The anatomy of the pelvic plexus in female cadavers: implications for retroperitoneal nerve-sparing surgery.

Background: The inferior hypogastric plexus (IHP) is a crucial structure for female continence and sexual function. A nerve-sparing approach should be pursued to reduce the risk of pelvic plexus damage during retroperitoneal pelvic surgery. Objectives: To analyse the relationship between the female IHP and several pelvic anatomical landmarks. Materials and Methods: Standardised cadaveric dissection was performed on 5 nulliparous female cadavers. The relationships of the IHP and the mid-cervical plane (MCP), the mid-sagittal plane (MSP), and the uterosacral ligament (USL) were investigated. Main outcome measures: Distance between IHP and MCP, MSP, and USL. Results: Distances between the right IHP and the right MSP (mean distance: 16.3 mm; range: 10.0-22.5 mm) and the right USL (mean distance: 4.8 mm; range: 0-15.0 mm) were shorter than those between the left IHP and ipsilateral landmarks (left MSP distance: 23.5 mm; range 18.0-30.0 mm; left USL distance: 5.0 mm; range: 0-20.0 mm). Although the MCP was 3.3 mm (range: 2.5-4.0 mm) left and lateral to the midsagittal line, the right IHP was closer to the MCP (mean distance: 19.6 mm; range: 13.0-25.0 mm) than the left one (mean distance: 20.2 mm; range: 15.0-26.0 mm). Conclusions: Distances between the right IHP and the MSP, MCP, and ipsilateral USL, are shorter compared to these associated to the left IHP. What is new?: Right autonomic pelvic plexus is closer to the midline planes and the ipsilateral USL. These anatomical relationships may be greatly helpful for pelvic surgeon while facing retroperitoneal pelvic surgery and looking for a nerve-sparing approach.

Intestinal-type mucinous ovarian carcinoma arising from a seromucinous precursor lesion.

OBJECTIVE: Mucinous ovarian carcinoma is a tumor with gastrointestinal differentiation, which is not associated with endometrial-type (endometriotic or seromucinous) precursors. Here, we describe a peculiar case of mucinous ovarian tumor with intestinal differentiation arising in a seromucinous lesion, which may represent a distinct entity. CASE PRESENTATION: A 58-year woman underwent surgery due to a 14.5-cm ovarian mass with lymph nodal, peritoneal, omental and colorectal involvement. Histological examination with ancillary immunohistochemical analysis has been performed. Histologically, the mass was a carcinoma with intestinal differentiation and expansile growth pattern, arising in a seromucinous cystadenoma with intestinal metaplasia. Both the carcinoma and the metaplasia showed loss of Müllerian markers (estrogen and progesterone receptors, PAX8) and positivity for intestinal-type markers (cytokeratin 20, CDX2). CONCLUSIONS: Our case may represent the ovarian counterpart of endometrial gastrointestinal-type carcinoma, which is an aggressive entity developing from gastrointestinal metaplasia of the endometrial epithelium. Acknowledging the existence of such entity might be relevant in terms of diagnosis and patient management.

The use of near-infrared imaging with indocyanine green in the ovarian tissue transplantation: a case report.

The request for fertility preservation has consistently increased in recent years. To our knowledge this case report is the first to describe the application of near-infrared intraoperative imaging using indocyanine green (NIR-ICG) during ovarian tissue transplantation (OTT), to assist surgeon choosing the site of implantation of ovarian fragments. OTT was performed in a 42-year-old woman using NIR-ICG to evaluate the vascularisation of peritoneal area as the site of implantation for the ovarian graft. we believe this new approach could be useful in identifying the best reimplantation site.

Evaluación de la fisioterapia precoz en las fracturas de la extremidad distal del radio tratadas mediante placa volar de ángulo fijo / Evaluation of early physical therapy in distal radius fractures treated with fixed-angle volar plate

Objetivo: analizar el resultado funcional de la fisioterapia precoz en pacientes con fracturas de la extremidad distal del radio (FEDR), tratados mediante placa volar de ángulo fijo (PVAF). Material y método: estudio prospectivo de 20 pacientes (61 ± 16 años de edad) con FEDR, tratados con PVAF y fisioterapia precoz que fueron valorados a los 60 y 120 días de la intervención, analizando los datos demográficos (sexo, edad y dominancia), datos relacionados a la fractura (clasificación de Fernández), datos funcionales (amplitudes del movimiento, fuerza de presión y pinza) y la funcionalidad mediante el cuestionario DASH. La muñeca contralateral se utilizó como control. Resultados: el tratamiento fisioterapéutico precoz demostró un aumento significativo (p< 0,05) de la amplitud del movimiento y fuerza de presión, comparando las tres evaluaciones. El movimiento de pronación no presentó diferencias entre la segunda y la tercera evaluación. Comparando la primera y la segunda evaluación de la muñeca fracturada con la muñeca contralateral (grupo control) encontramos diferencias significativas que desaparecieron en la tercera evaluación. La puntuación del cuestionario DASH mejoró significativamente. Conclusión: La tercera evaluación se aproxima a la normalidad por lo que el tratamiento rehabilitador precoz en pacientes con FEDR tratados con PVAF permite retornar a las actividades de forma más rápida (AU)

Objective: analyzing the functional results of the precocious physical therapy intervention in individuals with distal radius fractures (DRF) that had been through treatment with fixed-angle volar plate (FAVP). Methods: Twenty individuals were assessed (61 ± 16 years) 60 and 120 days after operation. Demographic data (sex, age and dominance), data related to fracture (classification of Fernández), functional data (range of motion, grip and pinch strength) and assessment of functionality by DASH were analyzed. The contralateral wrist was used as control. Results: Significant increases were observed (p< 0,05) in the range of motion, grip and pinch strength when compared the assessments. The exception was pronation, which shows no difference between the second and third assessment. Comparing the averages of the first and second evaluation of the fractured wrist with the average of contralateral wrist (control group) there was significant difference. However, comparing the averages of fractured wrists in the third assessment and the control group there was no difference. The DASH score was statistically significant. Conclusions: These results suggest that precocious physical therapy in patients treated with FAVP in the DRF provides that return to their daily activities faster (AU)

[Two children with hip pain and fever]. / Due ragazzi con dolore all'anca e febbre.

Myositis of the Obturator internus Muscle is an uncommon disease that usually strikes children and adolescents. It is characterized by fever, hip pain and limping. The more frequently etiologic agent involved is Stafylococcus aureus. In the diagnosis, the aid of imaging diagnostic techniques is critical. We report two adolescents with this condition.

A cortical mechanism for binding in visual working memory.

Luck and Vogel (1997) showed that the storage capacity of visual working memory is about four objects and that this capacity does not depend on the number of features making up the objects. Thus, visual working memory seems to process integrated objects rather than individual features, just as verbal working memory handles higher-order "chunks" instead of individual features or letters. In this article, we present a model based on synchronization and desynchronization of reverberatory neural assemblies, which can parsimoniously account for both the limited capacity of visual working memory, and for the temporary binding of multiple assemblies into a single pattern. A critical capacity of about three to four independent patterns showed up in our simulations, consistent with the results of Luck and Vogel. The same desynchronizing mechanism optimizing phase segregation between assemblies coding for separate features or multifeature objects poses a limit to the number of oscillatory reverberations. We show how retention of multiple features as visual chunks (feature conjunctions or objects) in terms of synchronized reverberatory assemblies may be achieved with and without long-term memory guidance.