Recent Articles

Facial nerve palsy is a condition with several implications, particularly when occurring in infancy and childhood. It represents a clinical problem with regard to its etiology, treatment options and its outcome, particularly when occurs in infants and children. There are several causes of facial nerve paralysis in children, as it can be congenital (due to delivery traumas and genetic or malformation diseases) or acquired (due to infective, inflammatory, neoplastic, traumatic or iatrogenic causes). Nonetheless, 40-75% of the cases of unilateral facial paralysis remain idiopathic. Unilateral familial congenital facial nerve palsy is an extremely rare condition that is usually syndromic, namely, in Moebius syndrome. The occurrence of isolated familial facial nerve palsy is even rarer, with only a few cases reported in the literature. Here we report a mother and her child both have congenital facial paralysis on the same side.

Introduction: Foreign body (FB) ingestion is frequently observed in surgical and endoscopic practice. They are often removed from the body cavities without causing any severe complications but occasionally they lead to serious damages. We report a case of a rosemary branch ingestion causing a duodenal and Inferior Vena Cava (IVC) perforation. Case Presentation: A 61 year-old man was admitted in ER with abdominal pain, vomiting and with a single episode of melaena. Vital parameters were stable. The abdomen was mildly distended but tender. Computed tomography (CT) scan revealed a foreign body in the second part of duodenum, passing through it, reaching and perforating the Inferior Vena Cava (IVC). An urgent Esophagogastroduodenoscopy (EGDS) confirmed the presence of a rosemary branch passing through the duodenum in correspondence of the lower duodenal knee. An emergency surgery with a median xifopubic laparotomy was performed. The foreign body removed firstly from the duodenum, then from IVC. No complication were observed in the postoperative period. Discussion: This case peculiarity was the paucisymptomatic presentation related to the severe lesion to the vessels and the bowel. Laparotomic approach was chosen to permit a secure and effective bleeding control. Probably the lack of symptoms, was due to the presence of an extended fibrotic reaction around the rosemary branch. Conclusion: Duodenal perforation and large vessels lesions due to foreign body ingestion are rare conditions that can lead to severe complications. Not withstanding the utilization of Computed Tomography (CT) scans and endoscopic procedures, the surgical management of bowel perforation induced by foreign bodies continues to present a formidable challenge. The optimal course of acting to ensure a favorable clinical outcome frequently relies upon the surgical approach adopted by the operating surgeon.

Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), also known as Hashimoto’s Encephalopathy (HE), is an immune-mediated condition that may present with a myriad of neuropsychiatric symptoms, making diagnosis a quandary. We report a case of a 70-year-old female who presented with subacute onset of mania and cognitive decline, diagnosed as bipolar disorder. She was treated with valproic acid for mood stabilization with minimal improvement in symptoms and six months later presented with new-onset seizures. Interestingly, her seizures started four days after discontinuing valproic acid. Following her admission to our hospital, a diagnosis of autoimmune epilepsy was suspected. EEG revealed multiple focal onset seizures with secondary generalization originating from the right frontocentral area and/or right temporal lobe. MRI revealed asymmetric cortical thickening along the paramedian right anterior frontal region thought to be nonspecific. She was empirically treated with pulse dose steroids and intravenous immunoglobulins. She underwent an extensive work up including neuroimaging studies that were unremarkable as well as serological testing for autoimmune etiologies. A high titer of anti-thyroid peroxidase (anti-TPO) antibodies was detected. She was clinically and biochemically euthyroid. A diagnosis of SREAT was rendered and the patient had significant clinical improvement in symptoms following administration of corticosteroids. SREAT is a diagnosis of exclusion but is supported by the presence of elevated anti-TPO and steroid responsiveness. Initial presentation may masquerade as a primary mood disorder, as in this case. Prompt diagnosis and treatment fully reverses neurological and psychiatric dysfunction in most cases.

This is an unusual report of a 33-year-old male with retrograde ejaculation as a complication of stand-alone L5-S1 anterior lumbar spinal fusion. This case is discussed in detail, with particular interest directed toward fertility issues and their implications. A plant-based diet was suggested as a treatment option due to the diet’s blood viscosity reduction properties. The patient initially noticed improvement after two months of starting the diet, with complete resolution of his retrograde ejaculation six months after beginning a plant-based diet. He successfully fathered a child a few years afterward.

Background: The migration of surgical clips after laparoscopic cholecystectomy is rare and can lead to complications such as clip-related biliary stones and intra-abdominal abscesses. In this article, we report a case of a retained dropped metal clip after a laparoscopic cholecystectomy resulting in an abscess that necessitated through the right abdominal wall and into the subcutaneous tissues 13 months later. Summary: Our patient is a 79-year-old male, with multiple comorbidities who underwent a laparoscopic cholecystectomy for acute cholecystitis. The cystic duct and artery were divided in-between 10-mm metallic clips. After 13 months, patient presented with a perihepatic abscess and a retained metallic clip necessitating through the right abdominal wall into the subcutaneous tissues. Patient was taken to the operating room and underwent an incision and drainage of the right abdominal wall abscess and retrieval of the migrating cholecystectomy clip. Conclusion: To avoid complications related to dropped cholecystectomy clips, it is important to use the correct technique for applying clips and attempt to retrieve any noticeably dropped clips intraoperatively.

The recent literature (last five years) on frailty in aging (ageing) adults is predominantly focused on predictors/ risk factors for frailty along with some studies on negative effects and interventions. Aging has been typically defined as starting as early as 60 or 65. And, frailty has been defined as reduced physiological and functional reserve or measured by grip strength, weakness, exhaustion and social isolation or by longer assessments like The Frailty Index for Elders. The prevalence rates for frailty in aging adults have been highly variable in this literature, ranging from a low of 5% to a high of 51% depending on the severity of the frailty. Negative effects have included falls and mortality. Predictors/risk factors have included social isolation, lack of exercise, bad nutrition, anemia, anorexia, depression and multiple demographic variables. Interventions have included physical activity, Mediterranean-style diet, combinations of exercise and diet and the anti-aging drug metformin. Potential underlying mechanisms for frailty have been the negative effects of inflammation and the positive effects of Klotho, an aging suppressor gene. More well-designed longitudinal studies are needed as well as more robust randomized controlled trials.

The recent literature (last five years) on inactivity and sedentary behavior in aging (ageing) adults is predominantly focused on negative effects of inactivity/sedentary behavior along with some studies on predictors/risk variables and interventions. Aging has been typically defined as starting as early as 60 or 65. And, inactivity has been defined as reduced time being active and/or increased time being sedentary. The prevalence rates for inactivity in aging adults have been highly variable in this literature, ranging from a low of 21% to a high of 79%. Negative effects have included cognitive impairment, reduced muscle strength, frailty, depression and mortality. The Negative biological effects have included increased cytokines and triglycerides as well as increased hippocampal volume and white matter hyperintensities. Predictors/risk factors have been social isolation, loneliness, inadequate nutrition and multiple demographic variables. Interventions have been effective including stepping, Pilates and mobile health exercises. More well-designed longitudinal studies are needed as well as more robust randomized controlled trials.

This review summarizes research on late life suicidality found in the recent literature (last five years). The prevalence has widely ranged from 5-56% for suicidality in late life. The research has focused primarily on predictors/risk factors for suicidality. Social factors have included bereavement, isolation and loneliness. Psychological problems have included anxiety, depression, cognitive impairment, sleep disturbances and prior suicide attempts. Physical conditions have included functional disability, inflammation, chronic illness and drug misuse. Interventions have focused primarily on exercise and increasing physical activity. The interpersonal theory of suicide (thwarted belongingness and perceived burdensomeness), inflammation and immune dysfunction have been considered potential underlying mechanisms for late life suicidality. This research is limited to self-report, cross-sectional studies that typically involve several variables, although the relative significance of the different variables is frequently not reported.

The Thematic Apperception Test (TAT) is a projective construction technique used to identify individual responses to ambiguous stimuli. The TAT may also be used to assess one’s object relations and to understand how one uses object representations to interpret interpersonal situations illustrated on TAT cards. While the TAT has not been widely used in assessing psychopathology, a few studies have investigated its use in identifying psychopathic traits. A review of available studies indicated the TAT has only been used minimally in the assessment of psychopathology, and even less so in the evaluation of psychopathy. To date, use of the Westen’s SCORS scoring system has provided varied results, with the greatest support for valid use of the TAT in assessing psychopathy found in borderline personality disorder evaluation (Garb et al., 2002).

Across cultures and throughout time, human aggression has been conceptualized in various ways. The monoamine oxidase A (MAOA) gene on the X chromosome (Grimsby et al., 1990) has been implicated in aggression from research originating in the 1990s (Cases et al., 1995; Shih & Thompson, 1999). Researchers have sought to create predictive models of aggression, and throughout decades of research have used several different tools to measure the construct such as the Buss-Perry Aggression Questionnaire and the Conners’ Teachers Rating Scale. This work will analyze and synthesize current scholarly research; a critical review of this impactful line of inquiry will also be provided.