Functional reconstruction of the irreparable upper trunk defect of the brachial plexus--a case report

We report a successful application of Oberlin's procedure combined with transfer of trapezius and latissimus dorsi with the teres major for reconstruction of elbow flexion as well as abduction and external rotation of the shoulder to a ten-year-old patient, who had a long defect of the left brachial plexus upper trunk caused by resection of the plexiform neuroma.

Rapid growth of acoustic neuromas after stereotactic radiotherapy in type 2 neurofibromatosis

We describe a rare complication of stereotactic radiotherapy for large acoustic neuromas in a patient with type 2 neurofibromatosis. We retrospectively reviewed the case of a 14-year-old girl who had been referred to our tertiary care center. Prior to referral, the patient had been evaluated for hoarseness. During the work-up, magnetic resonance imaging (MRI) detected two large bilateral acoustic neuromas and two bilateral jugular foramen tumors. The patient was diagnosed with type 2 neurofibromatosis, and she underwent stereotactic radiotherapy for treatment of the two acoustic neuromas; the jugular foramen tumors were not irradiated. The patient's post-treatment course was complicated by hydrocephalus and symptoms of brainstem compression, which required urgent surgical intervention. Follow-up MRI 7 months following radiotherapy demonstrated a rapid growth of the acoustic neuromas, but no appreciable change in the size of the jugular foramen neuromas. These findings suggest that the radiotherapy might have been the cause of the rapid growth of the acoustic neuromas. To our knowledge, no such report has been published in the literature, and this phenomenon might be unique. Our findings suggest that radiotherapy might not be the optimal first-line treatment for acoustic neuromas in patients with type 2 neurofibromatosis.

Selective innervation of retinorecipient brainstem nuclei by retinal ganglion cell axons regenerating through peripheral nerve grafts in adult rats

The pattern of axonal regeneration, specificity of reinnervation, and terminal arborization in the brainstem by axotomized retinal ganglion cell axons was studied in rats with peripheral nerve grafts linking the retina with ipsilateral regions of the brainstem, including dorsal and lateral aspects of the diencephalon and lateral aspect of the superior colliculus. Four to 13 months later, regenerated retinal projections were traced using intraocular injection of cholera toxin B subunit. In approximately one-third of the animals, regenerated retinal axons extended into the brainstem for distances of up to 6 mm. Although axons followed different patterns of ingrowth depending on their site of entry to the brainstem, within the pretectum, they innervated preferentially the nucleus of the optic tract and the olivary pretectal nucleus in which they formed two types of terminal arbors. Within the superior colliculus, axons extended laterally and formed a different terminal arbor type within the stratum griseum superficiale. In the remaining two-thirds of the animals, retinal fibers formed a neuroma-like structure at the site of entry into the brainstem, or a few fibers extended for very short distances within the neighboring neuropil. These experiments suggest that regenerated retinal axons are capable of a highly selective reinnervation pattern within adult denervated retinorecipient nuclei in which they form well defined terminal arbors that may persist for long periods of time. In addition, these studies provide the anatomical correlate for our previous functional study on the re-establishment of the pupillary light reflex in this experimental paradigm.

Multiple endocrine neoplasia syndrome, type III: review and case report

Successful treatment of the multiple endocrine neoplasia type III (MEN III) syndrome requires early diagnosis. It is highly possible that the patient's dentist may be the first practitioner with the opportunity to diagnose this potentially fatal syndrome. Additionally, patients with this syndrome having a pheochromocytoma and needing invasive dental treatment pose a life-threatening dental management risk. This article presents a review of the MEN II syndrome and a case report on the surgical management of a MEN III patient with a pheochromocytoma.

A chronically implanted delivery system of drugs to a nerve-end neuroma: effects on a behavioural chronic pain model

Autotomy has been suggested as an animal model of chronic pain. It starts about a week or two postoperatively and develops until 10 weeks after nerve section. This behaviour is thought to be triggered by activity of sensory fibres ending in a neuroma. Here we suggest to utilize it in combination with a novel drug delivery system which enables a direct and exclusive access of the drug to the neuroma. Alteration in the autotomy behaviour can then be related to the exclusive topical action on the sensory fibres within the neuroma. The sciatic nerve is transsected and its proximal end inserted into a PE tube sealed distally. A second, smaller tube originates in a wound exit in the back of the animal and subcutaneously leads into the large tube, where it is fixed by glue to the inner wall. Thus, the end of the smaller tube is juxtaposed to the nerve end. During the following weeks a neuroma develops within the tube. The resulting autotomy scores are then examined weekly. At various times after the operation, under light anaesthesia, drugs can be injected into the tube and the effect on the autotomy behaviour is monitored. An example is given, describing the autotomy suppressive effects of glycerol and alcohol, injected to different groups of rats immediately after the operation and compared to an injection 14 days postoperatively. This method is suggested as a pharmaco-behavioural assay for the assessment of the analgetic efficacy of drugs for chronic pain.

Medullary carcinoma of the thyroid, multiple phaeochromocytomas, mucosal neuromas, marfanoid habitus and other abnormalities (Sipple's syndrome)

A case of Sipple's syndrome is reported, in which the full phenotype was expressed. The patient had the typical marfanoid habitus, with thickened lips and alae nasi, neuromas on lips and tongue, medullary carcinoma of the thyroid gland, phaeochromocytomas, and medullated corneal nerve fibres. The plasma calcitonin level was initially elevated, rose on calcium infusion before thyroidectomy, and was undetectably after thyroidectomy. The urinary catecholamine excretion was elevated. The plasma parathyroid hormone, adrenocorticotrophin and growth hormone levels and the serum calcium level were normal.