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The Department of neurosurgery of the Sainte-Anne Hospital hosted Jean Talairach who created and developed stereotactic neurosurgery in France. Despite numerous neurosurgical and neuroscientific achievements, little is known about the life of Jean Talairach.Systematic screening of Sainte-Anne Hospital Museum, Henry Ey Library, and Bibliothèque Inter-Universitaire de Santé funds, and medical databases using the term "Jean Talairach".Jean Talairach started his medical career at the Sainte-Anne Hospital in 1942 as a psychiatrist and became a neurosurgeon due to his interest in stereotactic neurosurgery. During World War II, Jean Talairach joined the French Resistance in Paris, then the French First Army. Jean Talairach created an original and specific stereotactic methodology with appropriate stereotactic frame and tools and performed one of the first human stereotactic surgeries in 1948. He described the reference lines passing by the anterior and posterior commissures in 1952 and developed a tridimensional co-planar stereotactic atlas of the human brain. With the collaboration of Jean Bancaud, he created stereo-electroencephalography to investigate patients suffering from drug-resistant epilepsy. The "Sainte-Anne school" trained French and foreign stereotactic and functional neurosurgeons ensuring the spread of Jean Talairach's innovative ideas. Jean Talairach retired in 1980.Jean Talairach's achievements encapsulate the evolution of neurosurgery in France during the 20th century. He developed an original stereotactic methodology including a tridimensional stereotactic atlas of the human brain and a stereotactic frame. He created stereo-electroencephalography, which remains the gold-standard to investigate patients suffering from drug-resistant epilepsy.

Purpose: To compare the use of a new cyanoacrylate-based surgical glue and suture with sepa-rate points in skin wounds closure. Methods: Thirty-six rats were subjected to a 4cm dorsal longitudinal incision. Twelve were sub-jected to simple suture with polyamide 6-0, 12 rats underwent wall synthesis using Dermabond(r) and 12 was performed cutaneous synthesis with N-2-Butyl-Cyanoacrylate. Twelve of each group was euthanized on the seventh postoperative day, their blood was taken to biochemical tests and a layer of skin and subcutaneous tissue surrounding the surgical scar was randomly divided in two segments, to the submission of tension tests and to histological study. Results: There were no significant difference between groups (p>0.05). In the soft dermis there was more type I collagen production in group I (p0.05). In the compact dermis, all 3 groups showed similar results (p>0.05). The biomechanical study was similarity between the glue groups (p>0.05) but the group III proved to be different from the others having a higher resistance (p>0.05) . Conclusion: This glue does not cause any inflammation or kidney and hepatic toxicity. Polyamide sutures are more resistant and the glue should be used alone only in less tension are-as.

A sacral dimple measuring less than 5mm, within 25mm of the anus on the median line, with no other cutaneous anomaly, does not require any complementary examination. Parents can be reassured. However, any cutaneous depression in the sacrolumbar region not respecting these criteria must be considered as an occult dysraphism until proved otherwise. A medullary ultrasound examination and a consultation with a specialist (pediatric neurosurgeon) are necessary. The dermic sinus is the main differential diagnosis, with favorable outcome in case of early treatment before any infectious complication arises. Conversely, the risk of permanent sequelae is high if neglected or in case of late diagnosis.

The main goal of this study was to identify a way to optimize nutritional support during ICU stay and obtain information about catabolic state through non-invasive and reliable methods as ultrasonography. We designed an observational case-series of 11 critically ill patients hospitalised at NEURO-ICU at IRCCS Bellaria Hospital - Bologna. The population studied shown uniform characteristics wich allowed comparison for muscle mass changes. Primary endpoint was to evaluate ultrasound sensitivity for monitoring muscle mass changes considering muscle layer thickness. Secondarly we compared ultrasonographic data and biomarkers of catabolism (sCr, nitrogen balance) in order to assess correlation between nutritional intakes (calories and protein) and changes in muscle during monitoring range of time. According to statistical index (CV Muscle ultrasound resulted as a feasible method for assessing muscle changes during acute phase of critical illness. Correlation between muscle layer thickness and APACHEscore at ICU admission could represent a role of muscle mass in the prognostic response to critical illness.

A 51-year-old female (height 160 cm, weight 89 kg, BMI 34.8) presented at the emergency department complaining of sudden onset of sharp abdominal pain in the epigastrium, colicky in nature, dysphagia, nausea, and repeated retching with non-productive vomiting. She has had an adjustable gastric banding implanted laparoscopically 11 years earlier. Since then, she reported to have had only a moderate weight loss (initial BMI 44), although she was closely followed up and the reservoir properly filled by her obesity surgeon. A gastrografin was performed and showed no clear signs of slippage of the gastric band nor of gastric strangulation/ischemia. Nonetheless, the passage of the contrast through esophagogastric junction was slightly slow and restricted suggesting a moderate stenosis from the band. Two cubic centimeters of saline were aspirated from the reservoir to loosen the gastric band. However, on the following minutes, no significant relief of the sharp pain was observed. NSAIDS and morphine were repeatedly given without significant pain relief, and after a few hours, the pain was more intense and diffused to the upper abdomen. I.V. contract CT scan showed a large amount of free fluid, with severe small bowel distension and suspected volvulus and a transition point at the port site of the reservoir, suggesting a strangulated incisional hernia on this site and/or strangulating band adhesion. Urgent surgery was planned, and a laparoscopic approach was chosen. A large amount of free bloody fluid was found, and a long segment of small bowel was twisted around a strangulating band adhesion on the port site of the reservoir, incarcerated within an incisional hernia on the same port site. The strangulating band was cut, and the strangulated bowel was released. Gradual reversion of bowel ischemia was observed, and the gastric banding was removed according to the patient's preoperative request.

Summary In patients with malignant esophageal strictures within 6 cm from the upper esophageal sphincter, self-expanding metal stents placement represents a challenge because there is an increased risk of complications. The aim of this study was to assess the safety and effectiveness of large-diameter WallFlex® fully covered self-expanding metal stents for palliation of patients with proximal malignant esophageal strictures. From March 2010 to December 2012, 12 patients with proximal strictures (4–6 cm from the upper esophageal sphincter) and six with very proximal strictures (

OBJECTIVES: to compare the apical sealing ability of four root canal sealers. MATERIAL AND METHODS: forty extracted human maxillary canines were instrumented 1 mm short of the anatomical apex and randomly assigned to four groups (n=10), according to the root canal sealer used for obturation: Endofill, AH Plus, EndoREZ and Epiphany. Root canals were obturated with gutta-percha points, except for the Epiphany group, in which resin points (Resilon) were used. The teeth were immersed in India ink for seven days and clarified using methyl salicylate. The extent of apical dye penetration was measured with a measuroscope in all aspects of the canal. RESULTS: AH Plus (0.02 mm ± 0.07), Epiphany (0.00 mm ± 0.00) and EndoREZ (0.32 mm ± 0.62) did not differ statistically to each other (p>0.01). EndoFill presented the highest dye penetration mean (0.83 mm ± 0.73) and was statistically different from the other sealers (pOBJETIVOS: comparar a capacidade de selamento apical de quatro cimentos endodônticos. MÉTODOS: quarenta caninos superiores humanos extraídos foram instrumentados 1 mm aquém do ápice anatômico e distribuídos aleatoriamente em quatro grupos (n=10), de acordo com o cimento endodôntico utilizado para a obturação: Endofill, AH Plus, EndoREZ e Epiphany. Os canais radiculares foram obturados pela técnica da condensação lateral com os cimentos e com cones de guta-percha, exceto o grupo do Epiphany, no qual os cones de resina (Resilon) foram utilizados. Os dentes foram imersos em nanquim por sete dias e submetidos ao processo de diafanização e, então, clarificados empregando-se o salicilato de metila. A extensão de penetração via apical do corante foi medida por meio de um microscópio de mensuração em todas as faces do terço apical. RESULTADOS: AH Plus (0,02 mm ± 0,07), Epiphany (0,00 mm ± 0,00) e EndoREZ (0,32 mm ± 0,62) não diferiram estatisticamente entre si (p>0,01). EndoFill apresentou a maior média de penetração do corante (0,83 mm ± 0,73) e diferiu estatisticamente dos demais (p

The purpose of this study was to investigate the influence of cervical preflaring on the determination of the first file that binds at working length (WL) in buccal roots of maxillary premolars. Five groups (n=10) were formed at random and, after standard access cavities, the WL was determined 1 mm short from the apex. In group 1, the initial apical file was inserted without preflaring of cervical and middle thirds of the root canals. In groups 2 to 5, the cervical and middle thirds were enlarged with sizes 90 and 110 Gates-Glidden drills, K³ Orifice Opener instruments, ProTaper instruments and LA Axxess burs, respectively. Canals were sized manually with K-files, starting with #08 K-files inserted passively up to the WL. File sizes were increased until a binding sensation was felt at the WL and the size of the instrument was recorded. Transversal sections of the WL regions were examined under scanning electron microscopy and the discrepancies between the canal diameter and first file to bind at the WL were assessed. Significant differences (p0.05) between their results (83.2 µm and 73.6 µm, respectively). The discrepancy for ProTaper instruments was 35.4 µm on average. In conclusion, the instrument binding technique for determination of the anatomical diameter at the WL was not precise. Preflaring of the cervical and middle thirds improved the determination of the anatomical diameter at the WL, and the type of instrument played a major role. Canals preflared with LA Axxess burs showed a more accurate binding of the files to anatomical diameter. O objetivo deste estudo foi avaliar a influência do pré-alargamento cervical na determinação do instrumento apical inicial em raízes vestibulares de pré-molares superiores. Foram selecionados 50 primeiros pré-molares superiores apresentando duas raízes. Após a cirurgia de acesso e determinação do comprimento de trabalho 1mm aquém do ápice, os dentes foram divididos aleatoriamente em 5 grupos distintos, de acordo com o tipo de alargamento realizado no terço cervical e médio de cada canal: Grupo 1- sem alargamento cervical; Grupo 2 - brocas Gates-Glidden (90, 110); Grupo 3 - instrumentos K³ Orifice Openers; Grupo 4 - instrumentos ProTaper; Grupo 5 - brocas LA Axxess. Os canais foram explorados com uma lima tipo K inserindo-se passivamente uma lima 08 no comprimento de trabalho. Limas de diâmetros maiores foram sucessivamente introduzidas no canal radicular até obter a sensação de travamento no comprimento de trabalho, e o diâmetro desse instrumento foi registrado. As secções transversais realizadas no comprimento de trabalho foram observadas por microscopia eletrônica de varredura e a diferença entre o menor diâmetro do canal e o diâmetro do instrumento apical inicial foi calculada para cada amostra. Houve diferença estatisticamente significante entre os grupos experimentais (p

The Gastro-Laryngeal Tube (G-LT) is a modification of the laryngeal tube which provides a dedicated channel for the insertion of an endoscope while acting as a supraglottic airway for ventilation. The aim of this study was to assess the safety and effectiveness of this device in patients undergoing anesthesia for interventional endoscopic biliopancreatic procedures (IEBPPs).A total of 22 patients were included in the study. The G-LT was inserted successfully in all patients. Arterial oxygen saturation was stable; the mean value was 97.9%. The IEBPPs were performed successfully in all patients through the endoscopic channel, with a mean duration of 99 minutes. The maneuverability of the endoscope was considered good in all patients. There were two cases of sore throat after the procedures, two cases of asymptomatic erosion of the upper esophageal mucosa, one case of Mallory-Weiss syndrome, and one case of pancreatitis after endoscopic retrograde cholangiopancreatography.Our results suggest that the G-LT is an effective and secure device for airway management and for use during IEBPPs.

Uno dei principali problemi in neurochirurgia e in neurorianimazione e costituito dal mantenimento di un adeguato flusso ematico cerebrale. Condizioni patologiche di varia natura (traumatica, neoplastica, ischemica, emorragica, infettiva) possono, alterando l’equilibrio della dinamica intracranica, innescare un meccanismo di risposte che, se fino a un certo limite possono rappresentare un meccanismo di adattamento prima e di compenso subito dopo, superato quel limite tendono a provocare alterazioni che possono condurre a lesioni irreversibili del parenchima cerebrale (ischemia). Un adeguato e costante Flusso Ematico Cerebrale (FEC) e indispensabile per un ottimale funzionamento dell’encefalo e, poiche l’attivita cerebrale e strettamente correlata al metabolismo, deve esistere una continua regolazione del flusso ematico che ne permetta l’adeguamento rispetto alle esigenze metaboliche tissutali: si parla di accoppiamento flusso-metabolismo. Il flusso ematico cerebrale rappresenta il volume di sangue che affluisce all’encefalo nell’unita di tempo garantendo un ottimale apporto di ossigeno e glucosio; rappresenta circa il 15% della gittata cardiaca ed e pari a circa 750 ml/min. I fattori che presiedono alla regolazione del FEC sono vari, spesso riportati come sigle: Pressione Arteriosa (PAS) e Pressione Arteriosa Sistemica Media (PAM), Pressione Intracranica (PIC), Pressione di Perfusione Cerebrale (PPC), Resistenze Vascolari Cerebrali (RVC), fabbisogno cerebrale di O2 (Cerebral Metabolic Rate for Oxygen, CMRO2).

The aim of this study was to compare several parameters of GH/IGF-I axis activity in septic and trauma patients during Intensive Care Unit (ICU) stay. To this goal, 13 patients with sepsis (SEP) and 16 with trauma (TRA) were studied. Thirty-three adult subjects (AS) were studied as controls. Serum IGF-I and -II, IGFBP-1, -2 and -3, GH and GHBP levels were studied on day 1, 3, 5 and 7 after ICU admission, during comparable artificial nutrition in SEP and TRA and basally in AS. In 5 patients with SEP and 6 with TRA, the GH response to GHRH was evaluated on day 3. On ICU day 1, IGF-I and -II and IGFBP-3 in SEP were lower (p

Strong evidences suggest that glutamine (GLN) plays a key role of in several metabolic pathways and it has been recognized as an essential substrate for the appropriate function of many organs and the principal metabolic fuel for different rapidly dividing cells. Moreover, GLN is essential for cell metabolism because it is able to modulate gluconeogenesis, lipogenesis, anabolic processes, to preserve mitocondrial ATP levels and attenuate the activation of inducible nitric oxide synthase following ischemia, trauma and sepsis, and to maintain gut integrity. GLN supplementation might be important in stress conditions to maintain a stable tissue and plasma pool and improve the above pathways. The randomized clinical trials published so far evaluating GLN supplementation in elective surgical patients and in subjects receiving intensive care treatment - with few exceptions - suffer several important methodological limitations such as lack of sample size calculation, blindness, a priori definition of complications, intention-to-treat analysis, subgroup and post-hoc analysis, statistical underpower, and heterogeneous cohort enrollment. The protective effect of GLN supplementation on primary outcome measures, such as morbidity and mortality is not persuasive. The most methodologically robust trials evaluating GLN supplementation showed no benefits or even a trend to harm in specific subgroups. Up to now the available data do not support the routine use of GLN in elective surgical and in critically ill patients. Others large randomized trials are needed to clarify if there is any role for GLN supplementation in specific subgroups.

Aim: The aim of this paper was to evaluate the lower uterine segment (LUS) thickness through transvaginal sonography in late preterm and full term pregnancies with a single previous Cesarean section, to correlate the obtained LUS measurements with intraoperative observations, and to identify a predictive cut-off value in order to select the best candidates for a vaginal birth after Cesarean delivery (VBAC). Methods: Two hundred and fourteen women with a single previous Cesarean section who had an ultrasound measurement of the LUS thickness (stratified in S1, S2 and S3) in pregnancy were enrolled. The outcome of interest was the visual finding of a thin uterine scar at the time of the iterative Cesarean section. Linear regression was used to correlate the LUS thickness with gestational age (GA). A ROC curve has been used to determine the detection rate (DR) and the risk of each actual value of LUS thickness versus a thin uterine scar (outcome of interest). Results: The LUS thickness was correlated with the gestational age (R2=0.034, P-value =0.005). The DR as estimated by ROC curves to detect a translucent lower uterine segment (S3) was 94.1% at a false positive rate (FPR) of 20%. The correspondent cut-off value was 1.8 mm. Finally a likelihood ratio (LR) of observing S3 was estimated. At the quoted cut-off of 1.8 mm the LR was 3. As demonstrated, for a segment of 1 mm the LR was instead about 13. Conclusion: The obtained values lead us to the conclusion that a thickness less than 1.8 mm can be reasonably considered a valid cut-off value to identify patients with a higher risk of thin uterine scar.

AIM: The study aims to calculate the probability of a successful vaginal delivery in post-term low-risk women by using a set of predictors (maternal, fetal, and ultrasonographic) according to the number of dinoprostone gel applications. METHODS: This was an observational study of a cohort of 174 low-risk post-term singleton pregnancies. Parity, cervical status and length, and amniotic fluid volume (AFI) were evaluated immediately before prostaglandin gel induction at the Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy between January 2010 and October 2011. RESULTS: A consistent difference in vaginal delivery rates was observed for women who had one gel administration (Group 1) versus those who received either two or three gel administrations (Group 2): 77.5% at 24 hours and 97.4% at 48 hours vs. 27% at 24 hours and 54% at 48 hours (P

The purpose of this study was to investigate the influence of cervical preflaring on determination of the initial apical file in mesiobuccal roots of maxillary molars. Fifty first molars with degree of curvature of the mesiobuccal root between 10° and 15° were utilized. After standard access opening and removal of pulp tissue, the working length (WL) was determined at 1 mm from the root apex. Five groups (n=10) were formed at random, according to the type of cervical preflaring performed. In group 1, the size of the initial apical file was determined without cervical preflaring. In groups 2 to 5, the cervical and middle thirds of the canals were preflared with Gates-Glidden drills, K3 Orifice Opener instruments, ProTaper instruments and LA Axxess burs, respectively. Canals were sized manually with K-files, starting with size 08 K-files, inserted passively up to the WL. File sizes were increased until a binding sensation was felt at the WL and the size of the file was recorded. The binding instruments were fixed into the canals at the WL with methylcyanacrylate. Cross-sections of the WL region were examined under scanning electron microscopy and the discrepancies between the canal diameter and the diameter of first file to bind at the WL were calculated using UTHSCSA ImageTool software. Data were analyzed statistically by ANOVA and multiple comparisons were done by Tukey's HSD post-hoc test. Significant differences (p0.05) (means 0.1167 mm ± 0.0231 and 0.1313 mm ± 0.0344, respectively). In conclusion, preflaring of the cervical and middle thirds improved the determination of the initial apical instrument. Canals preflared with LA Axxess burs showed a more accurate binding of the files to the anatomical diameter at the WL in the mesiobuccal roots of maxillary first molars. Avaliou-se a influência do pré-alargamento cervical na determinação do instrumento apical inicial em raízes mésio-vestibulares de molares superiores. Foram selecionados 50 primeiros molares superiores com grau de curvatura da raiz mésio-vestibular padronizado entre 10 e 15 graus. Concluída a cirurgia de acesso e remoção do tecido pulpar, determinou-se o comprimento de trabalho a 1mm do ápice. Os dentes foram divididos aleatoriamente em 5 grupos (n=10), de acordo com o tipo de alargamento realizado: Grupo 1: sem alargamento cervical; Grupo 2: brocas Gates-Glidden; Grupo 3: Orifice Opener; Grupo 4; ProTaper; Grupo 5: LA Axxess. Os canais foram explorados com lima do tipo K inserindo-se passivamente a lima 08 no comprimento de trabalho. A seguir, limas de maiores diâmetros foram sucessivamente introduzidas no canal radicular, até se obter a sensação de travamento no comprimento de trabalho. O diâmetro desse instrumento foi registrado, e este foi fixado em posição no canal com cianoacrilato de metila. Secções transversais realizadas no comprimento de trabalho foram observadas ao microscópio eletrônico de varredura e a discrepância entre o menor diâmetro do canal e o diâmetro do instrumento apical inicial foram calculados para cada amostra, por meio de um software. As médias de diferença entre esses diâmetros obtidas em cada grupo foram submetidas à análise estatística. A análise de variância indicou diferença estatisticamente significante entre os grupos (p0,05) (média: 0,1167 mm ± 0,0231 e 0,1313 mm ± 0,0344 respectivamente) O pré-alargamento realizado com instrumentos ProTaper evidenciaram a média de 0,0567mm e desvio padrão 0,0354 para os valores de discrepância. Pode-se concluir que o pré-alargamento dos terços cervical e médio permitiu uma melhor determinação do instrumento apical inicial. O grupo no qual foram utilizados instrumentos LA Axxess refletiu com maior fidelidade o diâmetro anatômico no comprimento de trabalho em raízes mésio-vestibulares de primeiros molares.

This study aims to assess the best postoperative analgesia during maxillofacial surgery by using small doses of ketorolac or tramadol or their association and evaluates the presence of adverse effects due to NSAID or opioid use.After their informed consent, 51 patients ASA I and II undergoing major maxillofacial surgery, were randomised in three groups and the following protocol was used: group K received ketorolac (30 mg i.v.) at the time of skin closure and repeated after 8 hrs and 16 hrs from the end of the operation. Group T received tramadol (100 mg i.v.) in the same condition; and group KT received first tramadol (100 mg i.v.) during surgery and then ketorolac (30 mg) was given in the administrations that followed. Meperidine 50 mg was used in case of unsatisfactory analgesia. Pain was evaluated using pain intensity scores 2, 4, 6, 12 and 24 hours from the end of the operation. Data was analysed using Anova and c2 test.The groups were comparable with regard to age, weight, duration of surgery. Very good postoperative analgesia was recorded in three groups. There is no difference statistically between K, T and KT groups in the pain scores measured. Only a low number of patients required opioids administration to achieve adequate analgesia. The patients were considered to have achieved excellent analgesia in 64.8% in T group, in 41.2% of the K group and in 58.8% of the KT group. There were no cases of insufficient analgesia. We did not find a significant difference considering BP, HR, respiratory depression in the post-operative period. Vomiting was registered in 41.2% of this T group vs 11.2% of the K group and in 35.5% of the KT group.Ketorolac and Tramadol produced comparable, effective and low cost postoperative analgesia during maxillofacial surgery. There are only statistically significant differences considering side effects.

In this study we report the data obtained from extensive haemostatic testing of 25 patients undergoing orthotopic liver transplantation and the results of an open randomized pilot trial of antithrombin III concentrate administration during surgery. Marked differences in transfusional needs and in pre- and intraoperative blood coagulation and fibrinolytic changes were observed between recipients with liver cirrhosis and those with primary biliary cirrhosis. In the former, the increases in tissue-type plasminogen activator activity, total euglobulin fibrinolytic activity, and fibrin-derived degradation products occurred earlier and were more marked, as were the signs of increased thrombin formation. Supplementation of antithrombin III concentrate during surgery failed to induce significant changes in the main parameters studied and in the transfusional needs.