Identification of the Prodromal Symptoms and Pre-Ataxic Stage in Cerebellar Disorders: The Next Challenge

Cerebellar ataxias (CAs) manifest with a combination of motor incoordination, cognitive, affective and recently identified social symptoms. Novel therapies aim to stop the progression of the subgroup of the degenerative ataxias, or even to cure the disease with a functional and anatomical restoration of the cerebellar circuitry in the near future. The goal of stopping the progression of the disease is particularly relevant if applied at a very early stage of the disease, when the cerebellar reserve is only slightly impaired. Therefore, the search of the prodromal phase or pre-ataxic stage of CAs represents a very important challenge for the scientific community. The identification of pre-manifest individuals and the recruitment of individuals at risk has become a key-challenge to address neuroprotective therapies. The feasibility is high due to the recent progress in the biological and morphological biomarkers of CAs.

Efficacy of plasmapheresis as treatment for bilateral hyperviscosity syndrome related retinopathy in multiple myeloma

Purpose: To report a case of good clinical response to plasmapheresis as therapy for a bilateral hyperviscosity syndrome related retinopathy in a young patient with undiagnosed multiple myeloma (MM). Methods: Case report. Results: A 48-year-old caucasian man, previously diagnosed with monoclonal gammopathy of undetermined significance (MGUS), presented for medical attention for back ache and vision decrease, worst in the left eye. Ophthalmological examination revealed presence of bilateral CRVO-like retinopathy which raised the hypothesis of hyperviscosity syndrome (HVS). After confirmation of MM diagnosis, plasmapheresis were promptly begun. The right eye regained a good visual acuity and an anatomical restoration already notable 5 days from the first plasmapheresis. Conclusions: Fundoscopy lead to diagnosis of HVS, it is therefore advisable in all patients with MM in order to perform plasmapheresis as soon as possible if necessary. In case of atypical CRVO, haematological and inflammatory causes, should be always ruled out.

Closed reduction and percutaneous k-wire fixation for distal end radius fractures

Background: To evaluate radiological and functional outcome in fractures of the distal radius treated by K-wire fixation.Methods: Forty patients (16 males, 24 females) with different types of fractures of distal radius were treated. K-wire fixation was performed under axillary bolock or general anaesthesia. Anatomical restoration was evaluated by postero-anterior and lateral radiographs obtained preoperatively and at 09 months of follow up to evaluate Radial Height (RH), Radial Inclination (RI) and Volar Tilt (VT). Functional outcome was evaluated using Mayo scoring system.Results: According to Mayo score 72.5% (n=29) of our patients had excellent to good outcome while as 17.5% (n=7) had fair outcome and 10% (n=4) patients had poor outcome.Conclusions: Kirschner wire fixation is an inexpensive procedure that provides anatomic reduction, fracture fixation, and maintenance of reduction with an adequate method of immobilization.

Leukostasis retinopathy with leukemic infiltrates as onset manifestation of chronic myeloid leukemia: a case report

Purpose: To describe a case of retinopathy as onset manifestation of chronic myeloid leukemia (CML), successfully treated with leukapheresis and medical therapy. Methods: A 28-year-old male patient presented complaining painless acute visual impairment in his right eye (RE). He reported moderate asthenia and episodes of night sweats during the previous month. His past medical history was unremarkable. BCVA at presentation was 20/80 in RE and 20/32 in left eye (LE). Fundus examination revealed venous congestion, diffuse Roth spots, and whitish macular infiltrates in both eyes. OCT showed hyperreflective foveal infiltrates, in both eyes. Blood test showed markedly elevated white blood cells (WBCs) count (430 × 103/mm3). Clinical-instrumental examination revealed hepatosplenomegaly. These features were consistent with CML. The patient was treated with leukapheresis and nilotinib. Results: After 2 weeks of treatment, the WBCs count dropped (71 × 103/mm3), and the patient reported subjective improvement of symptoms. At 1-month follow-up, BCVA and retinopathy signs were improved in both eyes. OCT showed the almost complete resolution of foveal infiltrates with ellipsoid zone focal defects. At 4-months follow-up, we observed complete resolution of retinopathy. BCVA was 20/32 in RE and 20/25 in LE. OCT showed the persistence of ellipsoid zone focal defects in RE and complete anatomical restoration in LE. At 6-months follow-up, the patient was clinically well and his WBCs count was normal. Conclusion: In our case, the CML-related retinopathy represented the onset sign of the underlying systemic pathology, leading to proper management and treatment, with hematological normalization and resolution of the retinopathy.

Kết quả điều trị sa tạng chậu bằng phẫu thuật nội soi treo vào mỏm nhô

RESULT OF THE LAPAROSCOPIC PROMONTOFIXATION FOR THE PELVIC ORGANS PROLAPSE Background: Choosing the method of treating pelvic organs prolapse is still controversial. In this study, we reported the results of treatment for pelvic organ prolapse by laparoscopic promontofixation. Materials and methods: prospective study of effectiveness of treatment for female patients having pelvic organ prolapse, who were treated with laparoscopy from January 2019 to June 2019 at Hue Central Hospital. Results: The average duration of laparoscopic promontofixation is 218.6 minutes. Good result of anatomical restoration of the pelvic organs, 100% of cases without pelvic organ prolapse after surgery. Functional disorders caused by pelvic organs prolapse do not reappear after surgery. Conclusions: treatment for Pelvic organ prolapse by laparoscopic promontofixation is very effective, but the surgery time is long and the complications need to be monitored in the long term. Key words: pelvic organs prolapse, laparoscopic promontofixation.

Qualitative anatomical restoration of the contact point of teeth – prevention of localized forms of periodontal diseases

Relevance. The restoration of a high-quality anatomical and functional contact point of teeth plays an important role in preventing the development of localized forms of periodontal disease.Purpose. Development of recommendations for qualitative anatomical restoration of the contact point of teeth for the prevention of localized forms of periodontal diseases.Materials and methods. In our study, which consisted of pre-clinical and clinical stages, were analyzed 50 CT scan of the chewing group teeth calculated the ratio of approximal surfaces of molars and premolars to the width of their crowns and computer simulations of the results of restoration of contact point. We also conducted a comparative analysis of wedges of different material with different cross-sectional shapes. At the clinical stage, the restoration of the contact point of teeth in patients according to our recommendations was carried out.Results. On the basis of the data obtained during the study, a formula for calculating the height and size of the restored contact point was compiled. Recommendations for anatomical restoration of the contact point are formulated.Conclusion. The application of the recommendations developed by us allows anatomically qualitatively restore the contact point and prevent the development of localized periodontal diseases.

Changes in Sexual Function Following Uphold Transvaginal mesh Surgery for the Treatment of Urogenital Prolapse

Uphold transvaginal mesh implantation is an option for treating pelvic organ prolapse (POP). This prospective cohort study aims to evaluate the effect of Uphold transvaginal mesh implantation on female sexual function. 205 women with symptomatic POP were recruited and evaluated pre-operatively and re- evaluated six months post-operatively in terms of anatomical restoration, quality of life influenced by urinary incontinence and female sexual function. 30 women eventually completed the assessments and been statistically evaluated. The main outcome focused on sexual function. In our study, we found that Uphold transvaginal mesh surgery could achieve effective anatomical restoration of POP and better sexual function regardless of concomitant sling surgery.

Complications of intramedullar blocking osteosynthesis

The complications of intramedullary blocking osteosynthesis of diaphyseal fractures of the limb bones due to tactical errors, as well as ways of preventing them, have been identified and summarized. Typical tactical errors of intramedullary blocking osteosynthesis were: application of the method against indications, violation of the osteosynthesis technology and the use of inadequate «author’s» techniques, introduction of own intraoperative “corrections” and change of course of the surgical intervention, excessive reaming of the medullary canal, significant intraoperative trauma of bone fragments and soft tissues, the wrong type of blocking or untimely dynamization, lack of continuity in medical rehabilitation. The most negative impact on the anatomical restoration of the bone and the functional restoration of the limb has the reaming of the medullary canal, performed without appropriate indications and with technical errors.

Endovascular Treatment of Post-traumatic Carotid-cavernous Fistula Using Flow Diverter Stent

We describe a case of post-traumatic high-flow carotid-cavernous fistula that was successfully treated with coils and pipeline embolization device. Following the endovascular treatment, the patient experienced clinical improvement of symptoms with complete anatomical restoration of the internal carotid artery.