Comparative genome analyses of three serotypes of Lactococcus bacteria isolated from diseased cultured striped jack (Pseudocaranx dentex).

Lactococcosis, caused by members of the genus Lactococcus, represents a devastating disease inducing mass mortalities and economic losses in many fish species worldwide. The present work aimed to compare the whole genome sequences of three different serotypes of Lactococcus garvieae isolated from diseased cultured striped jack (Pseudocaranx dentex) in Ehime prefecture, Japan. The three serotypes showed different virulence in the challenge test using Japanese amberjack (Seriola quinqueradiata). The genome sequencing revealed that two of the strains (serotype I and serotype III) were identified as L. garvieae, while the third strain (serotype II) was identified as L. formosensis. The chromosome sizes of the three serotypes ranged from 1.9 to 2.0 Mb; the GC content ranges were 38.2 to 38.9%; and the numbers of predicted protein-coding sequences (CDSs) were from 1922 to 1959. Only the serotype II harbours two plasmids, sizes of around 14 kb and 9 kb. The detected virulence factors varied among the different serotypes with some shared factors like adherence, anti-phagocytosis, secretion system, toxin (haemolysin), serum resistance, antimicrobial resistance and others. The genomes also contained factors responsible for resistance to toxic compounds. The genome of the serotype III tended to encode more prophage regions than the other serotypes.

Sonographic reference values of cranial nerve size: A systematic review and meta-analysis.

INTRODUCTION/AIMS: Ultrasonography of the cranial nerves has recently gained attention for assessment of inflammatory, compressive, or degenerative neuropathies. However, sonographic reference values of cranial nerves have received less attention than those of peripheral nerves. In this systematic review and meta-analysis we aimed to provide current evidence of sonographic reference values for cranial nerve size. METHODS: By searching Medline (via PubMed), Scopus, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science, we conducted a systematic review and meta-analysis of studies that reported ultrasound measurements of the facial, spinal accessory, and hypoglossal nerves in healthy adults. We included studies that reported either the sonographic cross-sectional area (CSA) or the nerve diameter; the included nerves were subgrouped according to the site of nerve measurement. RESULTS: Fourteen studies with a total of 661 participants and 1437 ultrasound nerve measurements met the inclusion criteria. The anatomical sites for each nerve were combined to provide single-nerve mean measurements. We found an overall mean nerve diameter of 0.80 mm for the facial nerve, 0.63 mm for the spinal accessory nerve, and 1.82 mm2 for hypoglossal nerve CSA. DISCUSSION: This meta-analysis provides reference values for the diameter and cross-sectional area of the facial, spinal accessory, and hypoglossal nerves at different sites, which can be used as guidance in clinical practice to detect pathological changes in cranial nerve size in cranial neuropathies. We recommend further validation in large-scale studies as well as standardization of the scanning protocols.

Temporary spanning plate across the elbow for complex fractures of the distal humerus.

BACKGROUND: Open reduction internal fixation (ORIF) is the gold standard management of fractures of the distal humerus. Stable fixation to allow early mobilization is not always possible in cases with comminuted fracture patterns and bone loss, with a high failure rate. We propose augmentation of internal fixation in these unstable situations with a spanning plate across the elbow to protect the fixation construct temporarily until bone union. METHODS: Eighteen patients with complex distal humeral fractures were managed with standard ORIF technique augmented with a temporary plate spanning across the elbow as an internal fixator. Cases included were either very distal, comminuted (6 cases) or insufficiency fractures (4 cases) or revision fixation cases (8 cases). The temporary spanning plate was removed as soon as signs of early radiographic union were detected. RESULTS: Seventeen patients were available for final follow up at a mean 28.3 months. The spanning plate was removed after 3.4 months on average. At the final follow-up, the mean elbow total arc of motion was 86.3°. The mean Mayo Elbow Performance Score (MEPS) was 80, and the mean Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score was 27. CONCLUSION: Spanning the elbow temporarily with a plate in adjunct to standard ORIF technique is both simple and effective in achieving fracture stability and union and minimizes failure rates after fixation of comminuted, very distal fractures, osteoporotic cases, or revision fixation cases with bone loss. LEVEL OF EVIDENCE: Level IV, Therapeutic study.

Using Skin of the Cleft as Bipedicle flap for Release of the First Web Space in Congenital Central Deficiency.

We are describing a new technique to utilize the skin of the cleft as a bipedicle flap to reconstruct and to widen the narrow first web space in congenital central deficiency. The skin of the cleft maintains its attachments on the dorsal and palmar aspects of the hand and the index finger is passed (tunneled) underneath it so that the skin of the cleft comes to occupy the first web space. This technique ensures maintenance of good blood supply of the skin of the cleft and a rounded edge of the first web without scars across it.

Role of Oral Tramadol 50 mg in Reducing Pain During Colposcopy-Directed Cervical Biopsy: A Randomized Controlled Trial.

OBJECTIVE: The aim of the study was to assess safety and efficacy of 50-mg tramadol in reducing patient-perceived pain during colposcopy. MATERIAL AND METHODS: We conducted a randomized double-blind placebo-controlled trial in the colposcopy unit of a tertiary referral hospital, Cairo, Egypt, from April 2018 to October 2018. Our primary outcome was pain during colposcopy-guided ectocervical punch biopsy. Our secondary outcomes were pain during speculum insertion, acetic acid application, Lugol iodine application, endocervical curettage (ECC), endocervical brushing, 10-minute postprocedure, and additional analgesia requirement. Pain was assessed using 10-cm visual analog scale. RESULTS: One hundred fifty women were randomized into 2 groups: tramadol group (n = 75) received oral 50-mg tramadol tablets, and control group (n = 75) received placebo tablets. Both groups showed no significant difference in anticipated pain score (p = .56), pain scores during speculum insertion (p = .70), application of acetic acid (p = .40), and Lugol iodine (p = .79). However, the mean pain scores were significantly lower in tramadol group compared with placebo at ectocervical biopsy (p = .001), ECC (p = .001), endocervical brushing (p = .001), and 10 minutes after colposcopy (p = .001). Need for additional analgesia was significantly lower in tramadol group (p = .03). CONCLUSIONS: Oral tramadol 50 mg significantly reduces pain perception during colposcopy-guided ectocervical biopsy, ECC, endocervical brushing, and 10 minutes after colposcopy with tolerable adverse effects.

Residues and dissipation kinetic of abamectin, chlorfenapyr and pyridaben acaricides in green beans (Phaseolus vulgaris L.) under field conditions using QuEChERS method and HPLC.

The current study estimated the dissipation rates of abamectin, chlorfenapyr and pyridaben acaricides in pods of green beans (Phaseolus vulgaris L.) under field conditions in Egypt. Pesticides were extracted and cleaned-up by QuEChERS method and were analyzed by HPLC. The dissipation of these acaricides followed the first order kinetics model with half-life (t1/2) values 1.00, 3.50 and 1.50 days for abamectin, chlorfenapyr and pyridaben, respectively. The lowest residues, at different time intervals of field application rate of each pesticide, were observed with abamectin followed by pyridaben and then chlorfenapyr. Pre-harvest intervals (PHIs) were 10.00, 13.50 and 6.00 days for abamectin, chlorfenapyr and pyridaben, respectively and were below the established European maximum residue limits (EU MRLs) 10-14, 14-21 and 7-10 days after application, respectively. If the fresh pods will be consumed after harvest, it is expected that the presence of these pesticides in the food will have a negative impact on human health. Therefore, the elimination of the residues of these harmful pesticides must be carried out.

Therapeutic efficacy and safety of chamomile for state anxiety, generalized anxiety disorder, insomnia, and sleep quality: A systematic review and meta-analysis of randomized trials and quasi-randomized trials.

This systematic review and meta-analysis aimed to study the efficacy and safety of chamomile for the treatment of state anxiety, generalized anxiety disorders (GADs), sleep quality, and insomnia in human. Eleven databases including PubMed, Science Direct, Cochrane Central, and Scopus were searched to retrieve relevant randomized control trials (RCTs), and 12 RCTs were included. Random effect meta-analysis was performed by meta package of R statistical software version 3.4.3 and RevMan version 5.3. Our meta-analysis of three RCTs did not show any difference in case of anxiety (standardized mean difference = -0.15, 95% CI [-0.46, 0.16], P = 0.4214). Moreover, there is only one RCT that evaluated the effect of chamomile on insomnia and it found no significant change in insomnia severity index (P > 0.05). By using HAM-A scale, there was a significant improvement in GAD after 2 and 4 weeks of treatment (mean difference = -1.43, 95% CI [-2.47, -0.39], P = 0.007), (MD = -1.79, 95% CI [-3.14, -0.43], P = 0.0097), respectively. Noteworthy, our meta-analysis showed a significant improvement in sleep quality after chamomile administration (standardized mean difference = -0.73, 95% CI [-1.23, -0.23], P < 0.005). Mild adverse events were only reported by three RCTs. Chamomile appears to be efficacious and safe for sleep quality and GAD. Little evidence is there to show its effect on anxiety and insomnia. Larger RCTs are needed to ascertain these findings.

Visual aptamer-based capillary assay for ethanolamine using magnetic particles and strand displacement.

This work describes an aptamer-based capillary assay for ethanolamine (EA). It is making use of strand displacement format and magnetic particles. The capillary tubes are coated with three layers, viz. (a) first with short oligonucleotides complementary to the aptamer (EA-comp.); (b) then with magnetic particles (Dynabeads) coated with EA-binding aptamer (EA-aptamer), and (c) with short oligonucleotide-coated magnetic particles (EA-comp.). On exposure to a sample containing ethanolamine, the DNA-coated magnetic particles are released and subsequently collected and spatially separated using a permanent magnet. This results in the formation of a characteristic black/brown spots. The assay has a visual limit of detection of 5 nM and only requires 5 min of incubation. Quantification is possible through capture and analysis of digital (RGB) photos in the 5 to 75 nM EA concentration range. Furthermore, results from tap water and serum spiked with EA samples showed that the platform performs well in complex samples and can be applied to real sample analysis. The combined use of plastic capillaries, visual detection and passive flow make the method suited for implementation into a point-of-care device. Graphical abstract Schematic representation of the capillary assay steps.

Fluoroless-ureteroscopy for definitive management of distal ureteral calculi: randomized controlled trial.

INTRODUCTION: To assess the conversion rate during fluoroless-ureteroscopy (URS) and evaluate the feasibility, safety, and efficacy of fluoroless-URS as a definitive management of distal ureteral calculi. MATERIAL AND METHODS: Between May 2013 and August 2015, patients with radio-opaque distal ureteral calculi of ≤ 1 cm in size were randomized to undergo fluoroless-URS or standard URS. Patients with previous ureteral surgery, ureteral kinking, ureteral stricture, single kidney, additional proximal ureteral or renal calculi, uncontrolled coagulopathy, and/or congenital anomalies of the urinary tract were excluded. Patients' demographics, stone characteristics, operative data, stone free status, and complications were compared between both groups. RESULTS: Seventy-four cases in the fluoroless-URS group were compared with 80 cases in the standard-URS group. There was no significant difference in the baseline characteristics between both groups in terms of the mean patient's age (28.8 +/- 13.3 versus 29.5 ± 14.6 years; p = 0.76), body mass index (28.2 +/- 33 versus 27.6 +/- 2.3 kg/m²; p = 0.19), and stone size (7.2 +/- 1.5 versus 7.3 +/- 1.7 mm; p = 0.70), respectively. Furthermore, there was no significant difference in the outcome parameters between both groups in terms of operative time (42.4 +/- 8.3 versus 40.3 +/- 6.5 min; p = 0.08), stone free rate (93.2% versus 95%; p = 0.06), and overall complications (12.2% versus 8.75%; p = 0.08), respectively. There was significant difference between both techniques in terms of fluoroscopy time (p < 0.001). However, 6 (7.5%) fluoroless-URS cases necessitated the use of fluoroscopy intraoperatively. CONCLUSION: Ureteroscopic management of distal ureteral stones using fluoroless-URS technique could be feasible and safe, without radiation exposure for patients and medical personnel. However, fluoroscopy should always be available during fluoroless-URS.

Trichosporon jirovecii infection of red swamp crayfish (Procambarus clarkii).

One hundred and twenty-nine isolates of Trichosporon jirovecii were isolated from the melanized exoskeleton as well as eyestalks, gills, muscle and haemolymph of red swamp crayfish (Procambarus clarkii) collected from the River Nile, during summer 2015. Isolates were similar morphologically, biochemically and genetically. Also, random amplified polymorphic DNA (RAPD) analysis exhibited no polymorphism among the tested isolates. Virulence factors such as chitinase, protease, lipase activities and biofilm formation were examined. Challenge test, using a representative isolate (Tj_ASU8), proved its pathogenicity against crayfish. Magnesium oxide nanoparticles had a good antifungal activity with a minimum fungicidal concentration of 8 mg/ml. To the best of our knowledge, this is the first report for isolation of T. jirovecii from red swamp crayfish, showing melanization, from the River Nile. We assume that infected crayfish may act as a vector for this fungus and can disseminate infection to all susceptible hosts in the vicinity.

Radiographic Parameters to Predict Union After Volar Percutaneous Fixation of Herbert Type B1 and B2 Scaphoid Fractures.

PURPOSE: To study the angle of screw placement in relation to the scaphoid fracture plane and its effect on union after percutaneous fixation of scaphoid waist fractures. METHODS: Twenty-four consecutive scaphoid waist fractures were retrospectively evaluated for the orientation of screws in relation to the fracture plane using a method in which the sum-of-smaller angles (SSA) in 3 different radiographs were used to correlate with time to fracture union. RESULTS: All but one patient achieved union after percutaneous fixation of the scaphoid. Another patient required revision surgery within the study period for inadequate fixation. A shortened time to union was significantly correlated to larger SSA. CONCLUSIONS: SSA may be a reasonable predictor of union after percutaneous fixation of scaphoid waist fracture. It can be reliably calculated using plain radiographs. An SSA of 190° or more correlated with union by 8 weeks postoperatively.

Prediction of esophageal varices in cirrhotic patients with apparent diffusion coefficient of the spleen.

PURPOSE: To predict esophageal varices in cirrhotic patients with apparent diffusion coefficient (ADC) of the spleen and to correlate the ADC with clinical and laboratory biomarkers of esophageal varices. MATERIALS AND METHODS: This study was conducted upon 40 patients (28 male, 12 female; age ranged 19-45 years; mean age = 33 years) with biopsy-proven cirrhotic liver. Twenty age- and sex-matched healthy volunteers were included as a control group. Patients with varices (n = 15) and without varices (n = 25) and volunteers underwent echo-planar diffusion-weighted MR imaging of the abdomen with b factors of 0, 400, and 800 s/mm(2). The ADC maps of the abdomen were reconstructed. The ADC values of the spleen were calculated and correlated with the Child score, platelet count, and prothrombin time. RESULTS: The mean ADC value of the spleen in cirrhotic patients (1.34 ± 0.05 × 10(-3) mm(2)/s) was significantly different (P = 0.001) from that of volunteers (0.87 ± 0.04 × 10(-3) mm(2)/s). The ADC of the spleen in cirrhotic patients with varices (1.49 ± 0.05 × 10(-3) mm(2)/s) was significantly different (P = 0.001) from that of patients without varices (1.11 ± 0.06 × 10(-3) mm(2)/s). The cut-off ADC value of the spleen used for prediction of cirrhosis and varices was 1.15 and 1.29 × 10(-3) mm(2)/s with areas under the curve were 0.872 and 0.889, respectively. The ADC value of the spleen was correlated with the splenic volume (r = 0.862; P = 0.001), Child score (r = 0.742; P = 0.001), platelet count (r = -0.698; P = 0.01), and prothrombin time (r = 0.684; P = 0.01). CONCLUSION: The ADC value of the spleen can predict esophageal varices in cirrhotic patients and is well correlated with the clinical and laboratory biomarkers of esophageal varices.

Effect of magnesium sulphate on bi-spectral index (BIS) values during general anesthesia in children.

BACKGROUND: Magnesium was reported to reduce both the anesthetic requirements and the period needed to reach a bi-spectral index value of 60 when used intra-operatively (Br J Anaesth 83:302-20, 1999; Anesth Analg 20:1273-5, 1988; Br J Anaesth 89:594-8, 2002; Anesth Analg 87:206-10, 1998; Br J Anaesth 89:594-8, 2002; Br J Anaesth 94:438-41, 2005) and to minimize the emergence agitation (Anaesthesia 61:1058-63, 2006). Previous studies examined the influence of magnesium on the anesthetic requirements while the bi-spectral Index values were kept within a constant range. We evaluated the effect of intraoperative magnesium on the bi-spectral index values during pediatric anesthesia while we kept other anesthetic variables unchanged. METHODS: Eighty pediatric patients with ASA physical status I, age 2-8 years and scheduled for minor infra-umbilical elective procedures included in a prospective randomized controlled study. We randomly divided patients into two groups. Group I (40 patients); received a bolus dose 50 mg/kg of magnesium sulphate followed by an infusion at rate of 15 mg/kg/h throughout the procedure. Group II (40 patients); received the same amount in the form of ringer acetate for blinding. We compared between the groups regarding: 1) BIS values. 2) Hemodynamic parameters. 3) Arterial oxygen saturation 4) End-tidal CO2 5) Respiratory rate and 6) Tidal volume. RESULTS: Magnesium group (Group I) showed significantly lower BIS values and shorter time to achieve BIS values below 60. Respiratory parameters (tidal volume and respiratory rate) were significantly lower in the magnesium group. Otherwise, no significant differences between the study group and the control group were detected. DISCUSSION: Our study has the advantage of evaluating the direct effect of magnesium sulphate on the Bi-spectral index scale with keeping other intraoperative factors almost constant (as the type of operations, induction and maintenance techniques, end-tidal anesthetic concentration, analgesia and mode of ventilation) for accurate assessment. CONCLUSION: Magnesium produced significantly lower BIS values, less time to reach BIS values below 60, lower tidal volume and lower respiratory rate during pediatric general anesthesia. TRIAL REGISTRATION: Pan African Clinical Trial Registry, www.pactr.org , PACTR201312000666231 . Registered at 6 October 2013.

Management of neglected Bennett fracture in manual laborers by tension fixation.

PURPOSE: To report the results of open reduction and internal fixation (ORIF) of Bennett fractures in young, active patients using a K-wire and wire loop construct to achieve anatomical reduction and to allow return to manual labor. METHODS: In this prospective series, we treated 10 male manual laborers (mean age, 30 y; range, 20-44 y) with Bennett fractures diagnosed after a minimum of 12 weeks (mean, 16 wk; range, 12-18 wk). ORIF using 2 K-wires with a wire loop and a neutralizing transarticular K-wire was performed with direct articular visualization. Patients were evaluated for range of motion, grip strength, and pinch strength, and a visual analog scale score rated pain before surgery and 12 months later. RESULTS: The mean follow-up was 16 months (range, 12-36 mo). The average visual analog scale improved from 6 to 2, mean palmar abduction improved from 15° to 40°, mean radial abduction increased from 22° to 39°, average pinch strength improved from 9.9 kg to 15.5 kg, and average grip strength increased from 34 kg to 49 kg. Complications included transient irritation of the radial sensory nerve or lateral cutaneous nerve of the forearm in 3 patients, pin track granuloma formation in 2 patients, and marginal osteophyte formation in 2 patients. Union was achieved in all 10 patients, and 9 patients returned to their previous manual labor occupation. CONCLUSIONS: Our results suggest that neglected Bennett fractures can be effectively managed by ORIF using K-wires and a wire loop without compromising strength or motion. This technique reliably restored the anatomy and provided adequate thumb motion and strength to allow a return to manual labor. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Dissipation behavior, residue distribution, and exposure risk assessment of tebufenpyrad and milbemectin acaricides in strawberries under open field conditions.

Strawberries are a favorite fruit for most people, but the residues of pesticides on strawberries might be risky to human health. Tebufenpyrad and milbemectin are broad-spectrum acaricides with insecticide properties authorized for use on strawberries in Egypt. As a result, it is crucial to investigate their residues in the final product to ensure customers' safety. Consequently, field trials were conducted following the Good Agricultural Practices (GAPs) to study the dissipation rate and terminal residues of tebufenpyrad and milbemectin on strawberries. Tebufenpyrad and milbemectin residues in strawberries declined due to first-order decay process, showing significant degradation (88.5% and 94.7%, respectively) after 14 days. Risk assessment study was carried out by comparing the national estimated daily intake (NEDI) to the acceptable daily intake (ADI). The results demonstrated that the dietary risk posed by the residues of tebufenpyrad and milbemectin in strawberry fruits was acceptable for consumers. It is envisaged that the current study's findings would support the safe application of tebufenpyrad and milbemectin to strawberries and perhaps other crops in Egypt and other countries with similar climatic conditions.

Synthesis of a resorcinol-based derivative as a corrosion inhibitor for low-carbon steel in 0.5 mol L-1 HCl medium: chemical, electrochemical, and theoretical aspects.

This work illustrated the synthesis of a new simple resorcinol derivative, 4,6-dimethoxyisophthalohydrazide (DMIH) and confirmed its structure using 1H-NMR spectroscopy. The inhibiting performance of the DMIH compound in resisting the pitting action of a 0.5 mol L-1 HCl solution on low-carbon steel (LCS) was assessed. The newly synthesized compound had a simple structure and was dissolved in acidic media. The efficiency of the inhibitor was examined using chemical and electrochemical methods. The DMIH compound significantly decreased the rate of dissolution of LCS in HCl solution by adsorption. The adsorption was based on the Langmuir model. The DMIH compound is adsorbed on LCS via both chemisorption and physisorption. The DMIH compound is a mixed-type inhibitor. An inhibition efficiency (IE) of 83.8% was obtained using 300 ppm of the DMIH compound at 298 K. The IE decreased to 72% as the temperature increased to 328 K. When the concentration of DMIH increased from 50 to 300 ppm, the charge transfer resistance (R ct) increased from 134.7 to 404.8 ohm cm2, and the capacitance of the adsorbed layer decreased from 38 × 10-6 to 11 × 10-6 F cm-2. The high IE of the synthesized inhibitor was validated by the quantum characteristics. Monte Carlo (MC) simulations revealed that the DMIH compound adsorbed to the LCS quite well. The presence of a protective film on the LCS specimen was verified by the scanning electron microscopy (SEM) and atomic force microscopy (AFM) results. DMIH has significant potential to function as a corrosion inhibitor, as indicated by the comparative study between its performance and that of previously reported compounds. Although the structure of the DMIH compound is simpler than that of other inhibitors, it has been proven to be more effective.

Hypocalcemia in Patients With Osteoporosis and Normal Renal Function, Treated With Denosumab, a Retrospective Analysis.

Objective: The reported hypocalcemia in postmenopausal women with osteoporosis who received Denosumab was low (0.05%-1.7% to 7.4%). The major prediction factors were vitamin D and calcium levels and renal function. The objective is to evaluate the incidence of hypocalcemia in patients with osteoporosis, normal renal function, and vitamin D who received Denosumab. Method: A retrospective analysis was conducted using the medical records (2022-2023). We looked for hypocalcemia (albumin-adjusted calcium lower than 2.2 mmol/L). Results: Two hundred one postmenopausal women diagnosed with osteoporosis and received denosumab treatment were included. All patients received vitamin D3 capsules and calcium supplementation. The mean age of the patient was 75.7 ± 7.0 years (56-91 years). Hypocalcemia was observed in 46 (23%) patients following a subcutaneous dose of Denosumab 60 mg. Median calcium was 2.25 mmol/L (minimum: 0.890 mmol/L, maximum: 2.6 mmol/L). Fourteen (30.4%) patients had severe hypocalcemia (<1.8 mmol/L) and required parenteral correction. A comparison between hypocalcemia and patients with normal calcium indicated that the significant predictor of hypocalcemia was pretreatment parathyroid hormone levels (9.9 ± 11.8vs 7.6 ± 2.56 pmol/L, respectively; P < .005). The prognostic role of parathyroid hormone for the denosumab-associated hypocalcemia was assessed using ROC curve analysis. For the cut-off value of Parathyroid hormone = 6.8 pmol/L, giving serum parathyroid measurement an AUC of 0.668 (0.599-0.737) - P = .0007; sensitivity 85%; specificity 52%. Conclusion: Hypocalcemia induced by the denosumab treatment is more prevalent than previously shown in patients with osteoporosis receiving adequate calcium and vitamin D supplements. An elevated parathyroid hormone predicts hypocalcemia related to denosumab therapy in patients with normal calcium and vitamin D levels.

C2 root nerve sheath tumors management.

BACKGROUND: Upper cervical nerve sheath tumors (NST) arising mainly from C2 root and to lesser extent from C1 root are not uncommon, they constitute approximately 5-12% of spinal nerve sheath tumors and 18-30% of all cervical nerve sheath tumors, unique in presentation and their relationship to neighbouring structures owing to the discrete anatomy at the upper cervical-craniovertebral region, and have atendency for growth reaching large-sized tumors before manifesting clinically due to the capacious spinal canal at this region; accordingly the surgical approaches to such tumors are modified. The aim of this paper is to discuss the surgical strategies for upper cervical nerve sheath tumors. METHODS: Eleven patients (8 male and 3 females), age range 28-63 years, with C2 root nerve sheath tumors were operated upon based on their anatomical relations to the spinal cord. The magnetic resonance imaging findings were utilized to determine the surgical approach. The tumors had extra- and intradural components in 10 patients, while in one the tumor was purely intradural. The operative approaches included varied from extreme lateral transcondylar approach(n = 1) to laminectomy, whether complete(n = 3) a or hemilaminectomy(n = 7), with partial facetectomy(n = 7), and with suboccipital craniectomy(n = 2). RESULTS: The clinical picture ranged from spasticity (n = 8, 72,72 %), tingling and numbness below neck (n = 6, 54,54 %), weakness (n = 6, 54,54 %), posterior column involvement (n = 4, 26,36 %), and neck pain (n = 4, 36,36 %). The duration of symptoms ranged from 1 to 54 months, total excision was performed in 7 patients; while in 3 patients an extraspinal component, and in 1 patient a small intradural component, were left in situ. Eight patients showed improvement of myelopathy; 2 patients maintained their grades. One poor-grade patient was deteriorated. CONCLUSION: The surgical approaches for the C2 root nerve sheath tumors should be tailored according to the relationship to the spinal cord, determined by magnetic resonance imaging.

New flap for widening of the web space and correction of palmar contracture in complex clasped thumb.

In our experience, previous flaps designed for correction of the skin deficiency in complex clasped thumb do not sufficiently address the palmar contracture of the deformity. Moreover, the index finger flap, previously described by Ezaki and Oishi, provides insufficient skin at its apex with the possibility of incomplete correction and the frequent need of a thenar release incision. This article describes a flap designed for widening of the narrow thumb-index web space and release of the palmar thumb contracture in cases of congenital clasped thumb. This flap provides sufficient correction of the palmar contracture and at the same time provides adequate width and depth of the thumb-index web space.