Plantar fibromatosis, Ledderhose's disease, or Morbus Ledderhose is an uncommon benign nodular hyperplasia of the plantar aponeurosis. The aim of this paper was to report the case of a 47-year-old male patient who had concomitant Dupuytren's disease and failed all conservative measures. He was treated surgically with prompt and complete relief of symptoms postoperatively, and he has had no recurrence at the 2-year follow-up. In this richly documented case, we discuss details of the surgical technique and anatomy, which was important for a successful outcome and preventing complications. The technique for subtotal fasciectomy is reviewed and the relevance of the adequate choice of skin incision to prevent painful scarring, skin necrosis, and difficulties with shoe wearing is highlighted.

No abstract

No abstract

Many countries have applied mandatory confinement measures in response to the COVID-19 pandemic, such as school and kindergarten closures, which confined families to their homes. The study concerns the impacts of the first COVID-19 lockdown on the relationships between Portuguese parents and their children, in a non-clinical population composed of fathers and mothers of children between the ages of 12 months and 3 years and 364 days. An online questionnaire (set by the research team) and the Parenting Daily Hassles Scale (PDHS) concerning the confinement period were applied between 17 June and 29 July 2020. To assess the impacts of the lockdown, outcomes regarding the impacts perceived by the parents, the potential regression in the development of children, and the willingness to promote changes in family routines in the future, were considered. Of the total sample (n = 1885), 95.4% of the parents (n = 1798) said that, after confinement, the relationship with their children had improved or remained similar to the pre-confinement period; 97.3% (n = 1835) noticed positive changes in the development of their children, and 63.7% (n = 1200) noted that the relationships with their children during the confinement period would lead to some changes in family routines in the future. Multivariate regression analyses showed that most of the sociodemographic variables chosen were not associated with the outcomes. However, significant levels of pressure over parenting and parental overload (reported by high scores in the PDHS intensity and frequency scales), challenging behaviors of the children, and the impacts they had on parental tasks had negative influences on the studied outcomes. On the contrary, the number of adults living with their children, the perceptions regarding the development of their children, and sharing new experiences with them were significant factors for positively-perceived impacts on the relationships between them or in the desire to bring about changes in family routines in the future. The impacts of the lockdown on the relationships between parents and children aged between 1 and 3 years old were more dependent on relational aspects and on the parents’ sense of competence in exercising parental functions. We conclude that, despite the increased demands imposed by the lockdown, nearly all of the parents evaluated the quality of the relationship with their children as positive after this period.

Background: Anterior clinoidal meningiomas are heterogeneous types of lesions that comprise the parasellar lesions group. Due to their close relationship with the optic nerve and internal carotid artery, they become challenging pathologies for neurosurgeons. Case Description: Female 47, presented with superior temporal quadrantanopsia on the right side. Magnetic resonance image revealed type III clinoidal meningioma on the right side. She has undergone a pterional craniotomy for an optic canal unroofing and tumor extraction. Two years of postoperative follow-up the patient underwent a campimetry, which revealed an almost complete visual improvement. Conclusion: To date, the best surgical technique has not yet been defined, so the choice of treatment and surgical technique is based on each case and on the surgeons’ experience.

Anterior clinoidectomy (AC) is a key microsurgical step for the safe and successful management of parasellar pathologies that involve the anterior clinoid process (ACP) and the optic canal. Traditionally, extra and intradural ACs are performed separately according to the surgeon's experience or preference. The objective is to present and discuss the tailored AC concept through illustrative cases. We conducted a retrospective record review of three patients who underwent AC as a surgical step for the treatment of parasellar pathologies that involve the ACP and optic canal. A review of the relevant literature on AC was performed in the PubMed, LILACS, and SciELO databases. In all three cases, the pterional craniotomy was the preferred approach for AC. Case 1, a 47-year-old female patient with type III anterior clinoidal meningioma, underwent a tailored intradural technique (optic canal unroofing) with total tumor resection and complete visual recovery. Case 2, a 63-year-old female patient with a complex type II anterior clinoidal meningioma with extensive hyperostosis of the ACP, underwent a hybrid AC technique with complete removal of the tumor and visual improvement. Case 3, a 62-year-old female, underwent a tailored intradural AC for clipping an incidental carotid-ophthalmic aneurysm. Tailored AC aims to provide adequate exposure with less risk of neurovascular injury, allowing enough space to safely treat parasellar lesions. The type, size, and location of the lesion, as well as the surgeon’s experience, should always be considered for surgical planning.

Head trauma due to falls is often seen in children, however Penetrating Brain Injury (PBI) – the most life-threatening condition of Traumatic Brain Injury (TBI) - is exceedingly rare. Herein, we report and discuss the challenges encountered in surgical and post-operative management of a 13-old-child patient with PBI by a pickaxe, admitted in Glasgow Coma Scale (GCS) 3 and that not only survived, but also achieved a Glasgow Outcome Scale (GOS) after one year of postoperative follow-up. To our knowledge, this is the first case of pickaxe-induced brain injury on the American Continent and the youngest survivor of this trauma reported in literature.

Head trauma due to falls is often seen in children; however, penetrating brain injury (PBI), the most life-threatening condition of traumatic brain injury (TBI), is exceedingly rare. Herein, we report and discuss the challenges encountered in the surgical and postoperative management of a 13-year-old child patient with PBI by a pickaxe who was admitted to Glasgow Coma Scale (GCS) 3 and who not only survived but also achieved a good Glasgow Outcome Scale (GOS) after one year of postoperative follow-up. To our knowledge, this is the first case of pickaxe-induced brain injury on the American continent and the youngest survivor of this trauma reported in the literature.