A case of short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT). Discussion of clinical features and differential diagnosis

Chronic short–lasting headaches, in which trigeminal autonomic cephalalgias (TACs) are included, are relatively rare syndromes and not always well recognised. We present a case highly suggestive of short–lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) and we try to affirm essential points to distinguish the diagnosis from other TACs and chronic short–lasting headaches. We conclude that the qualifying points for differential diagnosis are number and duration of attacks in a day, presence of autonomic features and lack of indomethacin effect.

Effects of long-term dumping of harbor-dredged material on macrozoobenthos at four disposal sites along the Emilia-Romagna coast (Northern Adriatic Sea, Italy)

Sediment from harbors of the Emilia-Romagna (Northern Adriatic Sea) were dredged and dumped in four disposal areas characterized by muddy bottoms. The long-term effects of the dumping on macrozoobenthic communities were investigated before and after 6 month, 8 month, 2 years and 4 years. The disposal of dredged material did not influence the granulometry and %TOC in the sediment, and no alterations in the structure of the macrobenthic communities were observed in the four areas. The lack of impact could be ascribed to the environmental characteristics and precautionary measures taken to minimize the effects of the dumping. It appears that: (1) the communities of the dumping areas are well adapted to unstable environments; (2) the sediments were disposed gradually and homogeneously over relatively large areas; Other factors that help to reduce the impact of sediment disposal are the low concentrations of contaminants in dredged materials and the similarity of sediment in the dredged and disposal areas. Off-shore discharge appears a sustainable strategy for the management of uncontaminated dredged sediments from the Northern Adriatic Sea harbors.

Validity and Reliability of the Italian Version of the Quality of Life, Enjoyment and Satisfaction Questionnaire

The Quality of Life, Enjoyment and Satisfaction Questionnaire (Q-LES-Q) is increasingly used in psychiatry because it gives emphasis to the subjective perspective of patients on physical, psychological and social domains. This paper reports on the validation of the Italian version of the Q-LES-Q in a large multicenter study (EQUIP) conducted at five Italian sites on outpatients in treatment for anxiety disorders. Study participants underwent a broad assessment of psychopathology including the MINI-International Neuropsychiatric Interview, the Symptom Checklist (SCL-90) and the Clinical Global Impression (CGI). Cronbach's alpha was used to determine the internal consistency of the Q-LES-Q areas and Pearson's r was used to analyze the correlation between the areas of Q-LES-Q and those of the other instruments. The internal consistency of the Q-LES-Q proved to be substantial (>0.80 in each of the areas) as well as the test-retest reliability. The convergent validity of the Q-LES-Q vs. the Work and Social Adjustment Scale was examined. High correlations were found between scales measuring similar constructs in the two instruments and lower correlation between scales measuring different constructs. In conclusion, the Italian version of the Q-LES-Q proved to be as valid and reliable as the original English version.

The effects of sand extraction on the macrobenthos of a relict sands area (northern Adriatic Sea): results 12 months post-extraction

Sands for the nourishment of beaches along the Emilia-Romagna coast (northern Adriatic Sea) were dredged from an offshore area characterised by relict sands formed during the last Adriatic post-glacial transgression. The short-term effects of the sand extraction on macrozoobenthic communities were investigated before, during and 1, 6 and 12 months after dredging at three impacted stations and seven control stations. Sand extraction activities did not significantly influence the granulometry and %TOC in the sediment but caused almost complete defaunation at dredging stations. Yet, just 12 months after the extraction, the recolonisation of communities at the impacted stations was at an advanced stage. Unlike other studies on the effects of extraction of marine sand, no significant settlement of opportunistic species was observed. The limited impact of the sand extraction operation on the physical characteristics of the sediment and hydrological-sedimentary characteristics in the relict sand area should aid its rapid recovery and the restoration of the original community in a short period of time (2-4 years after dredging).

Cognitive and affective status in mild hypothyroidism and interactions with L-thyroxine treatment

OBJECTIVES

While clinical hypothyroidism is associated with frank neuropsychological and affective alterations and is considered one of the causes of reversible dementia, the occurrence of these alterations and their treatment in mild hypothyroidism (MH) remains a controversial issue. Our aim was therefore to evaluate cognitive and psychological functions in a selected population of recently-diagnosed MH patients with minor subjective symptoms.

MATERIALS AND METHODS

Thirty-six MH women (mean age 51.9 +/- 13.5 years) were observed after a careful assessment had excluded subjects with neurological, psychiatric and/or somatic disorders, or confounding conditions. The subjects were evaluated for thyroid function and tested with an extensive battery of neuropsychological tests and psychological rating scales, in basal conditions and after 6 months of L-thyroxine treatment.

RESULTS

Baseline neuropsychological performance was within the normal range, while an age-dependent reduction was found in attentive function. After L-thyroxine treatment, an increase in serum fT4 was detected in parallel with thyroid stimulating hormone (TSH) reduction. Verbal fluency and depression scores showed a slight improvement. A positive correlation was found between TSH reduction and improved mood scores.

CONCLUSION

From the analysis of the results, treatment of asymptomatic MH would seem advisable in order to re-set hormonal levels and, particularly in older subjects, to protect the brain against the potential risk of cognitive and affective dysfunctions.

Contribution of the initial features of systemic lupus erythematosus to the clinical evolution and survival of a cohort of Mediterranean patients

BACKGROUND

Systemic lupus erythematosus has a wide spectrum of immunological and clinical manifestations. Its course is characterised by exacerbations which may result in mortality or morbidity to vital organs/systems.

OBJECTIVE

To determine clear and early prognostic markers to avoid further complications.

METHODS

245 adult patients diagnosed between January 1978 and March 2001 were studied. Clinical manifestations and laboratory findings both at onset and during the clinical course were collected. The number, type, and severity of the flares were also noted. Statistical analyses between disease features at onset, subsequent flares, and mortality were performed.

RESULTS

239 patients entered the study. Their mean age at onset was 30 years. The mean time between onset and diagnosis was 36 months and the mean evolution time was 114 months. 205 patients developed 915 flares; 205 (22.4%) of these flares were major flares, and affected 110 patients. Cardiac, neurological, or renal affection at onset were associated with a higher probability of developing cardiac (p=0.022), neurological (p<0.001), and renal (p<0.001) exacerbations, respectively, during the evolution. Lupus anticoagulant (LA) and anticardiolipin antibodies (aCL) were predictors of stroke (aCL, p=0.000; LA, p=0.001). Age at diagnosis (p=0.003) and valvular disease at onset (p=0.008) were independent predictors of low survival.

CONCLUSIONS

Renal, cardiac, or neurological involvement and the presence of LA or aCL positivity at onset were predictors of renal, cardiac, or neurological flares, respectively. Age and valvular involvement at onset were found to be independent adverse outcome predictors for low survival.

Pelvic floor dyssynergia and psychiatric disorders. Does the snake bite its tail?

AIM

Psychological and/or psychiatric disorders (PSY) and functional gastrointestinal disorders (FGID) are often linked. Pelvic floor dyssynergia (PFD) is one of the most frequent FGID, but few studies have investigated its possible relationship with PSY. The aim of the present study was to evaluate whether an increased prevalence of PSY, and of what types, exist in patients affected with PFD.

METHODS

Thirty-four female patients PFD and 34 age- and gender-matched control subjects were evaluated. The prevalence rates of axis I psychiatric disorders (DSM IV) and of pathological temperaments (Schneider-Akiskal criteria) were determined.

RESULTS

PSY were detected in 29 patients (85.3%) and in 11 controls (32.3%), (p=0.000). A family load was present in 7 patients (20.6%) and in 2 controls (5.9%), (NS). Sixteen patients (47.0%) and no control subjects were diagnosed as having axis I psychiatric disorders (p=0.000); anxiety disorders were the most frequently represented condition. A pathological temperament was found in 28 patients (82.3%) (primarily the phobic-anxious temperament) and in 11 control subjects (32.3%),(p=0.000).

CONCLUSIONS

This study shows that there is a higher prevalence of PSY in PFD patients than in controls in particular, anxiety disorders and the phobic-anxious temperament. We would recommend that a psychiatric evaluation be carried out in patients with PFD, especially before starting rehabilitation therapy for obstructed defecation, as the presence of psychiatric disorders could alter the course and decrease the efficacy of such a rehabilitation program.

Heparin mobilizes xanthine oxidase and induces lung inflammation in acute pancreatitis

OBJECTIVE

To evaluate the effect of low molecular weight heparin on plasma xanthine oxidase concentrations and lung inflammatory response during acute pancreatitis.

DESIGN

Randomized, controlled trial.

SETTING

Experimental laboratory.

SUBJECTS

Male Wistar rats.

INTERVENTIONS

Acute pancreatitis was induced by intraductal administration of 5% sodium taurocholate. Low molecular weight heparin (0, 30, 90, or 300 units/kg) was administered immediately after induction of pancreatitis.

MEASUREMENTS AND MAIN RESULTS

Lipase and xanthine oxidase plasma concentrations were measured 3 hrs after pancreatitis induction. Expression of P-selectin messenger RNA and myeloperoxidase activity as a marker of neutrophil infiltration were determined in the lung. An increase in xanthine oxidase plasma concentrations was observed during pancreatitis. Administration of heparin also increased plasma xanthine oxidase activity in both control and pancreatitis animals. Measures of xanthine oxidase present in the endothelial surface indicate that during pancreatitis, the enzyme is released from the gastrointestinal endothelium. By contrast, heparin mobilizes xanthine oxidase from almost all organs evaluated. Neutrophil infiltration was increased in the lung during pancreatitis. Heparin administration further increased, in a dose-dependent manner, myeloperoxidase activity and P-selectin expression in the lung in animals with pancreatitis. By contrast, in control animals, heparin had no effect on myeloperoxidase activity and did not induce P-selectin up-regulation.

CONCLUSION

During acute pancreatitis, heparin administration might mobilize xanthine oxidase attached to endothelial cells, originating a free radical-generating system in the circulation that would trigger an inflammatory response in the lung.

Prevalence of macroprolactin detected by Elecsys 2010

BACKGROUND

Macroprolactin or big-big PRL is, usually, a complex of little prolactin (PRL) with anti-PRL autoantibody. There are some patients with hyperprolactinemia showing a high proportion of serum macroprolactin. However, its clinical significance is not clear. Immunoassays used to determine PRL differ in their ability to detect macroprolactin. Moreover, in recent years, PRL assays have changed from isotopic methods (radioimmunoassays and immunoradiometric assays) to non-isotopic automated immunoassays. The effect of macroprolactin on currently used methods is often unknown. The aim of this work was to study the different reactivity of macroprolactin in two immunoassays systems, Elecsys 2010 and ACS Centaur, and to assess the clinical repercussion of this condition.

METHODS

We studied retrospectively 956 consecutive routine patients. Samples with a PRL value >636 mIU/l (211 samples) were subjected to the polyethylene glycol (PEG) precipitation test to detect macroprolactin, and 2 of them also to gel filtration chromatography for further confirmation. PRL was measured by Elecsys 2010 and, alternatively, by ACS Centaur.

RESULTS

By Elecsys 2010, macroprolactin was detected in 19 patients (9%). After removing macroprolactin, PRL levels were within the normal range in every case but one. When original sera from patients with macroprolactin were processed with ACS Centaur. PRL levels were normal or only marginally elevated. The correlation of PRL values in samples with and without macroprolactin assayed by both systems was 0.64 and 0.98, respectively.

CONCLUSIONS

Nearly 9% of hyperprolactinemic patients detected by Elecsys 2010 may have macroprolactin, but the detection rate obtained using ACS Centaur is much lower. As macroprolactin seems to have minimal clinical relevance, it would be important that the users of PRL assays be aware to what extent macroprolactin interferes with their assays, and have available a validated method, such as the PEG precipitation test, to confirm the presence of macroprolactin.

[Hypoglycemia insulin test in the assessment of the hypothalamic-pituitary-adrenal function]

BACKGROUND

Recent advances in sensitivity and specificity of hormone immunoanalysis and their automatization have brought about changes in clinical laboratories that led us to review the need for some endocrine dynamic tests. The specific aim of this study was to determine the basal cortisol values predicting a normal or impaired response to the insulin hypoglycemia test (ITT).

SUBJECTS AND METHOD

We retrospectively analysed cortisol responses to ITT in 320 subjects. Moreover, we studied the impact the use of a new strategy has on economic cost, by means of a relative value unit (RVU) calculation.

RESULTS

No patient with a basal cortisol < 6 g/dl (13%) responded to the test whereas all those with a basal cortisol > 18 g/dl responded in full. The rest of patients exhibited a basal cortisol level between 6-18 g/dl, 39% of them responding and 16% showing an inadequate response. Baseline and peak cortisol concentrations were strongly correlated (r = 0.74; p < 0.0001). The cost of ITT was 131.6 RVU as compared to 17.8 RVU for cortisol.

CONCLUSIONS

Basal cortisol levels below 6 g/dl or above 18 g/dl make the test unnecessary. Cortisol measurement by automated methods, along with subsequent reduced assay times, allows us to apply new diagnosis strategies. Considering that the cost of ITT is 15 fold higher than that of single cortisol measurement, the potentially generated saving is significant.

Antiphosphatidylethanolamine antibodies contribute to the diagnosis of antiphospholipid syndrome in patients with systemic lupus erythematosus

OBJECTIVE

To evaluate the correlation between antiphosphatidylethanolamine antibodies (aPE) and some antiphospholipid antibodies (aPL)-related clinical manifestations in patients with systemic lupus erythematosus (SLE).

METHODS

Patients with SLE (n=217) were tested for the presence of aPE, anticardiolipin antibodies (aCL), and lupus anticoagulant (LA). The prospective aPL-related clinical manifestations studied were: thrombosis, thrombocytopenia, recurrent fetal losses, heart valvulopathies, hemolytic anemia, livedo reticularis, and pulmonary hypertension.

RESULTS

A total of 109 SLE patients (50.23%) were IgG aPE-positive; 17.51% presented aPE as the sole autoantibody and had some clinical features of aPL-related clinical manifestations. IgG aPE were associated to the presence of heart valvulopathies (p=0.002). A statistical difference was also found when considering high levels of IgG aPE (O.D.>0.600) in patients with livedo reticularis (p=0.008).

CONCLUSION

The evaluation of IgG aPE may allow us to detect some more patients with aPL-related clinical manifestations in the SLE population, aPE correlated particularly with valvulopathies and livedo reticularis.

Intact cross-modality text-specific repetition priming in patients with Alzheimer's disease

This study was aimed at investigating the basic mechanisms of the normal repetition priming evoked by text re-reading procedures in Alzheimer's disease (AD) patients (Monti, Gabrieli, Wilson, & Reminger, 1994; Monti et al., 1997). For this purpose, we contrasted the reading facilitation elicited by previous reading or listening to a text in a sample of AD patients and a group of age-matched normal controls. Consistent with previous evidence in normal undergraduates (Levy & Kirsner, 1989), previous listening to a text decreased the successive reading time of the same text (cross-modality priming). However, the reading facilitation elicited by previous reading of the same text (within-modality priming) was significantly larger than the facilitation evoked by previous listening. Compared to normal controls, AD patients showed intact cross-modality and within-modality priming. These data are discussed in the light of alternative hypotheses regarding the basic mechanisms of impaired and spared repetition priming in degenerative demented patients.

Evaluation of inlay butterfly cartilage tympanoplasty: a randomized clinical trial

OBJECTIVES/HYPOTHESIS

In 1998 Eavey described a new inlay technique for tympanoplasty in the pediatric age group using a cartilage graft through a transcanal approach. This technique was found to be effective and comfortable (no external canal incisions or ear packing). This study evaluated the efficacy of modified-inlay cartilage tympanoplasty compared with the conventional underlay tympanoplasty.

STUDY DESIGN

Randomized clinical trial.

METHODS

Patients were enrolled from December 1998 to March 2000. Seventy tympanoplasties were done in adults with medium-sized tympanic membrane (TM) perforations: 34 inlay tympanoplasties and 36 underlay tympanoplasties (control group). The main outcome measures were the "take rate" on the 30th postoperative day and the audiometric result at the second postoperative month. Secondary outcome measures include subjective postoperative hearing, postoperative pain, duration of surgery, and cost of the procedures.

RESULTS

The "take rate" did not differ between groups on the 30th postoperative day (88.2% in the inlay tympanoplasty group vs 86.1% in the underlay tympanoplasty group; P =.8). After a mean follow-up of 7.5 +/- 3.8 months (range, 3-16 mo), the "take rate" was 85.3% in the inlay tympanoplasty group and 83.3% in the underlay tympanoplasty group (P =.8). In the inlay tympanoplasty group there was closure of the air-bone gap (ABG) to within 10 dB in 64.7% and to within 20 dB in 94.1%. The corresponding numbers to underlay tympanoplasty were 75% and 97.2%. In only 2 cases (5.9%) in the inlay tympanoplasty group and in 1 case (2.8%) in the underlay tympanoplasty group the ABG was greater than 20 dB. No audiometric difference was observed between groups (P =.6). Most patients in the inlay tympanoplasty group reported immediate improvement in their hearing (P <.0001). Pain was reported by 10 patients in the inlay tympanoplasty group and by 30 patients in the underlay tympanoplasty group on the first postoperative day (P <.0001). The duration of the surgery (mean +/- standard deviation) was 33.6 +/- 7.8 minutes for the inlay tympanoplasty group and 62.9 +/- 12.7 minutes for the underlay tympanoplasty group (P <.0001). The estimated charge for inlay tympanoplasty at our institution was 65% less expensive than underlay tympanoplasty.

CONCLUSION

The "take rate" and audiometric results following inlay cartilage tympanoplasty or underlay tympanoplasty were similar. Inlay butterfly cartilage tympanoplasty did not require general anesthesia, was less expensive, and more comfortable to the patient.

Coronally advanced flap procedure: is the interdental papilla a prognostic factor for root coverage?

BACKGROUND

This study was designed to verify if the dimension of the interdental papilla may be a prognostic factor for the clinical outcome of the coronally advanced flap (CAF) in the treatment of gingival recessions.

METHODS

Thirty-three Miller Class I recessions were treated in 33 patients using the CAF procedure. Two types of measurements were performed: 1) clinical measurements (probing depth, recession depth, width of keratinized tissue, clinical attachment level) were recorded at baseline and 3 months after surgery and 2) all recessions were photographed and transformed into computer images. A specific software allowed recording of both linear and square measurements. The following digital measurements were recorded at baseline: 1) base, height, and area of the mesial and distal papillae adjacent to the involved tooth and 2) width/depth of the recession and the area of the exposed root surface of the involved tooth. The residual recession area, if any, was recorded 3 months after surgery. The digital measurements of the height and of the area of the papilla were used in statistical analysis (multiple linear regression and logistic regression) to evaluate a possible correlation with root coverage (mm2) and/or with complete root coverage.

RESULTS

Root coverage was not significantly correlated to the papilla area (P= 0.3692) or to papilla height (P= 0.0968). The complete root coverage was not correlated to the papilla area (P= 0.3181), but it was correlated to papilla height (P= 0.0499).

CONCLUSIONS

This study indicates that the root coverage following CAF procedure is not significantly correlated to papilla dimension. However, complete root coverage is significantly more frequent in sites with lower height of the adjacent papilla.

Expression and activation of a C-terminal truncated isoform of STAT5 (STAT5 Delta) following interleukin 2 administration or AZT monotherapy in HIV-infected individuals

Intermittent administration of recombinant interleukin-2 (rIL-2) to individuals infected with human immunodeficiency virus (HIV) has been shown to raise and maintain the absolute number of circulating CD4(+) T cells to normal or near normal levels. One of the signaling pathways triggered by IL-2 is the Janus kinase-signal transducer and activator of transcription (JAK-STAT). In particular, IL-2 activates the tyrosine kinases JAK1 and JAK3 and the transcription factors STAT3 and STAT5. We have previously observed that most HIV(+) individuals, unlike healthy seronegative controls, show a constitutive activation of STAT1 and a C-terminal truncated isoform of STAT5 (STAT5 Delta). In the present study, we have analyzed the protein level and activation state of STAT5 isoforms expressed in peripheral blood mononuclear cells of two HIV-infected individuals who showed a good or a poor response to intermittent IL-2 administration, respectively, and of a single individual before and after initiation of Zidovudine monotherapy. We provide evidence that both therapeutic interventions enhanced the expression and activation of the C-terminal truncated isoform of STAT5 (STAT5 Delta) in vivo.

The effects of allopurinol in hepatic ischemia and reperfusion: experimental study in rats

BACKGROUND/AIMS

Some studies have shown that postischemic hepatic dysfunction is mainly due to oxygen free radicals that are generated by xanthine oxidase. The present study was undertaken to determine the effect of allopurinol, an inhibitor of xanthine oxidase, on oxidative stress, liver injury and histologic alterations induced by hepatic ischemia-reperfusion in rats.

METHODS

One hundred and sixty Wistar rats were used and divided into three groups. Group 1: sham operation; group 2: 50 min of ischemia followed by 1 h of reperfusion, and group 3: pretreatment with allopurinol and 50 min of ischemia followed by 1 h of reperfusion. The effect of allopurinol was evaluated by plasma levels of alanine aminotransferase and aspartate aminotransferase, histopathologic studies, and lipid peroxidation measured by the thiobarbituric acid reactive substances method and chemiluminescence initiated by tert-butyl hydroperoxide technique.

RESULTS

Ischemia followed by reperfusion promoted an increase in lipid peroxidation of the hepatic cells when compared to the sham-operated group (p<0.05). This increase was attenuated in the group treated with allopurinol (p< 0.05). Allopurinol also showed a protective effect on hepatocellular necrosis (p<0.05), and the plasma levels of liver enzymes returned earlier to the normal range in rats pretreated with allopurinol in comparison to those that did not receive the drug (p<0.05).

CONCLUSIONS

Allopurinol exerted a protective effect on hepatic ischemia and reperfusion in rats. The administration of this drug prior to liver operations should be considered to be submitted to trials in humans.

Panic-agoraphobic spectrum: reliability and validity of assessment instruments

DSM IV is a simple, reliable diagnostic system with many advantages. However, DSM diagnostic criteria may not provide sufficient characterization of clinically significant symptoms. We have undertaken a project to assess an array (spectrum) of clinical features associated with different DSM Disorders. The purpose of this paper is to report on reliability of assessment instruments for Panic-Agoraphobic Spectrum (PAS), to document convergent validity of PAS symptom groupings, and to confirm the relationship between PAS and DSM IV Panic Disorder (PD). We studied 22 normal controls and 95 outpatients who met criteria for Panic Disorder with and without lifetime Major Depression, and Major Depression or Obsessive Compulsive Disorder without lifetime Panic Disorder. Assessment instruments had excellent reliability and there was good concordance between interview and self-report formats. PAS scores were highest in subjects with PD, followed by outpatients without PD, and were lowest in normal controls. PAS scores varied among PD patients, and a subgroup of patients without PD scored high on PAS. We conclude that PAS can be reliably assessed, and that it describes a valid, coherent constellation of features associated with DSM IV Panic Disorder, but providing additional important clinical information.