Late onset unilateral asterixis secondary to posterior cerebral artery infarction

Unilateral asterixis developed in a 56 year old man, 5 months after an infarct in the posterior cerebral artery territory, involving the posterolateral nuclear complex of the thalamus, documented by CT-scan and MRI. Unilateral asterixis in rarely reported in association with thalamic lesions and usually develops as an immediate postictal phenomenon. We discuss possible physiopathological mechanisms explaining the occurrence and the delayed onset of these involuntary movements.

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Sommario Un uomo di 56 anni ha sviluppato un'asterixis unilaterale, 5 mesi dopo aver presentato un infarto nel territorio dell'arteria cerebrale posteriore, che coinvolgeva i nuclei postero-laterali del talamo, come evidenziato dalla TC e dalla MRI. Asterixis unilaterali si sviluppano raramente in seguito a lesioni vascolari a livello del talamo e generalmente rappresentano un evento immediatamente successivo all'ictus. Nel caso descritto invece, i movimenti involontari si sono manifestati a notevole distanza di tempo. Gli autori discutono i possibili meccanismi fisiopatologici alla base di questi movimenti involontari e della loro insorgenza a distanza di tempo dall'ictus.

     

Prevalence and localization of nodal metastases in squamous cell carcinoma of the oral cavity: role and extension of neck dissection

Lymph node (LN) metastases represent the most important negative prognostic factor in squamous cell carcinoma (SCC) of the oral cavity, even though controversies still exist regarding their management. The aim of this study was to retrospectively analyze our experience in surgical management of SCC of the oral cavity with particular focus on the prevalence and localization of lymph nodal metastases and recurrences. The clinical records of 89 consecutive patients treated from 1983 to 2002 by concomitant surgery on both the T and N sites, excluding those undergoing salvage surgery, were reviewed. A total of 119 neck dissections (ND) were performed. Survival outcomes were calculated by the Kaplan–Meier method, while univariate comparisons by the log-rank and non-parametric tests were performed between different groups of patients. Five-year overall and determinate survivals were 50 and 57%, respectively. LN metastases were observed in 52% (56% of these showing extracapsular spread) and their presence strongly correlated with determinate survival (p < 0.0001). The prevalence of clinical and occult nodal disease was not related to the pT status. Neck levels II (59%) and I (56%) were most frequently involved. Metastases to level IV accounted for 15% of positive LN, even though 28% of them turned out to be skip metastases. Five neck recurrences were observed, only one of which was salvaged by surgery. The high prevalence of clinical and occult LN metastases in this setting suggests that ND should be performed on a nearly routine basis, even for lesions with a low-T category and a cN0 neck. Moreover, ND should always encompass level IV due to the possibility of skip metastases, particularly in tumors involving the oral tongue. In patients with a cN+ neck, levels from I to V should be addressed, particularly in the presence of metastases at levels III and IV.     

Large striatocapsular infarcts: Clinical features and risk factors

We defined large striatocapsular infarcts as subcortical softenings of more than 20 mm in diameter involving the territories of the lateral and medial groups of lenticulostriate arteries. The aim of this study of 56 patients was to compare the clinical features and risk factors of these infarcts with those of cortical and lacunar infarcts. On the whole, our data suggest that both the clinical features and risk factors of large striatocapsular infarcts are similar to those of cortical infarcts, but significantly different from those of lacunar infarcts. The clinical manifestations of large striatocapsular infarcts with a maximum diameter of less than 50 mm may sometimes resemble those of lacunar infarcts because neuropsychological disorders are less frequent; however, our study indicates that, even in these cases, cardioembolic sources and artery-to-arteiy embolism are significantly more frequent in large striatocapsular than in lacunar infarcts, thus suggesting a different pathogenesis.     

Rest-injected thallium-201 redistribution and resting technetium-99m methoxyisobutylisonitrile uptake in coronary artery disease: relation to the severity of coronary artery stenosis

To compare rest-injected thallium-201 (Tl) redistribution and resting technetium-99m methoxyisobutylisonitrile (^99mTc-MIBI) myocardial uptake in chronic coronary artery disease (CAD), 15 patients with angiographically proven CAD and left ventricular (LV) dysfunction (ejection fraction 34%±9%) were studied. All patients underwent rest-redistribution Tl and resting ^99mTc-MIBI cardiac imaging. Gated ^99mTc-MIBI images were also acquired to assess regional LV wall motion (WM). Myocardial segments (n=225) were divided into three groups on the basis of the degree of coronary artery stenosis: group 1 (total occlusion, n=82), group 2 (50%–99% of stenosis, n=84) and group 3 (<50% of stenosis, n=59). WM was significantly worse in groups 1 and 2 compared to group 3 (P<0.001), but no difference was observed between groups 1 and 2. TI and ^99mTc-MIBI uptake were significantly lower in groups 1 and 2 compared to group 3 (P < 0.001), and in group 1 compared to group 2 (P<0.001). When TI and ^99mTc-MIBI uptake were directly compared, TI uptake was higher than ^99mTc-MIBI uptake in group 1 (P<0.001), while no significant difference was observed in groups 2 and 3. Thus, both rest-injected TI redistribution and resting ^99mTc-MIBI uptake reflected the severity of coronary artery stenosis in CAD. However, in myocardial segments with total coronary occlusion T1 uptake was significantly higher than ^99mTc-MIBI uptake. Our data suggest that rest-injected Tl redistribution cardiac imaging may identify, more accurately than resting ^99mTc-MIBI imaging, the presence of viable myocardium in chronic CAD, particularly when the coronary blood flow is severely impaired.     

Clustering of Y chromosome deletions in subinterval E of interval 6 supports the existence of an oligozoospermia critical region outside the DAZ gene.

Y chromosome molecular analysis was performed using the STS-PCR technique in 50 patients with oligozoospermia. Microdeletions of interval 6 of the Y chromosome were detected in seven patients, in six of whom subinterval E was affected. All patients retained the RBM1 and DAZ genes, while in one deletion involved the SPGY gene. The size of the deletion was not apparently related to the severity of the disease. These results suggest the presence of an oligozoospermia critical region on the Y chromosome within subinterval E of interval 6.     

Circulating CD26 is negatively associated with inflammation in human and experimental arthritis

Dipeptidyl peptidase IV (DPPIV, CD26), a protease-cleaving N-terminal X-Pro dipeptide from selected proteins including some chemokines, is expressed both as a soluble form in plasma and on the cell surface of various immune and nonimmune cell types. To gain insights into the pathophysiological role of CD26 in arthritis, we explored DPPIV/CD26 expression during murine antigen-induced arthritis (AIA), an experimental model of arthritis. AIA induction led to reduced plasma DPPIV activity. In CD26-deficient mice, the severity of AIA was increased as assessed by enhanced technetium uptake and by increased histological parameters of inflammation (synovial thickness and exudate). We demonstrated that CD26 controls the in vivo half-life of the intact active form of the proinflammatory chemokine stromal cell-derived factor-1 (SDF-1). CD26-deficient mice exhibited increased levels of circulating active SDF-1, associated with increased numbers of SDF-1 receptor (CXCR4)-positive cells infiltrating arthritic joints. In a clinical study, plasma levels of DPPIV/CD26 from rheumatoid arthritis patients were significantly decreased when compared to those from osteoarthritis patients and inversely correlate with C-reactive protein levels. In conclusion, decreased circulating CD26 levels in arthritis may influence CD26-mediated regulation of the chemotactic SDF-1/CXCR4 axis.     

Thermotropic liquid crystalline polymers, 4. Study of crystalline and liquid-crystalline comb-like polymers with mesogenic side groups by IR spectroscopy

The IR spectra (in the region of 400–3600 cm^?1) of comb-like polymers in crystalline, liquid-crystalline, and fluid isotropic phases were studied, and the effect of the chemical structure of the long side chains on the crystalline and liquid-crystalline states were examined. The spectroscopic criteria of phase transitions in comb-like polymers were established and the fragments of the side chains involved in the formation of the liquid-crystalline phase, were determined.