[Effect of AChE and BuChE inhibition by rivastigmin in a group of old-old elderly patients with cerebrovascular impairment (SIVD type)]. / Effecto dell'inibizione AChE e BuChE tramite rivastigmina in un gruppo di soggetti geriatrici old-old affetti da demenza vascolare (SIVD-type).

AIM: Vascular dementia (VaD) is defined as a loss of cognitive function resulting from ischemic, hypoperfusive, or hemorrhagic brain lesions due to cerebrovascular disease or cardiovascular pathology. The main types of VaD are: Small Vessel Disease Dementia (sVAD), Large vessel disease dementia, hypoperfusive-ischemic dementia and hemorragic dementia. The sVAD is divided into two main categories: subcortical ischemic vascular dementia (SIVD) and cortical dementia. Currently, no drugs are approved for the treatment of VaD. This study aimed to determine whether rivastigmine, a second generation cholinesterase inhibitor with selectivity for the CNS, with capacity to inhibit both acetylcholinesterase (AChE) and butyryl-cholinesterase (BuChE), slows the rate of cognitive decline associated with VaD. METHODS: Study subjects were 27 male and 43 female outpatients aged 80.03±6.53 years, with Mini-Mental State Examination (MMSE) score ranging batween 22 and 12, affected by VaD. They were included in the study if they were undergoing pharmacological treatment with acetylsalicylic acid 100 mg for at least six months. Patients were divided into two groups: one group was treated with ASA 100 mg and rivastigmine patch 9.5 mg (Rivastigmine group), the other just with ASA 100 mg (ASA group). All patients were followed for 6 months, with a first evaluation (T0) and a second examination after six mounths of treatment (T1). RESULTS: Statistically data proved as the Rivastigmine group showed constant values at MMSE, compared with patients of the ASA group who experienced decline of their cognitive performances. The same result was found in CDR, ADL, GDS and NPI scales. It is remarkable to underline as Rivastigmine-treated patients had a mean improvement in GDS scales, in comparison with patients of the ASA group who showed a worsening of mood. CONCLUSION: Rivastigmine-therapy improves cognitive performance in elderly with SIVD.

[Autoimmune thrombocytopenia and pregnancy]. / Trombocitopenia autoimmune e gravidanza.

Immune thrombocytopenic purpura (ITP) is an autoimmune disorder with its highest frequency in young women in the reproductive years. An antepartum diagnosis of maternal thrombocytopenia has become more common because platelet counts are now included with routine complete blood cell counts. Sometimes platelet autoantibodies facilitate increased platelet destruction by the reticuloendothelial system especially the spleen. These autoantibodies (IgG) can cross the placenta and place the fetus at risk for thrombocytopenia and, sometimes, serious bleeding problems such as intracranial hemorrhage can occur. The treatment is performed by corticosteroids (prednisone) or intravenous immune gammaglobulin. Four patients with thrombocytopenia during pregnancy underwent medical treatment (prednisone 1 mg/kg/die). The results were successful. In one case only we did not have a clinical response after corticosteroid therapy. There were no intracranial hemorrhages; however the risk for the patients and fetal or neonatal hemorrhage is much lower than thought. Corticosteroid treatment is the first choice, but sometimes it can give a clinical negative response.

[Subarachnoid hemorrhage as initial manifestation of polyarteritis nodosa]. / Emorragia subaracnoidea come manifestazione iniziale di poliarterite nodosa.

The polyarteritis nodosa (P.A.N.) is frequently responsible of neurological disorders, both central and peripheral. However an involvement of the Central Nervous System is unusual at the beginning of the disease. Such particular case is reported having occurred in a man aged 49, struck by a subarachnoidal hemorrhage, which was an initial symptom of P.A.N. The differential diagnosis is not always easy in such cases, since the clinical findings could be mistaken for those of a subarachnoidal hemorrhage due to a malformed vessel rupture.