Lasker's coefficient of isonymy between and within 16 Sardinian villages in the periods 1825-1849, 1875-1899, and 1925-1949.

Coefficients of relationship by isonymy, based on the frequency of common surnames, were used to estimate the biological affinity between (R(ib)) and within (R(iw)) 16 Sardinian villages in the periods 1825-1849, 1875-1899, and 1925-1949. The database for the surname analysis consisted of 13,515 marriages registered in the parishes of villages, all belonging to the Sardinian linguistic area. The values of R(ib) and R(iw) tend to decrease in time. In all three periods, the R(ib) values generally decrease as the geographical distance between villages increases. The negative values of the Bravais-Pearson coefficient of correlation between the matrix of R(ib) values and the matrices of geographical distances (calculated both in a straight line and from road distances) are significant for each period (modified Mantel test), with slightly higher correlation coefficients for road distances. Moreover, the plots of isonymic relationships obtained by nonmetric multidimensional scaling for 1825-1849 and 1925-1949 show that the biological relationships between neighboring villages increase in the latter period. The positive values of the Bravais-Pearson coefficients of correlation between R(iw) and altitude are significant in all three periods, while the correlation between R(iw) and population size is not significant, even when altitude is controlled for. Since altitude is considered an indicator of isolation, the results obtained with the coefficient of relationship by isonymy within villages also support the isolation-by-distance model. R(ib) values provided a reliable picture of the biological relationships between 16 Sardinian villages, while R(iw) values illustrated the biological affinity within the communities for a period of 100 years, from 1825-1849 to 1925-1949.     

Guidelines for recognition and treatment of the psychoses associated with epilepsy

Epilepsy and psychiatric diseases are frequent comorbidities. Psychoses in patients with epilepsy have special physiopathology and several clinical presentations and prognoses. Their treatments are also specific, according to the specific diagnosis. This paper represents the summary of a consensus meeting held in November 2003 by a Belgian French-speaking group of neurologists, neuropediatricians and psychiatrists and proposes guidelines for the recognition and treatment of those entities.     

Acanthocytosis as a predisposing factor for non-ketotic hyperglycaemia induced chorea-ballism

BACKGROUND: Episodic non-ketotic hyperglycaemia in patients with diabetes may be responsible for a syndrome characterised by hemichorea-hemiballism associated with unique radiological features. OBJECTIVE: To investigate whether factors other than hyperglycaemia may be responsible for the neurological involvement. METHODS: Three patients who developed a persistent chorea-ballism syndrome triggered by a hyperglycaemic crisis were investigated. In these patients, the persistence of the involuntary movements required neuroleptic medication. RESULTS: T1 weighted magnetic resonance imaging revealed bilateral hyperintense lesions involving the striatum. Surprisingly, in these patients, the laboratory investigations revealed peripheral red blood cell acanthocytosis in a significant proportion of cells. CONCLUSION: Compared with the large population of patients with diabetes who do not show abnormal involuntary movements, unrecognised acanthocytosis in diabetes might render patients prone to develop hemichorea-hemiballism.     

Post-traumatic cutaneous meningioma

Cutaneous meningiomas are extremely rare tumours and their diagnosis is difficult. We describe the case of a patient who developed a paranasal swelling after head trauma and associated fractures in the same region years before. Histopathological examination of an incisional biopsy revealed the diagnosis of cutaneous meningioma. After one and a half years' follow up, surgical excision was performed because of progressive growth of the tumour and associated aesthetic problems. Extracranial meningiomas can develop probably secondary to trapping of meningeal tissue after trauma. If there is no intracranial connection surgical removal can be considered.     

Abnormal uterine bleeding: medical treatment with vaginal danazol and five-year follow-up

STUDY OBJECTIVE: To evaluate the clinical efficacy and patient satisfaction of long-term danazol delivered vaginally as treatment for heavy menstrual bleeding. DESIGN: Prospective study (Canadian Task Force classification II-3). SETTING: University hospital. PATIENTS: Twenty premenopausal women with endometrial hyperplasia or endometrial polyps. INTERVENTION: After curettage or hysteroscopic-directed biopsies, women used one 200-mg tablet of danazol vaginally every day, continuing the therapy as long as they were totally satisfied with it. MEASUREMENTS AND MAIN RESULTS: Women were instructed to keep a diary of menstrual bleeding and to rate blood loss on a visual analog scale from zero (no blood loss) to 10 (gushing-type bleeding). They were seen every month for 3 months, then every 3 months for 9 months, and then every 6 months for 4 years for Papanicolau smear, pelvic examination, and transvaginal ultrasonography. They were asked to bring their diary of menstrual bleeding. They were asked about side effects and their satisfaction with the therapy. Peripheral blood was drawn for blood count and serum chemistries. Hysteroscopic-directed biopsies were repeated after 3 months of therapy in women with endometrial hyperplasia. The severity of blood loss was significantly reduced in all women after 3 months of treatment. All women with endometrial hyperplasia had regression of hyperplastic endometrium. None of the women with endometrial polyps had sonographic signs of recurrence during therapy. Only 10 women (50%) completed 1-year follow-up, and only 5 women (25%) completed 5-year follow-up. CONCLUSION: These results suggest that long-term administration of vaginal danazol after curettage or hysteroscopic-directed biopsy is both efficacious and safe in women with heavy menstrual bleeding, but the rate of discontinuance is high.     

Carotid stent mobility with regard to head movements: in vitro analysis

Given that considerable motion of the carotid artery is present during head movements, we hypothesized that a flexible stent with low torsion might be favorable to avoid stress imparted to the stent and carotid artery. Therefore, we evaluated the flexibility of different expanded carotid stents before and after deployment in a carotid artery in vitro. Subsequently, we evaluated torsion of the bare expanded stents. Five stents (Wallstent [Boston Scientific Corp., Natick, MA], Acculink [Guidant Corp., Indianapolis, IN], Precise [Cordis Corp., Johnson & Johnson Company, Warren, NJ], Carotid SE [Medtronic AVE, Santa Rosa, CA], and Protégé [EV3, Plymouth, MN]) were tested. Flexibility was determined using a three-point bend test recording the bending load (BL) in grams required to flex the stent 25 degrees. Increased BL implies decreased flexibility. Torsion was measured by recording the rotation load (RL) in grams required to rotate the stents 30 degrees along its axis. Increased RL implies increased torsion. In the bare expanded state, the median BL was 6 g (range 1-22 g). The BL increased to 38 g (range 20-41 g) after deployment in a carotid artery, with the Carotid SE (21 g) and Wallstent (36 g) showing significantly lower BL (p < .0001 and p = .0016, respectively). Overall, the RL was 11 g (range 1-76 g). Significantly higher RL was required to rotate the Wallstent (73 g) and Precise (20 g) stents (p < .0001). The flexibility of the currently used stents decreases after deployment in a carotid artery irrespective of its flexibility in the bare state. Two stents showed increased torsion compared with the other stents. Limitations in both flexibility and torsion might influence the long-term performance of carotid angioplasty stenting.     

Early arterial lactate and prediction of outcome in preterm neonates admitted to a neonatal intensive care unit

AIM: In the present study early arterial lactate samples were examined to predict adverse outcome in preterm neonates. SUBJECTS AND METHODS: 88 preterm neonates (mean gestational age 29.8 weeks, mean birth weight 1,225 g) had arterial lactate levels measured from indwelling arterial catheters within the first 3 h of life. An adverse outcome was defined as death or abnormal neurodevelopment. The positive (PPV) and negative predictive value (NPV) of early arterial lactate levels for an adverse outcome (death or neurodevelopmental abnormalities) were calculated using receiver operating characteristic analysis. RESULTS: PPV and NPV of arterial lactate within 3 h after birth were 0.47 and 0.92, respectively, with a cutoff value of 5.7 mmol/l. Umbilical blood gas values and 1 and 5 min Apgar scores had much lower PPVs. CONCLUSION: Arterial lactate levels within 3 h of life can be used to select preterm neonates who are at risk of an adverse outcome.     

<Emphasis Type="Bold">Reproductive Endocrinology:</Emphasis> Uterine Perfusion and Hormonal Pattern in Patients with Polycystic Ovary Syndrome

Purpose: To evaluate whether polycystic ovary syndrome (PCOS) patients with different pulsatility index (PI) of uterine artery showed differences in their hormonal pattern. Methods: Eighty-eight PCOS-affected patients and 15 controls were submitted to Doppler flow measurement of uterine artery; LH, FSH PRL, estradiol, and androgens concentration determination; and BMI evaluation during early follicular phase. Results: The mean PI of uterine artery of PCOS patients was significantly higher than control group (2.97 ± 0.9 vs. 1.89 ± 0.2 respectively). The distribution of the PI'values was significantly different in the PCOS-affected patients and in control group. The plasma levels of DHEAS and BMI were significantly higher in PCOS patients with PI 3 than in PCOS patients with PI < 3. Conclusion: High resistance in the uterine artery is present in PCOS patients, but a wide range PI values of uterine artery is present. BMI and DHEAS seem to be factors interfering with uterine perfusion.