Management of psychogenic non-epileptic seizures: a multidisciplinary approach.

The International League against Epilepsy (ILAE) proposed a diagnostic scheme for psychogenic non-epileptic seizure (PNES). The debate on ethical aspects of the diagnostic procedures is ongoing, the treatment is not standardized and management might differ according to age group. The objective was to reach an expert and stakeholder consensus on PNES management. A board comprising adult and child neurologists, neuropsychologists, psychiatrists, pharmacologists, experts in forensic medicine and bioethics as well as patients' representatives was formed. The board chose five main topics regarding PNES: diagnosis; ethical issues; psychiatric comorbidities; psychological treatment; and pharmacological treatment. After a systematic review of the literature, the board met in a consensus conference in Catanzaro (Italy). Further consultations using a model of Delphi panel were held. The global level of evidence for all topics was low. Even though most questions were formulated separately for children/adolescents and adults, no major age-related differences emerged. The board established that the approach to PNES diagnosis should comply with ILAE recommendations. Seizure induction was considered ethical, preferring the least invasive techniques. The board recommended looking carefully for mood disturbances, personality disorders and psychic trauma in persons with PNES and considering cognitive-behavioural therapy as a first-line psychological approach and pharmacological treatment to manage comorbid conditions, namely anxiety and depression. Psychogenic non-epileptic seizure management should be multidisciplinary. High-quality long-term studies are needed to standardize PNES management.

Radiation endurance in Al2O3 nanoceramics.

The lack of suitable materials solutions stands as a major challenge for the development of advanced nuclear systems. Most issues are related to the simultaneous action of high temperatures, corrosive environments and radiation damage. Oxide nanoceramics are a promising class of materials which may benefit from the radiation tolerance of nanomaterials and the chemical compatibility of ceramics with many highly corrosive environments. Here, using thin films as a model system, we provide new insights into the radiation tolerance of oxide nanoceramics exposed to increasing damage levels at 600 °C -namely 20, 40 and 150 displacements per atom. Specifically, we investigate the evolution of the structural features, the mechanical properties, and the response to impact loading of Al2O3 thin films. Initially, the thin films contain a homogeneous dispersion of nanocrystals in an amorphous matrix. Irradiation induces crystallization of the amorphous phase, followed by grain growth. Crystallization brings along an enhancement of hardness, while grain growth induces softening according to the Hall-Petch effect. During grain growth, the excess mechanical energy is dissipated by twinning. The main energy dissipation mechanisms available upon impact loading are lattice plasticity and localized amorphization. These mechanisms are available in the irradiated material, but not in the as-deposited films.

[Round shadow in the lung of an unusual origin: chronic pneumonitis caused by occupational exposure to synthetic fibers]. / Ombra rotonda del polmone a genesi singolare: pneumonite cronica da esposizione professionale a fibre sintetiche.

A case of granulomatous pneumonia due to synthetic fibres was observed; no specific symptoms, blood patterns, radiographic findings were found. Some clinical considerations on this unusual syndrome are reported.

[Multiple choice questions in educational assessment: proposal of a computerized program]. / Le DSM (domande a scelta multipla) nella verifica dell'apprendimento: proposta di un programma computerizzato.

After a description of the basic criteria for the correct formulation of Multiple Choice Questions (MCQ) for use in the assessment of different levels in the intellectual process (memorising, data interpretation, problem solving) a package of computer programs for the use of MCQ in the assessment of what has been learned in a General Surgery course in the Faculty of Medicine and Surgery are presented. The MCQ is a valuable didactic tool that can well supplement though not replace oral examination for assessment at all stages of a course.

[The role of lymphadenectomy in the surgical treatment of cancer of the left colon and rectum]. / Il ruolo della linfectomia nella terapia chirurgica del cancro del colon sinistro e del retto.

The study of 89 cases of left colon and rectum cancer treated with oncology lymphectomy of II and III level, permits to confirm the main role of this surgical practice for a right tumoral stadiation. It's also confirmed the therapeutic role of lymphectomy with a 5 years follow-up, with a rescue of C1 cases, without a significative advantage of the extension to the III level.

[Carcinoid tumors of the appendix. Review of the literature and two case reports]. / I tumori carcinoidi dell'appendice. Analisi della letteratura e presentazione di due casi.

Gastrointestinal carcinoids are infrequent but at the same time hardly rare tumours. They are often chance findings but, as is clearly reported in the literature, their potential malignancy should not be overlooked. They are most commonly localised in the appendix. The authors describe two case reports of carcinoid tumours of the appendix, one of which was diagnosed during left hemicolectomy due to Crohn's disease and the other during acute appendicitis. Prognostic and therapeutic problems are discussed in the light of the most recent literature.

[Iterative pulmonary metastasis. Considerations on 28 surgically treated cases]. / Le metastasi polmonari iterative. Considerazioni su 28 casi operati.

Among 94 cases of pulmonary metastases treated by the exeresis of one or more nodules, 28 cases produced metastasis located in the lung only. Radical metastasectomy was performed on 250. Analysis of survival, also assessed in relation to every prognostic factor reveals the efficacy of surgical therapy even in iterative metastasectomy.

[Meckel's diverticulum. Case contributions]. / Il diverticolo di Meckel. Contributo casistico.

Eight cases of Meckel's diverticulum observed by the authors are reported. Different investigative methods, clinical and surgical aspects are discussed. Even asymptomatic Meckel's diverticulum discovered incidentally at surgery should usually be removed.

Psychiatric disorders in patients suffering from an acute cerebrovascular accident or traumatic injury, and their effects on rehabilitation: an observational study.

BACKGROUND: The presence of a post-traumatic psychiatric disorder in patients with acute injuries may have adverse effects on outcomes. AIM: In this study our aims were: (1) to assess the frequency of psychiatric disorders after a cerebrovascular accident or traumatic injury requiring rehabilitation; (2) to examine whether there was any correlation between psychiatric disorders and patients' baseline demographic and clinical variables. DESIGN: The study consisted of two phases: the first was cross-sectional and the second prospective with a 12-month follow-up. The period of recruitment was two years. The results of the first phase are presented here. SETTING: The study sample consisted of a consecutive series of patients admitted to hospital because of an acute cerebrovascular accident or a traumatic injury and referred for a rehabilitation program. Two inpatient Rehabilitation Hospitals were involved in the study. POPULATION: The sample consisted of 230 consecutive patients with a recent cerebrovascular accident or trauma included in a rehabilitation program. METHODS: The sample included: 89 men (39%) and 141 women (61%) aged 20-97 years. Psychiatric disorders and motor disabilities were assessed through psychiatric interview and the mini-international neuropsychiatric interview plus (MINI Plus) and, respectively, with the functional independent measure (FIM). In case of post-traumatic stress disorder (PTSD), severity was assessed through the Davidson's Trauma scale. Psychiatric disorders were correlated to demographic and clinical variables through univariate and multivariate analyses, the latter with logistic regression models. RESULTS: The most frequent entry diagnoses were traumatic fracture (41.3%) and stroke (37.0%). Ninety-three patients (40.4%) had one or more psychiatric disturbances at study entry, the commonest being depression (56 cases, 24.7%) and anxiety (23 cases, 10.0%). PTSD was present in 8 cases (3.5%). A history of psychiatric disorder was reported by 55 patients (24.2%) Compared to the rest of the study population, these subjects had more psychopathologic complaints (P<0.001). Mean total FIM score was 54.4 (SD=17.8) and 61.2 (SD=19.6) in patients with and without psychopathology (P<0.01) Independent predictors of psychopathology included past psychiatric history, lower total FIM scores, and limb amputation. Depression was predicted by history of psychiatric disorders and lack of partner. CONCLUSION: History of psychiatric disorders is the most relevant factor associated with psychopathology in patients with an acute cerebrovascular accident or traumatic injury, followed by lower total FIM scores, and type of pathologic event. CLINICAL REHABILITATION IMPACT: The presence of psychiatric disorders may potentially influence the rehabilitation process and outcomes; thus their recognition and management are key factors during a rehabilitation program.

Precision and accuracy in film stiffness measurement by Brillouin spectroscopy.

The interest in the measurement of the elastic properties of thin films is witnessed by a number of new techniques being proposed. However, the precision of results is seldom assessed in detail. Brillouin spectroscopy (BS) is an established optical, contactless, non-destructive technique, which provides a full elastic characterization of bulk materials and thin films. In the present work, the whole process of measurement of the elastic moduli by BS is critically analyzed: experimental setup, data recording, calibration, and calculation of the elastic moduli. It is shown that combining BS with ellipsometry a fully optical characterization can be obtained. The key factors affecting uncertainty of the results are identified and discussed. A procedure is proposed to discriminate factors affecting the precision from those affecting the accuracy. By the characterization of a model transparent material, silica in bulk and film form, it is demonstrated that both precision and accuracy of the elastic moduli measured by BS can reach 1% range, qualifying BS as a reference technique.

Clinical and genetic evaluation of a family showing both autism and epilepsy.

Autism is a strong genetic disorder, with an estimated heritability greater than 90%. Nonetheless, its specific genetic aetiology remains largely unknown. Autism is associated with epilepsy in early childhood and epilepsy occurs in 10-30% of individuals with autism. Here we report the case of a woman affected by a severe epileptic disorder with an onset at 14 years old. She is affected by a cryptogenetic focal epilepsy with complex partial (psychomotor) and secondarily generalized tonic-clonic seizures, which are drug resistant. The woman is married to a healthy man and has six children: two girls are healthy, a girl and two boys are affected by autism while one boy shows partial seizures. The three children with autism show moderate mental retardation and an EEG with no epileptiform alterations. The child with epileptic seizures shows an asymmetric EEG that is not necessarily pathological. In this family, no chromosomal rearrangements were detected by means of classical cytogenetic analyses. The presence of FRAXA alterations and of microdeletions of the 15q11-q13 chromosome region were also excluded. A genome-wide linkage analysis using microsatellite markers revealed several chromosome regions as possible susceptibility loci.