Takotsubo Syndrome Associated with COVID-19

Objective: The availability of public health information for optimised supportive care is critical during the COVID-19 pandemic. We describe the first case of COVID-19 complicated by Takotsubo cardiomyopathy. Materials and Methods: We report the clinical, laboratory and radiological findings of a patient with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results: The nasopharyngeal swab was positive for SARS-CoV-2 and x-ray images demonstrated pathognomonic pneumonia. The patient developed tachycardia and the echocardiogram confirmed the diagnosis of Takotsubo cardiomyopathy. Conclusions: Doctors should be aware of the need to thoroughly study this new infection in order to understand its underlying mechanisms and related complications

An expandable chamber for safe brain retraction: new technologies in the field of transcranial endoscopic surgery

Neurosurgery is a highly specialized field: it often involves surgical manipulation of noble structures and cerebral retraction is frequently necessary to reach deep-seated brain lesions. There are still no reliable methods preventing possible retraction complications. The objective of this study was to design work chambers well suited for transcranial endoscopic surgery while providing safe retraction of the surrounding brain tissue. The chamber is designed to be inserted close to the intracranial point of interest; once it is best placed it can be opened. This should guarantee an appreciable workspace similar to that of current neurosurgical procedures. The experimental aspect of this study involved the use of a force sensor to evaluate the pressures exerted on the brain tissue during the retraction phase. Following pterional craniotomy, pressure measurements were made during retraction with the use of a conventional metal spatula with different inclinations. Note that, although the force values necessary for retraction and exerted on the spatula by the neurosurgeon are the same, the local pressure exerted on the parenchyma at the edge of the spatula at different inclinations varied greatly. A new method of cerebral retraction using a chamber retractor (CR) has been designed to avoid any type of complication due to spatula edge overpressures and to maintain acceptable pressure values exerted on the parenchyma

Post Surgical Management of WHO Grade II Meningiomas: Our Experience, the Role of Gamma Knife and a Literature Review

Purpose: Grade II meningiomas are rarer than Grade I, and when operated on, bear a higher risk of local recurrence, with a 5-year progression free survival (PFS) ranging from 59 to 90%. Radiotherapy (RT) or radiosurgery, such as Gamma Knife radiosurgery (GKRS) can reduce the risk of relapse in patients with residual disease, even if their role, particularly after gross total resection (GTR), is still under debate. Main goal of this study was to compare the outcomes of different post-surgical management of grade II meningiomas, grouped by degree of surgical removal (Simpson Grade); next in order we wanted to define the role of GKRS for the treatment of residual disease or relapse. Methods: from November 2016 to November 2020 all patients harboring grade II meningiomas, were divided into three groups, based on post-surgical management: (1) wait and see, (2) conventional adjuvant radiotherapy and (3) stereotactic GKRS radiosurgery. Relapse rate and PFS were registered at the time of last follow up and results were classified as stable, recurrence next to or distant from the surgical cavity. In the second part of the study we collected data of all patients who underwent GKRS in our Centers from November 2017 to November 2020. Results: A total of 37 patients were recruited, including seven patients with multiple meningiomas. Out of 47 meningiomas, 33 (70.2%) were followed with a wait and see strategy, six (12.7%) were treated with adjuvant radiotherapy, and 8 patients (17.0%) with adjuvant GKRS. Follow up data were available for 43 (91.4%) meningiomas. Within the wait and see group, recurrence rates differed based on Simpson grades, lower recurrence rates being observed in three Simpson I cases (30%) compared to twelve relapses (60%) in patients with Simpson grade II/III. Finally, out of the 24 meningiomas undergoing GKRS (8 residual and 16 recurrence), 21 remained stable at follow up. Conclusions: Gross total resection (GTR) Simpson II and III have a significantly worse outcome as compared to Simpson I. The absence of adjuvant treatment leads to significant worsening of the disease progression curve. Adjuvant radiotherapy, especially GKRS, provides good local control of the disease and should be considered as an adjuvant treatment in all cases where Simpson I resection is not possible

Melatonin relations with respiratory quotient weaken on acute exposure to high altitude

High altitude (HA) exposure may affect human health and performance by involving the body timing system. Daily variations of melatonin may disrupt by HA exposure, thereby possibly affecting its relations with a metabolic parameter like the respiratory quotient (RQ). Sea level (SL) volunteers (7 women and 7 men, 21.0 +/- 2.04 y) were examined for daily changes in salivary melatonin concentration (SMC). Sampling was successively done at SL (Antofagasta, Chile) and, on acute HA exposure, at nearby Caspana (3,270 rn asl). Saliva was collected in special vials (Salimetrics Oral Swab, United Kingdom) at sunny noon (SMCD) and in the absence of blue light at midnight (SMCN). The samples were obtained after rinsing the mouth with tap water and were analyzed for SMC by immunoassay (ELISA kit; IBL International, Germany). RQ measurements (n = 12) were realized with a portable breath to breath metabolic system (Oxicon (TM) Mobile, Germany), between 8:00 PM and 10:00 PM, once at either location. At SL, SMCD, and SMCN values (mean +/- SD) were, respectively, 2.14 +/- 1.30 and 11.6 +/- 13.9 pg/ml (p tightly correlate with RQ at SL (r = -0.79) and weaker at HA (r = -0.31). SMCN-SMCD, as well as, SMC values at SL, on the other hand, respectively, correlate with the corresponding values at HA (r = 0.71 and r = 0.85). Acute exposure to HA appears to loosen relations of SMC with RQ. A personal profile in daily SMC variation, on the other hand, tends to be conserved at HA.This study was supported by FONDECYT Chile ( Project No1100161) and Bundesministerium fur Bildung und Forschung (Project CHLI2Anb, Domeyko-Center) Germany is gratefully acknowledged

Aneurismal subarachnoid hemorrhage during the {COVID}-19 outbreak in a Hub and Spoke system: observational multicenter cohort study in Lombardy, Italy

Background Lombardy was the most affected Italian region by the first phase of the COVID-19 pandemic and underwent urgent reorganization for the management of emergencies, including subarachnoid hemorrhage from a ruptured cerebral aneurysm (aSAH). The aim of the study was to define demographics, clinical, and therapeutic features of aSAH during the COVID-19 outbreak and compare these with a historical cohort. Methods In this observational multicenter cohort study, patients aged 18 years or older, who were diagnosed with aSAH at the participating centers in Lombardy from March 9 to May 10, 2020, were included (COVID-19 group). In order to minimize bias related to possible SAH seasonality, the control group was composed of patients diagnosed with aSAH from March 9 to May 10 of the three previous years, 2017\u20132018-2019 (pre-pandemic group). Twenty-three demographic, clinical, and therapeutic features were collected. Statistical analysis was performed. Results Seventy-two patients during the COVID-19 period and 179 in the control group were enrolled at 14 centers. Only 4 patients were positive for SARS-CoV-2. The \u201cdiagnostic delay\u201d was significantly increased (+68%) in the COVID-19 group vs. pre-pandemic (1.06 vs. 0.63 days, respectively, p-value=0.030), while \u201ctherapeutic delay\u201d did not differ significantly between the two periods (0.89 vs. 0.74 days, p-value=0.183). Patients with poor outcome (GOS at discharge from 1 to 3) were higher during the COVID-19 period (54.2%) compared to pre-pandemic (40.2%, p=0.044). In logistic regression analysis, in which outcome was the dichotomized Glasgow Out-come Scale (GOS), five variables showed p-values<0.05: age at admission, WFNS grade, treatment (none), days in ICU, and ischemia. Conclusions We documented a significantly increased \u201cdiagnostic delay\u201d for subarachnoid hemorrhages during the first COVID-19 outbreak in Lombardy. However, despite the dramatic situation that the healthcare system was experiencing, the Lombardy regional reorganization model, which allowed centralization of neurosurgical emergencies such as SAHs, avoided a \u201ctherapeutic delay\u201d and led to results overall comparable to the control period

Preliminary validation of FoRCaSco: a new Grading System for Cerebral and Cerebellar Cavernomas.

30sinoneMarco M Fontanella, Luca Zanin, PierPaolo Panciani, Francesco Belotti, Francesco Doglietto, Alice Cremonesi, Karol Migliorati, Elena Roca, Lucio De Maria, Alberto Franzin, Oscar Vivaldi, Federico Griva, Alessandro Narducci, Riccardo Draghi, Fabio Calbucci, Ignazio Borghesi, Emanuela Crobeddu, Christian Cossandi, Antonio Fioravanti, Jahard Aliaga Arias, Alba Scerrati, Pasquale De Bonis, Davide Locatelli, Edoardo Agosti, Pierlorenzo Veiceschi, Marco Ceraudo , Gianluigi Zona, Roberto Gasparotti, Lodovico Terzi di Bergamo, Daniele RigamontiM Fontanella, Marco; Zanin, Luca; Panciani, Pierpaolo; Belotti, Francesco; Doglietto, Francesco; Cremonesi, Alice; Migliorati, Karol; Roca, Elena; DE MARIA, Lucio; Franzin, Alberto; Vivaldi, Oscar; Griva, Federico; Narducci, Alessandro; Draghi, Riccardo; Calbucci, Fabio; Borghesi, Ignazio; Crobeddu, Emanuela; Cossandi, Christian; Fioravanti, Antonio; ALIAGA ARIAS, JAHARD MIJAIL; Scerrati, Alba; De Bonis, Pasquale; Locatelli, Davide; Agosti, Edoardo; Veiceschi, Pierlorenzo; Ceraudo, Marco; Zona, Gianluigi; Gasparotti, Roberto; Terzi di Bergamo, Lodovico; Rigamonti, Daniel