Performance of the Italian version of the mini-mental state examination in day hospital geriatric medical patients

The criterion validity of the Italian version of the Mini-Mental State Examination was tested in a group (114) of elderly medically ill day patients. Specificity was rather disappointing (66.3%) at the conventional threshold (23/24), as well as positive predictive value (32.7%). A lower threshold (21/22) offered the best compromise between sensitivity (93.8%) and specificity (80.6%). ROC analysis evidenced a good overall performance of MMSE (area under the curve 0.938). In those subjects not affected by dementia, age, low education and depressive illness had a significant effect on MMSE scores.     

14‐3‐3 protein in the CSF of inflammatory peripheral neuropathies

We describe a 65‐year‐old smoker male followed for five years for a pure motor demyelinating peripheral neuropathy. The patient had a monthly motor relapse with severe weakness restricting him to a wheelchair, so he needed monthly high dose IVIg. On EMG the MCV were very slowed (30 m/sec) without evidence of conduction blocks while SCV were in the normal range. CSF disclosed a high protein level. Laboratory findings did not reveal any other abnormality except for the presence of monoclonal gammopathy IgMk and high titer anti GD1a serum IgM antibodies (1:5000). In March 2003 he had the most severe relapse with flaccid tetraplegia and respiratory failure so severe that he required ventilatory support. A total body CT scan revealed a nodular lung lesion with diffuse lymphangiitis. Biopsy disclosed a lung adenocarcinoma with a severe infiltration of CD8 cells. Surgical eradication of the tumor caused the last severe relapse. At the moment the patient is relapse‐free and no more treatment was administered. The clinical course of the motor demyelinating relapsing neuropathy suggests a possible paraneoplastic pathogenesis of the neurological illness also supported by the severe inflammatory infiltration of the tumor.     

99mTc-tetrofosmin SPECT in solitary pulmonary nodule evaluation

A correct differential diagnosis between benign and malignant lesions is mandatory in patients with solitary pulmonary nodule (SPN). The aim of the present study was to investigate whether 99mTc-tetrofosmin SPECT may play a role in SPN evaluation. A consecutive series of 111 patients with an uncalcified 相似文献   

Stability of gold bead tissue markers

Significant soft tissue features in the orbit and elsewhere are not resolved by MRI or any other imaging method. We describe a new method that uses tiny ( approximately 0.1 mm diameter) gold beads as markers to visualize movements of such tissues with high spatial resolution ( approximately 100 microm) and moderate temporal resolution ( approximately 100 ms). We describe bead fabrication, implantation, imaging, and image processing to extract three-dimensional bead coordinates. We then present results of an experiment to determine the stability of gold bead tissue markers (GBTMs) over time in normally moving orbital tissues. Most beads (76%) implanted in sclera, muscle, tendon, and connective tissue were highly stable over the 6-month measurement period. Beads that were judged unstable drifted only a few 100 microm. Bead flows with gaze suggested that posterior Tenon's capsule moves with the globe, that the lateral rectus belly may sideslip, producing "bridle forces," and that the posterior medial rectus pulley sling moves freely anteriorly and posteriorly, but hardly vertically, as required by the "coordinated active pulley" hypothesis. The GBTM method seems applicable to study such short time course phenomena as extraocular muscle (EOM) and connective tissue movement as a function of gaze and such long time course phenomena as myopic eye growth.     

Effect of ischaemia on sensory potentials of normal subjects of different ages

In 73 normal subjects, from 10 to 82 years of age, maximum orthodromic sensory nerve conduction velocity was measured in the median nerve before and during a 30 minute period of vascular occlusion. During ischaemia progressive slowing in conduction velocity, decrease in amplitude, and increase in duration of the sensory action potential evoked at wrist and elbow by supramaximal stimulation of digit III were observed. However, a statistically significant difference (P<0·05 to P<0·01) between subjects was noted by grouping them by age: the older the subject, the longer the persistence of sensory response and the less marked the slowing in conduction velocity. The mechanism of the phenomenon has been discussed in relation to a similar longer resistance to ischaemia found in peripheral nerves of diabetic and uraemic patients.     

Caspofungin in the treatment of azole-refractory esophageal candidiasis in kidney transplant recipients

BACKGROUND: Infection is a common cause of morbidity and mortality in kidney transplant recipients. The incidence of esophageal and urogenital candidiasis in kidney and kidney-pancreas transplant recipients has not been well documented. Azoles are safe, effective agents to treat esophageal candidiasis. However, resistance to azoles is now becoming common. This study reports the use of caspofungin for the treatment of azole-resistant esophageal and urogenital candidiasis in kidney transplant recipients. PATIENTS AND METHODS: The incidence of esophageal and urogenital candidiasis was evaluated among 140 kidney transplantations and four combined kidney-pancreas transplants performed over a 2-year period. RESULTS: Twenty-two patients (15.7%) presented with esophageal candidiasis, while seven patients (5%) showed urogenital candidiasis. Thirteen patients with esophageal candidiasis (59%) and four patients (57%) with urogenital candidiasis did not improve after a week of azole treatment. A regimen of caspofungin was started in these patients, who tolerated the treatment. Urogenital candidiasis recurred in two patients 2 and 3 months after the treatment. One patient with esophageal candidiasis did not improve with caspofungin and was switched to amphotericin B therapy. There were no other recurrences of candidiasis among patients treated with caspofungin for a median follow-up of 8 months. CONCLUSIONS: Renal transplant patients remain at high risk for fungal infections. Although the number of patients was limited, the results of this study indicated that caspofungin is an effective, well-tolerated alternative for difficult-to-treat, azole-resistant candida infections in kidney and pancreas transplant recipients. The high costs of the drug limit the use of caspofungin as first-line antifungal therapy, reserving its use to recipients who had undergone unsuccessful azole therapy.     

Continuous intrathecal baclofen administration by a fully implantable electronic pump for severe spasticity treatment: our experience

AIM: With this 8-month study, we wanted to evaluate the efficacy of continuous intrathecal baclofen infusion delivery by a programmable pump for severe spasticity according to patient selection criteria, implantation technique and related parameters, and outcome after the initial follow-up period. METHODS: Intrathecal baclofen infusion was initiated in 30 patients within 24 h after a test dose of the agent resulted positive in spinal anaesthesia. During the procedure and the follow-up period, the following parameters were measured: incidence of anaesthesiological or surgical complications and adverse events, postdural puncture headache, prolonged motor block, difficulty in wound healing, infection, necessity to remove the pump; clinical response as measured on the Ashworth and spasms scales, quality of sleep, autonomy, quality of life and pain before and after intrathecal baclofen therapy. RESULTS: Perioperative vital parameters (mean duration of the operation, 86+/-13 min) were stable; no motor block or postdural puncture headache, early or late infection developed. The 1 case of delayed wound healing resolved with treatment; a dislocated catheter was repositioned in 1 other case. The differences in changes between pre- and posttreatment were statistically significant, with best results obtained on rigidity and pain. The mean length of hospital stay was 8+/-2 days. Baclofen tolerance was observed in 1 case, but resolved after baclofen holiday with morphine. One case of pump malfunctioning was resolved with replacement of the device; no new neurological deficits occurred thereafter. CONCLUSIONS: The good clinical response to treatment of spasticity and rigidity, improved quality of life, pain reduction and patient satisfaction with short length of admission demonstrate the efficacy of intrathecal baclofen therapy. Safe and efficacious, this mode of treatment appears to be the gold standard for treating severe spasticity.     

Neuroendocrine tumors. A rare case of duodenal carcinoids

The authors report their experience with a case of double duodenum carcinoid tumors occurring in a 59-year-old female patient. She presented with a one-year history of frequent abdominal painful episodes, associated with dyspepsia, emesis, pyrosis, eructation, skin flushing and easy strain. The laboratory examinations point out high hematic values of serotonin and gastrin, with a raising of urinary 5-HIAA. Preoperative endoscopic examinations showed the presence of 2 little sessile polypoid growths, placed in the duodenal bulb, one of this interested muscular tunic. The patient underwent Billroth I resection and was discharged on postoperative day 8. The authors after a little dissertation on that topic, go on to examine the current diagnostic and therapeutic possibilities. They confirm the elective role of surgical treatment of these rare tumors.