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Arch. klin. Chir., 68/1. - Berlin, Verlag von August Hirschwald, 1902, 8°, (4), 297, (1) pp., mit Abbildungen im Text, orig. Broschur. First Edition! "In 1901, Muscatello was nominated by von Recklinghausen for the Nobel Prize in Medicine for his works (Ueber die angeborenen Spalten des Schädels und der Wirbelsäule, Über einen nicht gewöhnlichen Fall von Cephalocele und über die postoperative Hydrocephalie, Über die Diagnose der Spina bifida und über die postoperative Hydrocephalie and Studi sul cefalocele e sulla spina bifida) on childhood spina bifida and hydrocephalus . " "Although he did not win this prize (this was given to Golgi), he continued to research and publish on spina bifida." "Muscatello described several forms of spina bifida including myelomeningocele, meningocele, myelocystocele, and spina bifida occulta. Myelomeningocele was described as "a hernia of the spinal cord with participation of the spinal cord." He developed surgical techniques for treating this pathology but recognized that surgery for rachischisis totalis was unwarranted as these children always died. He also realized that myelomeningoceles most commonly occurred in the lumbosacral region and less often in the cervical and thoracic regions of the spine. Surgically, he often found isolated groups of ectopic ganglion cells within the disorganized nerve roots. He observed that paralysis of the lower limbs, bladder, and the rectum and club feet were very common. However, for meningoceles, especially of the sacral region, he observed that motor function was usually good pre- and post-operatively. He noted that myelocystoceles can be confused with meningoceles and thought that many previously mentioned cases of meningocele were actually myelocystoceles. He found that myelocystoceles were most common in the lumbar region and were rarely found in the neck and even more rarely in the thoracic spine." "Muscatello documented many associated findings with spina bifida including caudal agenesis, kyphoscoliosis, absent radius, increased angulation of the sacrum, caudally displaced conus medullaris (e.g., tethered cord), fused ribs, and anomalous sternum. He also identified syringomyelia in the spinal cords of some patients, and the commonly found hydrocephalus of patients with myelomeningocele was, in his opinion, not enough evidence to suggest that hydrocephalus was the primary lesion leading to this form of spina bifida. He noted that the skin of patients born with spina bifida might have changes such as dark spots (e.g., flat capillary hemangiomas). Muscatello observed that although club feet were commonly seen in patients with myelocystoceles, paralysis of the bladder was uncommon." "Muscatello also described patients with occult spinal dysraphism, e.g., spina bifida occulta. For example, clear examples of split cord malformation were documented with one of these found to have an associated dermoid. He found that spina bifida occulta was most commonly encountered in the caudal portion of the spine. For this category of spinal dysraphism, he realized the association between focal hirsutism and underlying anomalies, such as split cord malformation, and observed that some of these cases were hereditary." Tardieu, G.G., Loukas, M., Fisahn, C. et al. Childs : The Italian Giuseppe Muscatello (1866-1951) and his contributions to our understanding of childhood spina bifida aperta and occulta. Child Nervous Syst (2017) 33: 389.
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