C1–C2 Instability Associated with Periodontoid Inflammatory Tissue Leading to Subarachnoid Hemorrhage: A Case Report and Review of the Literature

Abstract The authors present a case of atlantoaxial instability associated with C1–C2 inflammatory tissue leading to subarachnoid hemorrhage. A 65-year-old male patient arrived in June 2011 to the emergency unit for cervical pain and fever. Imaging studies documented periodontoid pseudotumor at C1–C2 level. Infective disease was suspected; the patient was therefore hospitalized and treated with antibiotics. Subsequent computed tomographic (CT) scans revealed C1–C2 instability. In August, the patient showed acute neurological deterioration and coma. Urgent brain CT revealed a hemorrhagic lesion which caused compression on the medulla oblongata, subarachnoid hemorrhage, and ventricular dilatation. An external ventricular drainage was positioned. Angio-CT and angiography did not show any vascular abnormalities. Cervical magnetic resonance imaging documented a solid tissue lesion between the atlas arch and axis. The lesion was associated with an epidural and subdural hematoma, exerting compression on brainstem. The patient underwent posterior decompression and C1–C2 fusion according to Harms technique in October, with significant clinical improvement. The authors present a case of atlantoaxial instability associated with a periodontoid pseudotumor at C1–C2 level determining dural sac compression. The patient showed an acute neurological deterioration caused by bleeding of the solid component of the cervical lesion. Hemorrhage of the solid component of periodontoid masses linked to atlantoaxial instability has not yet been reported in literature. To the best of our knowledge, this is the first case of C1–C2 instability with periodontoid pseudotumor leading to subarachnoid hemorrhage

Il recupero dell'area del Planetario di Lucca. Individuazione e sviluppo dell'idea progettuale attraverso l?analisi multi-criteri.

In questa tesi viene affrontato il tema del recupero di un edificio pubblico incompiuto e di un suo nuovo possibile inserimento in un contesto urbano particolare, dove sono già presenti realtà di tipo sia sportivo che culturale. Vengono analizzati gli aspetti della struttura originaria e i vincoli che gravano su di essa per cercare una nuova ipotetica destinazione d’uso che renda quanto più giustificato possibile un suo recupero architettonico. A tale scopo viene applicato un modello di analisi multi-criteri MCDA, più nello specifico di tipo ELECTRE, che permetterà di stabilire quale nuova funzione, tra le alternative progettuali analizzate, risulti la migliore. Definita questa viene progettata la riqualificazione dell'area, oltre che dello stabile principale, che permetta di rendere quanto più integrate le diverse funzioni che insistono sull’area di studio. Viene infine definito un ipotetico costo di intervento basandosi su un approccio di stima di tipo sintetico-parametrica al fine di quantificare le risorse economiche necessarie per la realizzazione dell’intervento. Grazie alla metodologia proposta si è riusciti a definire un processo di analisi che porta il professionista non solo a sviluppare una strategia per un recupero ottimale di una struttura, ma anche di poterne definire lo sforzo economico necessario per un completamento del progetto. The thesis deals with the theme of the recovery of an unfinished public building and its possible new insertion in a particular urban context, where both sporting and cultural realities are already present. The aspects of the original structure and the constraints that are on it are analyzed in order to seek a new hypothetical intended use that makes its architectural recovery as justified as possible. For this purpose, an MCDA multi-criteria analysis model is applied, more specifically the ELECTRE type, which will be of titles as a new function, among the design alternatives analyzed, given the best. Once this has been defined, the redevelopment of the main area is dealt with, as well as the building, which allows to render the various functions that exist in the study area as much as possible. Finally, a hypothetical cost of intervention is defined based on a synthetic-parametric estimation approach in order to quantify the economic resources necessary for carrying out the intervention. Thanks to the proposed methodology, it was possible to define an analysis process that leads the professional not only to develop a strategy for an optimal recovery of a structure, but also to be able to define the effort necessary to finish it

Multimodal management for benign skull base meningiomas.

International audienc

Lymphocitic infundibuloneurohypophysitis mimicking a pituitary adenoma

A rare case of infundibulo-neurohypophysitis mimicking a pituitary adenoma is presented. A 69-years-old female patient developed polyuria and polydipsia. Laboratory analysis revealed central diabetes insipidus. No hormonal abnormalities. Cranial-magnetic resonance imaging (MRI) showed a left sided mass in the adenohypophysis presuming a pituitary adenoma. The mass had contact to both internal carotids. Admission to our department for neurosurgical treatment followed. Ophthalmo - logic examination and neurological examination yielded normal findings. A second MRI focussing on the sellar-region showed a leftsided (T2-MRI.hyperintense), distended adenohypophysis, without contrast enhancement in T1. The stalk appeared thickened. T1- weighted sequences of the neurohypophysis showed loss of signal intensity. We diagnosed an infundibulo-neurohypophysitis and abstai - ned from surgical removal. The patient was discharged under treatment with corticosteroids and desmopressin. Hypophysitis is rare and shows special clinical characteristics. Despite defined radiological features to differentiate between hypophysitis and adenoma the possibility of misdiagnosis, and unnecessary surgical procedures, should always kept in mind

The biomarkers’ landscape of post-COVID-19 patients can suggest selective clinical interventions

Abstract In COVID-19 clinical symptoms can persist even after negativization also in individuals who have had mild or moderate disease. We here investigated the biomarkers that define the post-COVID-19 clinical state analyzing the exhaled breath condensate (EBC) of 38 post COVID-19 patients and 38 sex and age-matched healthy controls via nuclear magnetic resonance (NMR)-based metabolomics. Predicted gene-modulated microRNAs (miRNAs) related to COVID-19 were quantified from EBC of 10 patients and 10 controls. Finally, clinical parameters from all post-COVID-19 patients were correlated with metabolomic data. Post-COVID-19 patients and controls showed different metabolic phenotype (“metabotype”). From the metabolites, by using enrichment analysis we identified miRNAs that resulted up-regulated (hsa-miR146a-5p) and down-regulated (hsa-miR-126-3p and hsa-miR-223-3p) in post-COVID-19. Taken together, our multiomics data indicate that post-COVID-19 patients before rehabilitation are characterized by persistent inflammation, dysregulation of liver, endovascular thrombotic and pulmonary processes, and physical impairment, which should be the primary clinical targets to contrast the post-acute sequelae of COVID-19