Psychopathology and neoplastic disease: medico-social and medico-legal considerations.

The cognitive disability associated with stress in patients presenting cancer disease may exert a significant impact on the psychological health of the individual and even deteriorate the clinical diagnosis. The present study consists of a review of the available literature and an analysis of the association between psychopathologic disease and cancer by selecting useful contributions to the medicosocial discussion of the topic. Interesting considerations have emerged on the epidemiology and pathogenesis of the association between psychopathology and cancer that initiated possibilities towards a greater accuracy in the assessment of the patient that is not only limited to oncologic problems and outcomes.

Autism Spectrum Disorder and intact executive functioning.

Earliest notions concerning autism (Autism Spectrum Disorders, ASD) describe the disturbance in executive functioning. Despite altered definition, executive functioning, expressed as higher cognitive skills required complex behaviors linked to the prefrontal cortex, are defective in autism. Specific difficulties in children presenting autism or verbal disabilities at executive functioning levels have been identified. Nevertheless, the developmental deficit of executive functioning in autism is highly diversified with huge individual variation and may even be absent. The aim of the present study to examine the current standing of intact executive functioning intact in ASD. RESULTS: Analysis of ASD populations, whether high-functioning, Asperger's or autism Broad Phenotype, studied over a range of executive functions including response inhibition, planning, cognitive flexibility, cognitive inhibition, and alerting networks indicates an absence of damage/impairment compared to the typically-developed normal control subjects. CONCLUSIONS: These findings of intact executive functioning in ASD subjects provide a strong foundation on which to construct applications for growth environments and the rehabilitation of autistic subjects.

A rare case of myocardial infarction by myocardial bridging of circumflex artery.

Myocardial Bridging (MB) is a benign condition that may be considered as a possible cause of ischaemic cardiopathy up to myocardial infarction. The authors describe the autopsy case of an MB of circumflex artery in a person with a myocardial infarction of the posterior wall of the left ventricle. In this case, the chronic ischemic heart disease can be explained by the congenital anomaly and in the literature there is scientific evidence to support the thesis. The MB is a benign condition that in combination with other risk factors can cause ischemic heart disease.

[Legal medical considerations on a case of erectile dysfunction]. / Considerazioni medicolegali su un caso di disfunzione erettile.

The primary obstruction of the bladder neck is a condition which is diagnosed in many young people with symptoms of lower urinary tract, such as obstructive symptoms (difficulty in the initial phase of urination and urinary retention) and irritative symptoms (pollakiuria, dysuria and nocturia). These tests are needed for the diagnosis: uroflowmetry, urodynamics, rx urethrocystography. For the treatment are used alpha-blockers or surgery. The main diagnostic test is the urodynamic study. Even though the alpha-blockers are effective and safe drugs, sometimes the treatment is surgical. The gold standard is the transurethral incision of the prostate or bladder neck (TUIP), a technique with good results, but with some complications, including retrograde ejaculation, that is the most dangerous, and erectile dysfunction, that occurs in a lower percentage of patients. In this work was studied, in terms of forensic medicine, the case of a patient who is 35 years old and reported erectile dysfunction after an intervention of transurethral incision of the prostate or bladder neck. Although there is a limited possibility, documented in the literature, of erectile dysfunction as a result of TUIP, there is no sufficient evidence to confer the responsibility of patient's organic nature impotence to the health professional civil conduct which is directly related to the transurethral incision of the bladder neck, considering the presence of a lumbo-sacral disc disease in the patient, documented by CT two years before the surgery.

Altered cytokine and BDNF levels in autism spectrum disorder.

The contribution of neuroimmune functioning and brain-derived neurotrophic factor (BDNF) to functional dysregulation in autism spectrum disorder was assessed in 29 patients under treatment in two specialized centers of Basilicata (Chiaromonte and Matera), Southern Italy, through analysis of serum levels of cytokines and BDNF. Elevated levels of the pro-inflammatory cytokine, including interleukin-1, interleukin-6, interleukin-12, interleukin-23, tumor necrosis factor-α and BDNF were observed, regardless of age and gender. Comparisons were made with age- and gender-related healthy controls. The present findings reinforce current notions regarding immunoexcitotoxic mechanisms contributing to the pathophysiology of autistic disorder.

[Medical legal issues associated with the evaluation of herniated discs in seafarers to merchant ships]. / Problematiche medico legali associate alla valutazione delle ernie discali nei lavoratori marittimi di navi mercantili.

"Seafarer" means person employed with any job on board a ship offshore, whether publicly or privately, excluding ships of war. Day by day a seafarer is forced to confront a reality in constant motion and live in environments that require awkward movements, and restricting the normal mobility of the person. In order to verify the frequency of herniated discs in this particular category of workers, given the recent introduction of INAIL tabulated diseases, a study was conducted on a sample of seafarers. Data analysis showed that 48.3% of the seafarers of the sample has herniated lumbar disc, and 34.5% of these duties in the deck, and 65.5% of the machine. The study of sample, varied as to age and task being performed, supports the assertion that the individual risk factors, especially age and obesity, are not strongly implicated in the genesis of disk herniation suffered by seafarers while the work factors (vibrations) play a more significant role in the onset of this disease. This consideration is part of a context, that of legal medical evaluation and in particular the causal relationship, which currently seems rather lacking in terms of literature and scientific production.

[New horizons in medicine. Complexity and predictability in internal medicine]. / Nuovi orizzonti in Medicina. Complessità e predicibilità in Medicina Interna.

Being a highly sophisticated structure, the human body should be considered on a physical level as a whole of inter-correlated non-linear dynamic systems, which are by definition, complex systems because they are always conditioned in their operativity by numerous variables. We must draw attention to the opportunity that within the field of medical science the concept of complexity referring to diagnostic, therapeutic and prognostical problems, is distinct between structural and functional. The functional complexity of a system, a phenomena, an event, MY be recognized in its dynamics, only if analysed using modern methods recently brought to light, on the relationship which exist between classic determinism and deterministic chaos. Furthermore, also on practical level, the recent discoveries on the general principles, which are at the base of the functional complexity of non-linear dynamic systems, demonstrate exactly how fragile is the probabilistic predictability which guides a doctor in clinical reasoning in all its various stages; in the gathering of anamnestic and objective data; in the programming the researches aimed at confirming the validness of the diagnosis; in the therapy aimed at reaching the best possible results; in the prognosis which summarize the destiny of the binomial patient illness. The scientific enunciate of universal nature, which demonstrate how, from a tiny uncertainty in the initial functional data of a system, of a phenomena, of an event can unleash a condition of absolute unpredictability, find daily confirmation in both clinical and experimental medicine.(ABSTRACT TRUNCATED AT 250 WORDS)

[New horizons in medicine. The attractors]. / Nuovi orizzonti in medicina. Gli attrattori.

The discovery of the fact that chaotic systems can suddenly coagulate into deterministic systems, and that deterministic systems can precipitate into chaotic systems has, on the one hand, clearly revealed the limits of the Cartesian geometrization of random phenomena, and on the other, has made in possible to identify the attractor as the reference entity when studying the functional dynamics of biological systems. The attractors is identified as the point of equilibrium upon which the behaviour of a dynamic system stabilizes and towards which it is constantly attracted. In some systems the attractor is identified as an "ideal" optimum reference point termed "the point". In other systems, however, the attractor is identified as a closed curve: "the ultimate cycle". Lastly, in other systems the attractor is identified as a surface in which the space of the states delimits a flat doughnut-shaped image constituting a "torus". The recent discovery of the laws governing deterministic chaos has made it possible to identify a new type of attractor termed the "strange attractor". This attractor has a fractal dimension (i.e. one midway between linear and plane), is of finite dimension and depends on the initial condition of the system. In many biological functions it is now possible to demonstrate the presence of attractors that operate starting from different initial conditions or that vary with time or that display both these conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

[Preliminary evaluation of an association of polyunsaturated acids in primary hypertriglyceridemia]. / Prime valutazioni su una associazione di acidi grassi polinsaturi nella ipertrigliceridemia primitiva.

The above study was intended to evaluate changes in triglyceride blood level in subjects treated with a polyunsaturated fatty acid combination: docosahexanoic (DHA) and eicosapentaenoic (EPA) acid, compared to changes observed in patients treated with arachidonic acid. The results obtained show that a significant reduction of triglyceride blood level was achieved and was more marked in patients treated with the DHA-EPA combination compared to those treated with arachidonic acid only. An increase in the index of fatty acid unsaturation was observed in all patients without significant differences between treatments.

[New horizons in medicine. Fractals]. / Nuovi orizzonti in medicina. I frattali.

In these last few years, a vertiginous growth in the application of informatics in the field of science has generated a new branch of geometry: the geometry of irregularity whose paradigmatical expression is fractals. We can identify in the fractal an object of complex structure which, when gradually enlarged, shows up details which repeat themselves as the scale of enlargement is progressively run through. It is possible, therefore, by using fractals to study and quantify in a much more concise way and much less approximatively those structures which were until recently described as granulous, tentacular, ramified, etc. Fractals bridge the gap between mathematics and visual art and allow us to explore the rapport between determinism and apparent chaos in the study of non-linear biological systems. Fractal dimension is an intermediary one between linear and surface dimensions. The applications of fractals images in the study of certain problematics which concern the cardiovascular system are referred to synthetically; particularly those concerning the sectorial differences of myocardial blood flow and the branches of small coronary vessels, both in physiological and pathological conditions. Fractal images permit us to analyse the regional flow of the pulmonary parenchyma, and to quantify pulmonary damage from thromboembolism. Other applications of fractal studies regard the digestive system, the nervous system and mammary pathology. In specialistic fields, fractals have been studied in both ophthalmology and odontology, and also in biochemistry to study protein surfaces and fluids turbulence.