Idiopathic normal pressure hydrocephalus diagnosis: Quantitative and qualitative score predicting outcome of extended lumbar drainage.

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Treatment of Chiari III Malformation in Infant with 4K 3D ORBEYE Exoscope.

Chiari malformation (CM)-III is the rarest anomaly among CMs.1 Treatment of choice is surgical repair,2 although poor outcome and postoperative mortality has been reported.3 Surgical timing is still debated.4,5 We present the case of a male infant with a prenatal diagnosis of encephalocele. Presentation was characterized by hemodynamic instability, horizontal nystagmus, and left shoulder dystocia due to caesarean section, with a 64 mm × 49 mm × 76 mm soft, fluctuant, and translucent suboccipital-cervical sac. Magnetic resonance imaging revealed a median occipital bone defect with the meningoencephalic sac communicating with the vermian cistern and the fourth ventricle, moderate hydrocephalus, reduction of the posterior cranial fossa volume, hypoplasia of cerebellar hemispheric, vermian structures, and corpus callosum hypoplasia. The patient underwent surgery on day 4 with the use of a 4K 3D ORBEYE exoscope (Video 1). Surgery consisted of disengagement of nervous structures and repair of the neurocutaneous defect, followed on day 12 by a ventriculoperitoneal shunt with a programmable valve. The procedures were well tolerated. At the 14-month follow-up visit he was in range with growth charts (weight, height, and cranic circumference) and gained the physiologic stages of growth. He had no motor impairment but still present were convergent strabismus and mild left C5-C6 radiculopathy, secondary to shoulder dystocia. This is the first case reported in the literature of CM-III treated with the 4K 3D ORBEYE exoscope. Advantages of the exoscope were ergonomic positions for operative staff, possibility for the team to assist in the 4K 3D view, especially in cases with a narrow operative field, with a clear and detailed vision, although a learning curve is required6 to become a valid alternative in pediatric neurosurgery.

Unusual Case of Posterior Fossa Extradural Hematoma in a Child: Review of the Literature.

INTRODUCTION: Posterior fossa extradural hematoma (PFEH) is a rare pathology often due to nuchal region trauma. In children, PFEH causes rapid decline of the neurological status also for brain stem compression. Early brain computed tomography (CT) scan is necessary suspicious for PFEH. Most patients need surgical evacuation. CASE PRESENTATION: In this article, we present a 5-year-old patient arrived for meningitis that came out in favor of PFEH after an accurate history record. DISCUSSION/CONCLUSION: Accurate anamnestic records, especially in pediatric patients, prevent from misleading clinic and neurological presentation. Brain CT scan is an indispensable diagnostic tool in order to promptly recognize and treat PFEH considering that rapid cognitive impairment of patients raises the risk of mortality and morbidity.

Examining dietary variability of the earliest farmers of south-eastern Italy.

Stable isotope analysis of human remains has been used to address long-standing debates regarding the speed and degree to which the introduction of farming transformed diet. In Europe, this debate has centered on northern and Atlantic regions with much less attention devoted to the arrival of farming across the Mediterranean. This study presents carbon and nitrogen stable isotope analyses of collagen from 19 human and 37 faunal remains from eight sites in the Apulia and Marche regions of south-eastern and central Italy, dating to the early phases of agricultural adoption during the first half of the 6th Millennium BC. Where collagen preservation permitted, sulfur stable isotope analysis was also performed. Overall, there was significant isotopic variation between the different geographic regions, although there was also considerable uncertainty in interpreting these data, especially given heterogeneous isotope values for fauna from site to site. By considering isotope data from each region separately, it was noticeable that the degree of carbon isotope enrichment in humans compared to fauna was higher for individuals buried near the coast, consistent with increased marine consumption. Coastal individuals also had higher sulfur isotope values. Nitrogen isotope values were very variable between individuals and regions and, in some cases, were consistent with very high plant food consumption. Overall, early "farmers" in south-east and central Italy consumed a wide range of foods, including marine, and had much more variable stable isotope values than those observed in central and northern Europe during this period, perhaps indicating a different mode for agricultural adoption.

Primary prevention of sudden cardiac death: indications for cardioverter-defibrillator implantation.

Sudden cardiac death accounts for 400,000 to 450,000 deaths annually in Europe and in the United States. In patients with previous life-threatening arrhythmia, several perspective, randomized, controlled studies have demonstrated that implantable cardioverter-defibrillator (ICD) therapy is superior to the best antiarrhythmic therapy in prolonging survival. Furthermore, in a stratified-risk population with coronary artery disease, left ventricular ejection fraction < or = 35%, non-sustained ventricular arrhythmias, and inducible ventricular tachycardia, the ICD supports the class I level of recommendation by the guidelines published in 1998. The American College of Cardiology, American Heart Association, and North American Society of Pacing and Electrophysiology have updated the 1998 guidelines on the implantation of arrhythmia devices including in a class IIa level of recommendation also patients with a previous Q wave myocardial infarction and left ventricular ejection fraction < or = 30%, independently of their arrhythmic risk profile. In the recent years several randomized studies assessed the role of ICD treatment for primary prevention of sudden cardiac death and total mortality reduction in high-risk groups of patients with ischemic and non-ischemic dilated cardiomyopathy, with special reference to those with heart failure and ventricular dysfunction. This article reviews those trials that have resulted in defining indications for ICD, and that will expand its use in the future.

Preoperative evaluation and risk factors in patients undergoing lung resection for cancer.

Surgical resection remains the mainstay of treatment in lung cancer patients. Stratification of preoperative risk should be based on the functional status of pulmonary and cardiac systems usually damaged by cigarette smoking. Preoperative pulmonary evaluation should be performed taking into consideration the specific characteristics of the single patient and the type of surgery planned. Spirometry only may be required or oxygen consumption determination is necessary. Cardiac assessment should be based on clinical and instrumental examinations while invasive tests should be limited to high-risk patients. The potential difficulties in endotracheal intubation and lung isolation, the risk for desaturation during one-lung ventilation, and postoperative pain control should be analyzed.