Maurizio Riva

Ospedale Maggiore di Lodi · Department of Neurology

The past decade has seen extraordinary increase in worldwide availability of and access to several large multiple sclerosis (MS) databases and registries. MS registries represent powerful tools to provide meaningful information on the burden, natural history, and long-term safety and effectiveness of treatments. Moreover, patients, physicians, indu...

Background The incidence of glioblastoma among elderly patients is constantly increasing. The value of radiation therapy and concurrent/adjuvant chemotherapy has been widely assessed. So far, the role of surgery has not been thoroughly investigated. The study aimed to evaluate safety and impact of several entities of surgical resection on outcome o...

Background Brain metastases (BMs) occur in 20%-40% of adult cancer patients, and their incidence has increased from 2 to 5 times over the past 40 years. Treatment options include surgery, whole-brain radiation therapy (WBRT), and stereotactic radiosurgery (SRS). As a single modality, none of these are able to obtain an adequate local control (LC) o...

Italian operas can provide relevant information on the medical knowledge during the Romantic Age, especially in the field of neuroscience. One of the most renowned operas, "Nabucco" by Giuseppe Verdi (1813-1901) may provide us with some information on the state of knowledge on neuropsychiatric diseases in the first part of the nineteenth century. T...

In monkeys, motor outputs from premotor cortex (PM) involve cortico-cortical connections with primary motor cortex (M1). However, in humans, the functional organization of PM and its relationship with the corticospinal tract (CST) is still uncertain. This study was carried out in 21 patients undergoing intraoperative brain mapping prior to tumor re...

During the Middle Ages and the Renaissance, intellectuals often included clinical cases and medical descriptions in their literary works. These authors appeared to be more interested in internal and infectious diseases rather than in musculoskeletal disorders and orthopaedics. François Rabelais (1490-1553) was one of the most renowned humanists and...

Overweight, workaholic and caffeine abuser, Honoré de Balzac lived a life of excess. He prematurely died aged 51 due to a gangrene associated with congestive heart failure. Textual sources allowed us to take a glimpse into his last three months of life. Due to ventricular hypertrophy, Balzac's respiratory conditions were appalling and he developed...

Romantic operas provide a useful tool for historians to understand the perception of some medical disorders that existed during the nineteenth century. Somnambulism was still a mysterious condition during this time, since its pathogenesis was unknown. Hence, it comes as no surprise that somnambulism features in a number of operas, the best known of...

The deleterious effects of scabies, an infestation of the skin by the human itch mite Sarcoptes scabiei var. hominis, were well known in the Middle-Ages. Here we report descriptions of Medieval “itch” by the eminent Italian poets, Francesco Petrarca (1304-1374) and Giovanni Boccaccio (1313-1375). Both of them suffered from scabies and emphasised th...

Purpose The role of surgical resection for single, large brain metastases (≥2.1 cm) is not clearly defined yet. Various surgical strategies have been adopted with the aim to achieve a resection as wide as possible keeping functional neurological integrity. Aim of the study was to evaluate the safety and feasibility of supramarginal resection in ter...

The importance of adding molecular data to histology for better stratifying tumor patients has been recently proposed by WHO; an integrated diagnosis has been recommended for routine pathological practice, in which molecular data obtained from the most representative area of the tumor are associated to histological appearance. We have evaluated the...

Purpose The prognosis for newly diagnosed glioblastoma (GBM) has not yet undergone significantly improvements with a median survival time of 15–18 months. Local recurrence is the main reason of failure. Different treatment strategies are considered including a further surgery, second line chemotherapy, re-irradiation or combined treatment with diff...

Introduction The current standard treatment for glioblastoma multiforme (GBM) has led a median, overall survival (OS) of 14.6 months, a 2-year progression-free survival (PFS) of 11% and a 2-year OS of 27.2%. The predominantly local failure pattern indicates the need to intensify local treatment. Radiation therapy dose escalation did not result in a...

Purpose Positron emission tomography with carbon-11 labelled methionine (11C-METH PET) is a well-established imaging modality allowing to characterise tumour lesions on a metabolic and molecular level. The aim of the current study was to evaluate the relationship between 11C-METH PET semi-quantitative metrics and molecular biomarkers in patients af...

Surgical strategy for LGGs aims at maximal tumor removal and at the maintainance of patient full integrity, performing resection according to functional boundaries. Maximal resection is accomplished to reach tumor borders as visibile in volumetric FLAIR (total resection) and when possible even further (supratotal resection). Maximal tumor resection...

Introduction In case of large brain metastases (BMs), treatment option include whole-brain-radiation-therapy (WBRT), surgery, single dose radiosurgery (SRS) or Hypofractionated stereotactic radiosurgery (HSRS). None of these, when given as a single modality are able to obtain and adequate local control rate. Therefore a combined approach, if feasib...

In the history of medicine, the discovery and the use of the microscope in clinical practice and biomedical research was a revolutionary achievement. The cultural shift from the traditional macroscopic necroscopy to a microscopic and ultrastructural perspective was essential for the development of modern pathology and for recognising physiopatholog...

Epilepsy associated with neoplastic diseases in any site is a poorly understood manifestation that has important clinical and social implications. This article comprises a review based on a practical approach to three main categories of the population affected: 1) seizure or epilepsy in patients with structural active neoplastic brain lesions (prim...

Neurological and neuropsychological aspects of folk music and traditional dance have been poorly investigated by historical and scientific literature. Some of these performances could be indeed the manifestation of latent pathological conditions or the expression of liberation rituals. This chapter aimed at analyzing the relationships between tradi...

The arts can provide unique ways for determining how people not directly involved in medicine were viewing and informing others about physical and mental disorders. With operas, one need only think about how various perturbations of madness have been portrayed. Somnambulism has long been a particularly perplexing disorder, both to physicians and th...

Even though unhealthy consequences of night work for women have been evidenced by international scientific literature only in recent years, they were well acknowledged from ancient times. This essay traces the historical evolution of women's health conditions at work, focusing specifically on nocturnal work. Using the legendary web of Penelope of a...

Background: The year 2016 marks the bicentennial anniversary of the premiere of "The Barber of Seville" by Gioachino Rossini (1792-1868). This opera buffa, one of the most renowned in the world, puts on stage a sharp criticism against the physicians of that time in favour of empiric healers, respectively represented by the doctor Bartolo and the b...

The year 2015 marks the 750th anniversary from the birth of the medieval poet Dante Alighieri. Dante's work seems to provide precious information on medieval knowledge of anatomy and physiopathology of some musculoskeletal structures (including spine). Nonmedical works, including poetry, should be considered as a source for historians of orthopedic...

Cerebral venous thrombosis (CVT) may represent the clinical onset of malignancies or complicate their course, also in phase of quiescence. In literature, there are several case reports on the association between CVT and tumors, but there are few articles on its clinical characteristics in cancer patients (Pts). Our aim was to analyze the clinical c...

The year 2015 marks the 750th birth anniversary of the Italian poet Dante Alighieri (1265-1321). It is less known that Dante had a sound level of medical knowledge, probably derived by his academic studies. In his works, medieval notions of neuroanatomy and neurophysiology (e.g. the connection between brain and spinal cord, function of optic nerve...

The year 2014 has marked the tercentenary from the death of Bernardino Ramazzini (1633-1714), universally credited as the founder of Occupational Health (5, 9, 10, 11). Indeed, the renowned physician died on November 5th 1714 in Padua, where he had been appointed as Professor of Practical Medicine at the local prestigious University from the year 1...

Ancient non-medical texts can unexpectedly provide useful information on the development of knowledge about the heart and its diseases throughout history. The 750th anniversary of the birth of the Italian poet Dante Alighieri (1265-1321) provides a timely opportunity to analyze medical references in his works, in particular, focusing on literary de...

Myths and folklore, as expressions of popular beliefs, provide valuable information on medical knowledge in earlier times. Fairy tales have often recounted occupational maladies throughout the ages and also provide some insight into the toxic effects of certain metals, such as mercury. Much historical information can be gleaned from unexpected sour...

The aim of the ICARO-3 study was to evaluate whether intra-arterial treatment, compared to intravenous thrombolysis, increases the rate of favourable functional outcome at 3 months in acute ischemic stroke and extracranial ICA occlusion. ICARO-3 was a non-randomized therapeutic trial that performed a non-blind assessment of outcomes using retrospec...

During the seventeenth century, the description of the lymphatic system provided a decisive contribution to resolving the misconceptions of Galenic physiology concerning the production of blood in the liver. The transition from a liver-centered (hepatocentrism) to a heart-centered model (cardiocentrism) was fundamental in the history of medicine, s...

The Fifth International Conference on the History of Occupational and Environmental Health took place at the Erasmus University Medical Centre (Erasmus MC) in Rotterdam (The Netherlands) on April 24th and 25th, 2014. The Conference was organized by the Yellow Factory, the Erasmus University and the Arnold Leuftink Foundation, with the collaboration...

Resection of tumors involving language pathways requires the intraoperative identification of cortical and subcortical sites mediating the various language components, which determines the extent of resection (EOR). One of the critical point is which test(s) has to be performed during subcortical mapping. Object naming is the most used one, but it...

BACKGROUND: Recent studies suggest total/near total resection to be significantly associated with increased survival in low grade gliomas (LGGs) and reduced risk of malignant transformation. This study is aimed to prospectively evaluate whether preoperative chemotherapy with temozolomide can reduce tumor infiltration and improve the surgical resect...

Structural characterization of Low-Grade.Gliomas (LGGs) is depicted by MR or metabolic imaging, which when transferred into the neuronavigation system are used for guidance and tissue sampling. The combined use of intraoperative-Ultrasound-(US), corrects for brain shift. We present our experience on the use of MR, MET(methionine)-PET-TC, US for str...

Resection of Cortical-Spinal-Tract (CST) tumors requires the intraoperative identification of cortical-subcortical essential motor-sites. Neurophysiological strategies for motor mapping and monitoring available are: Low/High-Frequency, LF/HF, delivered with monopolar-bipolar probes, MEP monitoring. Tailoring them to the clinical status and tumor ch...

Intraoperative language mapping is standard for resection of gliomas involving language pathways, because it enables a maximal safe tumor removal. Intraoperative language mapping is a demanding procedure requiring a good level of patient collaboration, a complex peri-operative organization, and may cause patient fatigue. The selection of patients t...

Resection of language pathways tumors requires intraoperative identification of cortical and subcortical language essential sites. Language mapping is traditionally performed with LowFrequency(60Hz) stimulation. In patients with previous treatment or long history of seizures, the use of LF may be problematic and results in inadequate mapping. HighF...

The millennial flight against tuberculosis has been characterized by several defeats. Roman physicians suggested to consumptives better nutrition, sea voyages and change of air, while, during the Middle Ages, ‘royal touch’ were considered as an effective remedy for scrofula. In the following centuries, phthisis was cured using old herbal preparatio...

Auscultation is a fundamental part of medical examination.It is generally performed using a stethoscope whichallows listening to body sounds, in particular of the heartand lungs, the function of which can be initially exploredusing this instrument. According to Rabinowitz et al., despiteimprovements in diagnostic technology, "the ability toausculta...

Functional (conversion) neurological symptoms represent as one of the most common situations faced by neurologists in their everyday practice. Among them, acute or subacute functional weakness may mimic very prevalent conditions such as stroke or traumatic injury. Hence, accurate and reliable positive signs of functional weakness are valuable for o...

Eye is the official journal of the Royal College of Ophthalmologists. It aims to provide the practising ophthalmologist with information on the latest clinical and laboratory-based research.

Since antiquity, the mystery around sleep and its disorders, particularly parasomnias, has fostered superstitions, myths, and tales. In modern times, physicians attempted to explain these phenomena as neuropsychiatric and organic diseases. The definitive acknowledgment of parasomnias as organic disorders occurred only during the twentieth century w...

BACKGROUND: The treatment of patients with primary CNS lymphomas (PCNSL) has dramatically changed since the 1970's when whole brain radiation generated median survivals of about 12 months, significant neurotoxcity, and few long term survivors. High dose methotrexate (HD-MTX) monotherapy without radiation provides excellent response rates and 30% lo...

Even if the contagious nature of tuberculosis was universally accepted during the nineteenth century, its transmission to health care workers (HCWs) was initially denied by the scientific community. Working among TB patients was not considered dangerous for healthy adults, so the potential risks for HCWs were branded as unwarranted "phthisiophobia"...

Multiple sclerosis (MS) is the main cause of chronic disability in young people during their most productive years of life and therefore carries a high social and economic burden. The present study aimed to: (1) verify the capacity of an administrative data source to furnish data for constructing a model able to detect the occurrence of clinical re...

Background: the aim of this study was to assess healthcare demand of specific groups of population and their costs borne by Italian Health System, using healthcare administrative databases. Methods: demographic, clinical and economic data were obtained from datasets available at the Regional Health System, combined into a data warehouse (DENALI),...

One of the last century's greatest personalities in Occupational Medicine was Enrico Carlo Vigliani (1907-1992), director of the "Clinica del Lavoro" in Milan (1942-1977), editor-in-chief of "La Medicina del Lavoro" (1942-1991), Secretary-Treasurer and then President of the "Permanent Commission and International Association on Occupational Health"...

Occupational Health Doctors active in building sector firms frequently have to evaluate residual workers' osteomuscular function in patients coming back to work after an accident happened during work time or free time. Definition of their specific individual work suitability is usually carried out utilizing semeiotic tests in which subjective evalu...

Use of barrier creams among workers exposed to chemical risk has changed during last years and actually seems not to be very largely widespread even if there are not many up to date data about it. We report a research carried out evaluating effective presence in pharmacological market of barrier creams, their chemical characteristics, their composi...

This study assessed the immunisation status against hepatitis B in healthcare students and residents, before their hospital internship, as suggested by the "National Immunization Prevention Plan 2012-2014". The concentration of antibodies against hepatitis B was measured in 2,491 subjects (70.90% women), born between 1980 and 1993 and visited betwe...

The survey was aimed at developing a method and providing valuable tools to be used for risk assessment in dental practices and for the implementation of preventive and protective measures. For these purposes general (inspection card for the definition of risk level for health and safety) and specific tools (check-lists) were used. In each dental o...

A relevant part of deadly work accidents and of severe work accidents reported in national specific statistics coming from INAIL is until today caused by workers' falls during their at height work activities. Medical evaluation of eventual workers' hyper susceptibility to fall caused by balance alterations, if included in medical surveillance, is f...

Our research describes activities of Occupational Health carried out during last year in University of Milan Bicocca by Occupational Doctors. We describe results of medical surveillance in 1153 employees or students exposed to occupational risks for health and safety. We report results obtained, technical difficulties, organizational problems, and...

Our research describes a medical surveillance, not included in usual Occupational Health activities, carried out in last year among Red Cross Volunteers active in Monza e Brianza Provincial Committee. This medical surveillance has been managed according to internal rules of Red Cross and national specific Laws. We report data concerning medical exa...

The workload, the quality of professional relationships and emotional involvement have a significant impact on distress and burnout in health care-workers; this impact has an hight variability among the different environments and different care facilities (hospital, erderly nursing homes, home care). The risk assessment of work-related stress perfo...

Urinary evaluations of drug consumption among workers having high risk of accident became compulsory in Italian legislation few years ago. We report results of 322.110 single urinary drug detections carried out between 2008 and 2011 on 35.789 subjects. We verified technical difficulties arisen during laboratory detections and organizational difficu...

Construction has been one of the first sectors in which an organized system of occupational health protection has been implemented, as shown by the Egyptian physicians caring for workers and artisans in building sites. During the Middle Ages, first examples of accident prevention legislation in this field may be found among the Lombards. In the sam...

The movement computerized analysis of upper limb is a valid support in the definition of residual functional capability and of specific work suitability in complex cases. This methodology of evaluation is able to correctly and objectively define the tridimensional ranges of motion of every patient's upper limb. This fact can be particularly useful...

Our research included 1359 foreigner citizens actually working in Lombardy. To better evaluate the eventual presence of relational, cultural and work related problems in their daily work experience we used a specific questionnaire, directly filled in by Occupational Doctors during occupational medical surveillance enforced by law, composed by diffe...

This survey was aimed at showing the relationship between some working organizational indicators--work-related stress "sentinel events" such as sick leaves and work accident--and some sociodemographic (gender, age) and organizational (homogeneous tasks, departmental areas) parameters. In the decade 2001-2010 a progressive decrease of the absenteeis...

Occupational Medicine was born in the unified Italy, thanks to the contributions of statistics and epidemiology. In Milan, since the Medieval Ages there had been systems for recording health data (e.g. deaths and their presumed causes), but these data were analyzed only during the 19th century. In this context the "Accademia Fisio-Medico-Statistica...

Neoplastic dissemination to the leptomeninges is an increasingly common occurrence in patients with both haematological and solid tumors arising outside the central nervous system. Both refinement of diagnostic techniques (Magnetic resonance imaging) and increased survival in patients treated with targeted therapies for systemic tumors account for...

Background and purposes: In a case-control study in patients with acute ischemic stroke and extracranial internal carotid artery (eICA) occlusion, thrombolytic treatment was associated with increased mortality. The aim of this cohort study was to assess the efficacy and safety of thrombolysis in patients with eICA occlusion compared to those witho...

Background: The hospital is considered as one of the founding elements of modern medicine. Such an institution, originally born to be a center for housing the sick and the poor, has provided with a place to improve the medical knowledge and to educate new generations of nurses and physicians. This paper wants to remind the meaning and the developm...

Background: One of the last century's greatest personalities in Occupational Medicine was Enrico Carlo Vigliani (1907-1992), director of the "Clinica del Lavoro" in Milan (1942-1977), editor-in-chief of "La Medicina del Lavoro" (1942-1991), Secretary-Treasurer and then President of the "Permanent Commission and International Association on Occupati...

To analyze the pioneering research of Giuseppe Ferrario (1802-1870) on the epidemiology of apoplexy. To our knowledge, his work might have been the first to systematically investigate the epidemiology of cerebrovascular accidents, with the aim of shedding light on the underlying causes. A detailed analysis of the essay "Statistics of sudden deaths,...

Lead poisoning is one of the earliest identified and most known occupational disease. Its acute effects have been recognized from antiquity when this condition principally afflicted manual workers and slaves, actually scarcely considered by the medicine of that time. The Industrial Revolution caused an epidemic of metal intoxication, urging scienti...

Behavioral toxicology is an important discipline of toxicology that traces its roots back to the origin of psychology. A parallel development can be traced for behavioral toxicology and psychology, in that both were focused on the mind or behavior, as distinct from neurology, that recognized the brain as the ultimate target. Ancient physicians and...

Carlo Moreschi (1876-1921) was founding co-editor of the journal "Il Lavoro" (now known as "La Medicina del Lavoro"), together with Luigi Devoto in 1901. Despite this fact, many of his pioneering contributions to 20th century scientific debate are not well known outside Italy. Objectives: The aim of this paper therefore was to recall Moreschi' achi...

The differential diagnosis of vertebral fractures is not always easy, especially in patients with systemic metastatic cancer. In the following article, we present a case in which the primary differential diagnosis was osteoporotic vertebral compression fracture. This was confirmed on vertebral body biopsy, performed during vertebroplasty. We discus...