Acute pneumocephalus: an unusual complication of thoracotomy.

The authors describe a iatrogenic cerebrospinal fluid fistula into the pleural cavity, a rare and unusual complication of thoracic surgery. The importance of considering this diagnosis in patients who suffer from headache and altered mental status after thoracotomy and the early surgical repair of this potentially fatal complication are stressed.

Solitary plasmacytoma of the calvarium: two cases treated by operation alone.

Two cases of solitary plasmacytoma of the calvarium operated on with radical removal are reported. The two patients were not submitted to postoperative radiotherapy, unlike other cases reported in the literature. The authors stress that solitary plasmacytoma of the calvarium may have a good prognosis if radically removed, and in these cases radiotherapy is not necessary.

Acute spontaneous subdural hematomas.

Fifteen cases of spontaneous subdural hematoma are presented. A review of the literature reveals the rarity of this pathology. Symptomatological onset cannot be distinguished from the other cerebrovascular lesions. High mortality is connected with patient's consciousness level. CT scan performed in all patients presenting symptoms of cerebral stroke permitted to demonstrate this clinical entity is not so rare as the literature asserted.

[Radiotherapy of brain tumors in childhood]. / Radioterapia dei tumori cerebrali nell'infanzia.

External radiotherapy with high energy photons in children's brain tumors improves results of surgical treatment according to their histology. Radiotherapy treatment is a decisive factor in survival time and quality of life. Undifferentiated tumors with high radiosensitivity are treated when radiotherapy is the only means for recovery; tumors presenting histologically low malignancy in which effective radiotherapy treatment is uncertain and the risk of radiotherapy damage is the predominant factor. Radiotherapists who treat children's brains which in many cases are not yet totally myelinized , must have good technical ability. Literature and personal experience show that in medulloblastomas irradiation of the entire central nervous system associated with chemotherapy gives a survival time of 5 years in 50% of the cases; in glioblastomas and anaplastic astrocytomas, fortunately rare in children, results are poor; in brainstem tumors the association of the extracranial shunt to radiotherapy has improved results of survival time at 5 years to 50%. A good quality of life is frequent and radiological effects are rare. It is clear that radiotherapy has reached its maximum. Progress is still to be made thanks to discoveries of more effective radiosensitizer or radioprotector compounds.

[Radiotherapy of primary and secondary spinal tumors]. / La radioterapia dei tumori spinali primitivi e metastatici.

Radiotherapy in primary and metastatic spinal cord tumors following surgical treatment, or even without surgery, is very effective. The Authors analyse the different types of spinal tumors giving the survival time for every one. The results are related to the possible medullary damage before radiotherapy and to the sensibility of the tumor itself. The Authors emphasize the importance of two factors: 1) early diagnosis (myelography); 2) immediate therapy (high dose steroids, surgical decompression and/or radiotherapy).