Visuospatial working memory in Turner's syndrome.

Turner's syndrome is a genetic disorder, specific to women, in which one of the X chromosomes is partially or completely deleted. This syndrome is associated with physical features such as short stature or failure in primary and secondary sexual development, together with a specific pattern of cognitive functions. It has been suggested that women affected by Turner's syndrome perform poorly in tasks measuring visuospatial abilities and have a verbal IQ significantly higher than performance IQ. Although this result has received strong empirical support, the nature of the visuospatial deficit is still unclear. Recent studies on visuospatial processes have highlighted that the underlying cognitive structure is more complex than previously suggested and several dissociations have been reported (e.g., visual vs spatial, sequential vs simultaneous, or passive vs active processes). In the present study we analyze in detail the characteristics of the visuospatial deficit associated with Turner's syndrome by presenting four young women with a comprehensive battery of tasks designed to tap all aspects of visuospatial working memory. Results confirm that Turner's syndrome is associated with a general visuospatial working memory deficit, but the pattern of performance of different cases can be different, with a greater emphasis on active visuospatial processes. and on either sequential or simultaneous spatial processes.

Combined transcranial Doppler and electrophysiologic monitoring for carotid endarterectomy.

The results of carotid endarterectomy can be improved by reducing the perioperative embolic and hemodynamic risks. Electrophysiologic monitoring, although reliable, cannot provide full information. In this study, we report on the combined use of transcranial Doppler (TCD) and electrophysiologic monitoring in 153 patients undergoing 166 carotid endarterectomy procedures. TCD monitoring confirmed the low incidence of intolerance to cross-clamp (1.8%), showing a good correlation with electrophysiologic monitoring. In addition, it frequently showed embolic signals immediately after clamp release, but never during carotid dissection or in the final operative phases. Furthermore, TCD allowed the detection of hyperperfusional flow patterns in four cases, making immediate and aggressive control of arterial pressure possible.

Radiation-induced cerebral meningiomas. Case reports.

Two cases are presented of meningiomas following external cranial irradiation in which several features clearly indicate a causal relationship between radiotherapy and tumour development. In one patient multiple recurred meningioma was diagnosed 30 years after low-dose X-ray treatment of Tinea capitis; in the other patient the meningioma was diagnosed approximately 18 years after high-dose radiation therapy for astrocytoma. The features distinguishing radiation-induced meningiomas from other meningiomas are reviewed. The use of radiation therapy only in those cases in which there is clear evidence that it will have beneficial effects and that these effects will outweigh the risks is emphasized.

Electrophysiological (EEG-SSEP) monitoring during middle cerebral aneurysm surgery.

SSEPs were monitored during 38 procedures for aneurysms of the middle cerebral artery. In 13 selected patients intraoperative barbiturate protection with sodium thiopental was performed during temporary M1 occlusion. Combined EEG monitoring, showing burst suppression typical pattern of electrical cortical activity, allows a minimal dosage (3-6.5 mg/kg) of thiopental to achieve brain protection. Any patient with TYPE I SSEP changes had a new postoperative neurological deficit. Five patients during temporary middle cerebral artery clipping showed TYPE II SSEP changes and only one, not achieving burst suppression EEG pattern, had transient postoperative neurological deficit. In two other patients, a progressive worsening of TYPE II SSEP was observed; this was due to excessive brain retraction without brain protection and had a prolonged postoperative neurological deficit. Four patients showed TYPE IV SSEP changes during temporary M1 occlusion, one of whom was a 52-year-old woman, who, in spite of brain protection with thiopental, had serious postoperative neurological sequelae. In this patient N20 amplitude and central conduction time did not have full recovery to the preocclusive values. This study suggests that combined electrophysiological monitoring may reduce complications due to excessive retraction of cerebral tissue, make temporary clipping safer and improve the results of middle cerebral artery aneurysm surgery.

Reconstruction of the umbilicus: a simple technique.

The author proposes a simple technique for umbilical reconstruction. The new umbilicus is represented by an island flap that is sunken and then sutured to a circular skin defect drawn at the intersection of the xiphoid-pubic line and the transverse umbilical line. Before sinking, an accurate excision of the subcutaneous fat of the skin island is performed. A natural-looking elliptical scar is obtained, without any additional scar and providing good aesthetic results. The technique proposed can provide a good alternative to existing umbilicus reconstruction techniques.

[Lateral calcaneal flap in the reconstruction of the calcaneal and malleolar region]. / Il lembo calcaneare laterale nella ricostruzione delle regioni achillea e malleolare.

The authors discuss the efficacy of the lateral calcaneal artery flap in repairing the calcaneal and malleolar regions. The lateral calcaneal artery flap is a safe flap, with constant vascularization represented by the lateral calcaneal artery and the external saphenous vein; the flap has a sensory nerve (the sural nerve) and is a sensory flap. Its use in the calcaneal and malleolar region is very safe, because the vascular pedicle is constant and surgical transfer easy.

Spinal cavernous angioma producing subarachnoid hemorrhage. Case report.

A case of subarachnoid hemorrhage due to intramedullary cavernous angioma at the T9 level is presented. Literature dealing with subarachnoid hemorrhage due to intraspinal lesions is reviewed. The majority of cases of spinal subarachnoid hemorrhage are due to arteriovenous malformations, whereas bleeding by cavernous angioma is extremely rare. The subarachnoid hemorrhage is rare event (1.8%) in our series too. The clinical presentation of severe back pain with radicular component associated with signs of meningism (Fincher's syndrome) led us to carry out magnetic resonance imaging. This gave accurate diagnosis for surgical treatment. Laminectomy at T9-T10 level and total microsurgical removal of the vascular malformation were performed with total functional recovery.

[Total reconstruction of the lower lid by the Mustardé's technic]. / La ricostruzione totale della palpebra inferiore secondo Mustardé.

The total lower lid loss reconstructive technique of Mustardé is reported. The technique is presented step by step. The morphological and aesthetic results and the low incidence of complications are discussed.

[Non-hypertrophic breast ptosis: classification and surgical treatment]. / Le ptosi mammarie non ipertrofiche. Classificazione e trattamento chirurgico.

Non-hypertrophic breast ptosis are common diseases. Various degree of ptosis and different involutions of the breast tissue can condition the surgical treatment. Plastic surgery must provide the best surgical treatment in any case.

[Tissue expansion in head and neck regions]. / L'espansione tissutale nell'estremo cefalico.

The Authors describe their experience with the use of 56 tissue expanders implanted in the head and neck regions of 45 patients observed in a follow-up of an average of 25 months. They emphasize the various possibilities of reconstructive surgery with the use of tissue expanders and the different mental approach required in order to organize surgical when this technique is employed. The criteria used in the selection of the type of tissue expanders is outlined and useful advice concerning the formulation of a surgical plan which employs the most favourable approach in making to avoid poor functional or aesthetic results or secondary complications is presented. Furthermore the surgical technique used to obtain adequate pockets for the insertion of tissue expanders in the different anatomical areas of the head and neck is described. The Authors affiem that in order to avoid damage to the surrounding neurovascular structures and to obtain good tissue expansion, the correct level of dissection is imperative. The options of using different anatomical areas during reconstructive surgery are discussed. For example, the insertion of a tissue expander in the forehead permits the availability of a large amount of usable tissue during nasal reconstruction, thus leaving the donor area without tension and with minimal scarring. Many different causes of baldness can be treated with the use of tissue expanders, such as posttraumatic injury, burns or infections. Tissue expansion can be utilized in the cheek area for the reconstruction of the lower eyelids, the paranasal and the mandibular area. Tissue expanders used in the cervical area can be utilized for reconstructive surgery of the lower lip or the mandibular area. In addition, the Authors discuss possible complications of this technique such as infection, suture distension and tissue expander extrusion. Recommendations are discussed in order to prevent these major complications. Having reviewed their personal experience the Authors feel they can confirm the reliability of this revolutionary technique in the field of plastic and reconstructive surgery. The use of tissue expanders permits the surgeon to obtain improved functional and aesthetic results which only a few years ago were not conceivable.

[Idiopathic unilateral hypoplasia of the breast]. / L'ipoplasia mammaria monolaterale idiopatica.

Unilateral hypoplastic breast is a rare anomaly. The correction of the asymmetry is usually achieved by the use of breast implants or breast expanders. Sometimes the controlateral breast must be modified to gain a good symmetry.

Bilateral traumatic abducens nerve palsy. Case report.

Bilateral traumatic abducens nerve palsy after head injury is a rare event. We present a case associated with skull fractures and intracranial hematoma, with complete recovery of abducens nerve palsy after six months. The mechanism of the lesion, the clinical conditions and the radiological findings are presented.

Primary cauda equina tumors.

During the last seven years (1985-91) 28 primary tumours in the cauda among 104 intraspinal tumors were observed. The largest group (71%) comprised ependymomas and neurinomas. The rest included 5 lipomas, 2 astrocytomas and 1 epidermoid. Low-back pain without or with sciatic or crural irradiation was the most common initial symptom. The length of symptomatology is generally measured in months, because pain is erroneously referred to discal pathology for long time. The X-ray standard test and the CT scan have been of modest utility in the diagnosis of these lesions, but however they have been necessary for diagnostic screening. The MNR, a bloodness test, showed an important diagnostic value for the identification of these tumors; it is also useful in follow-up to exclude recurrence. The lipoma's and ependymoma's surgery, although performed by microsurgical techniques, showed great problems. Total removal of the ependymomas assured no recurrence at the follow-up. Sphincter disturbances were frequent after the operation, but they disappeared after some months. In most patients with lipomas the resection was partial, but at follow-up they were symptomless. Neurinomas' surgery presented less technical difficulties and the postoperative course was more favorable. Astrocytomas underwent to radiotherapy but their prognosis is not favorable.

Spontaneous regression of intracranial arteriovenous malformation.

Spontaneous regression of an arteriovenous malformation is rare. When complete or partial regression occurs, an associated factor is usually involved, such as intracranial hemorrhage, surgery, radiation therapy, or a new neurological deficit. Another case in which the resolution was totally spontaneous is presented here. We discuss the importance of transcranial doppler revealing the hemodynamic changes in the cerebral arteries in the presence of an AVM and when the latter is thrombosed. Several mechanisms for regression are considered, and we focus on the dissection of the afferent vessel, pointing out the role of such an event in the natural history of AVM.

Reduction mammaplasty and correction of ptosis: a personal technique.

New upper pedicle reduction mammaplasty and mastopexy techniques are presented. The surgical steps are described point by point. An analysis is made of the results obtained in 25 patients who underwent surgery between November of 1987 and November of 1988 and were examined in December of 1990 with a mean follow-up of 31.5 months. An assessment was made of the postoperative ptosis, which was minimal in 76 percent of patients. The overall assessment of breasts was satisfactory (good mammary morphology and a correct position of the nipple-areola complex). Nipple-areola complex sensitivity was unchanged in 80 percent of patients. Good-quality inframammary scars were observed in 92 percent of patients, with scar length never exceeding 4 cm. The overall complication rate was 32 percent, but only 12 percent were major complications. The technique presented is excellent when the quantity of glandular tissue to be removed is less than 400 gm, and it is not therefore recommended for gigantomasties.

Kasabach-Merritt syndrome associated to angiosarcoma of the breast. A case report and review of the literature.

INTRODUCTION: Kasabach-Merritt syndrome is characterized by the association of a consumptive thrombohemorrhagic disorder and angioma occurring usually in children. In the present study, a case of Kasabach-Merritt syndrome associated to an angiosarcoma of the breast is reported. CLINICAL HISTORY: The tumor together with the thrombohemorrhagic disorder manifested in a 28-year-old woman. The patient underwent mastectomy. The tumor recurred in the same site 2 years later. The patient died of severe anemia 8 years after the first appearance of the angiosarcoma. MATERIAL AND METHODS: Tissues were formalin fixed and paraffin embedded; in addition, selected sections were immunohistochemically stained. RESULTS AND CONCLUSIONS: A well-differentiated angiosarcoma was visible throughout the removed organ. A review of the literature showed that only 6 cases of Kasabach-Merritt syndrome associated to malignant vascular tumors have been previously reported. All these 6 cases occurred in adult patients. On the contrary, Kasabach-Merritt syndrome associated to benign vascular tumors affects children. This is the first case occurring in the breast.