Decompression and surgical stabilization in the palliative treatment of vertebral metastases.

Instability of the spine consequent to the diffusion of a primary tumor is a serious complication in cancer patients. The experience of our Service in the surgical treatment of vertebral metastases is reported. Since 1990, 21 patients have undergone surgery. The vertebral metastases were localized at the cervical level in 4 cases, thoracic in 13, and lumbar in 4. Pain was the first symptom in 18 patients. The necessary criterion for intervention was intractable severe pain and/or neurologic deficit. At the thoracic and lumbar levels (17 cases) a posterior approach was always used to perform wide decompressive laminectomy and to stabilize the spine. An anterior approach is unadvisable in light of the risk related to the operation and the long recovery time. In 13 cases Cotrel-Dubousset bars were utilized, in 3 cases Roy-Camille, and in 1 case Louis plates. After surgery, significant pain relief was noted in 85% of patients. Of those with neurologic deficit, improvement in neurologic status was seen in 50%; in 28% neurologic deficit was completely resolved. We conclude that, although palliative, wide laminectomy accompanied by stabilization is a satisfactory treatment of vertebral metastases. Given the appropriate indications, surgical treatment improves the patient's quality of life.

[Mechanical responses on isolated frog neuromuscular preparations in the presence of calcitonin]. / Risposte meccaniche di preparati neuromuscolari isolati di rana in presenza di calcitonina.

Previous observations had shown that, in the isolated rat preparations, calcitonin facilitates the excitement transmission from autonomic nerve-endings to smooth muscle. The present research, was designed to verify whether this facilitation effect could be present in somatic nerve-endings too. For this reason, we used the isolated frog "sciatic nerve-gastrocnemius muscle" preparation where the calcitonin influence on the beginning of a complete tetanic response was studied. The motor nerve-endings were stimulated at different frequencies. It was observed that the added calcitonin and/or an increased [Ca++] medium induced a complete tetanic response also at stimulating frequencies that, in the controls, provoked only a clonic response. Moreover, both the calcitonin and the increased [Ca++] medium frequently induced an increase in the mechanical muscle tension developed. These facilitating effects were reduced or even abolished with inhibition of Ca++-passage through the cell membrane by nifedipine. Therefore, we could hypothesize that the added calcitonin causes increased Ach-release from the somatic nerve-endings and that this action depends on facilitated Ca++-passage through the cell membrane of the nerve-endings and of the muscle fibres too.

On the neurological complications of internal and external shunt in patients with non-neoplastic stenosis of the aqueduct.

In our Department 35 patients have been operated for non-neoplastic stenosis of the aqueduct. In the first years, ventriculocisternal shunt according to Torkildsen was performed, obtaining 6 recoveries and 1 death. Later, ventriculosternostomy acc. to Stookey and Scarf, was carried out in 3 cases, obtaining 2 recoveries and 1 death; by using right ventriculo-atrial shunt we had 4 successes and 1 failure. More recently, since 1973, ventriculoperitoneal shunt has been carried out without deaths out of 21 operated patients. With this technique we have had many complications requiring repeated drainage system revisions in 9 cases, and evacuation of a chronic subdural haematoma in 3 cases. 2 patients, operated by drainage system revision and 1 for evacuation of subdural haematoma, had a dramatic postoperative course, characterised by apallic syndrome. Considering the results of the various techniques, we could conclude that the elective operation must be internal shunt (posterior or anterior ventriculocisternostomy) if, of course, the patency and the functionality of the cisterns have been ascertained.

[Facilitation of the onset of tetanic responses induced by 4-methylesculetol in amphibian isolated neuromuscular preparations]. / Facilitazioni sull'insorgenza delle risposte tetaniche indotte dal 4-metilesculetolo in preparati neuromuscolari isolati di anfibio.

Previous observations have shown that the 4-Methylesculetin (4ME) and the calcium provoke an increased response when the motor somatic and autonomic nerve-endings are stimolated. In the present research, we have studied the influence of the bioflavonoid and of an increased medium [Ca++] on the tetanic responses obtained from the isolated frog "sciatic nerve-gastrocnemius muscle" preparation. The 4ME has always facilitated the beginning of a complete tetanic response and has also frequently increased the developed mechanical tension. These effects appeared more evident when the bioflavonoid was employed together with the ascorbic acid. Moreover, an increased medium [Ca++] has induced similar effects. The nifedipine and the flunarizine, well-known Ca++ -antagonists, have constantly reduced or even abolished the facilitating effect induced by the bioflavonoid. On the basis of these results, we could hypothize that these observed facilitating effects are dependent on both an increased Ach-release and an increased muscle mechanical efficiency. Our previous results and also some literature data suggest that these effects could be due to an increased Ca++-passage through the cell membrane of the motor nervendings and of the muscle fibres too.

Hemifacial spasm: report of nine cases treated by posterior fossa microsurgical decompression.

Nine cases of hemifacial spasm have been treated, in our department until 1979, by posterior fossa microsurgical decompression, as described by Jannetta, without mortality or significant postoperative complications. A blood vessel was found crossing or looping the facial nerve in 8 cases. The relief of hemifacial spasm was immediate and complete in 7 cases, and partial in 1 case. This technique seems to be an effective and safe treatment, in this particular disease.