Neurophysiological aspects of chronic motor cortex stimulation

Chronic motor cortex stimulation is a treatment option for neuropathic drug-resistant pain and possibly associated movement disorders. Preliminary studies suggest the possibility to treat symptoms of Parkinson disease in selected patients. Recently, MCS has been suggested to enhance motor recovery in patients with poststroke hemiparesis. One or more electrodes are placed extradurally over the motor cortex through a burr hole or a small craniotomy, and then connected to a totally implantable neurostimulator. The accurate positioning of the stimulating electrodes over the motor cortex is the key point of the surgical procedure. Motor cortex identification results from the integration of anatomical, neuroradiological, functional, and neurophysiological data, taking into account the huge population variability. Intraoperative neurophysiological mapping of the motor cortex is of paramount importance, in spite of very sophisticated neuroradiological mathematical reconstructions of the motor area. We discuss and compare the different techniques that are utilized by different authors. Moreover, clinical neurophysiology is also helpful in evaluating the results of this neuromodulation procedure and in hypothesizing the mechanisms that are put in play by MCS.     

Donor characteristics do not influence transfusion-related acute lung injury incidence in a secondary analysis of two case-control studies

Objective

To investigate the relation between donor characteristics and TRALI incidence.

Prenatal detection of cri du chat syndrome on uncultured amniocytes using fluorescence in situ hybridization (FISH)

Fluorescence in situ hybridization (FISH) with a chromosome-region-specific DNA probe was used prospectively on uncultured amniocyte interphase cells to detect an unbalanced chromosome abnormality that resulted in cri du chat or 5p – syndrome. Confirmation was performed by routine cytogenetics.     

Surgical site infection following surgery for spinal deformity: About 102 patients

IntroductionComplex spinal surgery is known to be at risk of complications. Surgical site infection is a serious complication in spine surgery and its frequency is significantly increased in adult spinal deformity correction. The aim of this study is to identify patients’ characteristics and risk factors of surgical site infection (SSI) following an osteotomy.MethodsThis is a single-center retrospective study of patients who underwent an osteotomy between January 2015 and December 2017. Surgical site infection diagnosis was based upon patient's clinical evidence of infection, biologic parameters, microbiological criteria and/or image findings.ResultsIn total, 102 patients were eligible and 70 were women (68.6%). Mean age was 65 years old (27–83 years) and mean body mass index (BMI) was 26.14 kg.m⁻² (18.4–44.1). Eleven patients were in the SSI group and 91 in the No-SSI group. The mean Schwab grade was 1.5 (1–4) in the SSI group vs. 1.4 (1–5) in the No-SSI group (P = 0.435). The mean operative time was on 201.9 minutes (67–377). Mean length of stay was 20.6 days (10–73) in the SSI group vs. 15 days (5–44) in the No-SSI group (P = 0.041). Favorable outcome was found in 10 patients (90.9%) in the SSI group.ConclusionCorrection surgery for adult spinal deformity with osteotomies carries a high risk of complications specially SSI. Identification of risk factors, prevention and medical management of SSI should be well assessed.     

Paediatric intestinal transplantation: where are we now?

Intestinal transplantation (ITx) is the only curative treatment option for children with irreversible intestinal failure (IF) and complications of parenteral nutrition (PN). ITx is an immunologically difficult transplant due to the immune load of the donor gut; therefore, main causes of death and graft loss are immunological complications like sepsis or acute and chronic rejection. This article aims to help paediatricians in training understand when children should be referred for ITx, the different types of ITx, the complications these children might present with, and to learn about the journey a candidate for ITx must take with the support of the IF and ITx multidisciplinary teams (MDT).