Reading of lexically stressed words by Italian aphasic patients: a retrospective study

This retrospective study investigated whether there is evidence of a 3rd reading mechanism in a transparent orthography such as Italian, where (nearly) all words can be read through the sublexical route but stress cannot always be assigned by orthography-to-phonology rules. The presence and frequency of stress errors in lexically stressed words in 16 aphasic patients with impaired reading comprehension of those same words was checked. Nine patients were reexamined months later. Notwithstanding impaired reading comprehension, none of the patients made stress errors at first examination. At follow-up, all patients showed improvement of reading comprehension and only 2 patients still had better preserved oral reading. The authors concluded that even in transparent orthographies such as Italian, the noninteractive dual-route model is inadequate for explaining all patterns of reading performances. In nonprogressive aphasias, reading comprehension can recover in a larger number of patients, reducing the amplitude of the dissociation between reading aloud and reading comprehension and reducing the number of patients showing this dissociation.

Regulation of corticosteroid receptors in patients with anorexia nervosa and Cushing's syndrome

We have studied 16 patients with anorexia nervosa (11 with a stabilised weight loss and 5 in the weight-losing phase), 11 healthy controls, and 10 patients with Cushing's syndrome, by measuring plasma cortisol (by enzyme-immunoassay), ACTH (by RIA), corticosteroid (Type I-mineralocorticoid and Type II-glucocorticoid) receptors in mononuclear leukocytes (by radio-receptor assay), and lymphocyte subpopulations (by cytofluorimetry). In anorexic patients with a stabilised weight loss and in Cushing's syndrome the mean value of both Type I and Type II corticosteroid receptors in mononuclear leukocytes was significantly lower than in controls. The correlation between Type II receptors and plasma cortisol was inverse in stabilised anorexia nervosa and in Cushing's syndrome, and direct in healthy controls. Anorexic patients in the weight-losing phase showed a significant increase in plasma cortisol levels and a normal number of Type II receptors. From these results we hypothesise that in anorexia nervosa there is a progression from an increase in plasma cortisol in the weight-losing phase, to a concomitant decrease in Type II receptors when the disease is stabilised.

Treatment of a vertebral dissecting aneurysm with stents and coils: technical case report

OBJECTIVE AND IMPORTANCE

A clinical case of a dissecting aneurysm of the intracranial vertebral artery successfully treated with a combination of stents and coils is presented. The importance of long-term follow-up and the development of suitable materials and devices are emphasized.

CLINICAL PRESENTATION

This 48-year-old man with a history of progressive bilateral loss of vision caused by glaucoma developed sudden headache, nausea, and vomiting. At admission, he presented with psychomotor agitation and neck pain. A neurological examination showed bilateral IInd and VIth cranial nerve palsy and neck stiffness. Computed tomography demonstrated a diffuse subarachnoid hemorrhage. Digital subtraction angiography showed a fusiform dilation of Segment IV of the left vertebral artery, with a double lumen sign.

TECHNIQUE

A bifemoral intra-arterial approach was used. A FasTracker 18 (Target Therapeutics, Fremont, CA) microcatheter was advanced through the true arterial lumen and was then replaced by a self-expandable metallic wall stent. Because of reduced radiopacity, a balloon-expandable metallic stent was then placed as well. Next, with a FasTracker 10 advanced through the stent mesh, the aneurysm was embolized using Guglielmi detachable coils.

CONCLUSION

We applied a new technique to treat a dissecting aneurysm of the intracranial portion of the vertebral artery with a combination of stents and coils. Further work is required on the tracking, flexibility, and thrombogenic properties of diverse materials and devices. This evolving technology may play a role in the near future as the alternative of choice in some cases of aneurysm treatment via the endovascular route.

Pituitary tumors in adolescent patients

We report on a series of 48 patients, ages 14 to 20 year, with hypophyseal adenomas. Of these, 46 (96%) had secreting tumors, 3 had Cushing's disease, 9 had somatotrophinomas, and 34 (29 females and 5 males) had prolactinomas. Thirty cases were diagnosed as intrasellar adenomas (62%) while the remaining eighteen (38%) presented extrasellar expansion. Of 9 acromegalic patients, 7 had typical clinical and biochemical features 2 were exclusively prognatic with normal basal GH levels, but abnormal dynamic tests. Prolactinomas were noninvasive in women and faster growing and more extensive in men. Forty seven patients underwent surgery. Five of these required craniotomy and the rest approached through the sphenoidal bone (TSE). Remission was achieved in Cushing's disease, acromegaly, and female intrasellar prolactinomas. Larger tumors such as nonsecreting adenomas and male prolactinomas showed poor results after undergoing subtotal resections, with persistence of endocrinological disturbances. From our findings it appears that these tumors are aggressive in youth than in adults. Because there was a close relationship between tumor size, invasiveness, and the patients' final outcome, we conclude that early diagnosis and treatment is essential. Frequent complaints in adolescents such as irregular menses, retarded puberty, and growth disorders should be thoroughly investigated and not merely considered as transient or 'functional'.

Elevated proenkephalin-derived peptide levels in ACTH-producing adenomas: nucleus and cytoplasm localization

The biosynthesis of met-enkephalin in human pituitary and human pituitary adenomas is still not well known. In this work, we studied the processing of proenkephalin-derived peptides in postmortem human pituitary (PMHP), ACTH-producing adenomas (ACTH-PA), nonfunctioning adenomas (NFA), and GH-producing adenomas (GH-PA). ACTH-PA contained at least 10 times more proenkephalin-derived peptides than PMHP, NFA,and GH-PA. Proenkephalin processing was different in the four tested tissues. In ACTH-PA, proenkephalin was processed to high-, intermediate-, and low-mol-wt products. The highest met-enkephalin-containing peptides levels corresponded to intermediate and low-mol-wt materials, although met-enkephalinArg-Phe and synenkephalin immunoreactivity appeared only in high-mol-wt peptides. In PMHP and NFA, met-enkephalin-Arg-Phe immunoreactivity was detected in intermediate- and low-mol-wt materials, and it was absent in GH-PA. Immunoblotting of ACTH-PA showed that met-enkephalin-Arg-Phe immunoreactivity corresponded to peptides of 44, 32-30, 27, and 17 kDa. The 32-30 and 17-kDa molecules were localized in the nuclear fraction where they were extracted after enzymatic digestion with DNase I. Plasmatic met-enkephalin levels did not increase in patients with Cushing's disease, suggesting that the pentapeptide stored in ACTH-PA was not released to the general circulation. In conclusion, we demonstrated that only ACTH-PA contained high levels of proenkephalin peptides, which were stored in cytoplasm organelles and in the nucleus, probably bound to chromatin. These results suggest an adenoma-specific physiological role of proenkephalin products.

Reduced DNA synthesis in primary cultures of hepatocytes from old mice is restored by thymus grafts

We previously observed in vivo that a neonatal thymus grafted into old mice can correct age-related changes such as occurrence of hepatocyte tetraploid nuclei and impaired isoproterenol-induced DNA synthesis in submandibular glands. The aim of the present paper was to study the influence of age and thymus on basal and beta-adrenergic-stimulated DNA synthesis using primary cultures of mouse hepatocytes. In the absence of any adrenergic agents, cells from young mice show peak DNA synthesis between 36 and 48 h; old mice show a similar time course, but the peak is significantly reduced statistically. The main result is represented by the behavior of hepatocytes from old thymus-grafted mice, which recover the levels of [3H]-thymidine incorporation toward young-like values. Grafted animals also show a correction of total DNA content that is increased in old mice. The addition of isoproterenol does not modify the DNA synthetic pattern, whereas the antagonist propranolol causes a slight but statistically significant decrease.

[Percutaneous pigtail catheter drainage of peripheral breast abscesses]

Almost all peripheral non-lactational breast abscesses are staphylococcal in origin and so percutaneous drainage can be a valid alternative to surgical incision. Percutaneous drainage was performed in eight patients with one or more abscesses. A pigtail catheter was inserted only in foci greater than 3 cm. The results were good in 9 out of 10 purulent collections; one recurrence was observed in the smallest focus. All patients but one underwent local anesthesia and were managed as outpatients.

The role of bronchoalveolar lavage in the microbiological diagnosis of pneumonia in patients with haematological malignancies

In the aetiological diagnosis of pulmonary infections in patients affected by haematological malignancies we evaluated the utility of bronchoalveolar lavage (BAL). One hundred and twenty-seven BAL were performed in 119 patients. In our series, we identified the agent of pneumonia in 53.5% of episodes with the best results in aspergillosis, very common in these patients. The previous empirical anti-infective treatment was modified in 14 episodes (11%). The procedure was generally well tolerated and only one patient bled. We maintain that BAL is a useful diagnostic tool for detecting the agents of pulmonary infections in patients with haematological malignancies, especially when the routine microbiological procedures fail, and it also represents a good alternative to more invasive procedures.

[Combined surgical treatment with prosthesis of recurrent ventral and inguinal hernias]

The presence of associated incisional and groin hernias is relatively rare and it represents an important problem in surgical treatment. The authors here report their experience of three patients treated with no reabsorbable prostheses placed according to Rives' technique for incisional hernias, and according to Stoppa's for inguinal hernias.

Thyroid-thymus interaction on beta-adrenoceptor regulation during development and ageing

Up-regulation of brain cortex beta-adrenoceptors (beta ARs) can be induced by very acute stimulation with a single injection of T4 or T3 in young Balb/c-nu mice. We have also shown that this very rapid receptor increase can also be demonstrated in ageing animals when stimulated with T3 but not T4 injection. The aim of the present paper was to verify the capability of the thymus to reverse these impairments which we often observed in other experiments on old mice and young athymic nudes. The up-regulation induced by T4 and T3 was studied in normal and athymic nude young, normal old, and normal old and athymic nude young mice grafted with neonatal thymus 1 month earlier. In addition, since brain cortex bears both beta AR subpopulations, the eventual differential behavior of beta 1AR and beta 2AR subtypes was also investigated. Animals were injected intraperitoneally with saline, or saline containing 0.5 microgram T3 or 6.4 micrograms T4 per g body weight and killed 15 or 60 min after injection. Results show that thymus can recover the modifications of basal levels as well as T3-induced up-regulation of beta ARs in nude and old mice. On the contrary, impaired response to T4 stimulation is corrected in nude but not in old mice. The peripheral conversion of T4 into T3 can explain their differential influence since a correct conversion only occurs in presence of an efficient beta-adrenergic function. Thus, a vicious circle may occur with a decreasing number of beta-adrenoceptors causing in old age altered T4 to T3 conversion, in turn responsible for altered beta-adrenergic responsiveness to T4.

Semantic amnesia without dementia: documentation of a case

We described the case of a patient affected by a progressive semantic memory disorder associated with prevalent temporal lobe atrophy. This deficit seems to be "pure" in the sense that it has not been found to overlap with other cognitive deficits (intellectual, linguistic, perceptual, visuo-spatial etc.) for a long time. Furthermore, despite his impaired semantic knowledge, the autobiographical memory of the patient was largely intact. This case therefore represents a form of "semantic amnesia" without dementia, and supports the hypothesis that there is a partial distinction between "semantic" and "episodic" memory.

[Evaluation of left ventricular function in patients with mammary carcinoma after treatment with epidoxorubicin using a high-dose, short-term protocol]

Anthracyclines are effective chemotherapeutic agents against various malignancies but their therapeutic value is limited by well-known dose-related cardiotoxicity, mainly induced by oxygen free radicals. Left ventricular diastolic and systolic functional abnormalities precede the clinical evidence of cardiotoxicity. The aim of this study was to evaluate the possible cardiotoxicity of epidoxorubicin administered as "high-dose short-term" protocol. Twenty patients (mean age 50.4 +/- 7.9 years) without cardiac disease, affected by advanced breast cancer were studied. All patients were treated with epidoxorubicin as neoadjuvant chemotherapy according to the new protocol "high-dose short-term" (cumulative dose 475.8 +/- 35.6 mg/m2, range 450-600 mg/m2, in 4-6 weeks). The effectiveness of cancer chemotherapy was monitored by clinical evaluation and mammography performed before and after treatment. All patients underwent color Doppler echocardiography and resting radionuclide angiocardiography in baseline condition and 30 +/- 10 days after the last cycle of chemotherapy. All patients showed a significant reduction of tumor lesion after chemotherapy. Left ventricular systolic and diastolic function parameters obtained by echocardiography (fractional shortening 33.1 +/- 4.5% vs 32.4 +/- 4.8%; ejection fraction 63.6 +/- 6.2% vs 62.9 +/- 5.7%; E/A ratio 1.73 +/- 0.64 vs 1.82 +/- 0.67; E wave deceleration time 204 +/- 24.6 ms vs 208.5 +/- 31.7 ms;isovolumetric relaxation time 79 +/- 15.7 ms vs 80 +/- 17.8 ms) and radionuclide angiocardiography (ejection fraction 62.4 +/- 7% vs 61.8 +/- 5.9; peak ejection rate 2.87 +/- 0.44 VTD/s vs 2.74 +/- 0.46 VTD/s; peak filling rate 2.72 +/- 0.54 VTD/s vs 2.6 +/- 0.58 VTD/s) did not show significant changes after treatment. In conclusion, our results suggest that epidoxorubicin administration using the "high-dose short-term" protocol in patients with breast cancer does not induce early significant abnormalities of left ventricular systolic and diastolic function.

Memory and aphasia

Sixty-one acute and 17 chronic vascular left-hemisphere damaged patients were tested with five memory tasks that investigated verbal short-term (digit span) and long-term (paired-associate and story learning) memory, and spatial short- and long-term memory (Corsi's span and learning). Both brain-damaged groups were significantly impaired in all memory tasks (except for chronic patients in the story learning task) compared to normal controls. The presence of aphasia and locus of lesion (anterior, posterior and deep) had no effect on the memory impairment, with only one exception of paired-associate learning that was better performed by non-aphasic than aphasic patients. Eleven subjects were better at paired-associate learning than story recall, the reverse dissociation was never found. Finally, chronic patients performed significantly better than acute patients only in the Corsi's learning task.

Hyperosmolar nonketotic coma at the onset of type I diabetes in a child

A 12 yr-old child without any past medical history of diseases was admitted to hospital for sopor and polyuria. At admission he was markedly dehydrated. Blood glucose was 72 mmol/l, sodium 154 mmol/l, osmolarity 381 mOsm/Kg, urinary ketons were negative. He was rehydrated with hypotonic saline and treated with insulin. The osmolality and sodium initially increased to 176 mmol/l and 408 mOsm/Kg respectively and progressively decreased to normal levels. Serum transaminases increased to GOT 336 and GPT 209 U/l in the first days of treatment and normalized after 15 days. The anti-islet antibodies were positive. The non ketotic hyperosmolar coma and Type I diabetes is rare in children but this possibility must be kept in mind especially when some familial or psychological problems are present as in our case.

Acute radiodermatitis from accidental overexposure to X-rays

Approximately 2 weeks after accidental overexposure to X-ray radiation, a worker developed acute radiodermatitis on fingers of both hands. Exposure simulation indicated that total ionizing radiation absorbed by his fingers amounted to about 20 Gy. After 2 years, acute radiodermatitis evolved to chronicity of lesions with presence of atrophic skin, teleangiectasia, alopecia, and dyskeratosis on three right-hand fingers. Cytogenetic dosimetry of peripheral blood lymphocytes, performed 2 months after acute radiation, showed an increase of micronuclei (7% vs. 1 +/- 0.4% according to laboratory reference data). The increase was ascribed to the high dose of ionizing radiation absorbed by circulating lymphocytes in the vessels of overexposed tissues. The cytogenetic examination was repeated 27 months after acute irradiation; it was found that the percentage of micronuclei had been restored to within reference levels. The possibility of using cytogenetic dosimetry, following acute partial exposure to X-rays, not just as an indicator of previous exposure, but also as an indicator of the absorbed radiation dose is examined. Lastly, the possible stochastic effects that may set in on the skin of the affected fingers and the need for periodically monitoring the evolution of chronic skin lesions, are discussed.

Perseveration in two aphasic patients

In this paper we report the perseverative behavior of two aphasic patients, AB and MT. They were submitted to a standardized Language Examination and to verbal and nonverbal tasks designed to elicit perseveration. Some of the features pointed out in the literature were not confirmed. Perseveration was not semantically related to the target; a correct response did not have any special status; in many instances the perseveration had not been produced as a correct response and could reappear immediately or after many stimuli; the production of two consecutive correct responses did not inhibit the spontaneous recurrences and could again be followed by the perseveration of a previous wrong response. Perseveration did not set in in the same circumstances for the two patients: in AB it set in when the patient was unable to find the correct response; MT, on the contrary, while knowing the correct response, was unable to change her perseverative behavior from one response to the other. For both patients, however, it seems as if no inhibitory system stops pre-existing motor or verbal behavior.

Determination of the optimal conditions to study DNA synthesis in cultures of mouse hepatocytes

Mouse hepatocytes undergo profound changes during aging, such as increased nuclear volume, occurrence of tetraploid nuclei and impaired DNA synthesis following in vivo adrenergic stimulation. These alterations have been found reversible by implanting a neonatal thymus into old animals. In the present paper we studied the optimal experimental conditions in order to investigate the mechanisms of such actions in vitro. Unfortunately, in fact, most of data in the field comes from experiments on rats. Thus, we examined DNA synthesis of hepatocytes from mice cultivated in presence of neonatal calf serum only, or after the addition of the beta-adrenergic agonist isoproterenol or the beta-adrenergic antagonist propranolol. DNA synthesis in hepatocytes from young Balb/c-nu mice shows a peak between 36 and 48 h even in the absence of any specific stimulation other than newborn calf serum. The addition of isoproterenol does not modify the DNA synthetic pattern, while propranolol causes a slight but statistically significant decrease in 3H-thymidine incorporation. Results are compared with those obtained from other authors in rats.

Evolution of oral and written confrontation naming errors in aphasia. A retrospective study on vascular patients

Impaired naming is a common finding in aphasia but while it is known that naming errors diminish over time, longitudinal studies are rare. In this retrospective study, naming errors of 84 vascular aphasic patients are studied. Errors in oral and written confrontation naming tasks in two successive evaluations are tabulated and coded into one of 10 error types. No Response, Word-Finding Difficulty, Semantic Paraphasia, Unrelated Paraphasia, Phonemic/Orthographic Paraphasia, Neologism, Paraphasic Jargon, Phonemic/Neologistic Jargon, Stereotypy, and Other. All analyses were carried out on the difference scores, that is, the score in the second examination minus the score in the first examination. Results indicate that there is a significant decrease of No Responses (in oral and written naming) and Neologisms (in oral naming), and a significant increase of Orthographic Paraphasias in written naming. Moreover, the difference score for Phonemic/Orthographic Paraphasias was higher in written than oral naming. The difference scores for the other types of error were not statistically significant.

[Value of CA 125 as a tumor marker in ovarian carcinoma]

Cancer antigen 125 (CA 125) is a high molecular weight antigenic glycoprotein. It is recognized in the serum by a monoclonal antibody. Rising of serum levels is most frequently observed in borderline and malignant serous ovary tumors. Occasionally other cancers show elevated levels of CA 125. Structure derived from the celomic epithelium can also show elevated levels of CA 125.

PURPOSE

Review the useful of CA 125 for diagnosis and follow-up of patients with ovarian carcinoma.

METHOD

To obtain the information, an extensive and up-to-date bibliographic review was done about this topic.

RESULTS

This tumor marker has an excelent sensibility although it is not especific. As it cannot develop tumors smaller than 1 cm, it is not indicated for populational screenings.

CONCLUSION

CA 125 is useful to follow-up of patients whose ovarian carcinoma had already been diagnosed and suffered surgery procedures followed for chemotherapy. In this cases CA 125 show the therapeutic response.