Mild traumatic brain injury in an insured population: subjective complaints and return to employment

The great majority of traumatic brain injury (TBI) is of mild severity, with Glasgow Coma Scores (GCS) of 13-15, post-traumatic amnesia of less than 48 hours and brief, if any, hospitalization. All mild TBI admissions to hospital were provided with education in the form of a brief interview and a brochure on minor head trauma from the National Head Injury Foundation. Seventy-seven insured individuals with mild TBI were contacted by phone between 1 and 3 months post-injury to determine the frequency and severity of post-traumatic symptoms and the rate of return to work (RTW). Twenty-six per cent of those contacted had subjective complaints; 88% had returned to work or school; 16% of those returning did so with some symptoms. Only 45% of symptomatic individuals sought medical consultation for their condition when offered. Education about post-traumatic symptoms from the onset may provide sufficient reassurance to most individuals that future use of medical services is seen as unnecessary. Rate of RTW is relatively higher than reported in previous studies of mild TBI.     

Creating low-power photomicrographs by digital scanning of histological sections

The recent introduction of digital film scanners in the medical-scientific field provided everyone dealing with light-microscopy an easy method to obtain low-power photomicrographs from entire histological sections. Direct scanning of the common microscope slide allows the easy creation of high quality images. The digital images obtained may be improved or retouched using dedicated software and then printed on paper or film. The required instrumentation is relatively unexpensive and neither skilled staff nor expertise of photographic techniques is required. This reduces costs and saves time. The obtained images may be employed in histopathology, embryology, histochemistry, image analysis and telepathology, and are suitable for scientific papers, educational purposes and lecturing, as well as for daily reporting. The authors bring their personal experience in this field, making also a complete literature review on the topic.     

Association between SLC11A1 (formerly NRAMP1) and the risk of sarcoidosis in Poland

Sarcoidosis (SA) is a systemic granulomatous disorder of unknown etiology characterized by T helper 1-type inflammatory responses at sites of disease with signs of B cell hyperactivity. Like rheumatoid arthritis and diabetes, an infectious etiology has frequently been postulated but no single infectious trigger definitively identified. Polymorphic alleles at SLC11A1 have previously been associated with susceptibility to both the putative infectious agents and to these autoimmune disorders. We therefore investigated its candidacy as a genetic determinant of SA in Poland in an association-based study comparing 86 SA patients with 85 tuberculosis (TB) patients and 93 control subjects. The functional promoter (GT)(n) polymorphism and four of 10 other single nucleotide or insertion/deletion polymorphisms genotyped across SLC11A1 were informative in our sample. Consistent with previous autoimmune disease studies, allele 3 at the functional (GT)(n) promoter region repeat polymorphism was significantly associated with SA when compared with healthy controls (odds ratio 1.68; 95% CI: 1.01-2.81; P=0.04) or with TB patients (odds ratio 1.69; 95% CI: 1.042-0.78; P=0.03).     

A further study on the kinetics of the subcellular current events at the mouse end-plate in the presence of cimetidine and ranitidine

The cholinomimetic activity of Cimetidine and Ranitidine has been demonstrated by several authors. In the aim to better understand the phenomenon, we analyse the miniature end-plate current decay time. The prolongation of the decay phase of the synaptic current induced by the "selective" H2-antagonist Ranitidine, and to a lesser extent and at higher concentrations by Cimetidine, resembles that of the cholinesterase inhibitors. These agents usually prolong the quantal conductance change having little or no effect on the channel lifetime. The results of our previous experiments, which data were obtained by analyzing the "voltage" events, either spontaneous or evoked, of a classic frog preparation, showed a marked alteration of the temporal parameters. These effects, obtained at higher drug concentrations than those used in the present work, are now better defined by deriving extracellularly the "current" events. The results are also compared with those obtained by assaying the cholinesterase inhibitor Eserine, under the same experimental conditions.     

Chinese flap in head and neck surgery

Twenty patients underwent resections for head and neck cancer. The reconstructive procedure used was the free forearm flap with microsurgical technique on 22 occasions. The free forearm flap was used in its simple or composite form, with double or manifold islands, with a segment of the radius for mandible reconstruction or with two islands joined solely by the vascular pedicle, constituting what the authors call "tandem flap", with excellent results. The procedure does not replace conventional ones, but the authors believe it should be regarded as one of the choice flaps by surgeons dedicated to this special field.     

Evolution of the diagnostic accuracy of CT in clinical staging of patients with Hodgkin's disease

From 1983 through 1989, 141 untreated patients with Hodgkin's disease underwent CT of the abdomen. They subsequently underwent staging laparotomy plus splenectomy and multiple biopsies of liver and lymph nodes, at the Institute of Radiology and Hematology, University "La Sapienza", Rome. CT results were compared with surgical findings to evaluate CT sensitivity, specificity, and overall accuracy. The cases from this series were divided into two groups depending on the characteristics of the CT scanners employed. From 1983 to 1985, 78 patients were examined with 2nd-generation CT units; from 1986 to 1989, 63 patients underwent CT performed with 3rd-generation scanners. The results from the two groups were analyzed according to these parameters. A total number of 622 biopsies were performed, of spleen, liver, and lymph nodes. CT sensitivity, specificity, and overall accuracy were: 22.9% (group I) vs 43.7% (group II), 83.1% vs 92%, and 68.4% vs 81.2% for lymph nodes; 28.1% vs 36.3%, 93.5% vs 98%, and 66.7% vs 87.3% for the spleen, and 12.5% vs 42.8%, 97.1% vs 98.2%, and 88.5% vs 92.1% for the liver. Our results demonstrate an obvious increase in reliability with newer units, even though a high percentage of false-negatives were still observed in our series, which caused understaging in 19.4% of cases vs 24.4% in group I.     

Abulcassis, the grand master of Arabian surgery

In the tenth century Abulcassis lived in the rich caliphate of Cordoba, where he wrote Tarsif, his masterpiece, which truly corresponded to an encyclopedia whose last volume was devoted to bringing up to date the art of surgery.     

Management peculiarities of costovertebral hydatidosis

BackgroundCostovertebral hydatidosis is a rarely reported clinical and radiological entity, estimated at less than 1% of thoracic hydatid locations. Its management is still not codified.ObjectiveThe aim of our study was to specify the management peculiarities of costovertebral hydatidosis.MethodsBetween January 2000 and December 2018, 14 patients were managed for costovertebral hydatidosis in a thoracic surgery department.ResultsThe mean age of our patients was 48 years. The history of a prior hydatid disease was found in 7 patients. Imaging features were suggestive in 13 cases. They showed: involvement of the spinal canal (6 cases), of the soft tissues (5 cases) and spinal cord compression (3 cases). Costovertebral resection of the hydatid lesions was complete in 12 cases. Four patients presented postoperative complications.ConclusionCostovertebral hydatid involvement, may threaten the functional and vital prognosis. Therefore, early diagnosis and management are mandatory, before the occurrence of irreversible neurological impairment. Surgical resection remains the treatment of choice and must be complete whenever possible. Relapse is frequent, hence the importance of a regular follow-up.     

Genetic and genomic analysis of acute lymphoblastic leukemia in older adults reveals a distinct profile of abnormalities: analysis of 210 patients from the UKALL14 and UKALL60+ clinical trials

Despite being predominantly a childhood disease, the incidence of acute lymphoblastic leukemia (ALL) has a second peak in adults aged 60 years and over. These older adults fare extremely poorly with existing treatment strategies and very few studies have undertaken a comprehensive genetic and genomic characterization to improve prognosis in this age group. We performed cytogenetic, single nucleotide polymorphism (SNP) array and next-generation sequencing (NGS) analyses on samples from 210 patients aged ≥60 years from the UKALL14 and UKALL60+ clinical trials. BCR-ABL1-positive disease was present in 26% (55/210) of patients, followed by low hypodiploidy/near triploidy in 13% (28/210). Cytogenetically cryptic rearrangements in CRLF2, ZNF384 and MEF2D were detected in 5%, 1% and <1% of patients, respectively. Copy number abnormalities were common and deletions in ALL driver genes were seen in 77% of cases. IKZF1 deletion was present in 51% (40/78) of samples tested and the IKZF1^plus profile was identified in over a third (28/77) of cases of B-cell precursor ALL. The genetic good-risk abnormalities high hyperdiploidy (n=2), ETV6-RUNX1 (no cases) and ERG deletion (no cases) were exceptionally rare in this cohort. RAS pathway mutations were seen in 17% (4/23) of screened samples. KDM6A abnormalities, including biallelic deletions, were discovered in 5% (4/78) of SNP arrays and 9% (2/23) of NGS samples, and represent novel, potentially therapeutically actionable lesions using EZH2 inhibitors. Outcome remained poor with 5-year event-free and overall survival rates of 17% and 24%, respectively, across the cohort, indicating a need for novel therapeutic strategies.