Hydroxocobalamin to treat refractory vasoplegia following phaeochromocytoma resection in a child.

Phaeochromocytomas and paragangliomas are rare neuroendocrine tumours that often secrete catecholamines, which can cause dramatic swings in blood pressure and end-organ damage. During surgical resection of these tumours, antihypertensive drug infusions are often required, but after resection patients may become vasoplegic, in part due to cessation of catecholamine secretion by the tumour in the context of pre-operative α1 adrenoceptor antagonism. Numerous medications have been used to treat vasoplegia in this setting, including noradrenaline, vasopressin and, more recently, angiotensin II. We report the case of a patient who experienced vasoplegia after phaeochromocytoma resection which was refractory to vasopressin and angiotensin II infusions but was successfully treated with high dose hydroxocobalamin.

European core curriculum in neurorehabilitation.

To date, medical education lacks Europe-wide standards on neurorehabilitation. To address this, the European Federation of NeuroRehabilitation Societies (EFNR) here proposes a postgraduate neurorehabilitation training scheme. In particular, the European medical core curriculum in neurorehabilitation should include a two-year residency in a neurorehabilitation setting where trainees can gain practical experience. Furthermore, it should comprise six modules of classroom training organized as weekend seminars or summer/winter schools. In conclusion, after defining the European medical core curriculum in neurorehabilitation, the next activities of the EFNR will be to try and reach the largest possible consensus on its content among all national societies across Europe in order to further validate it and try to extend it to the other, non-medical, professionals on the neurorehabilitation team in line with their core curricula defined by each professional association.

Perspectivas para el desarrollo PRM y el punto de vista Italiano / Perspectives for PRM development and Italian point of view

En los últimos años, en numerosos documentos de la OMS, en su mayor parte los de la International Classification of Functioning, Disability and Health (ICF), y, recientemente, el informe mundial sobre discapacidad (World Report on Disability [WRD]), han descrito cómo la rehabilitación, y sus desarrollos científicos, prestan atención a los derechos de las personas discapacitadas para ayudar a cualquier país a crear una comunidad «inclusiva». En este período, esta concienciación es importante, sobre todo en Europa, donde los Servicios Sanitarios están cambiando por numerosas razones. El papel y la responsabilidad de la especialidad de Medicina Física y Rehabilitación (MFR) son demostrar cómo puede hacerse realidad un sistema amplio y global de rehabilitación (el Modelo Integrador del Funcionamiento y la Discapacidad), en el que participen y se renueven de manera sinérgica numerosos aspectos de los servicios sanitarios y sociales para obtener los mejores resultados para los individuos, del modo más apropiado, con una reducción de los gastos y una evitación del derroche de recursos. El objetivo es ofrecer oportunamente los diferentes cuidados en una continuidad y coherencia reales, en los que participen numerosos profesionales diferentes que guíen al paciente y mantengan el centro de atención en la «Persona» (posibilidades, pronóstico, deseos de autonomía, familia y contexto), evaluando las evidencias y los resultados en función de los desenlaces funcionales. En esta estrategia general, el Plan Nacional italiano de Rehabilitación es una tentativa de conectar las diferentes responsabilidades, servicios, e intervenciones de los especialistas en MFR, en distintos momentos y lugares, modificando en profundidad la «tradicional» relación entre los Servicios Sanitarios y la Rehabilitación (AU)

Many WHO documents in recent years, mainly ICF and recently WRD, have described how Rehabilitation, and its scientific developments, are focused on Disabled People Rights to help any Country to create an “inclusive” Community. This awareness is really important in this period, mainly in Europe, when Health Services are changing for many reasons. PRM role and responsibility are to show how can be realised a wide and global rehabilitation system involving and renovating many aspects of health and social services in a synergistic way to reach the best outcomes for people, in the suitable way, reducing expenses and wastes. Offering different cares timely, in a real continuity and coherence, involving and guiding many different professionals, maintaining the centre on the Person (possibilities, prognosis, free wishes, family and context), evaluating evidences and results on the functional outcomes. In this general strategy the Italian National Plan for Rehabilitation is an attempt to connect different responsibilities, facilities, interventions for PRM doctors, in different times and places, modifying deeply the "traditional" relationship between Health Services and Rehabilitation (AU)

Safety and efficacy of incobotulinum toxin type A (NT 201-Xeomin) for the treatment of post-stroke lower limb spasticity: a prospective open-label study.

BACKGROUND: In recent years, NT 201, a new botulinum toxin type A (BTX-A) free of complexing proteins, has been used for treating several movement disorders, showing safety and efficacy in upper limb spasticity. AIM: To assess the safety and evaluate the effects of BTX-A NT 201 free from complexing proteins for the treatment of post-stroke lower limb spasticity evaluating spasticity grade, passive ankle dorsi-flexion motion, and muscle's spasms, as well as its efficacy and rate of satisfaction for patients and for the physicians. DESIGN: Prospective open-label study. POPULATION: Patients (71) with post-stroke lower limb spasticity at least 5 months by the event. METHODS: Intramuscular injections of BTX-A NT 201 in soleus, medial, and lateral gastrocnemius with a maximum total dose of 180 U. Each patients was assessed at baseline, 30, and 90 days after treatment using Modified Ashworth Scale, Spasm Frequency Scale, evaluating passive ankle dorsi-flexion motion, and the rate of satisfaction for patients and investigators. RESULTS: Patients treated with BTX-A NT 201 reported a statistically significant reduction in muscle tone and spasms daily increasing passive ankle dorsi-flexion at 30 days, persisting also at 90 days of follow-up. CONCLUSION: BTX-A NT 201 for the treatment of post-stroke lower limb spasticity was safe and efficacious reducing muscle tone and spasms, and improving passive ankle dorsi-flexion movement. CLINICAL REHABILITATION IMPACT: These results confirmed the safety and effectiveness of a new type of BTX-A, with low immunogenity, useful to improve rehabilitative treatment of post-stroke lower limb spasticity.

Redes-modalidades (y necesidades) en rehabilitación: perspectivas para un progreso continuo / Network-modalities (and needs) in rehabilitation: Perspectives for a continuous development

En los últimos años, en numerosos doumentos de la OMS, en su mayor parte los de la International Classification of Functioning, Disability and Health (ICF), y, recientemente, el informe mundial sobre discapacidad (World Report on Disability [WRD]), han descrito cómo la rehabilitación, y sus desarrollos científicos, prestan atención a los derechos de las personas discapacitadas para ayudar a cualquier país a crear una comunidad «inclusiva». En este período, esta concienciación es importante, sobre todo en Europa, donde los Servicios Sanitarios están cambiando por numerosas razones. El papel y la responsabilidad de la especialidad de Medicina Física y Rehabilitación (MFR) son demostrar cómo puede hacerse realidad un sistema amplio y global de rehabilitación (el Modelo Integrador del Funcionamiento y la Discapacidad), en el que participen y se renueven de manera sinérgica numerosos aspectos de los servicios sanitarios y sociales para obtener los mejores resultados para los individuos, del modo más apropiado, con una reducción de los gastos y una evitación del derroche de recursos. El objetivo es ofrecer oportunamente los diferentes cuidados en una continuidad y coherencia reales, en los que participen numerosos profesionales diferentes que guíen al paciente y mantengan el centro de atención en la «Persona» (posibilidades, pronóstico, deseos de autonomía, familia y contexto), evaluando las evidencias y los resultados en función de los desenlaces funcionales. En esta estrategia general, el Plan Nacional italiano de Rehabilitación es una tentativa de conectar las diferentes responsabilidades, servicios, e intervenciones de los especialistas en MFR, en distintos momentos y lugares, modificando en profundidad la «tradicional» relación entre los Servicios Sanitarios y la Rehabilitación (AU)

Many WHO documents in recent years, mainly ICF and recently WRD, have described how Rehabilitation, and its scientific developments, are focused on Disabled People Rights to help any Country to create an “inclusive” Community. This awareness is really important in this period, mainly in Europe, when Health Services are changing for many reasons. PRM role and responsibility are to show how can be realised a wide and global rehabilitation system involving and renovating many aspects of health and social services in a synergistic way to reach the best outcomes for people, in the suitable way, reducing expenses and wastes. Offering different cares timely, in a real continuity and coherence, involving and guiding many different professionals, maintaining the centre on the Person (possibilities, prognosis, free wishes, family and context), evaluating evidences and results on the functional outcomes. In this general strategy the Italian National Plan for Rehabilitation is an attempt to connect different responsibilities, facilities, interventions for PRM doctors, in different times and places, modifying deeply the “traditional” relationship between Health Services and Rehabilitation (AU)

Magnetic nanoparticle biodistribution following intratumoral administration.

Recently, heat generated by iron oxide nanoparticles (IONPs) stimulated by an alternating magnetic field (AMF) has shown promise in the treatment of cancer. To determine the mechanism of nanoparticle-induced cytotoxicity, the physical association of the cancer cells and the nanoparticles must be determined. We have used transmission electron microscopy (TEM) to define the time dependent cellular uptake of intratumorally administered dextran-coated, core-shell configuration IONP having a mean hydrodynamic diameter of 100-130 nm in a murine breast adenocarcinoma cell line (MTG-B) in vivo. Tumors averaging volumes of 115 mm3 were injected with iron oxide nanoparticles. The tumors were then excised and fixed for TEM at time 0.1-120 h post-IONP injection. Intracellular uptake of IONPs was 5.0, 48.8 and 91.1% uptake at one, 2 and 4 h post-injection of IONPs, respectively. This information is essential for the effective use of IONP hyperthermia in cancer treatment.

[Obesity and Eating Disorders. Indications for the different levels of care. An Italian Expert Consensus Document]. / Documento di Consensus. Obesità e Disturbi dell'Alimentazione Indicazioni per i diversi livelli di trattamento.

This paper is an Italian Expert Consensus Document on multidimensional treatment of obesity and eating disorders. The Document is based on a wide survey of expert opinion. It presents, in particular, considerations regarding how clinicians go about choosing the most appropriate site of treatment for a given patient suffering from obesity and/or eating disorders: outpatient, partial hospitalization, residential rehabilitation centre, inpatient hospitalization. In a majority of instances obesity and eating disorders are long-term diseases and require a multiprofessional team-approach. In determining an initial level of care or a change to a different level of care, it is essential to consider together the overall physical condition, medical complications, disabilities, psychiatric comorbidity, psychology, behaviour, family, social resources, environment, and available services. We first created a review manuscript, a skeleton algorithm and two rating scales, based on the published guidelines and the existing research literature. As the second point we highlighted a number of clinical questions that had to be addressed in the specific context of our National Health Service and available specialized care units. Then we submitted eleven progressive revisions of the Document to the experts up to the final synthesis that was approved by the group. Of course, from point to point, some of the individual experts would differ with the consensus view. The document can be viewed as an expert consultation and the clinical judgement must always be tailored to the particular needs of each clinical situation. We will continue to revise the Document periodically based on new research information and on reassessment of expert opinion to keep it up-to-date. The Document was not financially sponsored.

The European physical and rehabilitation medicine journal network: historical notes on national journals.

AIM: In the last 40 years, physical and rehabilitation medicine (PRM) has made significant steps forward in Europe with the foundation of the European Federation of Physical Medicine and Rehabilitation (EFPMR) (1963) which gave rise to the European Society of Physical and Rehabilitation Medicine (ESPRM) (2004) the European Academy of Rehabilitation Medicine (1970), the PRM Section of the European Union of Medical Specialists (1974), and the European Board of PRM (1991). Our journal, formerly Europa Medico-physica (1964), the official journal of the EFPMR, now European Journal of Physical and Rehabilitation Medicine (EJPRM) and official journal of the ESPRM since 2008, is distinct for its steadfast European vocation, long-standing Mediter-ranean interests and connections with various national scientific societies. Jointly with the ESPRM, efforts are under way to set up the European Physical and Rehabilitation Medicine Journal Network (EPRMJN). The aim of this article is to present a profile of the national journals in the EPRMJN so as to give a better overview of how the scientific part of PRM in Europe has developed within a national perspective. METHODS: A profile of the following national journals is presented: Annals of Physical and Rehabilitation Medicine (France), Fizikalna i rehabilitacijska medicina (Physical and Rehabilitation Medicine) (Croatia), Neurorehabilitation (Bulgaria), Physical and Rehabilitation Medicine Portuguese Society Journal (Portugal), Physical Medicine, Rehabilitaton, Health (Bulgaria), Physikalische Medizin - Rehabilitationsmedizin - Kurort-medizin/Journal of Physical and Rehabilitation Medicine (Germany and Austria) Prevention and Rehabilitation (Bulgaria), Rehabilitacija (Rehabilitation) (Slovenia), Rehabilitación (Madr) (Spain), Turkish Journal of Physical Medicine and Rehabilitation (Turkey). CONCLUSION: Some national journals in Europe have a very long history and tradition of research and education. Having a better knowledge of these realities, usually hidden to the international readership owing to the English language barrier, could promote science in our specialty.

National journals of physical rehabilitation medicine in Europe: a survey.

BACKGROUND: The European Physical and Rehabilitation Medicine Journal Network (EPRMJN), a joint initiative between the European Society Physical and Rehabilitation Medicine (ESPRM) and the European Journal of Physical and Rehabilitation Medicine (EJPRM), has the aim to increase scientific knowledge among PRM specialists and foster collaboration among physical and rehabilitation medicine (PRM) journals. This article reports the results of a survey of national PRM journals in Europe we conducted to obtain an overview of the current state of PRM research in the European setting. RESULTS: Every year 682 PRM papers are published in a total of 66 issues per 3 294 page in the 16 national journals that responded to our survey, out of the 21 published in 15 countries; 12 countries have no PRM journals and two did not respond. Some 94% of the journals responding to the survey have a research aim and 88% an educational aim; all journals use a peer-review process (75% blinded); on average, 58.8 submissions are received per year, of which 6.7% are invited papers; the rejection rate is 21.4%. The majority of papers report original research, and main topics are musculoskeletal and neurological rehabilitation. CONCLUSION: Since the national journals published in Europe have a good peer review process and publish mainly original articles, it is possible that good research can be found. A major problem is the English language barrier to wider readerships, as many researchers publish only in their native language. The EPRMJN aims to discover this research and make it accessible to international audiences through systematic collection of articles appearing in the national journals of the EPRMJN and publication of content summaries on the ESPRM website.

Developing ICF core set for subjects with traumatic brain injury: an Italian clinical perspective.

AIM: The objective of this empirical study is to describe functioning and health of individuals with traumatic brain injury (TBI) and to identify the most common problems using the International Classification of Functioning Disability and Health (ICF). The specific aims are to describe the prevalence of problems in functioning as defined by the ICF of individuals with TBI, and to identify categories that explain most of the variance of the external standards. METHODS: 261 TBI patients from 24 Italian centres members of the Italian Network were consecutively enrolled into the study between July 2008 and January 2009. The study was conducted as an empirical cross-sectional study. RESULTS: The Extended ICF checklist captures the problems of TBI patients: many problems were reported within body function and body structure, but the most impaired categories were in Activity and Participation domain: the impaired categories reflect restrictions in challenging activities or activities related to later stages of recovery. The Environmental Factors in ICF were most frequently scored as facilitators: the support of the family is the most important environmental factor emerged, together. CONCLUSION: This study describes and identifies the most common problems in functioning of persons with TBI in an Italian sample. It emphasizes the importance of approaching the description of functioning and disability from a comprehensive perspective including not only body functions and structures but also activities and participation domains and environmental factors.