Psychogenic non-epileptic seizures and functional motor disorders in developmental age: A comparison of clinical and psychopathological features.

BACKGROUND: Psychogenic Non-Epileptic Seizures (PNES) and Functional Motor Disorders (FMDs) commonly represent the main clinical manifestations of Functional Neurological Disorders (FNDs). Despite their high prevalence in pediatric neurological services, literature on this topic is still spare for this population. The present study aimed to deepen the clinical knowledge of a pediatric FNDs sample through a demographic and clinical characterization of the most recurrent clinical patterns during the pediatric age. Moreover, a comparison of neuropsychological and psychopathological profiles of PNES and FMD patients was carried out to identify specific vulnerabilities and therapeutic targets linked with these different clinical manifestations. MATERIALS AND METHODS: A total of 43 FNDs patients (age range 7-17 years old) were retrospectively included in our study, enrolled in two subgroups: 20 with FMDs and 23 with PNES diagnosis. They were inpatients and outpatients referred over a period of 5 years and a standardized neurological, neuropsychological (WISC-IV/WAIS-IV), and psychiatric (CDI-2, MASC-2, ADES, DIS-Q, PID-5) evaluation was assessed. RESULTS: In PNES patients the most common clinical phenotypes were functional tonic-clonic (52%) and atonic (32%) manifestations while in the FMDs group were gait alterations (60%), functional myoclonus (35%), and tremor (35%). A higher frequency of cognitive impairment was reported in PNES patients with higher anxiety-depressive symptom rates than FMDs patients. CONCLUSIONS: Notably, specific neurocognitive and psychopathological profiles were described in PNES and FMDs, highlighting higher cognitive and psychiatric vulnerabilities in PNES, suggesting as well different strategy for therapeutic approaches.

An unusual case of mammary Paget’s disease in a woman with psoriasis.

Mammary Paget’s disease (MPD) is a malignant breast tumor, which is characterized by intraepidermal infiltration from malignant glandular epithelial cells. Often it may include an underlying ductal carcinoma in situ or an invasive ductal carcinoma. Clinically it appears as an erythematous patch, moist or crusted, with or without desquamation that in some cases becomes ulcerated, causing infiltration and inversion of the nipple. We report the clinical case of a 60-year-old woman, treated in our department for psoriasis, presenting with erythema of nipple and areola with nipple erosion, ulceration and poor secretion. Suspecting Paget’s disease of the nipple, radiological exams (mammography and breast MRI) were performed. A biopsy for histological examination was carried out and confirmed the diagnosis of mammary Paget’s disease. MPD is sometimes difficult to diagnose both clinically and radiologically, therefore it is important to distinguish from other conditions: in literature MPD is reported in differential diagnosis with psoriasis given its similar clinical features, and in some cases MPD has been treated with topical and systemic steroids due to a wrong diagnosis. However, the concomitance, in the same individual, of mammary Paget’s disease and psoriasis has never been described.

A vascular lesion mimicking a primitive brain tumour in a patient examined by 18F-choline PET/CT and MRI / Una lesión vascular imitando un tumor cerebral primitivo en un paciente examinado con PET 18F-colina/TAC y RM

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RECTAL IMPACTION DUE TO PRICKLY PEAR SEEDS BEZOAR: A CASE REPORT.

Fecal impaction is the third cause of lower gastrointestinal tract obstruction after strictures for colon cancer and postoperative adhesions. A rapid diagnosis is necessary to avoid complications due to intestinal obstruction. Rectal phytobezoar due to prickly pear fruit seeds are an extremely rare entity, in the literature about twenty similar cases are described. Prickly pears are common in many countries, even in the Mediterranean area. When the ingestion of their fruit is excessive, this can be harmful, leading to the formation of phytobezoar causing fecal impaction. We describe the first case of phytobezoar due to prickly pear fruit seeds in continental Europe: a 76-year-old Italian female who ingested almost 40 prickly pear fruit leading to the composition of a large rectal phytobezoar. The patient presented clinically with fecal impaction, diagnosed by imaging and successfully treated by rectal irrigation and manual disimpaction. Our aim is to remind the physicians of these risks in evaluating patients with intestinal obstruction, when there is positive anamnesis for provenience from some areas in which these fruits are eaten. We also want to underline the role of Imaging Multi Detector Computed Tomography (MDCT) in the diagnosis of these very uncommon entities.

Interactions between pupae of the pine processionary moth (Thaumetopoea pityocampa) and parasitoids in a Pinus forest.

Parasitoids are significant enemies of many economically important insects and there is some evidence to suggest that their actions have a role in terminating the outbreaks of forest Lepidoptera populations. In this study, we examined the impact of parasitoids on the pupae of the pine processionary moth, and highlighted the presence of several parasitoid species for this developmental stage. A higher rate of parasitism was found when the pupal density in the soil was reduced, but the rate of parasitism was not influenced by pupal morphological traits or by the presence or absence of a cocoon around a pupa. Of the external factors examined, a delay in the time of descent of larvae from the trees had a positive effect on the level of parasitism. Observational data indicated that dipteran and hymenopteran were the most abundant parasitoids to emerge from moth pupae. Our study highlights the complexity of the parasitoid-host dynamics, and stresses the importance of carefully determining environmental effects on host-parasitoid relations.

Luteal phase support with 17alpha-hydroxyprogesterone versus unsupported cycles in in vitro fertilization: a comparative randomized study.

This study was designed to determine the efficacy of 17alpha-hydroxyprogesterone caproate (17-OHPc) for luteal phase support in in vitro fertilization (IVF). For this purpose, a total of 86 IVF patients undergoing embryo transfer were randomly allocated to two groups as follows: (1) group A, including 43 patients who received the support of luteal phase through the intramuscular administration of 17-OHPc at a dosage of 341 mg every 3 days, and (2) group B, including 43 patients who received the intramuscular administration of a saline solution as placebo every 3 days. In both groups, the treatment was started within 24 h after embryo transfer until beta-HCG evaluation. In case of positive beta-HCG, it was extended until 12 weeks. Efficacy was assessed using the pregnancy rates, which was, per transfer, statistically significantly higher in group A than in group B (32.5 vs. 18.3% respectively). On the basis of our results, we emphasize the use of 17-OHPc for luteal phase support after IVF and embryo transfer.

Intramuscular versus vaginal administration of progesterone for luteal phase support after in vitro fertilization and embryo transfer. A comparative randomized study.

A total of 156 patients were randomly treated with exogenous natural progesterone (intramuscularly, 50 mg/day) and vaginal gel (90 mg/day) P or nothing (Controls) from the day before embryo transfer (ET) for two weeks. In case of positive beta-HCG, the treatment was continued for 12 weeks. Plasma P and 17 beta-Estradiol concentrations were estimated and compared with the control not supplemented group. Both treatments were able to increase significantly the luteal plasmatic values of P versus controls. The ongoing pregnancy and the living birth rates per transfer were significantly higher in the patients supplemented with intramuscular P than in those treated with vaginal gel P. The intramuscular natural P appears the most suitable route of administration for luteal phase support in IVF-ET procedures.

Microflora in adult periodontitis.

The subgingival microflora of adult periodontitis was studied in 8 adults (36-47 years) and compared with that of 10 periodontally healthy individuals (36-43 years). A total of 64 periodontal lesions were examined, and classified according to the attachment level in three categories: attachment loss > 6 mm, attachment loss 4-6 mm and attachment loss < 4 mm. Also for comparative purposes 20 gingival sulci were evaluated. Samples were taken using three standardized paper points and were incubated anaerobically in selective and non-selective media. The results showed a statistically significant association of Capnocytophaga gingivalis and Capnocytophaga sputigena with moderate periodontal lesions, while Haemophilus segnis has been correlated to severe periodontal lesions. We concluded that C. gingivalis, C. sputigena and H. segnis might be potentially conductive to periodontal deterioration in adult periodontitis.

Predominant microflora of severe, moderate and minimal periodontal lesions in young adults with rapidly progressive periodontitis.

The purpose of this investigation was to study the microflora of severe, moderate and minimal periodontal lesions, in young adults with rapidly progressive periodontitis (RPP). Subgingival plaque samples were taken from 142 periodontal lesions in 10 young adults aging 25 to 35 years. The examination of the subgingival microflora indicated that certain species, including Porphyromonas gingivalis, Bacteroides forsythus, Fusobacterium nucleatum, Actinobacillus actinomycetemcomitans, and Campylobacter species were found to be predominant in severe periodontal lesions. B. forsythus, P. gingivalis, Prevotella intermedia, F. nucleatum, Capnocytophaga ochracea, were predominant in medium lesions while Streptococcus species and Actinomyces species, C. ochracea, Haemophilus segnis and Veillonella parvula, were found in higher levels in minimal periodontal lesions.

Microbiota of rapidly progressive periodontitis lesions in association with clinical parameters.

The microbial population in 73 rapidly progressive periodontitis (RPP) lesions in 10 young adults aged 25 to 35 years (5 males, 5 females) was studied in relation to the clinical parameters probing depth, bleeding on probing, and suppuration, which were recorded at the sampled sites. Porphyromonas gingivalis was found to predominate (26.7%) in 73 periodontal lesions with clinical probing depth > 6 mm, followed by Bacteroides forsythus (23.6%), and Prevotella intermedia (15.7%). The prevalence of P. gingivalis was 91.7%, Fusobacterium nucleatum, 90.4%; Streptococcus intermedius, 87.7%; and B. forsythus, 53.4%. Significant differences between bleeding index 0, 1, and 2 (P < 0.05) in frequency of detection were found for P. intermedia, Campylobacter concisus, Selenomonas sputigena, and Peptostreptococcus micros at bleeding sites and for Streptococcus sanguis, Actinobacillus actinomycetemcomitans, and B. forsythus (P < 0.001) at non-bleeding sites. Between suppurating and non-suppurating sites, significant differences (P < 0.05) in frequency of isolation were found for P. intermedia, Capnocytophaga ochracea, and A. actinomycetemcomitans at suppurating sites and for F. nucleatum at non-suppurating sites.

[Heat exposure differentiates 2 electrophoretically equal allo-albumins]. / L'esposizione al calore differenzia due alloalbumine elettroforeticamente uguali.

An alloalbumin characterized by thermolability at 56 degrees C of its slow migration band is described in this paper. The comparison between this new variant and correspondent standard of the "Comitato Italiano per la Standardizzazione dei Metodi Ematologici e di Laboratorio" (CISMEL) allow some remarks upon classification of variants based on the electrophoretic mobility.

Thermolabile alloalbumin of slow type: a new variant?

A new variant of Alloalbumin, with electrophoretic mobility identical to CISMEL standard SO/BS, characterized by thermolability at 56 degrees C of its slow migration band is described in this paper. This thermolabile Alloalbumin was present in 5 out of 10 family members of the original propositus. The new Alloalbumin has been indicated BS/BG according to the CISMEL recommendations. Our observations indicates that Alloalbumins with the same electrophoretic mobility may differ in structural composition as evidentiated by the different behaviour of these Alloalbumins with respect to their thermostability.

Effects of an immunomodulating agent on peripheral blood lymphocytes and subgingival microflora in ligature-induced periodontitis.

The peripheral blood lymphocyte populations and the subgingival levels of black-pigmented Bacteroides species were monitored during the conversion of chronic gingivitis to progressing periodontitis in cynomolgus monkeys. In addition, the effects of an immunomodulating agent, the pentapeptide of thymopoietin (TP5), were determined. After the induction of active periodontitis, proportions of helper T-cells (OKT-4 positive) decreased from 31.5 to 26.4%, and proportions of B-cells (surface immunoglobulin positive) increased from 44.5 to 51.8%. Proportions of suppressor T-cells (OKT-8 positive) remained unchanged, but the numbers of OKT-8-positive cells increased. During this same time period the total cultivable subgingival flora increased from 1.5 X 10(6) to 3.5 X 10(6) per sample, with Bacteroides gingivalis increasing from 5.3 to 16.6% of the total cultivable subgingival flora. After 10 weeks of active periodontitis, animals were treated with either TP5 or placebo. Treatment with TP5 produced an increase in helper T-cells but had no effect on B-cells. The OKT-4/OKT-8 cell ratio, which decreased from 1.3 to 0.8 with disease induction, was increased to 1.1 after TP5 treatment but remained at 0.9 in placebo-treated animals. TP5 had no effect on the total cultivable subgingival flora but significantly decreased the subgingival proportions of B. gingivalis and other black-pigmented Bacteroides species. In this model system, active periodontitis was associated with an increase in B. gingivalis, a decreased helper/suppressor T-cell ratio, and increased levels of B-cells. Treatment with TP5 increased the helper/suppressor T-cell ratio and decreased B. gingivalis levels, suggesting that lymphocyte subsets have the potential to influence subgingival levels of potential periodontal pathogens.