Increase in 20-50 Hz (gamma frequencies) power spectrum and synchronization after chronic vagal nerve stimulation.

OBJECTIVE: Though vagus nerve stimulation (VNS) is an important option in pharmaco-resistant epilepsy, its mechanism of action remains unclear. The observation that VNS desynchronised the EEG activity in animals suggested that this mechanism could be involved in VNS antiepileptic effects in humans. Indeed VNS decreases spiking bursts, whereas its effects on the EEG background remain uncertain. The objective of the present study is to investigate how VNS affects local and inter regional syncronization in different frequencies in pharmaco-resistant partial epilepsy. METHODS: Digital recordings acquired in 11 epileptic subjects 1 year and 1 week before VNS surgery were compared with that obtained 1 month and 1 year after VNS activation. Power spectrum and synchronization were then analyzed and compared with an epileptic group of 10 patients treated with AEDs only. RESULTS: VNS decreases the synchronization of theta frequencies (P < 0.01), whereas it increases gamma power spectrum and synchronization (< 0.001 and 0.01, respectively). CONCLUSIONS: The reduction of theta frequencies and the increase in power spectrum and synchronization of gamma bands can be related to VNS anticonvulsant mechanism. In addition, gamma modulation could also play a seizure-independent role in improving attentional performances. SIGNIFICANCE: These results suggest that some antiepileptic mechanisms affected by VNS can be modulated by or be the reflection of EEG changes.

[Spigelian hernia. Diagnosis and surgical treatment]. / Ernia di Spigelio: diagnostica e trattamento.

Spigelian hernia (SH) is a rare partial abdominal wall defect; its manifestation is rare. Seven cases were observed--4 females and 3 males with mean age of 56.5 years (range 38-65)--in 857 patients operated for hernia (0.8%) between 1995 and 2003. Ultrasound examination avoid the diagnosis and marked the fascial defect, measuring diameter and sac contents. In all cases a surgical approach with an epicritic incision has be done and the fascia defect closed with properitoneal and subfascial polypropylene mesh (Prolene Hernia System, PHS). All patients underwent to follow-up demonstrating no recurrences or complications like mesh suppuration or dislocation.

[Color Doppler ultrasound in acute mesenteric ischemia: 2 case reports]. / Il rilievo ecocolordoppler nell'ischemia mesenterica acuta: descrizione di due casi clinici.

Acute mesenteric insufficiency is a surgical emergency with a difficult methodological approach. Its high mortality is mainly due to delay in the correct diagnosis. In turn this is due to the lack of specificity, especially in the early-middle phase of the clinical presentation, and of the laboratory data and abdominal radiographic findings. Echo-doppler ultrasound promises to be more accurate than conventional ultrasound in the diagnosis of visceral ischemia and may help to identify those patients who may require angiography. Two women presenting atrial fibrillation, abdominal pain, leukocytosis, hyperamylasemia were accepted in October 2000 ad March 2001. US colordoppler was performed 12 hours after admittance demonstrating a "stop" of enhancement of the superior mesenteric artery in one case and absence of enhancement in the other.

Bipolar affective disorder and Parkinson's disease: a rare, insidious and often unrecognized association.

Five patients (4 women) with Parkinson's disease (PD) and primary major psychiatric disorder (PMPD) meeting DSM-IV criteria for the diagnosis of bipolar affective disorder (BAD) were studied. Four patients had early onset PD. Four developed a severe psychiatric disorder a few years after starting dopaminergic therapy in presence of a mild motor disability and a mild cognitive impairment, with no evidence of cerebral atrophy at CT or MRI. Two patients developed a clear manic episode; the other three presented a severe depressive episode (in one case featuring a Cotard syndrome). None showed previous signs of long term L-dopa treatment syndrome (LTS), hallucinosis or other minor psychiatric disorders. The two manic episodes occurred shortly after an increase of dopaminergic therapy and in one case rapid cyclic mood fluctuations were observed. At the onset of psychiatric symptoms, all patients had an unspecific diagnosis of chronic delusional hallucinatory psychosis (CDHP).

[Defect of the broad ligament as a cause of internal hernia]. / Un difetto del legamento largo dell'utero causa di ernia interna.

Herniation of small bowel trough a defect of the broad ligament is an extremely rare event, more over in women never had surgical operations. Pathogenetic hypothesis are considered. Differential diagnosis may be difficult. The Authors report a recent observation of such small bowel herniation trough the left mesosalpynx.

[The kissing balloon in angioplasty of coronary stenosis involving the bifurcation of a major branch]. / II "kissing balloon" nella angioplastica delle stenosi coronariche interessanti la biforcazione di un ramo principale.

A case of severe effort angina treated with Percutaneous Transluminal Coronary Angioplasty (PTCA) is described. The critical coronary lesion involved the left anterior descending coronary artery and the origin of a first diagonal branch. The "kissing balloon" technique was used. After a year, the immediate positive angiographic results remained unchanged.

[Prognostic value of CEA in postoperative monitoring of colorectal cancers]. / Valore prognostico del CEA nel monitoraggio post-operatorio dei carcinomi del colon-retto.

The prognostic value of CEA for the purposes of postoperative monitoring assessed in 45 patients with cancer of the colon and rectum. Values were obtained 1-36 months after surgery in all operable cases. Means were also evaluated statistically at various follow-up times. In patients who relapsed, values stayed significantly higher for up to 6 months after surgery than in those who did not. Cockran's method showed that the prognostic significance of this difference 6 months after surgery was p less than 0.05.