[Managing the hospitalizations for older patients in University Hospital of Pisa]. / L'andamento dei ricoveri ordinari relativi ai pazienti anziani in un' Azienda Ospedaliera di Alta Specializzazione.

We have analyzed hospitalizations of older people (> 64) from 2002 to 2005. Patients, discharges and stay in hospital have increased, the variation has been statistically significant. We have noticed the same trend about the rehospitalizations. Patients and discharges coming from ASL 5 and zone 4 have decreased in relation with all the elderly people. The reduction of stay in hospital and the decrease of rehospitalizations have been statistically significant.

Cerebrospinal rhinorrhea in a patient with a posterior cranial fossa tumor.

A rare case of a meningioma of the posterior margin of the petrous temporal bone associated with cerebrospinal fluid rhinorrhea is presented. After a careful review of the literature, the possible pathogenesis of the fistulous tract is discussed.

Cerebral gliosarcomas: correlation of computed tomographic findings, surgical aspect, pathological features, and prognosis.

The cases of 5 patients with cerebral gliosarcomas examined by computed tomography are reported and the correlations among the computed tomographic (CT) findings, the surgical and histological aspects, and the prognosis are discussed. In some patients, these tumors appear on CT scan as intracerebral lesions, with large necrotic areas and peripheral contrast enhancement; this CT aspect, similar to that of glioblastomas, corresponds to a diffusely infiltrating growth of the tumor and the prevalence of a gliomatous component. In other patients, the tumor appears on the CT scan as a hyperdense mass with well-defined margins and homogenous contrast enhancement; this CT finding, which may mimic that of a meningioma, corresponds to a rather well-demarcated surgical aspect and the prevalence of sarcomatous component. In our series, we have also noticed a more prolonged survival in a patient with a CT aspect that suggested a meningioma and prevalence of the sarcomatous component.

Serum and cerebrospinal fluid enzymes in subarachnoid haemorrhage.

Serum levels of creatine kinase (CK) and its isoenzyme CK-MB, lactate dehydrogenase (LDH), hydroxybutyric dehydrogenase (HBDH), glutamic oxalacetic transaminase (GOT) and glutamic pyruvic transaminase (GPT) were studied in 50 patients with subarachnoid haemorrhage. In 18 cases the cerebrospinal fluid (CSF) was also examined for total concentration of CK and CK-MB. The results were correlated with the degree of neurological deterioration, the angiographic spasm and prognosis. Concurrent increase of CK-MB, LDH and HBDH serum levels indicates a poor prognosis, whereas increase of GOT and GPT does not have clinical significance. High CK-MB levels in CSF were associated with the worst clinical evolution. However, increase of serum enzymes coincided in most cases with the appearance of the spasm. Monitoring of CK-MB, LDH and HBDH serum levels can be useful for following the evolution of the spasm and in predicting the outcome for patients with subarachnoid haemorrhage.

Microsurgical nervous reconstruction using autografts: a two-year follow-up.

BACKGROUND: To analyze factors influencing surgical results after microsurgical reconstruction of injured nerves. METHODS: We report a series of 32 cases of microsurgical nerve reconstruction after traumatizing lesions using nervous autografts. The series comprises 8 reconstructions of radial nerve, 8 of median nerve, 6 of ulnar, and 10 of sciatic nerve. Motor and sensitive deficits have been evaluated preoperatively using a standard grading. RESULTS: A useful sensory recovery has been obtained in radial nerve, as well as in median and ulnar nerve reconstruction. Good results regarding the motor recovery have been obtained in superior limb nerve reconstruction. Sciatic nerve reconstruction showed the worse results. CONCLUSIONS: There is a big discrepance between superior limb vs inferior limb results. A more than 10 cm gap has a negative influence on the progression of regenerating axons, especially in median and ulnar nerves.

Chronic subdural haematoma after spinal anaesthesia. Case report.

In this study an interesting and not frequent case of non-traumatic chronic subdural haematoma after spinal anaesthesia is reported. After a careful review of the cases described in the literature, the Authors discussed the physiopathological mechanisms, emphasizing how the break of the bridge veins or of the subarachnoid granulations, the cerebral atrophy and the dehydration are factors which facilitate the appearance of this neurological complication. They suggest that a suitable post-operative rehydration is an important prevention factor.

Symptomatic tension pneumocephalus after evacuation of chronic subdural haematoma: report of seven cases.

We present seven cases of tension pneumocephalus developing after burr hole evacuation of chronic subdural haematoma. After a careful review of the literature we discuss the physiopathology, the diagnosis and the treatment of this complication of chronic subdural haematoma surgery.

Intracranial meningeal melanocytoma: case report.

A case of meningeal melanocytoma of the left sphenoid wing is reported and the other nine cases in the literature are reviewed. Meningeal melanocytoma is a benign melanotic tumor that derives from the melanocytes of the leptomeninges and may occur anywhere in the cranial and spinal meninges. Electron microscopy well demonstrates melanin and melanosomes within the tumor cells. The immunohistochemical pattern of this tumor includes strong positivity for S-100 protein, vimentin, and antimelanoma antibody and negativity for epithelial membrane antigen, neuron-specific enolase, cytokeratin, and glial fibrillary acidic protein. Complete surgical removal is the treatment of choice, whereas radiotherapy is usually unnecessary. In spite of benign biologic behavior of meningeal melanocytoma, the prognosis remains uncertain, because of the possible local recurrences.

Cystic lesions associated with meningiomas.

Three cases of meningiomas associated with large cysts are reported, and 58 other cases from the literature are reviewed. The etiology of these cysts is analyzed on the basis of surgical and pathological findings. The preoperative diagnosis of large computed tomographic hypodensities associated with meningiomas and the differential features from other cystic tumors are discussed. The surgical aspect of the solid tumor and particularly the absence of a capsule separating the tumor from the cyst are usually decisive in confirming the intratumoral nature of the cyst. In questionable cases a histologic evaluation of the cyst walls may be necessary.

[Pituitary invasive adenoma in a child. Case report of unusual extensive invasion of the orbit (author's transl)]. / Adénome invasif hypophysaire chez un enfant. A propos d'un cas rare d'extension à l'orbite.

A rare instance of pituitary invasive adenoma in a child has been reported; the unusual age of the patient and then the rarity of the orbit invasion has been emphasized. It has been further pointed out the histologically benign nature of the neoplasm, which on contrast behaves like a malignant adenoma, according to its rapid and serious anatomo-clinical evolution.

Giant spinal ependymoma. A case report.

A case of a very extensive spinal ependymoma, treated by operation and irradiation with good outcome, is reported and the other cases in the literature are reviewed. In patients with giant spinal ependymomas, operation is always necessary, whatever the extent of the tumour, although the removal is often incomplete. Nevertheless, even partial removal sometimes brings about a neurological improvement, because of the favourable effect of the laminectomy. Postoperative irradiation is useful in cases with the histological appearance of malignancy.