111,911 research outputs found
Fluorescein-guided resection of plexiform neurofibromas: how I do it
No full textBackground: Plexiform neurofibromas (PN) can determine pain, nerve function impairment, and, when extremely large, also deformity. Surgical is often partial, with possible recurrence, and the risk of malignant transformation. Method: We describe the surgical strategy in a case of huge multiple plexiform neurofibromas of the left arm. We attempted to achieve a safe resection under the intraoperative guidance of fluorescein, with a dedicated microscope filter (YELLOW560). This technique can be also applied to other locations. Conclusion: Fluorescein-guided surgery, coupled with intraoperative neurophysiological monitoring, increases the safe resection rate, considering the risks of neurological deficits and the possible malignant transformation
Letter: The Presence and Persistence of Unrealistic Expectations in Patients Undergoing Nerve Surgery
No full textWhat is the advantage of using sodium fluorescein during resection of peripheral nerve tumors?
No full textMinimally Invasive Carpal Tunnel Release: A Technical Note and a 20-Year Retrospective Series
No full textIntroductionThe surgical treatment of carpal tunnel syndrome (CTS) has been enriched, during the last years, by different minimally invasive techniques to decompress the median nerve at the wrist as the endoscopic approaches or modified open technique. However, controversy remains about their safety and complication rate. We present the results of our minimally-invasive technique to median nerve release at the wrist. We will discuss the instrumental preoperative assessment, surgical steps, post-operative management, and complications.MethodsWe retrospectively reviewed clinical and neurophysiological data of all patients admitted at our institution between January 2001 and December 2020 for CTS surgery. The technique, performed under local anesthesia, is based on a single, small, linear transverse incision proximal to the wrist fold. After unsharpened dissection of subcutaneous tissues, a grooved guide is inserted in a slightly medial direction towards the fourth finger; this strategy prevents possible damages of nerve branches that could originate at this level. A second small incision over the guide's tip allows a wide corridor in the context of the ligament. The carpalotome is then inserted into the guide; the two minor wounds are closed with 5-0 prolene sutures. The final result is a wide release of the nerve.ResultsA total of 1568 operations on 1371 patients were performed using the described technique at our institution. The patients' cohort showed a higher prevalence of women (68%), with a mean age of 56.4 years (range 24-88 years). Paresthesia and numbness of the first three fingers were the most frequent signs and symptoms. All patients were submitted to a preoperative electrophysiological evaluation, which revealed the typical signs of CTS in most patients. The US evaluation of the median nerve at the wrist was a more recent introduction, dating from 2018. In 47 patients, despite an electromyography (EMG) not showing marked neurophysiological signs of severe CTS, the ultrasonographic evaluation was strongly consistent with the clinical diagnosis. In such patients, carpal tunnel release determined the resolution of symptoms. In 99.8% of total cases, we obtained a complete symptoms remission, with the disappearance of acroparesthesia and numbness.ConclusionThe use of this technique has become widespread at our institution due to fewer local complications, a very low rate of recurrence, faster functional recovery, and reduced surgical time if compared to traditional open surgery and to endoscopic release too
The reduced brood nursing by mite-infested honey bees depends on their accelerated behavioral maturation
No full textExtensive annual losses of honey bee colonies (Apis mellifera L.) reported in the northern hemisphere
represent a global problem for agriculture and biodiversity. The parasitic mite Varroa destructor, in association
with deformed wing virus (DWV), plays a key role in this phenomenon, but the underlying
mechanisms are still unclear. To elucidate these mechanisms, we analyzed the gene expression profile of
uninfested and mite infested bees, under laboratory and field conditions, highlighting the effects of
parasitization on the bee's transcriptome under a variety of conditions and scenarios. Parasitization was
significantly correlated with higher viral loads. Honey bees exposed to mite infestation exhibited an
altered expression of genes related to stress response, immunity, nervous system function, metabolism
and behavioural maturation. Additionally, mite infested young bees showed a gene expression profile
resembling that of forager bees. To identify potential molecular markers of colony decline, the expression
of genes that were commonly regulated across the experiments were subsequently assessed in colonies
experiencing increasing mite infestation levels. These studies suggest that PGRP-2, hymenoptaecin, a
glucan recognition protein, UNC93 and a p450 cytocrome maybe suitable general biomarkers of Varroainduced
colony decline. Furthermore, the reliability of vitellogenin, a yolk protein previously identified as
a good marker of colony survival, was confirmed here
The effect of ozone injection within a common peroneal nerve schwannoma: A mistreatment due to a misdiagnosis
No full textBackground: Peripheral schwannomas can be misdiagnosed or mistreated as they can mimic other subcutaneous lesions, leading to wrong diagnosis and, therefore, to improper treatment. Case Description: A 23-years-old male presented a painful growing nodule at the left popliteal fossa, with distally irradiated pain. A first magnetic resonance imaging depicted a heterogeneous lesion between common peroneal and sural nerves but, surprisingly, the patient was submitted to perilesional injection of ozone-oxygen mixture, causing the onset of intense neuropathic pain. A second MRI showed a morphological change of tumor characteristics. He finally underwent surgery but, intraoperatively, inter-fascicular fibrous adherences were noticed, making the tumor removal more difficult and riskier. The histopathological diagnosis was of schwannoma with areas of foreign body reaction. Conclusion: The injection of ozone or other substances within a subcutaneous swelling should be avoided, before a complete imaging assessment; because of such swelling could be a peripheral nerve schwannoma. The correct assessment of a lesion of the limbs determining radiating pain should be carefully demanded to a thorough history, clinical examination, and appropriate imaging technique. To avoid incorrect management, the treatment of such tumors should be performed in the first place by dedicated equips with proven expertise in this field
Heptakis(6-O-(N-acetylyl-L-valine-tert-butylamide)-2,3-di-O-methyl)-b-cyclodextrin: a promising chiral solvating agent for NMR detrminations of enantiomeric compositions
No full textIntraoperative compound muscle action potentials (CMAPs) amplitude changes after decompression and neurolysis of peripheral nerves in upper limbs neuropathies: Electrophysiologial considerations and relation with clinical outcome
No full textBACKGROUND: Decompression and, when necessary, neurolysis in entrapment neuropathies of upper limbs are effective and safe procedures, but their correlation with the variation of compound muscle action potentials (CMAPs) is still unclear, based in particular on experimental models. In addition, there are few data regarding the efficacy of intraoperative neurophysiologic monitoring (IOM) to predict clinical early and late outcome after surgery in term of pain control and sensitive/motor recovery. We report about the association between the intraoperative anatomical and neurophysiological findings and the mid- and long-term postoperative clinical course in a surgical series. METHODS: We retrospectively reviewed clinical data of 24 patients among 68 admitted at our Institution for upper limb neuropathies from September 2012 to May 2015. All patients completed two preoperative questionnaires for assessing the level of disability (DASH) and of pain/ discomfort (NRS). CMAPs' amplitudes were intraoperatively detected, before and after decompression and neurolysis and the variations were then related to clinical outcome, evaluated through DASH and NRSquestionnaires at 6-, 9- and 12-months follow-up. RESULTS: A statistically significant difference was noted in CMAPs amplitudes before and after decompression (P<0.01). In two patients, this variation was so satisficing to determinate the end of procedure, without the need to perform neurolysis. Major correlations between the variation of CMAPs amplitude after surgery and change of DASH and NRSscores at follow-up were found. CONCLUSIONS: Variations of CMAPs amplitude provide real-time information on nerves function and may be helpful in predicting mid- and long-term postoperative outcome regarding pain relief and neurological functions
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