Multiple Sclerosis State of the Art (SMART): A Qualitative and Quantitative Analysis of Therapy's Adherence, Hospital Reliability's Perception, and Services Provided Quality.

The purpose of this study was to assess the adherence to therapy in patients with relapsing remitting multiple sclerosis (RR-MS) and to analyze the possible influence of factors such as hospital care and patients socioeconomic status. Two hundred eighty-five patients with RR-MS according to Mc Donald's criteria and naïve disease-modifying drugs (DMDs) naïve were enrolled. Two self-administered questionnaires addressing the management of patients at therapy prescription and the personal perception of the daily life changes caused by DMDs were administered at months 3 and 12. Full adherence, considered as correct use of the therapy prescribed, was observed in a very high percentage of subjects (97.3% and 93.9% at 3 and 12 months). The main cause for reduced adherence was single dose forgetfulness, followed by anxiety, pain at the injection site, and tiredness of "doing all injections." Nurses and neurologists of MS Center were identified as the major resource in coping with the disease at 3 and 12 months by patients. The neurologist was the health professional involved in MS management in 95% of cases and the nurse appeared to play a central role in patient training and drug administration management (50.3%).

Electroencephalographic correlates of vasovagal syncope induced by head-up tilt testing.

BACKGROUND AND PURPOSE: We sought to determine whether the introduction of EEG monitoring during head-up tilt testing could significantly improve the understanding of the cerebral events occurring during tilt-induced vasovagal syncope and the potential danger to the patient of this diagnostic procedure. METHODS: EEG monitoring was performed during head-up tilt testing in a group of 63 consecutive patients (27 males and 36 females; mean age, 41.5 years) with a history of recurrent syncope of unknown origin despite extensive clinical and laboratory assessment. RESULTS: Syncope occurred in 27 of 63 patients (42.8%) during head-up tilt testing and was found to be cardioinhibitory in 11 of 27 (40.7%) and vasodepressor in 16 of 27 (59.3%). All patients with a negative response to head-up tilt testing showed no significant EEG modifications. In patients with vasodepressor syncope, a generalized high-amplitude, 4- to 5-Hz (theta range) slowing of EEG activity appeared at the onset of syncope, followed by an increase of brain-wave amplitude with the reduction of frequency at 1.5 to 3 Hz (delta range). The return to the supine position was associated with brain-wave amplitude reduction and frequency increase to 4 to 5 Hz, followed by restoration of a normal EEG pattern and arousal (mean total duration of syncope, 23.2 seconds.). In patients with cardioinhibitory syncope, a generalized high-amplitude EEG slowing in the theta range was noted at the onset of syncope, followed by a brain-wave amplitude increase and slowing in the delta range. A sudden reduction of brain-wave amplitude then ensued, leading to the disappearance of electrocerebral activity ("flat" EEG). The return to the supine position did not allow either the immediate resolution of EEG abnormalities or consciousness recovery, both of which occurred after a further time interval (mean total duration of syncope, 41.4 seconds.). CONCLUSIONS: EEG monitoring during head-up tilt testing allowed recording and systematic description of electrocerebral abnormalities developing in the course of tilt-induced vasovagal syncope.

Variable cerebral dysfunction during tilt induced vasovagal syncope.

Electroencephalographic (EEG) monitoring was performed during head-up tilt testing (HUT) in a group of 63 consecutive patients (27 males, 36 females, mean age 41.5 years) with a history of recurrent syncope of unknown origin despite extensive clinical and laboratory evaluation. Syncope occurred in 27/63 patients (42.8%) during HUT and was cardioinhibitory in 11/27 (40.7%) and vasodepressor in 16/27 (59.3%). All patients with a negative response to HUT had no significant EEG modifications. In patients with vasodepressor syncope a generalized high amplitude 4-5 Hz (theta range) slowing of EEG activity appeared at the onset of syncope, followed by an increase in brain wave amplitude with a reduction of frequency at 1.5-3 Hz (delta range). The return to the supine position was associated with brain wave amplitude reduction and frequency increase to 4-5 Hz, followed by restoration of a normal EEG pattern and arousal (mean total duration of syncope 23.2 s). In patients with cardioinhibitory syncope, a generalized high amplitude EEG slowing in the theta range was noted at the onset of syncope, followed by a brain wave amplitude increase and slowing in the delta range. A sudden reduction of brain wave amplitude ensued leading to the disappearance of electroencephalographic activity ("flat" EEG). The return to the supine position was not followed by immediate resolution of EEG abnormalities or consciousness recovery, both occurring after a longer time interval (mean total duration of syncope 41.4 s). EEG monitoring during HUT allowed the recording and systematic description of electroencephalographic abnormalities developing in the course of tilt induced vasovagal syncope.

Severe ulcerative colitis, dural sinus thrombosis, and the lupus anticoagulant.

Thromboembolic disease is a well-recognized but very uncommon complication of inflammatory bowel disease. The mechanisms of the increased risk of thrombosis are not well understood: although several coagulation abnormalities have been described in inflammatory bowel disease patients, it is not clear whether they actually contribute to hypercoagulation or whether they are nonspecific markers of inflammation. Antiphospholipid antibodies (anticardiolipin antibodies and/or lupus anticoagulant) have recently been associated with an increased risk of thrombosis, particularly cerebrovascular disease in young patients. We report the case of a 33-yr-old female with severe ulcerative colitis at first attack who developed thrombosis of the superior and inferior longitudinal dural sinuses. No risk factors for thrombosis or coagulation abnormalities were observed; however, lupus anticoagulant was detected in the serum. The patient was successfully treated with osmotic agents, prophylactic anticonvulsant, and antiplatelet therapy, combined with i.v. steroids. After 6 months, the colitis is in remission, and the neurological recovery is good even if not yet complete.

Laparoscopy in obstetrics and gynecological emergencies.

The Authors underline the importance of the laparoscopy in the Obstetrical and Gyneacological emergencies. For this purpose, 74 consecutive laparoscopies, performed as emergencies at the Department of Obstetrics and Gynaecology of the University of Pavia, are considered and analyzed. The Authors stress that the celioscopy has allowed a precise diagnosis in all the cases examined, and, even thanks to percelioscopic surgery, has avoided some useless laparotomies. Even more, when it was necessary to perform a major surgical act, the right laparoscopic diagnosis has addressed the therapy in several cases to conservative surgery.

[IUD and gynecological infections]. / IUD e infezioni ginecologiche.

PIP: IUDs have assumed increasing importance as contraceptives. Better design and use of new materials has increased their safety and reduced their side effects. However, pathological problems are constantly reported in literature. They include menstrual alterations (menometrorrhagia), pelvic infection, ectopic pregnancies, and perforation of the uterus. Results of research conducted at the Gynecology and Obstetrics Clinic at the University of Pavia are reported. The pathogenesis and etiology of cervico-vaginitis, actinomyces infections, PID and septic abortion in patients using IUDs were examined. It is concluded that the use of the spiral IUD is contraindicated for women affected by immunodeficiency and for patients with diseases that require therapy with anti-inflammatory agents. Special attention should be given to nulliparous patients with cardiovalvular problems and to patients during the immediate postpartum period. The importance of performing a bacteriological cervico-vaginal examination before the insertion of the IUD is stressed. Aside from common aerobic germs, the patient should be examined for anaerobic germs and agents of sexually transmitted diseases. Any form of cervico-vaginitis should be treated prior to insertion. A bacteriological checkup should be performed continually in order to prevent possible phlogistic as well as asymptomatic or minor symptomatic complications. The IUD should be replaced within 2 years of insertion. If infections occur, the device must be removed and an antibiotic therapy initiated.^ieng

Hyperthermia after discontinuance of levodopa and bromocriptine therapy: impaired dopamine receptors a possible cause.

Hyperthermia, with no signs of any underlying infection, may occur in the course of neuroleptic malignant syndrome, fatal catatonia, heat stroke, or malignant hyperthermia. We describe hyperthermia as a complication after discontinuance of antiparkinsonian treatment with levodopa/carbidopa and bromocriptine. Impaired nigrostriatal, hypothalamic, and mesolimbic dopaminergic functions could be involved in pathogenesis.