Action tremor in Parkinson's disease: frequency and relationship to motor and non-motor signs.

BACKGROUND AND PURPOSE: Action tremor may occur in patients with Parkinson's disease and cause misdiagnosis with other movement disorders such as essential tremor and dystonia. Data on the frequency of action tremor in Parkinson's disease and on the relationships with other motor and non-motor signs are limited. METHODS: A cross-sectional study of 237 patients with Parkinson's disease staging 1-2 on the Hoehn-Yahr scale was conducted. Data on action tremor and other motor and non-motor signs were collected using the Unified Parkinson's Disease Rating Scale part III and the Non-Motor Symptoms Scale. RESULTS: Action tremor was found in 46% of patients and was associated with both severity of rest tremor (adjusted odds ratio 3.0, P < 0.001) and severity of rigidity (adjusted odds ratio 1.5, P = 0.004). No association was found between action tremor and severity of bradykinesia (adjusted odds ratio 0.97, P = 0.4) or axial symptoms (adjusted odds ratio 0.9, P = 0.3). Moreover, patients who had action tremor reported a significant lower mean number of non-motor symptoms than those who had not (2.1 ± 1.3 vs. 2.4 ± 1.3; P = 0.04). CONCLUSIONS: Action tremor is a relatively frequent motor sign in patients with Parkinson's disease staging 1-2 on the Hoehn-Yahr scale. Action tremor correlates with rest tremor and rigidity and may be associated with a lower burden of non-motor symptoms. These findings suggest a contribution of non-dopaminergic mechanisms to action tremor pathophysiology.

Microalbuminuria and hypertension in HIV-infected patients: a preliminary study of telmisartan.

BACKGROUND: There is increasing evidence of hypertension and microalbuminuria in HIV-infected patients, and these are two important risk factors for renal and cardiovascular disease. Anti-hypertensive drugs inhibiting the renin-angiotensin system exert an antiproteinuric effect. Telmisartan, an angiotensin II receptor blocker and partial peroxisome proliferator-activated receptor gamma (PPAR gamma) agonist that is approved for the treatment of hypertension, appears to exert a nephroprotective effect independent of blood pressure reduction in the general population. OBJECTIVE: The aim of this preliminary study was to evaluate possible nephroprotective effects of telmisartan in hypertensive HIV-positive patients with microalbuminuria. PATIENTS AND METHODS: Caucasian male patients with HIV infection (n=13) receiving stable combined antiretroviral therapy (without therapeutic changes for > 12 months) and a recent diagnosis of grade 1 hypertension were treated with daily oral telmisartan 80 mg for 6 months. Patients had suppressed viremia and a CD4 cell count > 300 cells/mL for 6 months, and microalbuminuria > 5 mg/dL. Systolic and diastolic blood pressure (SBP, DBP), triglycerides, total cholesterol, HDL cholesterol and LDL cholesterol, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), microalbuminuria, Modification of Diet Renal Disease-Glomerular Filtration Rate (MDRD-GFR), vascular endothelial growth factor (VEGF) and endothelin-1 were measured at baseline and at one, three and six months. All statistical analyses were performed using SAS 9.2. RESULTS: A significant reduction of microalbuminuria (p < 0.001) with stable MDRD-GFR was observed, although the main indices of renal function showed no substantial change. A significant reduction in mean SBP and DBP was observed at T1 and confirmed at T3 and T6 (SBP p < 0.001 and DBP p < 0.001), and there was BP normalization. Metabolic assessments showed an improvement in lipid parameters, and a significant decrease in insulin resistance assessed by the homeostasis model assessment index-insulin resistance (HOMA-IR) (p = 0.04). In addition, there was a statistically significant reduction in ESR (p = 0.02) and a non significant reduction in CRP. Other results included a significant reduction in serum VEGF and endothelin-1 levels (p < 0.001). CONCLUSIONS: From these preliminary findings, telmisartan has demonstrated efficacy in the control of hypertension and microalbuminuria in HIV-infected patients. Decreased microalbuminuria with stable MDRD-GFR may be indicative of a nephroprotective effect of telmisartan; mechanisms causing microalbuminuria in patients with HIV could be related to infection, chronic inflammation, and endothelial dysfunction. The decreased endothelin-1 and VEGF levels in patients in this study may be related to an endothelial protective effect of telmisartan. This study reports the first observation of renal and endothelial protective effects of telmisartan in HIV-positive patients.

[Effectiveness of the treatment with beta-glucan in the HPV-CIN 1 lesions]. / Efficacia del carbossimetilbetaglucano nella regressione delle alterazioni citologiche cervicali di basso grado HPV correlate.

AIM: The aim of the study was to evaluate the effectiveness of the beta-glucan in women with abnormal cytology, including the women with a positive screening for ASCUS-LSIL furtherly divided in women with positive cytology (ASCUS or LSIL) and negative colposcopy and women with abnormal cytology, positive colposcopy and human papilloma virus (HPV)-CIN1 hystology who opted for follow-up. METHODS: From September 2007 to December 2008, 60 women with ASCUS-LSIL diagnosis were recruited at the ambulatory of Lasersurgery and Cervico-Vaginal Patology, Department of Gynecology and Obstetrics of Policlinico Umberto I of Rome. The women was subdivided in two groups: 1) women with cytological diagnosis of ASCUS or LSIL and negative colposcopy; 2) women with abnormal cytology, positive colposcopy and HPV-CIN1 histology, who opted for follow-up. All the women were treated with two cycles of a daily topical application of beta-glucan for 20 consecutive days with a suspension of 10 days. The effects of beta-glucan were analyzed with colposcopy and cytology at 3.6 and 12 months from the beginning of the therapy. RESULTS: After 3 months of treatment, of the 30 women with positive cytology and negative colposcopy, 80% with ASCUS diagnosis resulted negative, 35% with LSIL diagnosis resulted negative; after 6 months 100% with ASCUS diagnosis resulted negative, 70% with LSIL diagnosis resulted negative; after 12 months 85% with LSIL diagnosis resulted negative. Of the 30 women with positive cytology, positive colposcopy and HPV-CIN1 histology after 3 months 20% resulted negative, after 6 months 60% resulted negative and after 12 months 80% resulted negative. The persistence of the HPV-CIN1 histology was verified in the 13% of the women. For these women the definitive treatment was the TFD. CONCLUSION: Our study demonstrate the effectiveness of the treatment with beta-glucan in the women with ASCUS-LSIL lesions and HPV-CIN1 lesions, increasing of the regressions rate after 12 months of the treatment of the 15-20%.

Beneficial effects of telmisartan in an HIV+ diabetic insulin-dependent patient.

In HIV-infected patients with metabolic disorders, as in the general population, there is evidence of hypertension requiring pharmacological treatment. The presence of diabetes constitutes a cluster of particularly high cardiovascular risks in patients, both regarding diabetic damage and hypertensive damage. We used telmisartan to manage high blood pressure values in an HIV-positive patient with insulin-dependent diabetes. Surprisingly, insulin therapy had to be suspended because of hypoglycemic fits and treatment with metformin was started. In conclusion, telmisartan was effective and well tolerated for the control of hypertension in this case and improved sensitivity to insulin. There are interesting effects of this drug in HIV-positive diabetic patients. Thus, if further studies confirm these effects, telmisartan may be the anti-hypertensive drug of first choice in HIV-infected subjects on combined antiretroviral therapy affected with diabetes and metabolic disorders.

Severe HIV-associated hypertriglyceridaemia treated with rosuvastatin plus omega-3 fatty acids.

Compared with healthy controls, HIV patients already have abnormal lipoprotein concentrations before the initiation of highly active antiretroviral therapy (HAART), which worsen with the therapy. HAART-associated dyslipidaemia features fundamental proatherogenic changes such as increased plasma triglycerides (TGs), increased total cholesterol and low-density lipoprotein cholesterol as well as decreased high-density lipoprotein cholesterol (HDL-C). The current guidelines for managing HIV-associated dyslipidaemia recommend diet and exercise counselling, alteration of HAART regimen or addition of lipid-lowering medications such as statins, fibrates and omega-3 (OM-3) fatty acids. Given that cardiovascular risk significantly increases with elevated lipid levels, selecting a drug to manage dyslipidaemia is particularly important. A case is described of an HIV patient who had severe hypertriglyceridaemia and bad metabolic parameters treated with rosuvastatin and OM-3 fatty acids. So we obtained a more marked reduction of TG levels than has never been described before in the literature, associated with a significant increase in HDL-C levels.

Acute urinary retention due to HSV-1: a case report.

Complications in urinary tract nervous routes due to herpes viruses as VZV and HSV-2 are well known. Acute urinary retention and chronic neuropathic pain are not rare when sacral dermatomes are involved by these viruses. However, an analogous condition has not yet been clearly ascribed to HSV-1 infection. We present a 32-year-old immunocompetent patient with fever, lumbar pain and acute urinary retention who had never had herpetic clinical manifestations. Urodynamic studies diagnosed a neurologic bladder with an absent filling sensation. Cystoscopic assessment revealed the presence of reddened and isolated small mucosal areas in the bladder walls. The search for herpes viruses in plasma and CSF by PCR assay were positive for HSV-1. After treatment with antiviral therapy the disease resolved. Intermittent catheterization was necessary and voiding dysfunction resolved after three weeks by its appearance. Neurological damage to the central nervous system (CNS) and/or PNS due to HSV-1 seems to be the most likely reason. The course of disease was benign and self-remitting.

Metabolic syndrome and cardiovascular risk in HIV-infected patients with lipodystrophy.

In this cross-sectional study, we evaluate potential predictors of Metabolic Syndrome (MS) in a group of 54 Caucasian chronically HIV-infected patients with lipodystrophy. According to ATP-III criteria, 22 patients were affected by MS and 32 were not. The mean age of the sample was 41.2+/-8.6 years, and most patients were males (74.1%); the two groups were homogeneous for gender, age, viro-immunologic status and the duration of antiviral therapy. The independent association between MS and several factors including demographic characteristics, type of highly-active antiviral therapy (HAART), viro-immunologic response, common cardiovascular risk factors (including Framingham scores), and selected cytokines (IFN-gamma, TNF-alpha, IL-2, IL-4, IL-6, IL-10 and IL-18), was investigated using stepwise forward logistic regression. At multivariate analysis, the only independent predictors of the metabolic syndrome were triglycerides and IL-18. A 10 mg/dL increase in triglycerides corresponds to an adjusted risk ratio for MS of 1.11 (95 percent IC: 1.04-1.19); and patients in the top tertile of IL-18 (those with IL-18 >/= 530 pg/L) had more than three times the likelihood of MS, as compared to the bottom and medium tertiles of IL-18 (patients with IL-18< 530 pg/L). This relationship was not attenuated by the inclusion of any other variable in the multivariate model. However, the association between metabolic syndrome and IL-18 is no longer significant when IL-18 is treated as a continuous variable (trend p = 0.087). Our results on HIV patients with lipodystrophy confirm previous findings on a strong independent association between IL-18 and MS in the general population. Further research is needed to clarify the mechanism of this association and its role in the development of cardiovascular disease in HIV patients.

Soy isoflavones, lactobacilli, Magnolia bark extract, vitamin D3 and calcium. Controlled clinical study in menopause.

AIM: Affective and behavioural disorders possibly concomitant to the vasomotor menopausal symptoms worsen quality of life. A rational formulation containing soy isoflavones (60 mg), lactobacilli (500 millions spores), calcium (141 mg) and vitamin D3 (5 microg) was added of Magnolia bark extract (60 mg) and magnesium (50 mg) (Estromineral serena, ES). The Magnolia extract active principles interact with GABA system and exhibit a sedative central action. Magnesium intervenes in enzymatic reactions of the energetic metabolism and protects the bone integrity. Aim of this controlled study was to compare the clinical activity and safety of ES versus calcium+vitamin D3 (Ca+D) in menopause. METHODS: A controlled, randomised, multicentre study was carried out in symptomatic menopausal women with sleep or mood alterations. Women received 1 tablet/day of ES or Ca+D for 24 weeks. Symptoms during the treatment and final judgements on efficacy and acceptability were evaluated. RESULTS: Eighty-nine women (44 ES and 45 Ca+D, mean age 53.8 years, in menopause since 56.6 months) participated to the study. Flushing, nocturnal sweating, palpitations, insomnia, asthenia, anxiety, mood depression, irritability, vaginal dryness, dyspareunia, and libido loss, significantly decreased in severity and frequency during ES versus Ca+D treatment even since the fourth week. Woman wellbeing (good/very good 66.7% vs 20%) judgement on efficacy (72.7% vs 17.1%) and acceptability (93.9% vs 31.4%) were significantly better for ES. CONCLUSIONS: The controlled study showed the efficacy of Magnolia extract and magnesium on psycho-affective and sleep disturbances in menopause, in addition to the effects of isoflavones on vasomotor symptoms. A global natural approach to menopause with ES evidenced its therapeutic usefulness and safety.

Pregnancy in immigrant women.

OBJECTIVE: We wanted to study how foreign women face pregnancy and childbirth in a society quite different from their own. METHODS: In 2004 we studied 328 pregnant women at the Department of Gynaecology at the "General Hospital Umberto I" in Rome. Information on patients' personal lives and experiences was collected. RESULTS: Women were classified into six (6) groups based on nationality, race, religion and culture. CONCLUSIONS: Arabian women had the most natural childbirths. African women had a longer duration of gestation. Women from Eastern Europe underwent frequent tests and examinations, but had the highest chance of having preterm births. Chinese women did not usually undergo many examinations and were able to tolerate pain during childbirth quite well.

Postoperative analgesia after cesarean section by continued administration of levobupivacaine with the On-Q Painbuster system over the fascia vs ketorolac + morphine i.v.

OBJECTIVE: This study aimed to detect if continuous local infusion of levobupivacaine with the On-Q Painbuster system provided postoperative analgesia of similar quality to morphine + ketorolac i.v. in patients undergoing cesarean section. MATERIALS AND METHODS: Using a randomized prospective double-blind study, 20 women undergoing cesarean section with a standardized spinal technique were randomly assigned into two groups to receive either 10 mg morphine + 120 mg ketorolac + saline solution up to 96 ml with an elastomeric pump i.v. (group A) or local infusion of levobupivacaine 0.2% with the On-Q PAINBUSTER system (group B). Both groups were administered ketorolac i.v. in bolus in case of pain. RESULTS: The two groups differed in their VAS scores with group A experiencing significantly less pain than group B; the consumption of analgesics was significantly lower in group A than in group B. CONCLUSIONS: The i.v. system with morphine and ketorolac is more effective than levobupivacaine subcutaneous infusion in reducing postoperative pain associated with cesarean section.

Preparation for childbirth in different cultures.

Anthropologically childbirth is an enigma because every woman experiences an identical physiological and biological process, wherever the event takes place: from a hut in the jungle to a modern hospital in the United States. Differences are due to the way that pregnancy, birth and the postnatal period are treated. For most women in developing countries, being a woman means being a mother: a female is not a woman until she has given birth to a child. Therefore during pregnancy she has to follow precise rules and regulations with ritual meanings for her protection and that help her get into the role of a mother. Medicine offers important technological resources for the prevention, diagnosis and treatment of pathology during pregnancy, but with a lack of attention to emotional support. Modern society must try to give pregnant women the trust in their bodies in order to reach the harmony necessary to give birth "willingly" and "with joy".

Effect of the treatment with ß-glucan in women with cervical cytologic report of atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesions (L-SIL).

AIM: The aim of this study was to evaluate the effect of ß-glucan in women with ASCUS or L-SIL, as detected by cervical cytologic screening. METHODS: A total of 356 women with ASCUS or L-SIL were enrolled and divided into two groups: 1) 176 patients, treated with topical ß-glucan; and 2) 180 patients who were only followed-up. The treatment consisted of two cycles of topical ß-glucan applied once a day for 20 consecutive days and treatment separated by ten days. The effect of ß-glucan was evaluated comparing Pap cytology results and colposcopic findings between treated patients and controls after 6 and 12 months of follow-up. RESULTS: After 6 months from enrollment, 63.1% (111/176) of patients treated with ß-glucan had a negative Pap smear versus 45% (81/180) of controls (P<0.001), and 43.4% (36/83) of treated patients versus 18.2% (14/77) of controls experienced the disappearance of colposcopic lesions (P=0.001). At the end of the 12-month follow up, 83.5% (147/176) of treated patients versus 60% (108/180) of controls had a negative Pap smear (P<0.001), and 55.4% (46/83) of treated patients versus 24.7% (19/77) of controls experienced the disappearance of colposcopic lesions (P<0.001). No side effects were observed in treated patients. CONCLUSION: ß-glucan increases the spontaneous regression rate of low-grade cytologic abnormalities as well as cervical findings.

[Use of alpha interferon in microcondylomatosis of the female genitalia]. / Impiego dell' alpha-interferon nella microcondilomatosi dell'apparato genitale femminile.

The Authors report the results of their research into the use of the alpha-interferon in the microcondylomatosis of the female genital apparatus. The therapy was successful in 18% of cases. Considering oncological risk connected with the permanency of the HPV in the uterine portio, the Authors consider they must continue the study on new diagnostic and therapeutic protocols.

[Management of female genital HPV infections by the LEEP method (Loop Electrosurgical Excisional Procedure)]. / Trattamento delle infezioni da HPV del tratto genitale femminile con metodica LEEP.

METHOD: Two different groups of women have been selected: group A (120 patients), affected by genital warts and ectropion, treated only with destructive therapy by means of LEEP (Loop Electrosurgical Excisional Procedure) with spheric electrod, while group B (20 patients), of which two affected by CIN I and resistant to other treatments for a period longer than 12 months, and 18 patients with a histologic diagnosis of CIN II, CINIII/HPV, treated with conization by LEEP method. After therapy, a follow-up has been carried out, with colposcopic, cytologic, histologic control, scheduled 1-3-6-12 months after therapy. RESULTS: The results proved positive, since recovery in the two groups (A and B), after treatment, has been 100% with no complications, verified by follow-up after 12 months. CONCLUSIONS: The introduction of LEEP, represents a simple alternative, fast, painless practical, at a minimum cost to the patient and the community, devoid of complications, without general anaesthesia in the treatment of CIN as well as of genital warts, substituting in this last case the loop with a sphere electrode. Moreover, it does not affect the function, as well as the anatomy of the organ, a primary factor is young patients desiring children. This technique permits to obtain at the end of the operation one or more tissue fragments to be used for histological examinations, with free margins from necrotic border, assuring the integrity of the tissue, and thus leading a correct diagnosis.

[Hypertension in twin pregnancy]. / Patologia ipertensiva nella gravidanza gemellare.

BACKGROUND: An increase of twin pregnancies has been observed during the last ten years and if not correctly treated, they may determine a situation at risk for mother and fetus. METHODS: The research intends to analyze the results obtained by the observation of 200 twin births in the period between 1991 and 1996 at the Obstetric and Gynaecological Clinic of the University of Rome "La Sapienza". The analysis has been made over a sample, observing the number of women showing arterial hypertension in pregnancy, the possible repercussions on fetus, and the morphological analysis of the placenta. RESULTS: Eleven women had blood pressure values of 130-90 mmHg (5.5%), albuminuria was not found, [five of them had only hypertension (2.3%) and six had hypertension associated with oedema]. The rate of premature delivery was 66.6%, while rate of term delivery was 66.7%. Delivery was spontaneous in 65% of cases, and caesarean section in 35%. Newborns were classified 80% as AGA (Appropriate for Gestational Age), and 20% as SGA (Small for Gestational Age). CONCLUSIONS: In personal experience with twin pregnancy, good results have been obtained with an early correction of risk factors (obesity, lower legs swellings, proteinuria), an intensive therapy, rest, cervical cerclage (if incontinent cervix is present), routinely hospitalization during the acute phase of the disease and a careful monitoring. This permitted to treat in time risk subjects, and to avoid gestosis syndrome.

[Hydatidiform mole. A case of hydrothorax, expression of a non-neoplastic complication]. / Mola vescicolare. Un caso di idrotorace, espressione di complicanza non neoplastica.

Marked stimulation of the chorionic gonadotropins underlies the frequent finding in the mole of larger ovaries with multiple luteal cysts, identifiable using ultrasound imaging, resembling ovarian hyperstimulation syndrome. The authors report a case of hyadatid pregnancy which presented serious non-neoplastic complications. Laboratory tests showed high values of beta-hCG and GOT/GPT, electrolytic alterations, hypoproteinemia, hypoalbuminemia, associated with conditions of severe dyspnea and tachycardia following hydrothorax diagnosed by X-ray. USG showed hypertrophic placenta containing anechoid lacunar areas and swollen ovaries with multiple luteal cysts. Positive results were achieved by using intensive therapy leading to the restitutio ad integrum of damaged functions. Endocrine hyperactivity of the molar trophoblast, with high levels of beta-hCG was responsible for ovarian hyperstimulation. Important findings for the early diagnosis of hyadatid pregnancy are: beta-hCG assay and ultrasound scan; moreover, an adequate follow-up lasting about 6 months is necessary to evaluate the serial trend of beta-hCG and the disappearance of ovarian luteal cysts.

Introducing colposcopy and vulvovaginoscopy as routine examinations for victims of sexual assault.

Victims of sexual assault require appropriate care, follow-up and information regarding their legal rights. Clinicians are faced with the challenging responsibility of identifying victims and providing effective interventive and preventive counselling. The most pressing medical task is to confirm the assault and to undertake correct documentation and exhibition of biological traces. Performing colposcopy and vulvovaginoscopy does not allow us to diagnose a sexual assault trauma, but it can help us to identify those microscopic lesions (due to the enhanced visualization and the higher resolution under which the genital areas are examined) that may not be seen during a normal clinical examination. The colposcopic and vulvovaginoscopic examination starts from the vulvar region looking for superficial lacerations and ecchymosis; the labia majora and minor are examined scrupulously, then the posterior forchette, the perineum and the hymen where it is possible to report microulcerations, contusions and even possible scars due to a precedent defloration. Recent advances in clinical forensic medicine show that trained examiners using colposcopy obtain evidence of genital trauma in 87% to 92% of rape victims. Colposcopy and vulvovaginoscopy must be performed within 48 hours from the sexual assault, because most of the lesions heal rapidly. Colposcopy and vulvovaginoscopy may be seen as a stressful invasion of a woman who is already vulnerable and at risk of the rape trauma syndrome. Prior information about colposcopy may reduce the level of anxiety experienced by many women undergoing this procedure. Incorporating colposcopy and vulvovaginoscopy into the routine assessment of sexual assault victims could be a valid way of identifying genital injuries; moreover the medical report will be more detailed and precise.

Proteinuria in an African HIV-infected patient: effects of telmisartan.

Kidney disease remains a major comorbidity of HIV infection especially in subjects of African ethnicity. HIV-associated renal disease with overt proteinuria has been associated with poorer outcomes and increased mortality. Telmisartan, an angiotensin II receptor blocker partial agonist of the PPAR-? approved for the treatment of hypertension, seems to exert a nephro-protective effect independent of blood pressure reduction in the general population. But data are lacking in HIV-positive patients with proteinuria. A case is described of an HIV-positive African patient with severe proteinuria treated with telmisartan. This therapy allowed proteinuria to be improved. This case shows for the first time that therapy with telmisartan has renoprotective effects also in an African HIV-infected patient.

Representing contrast detection as an eigenvalue problem.

Contrast detection can be formulated as an eigenvalue problem. One of the simplest resulting models has only two parameters. The model is space variant and employs the Hermite functions as eigenfunctions. Computing the response to a sinusoidal acuity grating yields the observer's contrast response. The model itself, however, is developed within an abstract mathematical framework which is general enough to include Fourier analysis as a special case. Consequently, the methods of Fourier analysis are generalized to those of eigenfunction expansion and the spectral theory of linear operators.