Surgical management of previously untreated glomus jugulare tumors

The treatment of glomus jugulare tumors is controversial. Changes in the surgical treatment of glomus jugulare tumors at The House Ear Clinic have allowed complete resection in 85% of patients with minimal morbidity and no surgical mortalities. Our experience with 52 previously untreated patients with glomus jugulare tumors is reviewed. Two primary surgical techniques were used. The mastoid/neck approach was used in 9 patients with small tumors limited to the jugular bulb. The infratemporal fossa approach was used in the remaining 43 tumors. Lower cranial nerve preservation was possible in the majority of patients with normal preoperative function. Modifications in the management of the facial nerve during the infratemporal fossa approach have resulted in good recovery of facial function (House grade I/VI or II/VI) in 95% of patients. Most patients (85%) were able to fully resume all preoperative activities. Our results suggest that surgical management is the treatment of choice in younger patients with glomus jugulare tumors.     

Visual dysfunction in patients with mitochondrial myopathies

Seventeen patients with biopsy-confirmed mitochondrial progressive external ophthalmoplegia underwent electroretinography and visual evoked potential testing to checkerboard-reversal stimuli to investigate subclinical visual dysfunction. Seven patients (41%) had impaired Snellen visual acuity that was never less than 0.6. Thirteen patients (76%) showed electroretinographic and/or visual evoked potential alterations, whereas six (35%) showed impairment on both tests. Two patients showed delayed VEP P100 latency without fundus, electroretinographic or visual acuity anomalies. Visual dysfunctions were not related to age at onset and course of the disease.Abbreviations PEO progressive external ophthalmoplegia     

Spinal cord injury: some epidemiological data. A review of 233 cases.

Two hundred thirty-three consecutive cases of traumatic para- and tetraplegia admitted to a department of Neurosurgery in Naples within ten years were reviewed and categorized according to etiology, level of lesion and clinical features. The age of the patients at the time of injury varied from 7 to 74 years with a mean age of 37.1 +/- 17.1 (male mean age = 35.8 +/- 16.7; female mean age = 41.5 +/- 18.2). The male/female sex ratio was 4.8. Of these patients 66 were paraplegic and 167 were tetraplegic. The analysis of the various causes of the spinal cord injury showed that the occupational activities take the first place (32.2%); injuries in recreational activities and road accidents accounted for the majority of the remaining cases.     

Neurological and behavioral sequelae in children operated on for brain abscess

In order to characterize neurological, intellectual and behavioral sequelae better after surgical treatment of brain abscess in childhood, 32 children were studied over a 10-year time span after treatment of a brain abscess. Depending on the clinical condition, surgical treatment consisted of simple aspiration through a burr hole or of total excision after craniotomy. There were only 3 postoperative deaths (9%). The scheduled time for long-term follow-up was 3 years after surgery. The patient assessment included information concerning the presence of seizures, accurate neurological examination, an EEG, and a battery of intellectual tests to evaluate the presence of behavioral-mental deficits. Late seizures developed in 7 of the 29 survivors. Five patients presented permanent hemiparesis after surgical treatment. It is noteworthy that the intellectual impairment observed was more severe in younger patients, while the behavioral disturbances were more marked in school-age children.Presented at the 11th Meeting of the European Society for Paediatric Neurosurgery, Naples 1988     

Histological analysis of the periapical tissues of dog deciduous teeth after root canal filling with diferent materials

The problem of finding an ideal material for filling root canals of deciduous teeth has not been solved yet. This fact led to the development of an experiment to histologically analyze the periapical tissue reaction to 3 root canal filling materials. Eighty root canals of dog deciduous anterior teeth from 6 animals, 60 days old, were used in this study. After biomechanical preparation, the root canals were filled with the following materials: slowly resorbable Maisto paste, Sealer 26 with iodoform, L&C paste (calcium hydroxide with olive oil) and as a control group, canals that were prepared but not filled. At thirty days after the treatment the animals were killed and the teeth prepared for histological analysis. The materials were ranked statistically from the best to the worst as follows: a - Maisto paste, b - Sealer 26 with iodoform, c - control group, d - L&C paste. There was significant difference (p = 0.01) only when the results of the other groups were compared with the L&C paste group. It was also observed that L&C paste was not biologically compatible and that the other materials were biocompatible but their resorption was not at the same rate as that of the deciduous teeth roots.     

Precursors of atherosclerosis in children: The Cittadella study. Follow-up and tracking of total serum cholesterol,triglycerides, and blood glucose

As part of a WHO project, precursors of atherosclerosis in children, a survey was made in Cittadella, a town in Northern Italy. Four hundred and eight children (49.7% males) aged 6, 9, 12, and 15 were examined and a blood sample for total cholesterol (TC), triglycerides (TG), and blood glucose (BG) was drawn one hour after an oral glucose load of 50 g. The same procedure was performed in the same subjects 3 years later. The mean values of TC in the age groups 6, 9, 12, and 15 were 155.2, 176.1, 191.5, 170.5 mg/dl, respectively. TG values were 54.4, 53.1, 55.8, 62.2 mg/dl and BG, 108.3, 85.2, 92.1, 97.4 mg/dl, respectively. A marked fall of TC at reexamination was found in initial age groups of 12 and 15. BG levels fell significantly only in those subjects initially examined at age 6, while TG showed a longitudinal increase in all age groups, though more markedly in the younger ones. Different body composition, and possibly a secular trend, might explain these findings. The tracking analysis showed that serum TC tends to maintain its percentile with increasing age in contrast to serum TG and BG tracking which was less consistent, suggesting the influence of factors other than those affecting changes in TC.     

Interactions of norepinephrine with Purkinje cell responses to putative amino acid neurotransmitters applied by microiontophoresis

In cerebellum, the evoked responses of the Purkinje neuron to both excitatory and inhibitory afferent input are enhanced by local norepinephrine (NE) administration. To determine the nature of this synergistic interaction between NE and the synaptic inputs, Purkinje cell responses to microiontophoretically applied amino acid neurotransmitters were examined before, during, and after NE iontophoresis. NE was found to preferentially augment GABA-induced inhibition, whereas it antagonized inhibition produced by glycine. This enhancement of GABA inhibition was seen at NE doses which caused minimal change in spontaneous activity, and at times after spontaneous discharge returned to control levels following NE application. Dopamine did not facilitate the response to GABA even at doses having direct depressant effects on spontaneous discharge. Glutamate-evoked excitations and subsquent depressions were also augmented during NE administration, relative to the level of background activity. Thus, NE selectively enhanced responses of Purkinje neurons produced by microiontophoretic application of amino acids postulated to be cerebellar neurotransmitters, supporting the hypothesis that NE acts on postsynaptic processes to increase the responsiveness of the Purkinje cell to afferent input. These data also provide evidence supporting the concept that a primary effect of noradrenergic input to cerebellum may be to modulate the action of other transmitters.     

Influence of the sealer and a plug in coronal leakage after post space preparation

The subject of this paper was to conduct an in vitro study of the coronal leakage after root canal filling and post space preparation. One hundred single-rooted human teeth had their crowns removed and the canals prepared and filled by the lateral condensation technique with gutta-percha points and the sealers CRCS and Endofill (a Grossman cement). After post space preparation, the remainder of the filling was protected or not with 1mm of a plug of the following materials: Coltosol, Super Bonder (cyanoacrylate-ester), CRCS and Endofill. After 24 hours in saline, the specimens were immersed in a 2% methylene blue solution in a vacuum environment for 24 hours. The teeth were then sectioned longitudinally, leakage was evaluated linearly and the obtained data were submitted to the Kruskal-Wallis test. The results with the two sealers studied were similar between themselves and worse (p<0.01) than the groups with a protector plug. The statistical analysis ordered the experimental groups from the best to the worst in the following way: a - Endofill-Super Bonder, CRCS-Super Bonder, CRCS-CRCS; b - Endofill-Endofill; c - Endofill-Coltosol, CRCS-Coltosol; d - Endofill, CRCS.