The utility of selective partial neurectomy of the musculocutaneous nerve in children with bilateral spastic elbow.

PURPOSE: This study aims to determine the utility of selective partial neurectomy of the musculocutaneous nerve (MCN) in pediatric patients with bilateral spastic elbow. METHODS: A prospective, cross-sectional, case series study was performed in nine pediatric patients (four females and five males) with bilateral spastic elbow, all with a 11.4-year-old average age, where 18 selective partial neurectomies of the MCN were carried out. They were evaluated with goniometry of both spastic elbows at resting position and active amplitude, and staging spasticity employing the Modified Ashworth Scale (MAS) in the preoperative and postoperative period. The results are reported 1 year after surgery. RESULTS: The etiology of the spasticity was secondary to cerebral palsy in eight patients (88.8%) and in one patient (11.11%) secondary to traumatic brain injury. A clinical improvement was observed in goniometry comparing the preoperative and postoperative resting position, a mean preoperative of 44.38 degrees (SD ± 7.61) versus 98.05 degrees (SD ± 24.44), respectively, and preoperative active amplitude a mean of 86.55 degrees (SD ± 15.97) versus the mean postoperative of 47.33 (SD ± 17.86). A relevant decrease on the MAS after surgical intervention was observed, resulting from an average preoperative state according to MAS of 3.78 (SD ± 0.42) to a postoperative state according to MAS of 1.44 (SD ± 0.51), these changes being statistically significant (p ≤ 0.001). No postoperative complications were observed. CONCLUSIONS: Selective partial neurectomy of the MCN has shown good results in patients with bilateral spastic elbow in whom antispastic drugs and physical therapy have failed, and has prove permanent effects.

Hydrocephalus in Mexican children with Coccidioidal Meningitis: Clinical, serological, and neuroimaging findings.

BACKGROUND: Coccidioidal meningitis (CM) is a fungal infectious disease that rarely affects children. Even in endemic areas, coccidiomycosis rarely affects the pediatric population. However, 40% of affected children develop hydrocephalus. Here, we describe the clinical, serological, and neuroimaging findings in a series of Mexican children admitted to our neurosurgical service with hydrocephalus and subsequently diagnosed with CM. METHODS: We report a prospective series of pediatric patients with hydrocephalus secondary to CM in an endemic area at the north of Mexico. Our report includes children with CM who were hospitalized from 2015 to 2019 in a regional hospital in Torreón, Coahuila. Clinical evolution was monitored for 1 year after hospital discharge. RESULTS: Our series include five children with CM (2-17-years-old, three female), who were hospitalized for hydrocephalus and developed intracranial hypertension. The most frequent neuroimaging findings were leptomeningeal enhancement (5/5) and basal arachnoiditis (4/5), followed by asymmetric hydrocephalus (3/5), abnormalities in fourth ventricle morphology (3/5), and cerebral vasculitis (2/5). CM was diagnosed by positive serology or pathology studies. All children were initially managed with fluconazole and a shunt was placed for management of hydrocephalus. Four patients recovered without permanent neurological deficits and one subject developed persistent vegetative state. One year after hospital discharge, none of the subjects died. CONCLUSION: This series contributes to the limited number of pediatric CM cases reported in the literature, and describes neuroimaging findings in the pediatric population. The cases here presented show that the identification of Coccidioides as causal agent in pediatric meningitis is crucial for targeted treatment and can affect dramatically neurological prognosis. Furthermore, our report stresses that even in endemic areas pediatric coccidiomycosis represents a diagnostic challenge, which is further exacerbated by the limited availability of resources in these regions. Therefore, a positive immunoglobulin G by enzyme immunoassay is enough for diagnosis of CM in endemic areas without access to CF.

A Low-Cost, Passive Navigation Training System for Image-Guided Spinal Intervention.

BACKGROUND: Navigation technology is used for training in various medical specialties, not least image-guided spinal interventions. Navigation practice is an important educational component that allows residents to understand how surgical instruments interact with complex anatomy and to learn basic surgical skills such as the tridimensional mental interpretation of bidimensional data. Inexpensive surgical simulators for spinal surgery, however, are lacking. We therefore designed a low-cost spinal surgery simulator (Spine MovDigSys 01) to allow 3-dimensional navigation via 2-dimensional images without altering or limiting the surgeon's natural movement. METHODS: A training system was developed with an anatomical lumbar model and 2 webcams to passively digitize surgical instruments under MATLAB software control. A proof-of-concept recognition task (vertebral body cannulation) and a pilot test of the system with 12 neuro- and orthopedic surgeons were performed to obtain feedback on the system. Position, orientation, and kinematic variables were determined and the lateral, posteroanterior, and anteroposterior views obtained. RESULTS: The system was tested with a proof-of-concept experimental task. Operator metrics including time of execution (t), intracorporeal length (d), insertion angle (α), average speed (v¯), and acceleration (a) were obtained accurately. These metrics were converted into assessment metrics such as smoothness of operation and linearity of insertion. Results from initial testing are shown and the system advantages and disadvantages described. CONCLUSIONS: This low-cost spinal surgery training system digitized the position and orientation of the instruments and allowed image-guided navigation, the generation of metrics, and graphic recording of the instrumental route. Spine MovDigSys 01 is useful for development of basic, noninnate skills and allows the novice apprentice to quickly and economically move beyond the basics.

Genomics and epigenetics: A study of ependymomas in pediatric patients.

OBJECTIVE: We identify chromosomal alterations, the methylation pattern and gene expression changes in pediatric ependymomas. METHODS: CGH microarray, methylation and gene expression were performed through the Agilent platform. The results were analyzed with the software MatLab, MapViewer, DAVID, GeneCards and Hippie. RESULTS: Amplification was found in 14q32.33, 2p22.3 and 8p22, and deletion was found in 8p11.23-p11.22 and 1q21.3. We observed 42.387 CpG islands with changes in their methylation pattern, in which we found 272 genes involved in signaling pathways related to carcinogenesis. We found 481 genes with altered expression. The genes IMMT, JHDMD1D, ASAH1, ZWINT, IPO7, GNAO1 and CISD3 were found to be altered among the three levels. CONCLUSION: The 2p22.3, 8p11.23-p11.22 and 14q32.33 regions were identified as the most important; the changes in the methylation pattern related to cell cycle and cancer genes occurred in MIB2, FGF18 and ITIH5. The IPO7, GNAO1 and ASAH1 genes may play a major role in ependymoma development.

Tractography of the spider monkey (Ateles geoffroyi) corpus callosum using diffusion tensor magnetic resonance imaging.

The objective of this research was to describe the organization, connectivity and microstructure of the corpus callosum of the spider monkey (Ateles geoffroyi). Non-invasive magnetic resonance imaging and diffusion-tensor imaging were obtained from three subjects using a 3T Philips scanner. We hypothesized that the arrangement of fibers in spider monkeys would be similar to that observed in other non-human primates. A repeated measure (n = 3) of fractional anisotropy values was obtained of each subject and for each callosal subdivision. Measurements of the diffusion properties of corpus callosum fibers exhibited a similar pattern to those reported in the literature for humans and chimpanzees. No statistical difference was reached when comparing this parameter between the different CC regions (p = 0.066). The highest fractional anisotropy values corresponded to regions projecting from the corpus callosum to the posterior cortical association areas, premotor and supplementary motor cortices. The lowest fractional anisotropy corresponded to projections to motor and sensory cortical areas. Analyses indicated that approximately 57% of the fibers projects to the frontal cortex and 43% to the post-central cortex. While this study had a small sample size, the results provided important information concerning the organization of the corpus callosum in spider monkeys.

Brachmann-Cornelia de Lange syndrome with a papilloma of the choroid plexus: analyses of molecular genetic characteristics of the patient and the tumor. A single-case study.

PURPOSE: A 10-month-old girl with a Brachmann-Cornelia de Lange syndrome and a choroid plexus papilloma of the brain was studied at the Hospital Infantil de México Federico Gómez (HIMFG) in Mexico City. METHODS AND RESULTS: Presumptive papilloma of the third ventricle was evidenced on CT and MR images and removed. Pathological analysis confirmed its origin. A posterior radiosurgery was required due to a tumor relapse. Karyotypes (GTG bands) of the patient and her parents undertaken at HIMFG were normal. Array comparative genomic hybridization (array CGH) analyses of blood DNA of the patient and her parents carried out at BlueGnome's Laboratory in Cambridge, UK, set in evidence amplification of genes SPNS2, GGT6, SMTNL2, PELP1, MYBBP1A, and ALOX15 in chromosome 17p of the patient. Since MYBBP1A is a proto-oncogene and ALOX15 participates in the development of cancer and metastases of tumors, further fluorescent in situ hybridization (FISH) analyses of these two genes were implemented at HIMFG. Amplification of the two genes was found in the tumor of the case under study but not in an unrelated papilloma of the choroid plexus. DISCUSSION: Further analyses of the association of choroid plexus papillomas with disorders of psycho-neural development and its relationship to molecular genetic modifications at chromosome 17p are now under way at HIMFG.

Expression of histone acetylases p300 and PCAF in pediatric astrocytomas.

OBJECTS: The protein 300 (p300) and p300/CBP-binding protein-associated factor (PCAF) are enzymes with histone acetyltransferase (HAT) activity, a function that can become deregulated in different tumors and affect biological responses. METHODS: Due to the lack of information on the deregulation of these HATs in pediatric tumors, this study evaluated the expression of both the mRNA and proteins of p300 and PCAF in 54 samples of pediatric astrocytomas embedded in paraffin. RESULTS: PCAF was not expressed in normal brain tissue. In grade I tumors, the expression of p300 (1.1 ± 0.1) and PCAF (1.2 ± 0.11) was greater than those observed in grade III tumors: 0.72 ± 0.15 for p300 and 0.55 ± 0.11 for PCAF, and grade IV tumors: 0.74 ± 0.13 for p300 and 0.55 ± 0.13 for PCAF (p < 0.05). Immunohistochemical staining revealed the same tendency towards a decrease in the expression of the protein as the degree of clinical severity increased. Patients with recurrent grades I, III, and IV tumors had the highest levels of PCAF, compared to those who showed no recurrence (p < 0.05). CONCLUSIONS: This work describes and confirms that these HATs play important roles in regulating genes and in the biological behavior of pediatric astrocytomas.

[First case report in Mexico of a diaphragmatic hernia, by Agustín Arellano in 1839]. / Hernia diafragmática. primer caso informado en México por el doctor Agustín Arellano en 1839.

Reports on partial lacking of the diaphragm and diaphragmatic hernia date to seventeenth century reports. In 1939 Arellano published in Mexico, a necropsy case of diaphragmatic hernia with holoprosencephaly and cyclocephaly. Agustín Arellano's was the the fifth or sixth report ever published worldwide and his manuscript was reported nine years before Bochdalek's publication. Before 1839, in the Americas, there is no other existing report describing this type of pathology, and we can safely assume Arellano's work was the first of its kind in the Western hemisphere. It is well known that, at the time, the quality ofscientific publications of this Mexican medical researcher could be compared to the level of any medical publication in the developed world. It is worth noting that the Journal were Arellano's work was published, named "Periodico de la Academia de Médicina de Mégico (sic), "founded and directed by Dr. Manuel Carpio in 1836, is the direct precursor of the present-day "Gaceta Médica de México" the oldest current medical journal in the Americas.