[Differential diagnosis of fever of unknown origin. A case of adult onset Still disease]. / Diagnosi differenziale della febbre di origine sconosciuta. Un caso di Morbo di Still dell'adulto.

BACKGROUND: A case of Still's disease in the adult, an uncommon seronegative rheumatoid arthritis-like disease with prominent systemic features is reported. This case did not show the typical clinical features and appeared like a fever of unknown origin. CASE REPORT: A 60 year-old female was admitted to the hospital for high fever occurred two months before without other important clinical symptoms and signs. Laboratory tests and morphologic images were negative for infectious diseases, tumours and immunological disorders. The course of the disease worsened and an hepatic failure threatened the patient life. The onset of many other typical clinical features, i.e. joints pain, characteristic skin rash, splenomegaly, throat pain, serositis and weight loss, led us to make a sure diagnosis and to save the patient with steroid therapy.

[Progressive paralysis. A case report]. / Paralisi progressiva. Descrizione di un caso.

STUDY OBJECTIVE: A fairly uncommon case of neurosyphilis is reported in a not immunocompromised patient. CASE REPORT: A case of general paresis in a 40 year-old male with the recent onset of mania is described. Psychiatric anamnesis was negative. Neurologic examination was negative. Laboratory tests were performed and serologic tests for syphilis were positive. Cerebrospinal fluid (CSF) examination showed 80 leukocytes/mm3, a reactive Venereal Disease Research Laboratory (VDRL) and normal protein concentration. CSF gamma globulin with an oligoclonal pattern and abnormal IgG index were found. A test for antibodies to Human Immunodeficiency Virus (HIV) was negative. The patient underwent a high dose intravenous penicillin G regimen for two weeks. A follow-up six months later showed a normal CSF even though the IgG index was still abnormal and the mental status was unchanged. CONCLUDING REMARKS: The authors suggest that patients with neurologic and/or psychiatric symptoms with a recent onset and a reactive VDRL should undergo a CSF examination to exclude a possible neurosyphilis.

[The nimodipine therapy of acute focal cerebral ischemia (minor stroke). A clinical study with an assessment of regional cerebral blood flow by SPECT]. / Terapia con nimodipina dell'ischemia cerebrale acuta a focolaio (minor stroke). Studio clinico con valutazione del flusso cerebrale regionale tramite SPECT.

Aim of the study is the evaluation of therapeutic effectiveness of nimodipine in acute focal cerebral ischaemia. Thirty patients affected by minor ischaemic stroke divided in two randomized groups have been studied consecutively: all the patients were treated with standard therapy, nimodipine was delivered in addition only to the patients of the first group. Both clinical evaluation using Mathew scale, modified by Gelmers, and flowmetric evaluation with SPECT were performed at different times. The results haven't shown any significant statistical difference in the effectiveness of the therapy between the two groups even if a positive clinical trend was evidenced in the group treated with nimodipine. The flowmetric study has shown the poor homogeneity of the groups from a physiopathological point of view not-with-standing the two groups were similar for the clinical severity, sex, age and vascular risk factors. We conclude that is advisable to carry out further trials in which the comparison study groups are more numerous and balanced also from a physiopathological point of view.