Life-threatening hypophosphataemia secondary to zoledronic acid implementation in a middle-age patient who presented with advanced osteolysis in the course of multiple myeloma

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Zespolenie nerwu twarzowego z połową nerwu podjęzykowego w leczeniu porażenia nerwu twarzowego

Background and purpose Commonly used classic hypoglossal (CN XII) to facial nerve (CN VII) anastomosis has the disadvantage of tongue hemiatrophy. Thus, various attempts have been made to modify this method to reduce the tongue damage. The aim of this report was to present the results of hemihypoglossal-facial nerve anastomosis (HHFA) technique in relation to facial muscles reanimation and hemitongue atrophy. Material and methods The first 7 consecutive patients who underwent CN VII anastomosis with half of the CNXII, for which the follow-up period exceeded 12 months, were analysed. During the procedure, CN VII was transected as proximally as possible after drilling the mastoid process. CN XII was separated longitudinally into two parts at a short distance to allow suture of the stumps without any tension. One half of CN XII was transected and sutured to the distal stump of CN VII. Recovery from facial palsy was quantified with the House-Brackmann grading system (HB). Tongue function was assessed according to the scale proposed by Martins. Results Features of initial reinnervation of facial muscles were visible after 6 months in all 7 patients. All patients achieved satisfactory outcome of CN VII regeneration (HB grade III) until the last control examination (12-27 months after surgery, mean 16). No or minimal tongue atrophy without deviation (grades I-II according to the Martins scale) was found in 4 patients. Mild hemiatrophy with tongue deviation < 30 degrees (grade III) was visible in 3 patients. Conclusions In our experience, HHFA is effective treatment of facial palsy and gives a chance to reduce damage of the tongue.Wstęp i cel pracy W leczeniu porażenia nerwu twarzowego często stosuje się zespolenie z nerwem podjęzykowym. Wadą tej metody jest połowiczy zanik języka, dlatego od wielu lat podejmuje się próby jej modyfikacji, aby zmniejszyć uszkodzenia języka. Celem pracy jest ocena wyników zespolenia nerwu twarzowego z połową nerwu podjęzykowego w kontekście reanimacji mięśni twarzy oraz następowego uszkodzenia języka. Materiał i metody Analizowano wyniki leczenia 7 pierwszych, kolejnych chorych, u których wykonano zespolenie nerwu twarzowego z połową nerwu podjęzykowego, u których czas obserwacji przekraczał 12 miesięcy. W czasie zabiegu wypreparowywano pień nerwu twarzowego z wyrostka sutko-watego oraz jego zewnątrzczaszkowy odcinek aż do jego podziału. Wypreparowywano nerw podjęzykowy, rozdzielano go podłużnie na dwie części na krótkim odcinku, aby uzyskać zespolenie bez żadnego napięcia. Jedną połowę nerwu pod-językowego zeszywano z kikutem dystalnym nerwu twarzowego. Wyniki reinerwacji mięśni twarzy oceniano wg skali House'a-Brackmanna (HB), natomiast nasilenie zbaczania i jednostronnego zaniku języka oceniano za pomocą skali zaproponowanej przez Martinsa. Wyniki Po upływie 6 miesięcy u wszystkich 7 chorych stwierdzono początkowe cechy reinerwacji mięśni twarzy. Do czasu ostatniej kontroli (12–27 miesięcy po zabiegu, średnio 16 miesięcy) u wszystkich chorych uzyskano satysfakcjonujący wynik regeneracji nerwu twarzowego (III stopień HB). Brak lub minimalny jednostronny zanik mięśni bez zbaczania języka (stopnie I–II wg Martinsa) stwierdzono u 4 pacjentów, a średniego stopnia zanik połowiczy ze zbaczaniem języka < 30 stopni (III stopień) u 3 pacjentów. Wnioski Zespolenie nerwu twarzowego z połową nerwu pod-językowego umożliwia w naszym doświadczeniu satysfakcjonującą reanimację mięśni twarzy i daje szanse na zmniejszenie uszkodzenia funkcji języka

Surgical treatment of intramedullary ependymomas

Object The aims of this study were to present the results of surgery for intramedullary ependymomas (IEs), analyze complication and recurrence rates, and analyze factors that might influence outcome. Methods The charts of 29 consecutive patients (women – 8, men – 21; mean age – 38 years; range: 18–72) operated for IE were retrospectively analyzed. Mean follow-up was 9 years. Eighteen tumors (62%) were located in the cervical or cervicothoracic spine, and average tumor length was four spinal levels. Twenty patients (69%) presented with neurological deficit. Results Gross total resections (GTRs) comprised 87% of cases, subtotal resections (STRs) 10%, and partial resections 3%. The neurological outcome on postoperative day 1 was as follows: modified McCormick scale (mMS) grade I – 6%, grade II – 21%, grade III – 21%, grade IV – 31%, and grade V – 21%; at follow-up, outcomes were mMS grade I – 42%, grade II – 34%, grade III – 10%, and grade V – 14% of patients. Compared to the preoperative period, 69% of patients deteriorated postoperatively; however, 62% improved or remained without deficit in follow-up, and deterioration persisted in 24%. The functional results were significantly worse when the intraoperative monitoring potentials dropped below 50% (p=0.005) and if the tumor involved >3 spinal levels (p=0.039). Fourteen postoperative complications in 10 patients (34%) included respiratory failure (14%), pneumonia (7%), urinary infection (10%), bed sores (10%), and CSF leak (7%). Two tumors progressed after STR, with progression-free survival times of 5 and 14 years. No recurrence was observed after GTR. Conclusions Total tumor resection is the treatment of choice in cases of IEs: no tumor re-growth occurred after total resection, 86% of patients were independent at follow-up, and the 10-year survival rate was 79%

Surgical treatment of sporadic and von Hippel–Lindau syndrome-associated intramedullary hemangioblastomas

Object Intramedullary hemangioblastomas are rare lesions. They can be related to von Hippel–Lindau syndrome or they may be sporadic. This study describes surgical treatment for this infrequent tumor. Methods Twelve consecutive patients received surgery to remove sporadic or von Hippel–Lindau syndrome-associated intramedullary hemangioblastomas. Patients were evaluated at four time points: before treatment, on postoperative day one, on the day of discharge, and at a follow-up examination. Results The patients showed good preoperative neurological status. The cohort had a slight female predominance. All tumors spanned at least one spinal segment. In all cases, total tumor removal was achieved, and a good outcome was obtained. None of the following factors had a significant effect on outcome: age, sex, tumor size, the presence of a syrinx, or the presence of von Hippel–Lindau syndrome. Conclusions The surgical removal of intramedullary hemangioblastomas resulted in satisfactory long-term functional outcomes. The best results were obtained before neurological symptoms occurred. Thus, we suggest that surgery should be considered for managing asymptomatic, surgically accessible, space-occupying lesions in sIH group, and isolated, space-occupying lesions in vHLS-IH group

Surgery for sporadic vestibular schwannoma. Part IV. Predictive factors influencing facial nerve function after surgery

Objective To analyze the impact of various clinical, radiological and perioperative factors that could influence the facial nerve intraoperative disruption risk (CNVII-IDR) and its long-term function (CNVII-LTF) after vestibular schwannoma (VS) surgery. Material and methods The study included 212 patients operated on for sporadic VS with no history of previous treatment for VS or CNVII palsy. The mean size of the tumor was 30mm. Gross (210) or near-total (2) resections were carried out using the retrosigmoid (210) or translabyrinthine (2) approach. Correlation studies and multivariate regression analysis (RA) were performed. Results In correlation studies, the CNVII-IDR was increased by: headaches and cerebellar ataxia if one of them was the first symptom of the tumor (33% and 29%, respectively, p=0.008); preoperative hydrocephalus (40% vs. 9%, p=0.01), tumor size >3cm (18% vs. 5%, p<0.01), tumor volume >10cm3 (19% vs. 4%, p<0.01), right-sided location 15% vs. 6%, p=0.047), lateral “park-bench” position (19% vs. 5% for supine position, p<0.01) and the procedure order (16% for the first 106 procedures vs. 6% for the last 106 procedures, p<0.05). In RA the tumor volume (p=0.012), side of the tumor (p=0.028) and patient's position during surgery (p=0.016) independently affected the CNVII-IDR. The following factors correlated significantly with satisfactory CNVII-LTF (HB grades I–III): tumor stage <T4 (p=0.000), tumor size ≤3cm (p=0.000), tumor volume ≤10cm3 (p=0.001), and left-sided location (p=0.048). Additional factors correlated significantly with very good CNVII-LTF (HB grades I–II): anterior CNVII displacement (p=0.044), nimodipine use (p=0.016), the absence of postoperative complications (p=0.019), CNVII responsive on final intraoperative EMG stimulation (p=0.000) and supine position during surgery (p=0.018). However, an independent impact on very good CNVII-LTF proved to be the tumor size (p=0.0000), side (p=0.0175), and nimodipine use (p=0.0349). Conclusions In our series, the factors related to size and side of the tumor confirmed an independent impact on CNVII-IDR and CNVIILTF. The significance of patient positioning may reflect the impact of learning curve as only the first 91 patients were operated on using the lateral “park-bench” position. An independent impact on CNVII-LTF was exerted by the perioperative use of nimodipine

Surgery for sporadic vestibular schwannoma. Part III: Facial and auditory nerve function

Objective The aim of this analysis was to assess short-term and long-term outcomes with respect to the preservation of facial and auditory nerve function following surgery for sporadic vestibular schwannomas. Material and methods The study included 220 consecutive patients operated on with the retrosigmoid (217) or translabyrinthine (3) approach. The mean extrameatal diameter of the tumor was 30mm. In 217 patients, gross total resection was performed and near-total in 3. Before surgery, the facial nerve (CNVII) weakness was found in 18% of patients and only 20% had serviceable hearing. Intraoperative neurophysiological CNVII monitoring was routinely used (the last 211 procedures). Intraoperative monitoring of the cochlear nerve function was used when the preservation of hearing was attempted (45 procedures). Results The rate of CNVII continuity loss during surgery was 11%, however, this decreased to 6% in the second half of the series. Facial nerve function deteriorated, in 88% of the patients shortly after surgery. However, it improved in 87% in follow-up. Delayed CNVII palsy was found in 5% of the patients and had a good prognosis in 88%. Final satisfactory CNVII function (CNVII-SF, HB grades I–III) was achieved in 76% of the patients when excluding the anastomosis results, and 87% when including them. In recent years, the rate of CNVII-SF has risen to 94%. Non-serviceable hearing was preserved in 49% of the patients, on whom it was attempted. Conclusion Considering the size of the tumors and extent of the resections, the preservation of CNVII function is currently very high. A close surveillance of CNVII function evolution following surgery is mandatory, as 2/3 of the patients discharged with deep paresis will need different face reanimation procedures. The preservation of useful hearing is still problematic, especially in patients with large tumors

Wstęp

Projekt dofinansowany ze środków UE, w ramach Programu Operacyjnego Wiedza Edukacja Rozwój 2014-2020. Oś Priorytetowa II Efektywne Polityki Publiczne dla Rynku Pracy, Gospodarki i Edukacji, Działania 2.10 Wysoka jakość systemu oświat

An association between genetic variation in the glutamatergic system and suicide attempts in alcoholâ dependent individuals

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138265/1/ajad12571_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138265/2/ajad12571.pd

Specjalistyczne Centrum Wspierające Edukację Włączającą w perspektywie uczestników projektu pilotażowego w powiecie łódzkim

Projekt dofinansowany ze środków UE, w ramach Programu Operacyjnego Wiedza Edukacja Rozwój 2014-2020. Oś Priorytetowa II Efektywne Polityki Publiczne dla Rynku Pracy, Gospodarki i Edukacji, Działania 2.10 Wysoka jakość systemu oświat