Changes in Primary Somatosensory Cortex Following Allogeneic Hand Transplantation or Autogenic Hand Replantation.

Former amputees who undergo allogeneic hand transplantation or autogenic hand replantation (jointly, "hand restoration") present a unique opportunity to measure the range of post-deafferentation plastic changes in the nervous system, especially primary somatosensory cortex (S1). However, few such patients exist, and previous studies compared single cases to small groups of typical adults. Here, we studied 5 individuals (n = 8 sessions: a transplant with 2 sessions, a transplant with 3 sessions, and three replants with 1 session each). We used functional magnetic resonance imaging (fMRI) to measure S1 responsiveness to controlled pneumatic tactile stimulation delivered to each patient's left and right fingertips and lower face. These data were compared with responses acquired from typical adults (n = 29) and current unilateral amputees (n = 19). During stimulation of the affected hand, patients' affected S1 (contralateral to affected hand) responded to stimulation in a manner similar both to amputees and to typical adults. The presence of contralateral responses indicated grossly typical S1 function, but responses were universally at the low end of the range of typical variability. Patients' affected S1 showed substantial individual variability in responses to stimulation of the intact hand: while all patients fell within the range of typical adults, some patient sessions (4/8) had substantial ipsilateral responses similar to those exhibited by current amputees. Unlike hand restoration patients, current amputees exhibited substantial S1 reorganization compared to typical adults, including bilateral S1 responses to stimulation of the intact hand. In all three participant groups, we assessed tactile localization by measuring individuals' ability to identify the location of touch on the palm and fingers. Curiously, while transplant patients improved their tactile sensory localization over time, this was uncorrelated with changes in S1 responses to tactile stimuli. Overall, our results provide the first description of cortical responses to well-controlled tactile stimulation after hand restoration. Our case studies indicate that hand restoration patients show S1 function within the range of both typical adults and amputees, but with low-amplitude and individual-specific responses that indicate a wide range of potential cortical neurological changes following de-afferentation and re-afferentation.

Dermatoscopic and Histopatological Aspect of Preneoplasia and Skin Cancers - Study on 74 Patients.

Dermoscopy is an important in-vivo, non-invasive diagnostic technique that allows visualization of morphological features not macroscopic visible. It has a major contribution in enhancing the diagnostic accuracy for pigmented skin lesions. Recent studies have shown that it also aids in the diagnosis of non-pigmented keratinizing skin lesions, including actinic keratosis and Bowen's disease. We performed a retrospective study in Dermamed Clinic Craiova, between January and June 2014, with the aim to correlate the dermoscopic and histopathological aspect of skin tumors. This study included a total of 74 patients, aged between 16 and 76 years. The dermatoscopic examination revealed 12 skin cancers, 51 precancerous lesions and 11 benign tumors. Those 12 subjects diagnosed with malignant tumors by dermatoscopic examination, had also histopathological examination and confirmation of the diagnosis, also 11 patients identified with benign tumors with dermatoscopic examination were subsequently confirmed by histopathological assesment. Out of the 51 patients with premalignant tumors, 48 patients had histopatological confirmation of it, and for 3 patients the result was squamous cell carcinoma. Thus dermatoscopic examination identified the malignant lesions with a specificity of 100% and a sensitivity of 80% with a positive predictive value of 100% and a negative predictive value of 94.12%, p<0.000.

Overlap Syndrome-Systemic Sclerosis, Systemic Lupus Erythematosus and Dermatomyositis - Case Report.

Overlap syndrome is often defined as an entity that satisfies the classification criteria for at least two distinct connective tissue disease. We present the case of a female patient, 39 years old, hospitalized in the Dermatology clinic of Emergency County Hospital in september 2014, for ulcerative lesions on the left hallux and the second and third left toes, associated with pain and difficulties in walking. After performing the clinical exam and paraclinical tests, we decided for both intravenous synthetic analogue of prostacyclin PGI2-iloprost and local therapeutic measures, with a favourable outcome of the ulcerations. Due to the fact that overlap syndrome is an entity with several visceral involvement and unpredictable evolution, we must not disregard the skin manifestation, so that we can prevent a severe evolution and improve the outcome. The case represents a permanent challenge for the multidisciplinary team that examine, survey and periodically adjust the treatment, based on the biological status and predominant symptoms.

Feedback and cognition in arm motor skill reacquisition after stroke.

BACKGROUND AND PURPOSE: A debated subject in stroke rehabilitation relates to the best type of training approach for motor recovery. First, we analyzed the effects of repetitive movement practice in 2 feedback conditions (knowledge of results [KR]; knowledge of performance, [KP]) on reacquisition of reaching. Second, we evaluated the impact of cognitive impairment on motor relearning ability. METHODS: A randomized controlled clinical trial was conducted in Montreal-area rehabilitation centers between 1998 and 2003 with 37 patients with chronic hemiparesis. Patients were randomly assigned to 3 groups: (1) KR (n=14) practiced a reaching task involving 75 repetitions per day, 5 days per week for 2 weeks, with 20% KR about movement precision; (2) KP (n=14) trained on the same task and schedule as KR but with faded KP about joint motions; and (3) control (C; n=9) practiced a nonreaching task. Physical (motor impairment, function) and kinematic (movement time, precision, segmentation, variability) variables were assessed before and after (immediately, 1 month) practice. Cognitive functions (memory, attention, mental flexibility, planning) were also evaluated. RESULTS: Kinematic gains in KR (precision) and KP (time, variability) exceeded those in C and depended on memory and mental flexibility deficits. In KP, more severely impaired patients made the most clinical gains (>2xC), which were related to memory and planning abilities. CONCLUSIONS: Use of KP during repetitive movement practice resulted in better motor outcomes. Stroke severity together with cognitive impairments are important factors for choosing motor rehabilitation interventions after stroke.