Nutritional Traits, Pasting Properties and Antioxidant Profile of Selected Genotypes of Sorghum, Oat and Maize Eligible for Gluten-Free Products

The technological and nutritional traits of food-grade sorghum hybrids, hulled/naked oat varieties and maize genotypes of different colors were studied for novel and healthier gluten-free foods. Oat genotypes showed the highest protein content, followed by maize and sorghum. The total starch and the total dietary fiber content were quite similar among the three species. Great variation was found in the amylose content, and the highest was in sorghum (27.12%), followed by oat 16.71% and maize 10.59%. Regarding the pasting profile, the rank of Peak Viscosity was sorghum (742.8 Brabender Unit, BU), followed by maize (729.3 BU) and oat (685.9 BU). Oat and sorghum genotypes had similar average breakdown (407.7 and 419.9 BU, respectively) and setback (690.7 and 682.1 BU, respectively), whereas maize showed lower values for both parameters (384.1 BU and 616.2 BU, respectively). The total antioxidant capacity, only in maize, significantly correlated with total flavonoid, phenolic and proanthocyanidin contents, indicating that all the measured compounds contributed to antioxidant capacity. The study indicated the importance of sounding out the nutritional and technological characteristics of gluten-free cereals in order to select suitable cultivars to be processed in different gluten-free foods with better and healthier quality.

Valorization of Two African Typical Crops, Sorghum and Cassava, by the Production of Different Dry Pasta Formulations

Mediterranean diet is changing to keep up with the increasingly multiethnic Italian society. With food being considered as a means of integration, innovative foods capable of mixing different raw materials could be of interest. In this work, some of the most consumed African foods such as sorghum, cassava, and durum wheat were used to produce wholegrain spaghetti to valorize their nutritional and sensorial aspects and to combine Italian and foreign tastes. Different pasta formulations (cassava, semolina, cassava:semolina, cassava:sorghum, cassava:durum wheat whole meal, sorghum:semolina) were developed and compared for their content of proteins, total starch, resistant starch, amylose, fiber, total antioxidant capacity, ash, cooking quality and sensorial characteristics. The enrichment of cassava flour with durum wheat and sorghum wholegrain enhanced the total antioxidant capacity, protein, and fiber content with respect to 100% cassava pasta. The presence of cassava or sorghum resulted in a high diameter variability of pasta samples, lower water absorption, and shorter optimal cooking time with respect to semolina pasta. Sensory evaluation of cooked pasta revealed better scores in blends containing semolina. Although the obtained pasta samples were interesting for their nutritional aspects, further adjustments are required in the pasta-making process to improve pasta quality.

Ancient Caucasian Wheats: A Contribution for Sustainable Diets and Food Diversity

Through the centuries, the domestication and modern breeding of wheat led to a significant loss of genetic variation in the cultivated gene pool with a consequent decrease in food diversity. Current trends towards low-input and sustainable agriculture call for the revitalization and exploitation of ancient wheats, which represent a reservoir of biodiversity useful to ensure sustainable wheat production in the context of climate change and low-input farming systems. Ancient Caucasian wheat species, such as the hulled wheats Triticum timopheevii (tetraploid A^uA^uGG) and Triticum zhukovskyi (hexaploid A^uA^uA^mA^mGG), are still grown to a limited extent in the Caucasus for the production of traditional foods. These Caucasian wheats were grown in Italy and were analyzed for physical, nutritional and technological characteristics and compared to durum wheat. Both Caucasian species revealed a high protein content (on average 18.5%) associated with a low gluten index, mainly in T. zhukovskyi, and test weight values comparable to commercial wheats. The total antioxidant capacity was revealed to be the double of that in durum wheat, suggesting the use of ancient Caucasian wheats for the production of healthy foods. Finally, the technological and rheological results indicated that Caucasian wheats could be potential raw material for the formulation of flat breads, biscuits and pasta.

Innovative Milling Processes to Improve the Technological and Nutritional Quality of Parboiled Brown Rice Pasta from Contrasting Amylose Content Cultivars

The demand for gluten-free products, including pasta, is increasing and rice pasta accounts for the largest share of this market. Usually, the production of rice pasta requires additives or specific technological processes able to improve its texture, cooking quality, and sensory properties. In this work, two rice cultivars, with different amylose content, were subjected to parboiling, micronization, and flour air fractionation to obtain brown rice pasta, without any supplement but rice itself. In particular, two types of pasta (spaghetti shape) were produced, one from 100% micronized wholemeal, and the other from refined rice flour replaced with 15% of the air-fractionated fine fraction. Regardless of the cultivar, pasta from wholemeal micronized flour showed higher protein and fiber content than refined flour enriched with fine fraction, whereas no differences were revealed in resistant starch and antioxidant capacity. Pasta from the high amylose content genotype showed the highest resistant starch content and the lowest predicted glycemic index along with sensorial characteristics as good as durum semolina pasta in fine fraction enriched pasta. Besides the technological processes, pasta quality was affected the most by the genotype, since pasta obtained from high amylose cv Gladio resulted in the best in terms of technological and sensory quality.

Using Einkorn and Tritordeum Brewers' Spent Grain to Increase the Nutritional Potential of Durum Wheat Pasta

Brewers' spent grain (BSG), the major by-product of the brewing industry, can be used as a functional ingredient to increase the nutritional value of cereal-based products. In this work, micronized BSG from the einkorn and tritordeum brewing processes were characterized and used to produce four macaroni pasta formulations enriched with BSG at ratios of 5 g and 10 g/100 g of semolina. Einkorn BSG showed the highest values for all the parameters analyzed-proteins, total dietary fiber (TDF) and total antioxidant capacity (TAC)-except for β-glucan. TDF increased up to 42 and 68% in pasta samples enriched with 10% of BSG from tritordeum and einkorn, respectively. The replacement of 10% of semolina with BSG from both cereals significantly increased the β-glucan content and TAC values. Finally, the addition of BSG from einkorn and tritordeum affected to a minimal extent the sensory properties of cooked pasta, which showed higher values of optimal cooking time and cooking loss, but lower total organic matter compared to semolina pasta. Results from the sensorial judgment fell in the good quality ranges for durum wheat pasta; the incorporation of 10% of einkorn BSG resulted in the best compromise in terms of technological, nutritional and sensorial aspects of enriched pasta.

Establishment of a Human Medulloblastoma Cell Line (Bo-101) Demonstrating Skeletal Muscle Differentiation

A permanent cell line, BO-101, was derived from a classic vermian medulloblastoma in a 9-year-old child. This line grew in vitro in adherent cultures and grew in athymic mice as serially transplantable intracranial and subcutaneous xenografts. Intracranial neoplasms grew as masses of small cells, which focally showed large cells with intense immunoreactivity for desmin, myoglobin and α-striated actin. The rhabdomyoblastic nature of these cells was confirmed ultrastructurally. The primary neoplasm showed immunoreactivity for synaptophysin, neuron-specific enolase and vimentin. A large panel of monoclonal antibodies and antisera against neuronal and glial antigens failed to show glial and neuronal immunoreactivity in the cell culture and xenografts. Despite the marked genotypic and phenotypic differences, the original neoplasm and the cell line share a common chromosomal marker del (12) (p 13.1). The BO-101 line differs phenotypically and genotypically from previously established medulloblastoma cell lines and further supports the heterogeneous biologic proprieties of the cell populations that constitute these neoplasms.

N-MYC and C-MYC Oncogenes Amplification in Medulloblastomas. Evidence of Particularly Aggressive Behavior of a Tumor with C-MYC Amplification

N-myc and c-myc amplification was investigated in 27 medulloblastomas. DNA was extracted from 19 formalin fixed and paraffin embedded tumors and from fresh frozen tumor tissue in 8 other cases. The results showed no evidence of amplification of N-myc oncogene and only 1 case had a 27 fold amplification of c-myc. Cytogenetically, this neoplasm presented numerous double minute chromosomes (DMs). Moreover, it had an unusual rapidly aggressive course with massive cerebrospinal fluid dissemination unresponsive to intrathecal chemotherapy. Our results indicate a low incidence of N-myc and c-myc gene amplification in medulloblastomas, suggesting that the oncogenic mechanism in these neoplasms is not closely related to DNA gene amplification. C-myc amplification, although not frequently observed, may however provide a growth advantage for medulloblastoma cells in vivo, favoring their rapid dissemination. Medulloblastomas with c-myc activation may represent a subgroup of tumors with a more aggressive behavior.

Childhood spinal glioblastoma multiforme with intracranial dissemination. A case report

Primary spinal cord tumors in children are uncommon and account for approximately 5% of all pediatric central nervous system tumors. Intracranial metastases from primary spinal cord tumors have rarely been reported. Spinal cord glioblastoma in children mainly involves the thoracic region, whereas involvement of the medullaris conus with intracranial dissemination has been described in six cases. This paper describes a pediatric case of thoracic glioblastoma multiforme with intracranial dissemination in the early stage of the clinical course and discuss the clinical and neuroradiological manifestations, the possible patterns of dissemination and finally to consider the therapeutic implications.

Occipital aneurysmal bone cyst secondary to eosinophilic granuloma

We describe the case of a 2-year-old male patient with an aneurysmal bone cyst (ABC) of the occiput secondary to unifocal eosinophilic granuloma (EG). The lesion presented as a painless mass of the scalp which had grown rapidly over the 2 weeks prior to admission. Radiologically, the lesion was osteolytic and multicystic with fluid-fluid levels. On histology, the cyst wall contained hemosiderin-laden histiocytes, spindle cells, multinucleated giant cells, Langerhans' cells and eosinophils. Surgical treatment consisted of en bloc resection. Fourteen months after surgery, the patient was well with no local recurrence. Association between EG and ABC is rare. To our knowledge, this is the first case involving the skull.

Cerebrospinal fluid shunt infections in infants

Infection remains a major cause of morbidity and mortality following CSF shunt procedures. In this study 191 shunt procedures carried out from January 1981 to December 1992 in a series of 81 infants (less than 6 months old) were retrospectively analyzed for possible risk factors. The overall surgical infection rate was 7.8%, with 15 infections occurring in 14 patients (17.2%). No significant difference in the rate of infections was found in relation to sex, birth weight, gestational age, and type of shunt procedure (primary insertion/revision). The occurrence of other infections during the period of shunt surgery did not influence the infection risk either. Intraventricular hemorrhage and central nervous system infections as causes of the hydrocephalus were found to correlate with septic risk. Young age (less than 6 months) seems to represent the main risk factor, and this is related both to the immunologic deficiency and to the particular features of residential bacterial flora in this age group.

Results of surgery in children with cerebral cavernous angiomas causing epilepsy

Epilepsy is the most frequent presenting symptom of cerebral cavernous angiomas or cavernomas, and surgical removal of these vascular malformations is considered the treatment of choice in patients with intractable or long-standing seizures, or in those with poor compliance to medical therapy. In this paper the results of surgical treatment in 11 children with seizures from cerebral cavernomas are reported. Surgery for deep-seated cavernomas was aided in 3 cases by a stereotactic localization technique, that allowed a limited approach with minimal brain damage. Major morbidity and mortality were absent; follow-up ranged between 1 to 16 years. Improved seizure control was seen in all the patients: eight (72%) became seizure-free with the same preoperative therapy; one became seizure-free with a lower drug dosage, and two (18%) were seizure-free without medical therapy. The removal of cavernomas prevented the risk of haemorrhages or further deficits from growth and, above all, avoided spreading and autonomization of the epileptogenic area induced by the cavernoma.

Surgical management of cerebral cavernous angiomas causing epilepsy

Epilepsy is the most frequent presenting symptom in patients with cerebral cavernous angiomas. Surgical removal of these vascular malformations causing epilepsy is usually recommended for patients with disabling, intractable seizures, while conservative management is indicated for neurologically intact patients with well controlled seizures. In this paper is reported a retrospective series of 36 patients suffering epilepsy from cerebral cavernous angiomas, and admitted at our Institution between 1975 and 1992. All patients were surgically treated; mortality and morbility were absent. The mean follow-up period was 5.9 years, since the 36 patients were alive and available for a control review in December, 1993. Seizure outcome of the patients resulted in a complete cure of the epileptic disorders in 9 (25%), improved seizure control with decreased medication in other 11 (30.5%), and epilepsy control with the same preoperative therapy in the remaining 16 (44.5%) patients. Furthermore, patients with preoperative neurological signs associated to epilepsy resulted improved. The authors conclude that surgery, where it is unlikely to cause neurological deficits, may allow a definitive cure of epilepsy in patients with cerebral cavernous angiomas, preventing the possible risks from hemorrhage and mass effect.

Surgical management of cavernous angiomas in children

Cavernous angiomas are vascular malformations affecting any part of the central nervous system (CNS). The management of asymptomatic cavernous angiomas is still debated due to their poorly understood natural history, although more data are now available regarding results of surgical treatment in symptomatic cases. The authors report their surgical experience with 18 pediatric patients operated on for symptomatic CNS cavernous angiomas. The children ranged in age from 10 months to 17 years, without a relevant sex difference. Cavernous angiomas were intracranial in 17 cases: 15 being in the supratentorial compartments and two in the cerebellum. Clinical manifestations were as follows: seizures in 11 cases, focal neurologic deficits in five, and headache in one. The 18th case was observed in a girl showing paraparesis in the spinal subdural-extramedullary space at T8-T9 level. Excision of four deep cerebral lesions was performed after stereotactic localization through non-eloquent cortex. Pathologic confirmation of cavernous angiomas was obtained in all patients. Mortality from surgical procedures was absent in this series. The follow-up period ranged from 1 to 16 years. All 11 epileptic patients obtained seizure control; improvement or stabilization of neurologic symptoms was observed in the remaining seven patients.

Regressing intracranial carotid occlusions in childhood

Though detected with increasing frequency, intracranial carotid artery dissection remains less common in infancy. We report on 3 otherwise healthy children aged 8, 12 and 15 years who presented with focal headache and stroke secondary to intracranial carotid occlusive disease consistent with arterial dissection. In 2 cases this was precipitated by strenuous physical exertion. The protean angiographic configuration included long tapered narrowing with focal stenosis, beaded narrowing with Moya Moya vascular network and 'string sign'; occlusion of the anterior cerebral artery was always present. Control angiograms revealed complete or partial recanalization in all cases suggesting self-healing dissection. The clinical course was smooth in all patients, and at long-term follow-up (5, 3, and 2 years) they remain in good neurological condition. Although intracranial carotid dissection has a poor reputation, regression to normal and fair outcome may sometimes occur as in the extracranial counterpart, suggesting the existence of benign forms of the disease. Surgical procedures should be weighed against the spontaneous resolution of the lesion.

Primary intrasellar germinoma: case report

Intracranial germinomas arising primarily within the sella turcica are extremely rare. Preoperative diagnosis is difficult to establish even with sophisticated procedures. Diabetes insipidus is the main clinical manifestation. The authors report a case of an apparently primary intrasellar germinoma causing subclinical pituitary apoplexy in a 12-year-old boy. The transsphenoidal approach and appropriate radiotherapeutic management were employed with a good outcome.

Intracranial tumors during the 1st year of life

Twenty-eight patients with intracranial tumors symptomatic during the 1st year of life were managed from January 1970 to March 1988. Supratentorial location (19 cases) was dominant over the infratentorial. The most common histological type was astrocytoma; choroid plexus papilloma and ependymal tumors followed in frequency. Twenty-two infants (78.6%) had associated hydrocephalus. Macrocrania, vomiting, delayed milestones, and behavioral disturbances were the chief clinical manifestations. Four patients were admitted in extremely deteriorated condition and died preoperatively. Twenty cases underwent surgery for tumor removal with a 1-month mortality rate of 20%. Tumor excision provided permanent relief of hydrocephalus in the majority of the surviving cases. Five patients received conventional radiotherapy. Stereotactic brachytherapy yielded an excellent result in 1 case. Overall 13 cases are currently alive; 6 of them have survived longer than 6 years. Fourteen of the 15 patients who were dead at follow-up succumbed within 1 year after diagnosis.

High concentrations of catecholamines in human hypothalamic-hypophysial blood

While the hypothalamic-hypophysial portal system has been extensively studied in laboratory animals, equivalent studies have not been performed in humans. Here, we present an experimental procedure for collecting suprapituitary blood in man. To solve the question on the origin of such blood we investigated specific markers of hypothalamic secretory activity: the catecholamines (CAs). We found (a) norepinephrine (NE), dopamine (DA), and epinephrine (E) concentrations from approximately 1.5 to 2.5, 3.5 to 4.5, and 6- to 10-fold higher, respectively, in suprapituitary than peripheral blood, (b) different NE/DA and NE/E ratios in favor of DA and E in suprapituitary blood, and (c), a complete (100%) group separation (suprapituitary vs. peripheral) when discriminant analysis included only DA and E. These data indicate that suprapituitary blood composition is different from that of the peripheral blood, and is particularly rich in CAs and claimed differences between DA and E release on one hand and NE release on the other in suprapituitary blood also are observed. We advance the hypothesis of a hypothalamic source of such amines draining via median eminence into portal vasculature, and name this blood "hypothalamic-hypophysial blood." Besides serving as "classical" neurotransmitters, CAs may also have a direct neurohormonal role in the regulation of the human hypothalamic-hypophysial function.

Bilateral traumatic third nerve palsy

Bilateral palsy of the third cranial nerve in a head-injured patient is described. Delayed computed tomography scanning demonstrated a midline necrotic lesion within the mesencephalon ventral to the aqueduct. The lesion, possibly the sequela of a focal contusion, involved both third nerve nuclear complexes and caused paralysis of their voluntary as well as autonomic functions. Gaze mechanisms and long tracts appeared to be less heavily damaged. The literature dealing with third nerve palsy, particularly bilateral cases, from traumatic and other origins is briefly reviewed.

Arachnoid cysts of the middle cranial fossa: experience with 77 cases treated surgically

Arachnoid cysts of the middle cranial fossa (Sylvian cysts), represent the most common type of intracranial leptomeningeal malformation. Among the 102 intracranial arachnoid cysts operated on at the authors' institution from January 1970 to August 1986, the 77 cases (75%) located in the middle cranial fossa are reviewed. The higher incidence in the first two decades of life (51 cases) as well as the marked predilection for the male sex (60 cases) and the left hemisphere (55 cases) are confirmed in the authors' experience. As for clinical presentation cranial deformities, symptoms of raised intracranial pressure and epilepsy constituted the most frequent features. In 13 patients a complicating lesion was associated: subdural or intracystic haematomas in 7 cases, subdural hygromas in 4 cases and, extradural haematomas in 2 cases. Based on the appearance at CT scan and the results at CT cisternography the authors proposed a classification into three basic types of increasing severity and different pathophysiologic conditions. All the patients underwent craniotomy, excision of the cyst walls and perforation into the basal cisterns. There was one postoperative death (mortality rate of 1.3%) due to meningitis. The remaining clinical results were gratifying in all three types of lesion; on follow-up CT scans the cysts of type I. and II. exhibited a steady tendency to reduction or obliteration while cerebral reexpansion seemed less evident in the third, most severe, type. The authors compare and discuss the options of radical open surgery versus shunting procedures.

Craniopagus twins. An unsuccessful separation and a clinical review of the entity

Craniopagus twinning is an extremely uncommon birth defect with an estimated incidence of 4-6 every 10 million births. The most complex and challenging issue is the feasibility of surgical separation, which involves not only technical but also socioethical problems and requires strict multidisciplinary cooperation between pediatricians, neuroradiologists, anesthesiologists, and plastic and neurological surgeons. The authors report a case in which separation was followed by the death of both twins and stress the importance, from the surgical and prognostic viewpoints, of the degree of vascular connections between the major dural sinuses. We propose a classification into three types according to severity.

Haemangioblastomas of the brain stem

Six cases of capillary haemangioblastoma involving the brain stem are presented. Some clinical and pathological peculiarities of this series are outlined. Four patients (two operated radically) showed good or excellent outcome, whereas two (one partial and one complete removal) died shortly after the operation. The chances of direct surgical approach in brain stem haemangioblastomas are considered and the pertinent literature summarized.

Benign cerebellar hematomas in children

Cerebellar hematoma is generally regarded as a rapidly progressive condition which necessitates prompt evacuation in most cases. Unlike adults, where hypertension is the most common etiological factor, children generally have underlying structural lesions (angiomas, tumors) that per se demand surgical intervention. While several reports describe nonsurgical management of cerebellar hematomas in adults, the spontaneous resolution of juvenile cerebellar hematomas is almost unknown. This paper describes a 16-year-old boy with a cerebellar hematoma of obscure etiology that was managed conservatively. This report indicates that nonsurgical treatment of cerebellar hematomas, once structural lesions have been excluded, may be attempted in neurologically stable children.

Extradural hematoma complicating middle fossa arachnoid cyst

Two cases of post-traumatic extradural hematoma complicating an arachnoid cyst of the middle cranial fossa in children are described. While subdural and intracystic hemorrhages are well-known complications from this malformation, the association with extradural hematoma has never been previously reported in the literature. The pathogenetic mechanisms are discussed and the particular vulnerability of intracranial arachnoid cysts is stressed.

Infratentorial arachnoid cysts

The infratentorial compartment represents the second most common location of arachnoid malformations. Ten arachnoid cysts of the posterior fossa, operated on between 1970 and 1983, are reviewed. These lesions, although congenital and developmental in nature, may present at any age, and males are more frequently affected. A high rate of birth-related trauma (50% in this series) is conceivably due to fetal macrocranium, and the enlarged head and psychomotor retardation prevail in infancy and childhood. In arachnoid cysts occurring during adulthood, symptoms and signs more clearly indicate a dysfunction of the posterior fossa. Besides computerized tomography, pneumoencephalography and metrizamide techniques are recommended to rule out a Dandy-Walker syndrome in doubtful cases, and to obtain information about the cerebrospinal fluid (CSF) circulation. It is particularly important to establish the presence and type of communication of cysts with the CSF pathways. Although infratentorial cysts often communicate, they can be space-occupying masses because of increasing CSF retention, which may be due to a ball-valve mechanism or to inadequate communication. The frequently associated hydrocephalus (seven of the 10 cases in this series had hydrocephalus) seemed to be dependent mainly upon mechanical factors. The authors discuss the indications for intracranial surgery versus shunting procedures and report the results achieved by direct cyst excision.

Stereotaxic biopsy and radioactive implantation for interstitial therapy of tumors of the pineal region

Stereotaxic biopsy was performed in 10 patients with tumors of the pineal region. On the basis of intraoperative tissue diagnosis, low-energy radioactive sources (125I) were implanted in seven patients for interstitial irradiation during the same stereotaxic procedure. Results were good in five cases. This therapeutic modality appears to be indicated in cases of proven low-grade malignancy, inasmuch as the implantation of radioactive sources in a highly malignant lesion carries the risk of severe, often irreversible, damage to the surrounding brain, because of possible seed migration.

[Neuroblastoma metastatic to the skull. Radiologic aspects and therapeutic problems]

Clinical-radiological findings, treatment and prognosis of cranial involvement in 19 cases of neuroblastoma stage IV have been considered. The most frequent clinical features were periorbital ecchymosis and intracranial hypertension. The radiographic aspects, graduated according to the type of the lesion, showed a close correlation with clinical findings and sometimes preceded them. Computerized tomography, carried out in 12 cases, was more reliable than plain films in identifying the site and extent of cranial lesions and the presence of cerebral extensions, as occurred in 2 patients. The presence of cranial involvement at diagnosis was an unfavorable prognostic sign. The 19 children were treated in various ways so that firm conclusions cannot be drawn, but cranial radiotherapy in combination with chemotherapy appeared to be more efficacious than chemotherapy alone.

Asymptomatic large arachnoid cyst of the middle cranial fossa. A clinical and neuropsychological study

The authors studied a 26-year-old healthy subject in whom a large arachnoid cyst of the right middle cranial fossa was revealed by chance. As there were no subjective or objective neurological findings, we checked the existence of any neuropsychological impairment. In spite of this, the patient obtained a good general performance level and sometimes the hemisphere containing the cyst performed better, in accordance with the patient's handedness.

Extraneural metastases from primary pineal tumors. Review of the literature

Extraneural metastases from primary pineal tumors are extremely rare: only 15 such cases could be found in th literature. Another case is presented of a 10-year-old boy who developed multiple pulmonary and skeletal metastases from a presumed primary pineal germinoma. The incidence and pathogenesis of distant dissemination in the different types of pineal tumors are discussed, with special comment on the controversial role of the direct surgical approach and shunting of cerebrospinal fluid.

Percutaneous trigeminal thermorhizotomy in treatment of malignant facial pain

Fifty-eight patients suffering from intractable pain in the trigeminal distribution due to neoplasms of the intracranial or facial regions underwent controlled percutaneous coagulation of the Gasserian ganglion (trigeminal thermorhizotomy). Of them, 35 were evaluated at varying time intervals from the intervention (mean: 7 months). While pain was completely relieved in 71 per cent of cases at discharge, the follow-up examination was consistent with 49 per cent of analgesias. The rationale of percutaneous thermocoagulation in malignant facial pain is given and the pertinent literature summarized.

Multiple recurrences of meningiomas

The authors report a case of a patient with a right sphenoid wing and a right parasagittal fronto parietal meningioma diagnosed 25 years after a right sphenoid wing meningioma had been removed. There was no evidence of Von Recklinghausen disease. The two tumors were benign. The problems concerning multiple meningiomas and recurrences of meningioma are briefly discussed.

Pineal germinoma with massive supratentorial extension. Case report

An uncommon case of huge pineal germinoma without associated ventricular enlargement is presented. The tumor extended supratentorially in dumb-bell form to affect both cerebral hemispheres, simulating a glioma at neuroradiological examinations. Subtotal removal through a bilateral parieto-occipital approach plus radiation therapy were followed by relief of symptoms for over one year since surgery. The misleading patterns of the tumor and the delayed onset of symptoms in our case are outlined.

Stereotaxic rostral mesencephalotomy in treatment of malignant faciothoracobrachial pain syndromes. A survey of 14 treated patients

Stereotaxic rostral mesencephalotomy was performed 19 times in 14 patients suffering from intractable pain syndromes due to malignant diseases. The satisfying results in terms of pain relief during a necessarily short follow-up period (mean 4.9 months) are outlined. Undesired side effects were mainly confined to oculomotor disorders, which partly subsided over the months following the operation. Some technical aspects of the procedure and the pertinent literature are briefly discussed.

Neurological toxoplasmosis presenting as a brain tumor. Case report

✓ A case of congenital toxoplasmic mass lesion is reported in an infant born to a mother who acquired Toxoplasma infection during her pregnancy. Radical surgery followed by chemotherapy appeared to be curative. Previously described cases of acquired and congenital mass lesions due to Toxoplasma infection are summarized. The possible delayed onset and the misleading features that congenital toxoplasmosis may display are stressed.

CT scan and metrizamide CT cisternography in arachnoid cysts of the middle cranial fossa: classification and pathophysiological aspects

Thirty-one cases of arachnoid cysts of the middle cranial fossa were investigated by CT scan, 7 of them undergoing additional metrizamide CT cisternography. In this paper we analyze and correlate the different findings from these two examinations and propose a classification of arachnoid cysts of the middle cranial fossa into three basic types. Pathophysiological and surgical implications are discussed.

The value of serum thyroglobulin measurement as a marker of cancer recurrence in the follow-up of patients previously treated for differentiated thyroid tumor

In order to verify the value of serum thyrogolbulin (hTg) determination to detect cancer recurrence, 104 patients previously treated with surgical and 131I total thyroid ablation of differentiated thyroid cancer were studied. Comparison of serum hTg results and 131I total body scans (131I TBS) was attempted. In 87 patients with negative 131 I TBS, serum hTg was undetectable in 80% of the patients whereas in 20% detectable amounts of hTg were measured. In 57 patients with positive 131I TBS, serum hTg was measurable in 72% of the patients whereas in 20% was undetectable. These contrasting results of serum hTg measurement and 131I TBS suggest to us the usefulness to use both tests in the detection of thyroid cancer recurrence.

Giant cerebral capillary telangiectasis in an infant

The authors describe an unusual and unique case of a giant capillary telangiectasis of the right frontal lobe encountered in a 10-month-old child. The patient presented with progressive neurologic symptoms mimicking a brain tumor. The lesions was resected in toto with good clinical results.

Hamartomas of the tuber cinereum and precocious puberty

5 cases of true precocious puberty (TPP) of cerebral origin are presented. The clinical and radiological features and the protracted follow-up allow, also in view of the literature, a highly presumptive diagnosis of a hamartoma of the tuber cinereum. The high incidence of these lesions in cases of TPP is emphasized, together with the importance of early neuroradiological assessment.

Familial occurrence of multiple intracranial aneurysms. Case reports and review of the literature

The authors report a family in which two members had multiple intracranial aneurysms. This is the third reported family with more than one member affected by multiple cerebral aneurysms. The congenital nature and the patterns of inheritance of the disease are discussed. The indications for elective investigation of the asymptomatic relatives are surgical prophylaxis on asymptomatic aneurysms are also briefly discussed.

Arachnoid cysts of the middle cranial fossa: a clinical and radiological study of 25 cases treated surgically

Arachnoid cysts of the middle cranial fossa are probably not so infrequent as previously thought. Twenty-five cases are reported together with the most relevant clinical and radiological findings. The authors emphasize the importance of computerized tomography (CT) in providing pre- and postoperative anatomical and physiopathological information. The potential morbidity of these lesions is stressed and surgical indications are discussed with preference for a radical craniotomy rather than a shunt procedure.

[Selective percutaneous thermorhizotomy in the surgical treatment of facial pain: personal considerations in light of 180 patients treated]

The purpose of this paper is to report the experience of the authors regarding the treatment of the primitive and secondary facial pains by Percutaneous Selective Thermorhizotomy (P.S.T.), 180 patients having been treated in the period of two years. The immediate postoperative control has obtained 156 good results (86,6%), 10 medium results (5,5%) and 14 (7,7%) unsuccessful. The failure of the P.S.T. in the treatment of the post-zosterian neuralgias, in the atypical and in the vascular pains is stated. The P.S.T. appears resolutive in the "tic doloreux" and secondary painful syndromes. A far follow up was performed (4 months-2 years) on 94 patients and a good result was kept at 64,2% among all of them. The shortage of the postoperative not expected collateral effect is also stated. The causes of unsuccessful and poor results (mistaking in the choice of the patient or tecnical mistaking) are discussed. It is finally suggested a careful personal value of the patient candidated to operation, in order to reduce the poor results and therefore improve the successful ones.

[Persistence of the median artery: possible cause of the carpal tunnel syndrome]

A case of Carpal Tunnel Syndrome (S.T.S.) in a patient with Persistence of the Median Artery is reported. The Authors consider this rare-condition as a possible cause of C.T.S. The persisting vessel may cause a damage to the Median Nerve in two difeent ways: 1) Compression and 2) Ischemia. The latter pathogenesis is expecially advocated when anastomotic connection between the Median Artery and the Radial and Ulnar Arteries as well as the Superficial Palmar Arch are poor. Two different clinical pictures are possible: an acute onset, after a thrombosis, or a chronic impairment when the vessel is previous. As treatment, the Authors always recommend the decompression of the Carpal Tunnel and the dissection of the Persisting Artery; on the other side, they consider the excision of the vessel possible only when a sufficient anastomotic blood-supply is ensured.

Naloxone potentiation of 2-Br-alpha-ergocryptine (CB 154) effects on GH secretion in man

The effect of the combined administration of either CB 154 (2.5 mg/osM) or L-DOPA (500 mg/osM) and naloxone have been studied in six normal male volunteers. Naloxone cause a clear-cut potentiation of CB 154 effects on human growth hormone (hGH) secretion and only a slight, statistically non-significant, potentiation of L-DOPA effects on hGH secretion. These results have been discussed in the light of morphofunctional findings showing possible interactions between dopamine (DA) systems and somatostatin-positive and enkephalin-positive nerve terminals.