An atypical assessment of Ebstein’s anomaly in an 86-year-old man

We present the echocardiographic analysis of an 86- year-old man affected by Ebstein’s anomaly. In the natural history of this congenital disease only 5% of patients survive beyond the fifth decade. The patient presented severe right atrial dilatation and right heart failure, and he was referred to our institution for supraventricular tachycardia

Almotriptan 12.5 mg in menstrually related migraine: A randomized, double-blind, placebo-controlled study

Background: Menstrually related migraine (MRM) affects more than half of female migraineurs. Because such migraines are often predictable, they provide a suitable target for treatment in the mild pain phase. The present study was designed to provide prospective data on the efficacy of almotriptan for treatment of MRM

Clinically integrated neuroanatomy modules using neurosurgery and intraoperative MRI/DTI tractography: their contribution to long-term retention of neuroanatomical knowledge

Neuroanatomy is often considered the part of the human anatomy syllabus students find hardest to study. To motivate them and boost their learning, clinical cases and neurosurgical images, mainly DTI tractographies produced using an intraoperative magnetic resonance imaging apparatus (MRI/DTI), were presented and discussed during integrated second-year neuroanatomy, neuroradiology and neurosurgery lectures over the five-year 2007-2012 period. Anonymous questionnaires, rated on the Likert scale, showed that the students appreciated this teaching procedure. The academic performance (exam marks for neuroanatomy) of those who attended all the integrated lectures, was slightly, though significantly higher than for students who attended the lectures only occasionally or not at all (p=0.04). Moreover, significantly better results were obtained at the 2012 national progress test (focusing on morphology) by students who attended the MRI/DTI-assisted lectures, compared to those who did so in part or not at all and compared to the national average. These results were obtained by students attending the second, third and, in particular, the fourth, fifth and sixth year (p≤0.0001) courses during the five above-mentioned academic years. The early study of real medical cases, including the relative surgical and post-operative phases, if illustrated by a good collaborative interdisciplinary team, can help direct the students positively towards their future professional reality, without any extra expense to the university. In conclusion, interactive learning tools, like our intraoperative MRI/DTI, motivate students and enhance their learning of neuroanatomy. Most probably it improves long-term retention, which appears to prove helpful during the clinical phase of their undergraduate careers

Evolution of migraine-associated symptoms in menstrually related migraine following symptomatic treatment with almotriptan

In addition to headache, migraine is characterized by a series of symptoms that negatively affects the quality of life of patients. Generally, these are represented by nausea, vomiting, photophobia, phonophobia and osmophobia, with a cumulative percentage of the onset in about 90% of the patients. From this point of view, menstrually related migraine—a particularly difficult-to-treat form of primary headache—is no different from other forms of migraine. Symptomatic treatment should therefore be evaluated not only in terms of headache relief, but also by considering its effect on these migraine-associated symptoms (MAS). Starting from the data collected in a recently completed multicentre, randomized, double-blind, placebo-controlled, cross-over study with almotriptan in menstrually related migraine, an analysis of the effect of this drug on the evolution of MAS was performed. Data suggest that almotriptan shows excellent efficacy on MAS in comparison to the placebo, with a significant reduction in the percentages of suffering patients over a 2-h period of time

Role of 1p/19q Codeletion in Diffuse Low-grade Glioma Tumour Prognosis

Background/Aim: In the latest 2021 WHO classification of central nervous system tumours (CNS), gliomas that present isocitrate dehydrogenase (IDH) mutations are defined as diffuse low-grade gliomas (DLGGs). IDH mutations are commonly observed in this tumour type. The Extent of Resection (EOR) positively influence survival; however, it is still debated whether the predictive value of EOR is independent of the 1p/19q co-deletion. We carried out a retrospective analysis on patients operated on for DLGG at the Sant’Andrea University Hospital Sapienza University of Rome, correlating the outcome with the presence of 1p/19q co-deletion and EOR. Patients and Methods: The study examined 66 patients with DLGG who had undergone surgery for tumour resection between 2008 and 2018. Patients with DLGG were divided into two groups; diffuse astrocytoma (DA) in which 1p/19q codeletion is absent and oligodendroglioma (OG) in which 1p/19q codeletion is present. According to EOR, both groups were divided into two subgroups: subtotal resection (STR) and gross total resection (GTR). Three end-point variables were considered: overall survival (OS), progression-free survival (PFS) and time to malignant transformation (TMT). Results: In the DA group, the GTR subgroup had an average OS of 81.6 months, an average PFS of 45.9 months and an average TMT of 63.6 months. After surgery, these patients had an average Karnofsky Performance Score (KPS) of 83.4. The STR subgroup had an average OS of 60.4 months, PFS was 38.7 months, and TMT was 46.4 months, post-operative KPS was 83.4. In contrast, in the OG group, the GTR averagely had 101.7 months of OS, 64.9 months of PFS, 80.3 months of TMT and an average post-operative KPS of 84.2, and the STR subgroup had an average of OS of 73.3 months, PFS of 48.2 months, TMT of 57.3 and an average postoperative KPS of 96.2. Conclusion: In patients affected by DLGGs, 1p/19q codeletion is significantly associated with prolonged survival and longer time-to-malignant transformation (TMT) compared to the absence of 1p/19q codeletion. Also, the extent of surgical resection (EOR) in DLGG patients has been confirmed as one of the main prognostic factors. However, its predictive value is substantially influenced by the presence of the 1p/19q codeletion

Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study

Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0–2 weeks, 3–4 weeks and 5–6 weeks of the diagnosis (odds ratio (95%CI) 4.1% (3.3–4.8), 3.9% (2.6–5.1) and 3.6% (2.0–5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5% (0.9– 2.1%)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2–8.7) vs. 2.4% (95%CI 1.4–3.4) vs. 1.3% (95%CI 0.6–2.0%), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay

Structural reforms in the Italian National Recovery and Resilience Plan A macroeconomic assessment of their potential effects

This paper assesses the potential macroeconomic impact of the critical structural reforms designed within the Italian Recovery and Resilience Plan (RRP). Reforms are investigated by a large-scale dynamic stochastic general equilibrium macro-model, adapted to capture the effects of the RRP measures. Exploiting the RRP official documents, we scrutinize and catalog detailed data from 482 milestones and 665 policy targets relevant to our assessment. Each reform is then mapped onto the model and simulated, showing its transmission mechanisms and macroeconomic and social impact. We document a significant potential impact on medium- and long-term GDP. The efficacy of the reform package emerges in the long run. In 2050, GDP would be 10% higher than in the alternative scenario where no reform is implemented. However, sizeable effects will be observed since 2026, when observed GDP would rise by 3.4%. The labour market and education measures primarily drive the impact of the reforms on GDP and employment. We also explore the distributional effects of the reform program. We find that a significant labour and capital income increase accompanies the aggregate positive effect on output

Impact of early surgery of ruptured cerebral aneurysms on vasospasm and hydrocephalus after SAH: Our preliminary results

objective Timing of surgical treatment of ruptured intracranial aneurysms has undergone a drastic change in the last few decades with preference for early surgery Our paper focuses specifically on the prognostic importance of timing of surgery, since early surgery of ruptured aneurysms provides immediately good clinical results. We present a series of cases operated in early and ultra early surgery, evaluating the technical aspects, the efficacy, the safety and the clinical results. Patients and Methods We retrospectively reviewed the clinical records and radiological imaging of patients treated for ruptured intracranial aneurysms who underwent early and ultra early clipping between January 2011 and April 2017 at our Institution. We included patients treated within the first 12 h and subsequently we divided our series in two subgroups based on the timing of surgery comparing the “early surgery” group (within 12 h) with the “ultra early surgery” group (within 6 h). Results Seventy-six (76) patients undergoing either early or ultra-early surgery for ruptured intracranial aneurysms have been reported Either early or ultra-early surgery showed a statistically favorable impact on reducing the incidence of both postoperative vasospasm and hydrocephalus. Ultra-early surgery group had the best outcome at the statistical analyses. (good postoperative 1Y GOSE.) Conclusions We strongly believe that patients affected by ruptured intracranial aneurysms excluding Hunt and Hess grade V patients) should be treated as soon as possible and hence it should be considered as an emergency surgery. This approach prevents immediately a second bleeding of the aneurysm, allows to treat any associated condition of intracranial hypertension including hematomas and hydrocephalus and to use safely aggressive medical therapy such as hypertension

Complex Regional Pain Syndrome after Spine Surgery: A Rare Complication in Mini-Invasive Lumbar Spine Surgery: An Updated Comprehensive Review

Background: Complex regional pain syndrome (CRPS) is a postoperative, misdiagnosed condition highlighted only by pain therapists after numerous failed attempts at pain control by the treating surgeon in the case of prolonged pain after surgery. It only occurs rarely after spine surgery, causing the neurosurgeon’s inappropriate decision to resort to a second surgical treatment. Methods: We performed a systematic review of the literature reporting and analyzing all recognized and reported cases of CRPS in patients undergoing spinal surgery to identify the best diagnostic and therapeutic strategies for this unusual condition. We compare our experience with the cases reported through a review of the literature. Results: We retrieve 20 articles. Most of the papers are clinical cases showing the disorder’s rarity after spine surgery. Most of the time, the syndrome followed uncomplicated lumbar spine surgery involving one segment. The most proposed therapy was chemical sympathectomy and spinal cord stimulation. Conclusion: CRPS is a rare pathology and is rarer after spine surgery. However, it is quite an invalidating disorder. Early therapy and resolution, however, require a rapid diagnosis of the syndrome. In our opinion, since CRPS occurs relatively rarely following spinal surgery, it should not have a substantial impact on the indications for and timing of these operations. Therefore, it is essential to diagnose this rare occurrence and treat it promptly and appropriately

Peritumoral Brain Edema in Relation to Tumor Size Is a Variable That Influences the Risk of Recurrence in Intracranial Meningiomas

Peritumoral brain edema (PBE) is common in intracranial meningiomas (IM) and can increase their morbidity. It is not uncommon for a neurosurgeon to confront meningiomas with a large proportion of PBE independently from the site and size of the contrast-enhancing lesion with increased surgical risks. We performed a retrospective review of 216 surgically-treated patients suffering from IM. We recorded clinical, biological, and radiological data based on the rate of tumor and edema volume and divided the patients into a group with high Edema/Tumor ratio and a group with a low ratio. We investigated how the ratio of edema/lesion may affect the outcome. Multivariate analysis was performed for the two groups. Smokers were found to be more likely to belong to the high-rate group. The edema/tumor ratio did not affect the surgical radicality; however, independently of the biological sub-type, WHO grading, and EOR, a higher frequency of recurrence is shown in patients with a high edema/tumor ratio (70.5% vs. 8.4%. p < 0.01). There is evidence to suggest that the blood-brain barrier (BBB) damage from smoke could play a role in an increased volume of PBE. The present study demonstrates that IMs showing a high PBE ratio to tumor volume at diagnosis are associated with a smoking habit and a higher incidence of recurrence independently of their biological type and grading