon 192 PON1 genotypes and coronary atherosclerosis in Italian patients. However, it did confirm that the PON1 low-activity allele is associated with a less atherogenic lipid profile.

Angiotensin-converting enzyme gene polymorphism is not associated with coronary atherosclerosis and myocardial infarction in a sample of Italian patients.

BACKGROUND: The deletion (D) allele of the angiotensin-converting enzyme (ACE) gene has been proposed as a genetic marker of the risk of ischaemic heart disease. However, the relationships between ACE genotypes, the development of coronary atherosclerosis and the occurrence of major coronary events are still controversial. METHODS: To investigate whether the ACE I/D (insertion/deletion) polymorphism predicts the risk of coronary stenosis and myocardial infarction (MI), ACE genotypes were determined in 394 consecutive patients who underwent coronary angiography. The presence determined in 394 consecutive patients who underwent coronary angiography. The presence of coronary artery disease (CAD) (defined by > 50% stenosis) was detected in 236 patients (CAD+); 85 of these individuals had a history of MI. Patients with coronary stenosis < 10% (n = 158) served as controls (CAD-). ACE genotypes were determined by agarose gel sizing after polymerase chain reaction (PCR) amplification. RESULTS: The distribution of ACE genotypes in CAD+ patients was not significantly different from that in CAD-patients (chi 2 = 2.63, P < 0.27). After controlling for other coronary risk factors, no significant increase in risk of CAD or MI was found to be associated with the D allele, regardless of whether the D allele was assumed to have a dominant, a codominant or a recessive effect. Similar results were observed in CAD+ patients at lower risk because of low body mass index and apolipoprotein B concentrations. Smoking, apolipoprotein B and history of hypertension were found to be independent predictors of CAD and MI. CONCLUSION: Our study did not provide evidence of a significant association between ACE genotypes and the development of coronary atherosclerosis. It also failed to support a role of ACE I/D polymorphism in favouring the conversion of coronary stenosis to MI.

[The type of coma as prognostic indicator in severe cranial trauma in childhood]. / Il tipo di coma quale indicatore prognostico nei gravi traumi cranici in età evolutiva.

Various methods are used by neurologists to evaluate posttraumatic brain damage. The most important and reliable are the length of posttraumatic amnesia and coma. In previous papers we have already described the value of the type of coma in the prognosis of serious head injury in childhood (Baracchini-Muratorio et al. 1985; Pruneti et al. 1985). In this study, 30 children (aged 6-12 years) with serious closed head injury and subsequent coma were evaluated. The children were divided into two groups according to the type of coma, using the Plum and Posner coma classification (1966) modified by Pagni et al. (1974). The children were followed up for at least two years (9 for five years) after the trauma by means of neurological, physical, EEG, CT scan and neuropsychological examinations. The neuropsychological test results confirm the hypothesis of a different evolution of sequelae in relation to the type of coma, independently of length of coma and site of brain damage.

[Alcoholic hepatopathy, deficiency pathology and serum transaminases. Presentation of 2 clinical cases]. / Epatopatia alcolica, patologia carenziale e transaminasi sieriche. Presentazione di due casi clinici.

The authors describe two cases of Vit B1 and B6 deficiency in alcoholics with malnutrition. In the first case serum levels of AST and ALT, initially below norm became higher after Vit B1 and Vit B6 intake; the second, with AST and ALT above norm in previous months, had AST and ALT with normal activity during the disease. The authors suggest that normal activity of AST and ALT during alcoholic hepatopathy could be related to a depletion of Vit B1 and Vit B6.

Gerstmann syndrome: a case report.

A case of Gerstmann syndrome following a trauma is presented. After one month the patient showed the four symptoms of the Gerstmann syndrome associated with slight visual memory and constructional praxis deficits. Eight months later, however, he showed only dyscalculia, dysgraphia, right-left disorientation and finger agnosia, in accordance with selective damage of the left angular gyrus revealed by CT scan. The findings seems to support the existence and the localizing value of Gerstmann syndrome.

[A case of wet beriberi]. / Su di un caso di beri-beri umido.

The AA. report a case of thymine acute deficiency in a 35 year old chronic alcoholic and malnourished male, who was admitted to the hospital because of high-output heart failure, peripheral polyneuropathy, cortico-cerebellar atrophy (associated with RMN), ataxia and peripheral edema. The diagnosis of wet Beri-beri combined with Wernicke-Korsakoff syndrome was made and appropriate therapy with pulse daily dose of parenteral thymine instituted. At the fifth day of therapy the cardio-circulatory hyperkinetic syndrome was markedly improved and after three weeks neurological damage was also alleviated. The AA. outline the importance of early diagnosis and treatment for this form of high-output heart failure, which has a poor prognosis and, if left untreated, can determine the death of the patient in a few days.

Orbital decompression for severe Graves' ophthalmopathy. Results of a three-wall operative technique.

Nine patients out of more than 300 with severe Graves' ophthalmopathy followed in this institution were submitted to orbital decompression carried out on 16 eyes by a three-wall procedure consisting of a transfrontal approach with the removal of the roof, the lateral wall and part of the floor of the orbit. All patients had been previously unsuccessfully treated by orbital radiotherapy and/or systemic corticosteroid administration. The main indications for surgery were marked proptosis or sight-threatening optic neuropathy. Results of treatment were evaluated on clinical grounds and by the variation of the ophthalmopathy index (OI). A significative reduction of proptosis was observed in all eyes, with a mean decrease in the Hertel reading of 3.2 mm, from 22.6 +/- 1.8 mm to 19.4 +/- 1.4 mm (p less than 0.001). A complete regression or improvement of inflammatory signs, corneal lesion and, with one exception, extraocular muscle dysfunction was obtained in all cases. Loss of visual acuity and other manifestations of optic neuropathy were present in 11 out of 16 eyes before surgery. A complete restoration or a marked improvement of optic neuropathy was obtained in 7 cases: failure occurred in the two patients (4 eyes) with longstanding sight loss. The OI decreased in all patients after surgery, from a mean pretreatment value of 8.6 to a mean posttreatment value of 3.8 (p less than 0.001). The clinical response to surgery was excellent in 4 cases, good in 3 and slight in 1; no changes were observed in the remaining patient. Bacterial meningitis which resolved with no sequelae occurred in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Behavioral treatment of children after severe head injury: a pilot study.

Little has been written on the treatment of cognitive and behavioral disorders in children following serious head injuries with coma. We have used the behavioral modification method known as Token Economy in 20 head-injured patients having a mean age of 11 years. The treatment, which involved the children's families, proved at one-year follow-up to be highly successful in normalizing maladaptive behavior.

Radiation-induced cerebral lesions in childhood.

Post-irradiation cerebral pathologies may appear in various forms from localized radiation necrosis to a plurifocal type or from local to diffuse vasculopathies. Contrary to the current prevalent opinion, these lesions are not rare in children since young nerve tissue is particularly sensitive to ionizing radiation. Given the seriousness of some of these lesions, the authors recommend careful evaluation of the risk involved in relation to the real necessity of administering irradiation therapy in childhood.

[Prolonged use of intravenous nitro derivatives in acute myocardial infarction (AMI)]. / Uso prolungato di nitroderivati per via endovenosa in corso di I.M.A.

A retrospective survey is made on 166 cases of acute myocardial infarction, treated with intravenous nitro-derivatives for eight days of continuous therapy. This therapeutic modality appears to gain four goals: a reduction in mortality of patients, a faster return of ST tract on isoelectric guideline, fewer ventricular pump failures. In the authors' point of view, a delay in the downward return of ST tract towards the isoelectric guideline is an important but ominous prognostic sign in this group of patients. Therefore, this modality of treatment is suggested for all patients with AMI, wherever the myocardial coronary lesion is localized.

Surgical treatment of Graves' ophthalmopathy by decompressive orbitotomy.

Malignant exophthalmos is often not resolvable using only medical or radiation therapy. The pressure on the optic nerve which is generally associated with it evolves rapidly in many cases towards optic atrophy and subsequently loss of vision. Only surgical treatment offers any guarantee of success and of the various techniques proposed, subfrontal orbital decompression seems clearly the more effective, in that it makes for an optimal alleviation of pressure in the optic pathways. The Authors describe their technique, a variation on the original approach, and report the results achieved with it.

Nasal meningioma. Report of a case.

A case of intranasal meningioma is reported. The possible etiopathogenic hypotheses are discussed. A possible primary intracranial localisation has to be excluded. Therapy is also briefly discussed.

Parkinsonian syndrome in the course of aqueductal stenosis hydrocephalus.

Report of a case of hydrocephalus secondary to stenosis of the aqueduct with associated parkinsonian syndrome. The suggested etiopathogenesis: damage to the striatal system favored by underlying weakness of the basal ganglia.

Peritoneal cerebrospinal fluid pseudocysts: a complication of ventriculoperitoneal shunts.

The authors report seven cases of peritoneal pseudocysts in children with ventriculoperitoneal shunts. After describing the etiopathogenetic hypotheses, the symptomatology and the diagnostic investigations, they review the various types of treatment adopted to date and propose a simple and effective method, which has resulted in rapid resolution of all seven cases.

Nasal meningioma. Report of a case.

A case of intranasal meningioma is reported. The possible etiopathogenic hypothesis is discussed giving advice on excluding a possible intracranial primary neoplasia. Therapy is also briefly discussed.

[Syndrome of ventricular overdrainage in children with fluid shunts]. / Sindromi da iperdrenaggio ventricolare in bambini portatori di shunt liquorali.

The authors emphasize the possible complications following the surgical operation by ventriculocaval or ventriculoperitoneal shunts in the neonatal hydrocephalus. These complications are mainly caused by the liquoral hyperdrenage which occurs for the differential pressure of the valve system, since this valve is operating by the differential pressure between cerebral ventricles and the receiving cavities and not by the absolute pressure existing in the ventricular cavity. The following late complications are examined: a) chronic subdural haematoma; b) slit ventricle syndrome. Their evolution often is deceitful and severe problems of differential diagnosis with others pathological infantile states arise.

Trigeminal schwannomas in adolescence.

Trigeminal neurinomas, unlike those of the acoustic nerve or of other cranial nerves, are relatively frequent in adolescence, making up 10% of the total. Two cases are described, bringing the number of reports in the world literature up to 13. The clinical, radiological and surgical data on these tumors are analyzed, and some particular aspects present in adolescence are pointed out.