Migraine and cerebral infarction in young people.

The objective of this study is to investigate relationship between migraine and cerebral infarction in young people. Patients aging 16-44 years, referred for stroke and age- and gender-matched controls were investigated for migraine following the International Headache Society criteria. Included people were 314 strokes and 314 controls. Each group consisted of 150 men and 164 women. Of the 105 persons with migraine (16.7%), 57 had migraine with aura (9.1%). In women, migraine with aura was related to stroke [35 women among strokes (21.3%) vs. 9 among controls (5.5%), P < 0.0001], whereas migraine without aura was not. After multivariate analysis, migraine with aura remained independently associated with stroke together with hypertension, and the estro-progestinic utilization. In men, migraine was not associated with stroke. In conclusion, migraine with aura appears to be associated with ischemic stroke in young women, independently from other common risk factors.

Norepinephrine reuptake is impaired in skeletal muscle of hypertensive rats in vivo.

Certain forms of experimental hypertension are characterized by organ-specific alterations of catecholaminergic pathways. The purpose of this study was to evaluate, in the same awake and freely moving normotensive Wistar-Kyoto rats (WKY) and spontaneously hypertensive rats (SHR) before and after the development of arterial hypertension, the norepinephrine (NE) turnover and, in particular, the neuronal NE reuptake activity that ends its effects once released from nerve terminals, in subcutaneous adipose tissue and in skeletal muscle, whose sympathetic efferents are respectively independent or dependent from baroreflexes. Plasma and tissue interstitial NE and 3,4-dihydroxyphenylethylene glycol (DHPG), its major deaminated metabolite, were measured before and after blockade of NE reuptake by tissue perfusion of desipramine through microdialysis probes. Arterial pressure and plasma NE in SHR were similar to those in WKY at 5 weeks of age but increased at 16 weeks of age. In contrast, plasma DHPG was already higher in young SHR. Basal interstitial NE and DHPG were increased in both tissues of young and old SHR compared with age-matched WKY. Desipramine induced a higher rise of interstitial NE in SHR of both ages, with a lesser increase in the skeletal muscle of old compared with young SHR. These results indicate an increased NE turnover in prehypertensive and hypertensive SHR in both baroreflex-dependent and -independent tissues, not shown by plasma NE levels in young SHR. In the skeletal muscle, where sympathetic efferents are baroreflex dependent, the reduced interstitial NE reuptake contributes to the higher availability of interstitial NE for postsynaptic effects in old SHR.

Assessment of water pollution and suitability to fish life in six Italian rivers.

This paper reports the results of a monitoring programme of six rivers (Serchio, Cecina, Cascina, ERa, Elsa and Pavone) that drain north-west Tuscany (Italy). In this area, agricultural, industrial and urbanization pressures affect water quality, also in terms of suitability for the survival of aquatic organisms. The river waters were monitored for several physico-chemical parameters (temperature, dissolved oxygen, suspended solids, total ammonia, nitrites, Cu, Cd, Cr, Ni and Pb) in order to assess the anthropogenic impact on the environmental conditions of these watercourses and their suitability for fish life. Statistical data handling was performed for each river and the percentage of physico-chemical parameters that, according to the E.C. law, were over the limits that must not be exceeded to protect fish life, was calculated and a classification was made of the six rivers in this sense. Concerning the metals, inter-element relationships (between chromium and nichel, lead and copper, nichel and lead and copper, copper and lead) were found which allow some remarks on the origins of the anthropogenic impacts, and comparisons were made with two metal-polluted watercourses in northern Italy, the Po and Lambro rivers. From the comparison, the Tuscan rivers showed generally lower metal contamination, especially with respect to the Lambro.

A comparison of Legionella pneumophila occurrence in hot water tanks and instantaneous devices in domestic, nosocomial, and community environments.

The aim of this study was to compare the occurrence of L. pneumophila in hot water samples from hot water tanks and instantaneous devices. Tanks and devices were all operated by heat exchangers employed in the town's district heating system. Thirty-six out of 171 (21%) hot water samples tested positive for L. pneumophila isolation, with 14.6% belonging to serogroup 1 and 6.4% to serogroups 2-14. The proportion of L. pneumophila detected in hot water reservoirs (30%) was higher than that observed in hot water instantaneous devices (6.2%). Differences in L. pneumophila isolation reflected different temperatures registered at the faucet: 60 degrees C for hot water from instantaneous devices. These data emphasize the need to control temperature in hot water distribution devices, thus inhibiting the formation of biofilm and L. pneumophila colonization.

[Re-evaluation of the diagnosis in congenital hypothyroidism]. / La rivalutazione della diagnosi nell'ipotiroidismo congenito.

Newborn screening for congenital hypothyroidism (CH) has become routine in Italy. It provided new information regarding the epidemiology, diagnosis and treatment of CH infants and allowed to identify transient disorders of thyroid function in infancy. In fact, when the permanence of hypothyroidism has not been established in the newborn period, a confirmation of the diagnosis at 2-3 years of life should be performed. In this study results regarding the diagnosis reevaluation performed in 23 out of 184 CH children followed at the follow-up center for CH of the University of Rome "La Sapienza", are reported. Eleven of 23 reevaluated children had transient hypothyroidism (TH) and permanent CH was confirmed in the others. Four of the 11 TH children had law gestational age at birth, 1 had high antithyroid peroxidase titre due to maternal autoimmune thyroiditis and 2 were resident in iodine deficient areas. Our results show the importance of diagnosis reevaluation to identify transient disorders of thyroid function in infancy and confirm the role of neonatal, maternal and environmental factors in the etiopathogenesis of TH.

Mutations in the gene encoding thyroid transcription factor-1 (TTF-1) are not a frequent cause of congenital hypothyroidism (CH) with thyroid dysgenesis.

Permanent congenital hypothyroidism (CH) has an incidence of 1/3000-4000 newborns and is among the most frequent cause of mental retardation and neurological alterations in children. In 80% to 85% of cases CH is associated with thyroid dysgenesis. A group of 61 patients with CH (22 with agenesis, 18 with ectopy, 1 with hypoplasia, and 20 cases with CH without thyroid enlargement but not further characterized) and 30 normal subjects were examined for the presence of mutations in the gene encoding the thyroid transcription factor 1 (TTF-1). The coding-region of the TTF-1 gene was analyzed in all cases by the single stranded conformational polymorphism (SSCP) and no mutations were detected. Direct sequencing also carried out in patients with thyroid agenesis confirmed the absence of mutations or polymorphisms in the TTF-1 gene. The absence of mutations in the TTF-1 gene in our samples indicates that the mutations in the TTF-1 gene are not a frequent cause of CH.

Intra-arterial thrombolysis in acute ischaemic stroke: experience with a superselective catheter embedded in the clot.

OBJECTIVES: To report experience of intra-arterial thrombolysis for acute stroke, performed with a microcatheter navigated into the intracranial circulation to impale the clot. METHODS: Patients were selected on the following criteria: (1) clinical examination suggesting a large vessel occlusion in stroke patients between 18 and 75 years; (2) no radiographic signs of large actual ischaemia on CT at admission; (3) angiographically documented occlusion of the middle cerebral artery (MCA) stem or of the basilar artery (BA), without occlusion of the ipsilateral extracranial internal carotid artery or of both the vertebral arteries; (4) end of the entire procedure within six hours of stroke. 12 patients with acute stroke were recruited, eight of whom had occlusion of the MCA stem and four of the BA. Urokinase was used as the thrombolytic agent. RESULTS: Complete recanalisation in six MCA stem and in two BA occurred, and partial recanalisation in two MCA stem and one BA. There was no recanalisation in one BA. A clinically silent haemorrhage occurred in two patients, and a parenchymal haematoma in one patient, all in MCA occlusions. At four months five patients achieved self sufficiency (four with MCA and one with BA occlusion). Six patients were dependent (three totally), and one died. CONCLUSIONS: The strict criteria of eligibility allowing the enrollment of very few patients and the procedure itself, requiring particular neuroradiological expertise, make this procedure not routine. Nevertheless, the approach can be considered a possible option for patients with acute ischaemic stroke.

Residual and recurrent acoustic neuroma in hearing preservation procedures: neuroradiologic and surgical findings.

Magnetic resonance imaging with gadolinium DTPA is currently the most accurate method for detecting small intracanalicular yestibular schwannomas. This imaging modality is not nearly as clear in diagnosis of a small residual or recurrent neuroma after a hearing preservation procedure. This study looked for gadolinium-enhanced MRI images mimicking recurrent lesions in 104 consecutive cases of unilateral acoustic neuroma removed with a hearing preservation technique by the retrosigmoid transmeatal approach. A number of cases with enhancing MRI images in the internal anditory canal were reoperated, permitting the histologic examination of the enhancing tissue. Criteria for the MRI diagnosis of residual-recurrent acoustic neuroma are presented, along with the short-to mid-term rate of "residual-recurrent" tumor.

Meta-[123I]iodobenzylguanidine single photon emission computed tomography in chemodectomas.

Chemodectoma is a rare, slow growing neoplasm with local aggressiveness and a high rate of residuals after surgery, arising from paraganglionic tissue (neural crest) and therefore able to take up Metaiodobenzylguanidine (MIBG). The aim of this study was to evaluate the diagnostic accuracy of 123I-MIBG Single Photon Emission Computed Tomography (SPECT) in comparison to Selective Digital Angiography (SDA), Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). We studied 50 patients (41 women, 9 men) mean age 56 years (range 14-79), with diagnostic suspicion of chemodectoma (CH). There were 2 groups of patients: Group A (26 patients) examined before Surgery and Group B (24 patients) examined after surgery. SPECT of the head and neck region was performed 4 hours after i.v. administration of 185 MBq of 123I-MIBG. All patients were pre-treated with iodine solution. We performed a qualitative evaluation of the reconstructed slices. In Group A, all patients with CH (24) showed accumulation of MIBG in agreement with SDA, CT and MRI: 2 patients (histologically one had a cordoma, the other metastasis of papillary thyroid carcinoma), did not show any accumulation of 123I-MIBG. In Group B, 6 patients showed accumulation of 123I-MIBG in local residuals, and 9 were negative. Six patients with a lesion smaller than 1.5 cm were negative. Three patients had a positive scan but no lesion on SDA, CT and MRI. 123I-MIBG SPECT proved to be useful procedure in the diagnosis of untreated CH. During follow-up after surgery this procedure may assume a role in the perspective of radiometabolic therapy with 131I-MIBG.

[2 cases of Beckwith-Wiedemann syndrome. Morphogenetic characteristics, cardiac involvement and current diagnostic possibilities]. / A proposito di due casi di sindrome di Beckwith-Widemann. Caratteristiche morfogenetiche, interessamento cardiaco ed attuali possibilità diagnostiche.

This report describes two new cases of BWS. This diagnosis of BWS may be missed because of variable or incomplete clinical expression. Recognition of such patients is important, however, because they have the potential for development of neoplasias. There also appears to be an increased risk of malignancies associated with hemihypertrophy and BWS.

Carotid pain during percutaneous angioplasty (PTA). Pathophysiology and clinical features.

Stretching of the internal carotid artery during percutaneous transluminal angioplasty (PTA) may be associated with transient neck, facial or cranial pain. We report a series of 53 cases who received PTA. Cervical pain occurred in 51% of patients, with a radiation to face and scalp in 33%. Analysis focused on: (a) description of pain intensity, quality, timing and location; (b) investigation about the role of individual and technical parameters that could influence the relative risk of pain onset during PTA; (c) comparison with other available data on pain syndromes related to the carotid artery. Intimal flapping on post-angioplasty angiograms, bradycardia during the procedure and previous history of AMI were associated with a higher risk of painful angioplasty. PTA may also serve as a tool to investigate carotid pain and may add further knowledge to the evidence available about the role of the carotid wall in the pathogenesis of facial and cranial pain.

[The instrumental and clinical laboratory follow-up of congenital hypothyroidism]. / Il follow-up laboratoristico strumentale e clinico dell'ipotiroidismo congenito.

Early diagnosis, L-tiroxine therapy and adequate follow-up are determinant to remove the damages resulting from hormone deficiency in congenital hypothyroidism (CH). In order to achieve a better intellectual development, the authors suggest some guidelines for a correct follow-up on the basis of their personal experience on a population of 160 children with CH. These guidelines include monitored therapy, biochemical controls, instrumental investigations, clinical and auxological serial examinations. To better predict the mental outcome of these patients as adults, the authors propose a longer follow-up till adolescents, especially in the children with more severe hypothyroidism at diagnosis.

Local intraarterial thrombolysis for acute stroke in the carotid artery territories.

We have tested the feasibility of local intraarterial thrombolytic therapy in ischemic stroke in the carotid artery territories observed within 5 h of the onset of symptoms. Only 5 of 615 consecutive patients were enrolled. They were 1 man and 4 women aged 50 to 75 years. Angiography disclosed occlusion of the M2 tract in one, of the M3 tract in one, of the carotid siphon in one of M4 tract in two. Intraarterial urokinase was infused at a mean dosage of 560,000 units close to the site of occlusion. Four of them had partial or complete recanalisation at early angiographic control and were independent at 6th month control. The one who did not demonstrate recanalisation was confined to a wheelchair. One patient, who had recanalisation, sustained a hemorrhagic transformation of the brain ischemia not interfering with outcome. Our experience, at the light of the low rate of enrollment, despite the results, suggest that intraarterial thrombolysis may be a therapeutic tool for selected patients with stroke in the carotid artery territories and not a routinary treatment for them.

Carotid percutaneous angioplasty.

Clinical benefit from treatment of symptomatic severe carotid stenoses has been demonstrated recently. The safety profile of endarterectomy, however, justifies the development of alternative techniques as percutaneous transluminal angioplasty (PTA), at least in mild to moderate stenoses. Early results and follow-up data from our series of 44 carotid stenoses treated by PTA are reviewed in this paper, in comparison with other reports from literature. PTA may be beneficial as a therapy of symptomatic internal carotid stenoses, provided its cost/effectiveness has been evaluated by a valid method.

Hematomas epidurales post-traumáticos de fosa posterior: presentació de 4 casos en el Hospital "Dr. Jesus Yerena" / Posterior fossa epidural hematoma: presentation of 4 cases

Se realizó un estudio de 4 casos de hematomas epidurales de fosa posterior, diagnosticados y tratados en el Hospital "Dr. Jesús Yerena" de Caracas, ocurridos en el período comprendido entre 1983 y 1990. Se encontró una mayor incidencia en la tercera década de la vida, todos en el sexo masculino, y el antecedente traumático estuvo presente en los 4 casos. Se revisa la bibliografía encontrándose que la clínica es inespecífica. La TAC es el método diagnóstico ideal y el tratamiento quirúrgico debe realizarse precozmente por la cercanía de estructuras nobles

Percutaneous discectomy using Onik's method: 3 years' experience.

A total of 234 patients treated by percutaneous discectomy at 237 levels and followed-up between 11 months and 3 years 4 months showed an overall success rate of about 75%. In a subgroup of 112 of these patients rechecked for a second time, the clinical results remain consistently good even 24 months after surgery. In a special group of 28 patients who complained only of low back pain, percutaneous discectomy achieved a success rate of 85.7%. Complications consisted of one disc infection which cleared without clinical or radiological sequelae (0.26%).

[Congenital hypothyroidism: organization and coordination of neonatal screening in Italy]. / Ipotiroidismo congenito: organizzazione e coordinamento dello screening neonatale in Italia.

Congenital hypothyroidism (IC) is the most frequent endocrine disease of the infancy and it is caused by primary deficiency of thyroid hormones. The damages derived by protracted hormone deficiency are diffused to all organs and systems and particularly severe for the development of central nervous system. Mental retardation can be prevented by early diagnosis and therapy. Early diagnosis is assured by neonatal thyroid screening performed on all newborns in the first days of life. The progress report on the screening situation in Italy as well as the national coordination realized in this field are presented.

A case of "young stroke" with ICA intracranial occlusion: pathogenetic implication for dissection in migraine.

The case of a "young stroke" affecting a 22 years old man is reported. Essential clinical features were drowsiness, headache, motor aphasia, right hemiparesis and Claude-Bernard-Horner in the left eye. An extensive investigative protocol was carried out which revealed an occlusion of the intracranial left ICA with subsequent recanalization. The possible causes of the stroke (migraine, dissection or combination of both) are discussed and the importance of a complete evaluation of patients of this kind is stressed.

Meningiomas en el Hospital Universitario de Caracas en los últimos 20 años / Meningiomas in the Hospital Universitario of Caracas in the last twenty years

El presente trabajo constituye una revisión de 135 casos que son la totalidad de los meningiomas comprobados anatomopatológicamente desde 1964 hasta el primer semestre de 1984, en el Servicio de Neurocirugía del Hospital Universitario de Caracas. La distribución por edad estuvo entre la 2da. década, 5 casos; 3ra. década, 10 casos; 4ta. década, 18 casos; 5ta. década, 30 casos 6ta década, 31 casos; 7a. década, 5 casos en los femeninos y 2,3,7,7,12 y 5 casos respectivamente en los masculinos. La sintomatología clínical global se ordenó por frecuencia en cefaleas, 58,51% trastornos visuales, 31,11%; trastornos motores, 22,22%; vómitos, 18,51%; trastornos sensoriales, 14,81%; convulsiones, 14,07%; diplopia, 11,11% y otros, 17,03%. Los signos se jerarquizan así: trastornos motores, 48,14% edema de papila, 47,40%; alteraciones de reflejos, 39,25%; toque de pared craneales, 37,77%; otros, 5,18%. Los tipos histológicos fueron: Meningotelial, 52,52% femeninos; 50% masculinos. Mixto-transicional, 22,23% y 36,11% Hemangiopericítico, 3,02% femenino y 5,5% masculino. Sarcomatoso, 2,02%; fibrosblásticos, 20% femenino y 8,30%, masculino. Todos fueron intervenidos. La evolución post-operatoria fué buena,89 casos sin radioteralia y 9 casos con radioterapia; fué regular en 23 casos sin radioterapia y 2 casos con radioterapia. Hubo 12 casos mortales. El seguimiento varió de 5 meses a 11 años. Hubo un total de recidivas de 32,32% femeninos y 33,33 masculinos