Ataxic hemiparesis syndrome: clinical and CT study of 20 new cases and review of the literature

20 new cases of ataxic hemiparesis syndrome (AHS) are reported and the findings compared with those of published cases. AHS may be due to lesions either of the brainstem or of supratentorial structures, where motor fibers run together with the cerebro-cerebellar pathways. Specific syndromes related to the lesion site cannot be identified from the clinical signs. Ischemic infarct is the most frequent cause of the syndrome, but hemorrhagic, neoplastic and demyelinating lesions have also been reported.

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Sommario Venti nuovi casi di emiparesi atassica sono stati osservati e confrontati con casi della letteratura. L'emiparesi atassica può conseguire a lesioni del tronco cerebrale o delle strutture sovratentoriali laddove le fibre motorie decorrono insieme alle vie cerebro-cerebellari. I quadri clinici osservati non consentono pertanto di identificare specifiche sindromi caratterizzate da danni anatomici comuni. Per quanto l'infarto ischemico ne sia di gran lunga la causa più frequente, l'emiparesi atassica è riportata anche in presenza di lesioni emorragiche, neoplastiche e demielinizzanti.

     

Arthroscopic treatment of acute acromioclavicular joint dislocation with double flip button

The ideal treatment for acute acromioclavicular joint dislocation is still controversial, both in terms of indications and surgical technique. The clinical and radiographic outcomes of 16 patients affected by acute AC joint dislocation (type III–V) and arthroscopically treated with a coracoclavicular double flip button are presented. Despite the excellent clinical results both in terms of Constant score (mean 97 points) and patient satisfaction, at a mean follow-up of 31 months the radiographs showed partial loss of reduction due to distal migration of the flip button within the upper third of the clavicle in one-fourth of the cases. The technique presented here proved to be safe and minimally invasive while delivering good aesthetic results and allowing for the treatment of associated lesions. Furthermore, the technique could benefit from more advanced retention devices, which ought to reduce or avoid migration of the flip buttons.     

Primary mammary focus of malignant non-Hodgkin's lymphoma. Apropos of 10 cases

The authors describe 10 cases of malignant non-Hodgkin's lymphoma in a mammary site in women aged 38 to 82 years. The clinical examination and the sometimes suggest an adenocarcinomatous lesion, thus leading to a useless surgical exeresis. An initial histological study provides the diagnosis. A complete assessment of extension allows an accurate staging and the refinement of the therapeutic schedule. Exclusive radiation therapy seems to be justified in low-malignancy forms remaining strictly confined to the breast. For the high- and medium-malignancy forms, the essential weapon is chemotherapy, which seems to improve the duration and rate of remission.     

Asymptomatic patient reoperated on for severe proximal stenosis of circular sequential vein graft

The case is described of a fifty year old man who underwent coronary bypass surgery using the circular sequential vein graft technique. At follow-up study (6 months after operation), despite his asymptomatic status, the effort test revealed antero-lateral myocardial ischemia. A coronary angiography showed a 90% proximal stenosis of the graft at 1.5 cm from the aortic anastomosis. The patient was reoperated on and the circular graft was reconstructed. Despite the severe stenosis this technique of myocardial revascularization has developed intercoronary anastomoses, improving the cardiac contractility and avoiding further clinical complications.     

Long-lasting effects on rheology and clearance of bronchial mucus after short-term administration of high doses of carbocysteine-lysine to patients with chronic bronchitis

The rheological behavior and clearance of bronchial mucus samples collected by protected expectoration from 24 out-patients with simple chronic bronchitis were investigated before, at the end of a short period of treatment (4 days) with a single oral dose of 2.7 g (sachet) of carbocysteine-lysine (evening meal), and on the 4th and 8th days after the end of treatment versus placebo. In the group treated with carbocysteine-lysine, there were significant reductions in viscosity (-67, -48, -62%) and increases in mucociliary transport (+41, +31, +34%) at the three times mentioned. The most striking finding was that the improvements were still present 8 days after cessation of treatment. The elasticity parameter was not affected in any statistically significant way (-10, -24, +65%). These findings suggest the presence of some type of 'post-mucoactive' effect.     

Role of p27 in Prostate Carcinogenesis

The cyclin dependent kinase inhibitor p27 binds to and inhibits preferentially S-phase kinases thereby halting cell cycle progression. Loss of p27 expression has been shown to be associated with aggressive behavior in a variety of human epithelial tumors including prostate cancer. In this review, the role of p27 in cell cycle progression as well as its regulation by the ubiquitin-proteasome pathway are discussed. The experimental evidence pointing to the role of p27 as a tumor suppressor gene is outlined. The data generated to date on the prognostic significance of loss of p27 protein expression in human prostate cancers are summarized. Finally, the implications of the changes in p27 expression which occur as a result of androgen ablation in normal and neoplastic prostate are discussed.     

EFFECTS OF RATION/SIZING DRUG TREATMENT OF PATIENTS WITH EPILEPSY AND MENTAL RETARDATION

Eighty patients with epilepsy and mental retardation were observed for a mean period of 12.5 months to assess the effects of 'rationalisation' of their drug treatment on both epilepsy and behaviour. Anticonvulsant drugs were modified to provide the best seizure control with the lowest toxicity, and psychotropic drugs also were monitored and modified if necessary to obtain the best results. At the end of the follow-up period the number of anti-epileptic drugs had fallen from 1.84 to 1.05 per patient. On admission to the study 47 patients were being treated with 85 psychotropic drugs: at the end of the follow-up 44 patients were taking 63 drugs. Seizures were significantly reduced in 16 of 39 patients with unsatisfactory control on admission to the study. Among 41 patients with initial satisfactory control, only 16 had relapse of seizures. Behavior did not change significantly.     

Echocardiographic approach in a new left ventricular assist device: Impella Recover 100.

Echocardiographic evaluation represents a basic tool for the treatment of patients undergoing ventricular assist device implant. Impella Recover 100 is a new left intraventricular assist device proposed for short-term mechanical circulatory support to be implanted without cardiopulmonary bypass. We report our experience with echocardiographic monitoring on a patient with ischemic cardiomyopathy who underwent Impella Recover 100 implant as a bridge to heart transplant. During the surgical procedure echocardiography had an essential role for anatomic evaluation of the heart and correct intraventricular positioning of the device. Moreover, during the whole period of assistance, echocardiography contributed to assessment of patient-device interaction and to check the device when malfunction was suggested.     

Effect of Intraluminal Flow on Proximal Tubular Reabsorption

Micropuncture techniques in the rat were used to reinvestigate the possibility that intraluminal flow rate per se may influence net volume reabsorption by the proximal tubule. An experimental design was devised which lowered intraluminal flow without affecting filtration rate of the nephron under study or without directly affecting other renal hemodynamics. In 11 rats flow of tubular fluid between early and late proximal tubular sites was reduced by partially collecting tubular fluid at the early puncture site. In 42 nephrons the rate of flow of tubular fluid was reduced an average of 45% without changing nephron filtration rate and there was an associated reduction in reabsorption between the two sites which averaged 29%. This indicated 63% balance between delivery of tubular fluid and the rate of reabsorption between two sites along proximal tubules. The results of these studies indicate that a reduction in delivery of normal filtrate along the proximal tubule is associated with a concordant reduction in the absolute rate of reabsorption. Since this relationship occurred in the absence of changes in renal hemodynamics or even a change in filtration rate of the nephron under study it is concluded that changes in intraluminal load per se play an important role in the phenomenon of glomerulotubular balance.     

Endotoxin priming exacerbates acute reflux pancreatitis in the rat

Recently, endotoxaemia has been reported as a prognostic marker in acute pancreatitis. However, the role of endotoxin in inducing or aggravating acute pancreatitis is not fully understood. We administered endotoxin 400 μg/kg i.p. to rats 24 h before performing either a closed duodenal loop (group B) or a sham operation (group D). Pancreatic damage and overall survival were compared with the results obtained in rats not exposed to endotoxin undergoing either closed duodenal loop (group A) or sham treatment (group C). In a first set of experiments, 24 h after laparotomy blood samples were collected and the animals were sacrificed; survival up to 8 days was estimated in a second set of experiments. Group B had higher lipase concentrations and more severe tissue damage than group C (P<0.05). A larger number of abscesses was observed in both group B and group D as compared to group C (P<0.05). Survival was significantly shorter in group B (P<0.0001). We conclude that priming with endotoxin worsens the extent of pancreatic damage induced by the closed duodenal loop procedure in the rat, possibly favouring selective homing of neutrophils to the site of inflammation, in similarity to what happens in the Shwartzman phenomenon.