Negative MRI and a seizure onset zone close to eloquent areas in FCD type II: Application of MRg-LiTT after a SEEG re-evaluation in pediatric patients with a previous failed surgery.

OBJECTIVE: Negative MRI and an epileptogenic zone (EZ) adjacent to eloquent areas are two main issues that can be encountered during pre-surgical evaluation for epilepsy surgery. Focal Cortical Dysplasia type II (FCD type II) is the most common aetiology underlying a negative MRI. The objective of this study is to present three cases of pediatric patients exhibiting negative MRI and a seizure onset zone close to eloquent areas, who previously underwent traditional open surgery or SEEG-guided radiofrequency thermocoagulations (RF-TC). After seizure seizure recrudescence, pre-surgical SEEG was re-evaluated and Magnetic Resonance-guided laser interstitial thermal therapy (MRg-LiTT) was performed. We discuss the SEEG patterns, the planning of laser probes trajectories and the outcomes one year after the procedure. METHODS: Pediatric patients who underwent SEEG followed by MRg-LiTT for drug-resistant epilepsy associated with FCD type II at our Centre were included. Pre-surgical videoEEG (vEEG), stereoEEG (sEEG), and MRI were reviewed. Post-procedure clinical outcome (measured by Engel score) and complications rates were evaluated. RESULTS: Three patients underwent 3 MRg-LiTT procedures from January 2022 to June 2022. Epileptogenic zone was previously studied via SEEG in all the patients. All the three patients pre-surgical MRI was deemed negative. Mean age at seizure onset was 47 months (21-96 months), mean age at MRg-LiTT was 12 years (10 years 10 months - 12 years 9 months). Engel class Ia outcome was achieved in patients #2 and #3, Engel class Ib in patient #1. Mean follow-up length was of 17 months (13 months - 20 months). Complications occurred in one patient (patient #2, extradural hematoma). CONCLUSIONS: The combined use of SEEG and MRg-LiTT in complex cases can lead to good outcomes both as a rescue therapy after failed surgery, but also as an alternative to open surgery after a successful SEEG-guided Radiofrequency Thermocoagulation (RF-TC). Specific SEEG patterns and a previous good outcome from RF-TC can be predictors of a favourable outcome.

Coronary stenting for unstable angina: predictors of 30-day and long-term clinical outcome.

BACKGROUND: Unstable angina is usually caused by acute thrombosis superimposed on a fissured plaque. Coronary artery stenting has been shown to improve short- and long-term results of coronary angioplasty in mainly stable patients with one-vessel disease, but it is uncertain whether its use in an unstable clinical setting can be safe and useful. This study sought to evaluate the results of coronary stenting in unstable angina and to determine patient, lesion and procedure-related predictors of 30-day and long-term ischemic events. METHODS: We studied 266 consecutive patients (mean age 62 +/- 9 years) with unstable angina who underwent coronary artery stenting. The procedure was performed electively in 24%, in bailout situations in 11% and for a suboptimal result of conventional angioplasty in 65%. After stent implantation, patients were treated with anticoagulation (61) on combined antiplatelet therapy (200). Multivariate logistic regression analyses were performed to determine 30-day and long-term predictive factors of ischemic complications. RESULTS: Procedural success was obtained in 261 patients (98.1%). During the first 30 days after stenting, one patient died from cardiogenic shock (0.3%) and six (22%) suffered a non-fatal Q-wave myocardial infarction. Patients with combined antiplatelet therapy had a significantly lower stent thrombosis rate (1.5% versus 11.4%, P = 0.002) than those treated with anticoagulant regimen. At long-term follow-up (17.7 +/- 9.4 months) cardiac mortality myocardial infarction and target-vessel revascularization rates were 0.4%, 1.5% and 9.3%, respectively. In multivessel and diabetic patients, a worse long-term event-free survival was observed. Logistic multivariate analysis revealed bailout stenting, anticoagulant therapy, implantation of stents longer than 15 mm as predictors of 30-day ischemic events. In addition, multivessel coronary artery disease and stent application with balloon size of less than 3 mm were predictive of long-term ischemic events. CONCLUSIONS: This study demonstrates that, either electively or after failure of conventional angioplasty, coronary stenting represents an effective therapy for patients with unstable angina. In the same clinical setting, combined antiplatelet therapy is associated with a lower 30-day stent thrombosis rate than anticoagulant therapy. Bailout stenting, anticoagulant therapy, implantation of stents longer than 15 mm were shown to be predictors of 30-day ischemic events, whereas multivessel coronary artery disease and stent application with small balloon size were predictive of long-term ischemic events.

[Endocoronary stent: its use to improve suboptimal outcome of angioplasty]. / Stent endocoronarcio: l'utilizzo per migliorare i risultati subottimali dell' angioplastica.

BACKGROUND: This single-center report describes the results of unplanned coronary stenting for the treatment of suboptimal angiographic results after conventional coronary angioplasty (PTCA), Suboptimal results of PTCA were defined as: a) residual stenosis > or = 30% with TIMI flow 3; b) presence of coronary dissection < 15 mm with TIMI flow 3. PATIENTS: From January 1994 to December 1995, 213 patients with suboptimal result of PTCA underwent coronary stent implantation. RESULTS: Stenting resulted in a technical and angiographic success in 99.5% of patients. In-hospital complications involved acute myocardial infarction (2.3%), coronary artery bypass grafting (1.4%), re-PTCA (2.3%) and vascular complications at the puncture site (1.4%). No deaths occurred. The in-hospital complication rate was similar in the groups of patients stented for coronary dissection or residual stenosis > or = 30%. Instead, the combined antiplatelet treatment group showed lower rates of subacute stent thrombosis (0.8 vs 8.9%; p = 0.011) and major complications (1.6 vs 10%; p = 0.016) than the ASA-warfarin treatment group. At a six-month follow-up, clinical restenosis was detected in 9.5% of patients. Re-PTCA was performed in 7.1% of patients and elective coronary bypass grafting in 2.8%. No acute myocardial infarction occurred and one patient presented a non-cardiovascular death. At the end of the follow-up, only 5.2% of the patient were still symptomatic. CONCLUSIONS: The unplanned use of intracoronary stenting for the treatment of suboptimal result of PTCA improves the immediate angiographic result, reducing the procedural complication rate with good short- and long-term clinical results.

Intravascular Stenting in a Female Patient with Spontaneous Coronary Dissection and Von WillebrandÕs Disease.

We report a case of spontaneous coronary dissection occurring in a 46-year-old women affected by von WillebrandÕs disease presenting with anterior myocardial infarction. The patient was treated with thrombolytic therapy and stent implantation. We believe that in patients with single vessel spontaneous coronary dissection and unstable clinical condition, coronary stenting may provide an alternative treatment in place of coronary surgery.

New platinum(II) complexes of beta-cyclodextrin diamine derivatives and their antitumor activity.

The new platinum(II) complexes of beta-cyclodextrin functionalized at the primary position with ethylenediamine or with propylenediamine were synthesized and characterized by mass spectrometry, electronic spectrophotometry, and multinuclear NMR spectroscopy. Platinum(II) complexation makes the cavity more asymmetric. These complexes were tested in vitro for their cytotoxic activity. The relevance of the low activity observed regarding the interaction between the cell and the cyclodextrin cavity is discussed.

[Computerized tomography as a diagnostic complement of standard radiograms in the evaluation of traumatic lesions of the carpal scaphoid. A study of 10 cases]. / La tomografia Computerizzata quale complemento diagnostico dei radiogrammi standard nella valutazione delle lesioni traumatiche delle scafoide carpale. Studio di 10 casi.

The authors investigated the value of direct coronal CT as a diagnostic complement to plain radiography in the assessment of post-traumatic scaphoid conditions. The series included 10 patients who were selected either for disagreement of clinical and radiological findings, the latter being negative (3 patients), or for better assessment of radiological findings, which had diagnosed bone lesions, in order to plan treatment (7 cases). CT provided additional information in 5 patients, demonstrating 2 nonunited fractures in the first group and 2 pseudoarthroses with no significant bone deformity and 1 osteonecrosis in the second group. These results, which proved essential to plan the subsequent treatment, show that CT has, at present, in specific cases, a definite role in evaluating post-traumatic scaphoid conditions, and stress the value of direct coronal images, which are both easy to interpret, being equivalent to radiographs in postero-anterior projection, and quick to perform.

[Nutritional assessment of aged patients with fractures of the proximal epiphysis of the femur]. / Valutazioni nutrizionali in pazienti anziani con frattura dell'epifisi prossimale del femore.

Forty-two patients (M/F 9/33; age 78 +/- 10 years) were studied during Hospital stay for femoral neck fractures (16 neck, 26 pertrochanteric fractures). All underwent fracture surgery (internal fixation in 30, arthroplasty in 12 patients). Food intake was evaluated daily, supplemented with specific recipes. Biochemical assessment of nutritional status (hemoglobin, hematocrit, total proteins, albumin, prealbumin, Na, K, Ca, Fe, P, Mg) was performed before and after surgery. Nitrogen balance was evaluated in 8 patients in the post-operative period (40 determinations). The study group was compared for post-surgical complications and mortality during Hospital stay with a historical control group without any nutritional survey. Mean daily caloric intake was (M +/- DS) 1014 +/- 360 in the preoperative period, 960 +/- 210 and 1036 +/- 185 postoperatively (5-9 and 10-15 days post-surgery, respectively). Mean nitrogen intake was, respectively, 7.5 +/- 2.6, 7 +/- 2.1, 6.9 +/- 1.6 gN/day. No significant differences were found. In the preoperative period, the following tests were found below the normal range: iron (median 30 micrograms/dL), albumin (median 3.1 g/dL), hemoglobin (median 12 g/dL) hematocrit (median 35%). After surgery, they decreased significantly; also prealbumin, in normal limits before surgery (20 +/- 0.7 mg/dl), decreased significantly 5-9 days after surgery. After 10-15 days from surgery, only prealbumin and iron reached the preoperative level.(ABSTRACT TRUNCATED AT 250 WORDS)

[Complement behavior in rats bearing Yoshida tumors subjected to treatment with gonadotropin and PGE2]. / Andamento del complemento nei ratti portatoridi tumore di Yoshida sottoposti a trattamento con gonadotropine e PGE2.

The haemolytic activity of the total Complement (CH50) and the fractions C3 and C4 were assayed in rats transplanted with Yoshida's tumor and then treated with hCG, LH-FSH and PGE2. A relevant increase, only concerning the values of the CH50 and C3 fraction, was observed in all animals in the early days after the transplantation, probably due to a sort of stress "by transplantation". Afterwards, hCG and PGE2 induced an increase in CH50 and C3 values, but not in the C4 fraction. Treatment with LH and FSH led to a very slight increase in the CH50 and C3. In the following days, as a consequence of the cachexia, a progressive reduction of the values of the Complement was observed in all animals. Those treated with hCG also showed a little increase of survival. The authors suggest that the increase in CH50 and C3 fraction induced by the treatment with hCG and PGE2 could be an expression of increase of the aspecific humoral immunity, as a compensatory mechanism of the cell-mediated immunological depression which occurs during neoplasias.

Modification of the complement induced by PGE2 and gonadotropins.

The Complement is one of the major effectors of the humoral aspecific immune system building up a defence mechanism of the organism. As it is known that some hormonal substances like gonadotropin (hCG) and some hormone-like substances (PGE2) influence the entire immunitary system, we wanted to see if they had specific action on the Complement. The measurement of CH50 was carried out using Mayer's method, derived by Ferrazzi and modified by us. Fractions C3 and C4 were measured by means of immunochemistry using Beckman nephelometer. The treatment with hCG (1,000 U + 10 Lf tetanus toxoid) caused an increase in the CH50 and in the fraction C3, while the fraction C4 was not modified. The treatment with PGE2 (0.25 microgram/rat/die) caused a higher increase of CH50 and C3 fraction. It seems possible to acknowledge C3 involvement in the variation of the Complement's haemolytic activity and this could confirm the intervention of the "alternative pathway". The notable increase in the activity of the Complement induced by hCG and PGE2 could indicate an alternative mechanism of activation of the aspecific humoral immunity in the defence of the organism in all those physio-pathological situations where these substances cause a state of depression of cellular mediated activity.