Recovery after Delayed Surgery in a Case of Spinal Subdural Hematoma

Spinal chronic subdural hematoma (SCSH) is a rare pathology usually associated with trauma or hematological alterations or is due to iatrogenic causes; rarely SCSH can be spontaneous. We report a case of a 79-year-old female who underwent a surgical evacuation of a spontaneous SCSH one year after diagnosis. She presented with a severe paraparesis and showed a considerable improvement in sensory-motor performances after surgery. The treatment of spontaneous SCSH is not well defined and universally accepted. Early surgery is mandatory in cases presenting with severe deficits. To the best of our knowledge, this is the first case showing a good outcome in a case of SCSH following a delayed surgery. In our opinion, an aggressive approach should be considered as a viable option in cases of spontaneous SCSH even after a lasting spinal cord compression.Peer Reviewe

Recovery after Delayed Surgery in a Case of Spinal Subdural Hematoma

6nonenonePier Paolo Panciani;Claudio Cornali;Alessandro Agnoletti;Giacomo Esposito;Gabriele Ronchetti;Marco FontanellaPier Paolo Panciani, ; Cornali, Claudio; Alessandro, Agnoletti; Giacomo, Esposito; Gabriele, Ronchetti; Fontanella, Marco Mari

Association between concussion history and knowledge among Italian youth soccer athletes

Objective To compare concussion-based knowledge between Ital- ian youth soccer athletes who reported a previously diagnosed concussion or concussion-like symptoms and those without prior concussion history. Design Cross sectional.Setting Self-reported survey. Subjects Male soccer athletes (n=766, age=16.9 ± 1.3 years, experience=6.6 ± 3.9 years) from 25 club teams across three professional leagues in Italy. Intervention The independent variables studied were diagnosed concussion group (prior diagnosed concussion vs. no diagnosed concussion) and self-reported concussion symptom group (experi- enced concussion-like symptoms vs. no concussion-like symptoms). Outcome measures The dependent variables were total knowl- edge scores, measured through accurate endorsement of symp- toms and responses to true and false prompts. Independent t- tests were used to determine group differences. Results 45 (6%) respondents indicated they sustained a physi- cian-diagnosed concussion. The mean number of diagnosed con- cussions was 0.065±0.3 (range 0–3). 198 (26.2%) respondents indicated they had experienced concussion-like symptoms. The mean frequency of self-reported concussion-like symptoms was 0.54±1.3 (range: 0–15). There were no significant differences in concussion symptom knowledge (P=0.616, 13.9±2.0 vs. 14.1 ±2.2) or true and false knowledge (P=0.390, 10.7±1.8 vs. 10.4 ±1.7) between the group with a previously diagnosed concussion compared to the one without. There were also no significant dif- ferences in concussion symptom knowledge (P=0.499, 14.2±2.1 vs 14.1±2.2) or true and false knowledge (P=0.256, 10.5±1.6 vs. 10.4±1.8) between the group that had experienced concus- sion-like symptoms compared to the group that had not. Conclusions These results suggest the necessity for targeted knowledge-based interventions for youth athletes, especially for those who sustain and report concussions

Prevention of Peritoneal Carcinomatosis from Colon Cancer in High-Risk Patients.

Introduction: Epidemiological data indicate that peritoneal spread from colorectal cancer is an event that involves 10–15% of patients at the time of primary cancer resection and about 25–50% of patients with recurrent disease, generally leading to death within weeks or months. The study compared the outcome in patients with advanced colonic cancer at high risk of peritoneal metastases without peritoneal or systemic spread, treated with standard colectomy or a more aggressive combined surgical approach. Materials and Methods: The experimental group underwent hemicolectomy, omentectomy, bilateral adnexectomy, hepatic round ligament resection, and appendectomy, followed by HIPEC. The control group comprised patients treated with standard surgical resection during the same period in the same hospital by different surgical teams. Results: Outcome data, morbidity, peritoneal recurrence rate, and overall, and disease-free survival, were compared. Peritoneal recurrence developed in 4% of patients in the experimental group and 22% of controls without increasing morbidity. Actuarial overall survival curves disclosed no significant differences, whereas actuarial disease-free survival curves showed a significant difference between groups. Conclusion: A more aggressive preventive surgical approach combined with HIPEC reduces the incidence of peritoneal recurrence in patients with advanced mucinous colonic cancer and also significantly increases disease-free survival compared with a homogeneous control group treated with a standard surgical approach without increasing morbidity

Ruptured Aneurysm in Sphenoid Sinus: Which Is the Best Treatment

Internal carotid artery (ICA) aneurysms involving the sphenoid sinus are uncommon, and their optimal treatment remains debated. We report the case of a patient presenting with recurrent epistaxis due to a bleeding cavernous ICA aneurysm. We suggest a combined endovascular and endoscopic approach when ICA occlusion may not be performed

Cigarette Smoking and Intracranial Aneurysms: A Pilot Analysis of SNPs in the CYP2A6 Gene in the Italian Population

BACKGROUND: Cigarette smoking is a modifiable risk factor associated with formation and rupture of intracranial aneurysms (IAs). Cytochrome P450 2A6 (CYP2A6) is the main enzyme implied in catabolism of nicotine and xenobiotics, giving rise to oxidative stress products. Our study investigated the associations between specific single-nucleotide polymorphisms (SNPs) in the CYP2A6 gene and the presence of sporadic IAs in a cluster of Italian patients, as well as their rupture regarding cigarette smoking habit. - METHODS: Three hundred and thirty-one Italian patients with sporadic IAs were recruited in a single institution. We recorded data on clinical onset with subarachnoid hemorrhage (SAH) and smoking habit. Genetic analysis was performed with a standard procedure on peripheral blood samples: CYP2A6 *1B2, CYP2A6 *2, and CYP2A6 *14 SNPs were analyzed in the study group along with 150 healthy control subjects. Statistical analysis was conducted according to genetic association study guidelines. RESULTS: In the patient cohort, the frequency of aSAH was significantly higher in current smokers (P < 0.001; OR =17.45), regardless of the pattern of CYP2A6 SNPs. There was a correlation between IA rupture and cigarette smoking in patients with the heterozygous CYP2A6 *1B2 allele (P < 0.001; OR=15.47). All patients carrying the heterozygous CYP2A6 *14 allele had an aSAH event (100%), regardless of smoking habit, although this correlation was not statistically significant (P = 1). CONCLUSIONS: According to our findings, a cigarette smoker carrying a fully active CYP2A6 enzyme (heterozygous *1B2 allele) may have an increased risk of IA rupture compared to those with functionally less active variants: further investigation on a larger sample is needed to verify this result. The role of the heterozygous CYP2A6 *14 allele in aSAH is yet to be clarified

Alcohol intake and the risk of intracerebral hemorrhage in the elderly

To investigate the role of alcohol as a causal factor for intracerebral hemorrhage (ICH) and whether its effects might vary according to the pathogenic mechanisms underlying cerebral bleeding.ObjectiveTo investigate the role of alcohol as a causal factor for intracerebral hemorrhage (ICH) and whether its effects might vary according to the pathogenic mechanisms underlying cerebral bleeding.MethodsWe performed a case-control analysis, comparing a cohort of consecutive white patients with ICH aged 55 years and older with a group of age-and sex-matched stroke-free controls, enrolled in the setting of the Multicenter Study on Cerebral Haemorrhage in Italy (MUCH-Italy) between 2002 and 2014. Participants were dichotomized into excessive drinkers (&gt; 45 g of alcohol) and light to moderate drinkers or nondrinkers. To isolate the unconfounded effect of alcohol on ICH, we used causal directed acyclic graphs and the back-door criterion to select a minimal sufficient adjustment set(s) of variables for multivariable analyses. Analyses were performed on the whole group as well as separately for lobar and deep ICH.ResultsWe analyzed 3,173 patients (1,471 lobar ICH and 1,702 deep ICH) and 3,155 controls. After adjusting for the preselected variables in the minimal sufficient adjustments, heavy alcohol intake was associated with deep ICH risk (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.36-2.09) as well as with the overall risk of ICH (OR, 1.38; 95% CI, 1.17-1.63), whereas no effect was found for lobar ICH (OR, 1.01; 95% CI, 0.77-1.32).ConclusionsIn white people aged 55 years and older, high alcohol intake might exert a causal effect on ICH, with a prominent role in the vascular pathologies underlying deep ICH