One-year caloric restriction and 12-week exercise training intervention in obese adults with type 2 diabetes: emphasis on metabolic control and resting metabolic rate.

PURPOSE: The effect of combined lifestyle interventions (LSI) including dietary and physical activity on metabolic health, energy metabolism and VO2max in diabetic patients has provided mixed results. We evaluated the impact of 1-year caloric restriction (CR), and 12-week supervised structured exercise training (SSET) on metabolic health, RMR and VO2max in obese adults with type 2 diabetes. METHODS: After 1-month education for LSI, 33 participants had anthropometric, biochemical and metabolic assessments. They then started CR based on RMR, and 3-month SSET during the months 1-3 (Early-SSET) or 4-6 (Late-SSET). Reassessments were planned after 3, 6 and 12 months. Using a per-protocol analysis, we evaluated parameter changes from baseline and their associations for the 23 participants (11 Early-SSET, 12 Late-SSET) who completed the study. RMR was adjusted (adjRMR) for age, sex, fat-free mass (FFM) and fat mass (FM). RESULTS: Compared with baseline, after 6 months we found significant increases in VO2max (+ 14%) and HDL-cholesterol (+ 13%), and reduction in body mass index (- 3%), FM (- 8%) and glycated hemoglobin (HbA1c, - 7%). Training-related caloric expenditure negatively correlated with changes in body weight (p < 0.001), FM (p < 0.001) and HbA1c (p = 0.006). These results were confirmed at the 12-month follow-up. Pooling together all follow-up data, adjRMR changes correlated with changes in glycemia (r = 0.29, p = 0.02), total-cholesterol (r = 0.29, p = 0.02) and VO2max (r = - 0.26,p = 0.02). No significant differences emerged between the Early- and Late-SSET groups. CONCLUSIONS: Combined intervention with SSET and CR improved metabolic control. Changes in metabolic health and fitness correlated with changes of adjRMR, which was reduced improving fitness, glycemia and cholesterolemia. CLINICAL TRIAL REGISTRY: Trial registration number: NCT03785379. URL of registration: http://clinicaltrials.gov .

Cortical evoked responses and transcutaneous electrotherapy.

Percutaneous electrostimulation, acupuncture, and direct stimulation of the central nervous system are supposed to be capable of reducing painful sensation by releasing enkephalins and endorphins. We treated six volunteers with electrotherapy, obtaining in all cases a clear reduction of the pain induced by electric stimulation of the median nerve at the wrist. During the treatment, the administration of naloxone, an antagonist of morphine, in four subjects provoked a short but clear and immediate return of pain. In the other two cases, the drug provoked a further decrease of the painful sensation. During electro-stimulation in all patients, the somatosensory evoked potentials showed a statistically significant decrease. In the four "naloxone-responsive" subjects, the cortical evoked responses returned to basal amplitude after naloxone. In the two patients with a clinically paradoxic response, nonsignificant modification in the cortical evoked potentials was noted.

The intercosto-brachial anastomosis in the treatment of cervical roots avulsions: clinical and neurophysiological considerations.

The Authors present their surgical and clinical experience about the intercosto-brachial anastomosis for treating traumatic avulsions of the cervical roots. The most interesting aspect in the postoperative course of these patients in their ability to regain a voluntary elbow flexion independently from the respiratory activity. A dinamic SPECT examination in a small series of cases suggests that some mechanisms of functional reorganization within the brain should be involved.

Significance of local extradural cooling on cervical spinal cord (experimental study).

The authors test the effectiveness of extradural cooling for the reduction of local edema and metabolic demand in spinal cord injuries. They measure the intramedullar temperature before and during local perfrigeration with a different method as compared to those previously reported in the literature.

Traumatic cerebral aneurysm in pediatric age. Case report.

Cerebral aneurysm following head trauma in pediatric age is a rare complication particularly in the absence of skull fractures or penetrating brain wounds as in the present case. In the presence of rapid worsening of neurological conditions after head trauma, one may take into consideration this complication among other possible vascular accidents.

Alterations of facial sensitivity induced by percutaneous thermocoagulation for trigeminal neuralgia.

Sixty patients with essential trigeminal neuralgia underwent selective percutaneous thermocoagulation of the gasserian ganglion. Immediate and long-term modifications of pain and tactile facila sensitivity, recurrences of pain, and occurrences of facial paresthesias were evaluated. Pin-prick and von Frey hair tests and somatosensory-evoked potentials were used to study facila sensitivity. Patients with mild alterations of sensitivity-treated with low temperatures of coagulation (60 degrees-70 degrees C)--had a lower incidence of paresthesias, although a higher risk of recurrence. Patients with severe alterations of sensitivity--a consequence of a temperature of coagulation above 70 degrees C--had a high incidence of paresthesias and a low risk of recurrence. In our opinion, the first kind of results are better.

Thrombosis of the superior sagittal sinus associated with idiopathic thrombocytosis.

An unusual association of thrombosis of the superior sagittal sinus and idiopathic thrombocytosis is reported. Etiology, clinical and radiological findings and therapeutic approach are discussed.

Selective percutaneous thermolesions of the ninth cranial nerve by lateral cervical approach: report of eight cases.

Percutaneous radiofrequency thermolesion of the petrous ganglion at the jugular foramen was employed for the treatment of glossopharyngeal neuralgia in eight cases, three with essential and five with symptomatic pain from oropharyngeal cancer. Because of its technical simplicity, the lateral cervical approach was preferred to the anterior lateral approach. Immediate and subsequent surgical results were satisfactory. No neurological complication was noted, except for transitory bradycardia and hypotension during the procedure.

[Transcutaneous electroanalgesia and naloxone. Clinical aspects (author's transl)]. / Modification de l'action antalgique de l'électrothérapie transcutanée après tracutanée après traitement avec naloxone. Note préliminaire.

Recently, Mayer (1977) and Adams (1976) proved that both acupuncture and direct electrostimulation of deep encephalic structures produce an analgesic effect releasing a neurotransmitter similar to morphine (endorphine). We have verified this hypothesis, using the transcutaneous electrotherapy in five patients with chronic pain at the back (postherpetic neuralgia in 3, pain cancer in 2). All patients related a certain analgesic effect during electrotherapy, with a reduction in pain of more than 50 per cent. During electroanalgesia we administered Naloxone (an antagonist of morphine). In 3 cases we observed a clear, although short, return of algic symptomatology. At the contrary, in other two patients Naloxone caused briefly a further and clear reduction in the pain.

The carpal tunnel syndrome. Anatomo-clinical correlations.

We review a series of 1,280 operated cases of carpal tunnel syndrome (CTS), with an unexpected high frequency of transverse muscular fibers within the carpal canal (11%), particularly in a group of young male patients under 30 years of age. This abnormal presence of muscle fibers could explain the early development of CTS in young male workers.

Combined thermocoagulation of the 5th and 9th cranial nerves for oral pain of neoplastic aetiology.

The authors report their limited but interesting experience in the treatment of intractable oral pain employing the technique of percutaneous radiofrequency thermocoagulation both of the trigeminal and glossopharyngeal nerves. The use of combined percutaneous thermolesions for cancer pain is rarely described in the literature. Immediate and long-term results confirm the usefulness of this surgical procedure.

[Naloxone and essential trigeminal neuralgia]. / Naloxone e nevralgia trigeminale essenziale.

From the correlation between pain and morphin-like peptides there comes the suggestion of an etiopathogenetic relation between essential trigeminal neuralgia and endorphins. The clinical and pharmacological observation utilizing Naloxone, a morphin-like substances antagonist, and the transcoutaneous electrotherapy there seem to exclude that this etiopathogenetic relation there can be.

[Spinal epidural empyema. Study of a clinical case]. / Empiema epidurale spinale. Studio di un caso clinico.

A case of epidural spinal abscess is reported. This rare lesion provoked a syndrome of thoracic spinal compression without biohumoral or anamnestic findings of phlogosis. After a brief review of literature, the Authors discuss the usefulness of cortical evoked responses in presence of clinical cross section of the spinal cord.

An unusual onset of a spinal cord tumour: subarachnoid bleeding and papilloedema. Case report.

A rare case of intracranial hypertension associated with subarachnoid bleeding from a spinal tumour is reported. Clinical features, review of the literature and pathogenetic factors are discussed.

Intrinsic haematopoietic activity of cerebellar haemangioblastomas. Ultrastructural study of three cases.

Three cerebellar haemangioblastomas were studied by electron microscopy. One of these shows electron-dense granules within the tumour cells, indicative of erythropoietic activity, as previously described in a haemangioblastoma. The biological significance of these granules is discussed. Biological assay of serum erythropoietic activity was performed in one case.

Multiple meningiomas.

The authors discuss the criteria of differential diagnosis for a correct use of the term "multiple meningiomas". Reviewing a series of 934 meningiomas, of which 834 were intracranial and 100 were spinal, they found 14 cases of multiple meningiomas, i.e. an incidence of 1.5%. The study shows that multiple meningiomas are quite similar to solitary meningiomas in all their biological characteristics. Furthermore, the possible presence of more than one meningioma must always be kept in mind in the clinical and radiological evaluation of a patient. The aetiology of multiple separate meningiomas is discussed: the hypothesis which suggests their origin from multicentric neoplastic foci activated by a supposed "tumour-producing factor" appears to be the most reliable.

Percutaneous thermocoagulation for sphenopalatine ganglion neuralgia.

The authors describe percutaneous radiofrequency (rf) thermocoagulation of the sphenopalatine ganglion used to treat seven patients with sphenopalatine ganglion neuralgia. The procedure was effective in relieving pain, without significant side-effects. All the patients have actually been free of pain during a follow-up of 6-28 months. The surgical technique and the rationale for its use are pointed out.