Transorbital endoscopic approaches to the skull base: a systematic literature review and anatomical description

Neurosurgical Review - Transorbital endoscopic approaches are increasing in popularity as they provide corridors to reach various areas of the ventral skull base through the orbit. They can be used...     

Destructive spondyloarthropathy and radiographic follow-up in hemodialysis patients

Nine patients undergoing regular dialytic treatment for more than 60 months showed clinical and radiologic features of a noninfective and destructive spondyloarthropathy. The cervical spine was most affected (100%), followed by the dorsal (three patients, 33.3%) and the lumbar spine (two patients, 22.2%). Typically, radiographs and CT scans revealed narrowing of intervertebral spaces, with destruction or sclerosis of the subchondral bone of the vertebral plate.Autopsy was performed on three patients; histologic study demonstrated the presence of large amyloid deposits containing ₂-microglobulin ( ₂-m) in the discs and peridiscal ligaments.A radiographic follow-up of the cervical spine was performed in seven patients after a period of 12 months and showed that the bone destruction in DSA is very rapid and progressive. The lower biocompatibility of the cuprophan membranes of dialyzers is probably the factor most responsible for hyperproduction of ₂-m and subsequently osteoarticular deposition of a new type of amyloidosis.     

Post-stroke depression: Relationships with morphological damage and cognition over time

The aim of the present study was to investigate the relationships between poststroke depression (PSD), lesion location and cognitive deficits after stroke. We studied 20 patients within the first month after clinical onset (T1), and one year later (T2). PSD was observed in 55% of patients at T1 and 35% of patients at T2. At T1, depression was reliably correlated with dorsal lesions in the right-hemisphere and anterior lesions in the left hemisphere. Lesion location was no longer a significant factor determining PSD at T2. Changes in PSD, from T1 to T2, were inversely correlated with the performances in cognitive tests exploring the domains of attention, visuospatial learning, executive/motor functions, and with the global composite cognitive score. Our data suggest that: 1) in the mix of influences that may produce PSD, lesion location is the main factor determining mood changes after stroke in the first month; 2) PSD produces deficits in attention, learning, and executive/motor functions, without affecting language and other cognitive domains.

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Sommario Scopo di questo studio sono i rapporti tra la depressione post-stroke (PSD), la localizzazione della lesione cerebrovascolare e i disturbi cognitivi conseguenti alla lesione. Abbiamo studiato 20 pazienti entro il primo mese dall'episodio ictale (T1) ed un anno dopo (T2). La PSD era osservabile nel 55% dei pazienti a T1 e nel 35% dei pazienti a T2. A T1, la PSD era significativamente correlata con lesioni dorsali nell'emisfero di destra e con lesioni anteriori nell'emisfero di sinistra. Queste correlazioni non erano più significative a T2. Le variazioni della PSD da T1 a T2 erano inversamente correlate con le prestazioni dei pazienti a compiti cognitivi di attenzione, apprendimento visuospaziale, funzioni esecutivo/motorie, e con un punteggio cognitivo composito.Questi dati suggeriscono che: 1) tra le numerose cause che possono produrre la PSD, la localizzazione della lesione sembra essere il fattore principale nel primo mese dopo l'episodio cerebrovascolare; 2) la PSD produce disturbi attentivi, di apprendimento visuospaziale ed esecutivi/motori senza determinare disturbi nella sfera del linguaggio e di altre funzioni cognitive.

     

Pharmacokinetics of VP16-213 given by different administration methods

Summary Plasma pharmacokinetics of VP16-213 were investigated after a 30–60 min infusion in 14 adult patients and six children. In adults the elimination half-life (T_1/2 ), plasma clearance (Cl_p) and volume of distribution (Vd) were respectively 7.05±0.67 h, 26.8±2.4 ml/min/m², and 15.7±1.8 l/m²; in children 3.37±0.5 h, 39.34±6.6 ml/min/m², and 9.97±3.7 l/m². After repeated daily doses no accumulation of VP16-213 was found in plasma. The unchanged drug found in the 24 h urine after administration amounted to 20–30% of the dose.In eight choriocarcinoma patients plasma levels of VP16-213 were measured after oral capsules and drinkable ampoules. The bioavailability compared to the i.v. route was variable, mean values being 57% for capsules and 91% for ampoules. In one further patient, with abnormal d-Xylose absorption results, VP16-213 was not detectable in plasma after the oral ampoule dose.Steady state levels investigated in three patients after 72 h continuous VP16-213 infusion (100 mg/m²/24 h) were around 2–5 g/ml. Levels of VP16-213 were undetectable in CSF after i.v. or oral administration.     

Some interpersonal consequences of being mentally ill or mentally retarded.

The present study was carried out at an institution for mentally retarded persons where the subjects (college students) were transported. Under the guise of being "normal," mentally ill, or mentally retarded, each of four confederates met three independent groups of subjects. The verbal reports of the subjects did not vary a great deal as a function of condition, but amount of pain inflicted in an experimental task was strikingly different. In the mentally retarded confederate condition, shocks delivered were shorter and less intense than those given in the "normal" or mentally ill confederate conditions. Since subjects had to teach the confederate, they might have been kinder in the mentally retarded confederate condition because less was expected of the learner. Evidence was also found suggesting that the social impact of stigmas depends on the personal characteristics of the stigmatized person.     

Comparison of the attitudes of Israeli therapists and lay persons to ethical dilemmas in psychotherapy

The issues of confidentiality and boundaries cause ethical dilemmas for psychotherapists. We investigated whether therapists have ethical attitudes to confidentiality and boundaries that are unique to their professional group compared with lay persons and whether gender or professional characteristics are associated with these attitudes. Clinical vignettes capturing ethical dilemmas regarding confidentiality and boundaries were presented to 93 psychotherapists of different professional backgrounds (professional group) and 55 staff and students from the fields of law and the humanities (lay group). In general, the lay group showed a greater tendency to maintain confidentiality than the professional group. Regarding boundaries, the majority of psychotherapists were against initiating any sexual relationship with current patients, former patients, students, or supervisees; the differences between the groups in this area were statistically significant. The vast majority of therapists (96.7%) disapproved of accepting money in advance compared with only 54.4% of the lay group. Analysis of the psychotherapists by professional background revealed that for the majority of the vignettes, there was no difference in attitude to confidentiality and boundaries between psychiatrists, psychologists, and social workers. The present study shows that therapists have different ethical codes from nontherapists regarding the issues of boundaries and the treatment contract. Therapists are stricter than nontherapists regarding issues of boundaries but less strict regarding issues of confidentiality, and there are some minor differences in the attitudes to these issues among different types of therapists.     

Auricular alloplastic reconstruction with osteointegrated implants: a new therapy option in microtia

Microtia has been treated over the years with autogenous tissues, although the results continue to improve, it is technically a very demanding procedure, even in the hands of a well trained surgeon. Osseointegrated implant-supported ear prosthesis, is less demanding, more straightforward, and offers a better cosmetic result. Since 1996 we have treated 8 patients with microtia types III and IV, with titanium osseointegrated implant-supported ear prosthesis in the bone of the mastoid process. The surgical procedure consists in two stages. First stage: when the three titanium screws are drill in the mastoid process of the temporal bone, with a previous CT scan of the area, that is used to measured the bone thickness. Second stage is done 3 to 6 months later. Ear remnants are removed at the beginning of the procedure, three titanium couplings are then secured to the integrated fixtures, a plastic cap is attached to each of the abutments, until healing takes place; three to four weeks later the auricular prosthesis made out of silicone over a metallic structure, will we plug in the titanium screws. Cosmetic results and patients acceptability have been good in all 8 cases, with few postoperative complications. This procedure has become and option for the patients with ear malformations.     

Value of P-glycoprotein and clinicopathologic factors as the basis for new treatment strategies in high-grade osteosarcoma of the extremities.

PURPOSE: To evaluate the prognostic value of P-glycoprotein and clinicopathologic parameters in a large series of high-grade osteosarcoma (OS) patients treated at the Rizzoli Institute. PATIENTS AND METHODS: With the use of immunohistochemistry, P-glycoprotein was assessed in 149 patients with primary, nonmetastatic, high-grade OS who were homogeneously treated with chemotherapy protocols based on doxorubicin, high-dose methotrexate, and cisplatin and the addition of ifosfamide in the postoperative phase. RESULTS: P-glycoprotein positivity was found in 47 of 149 cases (32%) and was significantly associated with a higher incidence of relapse and a worse outcome, as was age younger than 12 years and tumor volume greater then 150 mL at diagnosis. Multivariate analysis further confirmed the prognostic value of these parameters, which all were independent adverse prognostic factors. Event-free survival and proportional hazards regression analyses confirmed that overexpression of P-glycoprotein at clinical onset is the most important adverse prognostic factor for high-grade OS patients treated with these chemotherapy protocols. CONCLUSION: Increased P-glycoprotein levels, together with tumor volume and age, should be taken into consideration to identify, at time of diagnosis, subgroups of OS patients with a higher risk of recurrence. This subgroup identification will constitute the basis for drawing individualized treatment protocols on the basis of risk evaluation, with the aim of using more aggressive chemotherapy, or combination chemotherapy with other adjuvants, only in those patients for which more aggressive regimens are strictly necessary and warranted.