Salvatore Mingrino

Effect of transcutaneous electrotherapy on CSF β-endorphin content in patients without pain problems

Abstract To test the hypothesis of opiate‐like peptide release after transcutaneous electrotherapy we measured &bgr;‐endorphin cerebrospinal fluid (CSF) content in 13 patients without pain problems. The results indicate a time dependent increase of CSF &bgr;‐endorphin in the group of patients studied. This fact suggests that the analgesic properties of the treatment may be ascribed to an involvement of the endogenous opiates system, independently from the basal clinical conditions of the patients.

Immune infiltrates and cytokines in gliomas

SummaryFrozen sections of 21 gliomas were analysed to characterize inflammatory infiltrating cells, HLA-DR antigen expression and cytokine secretion. Mononuclear cells infiltrating the tumours were mostly macrophages, which were detected in 100% of cases, and expressed HLA-DR antigens. Lymphocytes were less frequently seen and expressed the CD8 phenotype.Interleukin-1 beta (IL-1β) and Interleukin-6 (IL-6), two cytokines mainly produced by activated cells of the macrophage lineage, were demonstrated expecially in neoplastic astrocytes. IL-1β immunoreactivity was detected in all tumours, and was prevalent in more anaplastic gliomas; IL-6 was found in anaplastic gliomas and in glioblastomas. IL-1 receptors were expressed by both infiltrating macrophages and neoplastic astrocytes in the gliomas analysed. These findings suggest that cytokine production in gliomas seems not related to immune reactions against the tumour and their synthesis by anaplastic astrocytes could follow an unregulated activation of many metabolic processes after neoplastic transformation.

Subarachnoid haemorrhage of unknown aetiology.

SummaryOne hundred and forty consecutive subarachnoid haemorrhages (SAH) which presented either an intracranial vascular malformation (102 cases: aneurysm 80 cases, AVH 22 cases) or remained of “unknown aetiology” (38 cases) were studied. SAH caused by other factors (neoplasms, thrombo-embolisms, systemic diseases etc.) were excluded. The 38 cases with bleeding of “unknown aetiology” have been studied by complete cerebral angiography, pneumoencephalogram or CT scan, and have been followed for two years.The most important clinical factors in the three groups have been compared by a statistical method to verify the hypothesis that SAH of “unknown aetiology” is caused by vascular micromalformations which are angiographically not evident either because of their small size or because of their “spontaneous” recovery after bleeding due to thrombosis and disappearance of the malformation.From the data collected it may be concluded that SAH of “unknown aetiology” is a benign lesion, typically occurring in middle age, but with no clear characteristics that enable identification of the anatomical substratum from it originates.

Risk factors for cerebral glioma in adults: a case-control study in an Italian population

SummaryA case-control study on risk factors for cerebral tumors was conducted on an adult Italian population by the four Neurosurgical Departments of the Veneto Region, i.e. Padua, Treviso, Verona and Vicenza. The study recruited 195 cases of histologically-confirmed cerebral glioma. One hospital control was selected for each case. Cases and controls were matched for age, sex, date of hospitalization and residence. Information on both cases and controls was obtained from a relative. Uninvolved interviewers administered a structured questionnaire including items on the subjects education, occupation, lifestyle, medical history, exposure to radiation for diagnosis or therapy, head trauma and blood group and the medical history of family members.The series of cerebral tumors was first considered as an indistinct set: none of the risk factors examined showed a statistically significant association. A positive association was found with blood group A (OR = 6) when low-grade astrocytomas (n = 41) were considered separately. As for the malignant astrocytomas (n = 132), there was a suggestive but not statistically significant association with the presence of CNS tumors among first-and second-degree relatives (OR = 7.0).On the whole, this study yielded no clear and meaningful association for the various risk factors analyzed.

Pituitary abscesses: Report of two cases and review of the literature

SummaryTwo cases of pituitary abscess are reported. Bacteriological and histological findings of both cases are discussed, together with data available from the literature.

Selective percutaneous thermolesions of the ninth cranial nerve by lateral cervical approach: report of eight cases

Percutaneous radiofrequency thermolesion of the petrous ganglion at the jugular foramen was employed for the treatment of glossopharyngeal neuralgia in eight cases, three with essential and five with symptomatic pain from oropharyngeal cancer. Because of its technical simplicity, the lateral cervical approach was preferred to the anterior lateral approach. Immediate and subsequent surgical results were satisfactory. No neurological complication was noted, except for transitory bradycardia and hypotension during the procedure.

Alterations of facial sensitivity induced by percutaneous thermocoagulation for trigeminal neuralgia

Sixty patients with essential trigeminal neuralgia underwent selective percutaneous thermocoagulation of the gasserian ganglion. Immediate and long-term modifications of pain and tactile facila sensitivity, recurrences of pain, and occurrences of facial paresthesias were evaluated. Pin-prick and von Frey hair tests and somatosensory-evoked potentials were used to study facila sensitivity. Patients with mild alterations of sensitivity-treated with low temperatures of coagulation (60 degrees-70 degrees C)--had a lower incidence of paresthesias, although a higher risk of recurrence. Patients with severe alterations of sensitivity--a consequence of a temperature of coagulation above 70 degrees C--had a high incidence of paresthesias and a low risk of recurrence. In our opinion, the first kind of results are better.

The Acromegaly-Gigantism Syndrome Report of Four Cases Treated Surgically

Four cases of growth-hormone-secreting pituitary adenoma, with associated aspects of acromegaly and gigantism, are reported in patients aged 12-26. All of the patients had macroadenomas and were treated surgically, three by the transsphenoidal approach and one with a transfrontal craniotomy. Histologic examination revealed eosinophilic adenomas in three of the cases and a mixed eosinophilic--chromophobe adenoma in one, all with cellular irregularities (mitosis and cellular and nuclear polymorphism), local invasivity, or both. Because surgical treatment did not produce complete normalization of growth hormone levels, radiotherapy followed the operations in all four cases. In our opinion, the treatment of acromegalic gigantism poses more therapeutic problems than that of simple acromegaly, with combined treatment (surgical, radiation, and medical) often being necessary.

Cortical evoked responses and transcutaneous electrotherapy

Percutaneous electrostimulation, acupuncture, and direct stimulation of the central nervous system are supposed to be capable of reducing painful sensation by releasing enkephalins and endorphins. We treated six volunteers with electrotherapy, obtaining in all cases a clear reduction of the pain induced by electric stimulation of the median nerve at the wrist. During the treatment, the administration of naloxone, an antagonist of morphine, in four subjects provoked a short but clear and immediate return of pain. In the other two cases, the drug provoked a further decrease of the painful sensation. During electrostimulation in all patients, the somatosensory evoked potentials showed a statistically significant decrease. In the four “haloxone-responsive” subjects, the cortical evoked responses returned to basal amplitude after naloxone. In the two patients with a clinically paradoxic response, nonsignificant modification in the cortical evoked potentials was noted.

Treatment of benign intracranial hypertension

SummaryThis study is based on 11 cases with pseudotumour cerebri. In each case a high dose of Escin was administered intravenously, and the drug effect during ICP recording was observed. In seven cases the drug manifested a significant hypotensive effect. In these cases the treatment with Escin (20 mg every 8 hours) was continued for 3 days; the control if ICP after this period showed a normal pressure in all cases. Oral treatment was continued at the same dosage for 20–30 days and the patient was then discharged. All patients presented complete remission of the clinical syndrome and fundus normalization. Follow-up after a year showed no recurrence. In three cases the treatment with Escin was unsuccessful; these patients were given dexamethasone, with normalization of the syndrome. Another case that presented with a severe picture of intracranial hypertension and visual impairment was treated with Escin and dexamethasone without positive result. The patient improved with external CSF drainage, and was treated by a shunt procedure that induced remission of the syndrome.