Ocular-motor profile and effects of memantine in a familial form of adult cerebellar ataxia with slow saccades and square wave saccadic intrusions

Fixation instability due to saccadic intrusions is a feature of autosomal recessive spinocerebellar ataxias, and includes square wave intrusions (SWI) and macrosaccadic oscillations (MSO). A recent report suggested that the non-competitive antagonist of NMDA receptors, memantine, could decrease MSO and improve fixation in patients with spinocerebellar ataxia with saccadic intrusions (SCASI). We similarly tested two sisters, respectively of 58 and 60 years, with an unrecognized form of recessive, adult-onset cerebellar ataxia, peripheral neuropathy and slow saccades, who showed prominent SWI and also complained with difficulty in reading. We tested horizontal visually guided saccades (10°–18°) and three minutes of steady fixation in each patient and in thirty healthy controls. Both patients showed a significant reduction of peak and mean velocity compared with control subjects. Large SWI interrupting steady fixation were prominent during steady fixation and especially following visually guided saccades. Eye movements were recorded before and during the treatment with memantine, 20 mg/daily for 6 months. The treatment with memantine reduced both the magnitude and frequency of SWI (the former significantly), but did not modified neurological conditions or saccade parameters. Thus, our report suggests that memantine may have some general suppressive effect on saccadic intrusions, including both SWI and MSO, thereby restoring the capacity of reading and visual attention in these and in other recessive forms of ataxia, including Friedreich’s, in which saccadic intrusions are prominent.

Respiratory failure and pharyngeal hematoma as presenting signs of Moschcowitz's syndrome: a case report and literature review

Moschcowitz's syndrome or thrombotic thrombocytopenic purpura is a quite rare pathology in childhood, being, as a matter of fact, more frequent among adult people. Often it is hard to distinguish from other pathologies in children both for its rare incidence and for the presence of clinical forms that are very heterogeneous and difficult to be classified. We report on a 13 year-old girl suffering from Moschcowitz's syndrome, in whom respiratory failure and pharyngeal hematoma were the first sign of the disease follone by jaundice, hematoma of the arm and limbs. The girl was treated with plasmapheresis with an improvement of her general condition. Since then we have followed up the girl for two years without any reappearance of the symptomatology. To our knowledge this is the first report of this peculiar presentation in children.

Dimethyl fumarate for relapsing MS

Dimethyl fumarate (DMF) is the latest oral therapy approved for relapsing-remitting multiple sclerosis (RRMS). In 2 placebo-controlled phase III trials, twice daily DMF demonstrated a 44%-53% reduction in annualized relapse rate and 71%-90% reduction in new MRI lesions. In one trial, DMF slowed the accumulation of disability, but not in the other trial. The main side effects of DMF include gastrointestinal symptoms (nausea, abdominal pain, vomiting, and diarrhea) and skin flushing, which peak at treatment initiation. There was no increased risk of opportunistic infections. Recommended safety monitoring includes complete blood count prior to treatment and annually while on treatment. Appealing aspects of DMF include potent efficacy, oral administration, and good safety and tolerability profiles. Altogether, DMF is an attractive option for first-line treatment, breakthrough disease activity, intolerance to other therapies, and possibly natalizumab-treated patients with positive JC virus serology.

The effect of the change from a herbage- to a concentrate-based diet on the oxidative stability of raw and cooked lamb meat

Over 89 days, 10 lambs (S) were fed concentrates and hay in stall, while 9 lambs (P) grazed at pasture. Two groups of 9 animals grazed at pasture until switching to a concentrate-based diet for 14 or 37 days before slaughter (P-S14 and P-S37). The fat content of longissimus dorsi muscle (LM) increased with increasing duration of concentrate feeding (P=0.05). As a consequence, the concentration of polyunsaturated fatty acids (PUFA) and of the highly peroxidisable (HP) PUFA in the polar lipids was similar between treatments. Lipid oxidation in fresh LM over 8 days of storage was affected by the diet (P<0.0005) with the P-S37 and P treatments producing, respectively, the highest and the lowest TBARS values. The P treatment reduced TBARS in cooked minced LM over 2 days of storage and no difference was found between the P-S14, P-S37 and S treatments. Colour stability of fresh LM was not noticeably affected by the dietary treatment.

Exacerbation of myasthenia gravis with voriconazole

INTRODUCTION

We describe a patient with stable generalized myasthenia gravis who presented with new onset severe ophthalmoplegia and ptosis after initiation of voriconazole for aspergillosis.

METHODS

Ligand-protein docking software was used to simulate the interaction of voriconazole with the acetylcholine receptor (AChR). We tested voriconazole binding to AChR in comparison to high affinity and neutral compounds.

RESULTS

There was no clinical improvement after intravenous immunoglobulin infusion and plasmapheresis. However, the patient improved slowly after withdrawal of voriconazole. Based on our results, voriconazole binds favorably to AChR and may putatively block muscle nicotinic AChRs. Other theoretical explanations include blocking potassium channels and reducing their intracellular trafficking.

CONCLUSIONS

The mechanisms involved in ocular exacerbation may be multi-factorial, reflecting the intricate dynamics of the neuromuscular junction. It is important to consider medications that harbor pyridine or pyrimidine moieties as potential causes of exacerbation in myasthenic patients, especially those who present with ocular symptoms.

Otorrhea in Kawasaki disease diagnosis complicated by an EBV infection: coincidental disease or a true association

The Authors report on two children affected by Kawasaki disease (KD). The diagnosis of KD was made after exclusion of conditions with similar presentation. At admission these children (cases 1 and 2) presented fever, purulent caseous pharyngotonsillitis, and cervical bilateral lymphadenopathy, as well as an erythematous non-vesicular rash over the face and trunk, and a mild bilateral non-exudative conjunctivitis in case 1. After respectively three and two days corticosteroid therapy was started without any significant improvement of the general condition and any diminutions of the fever. Two days later in case 1 the child presented a clear otorrhea, a cutaneous non vesicular rash, and soon after all the remaining signs of Kawasaki disease, in case 2 otorrhea was found after 4 days and then the other signs of the KD. These patients were treated with intravenous immunoglobulin (2 g/kg day), with an improvement of their general condition. To our knowledge we report the first cases of otorrhea in the setting of Kawasaki disease. We cannot exclude that the presence of Kawasaki disease in the context of otorrhea in children positive for Epstein-Barr virus (EBV) is merely coincidental. Besides, recent acquisitions show that KD is due to a new virus that could cross-react with the EBV. The Authors conclude that the presence of EBV infection or similar condition in a febrile child may not exclude Kawasaki disease and a differential diagnosis has to be performed for a timely commencement of intravenous immunoglobulin therapy.  

Procyanidins target mesenteric adipose tissue in Wistar lean rats and subcutaneous adipose tissue in Zucker obese rat

Visceral and subcutaneous adipose depots have different metabolic roles that may be involved in the development of obesity-related pathologies. Procyanidins have beneficial effects on insulin resistance, and they target adipose tissue. We analyse whether procyanidins exert different effects, depending on the adipose tissue depot, and whether these effects show a relation to the amount of phenolic compound in the tissue. We studied the effects of a grape seed procyanidin extract (GSPE) treatment at the transcriptional level on genes expressed differentially between mesenteric and subcutaneous adipose tissue depots and genes previously shown to be targets of procyanidins. Procyanidins target mesenteric adipose tissue in Wistar lean rats but subcutaneous adipose tissue in Zucker obese rats. Non-modified structures also accumulated, preferentially in the same respective tissues that were responsive to GSPE. Thus, procyanidins target and accumulate differently in mesenteric and subcutaneous adipose tissue depots, depending on the metabolic condition of the animal model.

Neuromuscular transmission failure in myasthenia gravis: decrement of safety factor and susceptibility of extraocular muscles

An appropriate density of acetylcholine receptors (AChRs) and Na(+) channels (NaChs) in the normal neuromuscular junction (NMJ) determines the magnitude of safety factor (SF) that guarantees fidelity of neuromuscular transmission. In myasthenia gravis (MG), an overall simplification of the postsynaptic folding secondary to NMJ destruction results in AChRs and NaChs depletion. Loss of AChRs and NaChs accounts, respectively, for 59% and 40% reduction of the SF at the endplate, which manifests as neuromuscular transmission failure. The extraocular muscles (EOM) have physiologically less developed postsynaptic folding, hence a lower baseline SF, which predisposes them to dysfunction in MG and development of fatigue during "high performance" eye movements, such as saccades. However, saccades in MG show stereotyped, conjugate initial components, similar to normal, which might reflect preserved neuromuscular transmission fidelity at the NMJ of the fast, pale global fibers, which have better developed postsynaptic folding than other extraocular fibers.

Intravenous Immunoglobulin Therapy When Plasmapheresis Fails in Thrombotic Thrombocytopenic Purpura Associated with Severe ADAMTS 13 Deficiency in Childhood: A Case Report

Thrombotic thrombocytopenic purpura (TTP) is a disorder of the blood-coagulation system, causing extensive microscopic clots to form in the small blood vessels throughout the body. TTP is quite a rare pathology in childhood, being more frequent among adults. Often it is hardly to distinguish from other haematological pathologies in children both for its uncommon incidence and for the presence of clinical forms that are heterogeneous and difficult to classify. We report the case of an 11-year-old girl suffering from TTP, in whom the study of metallo-protease ADAMST 13 showed a low value (<10%) with positive anti-ADAMTS 13 Ig G and inhibitor, strengthening the hypothesis of autoimmune genesis. The girl was initially treated with cycles of plasmapheresis with both poor compliance and benefit for the girl and later treated with IV Immunoglobulin. This last treatment resulted in a rapid improvement of the symptomatology and no reappearance of the clinical signs at four-year follow-up.

Dietary olive cake reduces the oxidation of lipids, including cholesterol, in lamb meat enriched in polyunsaturated fatty acids

Over 40 days, lambs were fed: concentrate (C), concentrate containing 20% linseed (L), concentrate containing 35% olive cake (OC), or concentrate containing 10% linseed and 17% olive cake (OCL). The polyunsaturated fatty acids (PUFA) and peroxidation index (PI) in phospholipids were increased by the L and OCL treatments (P=0.007 and P=0.003, respectively). The OC and OCL diets increased the concentration of tocopherol in muscle (P<0.001). Compared to the OC and OCL diet, the L diet increased fatty acid oxidation, measured as conjugated dienes (CD; P=0.003), peroxides (PV; P<0.001) and TBARS (P=0.002) in minced muscle over 11 days of storage in high-oxygen atmosphere. Also, the L diet increased (P<0.001) the levels cholesterol oxidation products (COPs). In conclusion, feeding olive cake improved the oxidative stability of lamb meat and the combination of olive cake and linseed improved the fatty acid composition of meat without compromising its oxidative stability.

Tracheostomy in childhood: new causes for an old strategy

INTRODUCTION

A review of the available literature has shown that the indications, epidemiology, and complications for tracheostomies are changing, and that no definite guidelines have been established. In the 1970s, the most common indication for tracheostomies in children was acute inflammatory airway obstruction. Modern neonatal intensive care units (ICU) have turned long-term intubation into an alternative to a tracheostomy. Currently, long-term intubation has become the most important indication for tracheostomies in children.

PATIENTS AND METHODS

We present our series involving tracheostomies performed in paediatric patients between 2004 and 2008 at our hospital. Sixteen patients underwent tracheostomies for respiratory failure and upper airway obstruction.

RESULTS

The total complications rate was 37.5%. In children < 1 year of age, the complications rate was 25%, while in children > 1 year of age, the complications rate was 12.5%.

CONCLUSIONS

Long-term intubation and its sequelae have now become one of the most important indications for tracheostomies in the paediatric age group.

Shared Copy Number Variation in Simultaneous Nephroblastoma and Neuroblastoma due to Fanconi Anemia

Concurrent emergence of nephroblastoma (Wilms Tumor; WT) and neuroblastoma (NB) is rare and mostly observed in patients with severe subtypes of Fanconi anemia (FA) with or without VACTER-L association (VL). We investigated the hypothesis that early consequences of genomic instability result in shared regions with copy number variation in different precursor cells that originate distinct embryonal tumors. We observed a newborn girl with FA and VL (aplasia of the thumbs, cloacal atresia (urogenital sinus), tethered cord at L3/L4, muscular ventricular septum defect, and horseshoe-kidney with a single ureter) who simultaneously acquired an epithelial-type WT in the left portion of the kidney and a poorly differentiated adrenal NB in infancy. A novel homozygous germline frameshift mutation in PALB2 (c.1676_c1677delAAinsG) leading to protein truncation (pGln526ArgfsX1) inherited from consanguineous parents formed the genetic basis of FA-N. Spontaneous and induced chromosomal instability was detected in the majority of cells analyzed from peripheral lymphocytes, bone marrow, and cultured fibroblasts. Bone marrow cells also showed complex chromosome rearrangements consistent with the myelodysplastic syndrome at 11 months of age. Array-comparative genomic hybridization analyses of both WT and NB showed shared gains or amplifications within the chromosomal regions 11p15.5 and 17q21.31-q25.3, including genes that are reportedly implicated in tumor development such as IGF2, H19, WT2, BIRC5, and HRAS.

[Cardiovascular risk among firefighters]

Firefighting is a high-hazard job for hearth disease, smoke exposure, physical exertion, psychological stressors and noise increase cardiovascular risk among fire fighters. In U.S.A. during the period 1984-2011 45% of on-duty fire fighter fatalities were due to sudden cardiac death. However numerous mortality studies have not shown consistent evidence of an increased risk of cardiovascular diseases. In Italy fire fighters, burdened with elevated cardiovascular risk and psycho-physical demand, have entry-level and periodic medical evaluations. For these workers wellness/fitness programs, strategies aimed to reduce cardiovascular risk factors and fitness evaluations to ensure that are physically capable of performing the essential job tasks of their profession should be encouraged.