Evidence for an abnormal cortical sensory processing in dystonia: selective enhancement of lower limb P37-N50 somatosensory evoked potential.

We evaluated brain stem P30, contralateral frontal N37, and the vertex-ipsilateral central P37, N50 somatosensory evoked potentials (SEPs) obtained in response to stimulation of the tibial nerve in 10 patients with idiopathic dystonia. Results were compared with those obtained in 10 healthy subjects matched for age and sex. The amplitude of the brain stem P30 potential and of the contralateral frontal N37 response in dystonic patients was not significantly different from that recorded in normal subjects. The vertex- ipsilateral central P37-N50 complex, which is thought to originate in the pre-rolandic cortex, was significantly enhanced in patients compared with the control group. These results suggest the enhancement of the vertex-ipsilateral central P37-N50 complex might reflect an abnormal response to somatosensory inputs of a precentral cortex which is excessively activated because of a disorder of the basal ganglia. Such inefficient sensory processing in motor areas might contribute to motor impairment in dystonia.

One-year experience with a new expanded polytetrafluoroethylene vascular graft for hemodialysis.

Hemodialysis access achieved through a prosthetic vascular graft has become more popular, especially in diabetic and older patients and those who have had several unsuccessful surgical accesses. From January to December 1996, we implanted a newly available expanded polytetrafluoroethylene (ePTFE) graft (DIASTAT Vascular Access Graft) that allows early cannulation in 18 patients (11 men and 7 women; mean age +/- SD, 63.7 +/- 11 years). Thirteen of these patients had at least one failed vascular access. All grafts were cannulated for dialysis within 7 days of implantation, with flow rates > or = 300 ml/min. The time to hemostasis after the first cannulation ranged from 2 to 4 min. The primary patency rate at one year was 56%. Four grafts developed thrombosis requiring surgical intervention; three were salvaged and one was removed. The one-year assisted or cumulative patency rate was 72%. One patient had persistent bleeding requiring graft revision immediately after surgery. The bleeding stopped and its origin was not determined. There were no graft infections or hematomas. Because of the early cannulation possible with the DIASTAT graft, as well as the lesser time to hemostasis than that generally achieved with standard ePTFE grafts, this prosthesis is a good alternative to autogenous access construction.

Familial cavernous hemangioma with atypical neuroimaging.

Three members of the same family were studied, all of whom had multiple intracerebral cavernous angiomas for which a dominant autosomal inheritance was hypothesised. The proband suffered from headaches, and physical examination revealed evident right hemiparesis. The second case started with a hemorrhagic cerebral stroke and the third was asymptomatic on neurological examination. Nuclear magnetic resonance (NMR), performed in two of the three cases, showed lesions whose number and extent were not radiologically characteristic of cavernous angioma. A cerebral biopsy of the proband enabled the diagnosis to be made. Despite the recent introduction of NMR, the nosological classification of familial forms can be difficult when the radiological lesions are atypical. In such cases, cerebral biopsy is not only a valid diagnostic aid, but is also indispensable for obtaining adequate genetic information.

Reversible cerebral ischemias: a comparative analysis of risk factors in TIAs and in RINDs.

A retrospective study in which 709 patients, 522 with RIND and 187 with TIA, were compared in respect of common risk factors (RFs) for acute cerebrovascular disease. The two forms of the disease differed significantly in respect of smoking, hematocrit, hypercholesteremia, hypertriglyceridemia and hyperuricacidemia. Although these RFs do not seem to be determinants of or discriminants between the two forms of acute cerebrovascular disease, it is nonetheless highly probable that, together with all the other RFs, they have a facilitatory role.

[Biliary ileus: personal cases]. / L'ileo biliare: contributo personale.

After a short review of world literature on the subject, four cases of biliary ileus, all with favourable outcome, are reported. Some considerations on the pathogenesis of occlusion of biliary origin and on its treatment are then set out: such treatment must always be surgical and of emergency type, providing not only for removal of the obstructing calculus, but also for exploration of the whole ileus. Where possible, cholecystectomy and closure of the bilio-digestive fistula should also be performed.

[Benign neoplasms of the stomach: personal cases]. / Le neoplasie benigne dello stomaco: casistica personale.

After discussing the diagnostic approach to benign tumours of the stomach on the basis of the most valid classifications in literature, the Authors describe the symptoms and frequency of these tumours. They then report 12 personally observed cases, and in particular one case of neurofibroma of the gastric fundus, which was exceptional for localisation, volume and clinical course. They conclude that only open extemporaneous surgical examination can provide confirmation of the benign nature of the neoformation. Therapy must in any case be surgical: the extent of removal will be governed by the extent and location of the tumour, and by the outcome of the histological examination.

[Pancreatic cystadenoma. Description of 2 cases and review]. / II cistoadenoma pancreatico. Descrizione di due casi e revisione della letteratura.

On the basis of two personal cases and a review of the most recent literature, the main features of this rare pancreatic condition are reported. Special attention is paid to the post-diagnostic importance of radical exeresis. This is the only way of preventing the patient running the risk of malignant degeneration. The observation of a bisalbuminaemic band and the association with an aberrant pancreatic adenoma were of interest in the two cases described.