Clinical and stabilometric measures predicting falls in Parkinson disease/parkinsonisms.

OBJECTIVES: Clinical predictors of falls in patients with Parkinson disease (PD) are fairly inaccurate. Stabilometric measures appear useful in investigating the relationship between balance, sensory disturbance, and falls. The aim of the study was to identify the best combination of clinical and stabilometric tests to predict falls prospectively. MATERIALS & METHODS: Fifty-three consecutive subjects with PD or parkinsonisms at risk of falls were included and followed for 6 months. Clinical variables were used as fall predictors: the Unified Parkinson Disease's Rating Scale (motor section) and the Longitudinal Aging study Amsterdam Physical Activity Questionnaire (LAPAQ). Variables from stabilometric platform underwent a principal component analysis. Multivariate logistic models were used to predict fallers using fall status (fallers: 1 + falls; recurrent fallers: 2 + falls) as dependent variable. RESULTS: Seven patients were lost to follow up, leaving 46 evaluable subjects. Of these, 32 (70%) were fallers and 22 (48%) were recurrent fallers. The only variable predicting fallers was the LAPAQ (odd ratio [OR] 0.99 (95% confidence interval [CI] 0.98-1.00); accuracy 71.7%; sensitivity 87.5%; specificity 35.7%). For recurrent fallers, Factor 2 (body sway velocity) (OR 2.37; 95% CI 1.01-5.58) and, in part, LAPAQ (OR 0.99; 95% CI 0.98-1.00) retained significance in the multivariate model, showing an accuracy of 76.9%, a sensitivity of 77.8%, and a specificity of 76.2%. CONCLUSIONS: A combination of clinical and instrumental tools is useful to identify fallers in PD or parkinsonisms. Body sway velocity and ability to perform the activities of daily living are the best predictors of recurrent falls.

Myocardial scintigraphy in acute myocardial infarction treated with systemic thrombolysis: how far are we from obtaining reliable information for rescue PTCA?

All noninvasive tests have an unsatisfactory accuracy in assessing patency of the infarct related vessel after systemic thrombolysis. In large infarctions, the prompt knowledge of the amount of jeopardized myocardium, as well as the eventual success of thrombolysis on the culprit lesion are major clinical needs in the subsequent decision making process, including the indication to rescue PTCA. Several reasons preclude a meaningful use of thallium scintigraphy in this setting: the most important one is the need to perform pre-thrombolytic images before the administration of the active agent, implying a delay in the administration of thrombolysis that is clinically not acceptable. SestaMIBI perfusion scintigraphy at rest seems more suitable in this regard. SestaMIBI practically does not redistribute in the myocardium, and this implies that after an administration at admission in the CCU, the pre-thrombolysis images can be acquired later, without any interference with the therapeutic schedule. The estimate of myocardial salvage can be obtained by the comparison of the perfusion pattern derived from a later sestaMIBI injection with the pre-lysis images. Both planar and tomographic reconstructions have satisfactory positive and negative predictive accuracy for the patency of the culprit vessel. Difficulties are related with the necessity of having this information timely; we describe a few protocols, appeared in the literature, that might contribute in solving such problems. SestaMIBI imaging in patients with acute myocardial infarction should be encouraged and extended, given its potential to represent one of the best tool to judge the amount of jeopardized myocardium, the obtained salvage, and to guide the decision making after systemic thrombolysis.

[Salvage surgery in squamous cell carcinoma of the oral cavity]. / Chirurgia di salvataggio nel carcinoma squamocellulare del cavo orale.

The objective of this work was to evaluate the results of salvage surgery in squamous cell carcinoma of the oral cavity. In the period 1983-1998, 127 patients consecutively underwent surgical treatment. Of these, 80 cases had not been treated previously (Group I), while 47 patients had come under our observation after radiotherapy alone or other treatment had failed (Group II). Local recurrence was observed in 29 cases, local/regional in 10 cases, and exclusively regional in eight cases. In both groups, the surgical T-approach was prevalently transoral (55 cases in Group I and 24 in Group II). A transmandibular approach was taken in most of the remaining patients (22 cases in Group I and 16 in Group II). One hundred patients (65 in Group I and 35 in Group II) underwent laterocervical neck dissection. The neoplasms in group I were staged as follows: pT1, 29%; pT2, 37.5%; pT3, 12.5%; pT4, 21%. In group II, the neoplasms were stages as: pT0, 17%; pT1, 21%; pT2, 38%; pT3, 13%; pT4, 11% (Group II). The overall 5-year survival rate was 38% and the overall determinate 5-year survival rate was 45%, distributed as follows in the two groups: 51% of the patients in Group I, 36% of the patients in Group II (p = 0.01). Restricting the analysis to Group II, the difference in the three year survival rate was 54% among the patients at stages I-II and 25% among the patients suffering from a recurrence at stages III-IV (p = 0.04). In patients whose recurrence was limited to the primary tumor, survival at 3 years was 49%; in those whose recurrence also had nodal involvement, survival was 27% (p = 0.05). Lastly, the 5-year survival rate was 45% in the patients whose recurrence had been diagnosed late and only 24% in the 24 patients whose recurrence had been diagnosed within a year of prior treatment (p = 0.09). In conclusion, the life expectancy of patients undergoing salvage surgery for squamous cell carcinoma of the oral cavity is significantly less with respect to patients undergoing first round treatment. This difference appears significant only in patients with a recurrence that was diagnosed at an advanced stage. In accordance with the previously published data, an early recurrence (within a year) and the presence of a recurrence in the neck are unfavorable prognostic factors.

[Castleman disease with lateral neck outset. Report of a clinical case]. / Malattia di Castleman ad esordio laterocervicale. Descrizione di un caso clinico.

This work presents the case of a young woman with Castleman's disease, manifest as an isolated, asymptomatic swelling in the supraclavear fossae. A fine needle biopsy was performed on the swelling and cytology on this material proved insignificant (blood cells), while CT and MRI did not show any significant vascular components nor did they provide any elements decisive for diagnosis, the neoformation being similar to a reactive lymph node. To determine the nature of the mass, the lesion was removed by cervicotomy. Histology then led to a definitive diagnosis of a hyaline vascular variant of Castleman's disease. The literature on the topic was then reviewed with an eye to otorhinolaryngological manifestations and the histological aspects and clinical-diagnostic approach are discussed in detail.