One-year caloric restriction and 12-week exercise training intervention in obese adults with type 2 diabetes: emphasis on metabolic control and resting metabolic rate.

PURPOSE: The effect of combined lifestyle interventions (LSI) including dietary and physical activity on metabolic health, energy metabolism and VO2max in diabetic patients has provided mixed results. We evaluated the impact of 1-year caloric restriction (CR), and 12-week supervised structured exercise training (SSET) on metabolic health, RMR and VO2max in obese adults with type 2 diabetes. METHODS: After 1-month education for LSI, 33 participants had anthropometric, biochemical and metabolic assessments. They then started CR based on RMR, and 3-month SSET during the months 1-3 (Early-SSET) or 4-6 (Late-SSET). Reassessments were planned after 3, 6 and 12 months. Using a per-protocol analysis, we evaluated parameter changes from baseline and their associations for the 23 participants (11 Early-SSET, 12 Late-SSET) who completed the study. RMR was adjusted (adjRMR) for age, sex, fat-free mass (FFM) and fat mass (FM). RESULTS: Compared with baseline, after 6 months we found significant increases in VO2max (+ 14%) and HDL-cholesterol (+ 13%), and reduction in body mass index (- 3%), FM (- 8%) and glycated hemoglobin (HbA1c, - 7%). Training-related caloric expenditure negatively correlated with changes in body weight (p < 0.001), FM (p < 0.001) and HbA1c (p = 0.006). These results were confirmed at the 12-month follow-up. Pooling together all follow-up data, adjRMR changes correlated with changes in glycemia (r = 0.29, p = 0.02), total-cholesterol (r = 0.29, p = 0.02) and VO2max (r = - 0.26,p = 0.02). No significant differences emerged between the Early- and Late-SSET groups. CONCLUSIONS: Combined intervention with SSET and CR improved metabolic control. Changes in metabolic health and fitness correlated with changes of adjRMR, which was reduced improving fitness, glycemia and cholesterolemia. CLINICAL TRIAL REGISTRY: Trial registration number: NCT03785379. URL of registration: http://clinicaltrials.gov .

The carpal tunnel syndrome. Anatomo-clinical correlations.

We review a series of 1,280 operated cases of carpal tunnel syndrome (CTS), with an unexpected high frequency of transverse muscular fibers within the carpal canal (11%), particularly in a group of young male patients under 30 years of age. This abnormal presence of muscle fibers could explain the early development of CTS in young male workers.

The intercosto-brachial anastomosis in the treatment of cervical roots avulsions: clinical and neurophysiological considerations.

The Authors present their surgical and clinical experience about the intercosto-brachial anastomosis for treating traumatic avulsions of the cervical roots. The most interesting aspect in the postoperative course of these patients in their ability to regain a voluntary elbow flexion independently from the respiratory activity. A dinamic SPECT examination in a small series of cases suggests that some mechanisms of functional reorganization within the brain should be involved.

Cerebral blood flow changes induced by electrical stimulation of the Gasserian ganglion after experimentally induced subarachnoid haemorrhage in pigs.

The effect of trigeminal electrical stimulation on cerebral blood flow has been studied in conditions of normal or reduced cerebral blood flow (CBF). Autologous blood was injected into the subarachnoid space of ten Pittmann-Moore pigs to induce subarachnoid haemorrhage (SAH) accompanied by cerebral blood flow (CBF) reduction. One week later, in six of ten animals, a considerable decrease of CBF was noted as evaluated by means of a recording-system monitoring over the right parieto-temporal calvarium the washout of 133Xenon injected into the internal carotid artery after the external carotid had been clamped. Continuous electrical stimulation of the Gasserian ganglion performed in the six animals with severely induced CBF reduction produced a remarkable cerebrovascular dilation and increase of CBF lasting over 3 h. Electrical stimulation of the Gasserian ganglion produced a similar pattern of vasodilation in six pigs in which no blood was injected and no reduction of CBF was evident. The mechanisms and the anatomical pathways which underlie these results are discussed.

Evaluation of beta-endorphin/beta-lipotropin immunoreactivity content in the CSF of patients affected by deafferentation pain syndromes.

Beta-endorphin/beta-lipotropin immunoreactivity (BE/BLPH-IR) content was evaluated in the CSF of patients suffering by deafferentation pain syndromes. BE/BLPH-IR CSF concentrations of these patients were compared with those obtained in a group of patients affected by low back pain and in a control group without pain problems. No statistically significant variation in BE/BLPH-IR levels were found between controls and subjects with different types of chronic pain.

[Aneurysmal cysts of the fronto-parietal bone]. / Cisti aneurismatica dell'osso fronto-parietale.

The authors describe the case of a patient affected by an aneurysmal bone cyst of the fronto-parietal bone. A short review of the literature follows.

Diencephalic syndrome following cervical spinal cord trauma.

The authors discuss about five cases of diabetes insipidus observed in patients affected by traumatic cervical spine fractures and/or dislocations, without either evident lesions of the cerebral structures at CT scan examination, or important craniocerebral trauma. In all patients polyuria and hyperthermia arose some days after the traumatic accident and regressed spontaneously or after exogeneous vasopressin administration. Vasopressin urinary levels confirmed the presence of a true diabetes insipidus, the origin of which is in largely obscure. A central medullary vasopressin mediated pathway, demonstrated only in experimental animals, may be responsible for such a finding.

Percutaneous thermocoagulation for sphenopalatine ganglion neuralgia.

The authors describe percutaneous radiofrequency (rf) thermocoagulation of the sphenopalatine ganglion used to treat seven patients with sphenopalatine ganglion neuralgia. The procedure was effective in relieving pain, without significant side-effects. All the patients have actually been free of pain during a follow-up of 6-28 months. The surgical technique and the rationale for its use are pointed out.

The treatment of hemifacial spasm with percutaneous radiofrequency thermocoagulation of the facial nerve.

The authors present their first results with the treatment of hemifacial spasm by controlled percutaneous thermocoagulation of the facial nerve. Seven patients have been treated to date with good immediate results on the movements, although a slight paresis of the homolateral facial musculature, aesthetically acceptable, persists after treatment. A long-term follow-up at more than 10 months was achieved in only 3 patients, who showed a complete regression of the spasm with partial disappearance of the facial hemiparesis.

Combined thermocoagulation of the 5th and 9th cranial nerves for oral pain of neoplastic aetiology.

The authors report their limited but interesting experience in the treatment of intractable oral pain employing the technique of percutaneous radiofrequency thermocoagulation both of the trigeminal and glossopharyngeal nerves. The use of combined percutaneous thermolesions for cancer pain is rarely described in the literature. Immediate and long-term results confirm the usefulness of this surgical procedure.

Accidental high voltage electrocution: a rare neurosurgical problem.

The authors describe a case of accidental electrocution from a high voltage current in a young worker, who was struck by the electric shock in the mid-occipital region. The case is especially interesting due to the improbability of anyone surviving after receiving a shock of more than 1000 V., and to the development of bilateral parieto-occipital haemorrhagic infarction with spastic paraparesis, directly caused by the high voltage current and not indirectly by heat generation or secondary head trauma.

Selective percutaneous thermolesions of the ninth cranial nerve by lateral cervical approach: report of eight cases.

Percutaneous radiofrequency thermolesion of the petrous ganglion at the jugular foramen was employed for the treatment of glossopharyngeal neuralgia in eight cases, three with essential and five with symptomatic pain from oropharyngeal cancer. Because of its technical simplicity, the lateral cervical approach was preferred to the anterior lateral approach. Immediate and subsequent surgical results were satisfactory. No neurological complication was noted, except for transitory bradycardia and hypotension during the procedure.

[Naloxone and essential trigeminal neuralgia]. / Naloxone e nevralgia trigeminale essenziale.

From the correlation between pain and morphin-like peptides there comes the suggestion of an etiopathogenetic relation between essential trigeminal neuralgia and endorphins. The clinical and pharmacological observation utilizing Naloxone, a morphin-like substances antagonist, and the transcoutaneous electrotherapy there seem to exclude that this etiopathogenetic relation there can be.

Traumatic cerebral aneurysm in pediatric age. Case report.

Cerebral aneurysm following head trauma in pediatric age is a rare complication particularly in the absence of skull fractures or penetrating brain wounds as in the present case. In the presence of rapid worsening of neurological conditions after head trauma, one may take into consideration this complication among other possible vascular accidents.

Alterations of facial sensitivity induced by percutaneous thermocoagulation for trigeminal neuralgia.

Sixty patients with essential trigeminal neuralgia underwent selective percutaneous thermocoagulation of the gasserian ganglion. Immediate and long-term modifications of pain and tactile facila sensitivity, recurrences of pain, and occurrences of facial paresthesias were evaluated. Pin-prick and von Frey hair tests and somatosensory-evoked potentials were used to study facila sensitivity. Patients with mild alterations of sensitivity-treated with low temperatures of coagulation (60 degrees-70 degrees C)--had a lower incidence of paresthesias, although a higher risk of recurrence. Patients with severe alterations of sensitivity--a consequence of a temperature of coagulation above 70 degrees C--had a high incidence of paresthesias and a low risk of recurrence. In our opinion, the first kind of results are better.

[Prognostic value of cortical evoked potentials in spinal-spinal cord pathology: study of 1 clinical case]. / Valore prognostico dei potenziali evocati corticali in patologia vertebro-midollare: studio di un caso clinico.

The clinical use of S.E.R. (Somesthesic Evoked Responses) from the lower limbs has peculiar prognostic value in cases of spinal pathology with clinical signs of transection, where other neuroradiological investigations are not helpful. However, in the present case of acute trasverse myelitis, persistence of an evoked response from the lower limbs was never followed by signs of recovery below the lesional level, while autopsy showed a complete degeneration of the descending spinal pathways with a good preservation of the posterior roots. The limits of this technique appear connected to the fact that the afferent volley of the S.E.R. travels exclusively along the posterior roots, not allowing a definite prognostic evaluation about function of the remainder descending pathways.