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Sarcoidosis is a systemic granulomatous disease that can affect multiple organ systems. Although many sarcoidosis patients are asymptomatic, the variable clinical progression of symptomatic patients and the nonspecific presentation make diagnosis difficult in certain cases. Musculoskeletal and sinonasal involvement of sarcoidosis are uncommon manifestations, and they are often only seen in patients with widespread disease. Diagnosis of osseous sarcoidosis, sarcoid arthropathy, and sarcoid rhinosinusitis are typically based on a combination of clinical history, radiological findings, and pathologic specimens. Although there are classic image findings, such as lacelike honeycomb appearance of small bones of the hands or hilar/mediastinal lymphadenopathy, sole reliance on image findings for the diagnosis of sarcoidosis is unreasonable as many findings are nonspecific. However, failure to include sarcoidosis in the differential diagnosis often leads to a delay in recognition of musculoskeletal or sinonasal involvement and results in ineffective treatment plan. Even in patients with biopsy-proven sarcoidosis, some image findings in isolation that may represent granulomatous infiltrates are disregarded as nonspecific without raising the possibility of sarcoidosis due to its rare occurrence. Here we discuss a case of multisystemic sarcoidosis in a 42-year-old female with a constellation of classic and rare findings of biopsy-proven sarcoidosis., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Background: Conventional craniotomy approaches involve substantial soft tissue manipulation that can cause complications. The transciliary supraorbital keyhole approach was developed to avoid these complications. The aim of this review is to evaluate the safety and the effectiveness of the transciliary supraorbital keyhole approach., Methods: We searched the PubMed/Medline database for full-text publications from 1996 onward containing data on 100 or more cases of aneurysm clipping or tumor resection by the transciliary supraorbital keyhole approach. The primary outcome was the incidence of approach-related complications. The secondary outcomes were the aneurysm occlusion rate and the extent of tumor resection., Results: Eight publications met the eligibility criteria. All publications were of the retrospective case-series or case-cohort type without any independent assessment of outcomes. The risk of bias at the individual study level may thus have influenced any conclusions drawn from the overall study population, which included 2783 patients with 3085 lesions (2508 aneurysms and 577 tumors). Approach-related complications included 3.3% cerebrospinal fluid collection or leak, 4.3% permanent and 1.6% temporary supraorbital hypesthesia, 2.9% permanent and 1% temporary facial nerve palsy, and 1% wound healing disturbance or wound infection. Complete aneurysm clipping was achieved in 97% of cases. Complete tumor resection in 90% of cases. The overall surgical revision rate was 2.5%. The esthetic outcome was typically reported as highly acceptable., Conclusions: This approach may represent a safe, effective, and less invasive alternative to conventional craniotomies in experienced hands and for a well-selected subset of patients. However, higher-level evidence is needed to confirm this hypothesis., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Constraint-Induced Movement therapy or CI therapy is an approach to physical rehabilitation elaborated from basic neuroscience and behavioral research with primates. The application of the CI therapy protocol to humans began with the upper extremity after stroke and was then modified and extended to cerebral palsy in young children, traumatic brain injury, and multiple sclerosis. A form of CI therapy was developed for the lower extremities and has been used effectively after stroke, spinal cord injury, fractured hip, multiple sclerosis, and cerebral palsy. Adaptations of the CI therapy paradigm have also been developed for aphasia, focal hand dystonia in musicians, and phantom limb pain. Human and animal studies using a variety of methods provide evidence that CI therapy produces marked neuroplastic changes in the structure and function of the CNS. Moreover, these changes appear to be important for the intervention's therapeutic effect., (© 2013 Elsevier B.V. All rights reserved.)

Background and Aims: Functional gastrointestinal disorders are diagnosed by the presence of a characteristic set of symptoms. Aims of this study were to validate the Rome symptom criteria by factor analysis and to determine whether symptoms cluster in the same way in different cultures., Methods: One thousand forty-one gastroenterology clinic patients in the US (response rate 53%) and 228 family members accompanying clinic patients in Italy (84%) completed a previously validated symptom questionnaire. Factor analysis identified clusters of symptoms which are highly correlated with each other, and these were compared to the Rome diagnostic criteria., Results: In the US, 13 factors were identified. The irritable bowel factor was composed of three core symptoms corresponding to the Rome II classification system. Two dyspepsia factors were identified which correspond to the ulcer- and motility-like subtypes proposed in the Rome I classification system. All symptoms of constipation formed a single cluster as proposed in the Rome II classification system. Symptom clusters in the US agreed well with symptom clusters identified in Italian subjects., Conclusions: Empirically derived symptom clusters agree in most respects with the Rome II classification system and support their validity. These symptom clusters are independent of cultural differences in diet and behaviour.

A questionnaire was distributed in early 1996 to 160 leading European neurological, neuro-pediatric and neurosurgical centers to assess the present status of Moyamoya disease in Europe. The response rate was 43%. Information was obtained on a total of 168 patients, of whom 110 had presented before 1992, and 58 from 1993 onward. 82% of the patients were Caucasian. In all other respects, the clinical findings were similar to those observed in Japan. The present study yields an incidence of 0.3 patients per center per year, which is approximately one-tenth of the incidence in Japan. Alongside these results, the history of the recognition and treatment of this disease in Europe is briefly discussed.

Six monkeys subjected to forelimb deafferentation on day of birth (two blinded and four not blinded) spontaneously developed use of the affected limbs for support of body weight, ambulation, and clasping objects. The sighted animals also used them for climbing and reaching toward objects. Thumb-forefinger prehension did not emerge spontaneously but could be brought into existence through training. In another series of experiments, 5 of 11 monkey fetuses, exteriorized two-thirds of the way through gestation and given forelimb deafferentation, survived through caesarian delivery and at least 5 months of infancy. Although all were quadriparetic due to postoperative mechanical deformation of the cervical region, they were able to use the affected limbs to make postural adjustments and for standing and rudimentary ambulation. The results indicate that, after birth, neither spinal reflexes nor local somatosensory feedback and vision are necessary for the development of most types of movement performed by the forelimb musculature in monkeys. Continuance of the prenatal research should permit determination of the role of somatic sensation in the intrauterine development of behavior.