Ruptured Brain Arteriovenous Malformations: Surgical Timing and Outcomes-A Retrospective Study of 25 Cases

Background One important problem in treatment of ruptured brain arteriovenous malformations (bAVMs) is surgical timing. The aim of the study was to understand which parameters affect surgical timing and outcomes the most. Materials and Methods Between January 2010 and December 2018, 25patients underwent surgery for a ruptured bAVM at our institute. Intracerebral hemorrhage (ICH) score was used to evaluate hemorrhage severity, while Spetzler-Martin scale for AVM architecture. We divided patients in two groups: early surgery and delayed surgery. The modified Rankin Scale (mRS) evaluated the outcomes. Results Eleven patients were in the early surgery group: age 38 ± 18 years, Glasgow Coma Scale (GCS) 7.64 ± 2.86, ICH score 2.82 ± 0.71, hematoma volume 45.55 ± 23.21 mL. Infratentorial origin of hemorrhage was found in 27.3% cases; AVM grades were I to II in 82%, III in 9%, and IV in 9% cases. Outcome at 3 months was favorable in 36.4% cases and in 54.5% after 1 year. Fourteen patients were in the delayed surgery group: age 41 ± 16 years, GCS 13.21 ± 2.39, ICH score 1.14 ± 0.81, hematoma volume 29.89 ± 21.33 mL. Infratentorial origin of hemorrhage was found in 14.2% cases; AVM grades were I to II in 50% and III in 50%. Outcome at 3 months was favorable in 78.6% cases and in 92.8% after 1 year. Conclusions The early outcome is influenced more by the ICH score, while the delayed outcome by Spetzler-Martin grading. These results suggest that it is better to perform surgery after a rest period, away from the hemorrhage when possible. Moreover, this study suggests how in young patient with a high ICH score and a low AVM grade, early surgery seems to be a valid and feasible therapeutic strategy

Spinal schwannomatosis in the absence of neurofibromatosis: A very rare condition

Schwannomatosis is defined as an extremely rare tumors syndrome characterized by the presence of multiple schwannomas in the absence of typical signs of NF1 and NF2 syndromes. The genetic and molecular analysis performed on these tumors makes it possible to name schwannomatosis as distinct clinical and genetic syndrome. The treatment in the case of symptomatic lesions is surgical removal; if the lesions are asymptomatic it is better to perform serial MRI studies. Given the high incidence of developing additional lesions in patients with schwannomatosis, it remains imperative to perform serial brain and spinal cord MRI studies during follow-up. The differential diagnosis is important including clinical and radiological criteria plus molecular genetic analysis of tumor cells and lymphocyte DNA. We report a rare case of spinal schwannomatosis in which genetic analysis performed on surgical samples showed two different mutations in the cells of the two lesions. © 2010 Surgical Associates Ltd

La chiesa di San Vincenzo a Modena. Ecclesia Divi Vincentii

Un complesso intervento di restauro ha restituito la chiesa di San Vincenzo, voluta nel Seicento dai Chierici Regolari Teatini, non solo a Modena e ai modenesi ma a tutti coloro che vorranno ripercorrere un suggestivo itinerario tra raffinatezza ed eleganti sinuosità delle espressioni artistiche seicentesche e austere raffigurazioni ottocentesche che introducono il visitatore alla singolare e suggestiva cappella mortuaria estense annessa alla chiesa.Qui il visitatore è circondato dalla memoria dei duchi d'Este, dalle loro consorti e dei loro figli che con i loro nomi e le loro presenze ricordano due secoli e mezzo di storia cittadina, da quando Modena, con Francesco I, era capitale del ducato estense fino alla Restaurazione con l'arciduca Francesco IV d'Austria-Este. Tuttavia anche il frequentatore meno attento è avvolto dalla suggestione di un luogo singolare, sacro e funerario, evocatore di memorie lontane e non può fare a meno di ripercorrere con lo sguardo nomi e date che si riferiscono a tempi ormai lontani

La chiesa di Sant\u2019Agostino a Modena. Pantheon Atestinum

La chiesa di Sant'Agostino, topograficamente ultima presenza religiosa (quasi "di confine", o "di cerniera" verso il contado) entro la cerchia muraria modenese, rievoca - tutt'insieme - personaggi illustri, ordini devozionali e potere politico, vicende economiche e gestionali, cerimonie e fasti artistici. In un arco temporale di quasi sette secoli, a partire dall'impianto primitivo.Attraverso quelle della chiesa, si possono leggere e interpretate vicende dalle moderne connotazioni: di poco influenti ordini mendicanti alla ricerca di emancipazioni economiche (il monastero si voleva affrancare dalla secolare dipendenza dalle elemosine), di ordini religiosi sempre pi\uf9 forti e autorevoli, di donazioni e gesti collettivi per contribuire alle spese (con forme che oggi definiremmo di sponsorizzazione patrocinata). E di propaganda: i riti, anche quelli funerari, diventavano modernamentepropaganda, anzi propaganda politica, per perpetuare "l'eternit\ue0 della fama"

O índice de necessidade de tratamento ortodôntico como um método de avaliação em saúde pública The index of orthodontic treatment need as an assessment method in public health

As má oclusões são consideradas problemas de saúde pública e, como tal, necessitam de um método de avaliação uniforme que priorize o atendimento dos indivíduos com maior necessidade de tratamento ortodôntico. Dentre os vários índices oclusais desenvolvidos com esta finalidade, o Índice de Necessidade de Tratamento Ortodôntico tem sido muito utilizado em diversos países. Como no Brasil a demanda por este tipo de tratamento nos serviços públicos excede a oferta, observa-se a necessidade da implementação de um meio adequado de seleção de pacientes. Assim, objetiva-se elucidar a forma de aplicação deste índice e os seus benefícios, pois o mesmo pode ser bastante útil em encaminhamentos e triagens ao tratamento ortodôntico.<br>Malocclusions are considered public health problems, needing a uniform method of assessment that prioritizes the attendance of individuals with greater orthodontic treatment need. Among the several oclusal indices developed with this purpose, the Index of Orthodontic Treatment Need has been used in many countries. As the demand for this treatment in public services in Brazil exceeds the offers, there is a need to implement an adequate method of patient's selection. Thus, the aim of this article is to elucidate this index methodology and its benefits, because it can be very useful in orthodontic treatment referrals and triages