Human amniotic membrane application in oral surgery-An ex vivo pilot study.

Objectives: The purpose of this pilot porcine study was to explore and illustrate the surgical application of human amniotic membrane (hAM) in an ex vivo model of medication-related osteonecrosis of the jaw (MRONJ). Material and methods: Five oral and maxillofacial surgeons participated to this study. MRONJ was simulated on porcine mandible specimens. hAM was applied using four different techniques: implantation with complete coverage, implantation with partial coverage, apposition and covering graft material. At the same time, the surgeons evaluated how well the hAM handled and its physical properties during the surgery. Results: Surgeons found that hAM had suitable mechanical properties, as it was easy to detach from the support, handle, bind to the defect and bury. hAM was also found to be strong and stable. The "implantation with complete coverage" and "implantation with partial coverage" techniques were the preferred choices for the MRONJ indication. Conclusion: This study shows that hAM is a graft material with suitable properties for oral surgery. It is preferable to use it buried under the gingiva with sutures above it, which increases its stability. This technical note aims to educate surgeons and provide them with details about the handling of hAM in oral surgery. Clinical relevance: Two surgical techniques for hAM application in MRONJ were identified and illustrated. hAM handling and physical properties during surgery were reported.

Treatments in Neurology: The Winding Road from 1897 to 2022.

BACKGROUND: For many years, neurology was seen as a purely observational discipline, focused on pathology and with little interest in treatments. SUMMARY: From the creation in 1897 of Monatsschrift für Psychiatrie und Neurologie, the forebear of European Neurology, to nowadays, there have been great changes in the paradigms and concepts of treatments in neurology. We present an overview of the evolution of neurological treatments from 1897 to 2022. KEY MESSAGES: However, the last 125 years have not consisted of constant progress. The exceptional advances made in some diseases (multiple sclerosis or surgical treatment of Parkinson's disease) cannot hide the stagnation in others (certain brain tumors or amyotrophic lateral sclerosis).

[Neurological shoulder pain and weakness : practical attitudes]. / Douleurs et faiblesse de l'épaule neurologique : attitudes pratiques.

Shoulder pain or paresis should be assessed carefully, as there are many possible causes, which can be osteoarticular, degenerative, inflammatory, or neurological. Weakness or pain can be related to cervicobrachialgia, plexitis, or focal mononeuropathy. The clinical picture should identify any muscular or mechanical origin of paresis responsible for pseudo-paretic functional limitation. Neurogenic scapulalgia with functional deficit implies the compression or entrapment of a nerve trunk including the axillary, long thoracic, accessory, suprascapular, or dorsal scapular nerves. Nerve conduction study and myography together with medical imaging help to identify the relevant etiology. Treatment mostly includes pain relief and physiotherapy, but surgery is rarely necessary.

L'épaule douloureuse ou parétique est d'appréhension délicate et de causes variées : ostéoarticulaire, dégénérative, inflammatoire ou neurologique. La faiblesse ou la douleur peuvent être liées à une cervicobrachialgie, une plexite ou une mononeuropathie focale. Le tableau clinique doit distinguer une parésie d'origine musculaire ou mécanique responsable alors d'une limitation fonctionnelle pseudo-parétique. Une scapulalgie déficitaire neurogène implique la recherche d'une mononeuropathie d'enclavement ou compressive d'un tronc nerveux, axillaire, long thoracique, accessoire du XIe nerf crânien, suprascapulaire ou dorsal de la scapula. Au besoin l'ENMG (électroneuromyogramme)et l'imagerie débrouilleront les multiples étiologies. Le traitement requiert le plus souvent une antalgie et une rééducation, rarement une chirurgie.

Main anatomical features of the calcarine sulcus: a 3D magnetic resonance imaging at 3T study.

OBJECTIVE: The purpose of our study was to determine the main anatomical features of the calcarine sulcus using a 3-T MRI. METHODS: Fifty human brains have been explored using an MRI 3-T in Doctors Center in Beirut (Lebanon). RESULTS: The calcarine sulcus was identified in 100% of cases. In most cases, it had a continuous aspect with several peaks. In all our specimens, the calcarine sulcus crosses the parieto-occipital fissure. The majority of their collateral branches and their connections with other sulci were located at the level of the calcarine sulcus properly. In the majority of specimens, the deepest part of the anterior calcarine sulcus forms a protrusion in the occipital horn of the lateral ventricle called calcar avis. CONCLUSION: Our study emphasizes the fact that the course patterns of the calcarine sulcus are highly variable. The description of the main anatomical features of the calcarine sulcus obtained from our study can be used as a reference for fMRI exploration and is useful for brain surgery.

Creative Minds in the Aftermath of the Great War: Four Neurologically Wounded Artists.

Many artists were involved in the First World War. Some of them were mobilized, like millions of soldiers, others enlisted to fight on the battlefield. The stories of writers who returned neurologically wounded from the war, such as Guillaume Apollinaire (1880-1918) or Blaise Cendrars (1887-1961), are well-known. The cases of painters and sculptors who suffered from First World War neurological wounds are scarce. Nevertheless, their injuries led to intense modifications of artistic practice. We detail four examples of artists whose creative mind was impacted by their First World War neurological wounds or diseases. The painter Jean-Julien Lemordant (1878-1968), who suffered from blindness after his injury, stopped his artistic work and became an icon of Franco-American friendship. The sculptor Maurice Prost (1894-1967), suffering from a neuroma due to the loss of his arm, built a special device to continue his work as a wildlife artist. The painter Georges Braque (1882-1963) was trepanned but carried on with his cubist work without ever mentioning the conflict. Conversely, the painter Fernand Léger (1881-1955), who suffered from a war neurosis, produced a significant war testimony through drawings and letters.

Louis-Ferdinand Céline: From First World War Neurological Wound to Mythomania.

The writer Louis Ferdinand Céline (1894-1961) developed a personal style which changed twentieth century French literature. As an enlisted soldier in 1912, he was involved in the Great War and his right arm was severely wounded. After the war, he became a medical doctor and a writer who published his first novel, Voyage au bout de la nuit (Journey to the End of the Night), in 1932. In the middle of the 1930s, he began to write anti-Semitic and racist pamphlets and turned to a collaborationist stance with Nazi Germany. After the Second World War, he was declared a national disgrace in France and fled to Denmark. In 1951, he was granted amnesty and went back to France, where he regained fame with his last three novels. Céline was a First World War neurologically wounded soldier who received a severe injury in the right arm leading to a radial nerve paralysis. Furthermore, in his texts and letters, he complained of many symptoms that he considered to be related to the First World War. In reality, to build a heroic image of himself, Céline rewrote his personal First World War history, in particular his war wounds. The aim of this reconstruction was to help him achieve literary fame. At the end of the Second World War, he also used this rewriting to organise his defence when he was accused and tried for collaborationism. Using medical and military archives, Céline's First World War medical mythology is reviewed to distinguish facts from fiction concerning his wound and other war neurological disturbances. We present the history of his radial nerve lesion and surgery, and confirm that Céline was never trepanned. Two other controversial neurological points, his left ear disease and his possible shell shock, are also discussed.

Arthur Rimbaud: "The Man with Wind Soles" - Riders' Osteosarcoma with Postamputation Stump Pain.

The famous poet Arthur Rimbaud (1854-1891) stopped writing poetry at 21 years and subsequently had a rather adventurous life mainly in the Arabic peninsula and Ethiopia. He died at 37 years, only a few months after the amputation of his right lower limb due to a developing tumor in the knee, which probably was an osteosarcoma in the lower third of the femur. His letters to his sister Isabelle suggest that he suffered from severe stump pain rather than phantom limb, but since he lived only shortly after surgery (he developed extensive carcinomatosis), one does not know whether a full phantom would have developed and how this would have affected his subsequent life.

Phantom Sensations, Supernumerary Phantom Limbs and Apotemnophilia: Three Body Representation Disorders.

Body representation disorders continue to be mysterious and involve the anatomical substrate that underlies the mental representation of the body. These disorders sit on the boundaries of neurological and psychiatric diseases. We present the main characteristics of 3 examples of body representation disorders: phantom sensations, supernumerary phantom limb, and apotemnophilia. The dysfunction of anatomical circuits that regulate body representation can sometimes have paradoxical features. In the case of phantom sensations, the patient feels the painful subjective sensation of the existence of the lost part of the body after amputation, surgery or trauma. In case of apotemnophilia, now named body integrity identity disorder, the subject wishes for the disappearance of the existing and normal limb, which can occasionally lead to self-amputation. More rarely, a brain-damaged patient with 4 existing limbs can report the existence of a supernumerary phantom limb.

Phantoms in artists: the lost limbs of Blaise Cendrars,Arthur Rimbaud, and Paul Wittgenstein.

There have been an increasing number of reports of postamputation pain and problems linked to phantom limbs over recent years, particularly in relation to war-related amputations. These problems, which are often poorly understood and considered rather mysterious, are still relevant because they are difficult to treat medically. Functional neuroimaging techniques now enable us to better understand their pathophysiology and to consider new rehabilitation techniques. Phantom limbs have often been a source of inspiration to writers, particularly in the period following the First World War, which was responsible for thousands of amputees. Some artists have suffered from postamputation complications themselves and have expressed them through their artistic works. Blaise Cendrars (1887-1961), one of the greatest authors of the twentieth century, suffered from stump pain and phantom limb phenomena for almost half a century following the amputation of his right arm during the First World War. He suffered from these phenomena until the end of his life and his literary work and personal correspondence are peppered with references to them. Arthur Rimbaud (1854-1891), one of the most famous poets in world literature, developed severe stump pain after his right leg was amputated due to a tumor. He survived for only six months after the procedure but left behind an account of the pain he experienced in correspondence to his family. The famous pianist Paul Wittgenstein (1887-1961), whose right arm was amputated during the First World War, became a famous left-handed concert pianist. The phantom movements of his right hand helped him to develop the dexterity of his left hand. The impact on the artistic life of these three men provides an original illustration of the various postamputation complications, specifically phantom limbs, stump pain, and moving phantom.

Ultrasound guidance of needle tip position for femoral nerve blockade: an observational study.

BACKGROUND: The femoral nerve lies in the ilio-fascial space in a groove formed by the iliac and psoas muscles (GIPM) posteriorly, and overlaid by the iliac fascia. Recommendations for needle insertion for femoral blockade using ultrasound imaging are to insert the needle tip behind the iliac fascia at the lateral side of the femoral nerve, but this part of the nerve is poorly visualised in some patients. A more accurate location of the lateral part of the femoral nerve might be achieved by identifying the GIPM and its lateral segment. OBJECTIVES: The objectives of this study are to determine the frequency of ultrasound visibility of the lateral part of the femoral nerve and GIPM, and to note the motor response to electrostimulation of the nerve and the spread of local anaesthetic when positioning the needle tip at the lateral segment of the GIPM. DESIGN: A prospective observational (case series) study. SETTING: Department of Anaesthesiology of a University Hospital. PATIENTS: Inpatients undergoing hip or knee surgery scheduled to have femoral nerve blockade were eligible to participate. INTERVENTIONS: The ultrasound probe was positioned in the inguinal region, and direct ultrasound identification of the femoral nerve, lying on the GIPM behind the iliac fascia, was obtained. A stimulating needle, inserted in-plane and advanced lateral to medial was directed towards the femoral nerve until it made contact with the target structure defined as the lateral segment of the GIPM. MAIN OUTCOME MEASURE: Ultrasound identification of the lateral part of the femoral nerve and GIPM. RESULTS: An image compatible with the lateral part of the femoral nerve was observed in 91 out of 100 patients. In the remaining nine patients, when the lateral part of the femoral nerve was not seen, GIPM could be visualised in five (55%) patients. The iliac fascia and GIPM were clearly visualised in 68 and 85 patients respectively. In 85 cases when the needle tip was placed at the lateral segment of GIPM, a quadriceps femoris muscle motor response was obtained, and the distribution of the anaesthetic solution was observed behind the iliac fascia in all patients. In two patients, only the iliac fascia was identified, and in the two patients, none of these structures was correctly visualised. CONCLUSION: The GIPM was seen in the majority undergoing ultrasound-guided femoral nerve blockade, even when the lateral part of the femoral nerve was not visualised. Using the lateral segment of GIPM as a target for needle tip location in an in-plane lateral to medial approach of the femoral nerve deserves further investigation.

Madness in blaise cendrars' novels: moravagine and company.

The literary work of Blaise Cendrars (1887-1961), né Frédéric Sauser, one of the major French-speaking authors of the 20th century, is imbued with references to neuropsychiatry. This theme is a constant presence in his writing as a result of his involvement of the First World War and his personal experiences, which were punctuated with neurologic and psychiatric events. Cendrars' own particular ideas on the genesis of mental disorders went against the more traditional views on psychiatry. He remained skeptical about hysteria and did not subscribe to psychoanalysis. His ideas were enriched by his experience with the war-related neuropsychiatric problems developed by soldiers. He thus proposed the notion of 'pathological fear' surrounding these disorders. There are a number of characters suffering from 'borderline' mental disorders in Cendrars' work, including two shocking, mad murderers, Moravagine and Fébronio. The character Moravagine, a neurology patient suffering from a brain tumor, enabled Cendrars to delve into the grey areas that can exist between neurologic and psychiatric diseases. Fébronio, a real psychotic, enabled Cendrars to explore ethnopsychiatry.

The missing hands of Blaise Cendrars.

The life and works of Blaise Cendrars (1887-1961), one of the greatest French literary authors of the 20th century, were profoundly influenced by neurology. Having been wounded in the Great War in 1915, his right forearm was amputated, and he very quickly began to suffer from stump pain and phantom hand phenomena, which persisted until his death. Following his amputation he became a left-handed writer. Half a century later, between 1956 and his death in 1961, he suffered two strokes which gradually paralyzed the left side of his body. After the second stroke in 1958, he became a 'handless writer', also partially losing his ability to express himself orally. Although the works of Blaise Cendrars portray characters with serious mental disorders, they also contain characters with real neurological diseases, such as the trepanated aphasic in 'J'ai Saigné'. The most famous of these is undoubtedly Moravagine, the protagonist of the eponymous novel, who presents acute behavioral disturbances. We learn from the autopsy report that he was in fact suffering from a brain tumor. On several occasions, including the complex case of Moravagine, and by presenting his ideas on hysteria, Blaise Cendrars, in his own way, addressed the somewhat fuzzy boundary that exists between psychiatry and neurology.