The interplay between arms-only propelling efficiency, power output and speed in master swimmers.

PURPOSE: To explore the interplay between arms-only propelling efficiency (η(p)), mechanical power output (W(tot)) and swimming speed (V); these three parameters are indeed related through the following equation V(3) = 1/kη(p)W(tot) (where k is the speed-specific drag; k = F/V(2)); thus, the larger are η(p) and W(tot) the larger is V. We furthermore wanted to test the hypothesis that a multiple linear regression between W(tot), η(p) and V would have a stronger correlation coefficient than a linear regression between W(tot) and V alone. METHODS: To this aim we recruited 29 master swimmers (21 M/8F) who were asked to perform (1) an incremental protocol at the arm-ergometer (dry-land test) to determine W(tot) at VO(2max) (e.g. V(max)); (2) a maximal 200 m swim trial (with a pull buoy: arms only) during which V and η(p) were determined. RESULTS: No relationship was found between W(max) and η(p) (not necessarily the swimmers with the largest W(max) are those with the largest η(p) and vice versa) whereas significant correlations were found between W(max) and V (R = 0.419, P = 0.024) and η(p) and V (R = 0.741, P = 0.001); a multiple linear regression indicates that about 75% of the variability of V can be explained by the variability of W(max) and η(p) (R = 0.865, P < 0.001). CONCLUSIONS: These findings indicate that η(p) should be taken into consideration when the relationship between W(max) and V is investigated and that this allows to better explain the inter-subject variability in performance (swimming speed).

Migraine with visual aura in developing age: visual disorders.

Visual disorders are an important symptom in the migraine of developing age. Different kinds of visual disturbances can precede, accompany or follow a migraine attack. These visual disturbances can be grouped into negative (hemianopsia, quadrantopsia, scotoma) and positive (phosphene, teicopsia, metamorphopsia, macropsia, micropsia, teleopsia, diplopia, dischromatopsia, hallucination disturbances) disorders. The pathogenetic mechanism of the visual phenomena of migraine has not yet been clarified. Various hypotheses have been proposed: vasospasm with consequent ischemia of some cerebral areas, the opening of arteriovenous shunts between the intra and extra cerebral circulation, the formation of microthrombi in arterioles and dopaminergic hypersensitivity of some nervous centers. We have studied 1787 children, affected by migraine with (13%) or without (87%) aura. Among the patients, 211 (12%) referred visual disorders, especially scotoma and phosphene. These data let us hypothesize that a relationship between migraine and visual disorders is present also in pediatric age. However this relationship is less important than in adults.

Evaluation of anxiety and depression in childhood migraine.

Childhood migraine can be the expression of an unconscious attempt of the small patient to show a discomfort which is denied through the defence of somatization. We considered a sample of 73 children, 39 males and 34 females suffering from migraine. We evaluated the presence of emotional disorders through diagnostic interviews consisting of one by one submission of the Anxiety Scale Questionnaire for Evolutive Age and the Children Depression Scale Test. Within our sample we are able to distinguish three groups: a first group negative for both anxiety and depressive disorders, thus defined as control group; a second group presenting anxiety depressive disorders and a third one presenting a mostly depressive symptomatology. We found a significantly higher incidence of migraine in male firstborn children belonging to the group with a condition associated to anxiety and depression.

Fever: a novelty among the symptoms accompanying migraine attacks in children.

Our casistic of 1787 children with headache, is made up of 943 males (53%) and 844 females (47%) aged 3-14 years. 1724 had primary headache. To make a precise diagnosis of primary headache, all the children have been subjected to a rigorous anamnesis, physical and diagnostic examination (blood, urine test, head x-rays-scans, sight test with cat's eyes). Symptoms that frequently accompany headache are: phono-photophobia, (47%), pallor (43%) nausea (41%) vomit (31%) intolerance to movement (40%) and fever (9%). We especially focused on fever which presented together with migraine in 156 (9%) of the 1724 subjects examined. Headache is an important syndrome and frequent in early childhood. Actually the hypothesis used to explain the etiopathogenetic mechanism is based on a disregulation of the neurotransmitters like serotonin, catecholamine and the prostaglandins.

Sleep disorders.

Sleep disorders occupay an important position among the pathologies which may precede the appearance of headache. Some authors consider sleep disorders an expression of a functional, biochemical and/or neurotransmission alteration at central nervous system level. Sleep disorders may be distinguished, according to the Association Sleep Disorders classification in: alteration of the sleep-awake cycle, hypersomnia, parasomnia, insomnia. We observed 1876 normal children ranging from 3 to 14 years of age, 1073 (60.4%) of whom presented sleep disorders. Few studies have been carried out on the incidence of sleep disorders on casistics of healthy children. Date reported in literature state that sleep disorders do not exceed 25% of cases that is not more than one child out of four presents sleep disorders. This percentage is much lower than the 60.4% rate observed by us in children suffering from primary headache. Our results stress the importance of sleep disorders as a cephalalgic risk factor.

[Plasmocytoma of the testis. Description of a clinical case and review of the literature]. / Plasmocitoma del testicolo. Descrizione di un caso clinico e revisione della letteratura.

Extraskeletal involvement of the testis during multiple myeloma is a rare disease; primary extraosseus myeloma of the testis is even more unusual, and shows progression to typical multiple myeloma after orchiectomy in most cases. A case-report of a multiple myeloma with testicular involvement is discussed; radiotherapy was performed successfully, instead of surgery, but diffuse skeletal lesions showed progression in spite of chemotherapy. A short review of the literature on this subject is made.

A first step quantification by correlation techniques of the variability in some time intervals measured on the Politecnico/Ca' Granda VCG Database On Young Normal Subjects.

The unevident variability during a 30-min period on intervals measured once every cardiac cycle was investigated by correlation techniques implemented on a digital computer, on normal healthy subjects from the "Politecnico/Ca' Granda VCG Database On Young Normal Subjects". Our most important conclusions are as follows: Generally each time series, related to the many interval values measured, shows that its variability is different from that of the R-R intervals. In particular Bazzett's formula, which provides the widely used "corrected QT interval", has to be amended.

A case of Fabry disease with central nervous system (CNS) demyelinating lesions: a double trouble?

We present the case of a 36-year-old woman affected with Fabry disease (FD), with neuroradiologic and laboratory tests suggestive of a coexistent inflammatory demyelinating disease. Since the age of 23, she presented recurrent neurologic deficits, such as right limb paresthesias, diplopia, and right leg weakness. Magnetic resonance imaging revealed multiple demyelinating lesions in periventricular areas, corpus callosum, and spinal cord. Cerebrospinal fluid analysis showed the presence of oligoclonal bands, while visual-evoked potentials were delayed with preserved morphology. FD is usually considered as a differential diagnosis of multiple sclerosis, but we think that the best explanation of all pathological features in this case is the coexistence of the two diseases.

Uterine and fetal blood flows in pregnancies complicated by preterm labor.

Flow velocity waveforms were recorded by Doppler ultrasonography from the uterine arteries, umbilical artery, thoracic descending aorta, renal artery and middle cerebral artery in fetuses of 57 pregnancies complicated by preterm labor with intact membranes. The uterine artery resistance index was significantly increased in patients with preterm labor when compared to reference limits for gestation, but no relationship was found with the time interval between Doppler recordings and delivery. The group of fetuses (n = 15) delivered within 48 h from entry to the study showed significantly reduced pulsatility index values from the middle cerebral artery when compared to fetuses delivered later or to the normal reference limits for gestation. No significant differences were found in the other vessels studied. In conclusion preterm delivery is associated with alterations in fetal cerebral waveforms and knowledge of these changes may prove useful in the evaluation of patients with preterm labor.

Indomethacin modifies the fetal hemodynamic response induced by percutaneous umbilical blood sampling.

OBJECTIVE: Percutaneous umbilical blood sampling induces a marked decrease of impedance to flow in the umbilical artery. Because these changes are believed to be the result of the release of prostanoids, we conducted a study to determine whether indomethacin administration before percutaneous umbilical blood sampling affects the hemodynamic response induced by this procedure. STUDY DESIGN: Percutaneous umbilical blood sampling was performed in 20 singleton pregnancies that were treated for 3 days before the procedure with indomethacin (25 mg orally 6 hours apart) as tocolytic agent and in 22 untreated pregnancies. All the procedures were uncomplicated, and sampling of the umbilical vein was confirmed by blood pressure measurement at the time of the procedure. The umbilical artery pulsatility index and the fetal heart rate were measured immediately before and after the procedure. The first and last aliquots of umbilical vein plasma obtained at the beginning and closing of the procedure were assayed for endothelin-1, 6-keto-prostaglandin F1 alpha and thromboxane B2. RESULTS: In untreated pregnancies percutaneous umbilical blood sampling induced a decrease of the umbilical artery pulsatility index (p < 0.0001) and an increase in 6-keto-prostaglandin F1 alpha (p < 0.001) and endothelin-1 levels (p = 0.001), whereas no significant changes were present in fetal heart rate and thromboxane B2 levels. In pregnancies treated with indomethacin, 6-keto-prostaglandin F1 alpha, and thromboxane B2, concentrations at the beginning of the procedure were both significantly less (p < 0.0001) than those found in untreated pregnancies. In pregnancies treated with indomethacin percutaneous umbilical blood sampling did not affect umbilical artery pulsatility index, and 6-keto-prostaglandin F1 alpha and thromboxane B2 levels did not vary during the procedure. However, endothelin-1 (p < 0.001) and fetal heart rate (p < 0.0001) increased after the procedure. CONCLUSION: Indomethacin affects the fetal hemodynamic response to percutaneous umbilical blood sampling by inhibiting the release of prostanoids and the fall in umbilical artery pulsatility index. Under this condition the fetus adapts to the procedure by increasing the heart rate.

Familial hemiplegic migraine in developmental age: report of two cases.

The authors report two cases of a particular type of migraine with aura, known as familial hemiplegic migraine (FHM). According to the International Headache Society (IHS) diagnostic criteria, the FHM can be diagnosed with the exception of organic causes, in a patient with migraine with aura including emiparesis of anything severity and with an end occurring a member of the family with similarity in the attach pattern. The two clinical cases reported clearly show these features and they can be considered exemplary for this type of pathology. This rare type of migraine has an unknown etiology, it seems to depend on a decreases of cerebral blood flow originative on the occipital lobe, over the subsequentially spreading anteriory region temporal and parietal lobe. The hypoperfusion with the next following neural ischemia is related to the variation of blood flow and/or "the spreading depression" supported by Leao and Olesen recently. We wanted to show these two cases so that the psychiatrist, the pediatrician, and the neurologist can be able to refer parents to the right approach, considering possibility of a pathology rare but benign; this is the FHM.

Erythrocyte and plasma levels of glutamate and aspartate in children affected by migraine.

In this study we determined plasma and erythrocyte amino acids in children affected by migraine, in order to evaluate glutamate and aspartate metabolism in the pathogenesis of this disorder. Fifteen children with migraine with aura (mean age +/- SD = 10.3 +/- 1.56), 19 children with migraine without aura (mean age +/- SD = 10.4 +/- 1.48) and 16 healthy normal controls (mean age +/- SD 10.6 +/- 1.53) were investigated. In both migraine groups there were significantly lower plasma glutamate and aspartate levels and significantly higher erythrocyte/plasma concentration (E/P) ratios of these amino acids with respect to the controls. Erythrocyte aspartate concentrations were significantly elevated in migraine children compared to the controls, while erythrocyte glutamate concentrations showed no significant differences between groups. Similar results were observed in both migraine groups. These results seem to suggest the presence of a higher activity of the erythrocytes' glutamate/aspartate transport system that could reflect a similar alteration at the neuronal/glial cell level in the CNS. Our study suggests an imbalance of the excitatory amino acid turnover in the pathogenesis of migraine in children.

Estudo sobre o diagnostico da giardiase por meio do metodo Kato-Katz. / Giardiasis diagnosis by Kato-Katz method

Foi verificado que e possivel diagnosticar a giardiase atraves de exame de fezes realizado pelo metodo de Kato-Katz, hoje bastante utilizado no Brasil. Todavia, para reconhecimento da protozoose em questao, a eficacia do processo da centrifugo-flutuacao em sulfato de zinco mostrou-se maior.As sensibilidades das tecnicas de KatoKatz e da sedimentacao espontanea em agua foram equiparaveis, afigurando-se mais produtivas, a proposito do emprego da primeira, as analises efetuadas imediatamente ou apos 24 horas em relacao a ocasiao do preparo