Epidemiology of myasthenia gravis in the province of Trento (northern Italy).

The epidemiology of myasthenia gravis (MG) was studied in the province of Trento (northern Italy) among 444,879 inhabitants. On prevalence day (December 31, 1990) the crude rate was 82.9 per million population: 113 for females and 50.7 for males. The incidence rate was 7.4 per million per year: 10.8 for females and 4.6 for males. Over the same observation period (1981-1990), we calculated a death rate of 1.12 per million population per year. MG predominates in females. Nevertheless, we observed some differences related to age and to presence of thymoma, and our data supports the recognition of three types of MG: (1) predominating in females with a peak frequency at about 20-29 years; (2) affecting both males and females, with a frequency increasing with age, and (3) associated with thymoma.

[Use of plasmapheresis in the treatment of Guillain-Barre acute polyradiculoneuritis]. / L'utilité de la plasmaphérèse dans le traitement de la Polyradiculonévrite aiguë de Guillain Barre.

Retrospective study on 23 GBP in-patients was undertaken in an attempt to evaluate the effectiveness of plasmapheresis used in 8 cases: all patients were treated with corticoids. Evaluation methods and criteria for the choice of patients are discussed. Plasmapheresis appeared no better than other therapeutic methods currently in use, including support methods.

Centronuclear myopathy with unusual clinical picture.

The authors describe two cases of familial muscle disease, a mother and her daughter, characterized by centrally placed nuclei and a predominance of hypotrophic type 1 fibers. Clinically the patients exhibited a muscular weakness and atrophy localized mainly distally. Both showed hypertrophy of their calves. The nosological classification of the cases is uncertain; however, both are considered as examples of centronuclear myopathy with unusual clinical features.

Epidemiology of primary intracranial neoplasms. Experiment in the Province of Trento, (Italy), 1977-1984.

The incidence rate for primary intracranial tumors in the Province of Trento (Italy) from 1977 to 1984, adjusted to the Italian population, is 8.5/100,000/year (8.0 for males and 9.1 for females). The age-specific distribution is nearly the same as that reported in other studies. It is bimodal with a mild increase until the ages of 40-44 years followed by a peak reaching a maximum at the ages of 55-64 years and then declining. The commonest tumors in males were glioblastomas (m/f ratio = 1.3) and in females meningiomas (m/f = 0.4). Pituitary adenomas were 15.3% of all tumors with a m/f ratio of 0.6. Factors causing discrepancies between the rates reported by various authors are discussed.

Primary intracranial tumors in the province of Trento-Italy (1977-1984). Distribution by administrative units.

The incidence rate for primary intracranial neoplasms in the province of Trento (Italy) is 8.5/100,000/year, but the figures in the eleven administrative units ('comprensori') are different. The increased rates in C6 Val di Non and C10 Vallagarina are mainly due to the number of malignant tumors in the 45- to 64-year-old males. The biggest provincial production of fruit and wine, and considerable amounts of pesticides and synthetic fertilizers used for many years are located in the above-mentioned units. For these substances and their derivatives there is evidence of carcinogenicity in humans, also with respect to the brain. The reported data can be considered as an epidemiological starting point to support an etiological hypothesis.

[Thoracic outlet syndrome]. / Sindrome dello stretto toracico superiore.

Thoracic outlet syndrome is produced by many aetiopathogenic factors that compress or stretch the brachial plexus in the subclavian region. Clinical aspects, diagnostic procedure and instrumental examinations are discussed. A treatment programme should be based on the many factors causing the syndrome. Most patients, however, derive benefit from a suitable exercise programme and this is recommended as an initial approach in all cases.

Primary intracranial tumors. Survey of incidence in the province of Trento in the years 1977-1981.

The incidence rate of primary intracranial tumors in the Province of Trento from 1977 to 1981 was 7.4 per 100,000 inhabitants per year. The age curve is as reported by other authors, with two peaks, one early and the other, much higher, at 50-59 years. This curve reflects that of malignant tumors in males. The age-adjusted crude rate in males proved to be 7.4 (4.9 for malignant and 2.5 for benign tumors). The corresponding value in females was 7.4 (3.5 and 4.0). The most frequent tumors in males were astrocytomas, grades III and IV (M/F ratio = 1.6), and in females meningiomas (M/F ratio = 0.6). Hypophyseal adenomas, which accounted for 15.4% of all tumors, had an M/F ratio of 0.4. The factors likely to be responsible for the differences in incidence rates reported in the various surveys are discussed.

Carcinoma of the prostate and motor neuron disease.

Non metastatic neurological concomitants of tumors are well known. They include an amyotrophic lateral sclerosis (ALS)-like syndrome in association with various tumors. The association with prostatic carcinoma is very rare. The case reported here seems to confirm the outcome of epidemiological research: the association is fortuitous.

[Treatment of abnormal movements of extrapyramidal origin with tiapride]. / Trattamento dei movimenti anormali di origine extrapiramidale con tiapride.

The authors report results attained by means of a replaced benzamide, thiapride, in the treatment of 21 subjects showing involuntary movements of extra-pyramidal origin and more exactly: extra-pyramidal syndromes due to drugs (3), idiopathic dyscinesias (8), choreas (6), dystonias (3), essential tremor (1). The drug was administered per os as well as per IM and EV. Results were good or fair in 71% of cases. The clearest improvements were obtained in iatrogenic dyscinesias (torticollis, diaphragm clonisms). The drug was well tolerated in all cases, both from the clinical and hematochemical standpoint, even at the highest dosages, and, in particular, no case of amenorrhea or galactorrhea was pointed out. Finally, the authors explain how the best results with thiapride may probably be obtained in those forms in which an hyperfunction of the dopaminergic system is proved, thanks to the competitive action of the molecule on presynaptic dopaminergic receptors.