A retrospective, multi-center cohort study evaluating the severity- related effects of cerebrolysin treatment on clinical outcomes in traumatic brain injury.

Traumatic brain injury (TBI) is a leading cause of death and disability for which there is currently no effective drug therapy available. Because drugs targeting a single TBI pathological pathway have failed to show clinical efficacy to date, pleiotropic agents with effects on multiple mechanisms of secondary brain damage could represent an effective option to improve brain recovery and clinical outcome in TBI patients. In this multicenter retrospective study, we investigated severity-related efficacy and safety of the add-on therapy with two concentrations (20 ml/day or 30 ml/day) of Cerebrolysin (EVER Neuro Pharma, Austria) in TBI patients. Adjunctive treatment with Cerrebrolysin started within 48 hours after TBI and clinical outcomes were ranked according to the Glasgow Outcome Scale and the Modified Rankin Disability Score at 10 and 30 days post-TBI. Analyses of efficacy were performed separately for subgroups of patients with mild, moderate or severe TBI according to Glasgow Coma Scale scores at admission. Compared to standard medical care alone (control group), both doses of Cerebrolysin were associated with improved clinical outcome scores at 10 days post-TBI in mild patients and at 10 and 30 days in moderate and severe cases. A dose-dependent effect of Cerebrolysin on TBI recovery was supported by the dose-related differences and the significant correlations with treatment duration observed for outcome measures. The safety and tolerability of Cerebrolysin in TBI patients was very good. In conclusion, the results of this large retrospective study revealed that early Cerebrolysin treatment is safe and is associated to improved TBI outcome.

Surgical treatment of a case of recurrent irradiated basal cell carcinoma of the head with a large soft tissue and bone defect.

Taking into account the great number of skin malignances that occur in the head and neck regions, problems related to their surgical treatment represent a constant concern for plastic surgeons. They have to deal with the difficulties of radical excision and also with reconstructive possibilities. More than 2/3 of these malignances are basal cell carcinomas, which, if left untreated might become very invasive, surgical treatment being more difficult in such cases. Recurrent carcinomas combined with radiation injuries represent a serious challenge even for experienced surgeons regarding the size of the defect and anatomical structures involved. In this paper we present a case of a patient with basal cell carcinoma of the parietal region and the reconstructive treatment involving neurosurgery and plastic surgery team approach, using microsurgery techniques. We also present the difficulties of the case as well as the final outcome that we consider the best option for the patient. The neurosurgical stage consisted in fongus removal, excluding all brain tissue located outside the dural limits, craniectomy, duraplasty and cranioplasty. Because of the large size of the defect and also because the local resources were exhausted we chose as a covering solution the free tissue transfer consisting in a latissimus dorsi musculocutaneous flap. The difficulties of these cases consist both in the aim of radical excision and the limited reconstructive options. In this case, our collaboration with the neurosurgery team proved to be crucial, permitting us to solve this case in a single operative time, with deep excision, reconstruction of the dura mater and cranioplasty, and reconstruction of the soft tissues with microsurgical free transfer.