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Amyotrophic lateral sclerosis (ALS) is an extremely complex neurodegenerative disease involving different cell types, but motoneuronal loss represents its main pathological feature. Moreover, compensatory plastic changes taking place in parallel to neurodegeneration are likely to affect the timing of ALS onset and progression and, interestingly, they might represent a promising target for disease-modifying treatments. Therefore, a simplified animal model mimicking motoneuronal loss without the other pathological aspects of ALS has been established by means of intramuscular injection of cholera toxin-B saporin (CTB-Sap), which is a targeted neurotoxin able to kill motoneurons by retrograde suicide transport. Previous studies employing the mouse CTB-Sap model have proven that spontaneous motor recovery is possible after a subtotal removal of a spinal motoneuronal pool. Although these kinds of plastic changes are not enough to counteract the functional effects of the progressive motoneuron degeneration, it would nevertheless represent a promising target for treatments aiming to postpone ALS onset and/or delay disease progression. Herein, the mouse CTB-Sap model has been used to test the efficacy of mitochondrial division inhibitor 1 (Mdivi-1) as a tool to counteract the CTB-Sap toxicity and/or to promote neuroplasticity. The homeostasis of mitochondrial fission/fusion dynamics is indeed important for cell integrity, and it could be affected during neurodegeneration. Lesioned mice were treated with Mdivi-1 and then examined by a series of behavioral test and histological analyses. The results have shown that the drug may be capable of reducing functional deficits after the lesion and promoting synaptic plasticity and neuroprotection, thus representing a putative translational approach for motoneuron disorders., Competing Interests: The authors declare no conflicts of interest.

Background: Standardisation of the intraoperative neuromonitoring (IONM) technique is a fundamental aspect in monitored thyroid surgery. Vagal nerve (VN) stimulation is essential for problem solving, recognition of any inferior laryngeal nerve (ILN) lesions and prediction of ILN post-operative function. Issues that have been overlooked in the literature, particularly in terms of prospective approaches, are the topographic relationship of the VN with the carotid and jugular vessels as well as the neurophysiology of the VN and ILN that have been studied, with a prospective approach, in patients with various thyroid diseases., Methods: Cooperation with the Human Morphology Department resulted in the completion of a dedicated anatomy report, with the clear objective of providing a detailed anatomic and neurophysiologic description of the VN (n = 263)., Results: VN identification and stimulation was feasible in all cases and did not result in increased morbidity or operative time. Most VNs lay on the posterior region of the carotid ship (73%), i.e. the P position in accordance with our model. Mean amplitudes of EMG signals obtained from VN stimulation were 750 ± 279 μV, lower than those obtained with direct INL stimulation (1,086 ± 349 μV)., Conclusion: A better understanding of the variability in the VN may be useful not only to minimise complications but also to guarantee an accurate IONM.

Object: Although transpedicular fixation is a biomechanically superior technique, it is not routinely used in the cervical spine. The risk of neurovascular injury in this region is considered high because the diameter of cervical pedicles is very small and their angle of insertion into the vertebral body varies. This study was conducted to analyze the clinical accuracy of stereotactically guided transpedicular screw insertion into the cervical spine., Methods: Twenty-seven patients underwent posterior stabilization of the cervical spine for degenerative instability resulting from myelopathy, fracture/dislocation, tumor, rheumatoid arthritis, and pyogenic spondylitis. Fixation included 1-6 motion segments (mean 2.2 segments). Transpedicular screws (3.5-mm diameter) were placed using 1 of 2 computer-assisted guidance systems and lateral fluoroscopic control. The intraoperative mean deviation of frameless stereotaxy was < 1.9 mm for all procedures., Results: No neurovascular complications resulted from screw insertion. Postoperative computed tomography (CT) scans revealed satisfactory positioning in 104 (90%) of 116 cervical pedicles and in all 12 thoracic pedicles. A noncritical lateral or inferior cortical breach was seen with 7 screws (6%). Critical malplacement (4%) was always lateral: 5 screws encroached into the vertebral artery foramen by 40-60% of its diameter; Doppler sonographic controls revealed no vascular compromise. Screw malplacement was mostly due to a small pedicle diameter that required a steep trajectory angle, which could not be achieved because of anatomical limitation in the exposure of the surgical field., Conclusions: Despite the use of frameless stereotaxy, there remains some risk of critical transpedicular screw malpositioning in the subaxial cervical spine. Results may be improved by the use of intraoperative CT scanning and navigated percutaneous screw insertion, which allow optimization of the transpedicular trajectory.

The aim of this review is to analyse anaesthesiologic preoperative assessment, intraoperative management and postoperative complications of patients with thyroid disease. A special care is paid to difficult airway recognition and resolving this situation. Anaesthetist's and surgeon's point of view of perioperative and postoperative complications is both discussed with special interest on early surgical complications and the need for urgent anaesthetic treatment. Particularly total intravenous anaesthesia and recurrent laryngeal nerve monitoring actually are two end-points in the thyroid surgery.

The retinotopic organization of striate and several extrastriate areas of ferret cortex has been established. Here we describe the representation of the visual field on the Suprasylvian visual area (Ssy). This cortical region runs mediolaterally along the posterior bank of the suprasylvian sulcus, and is distinct from adjoining areas in anatomical architecture. The Ssy lies immediately rostral to visual area 21, medial to lateral temporal areas, and lateral to posterior parietal areas. In electrophysiological experiments we made extracellular recordings in adult ferrets. We find that single and multiunit receptive fields range in size from 2 deg x 4 deg to 21 deg x 52 deg. The total visual field representation in Ssy spans over 70 deg in azimuth in the contralateral hemifield (with a small incursion into the ipsilateral hemifield), and from +36 deg to -30 deg in elevation. There are often two representations of the horizontal meridian. Furthermore, the location of the transition from upper to lower fields varies among animals. General features of topography are confirmed in anatomical experiments in which we made tracer injections into different locations in Ssy, and determined the location of retrograde label in area 17. Both isoelevation and isoazimuth lines can span substantial rostrocaudal and mediolateral distances in cortex, sometimes forming closed contours. This topography results in cortical magnifications averaging 0.07 mm/deg in elevation and 0.06 mm/deg in azimuth; however, some contours can run in such a way that it is possible to move a large distance on cortex without moving in the visual field. Because of these irregularities, Ssy contains a coarse representation of the contralateral visual field.

Background: Central venous catheters (CVCs) are used to deliver a variety of therapies, as well as for measurement of hemodynamic parameters. The major associated complication is catheter-related blood stream infection (CRBSI)., Method: Review of the pertinent English-language literature., Results: The incidence of CRBSI depends on how such infections are defined. Generally, the term includes all BSIs in patients with CVCs when other sources can be excluded, and if a culture of the catheter tip demonstrates a substantial number of colonies of the organism found in the blood stream. Important pathogenic determinants of catheter-related infection are the material of which the device is made and the intrinsic virulence of the organism. The site at which a catheter is placed influences the risk of infection. The types of organisms that most commonly cause hospital-acquired BSIs have changed over time. Migration of skin organisms at the insertion site into the cutaneous catheter tract with colonization of the catheter tip is the most common route of infection. Good hand hygiene before catheter insertion, combined with proper aseptic technique during its manipulation, provides protection against infection; maximal sterile barrier precautions during insertion reduce the incidence of CRBSI. Catheters that are coated or impregnated with antimicrobial or antiseptic agents can decrease the risk and the associated hospital costs. No studies have demonstrated that oral or parenteral antibacterial or antifungal drugs reduce the incidence of CRBSI in adults. Use of anticoagulants might have a role in the prevention of CRBSI. Catheter replacement at scheduled intervals has not lowered rates of local or systemic complications., Conclusions: Central venous catheters are used commonly to deliver a variety of therapies, such as large amounts of fluid or blood products during surgery or in intensive care units, chemotherapy, and parenteral nutrition, as well as for measurement of hemodynamic variables. The major complication associated with CVCs is CRBSI.

Interareal feedback connections are a fundamental aspect of cortical architecture, yet many aspects of their organization and functional relevance remain poorly understood. Previous studies have investigated the topography of feedback projections from extrastriate cortex to macaque area 17. We have extended this analysis to the ferret. We made restricted injections of cholera toxin B (CTb) into ferret area 17 and mapped the distribution of retrogradely labeled cells in extrastriate cortex. In addition to extensive label spreading within area 17, we found dense cell label in areas 18, 19, and 21 and the suprasylvian cortex and sparser connections from the lateral temporal and posterior parietal cortex. We made extensive physiological assessments of magnification factors in the extrastriate visual cortex and used these measures to convert the spread of labeled cortex in millimeters into a span in degrees of visual field. We also directly measured the visuotopic extents of receptive fields in the regions containing labeled cells in cases in which we made both CTb injections and physiological recordings in the same animals; we then compared the aggregate receptive field (ARF) of the labeled region in each extrastriate area with that of the injection site. In areas 18, 19, and 21, receptive fields of cells in regions containing labeled neurons overlapped those at the injection site but spanned a greater distance in visual space than the ARF of the injection site. The broad visuotopic extent of feedback connections is consistent with the suggestion that they contribute to response modulation by stimuli beyond the classical receptive field., (Copyright 2005 Wiley-Liss, Inc.)

Surgery, when feasible, rappresents the treatment of choice for lung cancer. Several problems can come to the attention of the anesthesiologist in relation to the respiratory function with implications in airway control (double-lumen tube for lung collapse required for better surgical exposure of the pulmonary tissue), mechanical and gas-exchange aspects (increase in airway pressure of the dependent lung, increased blood shunt). The effect of these disorders, with no compensatory mechanism (pulmonary hypoxic vasoconstriction) and in the absence of an anesthesiologist (higher FiO2, low tidal volumes, allowing "permissive hypercapnia", CPAP to the non-dependent lung), normal arterial oxygenation (hypoxemia) is impaired. Right heart failure is the major risk particularly in preexisting pulmonary hypertension Supraventricular arrytmias can often occur in case of history of cardiovascular disease, metabolic and mechanical intraoperative alterations (type and duration of surgery, pericardial and autonomic nervous system manipulations). Unusual complications are cardiac herniation and pulmonary re-expansion-edema.

A case of male breast carcinoma in a very young subject (seventeen years old) is described. Breast carcinoma in male is infrequent, and at a so young age it is really rare. The patient was subjected to "Patey" mastectomy with removing the lymph nodes of the breast with the tumor, and subcutaneous mastectomy at the opposite side breast. As agreed with the oncologist other therapy was carried out.

The authors explore the correlation between the neuroradiologic and clinical patterns of "subcortical arteriosclerotic encephalopathy" (SAE) or Binswanger's disease. The typical neuroradiologic pattern has been found in 62 of the 1804 CT scans of the department's archive. Available patients were enrolled for neuropsychologic evaluation. The authors point out that there is no correlation whatever between severity of the CT pattern and findings of psychological decline. Therefore SAE may be considered merely a neuroradiologic pattern. The discrepancy between neuroradiologic and clinical pattern depends on the individual history of every single patient as well as on the quality of the neuronal cells involved in vascular pathology. It may in fact be thought that the injury to command neurones plays a fundamental role in bringing about the psychopathologic picture.

Results of personal experience of the application of enteral nutrition in a group of patients (21) submitted to surgery for gastric cancer are reported. Enteral nutrition proved easy to perform, provided a significant improvement in some of the parameters considered in the study, was without significant complications and presented acceptable management costs.

In order to characterize neurological, intellectual and behavioral sequelae better after surgical treatment of brain abscess in childhood, 32 children were studied over a 10-year time span after treatment of a brain abscess. Depending on the clinical condition, surgical treatment consisted of simple aspiration through a burr hole or of total excision after craniotomy. There were only 3 postoperative deaths (9%). The scheduled time for long-term follow-up was 3 years after surgery. The patient assessment included information concerning the presence of seizures, accurate neurological examination, an EEG, and a battery of intellectual tests to evaluate the presence of behavioral-mental deficits. Late seizures developed in 7 of the 29 survivors. Five patients presented permanent hemiparesis after surgical treatment. It is noteworthy that the intellectual impairment observed was more severe in younger patients, while the behavioral disturbances were more marked in school-age children.

Rehabilitation by means of periodic irrigation is an easy-to-use method that is generally well accepted by the patient. By "giving up" an hour less a day, or better still every 48 hours, the patient can avoid the inconvenience of numerous, continual and uncontrollable evacuations. In confirmation of previous experiments, no significant differences were observed concerning early rehabilitation (up to 10 years after the operation). Irrigation has also been shown to have few negative aspects.

In order to investigate the role of EEG in minor head traumata in the pediatric age, EEG and CT scan findings were compared in a series of 103 consecutive cases of children hospitalized within 24 h after head trauma. The EEGs were classified as normal in 50 patients, borderline in 10 patients, and abnormal in 43 patients. CT scan showed contusion in 6 patients and extracerebral hematoma in 4. All cases of abnormal CT scans were reported for patients with frankly abnormal EEG findings. In contrast, no pathological findings were found in CT scans for patients with normal EEG. The data suggest that EEG findings can play a major role in the diagnostic workup of patients with minor head traumata. Specifically, in the case of asymptomatic patients with normal EEG findings, it is likely that the CT scan will also be normal.