Accelerated delay of random flaps in a rat model

Random flaps have been supplanted by more immediate and reliable reconstructive methods because the former require two or more procedures and a period of delay. This study was designed to test the hypothesis that a random flap can be elevated, delayed, and safely divided within 4 days. Ninety-two Sprague–Dawley rats were operated by elevating an 8 cm × 4 cm cranially based dorsal flap with its underlying panniculus carnosus muscle. The rats were divided into four groups, one control and three experimental, with 23 rats in each. In the control group, the flap was elevated and its caudal end divided at the same time without delay. In the experimental groups, we tested three delay procedures and all flaps had their caudal end divided 4 days after elevation. The number of flaps showing total viability compared to the flaps showing any amount of necrosis was as follows: control group 1:22, mini delay group 18:5, progressive craniocaudal elevation group 19:4, and the accelerated delay group 22:1. The extent of necrosis, expressed as mean percentage area of necrosis in each group, was as follows: control group 45.9%, in the mini delay group 2.3%, progressive craniocaudal elevation group 2.5%, and the accelerated delay group 0.1%. Delay of this random flap can be accomplished safely in 4 days. In terms of total flap survival and mean percentage necrosis, all three experimental delay procedures were effective in improving total viability and reducing the extent of necrosis significantly. We believe the observed difference in total viability and mean percentage necrosis in the accelerated delay group to be clinically significant.     

Olivopontocerebellar atrophy in a young patient: A case report with radiologic findings

BackgroundOlivopontocerebellar atrophy (OPCA) is a term that encompasses an increasing number of neurodegenerative syndromes that lack a unique pathogenesis but are known to result from a disruption in the relationship between the cerebellar cortex, dentate nucleus, and the inferior olivary nuclei. OPCA can be difficult to diagnose on clinical grounds only and recent data suggests that OPCA affects 3–5 individuals in every 100,000 and may constitute almost 6% of patients diagnosed with atypical parkinsonism.Case reportHerein, we report the case of a 36-year-old female that initially developed dysarthria and gait abnormalities and subsequently presented with progressive neurologic signs and symptoms. A routine MRI of the brain was performed and high-resolution images were taken through the entire posterior fossa which showed prominent widening of the CSF spaces in the posterior fossa, cerebellar atrophy and reduction in the size of the pons, consistent with a diagnosis of OPCA.ConclusionOlivopontocerebellar atrophy is challenging condition to diagnose on a clinical basis, and hence requires corroboration of clinical and physical examination findings with radiologic findings. MRI of the brain is the gold standard in assessing OPCA and is an extremely valuable imaging modality in distinguishing OPCA from other neurological disorders and allows for the precise determination of OPCA subtypes.     

Leiomyoma Infarction after Uterine Artery Embolization: Influence of Embolic Agent and Leiomyoma Size and Location on Outcome

Purpose

To study the factors that might impact infarction of individual uterine leiomyomas and total tumor burden after uterine artery embolization (UAE).

Phenotypic spectrum and genetics of SCN2A‐related disorders,treatment options,and outcomes in epilepsy and beyond

Pathogenic variants in the SCN2A gene are associated with a variety of neurodevelopmental phenotypes, defined in recent years through multicenter collaboration. Phenotypes include benign (self‐limited) neonatal and infantile epilepsy and more severe developmental and epileptic encephalopathies also presenting in early infancy. There is increasing evidence that an important phenotype linked to the gene is autism and intellectual disability without epilepsy or with rare seizures in later childhood. Other associations of SCN2A include the movement disorders chorea and episodic ataxia. It is likely that as genetic testing enters mainstream practice that new phenotypic associations will be identified. Some missense, gain of function variants tend to present in early infancy with epilepsy, whereas other missense or truncating, loss of function variants present with later‐onset epilepsies or intellectual disability only. Knowledge of both mutation type and functional consequences can guide precision therapy. Sodium channel blockers may be effective antiepileptic medications in gain of function, neonatal and infantile presentations.     

Iatrogenic brachial artery injury during pinning of supracondylar fracture of humerus: A rare injury

Complications following supracondylar fracture of humerus are well-known. Pre- and post-operative complications have been documented in the literature. Neurovascular injury due to fracture fragments following this type of fracture is described. Iatrogenic brachial artery during surgical treatment of this fracture is unknown to the literature. So we report a rare case of iatrogenic brachial artery injury during pinning of supracondylar fracture of humerus and try to create awareness to the surgeons that such injuries can occur with improper operative techniques.     

Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology

The International League Against Epilepsy (ILAE) presents a revised operational classification of seizure types. The purpose of such a revision is to recognize that some seizure types can have either a focal or generalized onset, to allow classification when the onset is unobserved, to include some missing seizure types, and to adopt more transparent names. Because current knowledge is insufficient to form a scientifically based classification, the 2017 Classification is operational (practical) and based on the 1981 Classification, extended in 2010. Changes include the following: (1) “partial” becomes “focal”; (2) awareness is used as a classifier of focal seizures; (3) the terms dyscognitive, simple partial, complex partial, psychic, and secondarily generalized are eliminated; (4) new focal seizure types include automatisms, behavior arrest, hyperkinetic, autonomic, cognitive, and emotional; (5) atonic, clonic, epileptic spasms, myoclonic, and tonic seizures can be of either focal or generalized onset; (6) focal to bilateral tonic–clonic seizure replaces secondarily generalized seizure; (7) new generalized seizure types are absence with eyelid myoclonia, myoclonic absence, myoclonic–atonic, myoclonic–tonic–clonic; and (8) seizures of unknown onset may have features that can still be classified. The new classification does not represent a fundamental change, but allows greater flexibility and transparency in naming seizure types.     

Genetics of epilepsy: epilepsy research foundation workshop report.

The Sixth Epilepsy Research Foundation workshop, held in Oxford in March 2006, brought together basic scientists, geneticists, epidemiologists, statisticians, pharmacologists and clinicians to consider progress, issues and strategies for harnessing genetics to improve the understanding and treatment of the epilepsies. General principles were considered, including the fundamental importance of clear study design, adequate patient numbers, defi ned phenotypes, robust statistical data handling, and follow-up of genetic discoveries. Topics where some progress had been made were considered including chromosomal abnormalities, neurodevelopment, hippocampal sclerosis, juvenile myoclonic epilepsy, focal cortical dysplasia and pharmacogenetics. The ethical aspects of epilepsy genetics were reviewed. Principles and limitations of collaboration were discussed. Presentations and their matched discussions are produced here. There was optimism that further genetic research in epilepsy was not only feasible, but might lead to improvements in the lives of people with epilepsy.     

Diagnosing and phenotyping visual synaesthesia: a preliminary evaluation of the revised test of genuineness (TOG-R)

Synaesthesia, a neurological condition affecting approximately .05% of the population, is characterised by anomalous sensory perception: a stimulus in one sensory modality triggers an automatic, instantaneous, consistent response in another modality (e.g., sound evokes colour) or in a different aspect of the same modality (e.g., black text evokes colour). As evidence was limited to case studies based on self-report, the existence of synaesthesia was regarded with scepticism until the development of the Test of Genuineness (TOG) in 1987, which measures the consistency of stimulus-response linkage: synaesthetes typically score between 70-90% range, whereas controls typically score between 20-38%. However, the TOG had only limited ability to quantify the characteristics of visual synaesthesia. In this study, the revised Test of Genuineness (TOG-R), utilising the Pantone-based Cambridge Synaesthesia Charts, was given to 26 synaesthetes and 23 controls. Results confirmed that the TOG-R is equally accurate in the diagnosis of synaesthesia; synaesthetes scored significantly (t47 = 16.01, p < .001) higher (mean = 71.3%, SEM = 1.4%) than controls (mean = 33%, SEM = 2.0%). The TOG-R provides greater precision in quantifying the closeness of colour matches and enables a more detailed analysis of visual synaesthesia. Synaesthetes were phenotyped into broad- and narrowband based on their overall responsiveness to auditory stimuli, with bandwidth determined primarily by responsiveness to non-word stimuli. They were further sub-phenotyped based on responses to sub-groups of stimuli into word-colour (WC) and music-colour (MC). Development of this instrument has important implications for the diagnosis and phenotyping of visual synaesthesia.