White-line: A new finding in laryngopharyngeal reflux objective evaluation

Laryngopharyngeal reflux (LPR) indicates the reflux-induced extra-esophageal disorders. LPR and gastroesophageal reflux disease (GERD) occur by the same mechanism: the escape of gastric contents into the esophagus and beyond. However, the classic GERD symptoms are not typical in LPR disease, which can cause a lot of symptoms none of which is specific, making the diagnosis often elusive. The protective mechanisms present in the esophagus are entirely lacking in the larynx, and more generally in upper aerodigestive tract, making them particularly vulnerable to injury from acidic gastric contents. Since gastric acid backflow can affect supraesophageal structures, even in the absence of heartburn or regurgitation symptoms, an early diagnosis is important to prevent the onset of histological modifications in the supraesophageal mucosa.     

Protection of the Proximal Articular Cartilage During Percutaneous Thermal Ablation of Acetabular Metastasis Using Temperature Monitoring

CardioVascular and Interventional Radiology - To review our initial experience in acetabular cartilage protection from thermal injury with temperature monitoring during percutaneous image-guided...     

The attracting power of the gaze of politicians is modulated by the personality and ideological attitude of their voters: a functional magnetic resonance imaging study

Observing someone rapidly moving their eyes induces reflexive shifts of overt and covert attention in the onlooker. Previous studies have shown that this process can be modulated by the onlooker's personality, as well as by the social features of the person depicted in the cued face. Here, we investigated whether an individual's preference for social dominance orientation, in‐group perceived similarity (PS), and political affiliation of the cued‐face modulated neural activity within specific nodes of the social attention network. During functional magnetic resonance imaging, participants were requested to perform a gaze‐following task to investigate whether the directional gaze of various Italian political personages might influence the oculomotor behaviour of in‐group or out‐group voters. After scanning, we acquired measures of PS in personality traits with each political personage and preference for social dominance orientation. Behavioural data showed that higher gaze interference for in‐group than out‐group political personages was predicted by a higher preference for social hierarchy. Higher blood oxygenation level‐dependent activity in incongruent vs. congruent conditions was found in areas associated with orienting to socially salient events and monitoring response conflict, namely the left frontal eye field, right supramarginal gyrus, mid‐cingulate cortex and left anterior insula. Interestingly, higher ratings of PS with the in‐group and less preference for social hierarchy predicted increased activity in the left frontal eye field during distracting gaze movements of in‐group as compared with out‐group political personages. Our results suggest that neural activity in the social orienting circuit is modulated by higher‐order social dimensions, such as in‐group PS and individual differences in ideological attitudes.     

MRI role in morphological and functional assessment of the levator ani muscle: Use in patients affected by stress urinary incontinence (SUI) before and after pelvic floor rehabilitation

Objective

Pelvic floor dysfunctions affect a very high proportion of female population. Magnetic resonance imaging is the only technique able to provide a multiplanar overview of pelvic organs and muscles without the use of ionizing radiation. The aim of our prospective study is to objectively evaluate the effectiveness of perineal re-education applying MR technique.

Materials and methods

22 patients affected by stress urinary incontinence were enrolled in our prospective study. They underwent urogynaecological, urodynamic examinations, and a questionnaire about symptoms (ICIQ-UI) to investigate the degree of their interference with daily activities. Then they underwent a morphological and dynamic MR exam.

Results

The pre-perineal rehabilitation MR examinations showed an asymmetry of the levator ani muscle in 87% of patients; the remaining 13% showed a muscular bilateral volume reduction. In the group with unilateral defect, the muscle total volume had values between 15 and 21 cm³. Its overall volume was 34.2% smaller on the defective side (9.28 ± 0.26 cm³) compared to the normal side (12.64 ± 12.31 cm³, P < 0.001).In patients with a bilateral impairment, the muscle was replaced by fibro-fatty tissue, without a significant asymmetry between the two sides. The post-perineal rehabilitation MR tests showed three different degrees of response to therapy, with a “complete response” found in 67% of patients and no response in 13%.

Conclusions

MR is an useful tool in the management of patients affected by stress urinary incontinence with indication for perineal rehabilitation. Its objective data allow to distinguish different types of response to therapy and, consequently, different outcomes in terms of additional treatments.     

A longitudinal study of brain atrophy and cognitive disturbances in the early phase of relapsing-remitting multiple sclerosis

OBJECTIVE: (a) To establish whether the cognitive decline of the early phase of relapsing-remitting multiple sclerosis depends on the progression of the burden of disease, or on the loss of brain parenchyma, or is influenced by both; (b) to monitor the loss of brain parenchyma in the early phase of the disease; and (c) to examine its possible relation with the progression of physical disability. METHODS: For 2 years 53 patients with clinically definite relapsing-remitting multiple sclerosis with disease duration 1-5 years and expanded disability status scale < or =5.0 at baseline were monitored. The neuropsychological performances, the psychological functioning, the neurological impairment, and the disability have been assessed at baseline and after 2 years. Patients also underwent PD/T2 and T1 weighted brain MRI. T2 and T1 lesion volumes were measured by a semiautomatic technique. Quantification of brain parenchymal volumes was obtained using a highly reproducible computerised interactive program. The relation between cognitive impairment and MRI findings has been investigated by partial correlation and stepwise multiple regression analyses excluding the effects of age, education, anxiety, depression, and total days of steroid use. RESULTS: In the 2 years of the study the mean change for T2 and T1 lesion volumes and brain parenchymal volumes were +1.7 ml (95% confidence interval (95% CI) 1.3-2.2, p=0.005, (29.8%); +0.2 ml, 95% CI 0.15-0.26, p=0.004, (25%); and -32.3 ml, 95% CI 24.2-42.3, p<0.0001, (2.7%), respectively. Overall, 14 patients (26.4%) were judged to be cognitively impaired at baseline and 28 (52.8%) at the end of the follow up. Of the 18 neuropsychological tests and subtests employed in the study, patients with multiple sclerosis failed 5.8 (SD 2.3) tests at the baseline and 8.4 (SD 2.9) (p<0.0001) tests at the end of the study. When the cognitive changes were examined in individual patients, five (9.4%) of them were considered cognitively improved, 33 (62.3%) remained stable, and 15 (28.3%) worsened over 2 years. T2 and T1 volume changes in improved, stable, and worsened patients did not show any significant difference, whereas brain parenchymal volume decrease in cognitively worsened patients was significantly greater (-66 ml (5.4%), 95% CI 37-108.9, p=0.0031). The cognitive impairment was independently predicted over 2 years only by the change of brain parenchymal volumes (R=0.51, p=0.0003). Ten patients (18.9%), who worsened by one or more points in the EDSS during the follow up period had significant decreases in brain parenchymal volumes (-99 ml (8%), 95% CI 47.6-182.3, p=0.005). At the end of the study the loss of brain parenchyma correlated significantly with change in EDSS (r= 0.59, p<0.0001). CONCLUSIONS: In the early phase of relapsing-remitting multiple sclerosis the cognitive deterioration relies more on the development of brain parenchymal volume atrophy than on the extent of burden of disease in the brain. The loss of brain parenchymal volume underlies the progressive accumulation of physical disability from the initial phase of the disease, which becomes more demonstrable only if studied with longer observation periods. Probably, the main pathological substrate of brain atrophy in the early stage of the disease is early axonal loss, which causes the progression of neurological deficits and the development of cognitive impairment. These data support the debated opinion that disease modifying therapy should be initiated as early as possible.     

Contraceptive methods,induced abortion,first sexual intercourse age,in a group of 1635 students of the University of Rome

The authors report some data about contraceptive choice among young women examined in the Preventive Medicine Center of the University of Rome. Menarche age, menstrual cycle, age at 1st sexual intercourse, contraceptive method used, number of abortions, and pregnancies were examined. Moreover, the relationships between age at 1st sexual intercourse and contraceptive method and abortion were considered. Mean age at 1st intercourse was about 17.5 years. Pill and IUD were used by 11% and 5% respectively of the female students. Coitus interruptus was used among 83.3% of the cases. The prevalence of previous abortion was about 12.6%. The menstrual cycle characteristics did not influence the contraceptive choice of these students. Finally, previous abortion or pregnancy influenced contraceptive choice; in fact about 15% and 16.5% of the women with previous abortion performed or pregnancy experienced adopted the pill and IUD as contraceptive methods. (author's modified)