14 research outputs found
Do antiplatelet and anticoagulant drugs modify outcome of patients treated for chronic subdural hematoma? Still a controversial issue
No full textAnticoagulants(ACs) and antiplatelet aggregation agents(AAAs) seem to be correlated to a higher incidence of chronic subdural hematoma(CSDH) but whether or not they contribute to its recurrence is debated. Few data are available on clinical outcomes and indications for the management of this therapy are not so well defined. We investigated the role of ACs and AAAs in modifying patients clinical outcomes treated for CSDH, especially for re-bleedings
Chronic subdural hematoma in patients aged 80 years and older: A two-centre study
No full textObjective: Chronic subdural hematoma (CSDH) is a common condition in the elderly, and the ageing of population will increase the number of "superaged" patients presenting this pathology for the years to come. Few studies investigating the outcome of superaged patients surgically treated for CSDH are available, and study populations are generally small. The outcome of surgically treated patients and risk factors are not completely clear.Aim of the work is to identify the risk factors which may influence the outcome of patients aged 80 years and older surgically treated for CSDH.Patients and Methods: This is a retrospective two-centre study including 151 surgically treated patients. A univariate (Fisher exact test) and multivariate (logistic regression) analysis of possible risk factors influencing outcome was performed. Outcome was expressed as: 6-month clinical outcome, 6-month mortality, complications and length of hospital stay.Results: Univariate analysis showed an association between Charlson Comorbidity Index (CCI) and 6-month clinical outcome (p = 0,048), complications (p = 0,034) and 6-month mortality (p = 0,007). Antithrombotic drugs were associated with longer hospital stay (p < 0,001). Logistic regression analysis showed an association between CCI and complications (p = 0,016, HR = 3,18) and 6-month mortality (p = 0,034, HR = 11,71), and between antithrombotic drugs and longer hospital stay (p = 0,002, HR = 3,07).Conclusions: Age alone is not a predictor of bad outcome for patients aged 80 years and older surgically treated for CSDH. Charlson Comorbidity Index (CCI) may prove a valuable outcome predicting tool in these patients, and a longer hospital stay may be anticipated for patients under antithrombotic agents
Dieci lampade accese: il mosaico della facciata di Santa Maria in Trastevere nella sua versione originaria.
No full textIl mosaico del cavetto di Santa Maria in Trastevere (primo quarto del XIII secolo) rappresenta un giardino paradisiaco, dominato al centro da una Maria lactans, verso la quale convergono dieci sante, cinque per lato, recanti lampade in mano. Già in età medievale l'opera è stata oggetto di una serie di rifacimenti che hanno compromesso l'autenticità di alcuni dettagli figurativi. Il fatto che le prime due sante di destra abbiano la testa velata e sostengano lampade prive di fiamma (a differenza di tutte le altre che hanno in testa una corona ed esibiscono lumi accesi) ha dato adito a pensare - anche di recente - che la versione primitiva del mosaico di Trastevere potesse raffigurare la parabola del vangelo di Matteo (25, 1-13) delle Vergini savie (a sinistra, con la corona e le lampade accese) e delle Vergini stolte (a destra, con il velo e le lampade spente). Sulla base di una serie di confronti iconografici, e del riesame delle alterazioni dovute ai numerosi restauri, il presente contributo evidenzia le debolezze di questa ipotesi: la versione primitiva del mosaico rappresentava, più verosimilmente, dieci sante vergini in Paradiso, tutte con le lampade accese, emblema di fede. Con ogni probabilità, la scelta del soggetto trae ispirazione dalla leggenda locale del fons olei, secondo la quale nel I secolo a.C., nel punto ove poi sorse la basilica, affiorò dalla terra una sorgente di liquido oleoso.The mosaic on the cavetto of Santa Maria in Trastevere (first quarter of the 13th century) illustrates the garden of Paradise, dominated in the centre by a Maria lactans. Ten figures of saints turn towards her, five on each side, carrying lamps in their hands. Already in the Middle Ages the work underwent renovations that compromised the authenticity of some figurative details. The first two saints on the right have veiled heads and hold flameless lamps, unlike all the others who have a crown on their heads and exhibit lit lamps. This is the reason why someone believes the oldest version of the mosaic represented the parable of the Wise and the Foolish Virgins (Gospel of Matthew, 25, 1-13): the Wise Virgins on the left, with crowns and lit lamps; the Foolish Virgins on the right, with veils and unlit lamps. On the basis of a series of iconographic comparisons, and of the re-examination of the alterations due to the numerous restorations, this contribution highlights the weaknesses of this hypothesis. The primitive version of the mosaic, more likely, represented ten virgin saints in Paradise, all with the lamps lit, emblem of faith. The choice of the subject probably draws inspiration from the local legend of the fons olei, according to which in the 1st century BC, at the point where the basilica was later built, a source of oily liquid emerged from the earth
Functional Outcome after odontoid fractures in the elderly
No full textWhile several papers on mortality and the fusion rate in elderly patients treated surgically or non-surgically for odontoid fractures exist, little information is available on quality of life after treatment. The aim of treatment in these patients should not be fracture healing alone but also quality of life improvement. A literature search using PubMed identified seven papers including information on functional evaluation of 402 patients. Patients treated with anterior screw fixation had a good functional outcome in 92.6% of cases. This percentage seemed to decrease in octogenarians. Less information was available for patients treated with posterior approaches; it would seem that up to a half of such patients experienced pain and limitations in activities of daily living after surgery. Patients treated with a halo device had a functional outcome that was worse (or at least no better) than that of patients treated with surgery, with absence of limitations in activities of daily living in 77.3% of patients. Patients treated with a collar had a good functional outcome in the majority of cases, with absence of limitations in activities of daily living in 89% of patients. More studies are needed for evaluation of functional outcome, especially in patients treated with a collar, a halo device or a posterior approach
Role of 11C Methionine Positron Emission Tomography (11CMETPET) for Surgery and Radiation Therapy Planning in Newly Diagnosed Glioblastoma Patients Enrolled into a Phase II Clinical Study
No full text(1) Background: We investigated the role of [11C]-methionine PET in a cohort of newly diagnosed glioblastoma multiforme (GBM) patients to evaluate whether it could modify the extent of surgical resection and improve radiation therapy volume delineation. (2) Methods: Newly diagnosed GBM patients, ages 18–70, with a Karnofsky performance scale (KPS) ≥ 70 with available MRI and [11C]-methionine PET were included. Patients were treated with different amounts of surgical resection followed by radio-chemotherapy. The role of [11C]-methionine PET in surgical and RT planning was analyzed. A threshold of SUVmax was searched. (3) Results: From August 2013 to April 2016, 93 patients were treated and included in this analysis. Residual tumor volume was detected in 63 cases on MRI and in 78 on [11C]-methionine PET, including 15 receiving gross total resection. The location of uptake was mainly observed in FLAIR abnormalities. [11C]-methionine uptake changed RT volume in 11% of patients. The presence of [11C]-methionine uptake in patients receiving GTR proved to influence survival (p = 0.029). The threshold of the SUVmax conditioning outcome was five. (4) Conclusions: [11C]-methionine PET allowed to detect areas at higher risk of recurrence located in FLAIR abnormalities in patients affected by GBM. A challenging issue is represented by integrating morphological and functional imaging to better define the extent of surgical resection to perform
Growth and rupture of an intracranial aneurysm: the role of wall aneurysmal enhancement and CD68+
No full textIntroductionIntracranial aneurysms occur in 3%–5% of the general population. While the precise biological mechanisms underlying the formation, growth, and sudden rupture of intracranial aneurysms remain partially unknown, recent research has shed light on the potential role of inflammation in aneurysm development and rupture. In addition, there are ongoing investigations exploring the feasibility of employing new drug therapies for controlling the risk factors associated with aneurysms. CD68, a glycosylated glycoprotein and the human homolog of macrosialin, is prominently expressed in monocyte/macrophages within inflamed tissues and has shown potential application in oncology. An observational study was conducted with the aim of comparing the histological characteristics of aneurysm walls with preoperative MRI scans, specifically focusing on CD68 activity.MethodAn observational pilot study was conducted to investigate the histological characteristics of the aneurysm wall that could be potentially associated with aneurysm growth and rupture. A total of 22 patients diagnosed with ruptured and unruptured intracranial aneurysms who had undergone conventional clipping between January 2017 and December 2022 were included in the study.ResultsA histopathological analysis of the aneurysm wall was performed in all patients, particularly focusing on the presence of CD68. A preoperative MRI with gadolinium was conducted in 10 patients with unruptured aneurysms and six patients with ruptured aneurysms. An emergency clipping was performed in the remaining six patients. The results showed that CD68 positivity and wall enhancement were significantly associated with intracranial aneurysm wall degeneration, growth, and rupture.ConclusionThe histological and radiological inflammatory findings observed in the wall of cerebral aneurysms, as well as the CD68 positivity, are significantly associated with the risk of intracranial aneurysm growth and rupture. This study highlights the crucial importance of considering clinical and medical data when making treatment decisions for intracranial aneurysms. Furthermore, it emphasizes the relevance of evaluating wall enhancement in MRI scans as part of the diagnostic and prognostic process
Multimodal Intraoperative Neurophysiological Monitoring in Intramedullary Spinal Cord Tumors: A 10-Year Single Center Experience
No full textObjective: The study aimed at evaluating the efficacy and the ability of D-wave monitoring combined with somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) to predict functional outcomes in intramedullary spinal cord tumor (IMSCT) surgery. Methods: Between December 2011 and December 2020, all patients harboring IMSCT who underwent surgery at our institution were prospectively collected in a surgical spinal registry and retrospectively analyzed. Patient charts and surgical and histological reports were analyzed. The multimodal IONM included SSEPs, MEPs, and—whenever possible—D-waves. All patients were evaluated using the modified McCormick and Frankel grade at admission and 3, 6, and 12 months of follow-up. Results: Sixty-four patients were enrolled in the study. SSEP and MEP monitoring was performed in all patients. The D-wave was not recordable in seven patients (11%). Significant IONM changes (at least one evoked potential modality) were registered in 26 (41%) of the 64 patients. In five cases (8%) where the SSEPs and MEPs lost and the D-wave permanently dropped by about 50%, patients experienced a permanent deterioration of their neurological status. Multimodal IONM (SSEP, MEP, and D-wave neuromonitoring) significantly predicted postoperative deficits (p = 0.0001), with a sensitivity of 100.00% and a specificity of 95.65%. However, D-waves demonstrated significantly higher sensitivity (100%) than MEPs (62.5%) and SSEPs (71.42%) alone. These tests’ specificities were 85.10%, 13.89%, and 17.39%, respectively. Comparing the area under ROC curves (AUCs) of these evoked potentials in 53 patients (where all three modalities of IONM were registered) using the pairwise t-test, D-wave monitoring appeared to have higher accuracy and ability to predict postoperative deficits with strong statistical significance compared with MEP and SSEP alone (0.992 vs. 0.798 vs. 0.542; p = 0.018 and p < 0.001). Conclusion: The use of multimodal IONM showed a statistically significant greater ability to predict postoperative deficits compared with SSEP, MEP, and D-wave monitoring alone. D-wave recording significantly increased the accuracy and clinical value of neurophysiological monitoring in IMSCT tumor resection
THE DENTATE NUCLEUS AND THE FLEECE OF STILLING: NARRATIVE REVIEW ON THE HISTORY OF INTRACEREBELLAR WHITE MATTER ANATOMY
No full textIntroduction: The cerebellum harbors a variety of different functions, ranging from motor to cognitive and linguistic skills. This complex functional landscape is founded on an intricate and specific architecture of intracerebellar white matter fibers surrounding the dentate nucleus, which is extremely difficult to visualize with modern imaging techniques. Though, surgeons may greatly benefit from detailed knowledge of this anatomy. Historic studies have proved how anatomic dissections allow an accurate study of intracerebellar white matter bundles, providing essential information about the relations between dentate
nucleus, cerebellar cortex and cerebellar peduncles. Throughout the centuries, the concept of dentate capsule, the so called Fleece of Stilling, has been demonstrated by multiple Authors but has been neglected in recent times.
Materials and Methods: An extensive historical literature research was conducted through multiple digital libraries, searching for complete digitalized works of selected historical anatomists, with the specific goal of reconstructing the evolution of knowledge relative to intracerebellar white matter architecture from the second half of the XVIIIth century to recent years. Key Authors have been selected and their original works were studied and reviewed.
Results: Essays and atlases from Malacarne, Vicq d’Azyr, Reil, Meckel, Arnold, Stilling, Cajal, Dejerine and Jakob were collected. Their anatomic descriptions and illustrations were discussed and detailed, demonstrating their discoveries about intracerebellar white matter anatomy.
Conclusion: Information deriving from studies performed by the major anatomists of the past highlights pivotal anatomical information. Integration of this knowledge with modern imaging technologies may have an important surgical impact
VENUS GENETRIX AUGUSTA Y LOS DIOSES DE HISPALIS EN LA DONACIÓN FAMILIAR DE UN DIFFUSOR OLEARIUS HACIA 146 D.C.
No full textEn este trabajo se presenta un pedestal inédito recientemente aparecido en Sevilla, dedicado por Valeria Valentina a Venus Genetrix Augusta... in honorem corporis oleariorum. Se relaciona con otro idéntico, ofrecido por su hermana Valeria Qu[arta?] a Minerva Augusta (HEp 10, 2000, 577). Ambas dicen completar con ello el cultus de un opus exornatum por su padre, (M.) Valerius Valens, que posiblemente es el mismo diffusor olearius testimoniado en tituli picti del Testaccio entre 138-153 d.C. La autora sugiere que esta donación familiar, h. 145 d.C., sería más extensa, y honraría a la tríada capitolina y a Venus Genetrix como mater de la estirpe de Julio César. Estas cuatro serían las divinidades máximas de Hispalis, teniendo en cuenta la Lex Ursonensis y el ser Hispalis, como Urso, una colonia cesariana de hacia el 45 a.C. No es descartable que junto a ellas figurara Hercules, el mítico fundador de la ciudad. Los datos arqueológicos del contexto del pedestal, probablemente casi in situ, sugieren la ubicación exacta de la sede del corpus oleariorum (de carácter más bien provincial) en el entorno de las calles Argote de Molina y Francos, dentro del llamado «foro de las Corporaciones» y cerca del Baetis. Quizá el aula de culto imperial de esta corporación se hallaba en un patio porticado del interior de este complejo de edificios. La autora sugiere finalmente una hipótesis para los debatidos diffusores olei: serían lo que hoy conocemos como «envasadores» y «mayoristas»: a la vez compradores y vendedores, poderosos y a veces con contratas estatales: ad annonam Urbis. M. Valerius Valens debió de contarse entre ellos. AbstractThis paper presents an unpublished marble pedestal recently discovered in Sevilla. Valeria Valentina dedicated it to Venus Genetrix Augusta in honorem corporis oleariorum. It is related to an identical pedestal offered by Valeria Qu[arta?], sister of the aforementioned, to Minerva Augusta (HEp 10, 2000, 577). Both pieces completed the opus exornatum offered by their father, (M.) Valerius Valens, possibly the same diffusor olearius mentioned in tituli picti from the Testaccio around 138-153 A.D. The author suggests that this family donatio, circa 145 AD, was more extend, and honoured both the capitoline triad and Venus Genetrix, mater of the lineage of Julius Caesar. These four deities according to the Lex Ursonensis were the maximi divinities in Urso. Therefore, it seems logical to think that being Hispalis another caesarian colony of 45 B.C it would have the same divinities. Furthermore, Hercules, the mythical founder of the city, could be also considered amongst the Maximi. The archaeological data from the surroundings and the context of the pedestal, probably in situ, suggest that the exact location of the headquarters of this corpus oleariorum (maybe provincial) could be underneath Argote de Molina and Francos streets, within the limits of the «foro de las Corporaciones» and near the river Baetis. It is possible that the aula for the imperial cult of this association was located in a porticoed yard inside the building complex. Finally, the author proposes an explanation for the debated diffusores olei, considering them as what we know today as «bottlers» and «wholesalers»: both buyers and sellers, powerful and sometimes with public concessions: ad annonam Urbis. M. Valerius Valens, probably from Astigi. should be counted among them.
