Antonio Riccio

CCNU-chemotherapy of hemispheric supratentorial glioblastoma multiforme

One hundred and three patients with hemispheric supratentorial glioblastoma multiforme were studied. All patients were operated on and a histologic diagnosis of glioblastoma multiforme was made. Patients were randomly placed in one of three treatment schedules within 3 weeks of surgery: Group A: combined radiation therapy and drug (CCNU) therapy (26 cases); Group B: CCNU given orally every 6–8 weeks (27 cases); Group C: standard radiation therapy alone (50 cases). All patients were periodically controlled by clinical and instrumental (EEG, scan, EMG, CAT) evaluations; laboratory data examinations were also frequently performed. The treatment results have been evaluated according to length of survival, social quality of life, and positive or negative response to chemotherapy. In our opinion the clinical findings are interesting but the statistical results are somewhat negative, especially when the groups of patients are not homogeneous.

Mucocele of neurosurgical interest : clinical considerations on five cases

SummaryThe authors present five patients with mucocele, submitted to neurosurgery. Two had mucoceles spreading from the frontal and/ or the anterior ethmoidal sinuses and had only compressive mass symptoms, either on the ocular globe or on the frontal lobe or on both. Three patients had mucoceles growing from the sphenoid and/ or posterior ethmoidal sinuses. In these latter, the mass symptoms were less evident. All the patients suffered excruciating retro-ocular pain and two presented cranial nerve damage.The correct diagnosis in these cases is crucial to avoid a too aggressive treatment since these patients are generally sent to a neurosurgeon for a suspected cranial base malignancy or an invasive pituitary adenoma. The principles of a correct differential diagnosis and of operative treatment are outlined based on an analysis of the literature and the authors experience.

Establishment, characterization and chemosensitivity of two human glioma derived cell lines

SummaryTwo continuous human glioma derived cell lines, LI and DF, were established in our laboratory. Both cell lines showed cytological features andin vitro behavior similar to those of the respective original neoplasms. These two lines were characterized for their main biological properties includingin vitro andin vivo growth rate, clonogenic ability and tumorigenicity in nude mice. The plating efficiencies were generally high both during exponential and stationary growth phases and a high tumorigenicity was observed. All injected nude mice developed tumors. The two lines were tested for chemosensitivity to 1,3-bis(2-chloroethyl)-1-1nitrosourea (BCNU) and cis-Diamminedichloroplatinum II (DDP).Heterogeneity in biological features and in drug sensitivity was observed. Exposure of the two lines to BCNU and DDP showed that the glioblastoma (LI) was less sensitive than the anaplastic astrocytoma (DF). For both lines BCNU was more effective on cells in plateau than in exponential phase, while the killing effect of DDP was not phase-dependent.

The potential role of lonidamine (LND) in the treatment of malignant glioma. Phase II study.

SummaryUp-to-date unsatisfactory results obtained in multimodality treatments of malignant glioma have prompted the research of new therapeutic modalities with ‘unconventional’ modes of action. Lonidamine (LND) is a drug which reduces aerobic glycolytic activity in both human and experimental tumors. This effect mainly depends on the inhibition of mitochondrially-bound hexokinase (HK) which is present in large amounts in malignant cells. A Phase II study was conducted on patients with recurrent glioma; 12 patients were admitted to the study. Clinical side effects were moderate, necessitating a reduction of the dosage in only 1 case. The objective results were evaluated according to the indications of Levin. 2 responders and 3 cases of stable disease were observed out of 10 evaluable patients. The potential value of this new drug is discussed.

Computed tomographic cisternography with iopamidol in the diagnosis of primary empty sella

Twenty-one patients with primary empty sella were studied with computed tomography iopamidol cisternography. Ten milliliters of iopamidol at a concentration of 200 mg I/mL was administered intrathecally via the lumbar route. Eleven patients had a partial and 10 a complete empty sella. In six cases the third ventricle had prolapsed to the level of the interclinoid plane. There was no relationship between the clinical presentation and the grade of empty sella. The quality of the images obtained was always good or excellent. Cisternographies were performed in all of the patients although in 13 of them the correct diagnosis could have been achieved with a standard contrast-medium-enhanced computed tomography scan. The overall complication rate was 29%. Four patients (19%) had mild headaches and nausea; two patients (10%) had more severe side effects: vomiting, discomfort, and meningism. Computed tomographic cisternography with low-concentration iopamidol is a safe diagnostic procedure that allows a definite visualization of the anatomic alterations that occur in patients with empty sella. We think that this procedure should always be employed in symptomatic patients.

Spinal Chordomas in Infancy

Chordomas are extremely rare among the spinal tumors in pediatric age. The sacrococcygeal region is the typical site of such a lesion. A case of spinal chordoma in a child 4 years old, at the T12

Bone tumors of the base of the skull with ocular symptoms

Primitive bone tumors of the skull base are rare and usually discovered too late to allow definite surgical procedures. the authors present here three characteristic cases out of their series: chondroma of the middle clanial fossa, en plaque meningioma of the sphenoid ridge, and giant osteoma of the sphenoid.The first tumor was operated via a combined extra-intradural approach and was removed partially because of internal carotid artery and cavernous sinus involvement. the others were removed radically via unilateral and bilateral extradural approaches.The cranial base was reconstructed with autologous bone grafts taken from the inner surface of the bone flap. In the latter cases a prompt diagnosis allowed the patients to be cured with safe surgical procedures. the cosmetic and functional results are good. the cranial nerves are never severely damaged during operation and if pre-operatively impaired, they almost always recover their function.

High dose polichemotherapy with autologous bone marrow transplantation in recurrent medulloblastoma. A pilote study

Despite the rising survival rate, no therapeutic regimen available at present can cure recurrent medulloblastoma, and the late effects of the current treatments are largely unknown. Thus the management of medulloblastoma remains a perplexing problem.