Biagio Gallicchio

Spondylodiscitis. Clinical and magnetic resonance diagnosis.

Study Design. This study reviews 65 patients with spondylodiscitis, both spontaneous and postoperative and of different etiology, studied by magnetic resonance imaging. Objectives. To define the magnetic resonance imaging characteristics of infections of the spine in acute and chronic stages and to evaluate the role of magnetic resonance imaging in defining their etiology. Background Data. Early diagnosis of spondylodiscitis is often difficult because of the long latent period. Radiographs of the spine, bone scan, and computed tomography scan provide insufficient data. Methods. Among 65 patients with spondylodiscitis studied by magnetic resonance imaging, 24 were examined in the acute stage (clinical evolution between 7 days and 20 days), and 41 were examined in the chronic stage (3‐6 weeks). The etiologic agent was staphylococcus in eight cases, Brucella in 13, Mycobacterium tuberculosis in 29, Salmonella in four, and unknown in 11. Results. In cases observed in the acute stage, the disc and the vertebral bodies were hypointense in T1 and hyperintense in T2; this relatively constant finding was not correlated with the etiologic agent. In the chronic stage, cases caused by Brucella or of unknown etiology showed long T1 and T2 relaxation times, with precocious contrast enhancement of the disc; in cases of tubercular etiology there was slight shortening of T1, with inhomogeneous enhancement of the involved vertebral bodies and late disc enhancement. Conclusions. Magnetic resonance imaging is the investigation method of choice in diagnosing spondylodiscitis, especially in very early stages of the disorder, when other investigations still yield negative results. In chronic stages, magnetic resonance imaging also allows tubercular spondylodiscitis to be distinguished from cases of different etiology.

Cerebral edema associated with meningiomas.

Fifty patients with intracranial meningiomas have been retrospectively examined, and the cerebral edema on computed tomography scan has been correlated with the clinical evolution, size, location, and histological features of the tumor. The degree of brain edema was found to be related to the clinical evolution and the size of the tumor, whereas the histological features were less significant. These results are discussed after reviewing the data of five other series in the literature of this subject. A correlation between the tumor steroid receptors and edema is suggested.

Oestrogen and progesterone sensitivity in cultured meningioma cells.

Several studies have detected oestrogen and progesterone receptors in meningioma specimens; recently we have also confirmed the presence of steroid receptors in cultured cells from meningiomas. This paper describes the oestrogen and progesterone receptor assay in cultured cells from 6 meningiomas and the influence of steroid hormones on the cell growth and morphology. Four (66%) of the 6 specimens were positive for both receptors. Growth of cultured cells from tumours without receptors is not appreciably modified by the addition of hormones; the cultured cells from tumours with positive receptors are not essentially influenced by oestrogen, whereas progesterone produces a rapid and marked suppression of the cell growth and modifies their form and adhesivity; also the addition of an oestrogen and progesterone blend produces growth suppression. A similar effect of the progesterone on the cultured cells has also been obtained in a specimen of malignant meningioma. The results of this study suggest that the modulation of progesterone levels may be of therapeutic usefulness, particularly in patients with recurrent malignant meningiomas.

Megadolichobasilar artery and acute cerebrovascular pathology

Sixteen patients with a megadolichobasilar artery and acute cerebrovascular symptoms are reported. All were explored by computerized tomography and vertebral angiography. Nine had transient ischaemic attacks or definitive ischaemic lesions, whereas 7 had subarachnoid or intracerebral haemorrhage. Among the patients with ischaemic troubles, vertebro-basilar insufficiency and pontine infarction were the most common clinico-radiological findings. Among the patients with intracranial haemorrhage, 4 had associated aneurysms or arteriovenous malformations, while 3 had subarachnoid or intracerebral haemorrhage with no vascular malformations on the angiograms. The possible relationships between the megadolichobasilar anomaly and the cerebral ischaemic or haemorrhagic pathologies are discussed also from a review of the pertinent literature.

Estrogen and progesterone receptors in meningiomas

Estradiol and progesterone receptors were studied in 14 patients with meningiomas. Estrogen receptors were detected by specific monoclonal antibodies, whereas progesterone receptors were assayed by the dextran-coated charcoal method. In 9 cases the estrogen receptors were also investigated in cultured tumor cells. Positive estrogen and progesterone receptors were found in 86% of patients. The results have been compared with 11 published series of sex steroid assays in meningiomas. The different rate of positive results in most series can be explained by preoperative glucocorticoid therapy. There is no correlation between the estrogen and progesterone receptor activity, the sex and age of the patients, and the location and histological features of the meningioma. The authors suggest that assays of antiestrogen and antiprogestin drugs in cultured cells can indicate whether this estrogen and progesterone receptor activity may be of therapeutic use.

Coiling of the vertebral artery presenting with neuralgic pain

A rare case of radicular pain in the arm due to compression of the C6 nerve root by coiling of the vertebral artery is reported; the diagnosis was confirmed by computed tomography (CT), magnetic resonance (MR) angiography and echocolordoppler. Although the enlargement of an intervertebral foramen by a tortuous vertebral artery has been described previously, the occurrence of radicular pain is exceptional. Magnetic resonance imaging (MRI), MR angiography and echocolordoppler allow to differentiate foraminal enlargement due to vascular anomalies of the vertebral artery from that more commonly due to tumor compression, mainly from neurinoma. Surgical decompression may be considered in symptomatic cases.

Diagnosis of carotid artery occlusion by duplex scanning

This paper reviews 70 patients, with complete occlusion of the internal carotid artery, investigated by duplex scanning. The correlation between the echogenicity of the occlusion (anechogenic, hypoechogenic or hyperechogenic) and the time interval between the ischaemic symptoms and the ultrasonic investigation showed that some occlusions are hypoanechogenic and others hyperechogenic, in spite of the time interval, and consequently the echogenicity of the occlusion cannot be correlated with the time of its formation. Duplex scanning allows a correct diagnosis in almost all cases of carotid artery occlusion by comparison of the morphological and flowmetric data. The 95% sensitivity in 20 cases was explored by digital angiography also. It was concluded that angiography was usually unnecessary to confirm a carotid occlusion and its use could be limited to rare, doubtful, cases and to patients with contralateral stenosis i.e. candidates for surgery.

Fibromuscular dysplasia of the carotid arteries. Clinical and radiological considerations.

Seven patients with fibromuscular dysplasia of the carotid arteries are described. Three were asymptomatic and four had ischemic troubles. Angiographically, 3 had a fibromuscular dysplasia of type 1 and 4 of type 2; one patient also had an associated aneurysm of the cervical internal carotid artery. The neurological troubles and their pathogenesis, the angiographic findings and the differential diagnosis of this angiopathy are briefly discussed; the surgical procedures and their risks are also analyzed.

Ultrasonographic findings that predict carotid restenosis after endoarterectomy

Abstract Objective: To analyze ultrasonographic changes after carotid endoarterectomy and to relate the changes to recurrent carotid stenosis. Methods: Eighty patients who underwent carotid endarterectomy have been followed-up by duplex scanning. The B-mode ultrasonography was performed at 7 days, 1 month, 3 months, 6 months, and every 6 months after the operation. The postoperative echotomographic findings have been correlated to the appearance of the restenosis. The patients were divided into two groups: group A with postoperative restenosis (12 cases) and group B without restenosis (68 cases). The findings have been considered as normal (visibility of the suture line, and limits of the endarterectomy) and pathological (intimal flaps, lesions from clamp, residual fragments of the plaque, ectasia of the endarterectomized segment, visibility of the blood flow in the jugular vein). Results: The time of appearance of the neointima was significantly shorter in group A than in group B. The visibility of blood flow in B-mode echograms was significantly more present in patients of group A (75%) than in patients of group B (4.4%). Conclusions: This study confirms that patients with a high risk of postoperative restenosis are those with visibility of the blood flow in the jugular vein associated to early appearance of the neointima (within 3 months after the operation). On the other hand, other factors as the visibility of the suture line, the transition points between the endarterectomized portion of the vessel, the intimal flaps and the ectasia of the treated segment are not correlated to the appearance of restenosis.

Transient visual symptoms and carotid artery disease. Exploration by real-time B-mode echotomography.

The real-time B-mode echotomographies of 100 patients with transient visual symptoms have been reviewed and their findings have been compared with those of other 100 patients with transient ischemic attacks, who never had visual disturbances in their clinical history. The rate of pathologic echotomographies was higher in the group of patients with transient visual symptoms (72%), who also had a higher percentage (50% of the positive cases) of small or mild plaques without significant hemodynamic effects. The amaurosis fugax, particularly when associated with hemispheric ischemic symptoms, should suggest a carotid disease. The non-invasive exploration by real-time B-mode echotomography and Doppler with spectral analysis is the method of choice for the diagnosis of patients with transient visual symptoms.