Subtotal calvarial vault reconstruction utilizing a customized polyetheretherketone (PEEK) implant with chimeric microvascular soft tissue coverage in a patient with syndrome of the trephined: A case report

The syndrome of the trephined is a neurologic phenomenon that manifests as sudden decline in cognition, behavior, and sensorimotor function due to loss of intracranial domain. This scenario typically occurs in the setting of large craniectomy defects, resulting from trauma, infection, and/or oncologic extirpation. Cranioplasty has been shown to reverse these symptoms by normalizing cerebral hemodynamics and metabolism. However, successful reconstruction may be difficult in patients with complex and/or hostile calvarial defects. We present the case of a 48-year-old male with a large cranial bone defect, who failed autologous cranioplasty secondary to infection, and developed rapid neurologic deterioration leading to a near-vegetative state. Following debridement and antibiotic therapy, delayed cranioplasty was accomplished using a polyetheretherketone (PEEK) implant with free chimeric latissimus dorsi/serratus anterior myocutaneous flap transfer for vascularized resurfacing. Significant improvements in cognition and motor skill were noted in the early postoperative period. At 6-month follow-up, the patient had regained the ability to speak, ambulate and self-feed—correlating with evidence of cerebral/ventricular re-expansion on computed tomography. Based on our findings, we advocate delayed alloplastic implantation with total vascularized soft tissue coverage as a viable alternative for reconstructing extensive, hostile calvarial defects in patients with the syndrome of the trephined.

Diabetes among Latinos in the Southwestern United States: border health and binational cooperation / Diabetes en la población de origen latino del sudoeste de los Estados Unidos: salud fronteriza y cooperación binacional

This analysis reviews cooperation between the four border states of the United States of America (Arizona, California, New Mexico, and Texas) and international partners in Mexico with regard to type 2 diabetes among Latinos. Binational cooperation, academic collaboration, preventative health initiatives, and efforts to improve health care access for the border population are highlighted. This meta-analysis of the literature points out causative factors of the increased type 2 diabetes prevalence among Latinos in the United States; an inverse correlation between diabetes and education and socioeconomic level; contributing factors, including barriers with language, health care payment, transportation, and underestimating diabetes implications; and a lack of social and environmental support for disease management. Medical and indirect costs in socioeconomic terms are also included. Cooperation between the United States and Mexico may be beneficial to promoting further collaborative efforts between these nations, and serve as a template for greater cooperative efforts to mitigate the substantial public health and socioeconomic implications of type 2 diabetes globally.

Este análisis examina la cooperación de los cuatro estados fronterizos de los Estados Unidos de América (Arizona, California, Nuevo México y Texas) y los socios internacionales de México con respecto a la diabetes de tipo 2 en la población de origen latino. Se destacan la cooperación binacional, la colaboración académica, las iniciativas de prevención en salud, y las actividades orientadas a mejorar el acceso a la atención de salud por parte de la población de la frontera. Este metanálisis de la bibliografía señala los factores causales del aumento de la prevalencia de la diabetes de tipo 2 en la población de origen latino de los Estados Unidos; una correlación inversa entre la diabetes y el grado de formación y el nivel socioeconómico; los factores contribuyentes, incluidas las barreras relacionadas con el idioma, el pago de la atención de salud, el transporte, y la infravaloración de las consecuencias de la diabetes; y una falta de apoyo social y ambiental para el tratamiento de la enfermedad. También se incluyen los costos médicos y los indirectos en términos socioeconómicos. La cooperación entre los Estados Unidos y México - podría ser beneficiosa para promover nuevas iniciativas de colaboración entre estas naciones y servir como mo-delo a otras iniciativas más amplias de cooperación dirigidas a mitigar las sustanciales consecuencias de salud pública y socioeconómicas de la diabetes de tipo 2 a escala mundial.

Scleral depressed vitreous shaving, 360 laser, and perfluoropropane (C3 F8) for retinal detachment.

Purpose: To review the characteristics and outcomes of patients who underwent pars plana vitrectomy (PPV) with scleral depressed vitreous shaving, 360 degree peripheral endolaser, and 14% C3F8 gas for rhegmatogenous retinal detachment (RRD). Materials and Methods: A retrospective review of a consecutive series of patients who underwent primary repair of RRD by PPV with scleral depressed vitreous shaving, 360 degree peripheral endolaser, and 14% perfluoropropane (C3F8) was conducted. Patients with less than 3 months follow‑up, previous retinal surgery, and higher than grade B proliferative vitreoretinopathy were excluded. Results: Ninety‑one eyes were included in the study. The mean age was 60.1 years. The mean follow‑up was 13.7 months. The macula was detached in 63% (58/91) of the eyes. The reattachment rate after one surgical procedure was 95% (86/91) while overall reattachment rate was 100%. There was no statistically significant difference between reattachment rates of superior, nasal/temporal, or inferior RRDs. The mean final best corrected visual acuity (BCVA) was 20/40. Of all the patients, 66% of patients with macula‑off RRDs had a final BCVA of 20/40 or better. Conclusions: PPV with scleral depressed vitreous shaving, 360 degree peripheral endolaser, and 14% C3F8 leads to successful anatomical reattachment with visual improvement in patients with primary RRD.

Sinovitis pigmentada vilonodular da coluna torácica: relato de caso e revisão da literatura / Sinovitis vellonodular pigmentada de la columna torácica: informe de un caso y revisión de la literatura / Pigmented villonodular synovitis of the thoracic spine: case report and review of the literature

Pigmented Villonodular Synovitis (PVNS), a lesion of the synovial tissues, is rarely found in the spine. We present a 73-year-old male with increasing lower extremity weakness and paresthesias. MRI scans revealed disc herniation and spinal cord compression at the T11-T12 and T12- L1 levels. Intraoperative exploration revealed an epidural mass originating in the T12 lamina, compressing the spinal cord at T11-T12. Pathologic examination was consistent with pigmented villonodular synovitis.

Sinovitis pigmentada vilonodular (PVNS) é uma lesão do tecido sinovial e raramente é encontrada na coluna vertebral. Apresentamos o caso de um homem de 73 anos de idade com aumento de fraqueza da extremidade inferior e parestesia. O exame de imagem por ressonância magnética revelou hérnia de disco e compressão no nível T11-T12 e T12-L1. A exploração cirúrgica evidenciou massa epidural orginária em T2 e compressão da medula espinhal no nível de T11-T12. O exame patológico foi compatível com sinovitis pigmentada vilonodular .

Sinovitis vellonodular pigmentada (PVNS) es una lesión del tejido sinovial y raramente se encuentra en la columna vertebral. Presentamos el caso de un hombre de 73 años de edad que mostró aumento de la flaqueza de la extremidad inferior y parestesias. El examen de imagen por resonancia magnética indicó una hernia de disco y compresión en el nivel de T11-T12 y T12-L1. La exploración quirúrgica evidenció una masa epidural originaria en T2 y compresión de la médula espinal a nivel de T11-T12. El examen patológico fue compatible con sinovitis vellonodular pigmentada.