Reduced Neural Satiety Responses in Women Affected by Obesity.

Overweight and obesity are major risk factors for a number of chronic diseases, including diabetes, cardiovascular diseases, and cancer. Obesity rates are on the rise worldwide with women more frequently affected than men. Hedonic responses to food seem to play a key role in obesity, but the exact mechanisms and relationships are still poorly understood. In this study, we investigate the perceived pleasantness of food rewards in relation to satiety and calories consumed during an ad libitum meal in women. Using functional magnetic resonance imaging (fMRI) and a milkshake consumption task, we studied how experienced food values are encoded in women with healthy weight, overweight or obesity. Participants rated the pleasantness and intensity of high and low caloric milkshakes in the fMRI scanner during both the fasted and fed states. We found differences in the neural responses and experienced pleasantness of high and low caloric milkshakes depending on satiety and Body Mass Index (BMI). Women with both high ad libitum consumption levels and high BMI reported greater experienced pleasantness for milkshakes. In contrast, among women with low ad libitum consumption levels, greater BMI was associated with less experienced pleasantness. At the neural level, satiety affected women with obesity to a lesser degree than women with healthy weight. Thus, having obesity was associated with altered relationships between food consumption and the hedonic responses to food rewards as well as reduced satiety effects in women.

Metastatic volume: an old oncologic concept and a new prognostic factor for stage IV melanoma patients.

BACKGROUND: The last melanoma staging system of the 2009 American Joint Committee on Cancer takes into account, for stage IV disease, the serum levels of lactate dehydrogenase (LDH) and the site of distant metastases. OBJECTIVE: Our aim was to compare the significance of metastatic volume, as evaluated at the time of stage IV melanoma diagnosis, with other clinical predictors of prognosis. METHODS: We conducted a retrospective multicentric study. To establish which variables were statistically correlated both with death and survival time, contingency tables were evaluated. The overall survival curves were compared using the Kaplan-Meier method. RESULTS: Metastatic volume and number of affected organs were statistically related to death. In detail, patients with a metastatic volume >15 cm(3) had a worse prognosis than those with a volume lower than this value (survival probability at 60 months: 6.8 vs. 40.9%, respectively). The Kaplan-Meier method confirmed that survival time was significantly related to the site(s) of metastases, to elevated LDH serum levels and to melanoma stage according to the latest system. CONCLUSION: Our results suggest that metastatic volume may be considered as a useful prognostic factor for survival among melanoma patients.

Evaluating the acute contributions of dopaminergic replacement to gait with obstacles in Parkinson's disease.

The influence of dopaminergic replacement (DR) on gait in people with Parkinson's disease (PD) is well documented. However, little is known about the acute effects of dopamine on more complex locomotor tasks that require visual guidance to avoid obstacles during gait. The authors investigated the influence of DR on locomotor behavior in a task where movement planning and control might be challenged by the height of the obstacle. The PD group included patients diagnosed with idiopathic PD (n = 12), as well as healthy controls (n = 12). Patients walked and stepped over obstacles of different heights before (OFF) and after (ON) levodopa intake. Spatial adjustments were not modulated by DR, but the step time to perform these anticipatory gait adjustments was longer only in PD-OFF (compared with healthy controls) when approaching the highest obstacle, but not PD-ON. During the crossing phase, trail limb toe clearance of PD patients was shorter than healthy controls only during the OFF state. ON-OFF comparisons were significantly different only for the time to reach the lead foot clearance over the highest obstacle. In summary, DR partially improved movement slowness but did not directly affect movement amplitude of lower limb regulation in this gait task.

The blue globular pattern in dermoscopy.

BACKGROUND: Seborrheic keratosis (SK) is a frequent benign epithelial skin tumor. Generally its diagnosis is clinical, however SK can sometimes clinically simulate a melanocytic lesion; therefore we need dermoscopy to reach a correct diagnosis. Milia-like cysts and comedo-like openings are the common dermoscopic features of SK, but it is not a rare finding that SK can display one or more dermoscopic patterns suggestive of a melanocytic origin. OBJECTIVES: We describe a case series of SKs with a blue globular pattern simulating a melanocytic lesion. METHODS: We retrospectively evaluated 224 SKs seen during 2011 at the Dermatoscopy Unit of the Department of Dermatology, University of Rome 'Sapienza'. RESULTS: Five SKs showed a blue globular pattern, without the SK main features generally seen in dermoscopy; globules were multiple, round or oval, well-demarcated, small and medium-sized, blue-colored and equally distributed within the lesion. Histopathologic examination was consistent with acanthotic SK. CONCLUSIONS: Identification of the blue globular pattern can be helpful for the dermoscopic diagnosis of SK, especially when its common dermoscopic features are absent.

Design of multifunctional compounds for cardiovascular disease: from natural scaffolds to "classical" multitarget approach.

Cardiovascular disease represents the main cause of death worldwide. Novel therapies to reduce elevated blood pressure and treat resistant hypertension, to consequently reduce the associated cardiovascular risk factors, are still required. Among the different strategies commonly used in medicinal chemistry to develop new molecules, the synthesis of multitarget/hybrid compounds combining two or more pharmacophore groups targeting simultaneously selected factors involved in cardiovascular diseases, has gained increasing interest. This review will focus on the most recent literature on multifunctional cardiovascular drugs, paying particular attention on hybrid compounds bearing natural scaffolds, considering that compounds derived from medicinal extracts are generally appealing for the medicinal chemist as they often bear the so-called "privileged structures". Moreover, taking into account many excellent reviews dealing with multitarget cardiovascular drugs published in the last few years, mainly devoted to RAAS inhibition and/or NO donors hybrid drugs, herein the most significant results obtained and the benefits and limitations of these approaches will be highlighted.

The International Physical Activity Questionnaire-long form overestimates self-reported physical activity of Brazilian adults.

OBJECTIVE: To explore issues associated with measuring physical activity using the International Physical Activity Questionnaire (IPAQ)-long form in adults living in a mid-sized Brazilian city. METHODS: A stratified random sampling procedure was used to select a representative sample of adults living in Rio Claro. This yielded 1572 participants who were interviewed using the IPAQ-long form. The data were analysed using standard statistical procedures. RESULTS: Overall, 83% of men and 89% of women reported at least 150 min of combined moderate and/or vigorous physical activity per week. Reliable values of leisure and transportation-related physical activity were observed for both males and females. With regard to the household and work-related physical activity domains, both males and females reported unusually high levels of participation. CONCLUSION: The IPAQ-long form appears to overestimate levels of physical activity for both males and females, suggesting that the instrument has problems in measuring levels of physical activity in Brazilian adults. Accordingly, caution is warranted before using IPAQ data to support public policy decisions related to physical activity.

Antibacterial activity of methyl aminolevulinate photodynamic therapy in the treatment of a cutaneous ulcer.

We describe a 79-year-old female with a chronic venous ulceration infected by Staphylococcus aureus and Enterococcus faecalis and not responsive to conventional treatments. The patient was treated with Methyl-Aminolaevulinate Photodynamic Therapy (MAL-PDT). After four weeks the cutaneous swabs become negative and we observed a significant clinical improvement. Therefore we suppose that MALPDT could represent a valid therapeutic option in the treatment of infected chronic ulcers.

Consensus conference on laparoscopic appendectomy: development of guidelines.

AIM: Laparoscopic appendectomy (LA) is not yet unanimously considered the gold standard treatment for appendicitis, despite the increasing use of advanced laparoscopic operations and the high incidence of the disease. METHOD: Due to the results of an audit which classified LA as widespread in Italy, a Consensus Conference was organized, in order to give evidence-based answers to the most debated problems regarding the operation. After researching the literature, a panel of 20 experts were selected and interviewed on hot topics; a subsequent discussion using the Delphi methodology was utilized in the course of the consensus conference and submitted to the evaluation of an audience of surgeons. RESULTS: Checkpoint statements were formulated whenever an agreement was reached. A level of evidence was then assigned to single statements and the process revised by two external reviewers. CONCLUSION: Consensus development guidelines are herein reported and regard diagnostic pathway, diagnostic laparoscopy, indications, behaviour in case of innocent appendix, technical aspects, learning curve; however, some questions remain unsolved due to the lack of evidence.

Influencia de la actividad física en la enfermedad de Alzheimer: un caso clínico / Influence of physical activity in Alzheimer's disease: a clinical case

La demencia de Alzheimer (DA) es una patología neurodegenerativa que causa declive cognitivo y motriz del paciente. El objetivo de este trabajo fue analizar la influencia de un programa de actividad física con relación a las funciones cognitivas, síntomas depresivos y capacidad funcional de una paciente con diagnóstico de DA probable. El sujeto, una mujer de 79 años, participó del programa durante tres meses, con frecuencia de tres veces semanales de 50min. Fueron utilizados el Cambridge Cognitive Examination, la Geriatric Depression Scale y la batería motriz de la American Alliance for Health Physical Education,Recreation and Dance. Los resultados referentes a los síntomas depresivos y la capacidad funcional fueron significativamente positivos. No hubo cambios con relación a las funciones cognitivas. En conclusión, este programa de actividad física parece constituirse en una intervención que contribuye en el tratamiento del paciente con DA, al mejorar la capacidad funcional y estimular las tareas cognitivas(AU)

Alzheimer's dementia (AD) is a neurodegenerative disorder that causes motor and cognitive decline. The aim of this study was to analyze the influence of a specific physical activity program on the cognitive, depressive symptoms and functional capacity of patients with diagnosis of probable AD. The subject, a 79-year old woman, participated in this program for three months, with 50min sessions three times a week. The instruments used were the Cambridge Cognitive Examination; the Geriatric Depression Scale; and the Battery of the American Alliance for Health Physical Education, Recreation and Dance. The results in relationship with the depressive symptoms and functional capacity were significantly positive. There were no changes in regards to the patient's cognitive functions. In conclusion, this physical activity program seems to be an important part of the treatment for patients with AD, as it improves the functional capacity and also stimulates cognitive tasks(AU)

Bromhidrosis induced by sphingomonas paucimobilis: a case report.

Bromhidrosis is a clinical disorder characterized by excessive or abnormal foul axillary odour due to the interaction of apocrine glands with micro-organisms which causes a serious personal and social handicap for affected people. We present the case of a 50-year-old caucasian female with bromhidrosis. The patient referred that this symptom had begun two months previously. Her past treatments included antibacterial soap, topical antibacterial agents and perfumes, but none of these relieved the patient of the odour. A cultural examination of axillary smear was carried out and it revealed the presence of ciprofloxacin sensible Sphingomonas paucimobilis. Therefore the patient was treated with ciprofloxacin and after 1 week the infection resolved completely.

El tratamiento fisioterapéutico ¿es efectivo en el mantenimiento físico y en la reducción del declive cognitivo de las demencias? / Is physical therapy effective in physical maintenance and in the reduction of the cognitive decline in dementias?

Introdución. La demencia consiste en una enfermedadcrónica y generalmente degenerativa que lleva a unapérdida progresiva de las habilidades cognitivas y físicas de los individuos.Objetivo. Verificar la efectividad de 3 meses detratamiento fisioterapéutico sobre las funcionescognitivas y el equilibrio de adultos mayoresinstitucionalizados con demencia.Pacientes y métodos. Participaron en esta investigación30 personas, divididas en dos grupos: el experimental(GE) y el control (GC). El GE estaba formado por15 participantes con una edad media de 71,6 ± 8,5 años y escolaridad de 4,7 ± 4,2 años; el GC, por 15 sujetos con edad media de 78,5 ± 7,6 años y escolaridad de 2,2 ± 1,8 años. Todos los participantes realizaron el Mini Examen del Estado Mental (MMSE), el test de Fluidez Verbal Semántica, el test de dibujar un reloj, el test del equilibrio de Berg y el test de “levántate y anda” (up and go test). Para el análisis estadístico de los datos se utilizó el análisis multivariado (MANOVA), con el 5% de significancia (p < 0,05).Resultados. Los resultados indicaron una diferencia entrelos grupos con relación a la edad (Fisher: 0,2; p < 0,05)y a la escolaridad (Fisher: 2,6; p < 0,05). MANOVAreveló beneficios del tratamiento fisioterapéutico sobreel equilibrio (Fisher: 7,3; p < 0,01), pero no sobre lasfunciones cognitivas (Fisher: 0,3; p > 0,05).Conclusiones. Dichos resultados permitieron sugerir quela estimulación cognitiva y motora deben ser incluidasen el tratamiento fisioterapéutico, aunque no se hayanobservado efectos positivos del tratamiento sobre lasfunciones cognitivas. Quedan dudas de si unaintervención más prolongada en una muestra máshomogénea podría proporcionar una reducción deldeclive cognitivo

Introduction. Dementia is a chronic andneurodegenerative disease responsible for a progressivedecline of cognition and physical capacity.Objective: To verify the effectiviness of three monthsof physiotherapy intervention on cognitive functionsand balance of institutionilized elderly people withdementia.Patients and methods. This study has comprised thirtysubjects, divided in two groups: EG (experimentalgroup) and CG (control group). EG was composed by15 participants with mean age of 71,6 ± 8,5 years andscholarity of 4,7 ± 4,2 years. CG was formed by15 subjects with mean age of 78,5 ± 7,6 years andscholarity of 2,2 ± 1,8 years. The sample was evaluatedby means of the following instruments: Mini-MentalState Examination, Semantic Verbal Fluency test,Clock Drawing test, Berg Balance Scale and TimedGet Up and Go test. The statistical procedures weredone by means of Multivariate Analisis of Variance(MANOVA), with significance of 5% (p < 0,05).Results. The results has shown a heterogeneity of bothgroups related to age (F = 0,2, p < 0,05) and scholarity(F = 2,6, p < 0,05). MANOVA pointed beneficts ofphysiotherapy on balance (F = 7,3, p < 0,01) but not oncognitive functions (F = 0,3, p > 0,05).Conclusions. Three months of physiotherapy wereeffective to improuve physical capacity of institucionilized elderly people with dementia. Neverthless, it was not able to minimize cognitive decline commonly seen on dementia. The question if a prolonged intervention could propitiate cognitive beneficts remains, specially in a more homogeneous groups

[Depressive symptoms and motor condition in Parkinson's disease patients]. / Síntomas depresivos y trastorno motor en pacientes con enfermedad de Parkinson.

INTRODUCTION: Complex relations between brain and psychopathology have attracted the interest of researchers, aiming to clarify the neurobiological mechanisms of depression in Parkinson's disease, obviously in addiction to mental features. AIMS: The association of motor impairment and decline of personal autonomy with severity of depressive symptoms was the hypothesis of the present study. Aiming to check this hypothesis, the objective of this study consisted in investigating relationships between the severity of depressive symptoms and motor characteristics of Parkinson's disease. PATIENTS AND METHODS: Thirty patients (53 to 80 year-old) with medical diagnosis of idiopathic Parkinson's disease in initial clinic stages were studied. The Unified Parkinson's Disease Rating Scale, Hoehn-Yahr Scale, and Schwab & England Scale were used to assess the clinic signs and symptoms. The depressive symptoms were identified by complete anamnesis, examination of mental condition, and the Hamilton Rating Scale for Depression and the Anxiety and Depression Scale. Statistical analysis was performed by Pearson's correlation and multiple regression analysis. RESULTS: A significant correlation of severity of depression symptoms with disease stage (p < 0.02), with motor signs (p < 0.008), and with functional performance (p < 0.007) was found. CONCLUSION: There was significant association between motor impairment and severity of depressive symptoms, and between depression and early disease onset or prolonged duration of Parkinson's disease.

Síntomas depresivos y trastorno motor en pacientes con enfermedad de Parkinsonª / Depressive symptoms and motor condition in parkinson’s disease patients

Las relaciones complejas entre el cerebro y la psicopatología han atraído el interés de los investigadores, que pretenden esclarecer los mecanismos neurobiológicos de la depresión en la enfermedad de Parkinson, además, obviamente,de las características mentales. Objetivos. La hipótesis del presente estudio fue la asociación del trastorno motor y la disminución de la autonomía personal con la intensidad de los síntomas depresivos. Con el fin de contrastar esta hipótesis, el objetivo de este estudio consistía en investigar las relaciones entre la intensidad de los síntomas depresivos y las características motoras de la enfermedad de Parkinson. Pacientes y métodos. Se estudió a 30 pacientes (de 53 a 80 años de edad) con un diagnóstico de enfermedad de Parkinson idiopática en fases clínicas iniciales. Se utilizó la escala unificada de valoración delparkinsonismo, la escala Hoehn-Yahr y la escala Schwab-England para evaluar los signos y síntomas clínicos. Los síntomas depresivos se identificaron mediante una anamnesis exhaustiva, el examen del estado mental, la escala de Hamilton para la depresióny la escala de ansiedad y depresión. Se realizaron análisis estadísticos mediante la correlación de Pearson y el análisis de regresión múltiple. Resultados. Se encontró una correlación significativa de la intensidad de los síntomas de la depresióncon la fase de la enfermedad (p < 0,02), con los signos motores (p < 0,008) y con el rendimiento funcional (p < 0,007). Conclusión. Hubo una asociación significativa entre el trastorno motor y la intensidad de los síntomas depresivos, y entre la depresión y el inicio precoz de la enfermedad o duración prolongada de la enfermedad de Parkinson

Complex relations between brain and psychopathology have attracted the interest of researchers,aiming to clarify the neurobiological mechanisms of depression in Parkinson’s disease, obviously in addiction to mental features. Aims. The association of motor impairment and decline of personal autonomy with severity of depressive symptoms was the hypothesis of the present study. Aiming to check this hypothesis, the objective of this study consisted in investigatingrelationships between the severity of depressive symptoms and motor characteristics of Parkinson’s disease. Patients and methods. Thirty patients (53 to 80 year-old) with medical diagnosis of idiopathic Parkinson’s disease in initial clinic stageswere studied. The Unified Parkinson’s Disease Rating Scale, Hoehn-Yahr Scale, and Schwab & England Scale were used to assess the clinic signs and symptoms. The depressive symptoms were identified by complete anamnesis, examination of mentalcondition, and the Hamilton Rating Scale for Depression and the Anxiety and Depression Scale. Statistical analysis was performed by Pearson’s correlation and multiple regression analysis. Results. A significant correlation of severity of depressionsymptoms with disease stage (p < 0.02), with motor signs (p < 0.008), and with functional performance (p < 0.007) was found.Conclusion. There was significant association between motor impairment and severity of depressive symptoms, and between depression and early disease onset or prolonged duration of Parkinson’s disease

Risco de quedas em idosos com doença de Parkinson e demência de Alzheimer: um estudo transversal / Risk of falls among elderly people with Parkinson's disease and Alzheimer's dementia: a cross-sectional study

OBJETIVO: Comparar o risco de quedas entre idosos com doença de Parkinson (DP), demência de Alzheimer (DA) e saudáveis (controle). Além disso, pretendeu-se analisar as relações do risco de quedas com declínio cognitivo e com nível de atividade física. MÉTODO: vinte idosos, sendo sete com DP (69,57 ± 2,40 anos), seis com DA (77,5 ± 2,32 anos) e sete saudáveis (74,71 ± 2,58 anos), foram avaliados por meio dos seguintes instrumentos: Escala de Equilíbrio Funcional de Berg (EEFB), Timed Up and Go test (TUG), Mini-Exame do Estado Mental (MEEM) e Questionário Baecke Modificado para Idosos (QBMI). RESULTADOS: O teste de Kruskal-Wallis apontou diferença significativa entre os grupos, tanto em relação à EEFB (KW=9,67, p<0,01), quanto em relação ao TUG (KW=9,14, p<0,01, para tempo despendido, e KW=10,04, p<0,01, para número de passos). A "análise aos pares" do teste post-hoc de Bonferroni apontou comprometimento maior do equilíbrio no grupo DA, no qual também foram observados menores valores no MEEM. O grupo DP foi caracterizado por apresentar um maior nível de atividade física. A análise de correlação de Spearman apontou correlação baixa entre MEEM e EEFB (r s=0,59); entre MEEM e TUG (r s=-0,62 e r s=-0,52); entre QBMI e EEFB (r s=0,54); e entre QBMI e TUG (r s=-0,39 e r s=-0,42). CONCLUSÕES: As baixas correlações observadas devem ser analisadas com cautela, pois tais variáveis sofrem influência de múltiplos fatores. No grupo DA, o declínio cognitivo pode estar relacionado ao maior risco de quedas e, no grupo DP, a atividade física pode ter auxiliado a manter um risco de quedas próximo ao grupo controle.

OBJECTIVE: To compare the risk of falls among elderly people with Parkinson's disease (PD) and Alzheimer's dementia (AD) and among healthy peers (controls). In addition, the aim was to analyze relationships between risk of falls and cognitive decay and between risk of falls and physical activity. METHOD: Twenty subjects were assessed: seven with PD (69.57 ± 2.40 years), six with AD (77.5 ± 2.32 years) and seven healthy peers (74.71 ± 2.58 years). The following instruments were used: Berg Balance Scale (BBS), Timed Up and Go test (TUG), Mini-Mental State Examination (MMSE) and Modified Baecke Questionnaire for Older Adults (MBQOA). RESULTS: The Kruskal-Wallis (KW) test indicated significant differences between the groups, relating to BBS (KW = 9.67, p<0.01) and TUG (KW = 9.14, p<0.01, for time expended, and KW = 10.04, p<0.01, for number of steps). Bonferroni post-hoc pairs analysis showed that balance was highly compromised in the AD group, such that lower MMSE values were observed. The PD group was characterized by presenting higher levels of physical activity. Spearman's test produced low correlations between MMSE and BBS (r s=0.59); MMSE and TUG (r s=-0.52 and r s=-0.62); MBQOA and BBS (r s=0.54); and MBQOA and TUG (r s=-0.39 and r s=-0.42). CONCLUSION: These low correlations must be analyzed carefully, because these variables are influenced by multiple factors. In the AD group, the cognitive decay can be positively associated with greater risk of falls. In the PD group, physical activity may have assisted in maintaining the risk of falls at similar levels to the control group.

Parâmetros cinemáticos da marcha com obstáculos em idosos com Doença de Parkinson, com e sem efeito da levodopa: um estudo piloto / Kinematic parameters for gait with obstacles among elderly patients with Parkinson's disease, with and without levodopa: a pilot study

CONTEXTO: Os efeitos da levodopa na marcha de pacientes com Doença de Parkinson (DP) em terrenos desobstruídos são conhecidos, mas pouco se conhece sobre seus efeitos na marcha com obstáculos. OBJETIVO: Este estudo objetivou descrever, por meio de ferramenta cinemática, o comportamento locomotor de pacientes com DP e verificar as estratégias locomotoras, sem e sob o efeito da levodopa, durante a ultrapassagem de obstáculos de diferentes alturas. MÉTODO: Cinco pacientes com DP (Hoehn e Yahr= 2±0; idade= 68,4±5,7 anos) percorreram, andando, 10m e ultrapassaram um de dois obstáculos (alto= metade da altura do joelho e baixo= altura do tornozelo) posicionado no meio da passarela em duas sessões (em jejum e no pico de ação do medicamento). As seguintes variáveis foram coletadas e analisadas: distância horizontal pé-obstáculo (DHPO), distância vertical pé-obstáculo (DVPO); distância horizontal obstáculo-pé (DHOP) e velocidades médias, horizontais e verticais, nas fases de abordagem e aterrissagem (respectivamente, VHAO,VVAO; VHDO,VVDO). RESULTADOS: A ANOVA, por tentativa, revelou efeito principal de obstáculo para DVPO (F1,49=15,33; p< 0,001), para VVAO (F1,49= 82,184; p< 0,001), para VHDO (F1,49= 15,33; p< 0,001) e para VVDO (F1,49= 31,30; p< 0,001); e efeito principal de medicamento para DVPO (F1,49= 6,66; p< 0,013) e para VVAO (F1,49= 10,174; p< 0,002). CONCLUSÕES: Pacientes foram mais perturbados pelo obstáculo alto. Os sintomas da DP (bradicinesia e hipocinesia) foram diminuídos com o medicamento, evidenciando aumento geral da velocidade da perna de abordagem e da margem de segurança sobre os obstáculos. Pacientes com DP, independente da condição de medicamento, apresentaram um comportamento que garantiu segurança e estabilidade na marcha.

Randomized clinical trial of laparoscopic cholecystectomy performed with mini-instruments.

BACKGROUND: The outcomes after traditional laparoscopic cholecystectomy (LC; one 10-mm port, one 12-mm port and two 5-mm ports) and minilaparoscopic cholecystectomy (MLC; three 3-mm ports and one 12-mm port) for gallstone disease were compared. METHODS: The study was a randomized, single-blind trial comparing LC with MLC. Only elective patients were eligible for inclusion. LC was a routine procedure at the institution in which the study was performed, whereas MLC was introduced after a short training period. The randomization period was from January to December 2001. RESULTS: Of 175 patients who had elective minimal access cholecystectomy during the randomization period, 135 entered the trial: 68 underwent LC and 67 underwent MLC. The groups were matched for age, sex and preoperative characteristics. Median (range) operating times for LC and MLC were similar (45 (20-120) and 50 (20-170) min respectively). Intraoperative and postoperative complication rates, the time for the patient to resume walking, eating and passing stools, and median hospital stay were the same in the two groups. The level of postoperative pain was lower in the MLC group at 1 h (P = 0.011), 3 h (P = 0.012), 6 h (P = 0.003), 12 h (P = 0.052) and 24 h (P = 0.034). Patients who had MLC received fewer injections of analgesic (P = 0.036) and more patients in this group expressed satisfaction with the cosmetic result (P = 0.001). CONCLUSION: MLC took a similar time to perform and caused less postoperative pain than the standard laparoscopic procedure. Reducing the port size further enhanced the advantages of laparoscopic over open cholecystectomy.

Scoring system to predict asymptomatic choledocholithiasis before laparoscopic cholecystectomy. A matched case-control study.

BACKGROUND: The purpose of this prospective study was to evaluate if a recently proposed score system based on six preoperative parameters [history of colic pain and/or jaundice, dyspepsia, cholecystitis, ultrasound (US), evidence of common bile duct stones (CBDS), number and size of gallbladder stones at US, level of serum glutamic oxalacetic transaminase and/or alkaline phosphatase is effective in the selection of patients undergoing laparoscopic cholecystectomy (LC) with asymptomatic CBDS and could allow a significant reduction of the total number of preoperative examinations. METHODS: In the case group, 408 patients were categorized into low-, medium-, and high-risk classes and underwent, respectively, no further preoperative assessment of the bile duct, intravenous cholangiography (IVC), and endoscopic retrograde cholangiography (ERC). Intraoperative cholangiography (IOC) was performed whenever the surgeon was in doubt as to biliary anatomy or bile duct clearance. These patients were compared with 408 retrospectively matched patients (control group) undergoing routine preoperative IVC and/or ERC. RESULTS: In the case group, significantly lower numbers of IVC (120 vs 392) and IOC (3 vs 16) were performed ( p < 0.005), whereas no difference in the total number of ERCs was noted. One patient in the control group had retained CBDS detected during follow-up evaluation, whereas none occurred in the case group. CONCLUSION: The proposed scoring system allows selective use of IVC, ERC, and/or IOC in patients undergoing elective LC.

Neuropathy as the only symptom of common carotid artery spontaneous rupture. Case report.

We describe a case of a false aneurysm of the common carotid artery, caused by spontaneous carotid rupture, with atypical clinical presentation. The patient came to the our Hospital complaining of left shoulder pain and functional impairment of her left arm, during the past 20 days. The diagnostic work-up, color Doppler ultrasound, MR and angiography, evidenced a cervical false aneurysm; the electromyography showed denervation of the deltoid muscle, caused by cervical nerve roots compression. The therapeutic stages were initially an endovascular stent placement; then a surgical stage with evacuation for the hematoma and reconstruction of the carotid artery with saphenous graft.

Acetylcholinesterase inhibitors: SAR and kinetic studies on omega-[N-methyl-N-(3-alkylcarbamoyloxyphenyl)methyl]aminoalkoxyaryl derivatives.

In this work, we further investigated a class of carbamic cholinesterase inhibitors introduced in a previous paper (Rampa et al. J. Med. Chem. 1998, 41, 3976). Some new omega-[N-methyl-N-(3-alkylcarbamoyloxyphenyl)methyl]aminoalkoxyaryl analogues were designed, synthesized, and evaluated for their inhibitory activity against both acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE). The structure of the lead compound (xanthostigmine) was systematically varied with the aim to optimize the different parts of the molecule. Moreover, such a structure-activity relationships (SAR) study was integrated with a kinetic analysis of the mechanism of AChE inhibition for two representative compounds. The structural modifications lead to a compound (12b) showing an IC(50) value for the AChE inhibition of 0.32 +/- 0.09 nM and to a group of BuChE inhibitors also active at the nanomolar level, the most potent of which (15d) was characterized by an IC(50) value of 3.3 +/- 0.4 nM. The kinetic analysis allowed for clarification of the role played by different molecular moieties with regard to the rate of AChE carbamoylation and the duration of inhibition. On the basis of the results presented here, it was concluded that the cholinesterase inhibitors of this class possess promising characteristics in view of a potential development as drugs for the treatment of Alzheimer's disease.

A new class of nonsteroidal aromatase inhibitors: design and synthesis of chromone and xanthone derivatives and inhibition of the P450 enzymes aromatase and 17 alpha-hydroxylase/C17,20-lyase.

Aromatase (P450arom) is a target of pharmacological interest for the treatment of breast cancer. In this paper, we report the design, synthesis, and in vitro biological evaluation of a series of new (di)benzopyranone-based inhibitors of this enzyme. The design of the new compounds was guided by a CoMFA model previously developed for a series of nonsteroidal aromatase inhibitors. Both the chromone and the xanthone nuclei were taken as molecular skeletons, and the functions supposed to be critical for binding to the aromatase active site - a heterocyclic ring (imidazole or 1,3,4-triazole) linked to the aromatic moiety by a methylene unit and an H-bond accepting function (CN, NO(2), Br) located on the aromatic ring at a suitable distance from the heterocyclic nitrogen carrying the lone pair--were attached to them. The chromone, xanthone, and flavone derivatives were prepared by conventional synthetic methods from the appropriate methyl analogues. Aromatase inhibitory activities were determined by the method of Thompson and Siiteri, using human placental microsomes and [1 beta,2 beta-(3)H]testosterone as the labeled substrate. All the compounds were also tested on 17 alpha-hydroxylase/C17,20-lyase (P450 17), an enzyme of therapeutic interest for the treatment of prostatic diseases. The goal to find new potent inhibitors of aromatase was reached with the xanthone derivatives 22d,e (IC(50) values 43 and 40 nM, respectively), which exceeded the potency of the known reference drug fadrozole and also showed high selectivity with respect to P450 17. Moreover, compounds 22g-i based on the same xanthonic nucleus showed fairly high potency as P450 17 inhibitors (IC(50) values 220, 130, and 42 nM, respectively). Thus, they might be new leads for the development of drug candidates for androgen-dependent diseases.