Idiopathic sudden sensorineural hearing loss and ménière syndrome: The role of cerebral venous drainage.

OBJECTIVES: To evaluate the influence of cerebral venous drainage on the pathogenesis of idiopathic sudden sensorineural hearing loss (ISSHL) and Ménière syndrome (MD). DESIGN: Observational, prospective, cohort study. SETTING: ENT and Cardiology Departments (University of Bari, Policlinico Hospital, Bari, Italy). PARTICIPANTS: We enrolled 59 consecutive patients (32 males, mean age 53.05 + 15.37 years): 40 ISSHL and 19 MD. MAIN OUTCOME MEASURE: All patients underwent physical examination, biochemical evaluation (glycemic and lipid profile, viral serology, C reactive protein, etc), audiometric (tonal, vocal, vestibular evoked myogenic potentials and auditory brainstem response test) and impedentiometric examination. The pure tone average (PTA) was calculated for the following frequencies: 250, 500, 1000, 2000, 3000, 4000, 8000. An echo-color Doppler evaluation of the venous cerebral veins, internal jugular (IJV) and vertebral veins (VV) at supine and 90° position was performed. RESULTS: No morphological alterations were found both in patients and controls. There were no signs of stenosis, blocked flow, membranes, etc. We found lower minimum, mean and maximum velocities in distal IJVs (P = .019; P = .013; P = .022; respectively) and left VVs (P = .027; P = .008; P = .001; respectively) in supine (0°) position in both MD and ISSHL patients as compared to controls. The same was for orthostatic position (90°). We found negative correlations between the velocities in extracranial veins and PTA values: therefore, the worst the audiometric performance of the subjects, the lower the velocities in the venous cerebral drainage. CONCLUSIONS: Idiopathic sudden sensorineural hearing loss and Ménière syndrome patients showed altered venous flow in IJVs and VVs as compared to controls, independently from posture. This different behavior of venous tone control can influence the ear performance and may have a role in the pathogenesis of both diseases.

Development and validation of the multiple sclerosis questionnaire for the evaluation of job difficulties (MSQ-Job).

OBJECTIVE: Multiple sclerosis (MS) affects young adults of working age. Difficulties in work-related activities are usually ascribed to MS symptoms, while the impact of workplace features is underestimated. This article presents the Multiple Sclerosis Questionnaire for Job Difficulties (MSQ-Job), designed to assess working difficulties due to MS symptoms and workplace features. METHODS: A sample of employed MS patients completed the MSQ-Job, the WHO-Disability Assessment Schedule (WHODAS 2.0) and the 54-items MS Quality of Life Questionnaires (MSQOL-54); the expanded disability status scale (EDSS) was used to define MS severity. Factor structure was evaluated using principal component extraction and Oblimin rotation; internal consistency was assessed with Cronbach's alpha; construct and discriminant validity using t-test (EDSS 0-2 vs >2; patients self-reporting need for support vs patients reporting no needs; full-time vs part-time employees); and Pearson's correlation with WHODAS 2.0 and MSQOL-54. RESULTS: The MSQ-Job is a 42-item questionnaire with six scales and an overall factor. Scores range on a 0-100 scale (higher scores indicate more and more severe difficulties); patients with EDSS>2 and self-reporting support needs had worse scores than those with EDSS 0-2 and without needs. Correlations with WHODAS 2.0 and MSQOL-54 were generally significant (P < 0.0007) and below 0.70. CONCLUSIONS: The MSQ-Job jointly measures the impact of respondents' symptoms and workplace features on work activities and enables to assess the effects of clinical and occupational interventions and better describe the impact of MS indirect costs.

Maisonneuve fracture treated with suture-button system stabilization combined with plate and arthroscopic assistance (SBPAA): Clinical and radiological evaluation in short-medium period.

The aim of this study was to estimate the time needed for patients with Maisonneuve fractures to return to routine activities, after treatment with a suture-button system stabilization combined with plate and arthroscopic assistance (SBPAA). Methods: The study included 13 patients treated at our surgical department from January 2018 to June2022. Specific radiographical follow-up and periodic checks were performed in a short -to-medium term period, to evaluate syndesmosis evolution and tibiofibular overlap with medial clear space (MCS). Results: Progressive recovery and improvement were observed during follow-up from both radiographic and clinical perspective. Data showed that patients were able to return to full weight-bearing walking around the ninth week and to sport activities in 7.5 months. Long-term complications associated with residual joint stiffness, complex regional pain syndrome, or wound complications were observed in three patients. Conclusions: Intraoperative arthroscopy represent a valid diagnostic tool to better recognize and evaluate osteochondral lesions in case of syndesmosys. The study demonstrates the importance of intraoperative arthroscopy for recognizing and treating associated osteochondral lesions with proper syndesmosis evaluation. Plate associated to double TightRope represent valid solution to functionally fix and reduce fractures. Additionally, it imitates the normal syndesmosis's anatomy and provides elasticity and robustness, guaranteeing a rapid return to sporting activity. Data and casuistry support these findings.

Subtalar dislocation: a narrative review.

BACKGROUND: Subtalar joint dislocation (1% of all dislocations) is the permanent loss of articular relationships in the talonavicular and talocalcaneal joints, without other involvement of the foot. Dislocation can occur medially (85%), laterally (15%), posteriorly (2.5%) and anteriorly (1%). Reduction can be performed by closed or open technique; lateral dislocations often require open reduction because of inclusion of soft tissues or bone fragments. Lateral dislocations are frequently complicated by bone exposure, risk of infection and associated soft tissues injuries. AIM OF THE STUDY: The aim of this study is to explain main characteristics and to clarify the most important pitfalls of subtalar dislocations. MATERIALS AND METHODS: We examined 47 articles published in the last thirty years (389 cases). For each dislocation we reviewed its main characteristics: direction, bone exposure, need for open reduction and for surgical stabilisation, associated injuries and method used for diagnosis. RESULTS: Medial dislocations (68.1%) has greater incidence compared to lateral ones (27.7%). Bone exposure (44.5%), associated lesions (44.5%) and need for surgical reduction (48.2%) are much more represented in lateral dislocation than in the others. CONCLUSIONS: Subtalar dislocations, especially the lateral one, represent a challenge for surgeons. Lateral subtalar dislocation occurs following high-energy trauma often involving associated injuries. Closed reduction could be unsuccessful and patients must undergo surgical reduction. After reduction CT scan is recommended. Our narrative review confirms these findings.

Cytochalasin-stimulated steroidogenesis from high density lipoproteins.

The cytochalasins stimulate steroid secretion of Y-1 adrenal tumor cells two-to threefold. The order of potencies is cytochalasin E is greater than D is greater than B, but the maximum response is the the same and always less than with ACTH. Like that with ACTH, the stimulation has a rapid onset, is easily reversible, is inhibited by cucloheximide and aminoglutethimide, and occurs at a stage before pregnenolone. Although the cytochalasin, like ACTH, produce cell rounding, it is shown that this morphological change is not necessarily coupled to steridogenesis. Unlike ACTH, cytochalasin B does not measurably increase cellular levels of cAMP at concentrations that lead to maximal steroidogenesis. The cytochalasin B-induced stimulation of steroidogenesis, unlike the short-term ACTH effect, fails to occur in the absence of serum. This lack of response can be corrected by even low concentrations of human high density lipoproteins (HDL) but not by low density lipoproteins (LDL). We, therefore, propose that cytochalasin B enhances the availability of cholesterol bound to HDL for steroidogenesis by Y-1 adrenal cells.

The role of procalcitonin outside of the Intensive Care Unit (ICU): a multidisciplinary approach.

OBJECTIVE: Biochemical markers are commonly used in medicine to guide diagnostic investigation or therapy duration and/or monitor treatment efficacy. Due to the emergence and spread of antimicrobial resistance, markers able to prompt a more rational use of antimicrobial therapy are regarded with the greatest attention. Procalcitonin (PCT) certainly stands out among others, yet its role must be better established especially outside of the critical care area. Data about PCT utilization in non-critical patients, optimal negativity cut-offs as well as a protocol for measurement timing are all lacking. MATERIALS AND METHODS: To address these issues, a focus group was set up to propose and endorse shared statements regarding the most beneficial use of PCT in real life as infection marker for non-critical patients, based on the authors' experience and a review of recent literature. RESULTS: A group of nine experts in the fields of Infectious Diseases, Internal Medicine, Microbiology, Clinical Chemistry, Surgery and Medical Economics participated in the discussion of nine pre-specified statements. CONCLUSIONS: The potential role for PCT in differentiating infectious and non-infectious clinical syndromes and guiding antimicrobial therapy discontinuation was acknowledged. Moreover, a shared measurement protocol and desirable cut-offs for the non-critical area were proposed. Finally, observations were made about a reasonable selection of the patient population to be tested.

Erratum to: The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections.

[This corrects the article DOI: 10.1186/s13017-017-0141-6.].

Focus on the prophylaxis, epidemiology and therapy of methicillin-resistant Staphylococcus aureus surgical site infections and a position paper on associated risk factors: the perspective of an Italian group of surgeons.

BACKGROUND: The aim of this research was to study the epidemiology, microbiology, prophylaxis, and antibiotic therapy of surgical site infections (SSIs), especially those caused by methicillin-resistant Staphylococcus aureus (MRSA), and identify the risk factors for these infections. In Italy SSIs occur in about 5 % of all surgical procedures. They are predominantly caused by staphylococci, and 30 % of them are diagnosed after discharge. In every surgical specialty there are specific procedures more associated with SSIs. METHODS: The authors conducted a systematic review of the literature on SSIs, especially MRSA infections, and used the Delphi method to identify risk factors for these resistant infections. RESULTS: Risk factors associated with MRSA SSIs identified by the Delphi method were: patients from long-term care facilities, recent hospitalization (within the preceding 30 days), Charlson score > 5 points, chronic obstructive pulmonary disease and thoracic surgery, antibiotic therapy with beta-lactams (especially cephalosporins and carbapenem) and/or quinolones in the preceding 30 days, age 75 years or older, current duration of hospitalization >16 days, and surgery with prothesis implantation. Protective factors were adequate antibiotic prophylaxis, laparoscopic surgery and the presence of an active, in-hospital surveillance program for the control of infections. MRSA therapy, especially with agents that enable the patient's rapid discharge from hospital is described. CONCLUSION: The prevention, identification and treatment of SSIs, especially those caused by MRSA, should be implemented in surgical units in order to improve clinical and economic outcomes.

Phantom lower limb as a perceptual marker of neural plasticity in the mature human brain.

Three lower limb amputees, who reported phantom sensations, referred somatic stimuli delivered to skin regions proximal to the stump to select points on the phantom limb. Stimuli on the rectum and anus (e.g. during defecation) and on genital areas (e.g. during sexual intercourse) induced analogous, although less precise, mislocation to the phantom limb. Although the representation of the stump in the somatosensory pathway is lateral to that of the amputated lower limb, both anus and genitals are mapped medially to the areas formerly subserving the amputated lower limb. Therefore the mislocalization phenomenon can be considered as a perceptual landmark of new functional connections between the deprived areas and the adjacent ones, thus suggesting a dynamic neural remodelling in the mature nervous system, which was previously considered as a static entity.

Chronic lymphocytic leukemia-associated membranous glomerulopathy: remission with fludarabine.

In some individuals, chronic lymphocytic leukemia (CLL) may be associated with glomerular disease from membranous nephropathy with resultant nephrotic syndrome. CLL is characterized by abnormal immunoregulation with a malignant clonal proliferation of lymphocytes. The association between the abnormal clone and nephrotic syndrome is suggested in some cases by the remission of proteinuria with a reduction in abnormal lymphocyte number after treatment with antineoplastic agents. For the first time, we describe a patient with CLL and associated membranous glomerulopathy whose nephrotic syndrome remitted after treatment with fludarabine, a new purine analogue used in the treatment of refractory CLL.

Auditory feature conjunction in patients with schizophrenia.

The neural mechanisms supporting performance during single feature and feature conjunction tasks were investigated in patients with schizophrenia and age-matched controls using event-related brain potentials. In different blocks of trials, participants responded to auditory targets defined by one of two pitches, one of two locations, or both pitch and location. All participants were faster and more accurate in detecting targets defined by a single feature than for targets defined by a conjunction of features. Compared with the single feature conditions, conjunction targets were associated with enhanced negativity between 200 and 250ms (N2) post-stimulus and showed a delayed P3b latency. Compared with controls, patients with schizophrenia showed reduced N1 and N2 amplitude elicited by single and conjunctive targets. The results are consistent with defective perceptual mechanisms in schizophrenia. The fact that both performance and P3b amplitude were similar in patients and controls suggests that controlled processes compensate for processes normally carried out by early perceptual mechanisms.

Rapid sensory remapping in the adult human brain as inferred from phantom breast perception.

We provide evidence for a perceptual marker of neuroplasticity in female mastectomy patients who reported phantom breast perceptions. When tactile stimuli were delivered to dorso-thoracic, shoulder and pinna regions ipsilateral to the mastectomy, these patients (in some cases even 5 days after the operation) referred the stimuli to the amputated breast mainly to the nipple. The somatosensory representation of the stimulated regions is probably adjacent to the former representation of the amputated breast. These results suggest that input from stimulated regions of the skin can drive neurones originally driven by input from the amputated breast. The apparent functional relation between pinna and nipple might give clues to the mechanisms underlying referred sensations and pain.

Global and local processing of musical sequences: an event-related brain potential study.

Musical processing can be decomposed into the appreciation of global/holistic and local elements. Here, we investigated the pattern of neural activity associated with the processing of contour-violated (CV) and contour-preserved (CP) melodies. The CV and CP musical sequences were obtained by altering the pitch value of one note within the musical phrase, while keeping both the scale and the key constant. In the unadulterated melody, there was a sustained negativity that was larger over the right than left fronto-central regions. Participants were equally accurate in detecting CV and CP trials, but were slower in detecting CP than CV trials. Globally altered melodies (i.e. CV) generated an early, negative waveform (N2) and a P3b deflection, whereas the CP target only generated a P3b wave. This suggests that global precedence may occur at an early perceptual stage and argues in favor of fractionating musical processing into global and local components.

Event-related brain activity associated with auditory pattern processing.

One of the basic properties of the auditory system is the ability to analyse complex temporal patterns. Here, we investigated the neural activity associated with auditory pattern processing using event-related brain potentials. Participants were presented with a continuously repeating sequence of four tones with rare changes in either the frequency or timing of one of the tones. Both frequency- and time-deviant sounds generated mismatch negativity (MMN) waves that peaked at midline central electrode sites and inverted in polarity at inferior temporal and occipital sites, consistent with generators in the supratemporal plane. The MMN scalp topography was similar for the frequency- and time-deviant stimuli, suggesting that both spectral and temporal relations among elements of an auditory pattern are encoded in a unified memory trace.

Binding visual features during high-rate serial presentation.

The neural mechanism supporting performance during single and feature conjunction detection was investigated using event-related brain potentials. In different blocks of trials, participants responded to visual targets defined by one of two colors, one of two orientations, or both color and orientation. Participants were faster and more accurate in detecting targets defined by a single feature than for targets defined by a conjunction of features. Compared with the single feature conditions, conjunction targets were associated with enhanced negativity between 230 and 270 ms post-stimulus and showed a delayed P3 latency. The relative timing of feature specific attention effects isolated in difference potential shows that feature conjunction occurs concurrently with the analysis of single features.

Event-related brain activity associated with auditory pattern processing.

One of the basic properties of the auditory system is the ability to analyze complex temporal patterns. Here, we investigated the neural activity associated with auditory pattern processing using event-related brain potentials. Participants were presented with a continuously repeating sequence of four tones with rare changes in either the frequency or timing of one of the tones. Both frequency- and time-deviant sounds generated mismatch negativity (MMN) waves that peaked at midline central electrode sites and inverted in polarity at inferior temporal and occipital sites, consistent with generators in the supratemporal plane. The MMN scalp topography was similar for the frequency- and time-deviant stimuli, suggesting that both spectral and temporal relations among elements of an auditory pattern are encoded in a unified memory trace.

Motor disinhibition in affected and unaffected hemisphere in the early period of recovery after stroke.

OBJECTIVES: To investigate motor disinhibition in affected and unaffected motor areas in the acute stage after stroke and during the early period of recovery. METHODS: Fifteen patients with moderate to severe hemiparesis after acute unilateral stroke were compared with 10 healthy age-matched controls. We used paired transcranial magnetic stimulation to study intracortical inhibition and facilitation from the thenar eminence muscles on both sides. F-wave from the median nerve on both sides were recorded. The recordings were performed 5-7 days (T1) and 30 days after stroke. RESULTS: In 10 patients who showed the presence of reliable motor evoked potentials on the affected side, intracortical inhibition was significantly reduced. On the unaffected side intracortical inhibition (ICI) was significantly reduced in all patients. Patients who presented significant motor recovery after 30 days showed persistence of abnormal disinhibition in the affected hemisphere but a return to normal ICI in the unaffected hemisphere. Patients with poor motor recovery showed persistence of abnormal disinhibition on both sides. No significant changes were observed in F-wave amplitude. CONCLUSIONS: Motor disinhibition occurs on both sides after stroke in all acute stage patients. Changes in motor disinhibition on unaffected side also are related to motor recovery.

Masking of spatial frequency in visual memory depends on distal, not retinal, frequency.

Spatial frequency discrimination thresholds measured in a two-interval forced choice paradigm are virtually constant across inter-stimulus intervals ranging from 400 to 30,000 msec, demonstrating that an accurate representation of spatial frequency is maintained in short-term memory. This representation can be degraded by briefly flashing a grating during the retention interval. Moreover, this memory masking effect varies with the spatial frequency of the mask, suggesting that the mechanisms used to store spatial frequency in memory are similar to low-level visual filters. In this paper we replicate those previous findings and extend them by showing (1) that accurate memory for spatial frequency lasts as long as 1 min; (2) that memory masking is based on distal (c/cm), not retinal (c/deg), spatial frequency.

Tall cell variant of papillary thyroid cancer.

Papillary histologic type is the most common form of thyroid carcinoma amounting to 85% cases. This pathology presents a rather good prognosis, but a few years ago, new subtypes have been described. Some of these variants show a fairly good prognosis i.e follicular, macropapillary, encapsulated while others appear to have a decidedly worse one, columnar cells, diffused sclerosing, or even to be clearly malignant as in the case of the tall cell variant. The authors report a case treated by a combined surgical and radiometabolic therapy and evidence the main characteristics of this rare and underestimated neoplasia.