This report aims to present the guidelines of management and repair strategy in the surgical treatment of brachial plexus injuries (BPI) according to the Authors' experience, by analyzing a surgical series of 428 supraclavicular lesions. Methods From April 1990 to June 2013 the Authors have operated 578 posttraumatic BPI in adults: 428 supraclavicular and 150 infraclavicular injuries. Supraclavicular lesions have been retrospectively reviewed, focusing on the diagnostic assessment, the timing of surgery, the surgical findings, the repair strategies and their outcome. Infraclavicular injuries have been excluded from this study due to their higher variability in findings, with consequent lack of homogeneity in outcome. Preoperative assessment Patients were evaluated clinically (Figure 1) and by neuroradiological (MyeloCT or MR Myelography) (Figure 2) and electrodiagnostic studies (EDS). Imaging studies are preferably indicated after 3-4 weeks from the causative event due to the fact that pseudomeningoceles need a few weeks to form [1,2].

Background: Light is one of the most important factors in our interaction with the environment; it is indispensable to visual function and neuroendocrine regulation, and is essential to our emotional perception and evaluation of the environment. Previous studies have focussed on the effects of prolonged anomalous exposure to artificial light and, in the field of work-related illness. Studies have been carried out on shift-work personnel, who are obliged to experience alterations in the physiological alternation of day and night, with anomalous exposure to light stimuli in hours normally reserved for sleep. In order to identify any signs and symptoms of the so-called ill-lighting syndrome, we carried out a study on a sample of anaesthesiologists and nurses employed in the operating theatres and Intensive Care Departments of three Italian hospitals. We measured the subjective emotional discomfort (stress) experienced by these subjects, and its correlation with environmental discomfort factors, in particular the level of lighting, in their workplace.

The aim of this paper is to report on our ample experience with the medial cord to musculocutaneous (MCMc) nerve transfer. The MCMc technique is a new type of neurotization which is able to reanimate the elbow flexion in multilevel avulsive injuries of the brachial plexus provided that at least the T1 root is intact. A series of 180 consecutive patients, divided into four classes according to the quality of hand function, is available for a long-term follow-up after brachial plexus surgery. The patients enrolled for the study have in common a brachial plexus palsy showing multiple cervical root avulsive injuries at two (C5-C6), three (C5-C6-C7) and four (C5-C6-C7-C8) levels. The reinnervation of the musculocutaneous nerve is obtained via an end-to-end transfer from two donor fascicles located in the medial cord. The selected fascicles are those directed principally to the flexor carpi radialis, ulnaris and, to a lesser degree, the flexor digitorum profundus. Under normal anatomic conditions, they are located in the medial cord, and their site corresponds to the inverted V-shaped bifurcation between the internal contribution of the median nerve and the ulnar nerve. The technique has no failure and no complications when the hand shows a normal wrist and finger flexion and a normal intrinsic function. In case of suboptimal conditions of the hand, the technique has proved technically more challenging, but still with 67% satisfactory results. In the four-root avulsive injuries, however, this method shows its limitations and an alternative strategy should be preferred when possible. EMG analysis shows a reinnervation in both the biceps and the brachialis muscles, explaining the high quality of the observed results. Moreover, this technique theoretically offers the possibility of a "second attempt" at a more distal level in case of failure of the first surgery. This procedure is quick, safe, extremely effective and easily feasible by an experienced plexus surgeon. The ideal candidate is a patient harbouring a C5-C6 avulsive injury of the upper brachial plexus with a normally functioning hand.

The increased amplitude in particularly of cortical SSEPs (N20/P25), detected specifically during steady-state hypothermia, seems to support the clinical utility of this methodology in monitoring the brain function not only during cardiac surgery with CPB, but also in other settings like therapeutic hypothermia procedures in an intensive care unit.

Background: Early postoperative stroke is an adverse syndrome after coronary bypass surgery. This report focuses on overcoming of cerebral ischemia as a result of haemodynamic instability during heart enucleation in off-pump procedure.