Anatomical variations of the median nerve and of the vascular-nervous structures at the wrist.

Three cases of anatomical variation of the median nerve at the wrist found during our surgical activity led us to take the opportunity to expose anatomical variations by reviewing already published reviews. Consequently, on the basis of anatomical studies, clinical reports and imaging, as a result of careful examination of the published literature, it has been observed that the interventions in such anatomical area must take into account these variations. In particular, the most performed procedure is the lysis of the transverse carpal ligament (TCL), which is not free from complications. In our opinion it is therefore necessary, in order to avoid the complications of the nervous, vascular and tendinous sections, to use some specific technical procedures.

Influence of occlusal characteristics, food intake and oral hygiene habits on dental caries in adolescents: a cross-sectional study.

AIM: Dental caries is one of the most common oral diseases affecting children. The complex multifactorial aetiology of caries involves host (saliva composition and tooth enamel characteristics), oral microflora and substrate (oral hygiene quality and dietary habits composition). Occlusal characteristics may be also a factor in dental caries development. The aim of this aepidemiologic study was to verify the association between DMFT (Decayed, Missed, Filled Teeth) index and occlusal characteristics, dietary habits, oral hygiene habits and parents' education level in a sample of 12-year-old schoolchildren from Southern Italy. MATERIALS AND METHODS: A sample of 536 children was examined to detect dental caries status and several occlusal variables (i.e. molar relationship, overjet and overbite, presence of crossbite, scissor bite, crowding, diastemas and/or midline deviation). A questionnaire to retrieve parents' educational level, patient's dietary and oral hygiene habits was administered. The associations among these variables were assessed statistically through the ?2 test. RESULTS: A positive association was found between caries, parents' social status and some occlusal disorders. va specificato, l'abstract non può essere una caccia al tesoro. In relation to occlusal variables, crossbite (?2=3.96, P=0.04) was significantly associated to caries. A significant association was also found between the education level of mothers (?2=7.74, P<0.01) and fathers (?2=6.35, P=0.01) and the presence of caries. Dietary habits, oral hygiene and remaining occlusal characteristics were not associated with caries presence (all P>0.05). CONCLUSIONS: Of the evaluated occlusal characteristics only posterior crossbite was associated with caries prevalence. Education level of the parents was the other factor significantly associated with caries. Dietary habits, oral hygiene frequency and the remaining occlusal characteristics were not associated with dental caries.

Lymphangioma of the tongue associated with open bite: case report.

BACKGROUND: Lymphangioma of the tongue is a rare condition related to congenital malformations of the lymphatic system. It may have different implications such as macroglossia. This condition could exacerbate in aesthetic abnormalities and functional problems such as maxillofacial structural deformities, dysphagia, airway obstruction and speech difficulties. The aim of this paper is to describe this disease by means of a case report. CASE REPORT: A 4-year-old patient was referred to our department presenting macroglossia, functional difficulty during swallowing and mastication, speech disturbances, airway obstruction, and deformities of the maxillofacial structures. Diagnosis of lymphangioma was confirmed by biopsy. After surgical removal of the lesion, the patient was treated with rapid palatal expansion, functional appliance with lingual grid and fixed multibracket appliance. After treatment, improvement in function, indicated by the gradual increase in occlusal force, could be taken as a positive sign of stability. CONCLUSION: The 3-step treatment protocol described in this article proves to be effective in controlling the malocclusion in the three planes of the space in a patient affected by lymphangioma of the tongue.

Invasive mould disease in haematologic patients: comparison between fusariosis and aspergillosis.

OBJECTIVES: To compare the epidemiology, clinical presentation, diagnosis, treatment, and outcome of haematologic patients with invasive aspergillosis (IA) or invasive fusariosis (IF). METHODS: We retrospectively reviewed the charts of 36 patients with IA and 26 with IF diagnosed between 2006 and 2017 in haematologic patients, and compared baseline characteristics, coexisting exposures, clinical manifestations, treatment, and the outcome. RESULTS: Fever was more frequent in IF (96.2% vs. 63.9%, p 0.003), whereas pneumonia (88.9% vs. 50.0%, p 0.001) and sinusitis (63.9% vs. 38.5%, p 0.048) were more frequent in IA. Skin lesions and positive blood cultures occurred exclusively in patients with IF. Among patients with pneumonia, the halo sign was more frequent in IA (62.5% vs. 23.1%, p 0.02). Serum galactomannan was positive in 88.6% of patients with IA and in 73.3% with IF (p 0.18), with no differences in the median number of positive tests and galactomannan values. Positive serum galactomannan plus lung infiltrates was the predominant clinical presentation in IA and occurred in four of 13 patients with IF and lung involvement. The 30-day survival was 77.7% in IA and 46.1% in IF (p 0.01). CONCLUSIONS: IA and IF share the same epidemiologic scenario but different clinical presentations in the majority of cases, with disease in the airways in IA, and fever, metastatic skin lesions, and positive blood cultures in IF. However, a substantial proportion of patients with IF present with a clinical picture similar to IA, with fever, lung infiltrates, and positive serum galactomannan.

Birthday of peripheral nervous system surgery: the contribution of Gabriele Ferrara (1543-1627).

SURGERY OF THE peripheral nerves has only recently achieved brilliant results thanks to technological advances in the development of neurosurgical instrumentation. In past centuries, few surgeons made relevant contributions to this topic and improvement was slow and difficult. Avicenna, Guglielmo da Saliceto, and Guido Lanfranchi reported some attempts to suture nerves directly, but Gabriele Ferrara was the first to give a lucid and succinct description of suturing of the stumps of a transected nerve. He described applying gentle traction on the retracted stumps, suturing using a special needle with an eye, after immersion in a decoction of red wine, rosemary, and roses (alcoholic disinfection?), and, finally, insulating the sutured segment with a mixture of oils. We are celebrating the 400th anniversary of the first edition of his fundamental work (1596-1996), and we truly esteem this surgeon, a pioneer of peripheral nerve surgery wo primarily contributed to its progress.

Tuberculoma of the ulnar nerve: case report.

A peripheral nerve tuberculoma, the third on record, involved the ulnar nerve, as did the other two. This case report is followed by a discussion of the pathogenesis and diagnosis of this lesion. Its pathogenesis is unclear. Direct infection from a tuberculous sister was disproved, and infection via a local wound is highly unlikely. A previous, silent form of tuberculosis seems to have been the cause.

Intraneural synovial cyst of the peroneal nerve: report of two cases and review of the literature.

We report two cases of peroneal nerve compression caused by an intraneural synovial cyst and discuss the pathogenesis, clinical and electrophysiological diagnosis, and treatment of these uncommon lesions in the light of the salient published work on the subject.

Isolated lesion of the axillary nerve: surgical treatment and outcome in 12 cases.

We report a series of 12 cases of isolated lesions of the axillary nerve treated surgically. We discuss the pathogenesis, clinical pattern, and surgical treatment of this lesion together with the results obtained.

Familial meningiomas. Report of two cases.

The Authors report a case of intracranial meningioma in two sisters, with no evidence of neurofibromatosis. A study of the karyotype has been performed; in one patient we have found a pericentric inversion of one chromosome 9. The possible role of the genetical factors in the develop of familial meningiomas is discussed.

Late intraneural metastasis of the brachial plexus from mammary carcinoma. Report of a case.

A rare case of late intraneural metastasis of the brachial plexus from mammary carcinoma is reported. The lesion was strictly intraneural and had a latency of 29 years and the diagnosis was made incidentally in the course of surgery. The clinicopathological and diagnostic features of the tumor are discussed in the light of the accessible literature.

Meningioma following high-dose radiation therapy. Case report and review of the literature.

A case of meningioma induced by high-dose radiation therapy (40 Gy) is reported. The radiation had been given 11 years previously following operation for cerebral astrocytoma. Pertinent cases of benign meningioma occurring after radiation therapy are reviewed and analyzed.

Intramedullary subependymoma of the cervical spinal cord.

The authors report a rare case of intramedullary subependymoma of the spinal cord. The case is discussed and a review of the literature is presented.

Ganglion of deep peroneal nerve: electrophysiology and CT scan in the diagnosis.

Deep peroneal nerve mononeuropathy is rarely observed in clinical practice. We describe a case in which the syndrome was caused by a clinically not detectable ganglion within the anterior compartment of the leg. Electrophysiological data allowed us to localize the site of the lesion for a correct planning of CT scan. CT scan showed a low density tissue occupying the anterior compartment of the leg and its relationships to muscles, septa, bones and vessels. Electrophysiological data and CT scan utilities are discussed.

Purely epithelioid schwannoma. Two case reports and a review of the literature.

The authors describe 2 cases of purely epithelioid schwannomas, one spinal the other peripheral. At surgery, the spinal schwannoma appeared as an orange-sized, solid, brown mass. Total removal of the tumor was performed. The peripheral schwannoma appeared as a fusiform, brown, movable mass in the sensitive branch of the left tibial nerve and was removed by a wide en bloc excision. Intraoperative nerve action potentials were performed both prior to and following excision of the lesion. Histologically, the tumors were composed of round or polygonal cells arranged in necrotic clusters and anastomosing cords. There were areas of spindle cells. The epithelioid cells were round to oval with abundant cytoplasm. Mitoses were frequent (3 out of 10 in high-power field). S100 protein immunoreactivity was present diffusely in tumor cells (both nuclear and cytoplasmic), whereas cytokeratin, NSE, and anti-melanoma reactions gave negative results. After a long follow-up, the neurological condition of the patients is excellent and there are no signs of either recurrence or metastasis. The therapeutic management of epithelioid schwannoma is discussed.

Bilateral cervical posterior rhizotomy: effects on dystonia and athetosis, on respiration and other autonomic functions.

Bilateral cervical posterior rhizotomy of C1 through C4, C5 or C6 was performed in 16 patients affected by dystonia and athetosis resulting from infantile cerebral palsy. The majority showed decreased muscle spasms and athetoid movements, with some improvements in their posture and voluntary mobility. 5 patients suffered from uneven and irregular breathing associated with lethargy immediately postoperatively, and 4 also showed reduced diaphragmatic activity; all 4 of these patients developed pneumonia, transitory in 3, but fatal to the other. Urinary retention lasting for a maximum of 3 months occurred in 4 of the 5 patients. The authors suggest that the lesion of ascending reticular fibers in the cervical posterior roots could have been responsible for the observations.

290 surgical procedures for ulnar nerve entrapment at the elbow: physiopathology, clinical experience and results.

Ulnar nerve entrapment at the elbow is an important and relatively frequent pathological condition that may be related to different causes depending on individual or external factors. The cause of the nerve lesion is also idiopathic in about one-quarter to one-third of cases. This variable aetiopathogenetic presentation has often suggested different diagnostic and clinical approaches and, moreover, various surgical procedures. We present our 8-years surgical experience with 290 cases of ulnar nerve entrapment at the elbow analysing the salient clinical features and the results of the surgical treatment in the light of the relevant literature available on this topic.

Synovial cysts: clinical and neuroradiological aspects.

Lumbar and intraneural synovial cysts are uncommon lesions, although their incidence has increased since the introduction of MRI. The authors describe the results of a study comprising 23 patients with synovial cyst (5 lumbar, 19 intraneural). Neuroradiological investigations included CT scan and MRI; however, it was not always possible to diagnose the nature of the lesion. In 18 cases the lesion was removed totally including its capsule; in the other 5 cases it was removed subtotally. Seven of the 23 patients presented a total remission of symptoms/signs, 11 improved and 5 remained unchanged. The importance of treating synovial cysts as radically as possible is discussed together with their most significant clinical and neuroradiological aspects.

Benign neural sheath tumours of major nerves: characteristics in 119 surgical cases.

Peripheral benign nerve sheath tumours are infrequent tumours and affect major nerve trunks. Some authors have indicated a high and prohibitive incidence of neurological injury in resection of these lesions. The authors describe their findings in a retrospective study comprising 119 patients with spontaneous benign nerve sheath tumours of the peripheral nervous system. Seventy-three patients had a schwannoma, 41 had neurofibroma and 5 had plexiform neurofibroma; 25 of the 119 patients suffered from neurofibromatosis. All schwannomas were excised completely and the outcome of patients was 41.0% improved, 6.8% worsened, 52.0% unchanged. Twenty-eight neurofibromas were excised completely and 13 subtotally; the outcome for patients was 19.5% improved, 19.5% worsened and 61% unchanged. All plexiform neurofibromas were removed subtotally and the outcome for patients was 20% improved and 80% unchanged. The best surgical results at average follow-up of 6 years were observed in the patients with schwannoma, the worst in those with plexiform neurofibroma. Our results demonstrated that it is often possible to remove schwannomas as well as neurofibromas with an acceptable risk of injury to the nerve.

A report on radiation-induced gliomas.

Radiation-induced gliomas are uncommon, with only 73 cases on record to date. The disease that most frequently occasioned radiation therapy has been acute lymphoblastic leukemia (ALL). Three more cases are added here, two after irradiation for ALL and one after irradiation for tinea capitis. In a review of the relevant literature, the authors stress the possibility that the ALL-glioma and the retinoblastoma-glioma links point to syndromes in their own right that may occur without radiation therapy.