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Schneider C, Zangrandi A, Sollmann N, Bonfert MV, Beaulieu LD. Checklist on the Quality of the Repetitive Peripheral Magnetic Stimulation (rPMS) Methods in Research: An International Delphi Study. Front Neurol 2022; 13:852848. [PMID: 35392633 PMCID: PMC8981720 DOI: 10.3389/fneur.2022.852848] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/28/2022] [Indexed: 12/24/2022] Open
Abstract
An increasing number of clinical research studies have used repetitive peripheral magnetic stimulation (rPMS) in recent years to alleviate pain or improve motor function. rPMS is non-invasive, painless, and administrated over peripheral nerve, spinal cord roots, or a muscle using a coil affixed to the skin and connected to a rapid-rate magnetic stimulator. Despite the clinical impact and scientific interest, the methodological inconsistencies or incomplete details and findings between studies could make the rPMS demonstration difficult to replicate. Given the lack of guidelines in rPMS literature, the present study aimed at developing a checklist to improve the quality of rPMS methods in research. An international panel of experts identified among those who had previously published on the topic were enrolled in a two-round web-based Delphi study with the aim of reaching a consensus on the items that should be reported or controlled in any rPMS study. The consensual rPMS checklist obtained comprises 8 subject-related items (e.g., age, sex), 16 methodological items (e.g., coil type, pulse duration), and 11 stimulation protocol items (e.g., paradigm of stimulation, number of pulses). This checklist will contribute to new interventional or exploratory rPMS research to guide researchers or clinicians on the methods to use to test and publish rPMS after-effects. Overall, the checklist will guide the peer-review process on the quality of rPMS methods reported in a publication. Given the dynamic nature of a consensus between international experts, it is expected that future research will affine the checklist.
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Affiliation(s)
- Cyril Schneider
- Noninvasive Stimulation Laboratory (NovaStim), Neuroscience Division, Research Center of CHU de Québec-Université Laval, Quebec City, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- *Correspondence: Cyril Schneider
| | - Andrea Zangrandi
- Noninvasive Stimulation Laboratory (NovaStim), Neuroscience Division, Research Center of CHU de Québec-Université Laval, Quebec City, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Michaela Veronika Bonfert
- Division of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Munich, Germany
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Allen Demers F, Zangrandi A, Schneider C. Theta-Burst Stimulation of Forearm Muscles in Patients With Complex Regional Pain Syndrome: Influence on Brain and Clinical Outcomes. Front Pain Res 2021; 2:736806. [PMID: 35295471 PMCID: PMC8915654 DOI: 10.3389/fpain.2021.736806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: Complex regional pain syndrome (CRPS) is a common pain condition characterized by the changes in the brain that are not yet addressed by conventional treatment regimens. Repetitive peripheral magnetic stimulation (rPMS) of muscles is painless and non-invasive and can influence these changes (the induction of brain plasticity) to reduce pain and improve motricity. In patients with CRPS, this open-label pilot study tested rPMS after-effects on the pain intensity and sensorimotor control of the upper limb along with the excitability changes of the primary motor cortex (M1). Methods: Eight patients with CRPS were enrolled in a single-session program. Patients were tested at pre- and post-rPMS over the flexor digitorum superficialis (FDS) muscle. The clinical outcomes were pain intensity, proprioception, active range of motion (ROM), and grip strength. M1 excitability was tested using the single- and paired-pulse transcranial magnetic stimulation (TMS) of M1. Results: In our small sample study, rPMS reduced instant and week pain, improved proprioception and ROM, and reduced the hemispheric imbalance of several TMS outcomes. The more M1 contralateral to the CRPS side was hyperactivated at baseline, the more pain was reduced. Discussion: This open-label pilot study provided promising findings for the use of rPMS in CRPS with a focus on M1 plastic changes. Future randomized, placebo-controlled clinical trials should confirm the existence of a causal relationship between the TMS outcomes and post-rPMS decrease of pain. This will favor the development of personalized treatments of peripheral non-invasive neurostimulation in CRPS.
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Affiliation(s)
- Fannie Allen Demers
- Noninvasive Stimulation Laboratory (NovaStim), Quebec City, QC, Canada
- Neuroscience Division of Centre de Recherche du CHU of Québec – Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Andrea Zangrandi
- Noninvasive Stimulation Laboratory (NovaStim), Quebec City, QC, Canada
- Neuroscience Division of Centre de Recherche du CHU of Québec – Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Cyril Schneider
- Noninvasive Stimulation Laboratory (NovaStim), Quebec City, QC, Canada
- Neuroscience Division of Centre de Recherche du CHU of Québec – Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- Department of Rehabilitation, Université Laval, Quebec City, QC, Canada
- *Correspondence: Cyril Schneider
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Zangrandi A, Allen Demers F, Schneider C. Complex Regional Pain Syndrome. A Comprehensive Review on Neuroplastic Changes Supporting the Use of Non-invasive Neurostimulation in Clinical Settings. Front Pain Res (Lausanne) 2021; 2:732343. [PMID: 35295500 PMCID: PMC8915550 DOI: 10.3389/fpain.2021.732343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Complex regional pain syndrome (CRPS) is a rare debilitating disorder characterized by severe pain affecting one or more limbs. CRPS presents a complex multifactorial physiopathology. The peripheral and sensorimotor abnormalities reflect maladaptive changes of the central nervous system. These changes of volume, connectivity, activation, metabolism, etc., could be the keys to understand chronicization, refractoriness to conventional treatment, and developing more efficient treatments. Objective: This review discusses the use of non-pharmacological, non-invasive neurostimulation techniques in CRPS, with regard to the CRPS physiopathology, brain changes underlying chronicization, conventional approaches to treat CRPS, current evidence, and mechanisms of action of peripheral and brain stimulation. Conclusion: Future work is warranted to foster the evidence of the efficacy of non-invasive neurostimulation in CRPS. It seems that the approach has to be individualized owing to the integrity of the brain and corticospinal function. Non-invasive neurostimulation of the brain or of nerve/muscles/spinal roots, alone or in combination with conventional therapy, represents a fertile ground to develop more efficient approaches for pain management in CRPS.
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Affiliation(s)
- Andrea Zangrandi
- Noninvasive Neurostimulation Laboratory (NovaStim), Quebec City, QC, Canada
- Neuroscience Division of Centre de Recherche du CHU of Québec, Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Fannie Allen Demers
- Noninvasive Neurostimulation Laboratory (NovaStim), Quebec City, QC, Canada
- Neuroscience Division of Centre de Recherche du CHU of Québec, Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Cyril Schneider
- Noninvasive Neurostimulation Laboratory (NovaStim), Quebec City, QC, Canada
- Neuroscience Division of Centre de Recherche du CHU of Québec, Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- Department Rehabilitation, Université Laval, Quebec City, QC, Canada
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Zangrandi A, D'Alonzo M, Cipriani C, Di Pino G. Neurophysiology of slip sensation and grip reaction: insights for hand prosthesis control of slippage. J Neurophysiol 2021; 126:477-492. [PMID: 34232750 PMCID: PMC7613203 DOI: 10.1152/jn.00087.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Sensory feedback is pivotal for a proficient dexterity of the hand. By modulating the grip force in function of the quick and not completely predictable change of the load force, grabbed objects are prevented to slip from the hand. Slippage control is an enabling achievement to all manipulation abilities. However, in hand prosthetics, the performance of even the most innovative research solutions proposed so far to control slippage remain distant from the human physiology. Indeed, slippage control involves parallel and compensatory activation of multiple mechanoceptors, spinal and supraspinal reflexes, and higher-order voluntary behavioral adjustments. In this work, we reviewed the literature on physiological correlates of slippage to propose a three-phases model for the slip sensation and reaction. Furthermore, we discuss the main strategies employed so far in the research studies that tried to restore slippage control in amputees. In the light of the proposed three-phase slippage model and from the weaknesses of already implemented solutions, we proposed several physiology-inspired solutions for slippage control to be implemented in the future hand prostheses. Understanding the physiological basis of slip detection and perception and implementing them in novel hand feedback system would make prosthesis manipulation more efficient and would boost its perceived naturalness, fostering the sense of agency for the hand movements.
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Affiliation(s)
- Andrea Zangrandi
- Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction (NeXTlab), Università Campus Bio-Medico di Roma, Rome, Italy
| | - Marco D'Alonzo
- Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction (NeXTlab), Università Campus Bio-Medico di Roma, Rome, Italy
| | - Christian Cipriani
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Department of Excellence in Robotics & A.I., Scuola Superiore Sant'Anna, Pisa, Italy
| | - Giovanni Di Pino
- Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction (NeXTlab), Università Campus Bio-Medico di Roma, Rome, Italy
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Mioli A, Diolaiuti F, Zangrandi A, Orsini P, Sebastiani L, Santarcangelo EL. Multisensory Integration Is Modulated by Hypnotizability. Int J Clin Exp Hypn 2021; 69:215-224. [PMID: 33560171 DOI: 10.1080/00207144.2021.1877089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study investigated multisensory integration in 29 medium-to-high (mid-highs) and 24 low-to-medium (mid-lows) hypnotizable individuals, classified according to the Stanford Hypnotic Susceptibility Scale, Form A. Participants completed a simultaneity judgment (SJ) task, where an auditory and a visual stimulus were presented in close proximity to their body in a range of 11 stimulus onset asynchronies. Results show that mid-highs were prone to judge audiovisual stimuli as simultaneous over a wider range of time intervals between sensory stimuli, as expressed by a broader temporal binding window, when the visual stimulus precedes the auditory one. No significant difference was observed for response times. Findings indicate a role of hypnotizability in multisensory integration likely due to the highs' cerebellar peculiarities and/or sensory modality preference.
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Affiliation(s)
- Alessandro Mioli
- Department of Medicine and Surgery, Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction, Rome, Italy
| | - Francesca Diolaiuti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Andrea Zangrandi
- Department of Medicine and Surgery, Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction, Rome, Italy.,Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neuro-Motor Diseases, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Paolo Orsini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Laura Sebastiani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Enrica L Santarcangelo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
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Jalal B, Moruzzi L, Zangrandi A, Filardi M, Franceschini C, Pizza F, Plazzi G. Meditation-Relaxation (MR Therapy) for Sleep Paralysis: A Pilot Study in Patients With Narcolepsy. Front Neurol 2020; 11:922. [PMID: 32903364 PMCID: PMC7434831 DOI: 10.3389/fneur.2020.00922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/17/2020] [Indexed: 01/04/2023] Open
Abstract
Sleep paralysis (SP) is a condition where a person is paralyzed upon waking or falling asleep. SP afflicts ~20% of people, and is also one of the typical symptoms in narcolepsy. During SP the sleeper may experience hallucinations. Unsurprisingly, SP is associated with great fear globally. To date, there are no published clinical trials or outcome data for treating this condition. However, few non-pharmacological interventions have been proposed, including cognitive behavioral approaches, and case studies showing clinical amelioration with auto-hypnosis and Meditation-Relaxation (MR) therapy. The latter for instance showed positive preliminary results; when applied for 8 weeks it reduced SP frequency and anxiety/worry symptoms. With this paper we aimed to evaluate, with a small-scale pilot study, the efficacy of MR therapy for SP in patients with narcolepsy. Ten patients with narcolepsy and SP were enrolled in the study. Notably, MR therapy (n = 6), applied for 8 weeks, resulted in a dramatic decrease in the number of days SP occurred (50% reduction); and the total number of SP episodes (54% reduction) in the last month of the study (demonstrated by large within-group effect sizes); unlike the control intervention (deep breathing) (n = 4). These findings are preliminary and exploratory given the small sample. Nonetheless, they represent the first proof of concept at providing empirically-guided insights into the possible efficacy of a novel treatment for frequently occurring SP. Although the study was conducted in patients with narcolepsy we cautiously suggest that the findings may generalize to individuals with isolated SP.
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Affiliation(s)
- Baland Jalal
- Behavioural and Clinical Neuroscience Institute and Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Ludovico Moruzzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Andrea Zangrandi
- Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neuro-Motor Diseases, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Marco Filardi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | | | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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7
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Soliani L, Salerno GG, Pisani F, Barigazzi I, Rizzi S, Spagnoli C, Frattini D, Zangrandi A, Fusco C. Neuropsychological and behavioral disorders as presentation symptoms in two brothers with early-infantile Niemann-Pick type C. Acta Biomed 2020; 91:e2020075. [PMID: 32921771 PMCID: PMC7716979 DOI: 10.23750/abm.v91i3.9272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 11/23/2022]
Abstract
Background: Niemann-Pick disease type C (NPC) is a lysosomal storage disease caused by mutations in NPC1 or NPC2 genes. Case presentation: We present two brothers with the same compound heterozygous variants in exon 13 of the NPC1 gene (18q11.2), the first one (c.1955C> G, p. Ser652Trp), inherited from the mother, the second (c.2107T>A p.Phe703Ile) inherited from the father, associated to the classical biochemical phenotype of NPC. The two brothers presented unspecific neurologic symptoms with difference in age of onset: one presented and previously described dyspraxia and motor clumsiness at age 7 years, the other showed a systemic presentation with hepatosplenomegaly noted at the age of two months and neurological symptoms onset at age 4 with speech disturbance. Clinical evolution and neuroimaging data led to the final diagnosis. Systemic signs did not correlate with the onset of neurological symptoms. Miglustat therapy was started in both patients. Conclusions: We highlight the extreme phenotypic heterogeneity of NP-C in the presence of the same genetic variant and the unspecificity of neurologic signs at onset as previously reported. We report some positive effects of miglustat on disease progression assessed also with neuropsychological follow-up, with an age-dependent response.
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Affiliation(s)
- Luca Soliani
- Department of Pediatrics, Child Neurology Unit, Presidio Ospedaliero Provinciale Santa Maria Nuova Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Grazia Gabriella Salerno
- Department of Pediatrics, Child Neurology Unit, Presidio Ospedaliero Provinciale Santa Maria Nuova Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Francesco Pisani
- Child Neuropsychiatric Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Ilaria Barigazzi
- Department of Pediatrics, Child Neurology Unit, Presidio Ospedaliero Provinciale Santa Maria Nuova Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Susanna Rizzi
- Department of Pediatrics, Child Neurology Unit, Presidio Ospedaliero Provinciale Santa Maria Nuova Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Carlotta Spagnoli
- Department of Pediatrics, Child Neurology Unit, Presidio Ospedaliero Provinciale Santa Maria Nuova Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Daniele Frattini
- Department of Pediatrics, Child Neurology Unit, Presidio Ospedaliero Provinciale Santa Maria Nuova Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Andrea Zangrandi
- Department of Pediatrics, Child Neurology Unit, Presidio Ospedaliero Provinciale Santa Maria Nuova Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Carlo Fusco
- Department of Pediatrics, Child Neurology Unit, Presidio Ospedaliero Provinciale Santa Maria Nuova Azienda USL-IRCCS di Reggio Emilia; Pediatric Neurophysiology Laboratory, Presidio Ospedaliero Provinciale Santa Maria Nuova Azienda USL-IRCCS di Reggio Emilia, Italy.
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Zangrandi A, Mioli A, Marti A, Ghidoni E, Gasparini F. Multimodal semantic battery to monitor progressive loss of concepts in the semantic variant of primary progressive aphasia (svPPA): an innovative proposal. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2020; 28:438-454. [PMID: 32573335 DOI: 10.1080/13825585.2020.1782826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Semantic variant primary progressive aphasia (svPPA) is a rare neurodegenerative disease characterized by a progressive loss of semantic knowledge. Patients with svPPA show anomia, impaired word comprehension, poor object recognition, and difficulties in retrieving semantic information. svPPA is also a unique "natural" model that allows clinicians and cognitive neuroscientists to study the organization of semantic memory because only semantic knowledge is affected in the initial period of the disease, with relative sparing of other cognitive domains. In the clinical practice, semantic memory is commonly tested only with verbal tests. The aim of the present study was to preliminary test a new Multimodal Semantic Battery developed in our laboratory, which comprised 11 subtests designed to assess the semantic knowledge of multiple items via all input modalities. The battery was administered twice, over four years, to a patient diagnosed with svPPA. We found that when extensively tested with multiple tests, in some cases, he was still able to recall semantic features of the items that otherwise would not have emerged with standard semantic tests. These results are discussed for the clinical practice: monitoring semantic memory through all modalities in a practical and reliable way could be useful for both clinicians and experimental researchers to better investigate the breakdown of semantic knowledge.
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Affiliation(s)
- Andrea Zangrandi
- Azienda Ospedaliera Santa Maria Nuova di Reggio Emilia, Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neuro-Motor Diseases , Reggio Emilia, Italy
| | - Alessandro Mioli
- Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction, Università Campus Bio-Medico , Rome, Italy
| | - Alessandro Marti
- Azienda Ospedaliera Santa Maria Nuova di Reggio Emilia, Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neuro-Motor Diseases , Reggio Emilia, Italy
| | - Enrico Ghidoni
- Azienda Ospedaliera Santa Maria Nuova di Reggio Emilia, Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neuro-Motor Diseases , Reggio Emilia, Italy
| | - Federico Gasparini
- Azienda Ospedaliera Santa Maria Nuova di Reggio Emilia, Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neuro-Motor Diseases , Reggio Emilia, Italy
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Baiardi S, Rizzi R, Capellari S, Bartoletti-Stella A, Zangrandi A, Gasparini F, Ghidoni E, Parchi P. Gerstmann-Sträussler-Scheinker disease ( PRNP p.D202N) presenting with atypical parkinsonism. Neurol Genet 2020; 6:e400. [PMID: 32274419 PMCID: PMC7112137 DOI: 10.1212/nxg.0000000000000400] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/10/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Simone Baiardi
- Department of Biomedical and Neuromotor Sciences (S.B., S.C.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (S.B., S.C., A.B.-S., P.P.); Neurology Unit (R.R.), Department of Neuro-Motor Diseases, Azienda Unità Sanitaria Locale - IRCCS; Clinical Neuropsychology (A.Z., F.G., E.G.), Cognitive Disorders and Dyslexia Unit, Department of Neuro-Motor Diseases, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia; and Department of Diagnostic Experimental and Specialty Medicine (DIMES) (P.P.), University of Bologna, Italy
| | - Romana Rizzi
- Department of Biomedical and Neuromotor Sciences (S.B., S.C.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (S.B., S.C., A.B.-S., P.P.); Neurology Unit (R.R.), Department of Neuro-Motor Diseases, Azienda Unità Sanitaria Locale - IRCCS; Clinical Neuropsychology (A.Z., F.G., E.G.), Cognitive Disorders and Dyslexia Unit, Department of Neuro-Motor Diseases, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia; and Department of Diagnostic Experimental and Specialty Medicine (DIMES) (P.P.), University of Bologna, Italy
| | - Sabina Capellari
- Department of Biomedical and Neuromotor Sciences (S.B., S.C.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (S.B., S.C., A.B.-S., P.P.); Neurology Unit (R.R.), Department of Neuro-Motor Diseases, Azienda Unità Sanitaria Locale - IRCCS; Clinical Neuropsychology (A.Z., F.G., E.G.), Cognitive Disorders and Dyslexia Unit, Department of Neuro-Motor Diseases, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia; and Department of Diagnostic Experimental and Specialty Medicine (DIMES) (P.P.), University of Bologna, Italy
| | - Anna Bartoletti-Stella
- Department of Biomedical and Neuromotor Sciences (S.B., S.C.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (S.B., S.C., A.B.-S., P.P.); Neurology Unit (R.R.), Department of Neuro-Motor Diseases, Azienda Unità Sanitaria Locale - IRCCS; Clinical Neuropsychology (A.Z., F.G., E.G.), Cognitive Disorders and Dyslexia Unit, Department of Neuro-Motor Diseases, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia; and Department of Diagnostic Experimental and Specialty Medicine (DIMES) (P.P.), University of Bologna, Italy
| | - Andrea Zangrandi
- Department of Biomedical and Neuromotor Sciences (S.B., S.C.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (S.B., S.C., A.B.-S., P.P.); Neurology Unit (R.R.), Department of Neuro-Motor Diseases, Azienda Unità Sanitaria Locale - IRCCS; Clinical Neuropsychology (A.Z., F.G., E.G.), Cognitive Disorders and Dyslexia Unit, Department of Neuro-Motor Diseases, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia; and Department of Diagnostic Experimental and Specialty Medicine (DIMES) (P.P.), University of Bologna, Italy
| | - Federico Gasparini
- Department of Biomedical and Neuromotor Sciences (S.B., S.C.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (S.B., S.C., A.B.-S., P.P.); Neurology Unit (R.R.), Department of Neuro-Motor Diseases, Azienda Unità Sanitaria Locale - IRCCS; Clinical Neuropsychology (A.Z., F.G., E.G.), Cognitive Disorders and Dyslexia Unit, Department of Neuro-Motor Diseases, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia; and Department of Diagnostic Experimental and Specialty Medicine (DIMES) (P.P.), University of Bologna, Italy
| | - Enrico Ghidoni
- Department of Biomedical and Neuromotor Sciences (S.B., S.C.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (S.B., S.C., A.B.-S., P.P.); Neurology Unit (R.R.), Department of Neuro-Motor Diseases, Azienda Unità Sanitaria Locale - IRCCS; Clinical Neuropsychology (A.Z., F.G., E.G.), Cognitive Disorders and Dyslexia Unit, Department of Neuro-Motor Diseases, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia; and Department of Diagnostic Experimental and Specialty Medicine (DIMES) (P.P.), University of Bologna, Italy
| | - Piero Parchi
- Department of Biomedical and Neuromotor Sciences (S.B., S.C.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (S.B., S.C., A.B.-S., P.P.); Neurology Unit (R.R.), Department of Neuro-Motor Diseases, Azienda Unità Sanitaria Locale - IRCCS; Clinical Neuropsychology (A.Z., F.G., E.G.), Cognitive Disorders and Dyslexia Unit, Department of Neuro-Motor Diseases, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia; and Department of Diagnostic Experimental and Specialty Medicine (DIMES) (P.P.), University of Bologna, Italy
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Zangrandi A, Mioli A, D'Alonzo M, Formica D, Pellegrino G, Di Pino G. Conditioning transcranial magnetic stimulation of ventral premotor cortex shortens simple reaction time. Cortex 2019; 121:322-331. [PMID: 31670027 DOI: 10.1016/j.cortex.2019.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/23/2019] [Accepted: 09/04/2019] [Indexed: 12/13/2022]
Abstract
The ventral premotor cortex (PMv) is a key area of the sensorimotor control loop, it subtends complex motor sequences, especially when the hand is involved. However, its specific contribution to simple motor response to sensory cue is still not completely clear. To investigate the role of PMv, we used transcranial magnetic stimulation (TMS) to interfere with its function during a simple reaction time (SRT) task. We ran two experiments where participants were required to respond as fast as possible to a median nerve stimulation (go-signal), while sub-M1-threshold single pulse TMS was delivered either on left (contralateral) PMv or right (ipsilateral to sensory stimulus and motor response) PMv, 5-65 ms after the go-signal. TMS delivered on either PMv up to 25 ms after the go-signal shortened reaction time. This is the time window compatible with the arrive of sensory afferences, as if conditioning before sensory afferences arrive lower the threshold needed to release the pre-planned motor program to the primary motor cortex. This is in line with a putative PMv function of buffer of pre-planned motor program not strictly lateralized in one hemisphere.
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Affiliation(s)
- Andrea Zangrandi
- Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction, Università Campus Bio-Medico, Rome, Italy
| | - Alessandro Mioli
- Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction, Università Campus Bio-Medico, Rome, Italy
| | - Marco D'Alonzo
- Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction, Università Campus Bio-Medico, Rome, Italy
| | - Domenico Formica
- Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction, Università Campus Bio-Medico, Rome, Italy
| | - Giovanni Pellegrino
- San Camillo Hospital IRCCS, Venice, Italy; Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Giovanni Di Pino
- Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction, Università Campus Bio-Medico, Rome, Italy.
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Zangrandi A, Gasparini F, Marti A, Bhalla R, Napoli M, Angelini D, Ghidoni E, Rizzi R. A 9-year neuropsychological report of a patient with LGI1-associated limbic encephalitis. J Clin Exp Neuropsychol 2019; 41:749-759. [PMID: 31142216 DOI: 10.1080/13803395.2019.1617836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Introduction: Anti-leucine-rich glioma-inactivated 1 limbic encephalitis (LGI1-LE) is an autoimmune disorder associated with antibodies to voltage-gated potassium channels (VGKC). It is a non-paraneoplastic and partially reversible encephalitis that can be diagnosed via serological testing. Untreated LGI1-LE can be associated with neurocognitive as well as neuropsychiatric sequelae. Here we report the neuropsychological and clinical profile of a patient with LGI1-LE following three different treatment approaches: plasmapheresis (PA), intravenous immunoglobulin (IVIG), and corticosteroids (CO). Method: We investigated our patient with 10 neuropsychological evaluations obtained over a 9-year follow-up period. Multiple MRI scans, EEG recordings, neurological examinations, and serum tests were also obtained. Results: The neurocognitive profile of our patient was characterized by long-term memory impairment (verbal and visual-spatial), and deficits in aspects of executive functioning and language. Neuropsychiatric symptoms of depression and anxiety were noted intermittently. Conclusions: Non-specific treatment prior to diagnosis had marginal effects on neurocognitive profile, neuropsychiatric symptoms, or control of epileptic seizure. In contrast, specific treatments for LGI1-LE following diagnosis resulted in neurocognitive improvement and epileptic control. Among the three treatments, IVIG and CO had the most beneficial impact on neurocognitive status, likely due to the continuity of administration.
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Affiliation(s)
- Andrea Zangrandi
- a Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neuro-Motor Diseases , Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia , Reggio Emilia , Italy
| | - Federico Gasparini
- a Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neuro-Motor Diseases , Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia , Reggio Emilia , Italy
| | - Alessandro Marti
- a Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neuro-Motor Diseases , Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia , Reggio Emilia , Italy
| | - Rishi Bhalla
- b Department of Psychiatry , University of British Columbia , Vancouver , Canada
| | - Manuela Napoli
- c Neuroradiology Unit, Department of Diagnostic Imaging , Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia , Reggio Emilia , Italy
| | - Damiano Angelini
- a Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neuro-Motor Diseases , Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia , Reggio Emilia , Italy
| | - Enrico Ghidoni
- a Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neuro-Motor Diseases , Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia , Reggio Emilia , Italy
| | - Romana Rizzi
- d Neurology Unit, Department of Neuro-Motor Diseases , Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia , Reggio Emilia , Italy
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Rizzi R, Fisicaro F, Zangrandi A, Ghidoni E, Baiardi S, Ragazzi M, Parchi P. Sudden cardiac death in a patient with LGI1 antibody-associated encephalitis. Seizure 2019; 65:148-150. [PMID: 30708290 DOI: 10.1016/j.seizure.2019.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/13/2019] [Accepted: 01/15/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Romana Rizzi
- Neurology Unit, Department of Neuro-Motor Diseases, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Francesco Fisicaro
- Department of Medical and Surgical Sciences and Advanced Technologies, Section of Neurosciences, University of Catania, Catania, Italy
| | - Andrea Zangrandi
- Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neuro-Motor Diseases, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy.
| | - Enrico Ghidoni
- Neurology Unit, Department of Neuro-Motor Diseases, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy; Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neuro-Motor Diseases, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Simone Baiardi
- Department for Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Moira Ragazzi
- Department of Pathology, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Piero Parchi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Italy
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13
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Zangrandi A, Gasparini F, Imovilli A, Napoli M, Marti A, Angelini D, Barletta-Rodolfi C, Ghidoni E. Atypical non-progressive semantic impairment following allogeneic bone marrow transplantation in a patient with Waldenström’s macroglobulinemia: A case report. Clin Neuropsychol 2018; 33:798-810. [DOI: 10.1080/13854046.2018.1499966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Andrea Zangrandi
- Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neurology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Federico Gasparini
- Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neurology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Annalisa Imovilli
- Department of Haematology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Manuela Napoli
- Neuroradiology Unit, Department of Diagnostic Imaging, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Alessandro Marti
- Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neurology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Damiano Angelini
- Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neurology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Caterina Barletta-Rodolfi
- Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neurology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Enrico Ghidoni
- Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neurology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
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14
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Mordenti P, Seghini P, Di Nunzio C, Michieletti E, Stroppa E, Zangrandi A, Cavanna L. Central Nervous System metastastasis in gastric or gastro-esophageal junction cancer, correlation with human epidermal growth factor 2 (HER-2) status. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv344.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mordenti P, Zaffignani E, Nobili E, Di Cicilia R, Zangrandi A, Anselmi E, Cavanna L. Psoriasiform dermatitis and hepatocellular carcinoma: a new case of Bazex syndrome. GIORN ITAL DERMAT V 2015; 150:628-630. [PMID: 26333558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- P Mordenti
- Department of Onco-Hematology, Guglielmo da Saliceto Hospital, Piacenza, Italy -
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16
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Ferrozzi F, Tognini G, Zuccoli G, Gabrielli M, Zangrandi A, Campani R. [Gastric stromal tumors. Findings with computerized tomography]. Radiol Med 2000; 99:56-61. [PMID: 10803188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
PURPOSE Gastric stromal tumors are an ill-defined group of lesions arising from muscle wall cells and characterized by extremely variable biological patterns. Thanks to modern immunohistochemical and ultrastructural techniques, four main classes of these lesions have been identified, namely: 1) tumors with differentiation toward smooth muscle cells; 2) tumors with differentiation toward neural elements; 3) tumors with dual differentiation toward both cell types; 4) tumors lacking differentiation toward either cell type. We investigated the yield of CT in diagnosing and characterizing gastric stromal tumors. MATERIAL AND METHODS We retrospectively reviewed the CT findings of 38 patients (15 men and 23 women; mean age 51 years) with pathologically proven gastric stromal tumors, namely 31 of myoid origin, 4 of neural origin, 2 with both muscle and neural differentiation, 1 lacking differentiation with either cell type. Morphological (size, margins, growth pattern, enlarged lymph nodes, metastases) and structural (density, calcifications, necrosis, cystic changes, enhancement patterns) parameters were evaluated and compared with histopathologic diagnosis. RESULTS The myoid tumors involved gastric fundus in 9/13 and 5/7 benign lesions and lesions with variable biological patterns, respectively, while the malignant tumors exhibited diffuse involvement in 7/11 of cases. Eleven of 13 benign lesions had regular shape and a diameter +/- 5 cm, while 5/7 intermediate tumors and 7/11 malignant ones were 6-10 cm and over 10 cm (1/7 and 3/11, respectively). Tumor growth was intramural (6/13) or mixed (5/13) in the benign lesions, mainly exophytic in the malignant ones, and finally variable (2/7 intramural, 3/7 exophytic and 2/7 mixed) in the tumors with intermediate patterns. Calcifications were identified only in 3 benign lesions. Structure was homogeneous in 11/13 of the benign lesions with regular contrast enhancement (10/12), heterogeneous due to necrotic areas in nearly all (10/11) or most (5/7) malignant and intermediate forms, respectively. Enlarged lymph nodes (4/11) or synchronous metastases (7/11) were found in the malignant lesions. Our two schwannomas had a pseudocystic structure with regular peripheral contrast enhancement; the neurofibroma was characterized by multiple, markedly hypodense and hypovascular lesions. Both the malignant neurogen form and the two tumors with dual differentiation showed a diffuse, aspecific and infiltrating pattern. The lesion without differentiation had a "benign" shape and structure even though it developed metastases two years after radical surgery. CONCLUSIONS Despite the lack of specificity of CT patterns of gastric stromal tumors, these parameters are useful in differentiating benign from overtly malignant forms. The definition "gastric stromal tumor with benign, variable, or malignant macroscopic appearance" should be used in the radiologic report.
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Affiliation(s)
- F Ferrozzi
- Istituto di Scienze Radiologiche, Università degli Studi, Parma.
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17
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Croce P, De Giorgi O, Votta P, Zangrandi A, Semeraro G. [Endometriosis of the ileum and colon complicated by intestinal obstruction. Report of two cases]. Minerva Ginecol 1999; 51:189-92. [PMID: 10431528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
The authors report two cases of intestinal occlusion, one ileal and the other colic, caused by endometriosis. Both patients underwent surgery. Following a review of data in the literature regarding the frequency, pathogenesis, diagnosis and management, the authors conclude that pre- and intraoperative diagnosis is often impossible in these cases and must be postponed to histological analysis. Full remission was achieved after surgery.
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Affiliation(s)
- P Croce
- Divisione di Ginecologia ed Ostetricia, Civico Ospedale, Codogno Milano
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18
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Buscarini L, Buscarini E, Di Stasi M, Quaretti P, Zangrandi A. Percutaneous radiofrequency thermal ablation combined with transcatheter arterial embolization in the treatment of large hepatocellular carcinoma. Ultraschall Med 1999; 20:47-53. [PMID: 10407974 DOI: 10.1055/s-1999-14233] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE To evaluate whether the combination of hepatic segmental transcatheter arterial embolization (TAE) with percutaneous radiofrequency (RF) ablation can increase the volume of coagulation necrosis to treat patients with large hepatocellular carcinoma (HCC). METHOD Fourteen patients with cirrhosis and HCC whose greatest diameter ranged from 3.8 to 6.8 cm (mean, 5.2 cm) underwent segmental TAE followed within 3 days by RF interstitial thermal ablation with an expandable needle electrode inserted into the tumour under sonographic guidance, after local anesthesia. We made one or more needle electrode insertions depending on tumor shape. Posttreatment necrosis was evaluated by ultrasonography, dynamic computed tomography (CT) and alpha-fetoprotein dosage in all cases, repeated every three to four months. RESULTS Tumor ablation was obtained in one session in 11 (78%) patients (with one needle electrode insertion in 8 patients), in two sessions in 1, in three sessions in 2. In a mean follow-up of 13.2 months (range 6-23) two patients died from unrelated causes; one patient showed multinodular HCC 6 months after the treatment; 4 patients developed new lesions, treated by a new course of RF ablation (3 cases) or by surgery (1 case); therefore 11/12 patients still in follow-up were disease-free. No fatal complications were observed. One month after the treatment, fluid collection at the site of the ablated tumor was observed in one patient which was percutaneously drained. CONCLUSIONS Percutaneous RF thermal ablation performed after TAE effectively treated HCCs larger than tumors suitable for segmental TAE or RF application alone; the result was achieved in two thirds of the cases in a single session with only one needle electrode insertion.
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Affiliation(s)
- L Buscarini
- Department of Gastroenterology, Hospital of Piacenza, Italy
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19
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Rossi S, Garbagnati F, De Francesco I, Accocella F, Leonardi L, Quaretti P, Zangrandi A, Paties C, Lencioni R. Relationship between the shape and size of radiofrequency induced thermal lesions and hepatic vascularization. Tumori 1999; 85:128-32. [PMID: 10363079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
AIMS AND BACKGROUND The aim of this study was to evaluate the relationship between hepatic vascularisation and the final size and shape of radiofrequency (RF) induced thermal lesions. METHODS Series of four RF thermal lesions were created in explanted calf livers and in pig livers maintaining the following experimental conditions throughout the procedure: normal hepatic perfusion, occlusion of the hepatic artery, occlusion of the portal vein, occlusion of both hepatic artery and portal vein (Pringle maneuver) and subtotal occlusion of the hepatic veins. A 14G expandable needle electrode was used to make the thermal lesions. Each lesion was created applying predetermined temperatures ranging between 95 and 115 degrees C and an exposure time of 20 minutes. RESULTS Occlusion of the hepatic artery during the RF procedure resulted in moderate and not significant increases in thermal lesion diameter compared with those obtained in normally perfused liver (3.0 +/- 0.4 cm vs 3.0 +/- 0.2 cm), while occlusion of the portal vein resulted in larger lesion diameters (3.5 +/- 0.3 cm). In both these cases the diameters of the thermal lesions were smaller than those obtained in explanted calf liver (4.0 +/- 0.3 cm) and their shape showed peripheral irregularities. Thermal lesions larger than those seen in normally perfused liver and equaling those observed in explanted calf liver were created both during the Pringle maneuver (4.0 +/- 0.2 cm) and after subtotal occlusion of the hepatic veins (4.0 +/- 0.3 cm). In both these cases the thermal lesions were regular in shape. CONCLUSIONS Occlusion of the blood flow during the RF procedure avoids heat loss by convection, resulting in the creation of larger thermal lesions than those obtained in normally vascularized liver using the same electrode, temperatures and exposure time. This technique could therefore be employed in humans to destroy large hepatic tumor nodules.
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Affiliation(s)
- S Rossi
- Department of Gastroenterology, Public Hospital of Piacenza, Italy
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20
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Accordino R, Zangrandi A, Inzani E, Delfrate R, Gasparini G, Lagasi L. [Jejunal diverticulosis. Presentation of a clinical case]. MINERVA CHIR 1998; 53:427-30. [PMID: 9780635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Jejunal diverticulosis is a rare and often asymptomatic disease, generally presenting as an occasional finding during laparotomy for other diseases. There are no established criteria for the treatment of such diverticula. Due to the possible onset of acute complications, surgical management must be considered. Personal experience on a case of jejunal diverticulosis in a woman who presented with acute complications of surgical peritoneal adhesions is described. Through examinations of small intestine discovered many diverticula, mainly in the mesenteric side; two diverticula were particularly large. Even though there appeared to be no symptoms due to the diverticula, major diverticula were considered at risk for acute complications. Because their reduction was not easily achievable, they were resected and enterotomies were stitched. Postoperative course was uneventful and after 2 years the patient is alive and well. Features of this rare entity are analyzed with regard to data reported in the literature, with special reference to some pathogenetic theories.
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Affiliation(s)
- R Accordino
- Divisione di Chirugia Generale, Presidio Ospedaliero Borgovalditaro, PR
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21
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Rossi S, Buscarini E, Garbagnati F, Di Stasi M, Quaretti P, Rago M, Zangrandi A, Andreola S, Silverman D, Buscarini L. Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode. AJR Am J Roentgenol 1998; 170:1015-22. [PMID: 9530052 DOI: 10.2214/ajr.170.4.9530052] [Citation(s) in RCA: 458] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the usefulness of expandable RF needle electrodes in the treatment of hepatic cancer. SUBJECTS AND METHODS Thirty-seven patients, 23 of whom had 26 hepatocellular carcinoma nodules and 14 of whom had 19 hepatic metastatic nodules, underwent treatment by RF interstitial thermal ablation with expandable needle electrodes. Forty-five tumor nodules were treated in 64 RF interstitial thermal ablation sessions with 83 needle electrode insertions. The mean diameter of the tumor nodules was 2.5 cm (range, 1.1-3.5 cm). Immediate posttreatment tumor necrosis was evaluated by dynamic CT in all cases. Two patients with hepatocellular carcinoma and three patients with metastases underwent surgical resection 20-60 days after RF treatment. The remaining 32 patients were followed up clinically. RESULTS The mean number of RF interstitial thermal ablation sessions to complete tumor nodule treatment was 1.4. Mean number of needle electrode insertions was 1.8. No complications were observed. Posttreatment dynamic CT showed a completely nonenhancing area in the site of the treated tumor in 44 of 45 cases. The remaining patient with metastatic disease had persistent enhancing tissue. Histology showed complete necrosis in four treated tumor nodules and residual viable cancer in one. Twenty-one patients with hepatocellular carcinoma were followed up for 6-19 months (mean, 10 months). Of these patients, six showed recurrences and 15 remained apparently disease-free. Two patients died, one from advanced cancer and one from other causes. Eleven patients with hepatic metastases were followed up for 7-20 months (mean, 12 months). Of these patients, nine showed recurrent disease and only two remained apparently disease-free. Two patients died from disseminated disease. CONCLUSION RF interstitial thermal ablation of hepatic tumor by expandable needle electrodes is a safe and effective technique. Local ablation of tumors not exceeding 3.5 cm in diameter is achieved in a short time without complications.
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Affiliation(s)
- S Rossi
- Department of Gastroenterology, Hospital of Piacenza, Italy
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22
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Solcia E, Rindi G, Paolotti D, Luinetti O, Klersy C, Zangrandi A, La Rosa S, Capella C. Natural history, clinicopathologic classification and prognosis of gastric ECL cell tumors. Yale J Biol Med 1998; 71:285-90. [PMID: 10461359 PMCID: PMC2578994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
A series of 50 gastric endocrine tumors classified according to Rindi et al. [1] comprised 12 small cell neuroendocrine carcinomas (NEC) and 38 ECL cell carcinoids, of which 22 associated with type A chronic atrophic gastritis (A-CAG), eight with hypertrophic gastropathy due to combined Multiple Endocrine Neoplasia and Zollinger/Ellison syndrome (MEN/ZES), and eight sporadic. Variables found to predict tumor malignancy were: size > 2 cm, > 2 mitoses and > 130 Ki67 positive cells/10 high power fields (HPF), grade 2 or 3 histology, angioinvasion, p53 protein nuclear accumulation, and the presence of a single tumor. None of these factors increased significantly the predicting ability of tumor classification itself, although grade 2 + 3 shows 100 percent negative predictive value and Ki67 and angioinvasion 100 percent positive predictive value. When the mostly non-malignant A-CAG and MEN-ZES tumors were analysed against the mostly malignant sporadic and NEC tumors, a positive predictive value of 90 percent and a negative predictive value of 93 percent was obtained. Investigation of a larger tumor series is under way with the aim to develop an optimal model for prognostic evaluation of gastric endocrine tumors.
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Affiliation(s)
- E Solcia
- Department of Human Pathology, University of Pavia, Italy
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23
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Affiliation(s)
- C Paties
- Department of Pathology, Placenza Civil Hospital, Italy
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24
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Ramponi C, Zangrandi A. [The budget in health structures: business management and diffuse responsibility]. G Ital Cardiol 1996; 26:333-9. [PMID: 8690188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- C Ramponi
- Scuola di Direzione Aziendale dell'Università L. Bocconi di Milano
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Abstract
Primary hepatic leiomyosarcomas are exceedingly rare tumors. To the best of our knowledge, only 17 cases have been reported in literature. We report the computed tomographic findings of two cases of primary location in the liver. We also discuss the differential diagnosis of such lesions.
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Affiliation(s)
- F Ferrozzi
- Istituto di Scienze Radiologiche, Universita' degli Studi di Parma, Viale Gramsci N. 14, 43100 Parma, Italy
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Abstract
BACKGROUND Apocrine carcinomas of the skin are rare and incompletely studied neoplasms. METHODS An immunohistochemical and ultrastructural study is reported of specimens from six patients with apocrine skin carcinoma in various body sites. Three tumors were in the axilla; one, the eyelid; one, the ear; and one, the scalp. There were three local recurrences and three regional lymph node metastases, but no patient died of cancer (follow-up, 2-10 years). RESULTS The most reliable histopathologic criteria for identifying apocrine skin carcinoma appear to be decapitation secretion, periodic acid-Schiff-positive diastase-resistant material in the cells or lumen, and immunoreactivity with gross cystic disease fluid protein 15. All specimens expressed common epithelial antigens (cytokeratins, carcinoembryonic antigen, and epithelial membrane antigen) and histiocytic-secretive antigens (Leu-M1, lysozyme, LN5, alpha-1-antitrypsin, and alpha-1-antichymotrypsin). S-100 protein was found in the three nonaxillary tumors. Ultrastructurally, the primary tumors, and especially the secondary lesions, were dedifferentiated compared with normal apocrine glands. CONCLUSIONS Apocrine differentiation in skin tumors does not indicate an exclusive origin from the apocrine sweat glands; these neoplasms usually have an indolent clinical course.
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Affiliation(s)
- C Paties
- Department of Pathology, Piacenza Civil Hospital, Italy
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27
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Paties C, Zangrandi A, Vassallo G, Rindi G, Solcia E. Multidirectional carcinoma of the thymus with neuroendocrine and sarcomatoid components and carcinoid syndrome. Pathol Res Pract 1991; 187:170-7. [PMID: 2067996 DOI: 10.1016/s0344-0338(11)80767-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We report a case of metastatic thymic neoplasm occurring in a 62-year-old Caucasian man. The tumor was polymorphic, with intimately admixed carcinoid, sarcomatous and undifferentiated components. Sarcomatous cells were spindle-shaped and immunoreactive for vimentin, actin and desmin. Carcinoid cells reacted for cytokeratin as well as with a panel of general neuroendocrine markers, including chromogranins A and B, synaptophysin, protein gene product (PGP) 9.5, neuron specific enolase (NSE), Leu 7 and Grimelius' silver. The endocrine nature of the latter cells was confirmed by ultrastructural evidence of abundant electron-dense granules 100 to 300 nm in size. Among the various hormones investigated immunohistochemically only the alpha chain of human chorionic gonadotropin (alpha-hCG) was detected in tumor cells. The neoplasm recurred after surgical resection and caused a typical carcinoid syndrome with skin flushing and increased urinary 5-hydroxyindolacetic acid (5-HIAA). The diagnosis of multidirectional thymic carcinoma with two lines of differentiation, of carcinoid and sarcomatoid type, was made.
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Affiliation(s)
- C Paties
- Department of Pathology, Piacenza Civil Hospital, Italy
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Bergonzi G, Paties C, Vassallo G, Zangrandi A, Poisetti PG, Ballocchi S, Fontana F, Scarpioni L. Dextran deposits in tissues of patients undergoing haemodialysis. Nephrol Dial Transplant 1990; 5:54-8. [PMID: 1691467 DOI: 10.1093/ndt/5.1.54] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Recently the possible storage of dextran-related material in patients undergoing regular haemodialysis has been suggested. We examined biopsy and autopsy specimens of 32 patients treated with regular haemodialysis for 61 +/- 34 months. All patients received dextran-40 as a plasma expander because of hypotension during haemodialysis. The same study was carried out in a control group of 11 haemodialysed patients who were given other plasma expanders. In the 11 patients who received larger doses of dextran-40 (0.38 g/kg body weight per week) we found particles in the cytoplasm of macrophages in various organs, which proved PAS positive and diastase resistant on light microscopy, and birefringent on polarisation. Electron microscopy revealed a fibrillar structure, but ionic analysis by electronic sampler on scanning electron microscopy excluded the presence of silicon. No intracellular inclusions were observed in the control group, nor in the patients given dextran-40 in doses lower than 0.08 g/kg body weight per week. As we also found a linear relationship between the number of particles and the dextran-40 doses given, we hypothesise that the material demonstrated in the macrophages is a structurally modified dextran.
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Aricó M, Parigi GB, Locatelli D, Bragheri R, Lombardi F, Zangrandi A. Turcot's syndrome with intestinal lymphoma in a child: an unusual case of triple tumor. Med Pediatr Oncol 1990; 18:252-5. [PMID: 2158616 DOI: 10.1002/mpo.2950180319] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Turcot's syndrome, the association of brain tumor (usually glioblastoma, medullo-blastoma, or astrocytoma) and colonic polyps, is a very rare condition of which about 20 cases have been reported. It has been described only once previously with cancer in a third organ system. In this paper, we report a child affected with colonic polyposis and astrocytoma (i.e., Turcot's syndrome) associated with intestinal non-Hodgkin's lymphoma.
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Affiliation(s)
- M Aricó
- Department of Pediatrics, University of Pavia, IRCCS Policlinico S. Matteo, Italy
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Iannotta F, Zangrandi A. [Comparison of 2 isocaloric diets with different carbohydrate content in the treatment of essential obesity]. Minerva Med 1980; 71:1101-10. [PMID: 6990303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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