Assessing cochlear evoked potentials after electrocautery-induced trauma to the utricle

Utriculostomy is a new surgical alternative for Ménière's disease. The basis of this procedure is that the outcome of an electrocautery-induced utricular trauma does not affect cochlear function. However, a demonstration of the hypothesis that this approach to the utricle would preserve hearing is still pending.ObjectiveTo determine whether any changes would occur in the electrical potentials evoked in the cochlea and auditory nerve before, during, and 1 month after a surgical procedure in the utricule in an animal model.Materials and MethodsAn experimental study. Eight sheep underwent electrocautery-induced utricular trauma, and their cochlear function was assessed by electrocochleography – recording of electrical evoked potentials, in the preoperative, immediate postoperative and medium-term postoperative periods. The results were analyzed statistically.ResultsThere were no statistically significant variations in amplitude (p = 0.099) and latency (p = 0.591) before and 1 month after the surgical procedure. There was a statistically significant change in the summation of the potential/action potential area ratio (p = 0.0122), a calculated loss of 11.8 dB.ConclusionThe intervention performed in this study enabled us to conclude that, taking into account the impaired electrophysiological responses observed during and 1 month after the surgical procedure, hearing was preserved in the operated sheep.     

Mandibular Molar Rehabilitation Using Orthodontic Extrusion Associated with Odontoplasty

The aim of this clinical report is to describe the successful treatment of a mandibular first molar presenting an extensive fracture at the buccal aspect in a young patient. The extension of the fracture was a negative prognostic factor for tooth maintenance. An alternative clinical treatment was proposed since the patient was young and presented with good oral hygiene and periodontal health. The treatment was based on orthodontic forced eruption associated with odontoplasty. A 3‐year follow‐up after the surgical procedure demonstrated the maintenance of periodontal health and good plaque control. It can be concluded that orthodontic forced eruption associated with odontoplasty promoted favorable conditions for prosthetic rehabilitation and is a feasible procedure in the treatment of tooth fracture extended below the cementoenamel junction.     

Atti SUN -Laparoscopic management of sacral neurinoma causing hydronephrosis

We report the case of a sacral neurinoma, which presented with mild hydronephrosis, due to compression of the right ureter, in a 71-yr old woman admitted to our hospital with recurrent urinary tract infections. CT and MRI detected a 4 x 4 cm mass pressing on the right ureter at the sacral level, in continuity with the second sacral foramen. Given this finding, the mass was thought to be of presumable neurogenic origin. In order to both reach a conclusive diagnosis and relieve the compression of the ureter, a laparoscopic resection of the mass was performed. Surgery was successful and the pathologic examination revealed a sacral Antoni A neurinoma. Neurinomas, also called Schwannomas, are uncommon benign nerve sheath tumors arising from Schwann cells. Their diagnosis can be extremely difficult due to their aspecific symptoms and the lack of pathognomonic characteristics on imaging exams. Therefore, histopathologic evaluation is essential in establishing the diagnosis. Surgical resection seems to be the best approach, both for diagnostic and therapeutic purposes.     

Bioenergetics and biomechanics of cycling: the role of ‘internal work’

The ‘dissection’ of energy expenditure of cycling into the metabolic equivalent of the different forms of mechanical work done, inaugurated 30 years ago by di Prampero and collaborators, has been much debated in the last few decades. The mechanical internal work, particularly, which is currently associated to the movement of the lower limbs, has been approached, estimated and discussed in several different ways and there is no agreed consensus on its role in cycling. This paper, through re-processing previously published data of oxygen consumption during pedalling at different frequency, external load and limb mass, proposes a model equation and a multiple non-linear regression as the method to assess the internal work of cycling. With that tool a very consistent metabolic equivalent of the internal work is obtained. However, a software simulation of pedalling limbs showed, as suggested in the literature, that the link with the chain ring allows the system to passively revolve forever, after an initial push. This result challenges the very existence of the ‘kinematic internal work’ of cycling. We conclude and suggest that the ‘viscous internal work’, an often neglected and almost unmeasurable portion of the internal work that could be proportional to the ‘kinematic’ form, is responsible for the extra metabolic expenditure as measured when the pedalling frequency of cycling increases.     

Norwegian scabies mimicking rupioid psoriasis

Norwegian scabies is a highly contagious skin infestation caused by an ectoparasite, Scarcoptes scabiei var. Hominis, which mainly affects immunosuppressed individuals. Clinically, it may simulate various dermatoses such as psoriasis, Darier''s disease, seborrheic dermatitis, among others. This is a case report of a 33-year-old woman, immunocompetent, diagnosed with generalized anxiety disorder (cancer phobia), who had erythematous, well-defined plaques, covered with rupioid crusts, on her neck, axillary folds, breast, periumbilical region, groin area, besides upper back and elbows, mimicking an extremely rare variant of psoriasis, denominated rupioid psoriasis.