Patterns of motor control reorganization in a patient with mirror movements.

OBJECTIVE: To explore motor control reorganization in a 40-year-old, left-handed patient with perinatally acquired mirror movements. METHODS: We performed simultaneous bilateral recordings of motor evoked potentials (MEPs) following focal transcranial magnetic stimulation (fTMS) and of central silent period (cSP) during unilateral voluntary contraction in abductor pollicis brevis (APB) and abductor digiti minimi (ADM) muscles. RESULTS: For both muscles the MEP study showed bilateral fast-conducting corticospinal projections from the right undamaged hemisphere, and residual contralateral projections from the left hemisphere. The cSP findings differed in the two muscles: the mirror phenomenon was bilateral in the ADM, but present only on the right side in the APB muscles; the mirror activity of right ADM and APB muscles was inhibited only by fTMS of the ipsilateral right motor cortex; the mirror phenomenon in the left ADM muscle was inhibited only by fTMS of the contralateral right motor cortex. CONCLUSIONS: Mirror movements of right APB and ADM muscles were sustained by the ipsilateral connections from the undamaged motor cortex, while the mirror phenomenon in the left ADM muscle could be explained by hypothesizing a bilateral activation of motor cortices. This previously unreported electrophysiological picture demonstrates that different patterns of motor control may realize after perinatal cerebral lesions, even in different distal muscles of the same patient.

Post-exercise facilitation and depression of motor evoked potentials to transcranial magnetic stimulation: a study in multiple sclerosis.

OBJECTIVE: To evaluate motor cortex excitability changes by transcranial magnetic stimulation (TMS) following repetitive muscle contractions in patients with multiple sclerosis (MS); to state whether a typical pattern of post-exercise motor evoked potentials (MEPs) is related to clinical fatigue in MS. METHODS: In 41 patients with definite MS (32 with fatigue and 9 without fatigue according to Fatigue Severity Scale) and 13 controls, MEPs were recorded at rest: at baseline condition, following repetitive contractions until fatigue, and after fatigue, to evaluate post-exercise MEP facilitation (PEF) and depression (PED). RESULTS: After exercise, MEP amplitude significantly increased both in patients and controls (PEF). When fatigue set in, MEP amplitude was significantly reduced in normal subjects (PED), but not in patients. Post-exercise MEP findings were similar both in patients with and without fatigue. CONCLUSIONS: Our findings suggest an intracortical motor dysfunction following a voluntary contraction in MS patients, possibly due to failure of depression of facilitatory cortical circuits, or alternatively of inhibitory mechanisms.

Patterns of recovery and change in verbal and nonverbal functions in a case of crossed aphasia: implications for models of functional brain lateralization and localization.

We present a 2-year verbal and nonverbal follow-up of a crossed aphasic patient. The patient had suffered from widespread ischemic damage in the area of right middle cerebral artery, with a parieto-temporal lesion. Three months postonset he showed classical Wernicke's aphasia associated with oral, limb and constructional apraxia and left hemineglect. However, follow-up findings showed a complex, dynamic pattern entirely consistent with cognitive models of language and nonlanguage abilities. Current models of functional brain lateralizations could not satisfactorily account for such longitudinal, fine-grain observations.

Flow cytometrically determined DNA content of breast carcinoma and benign lesions: correlations with histopathological parameters.

The relative DNA content of cellular samples from 54 patients affected by breast carcinomas and 20 affected by benign breast lesions (including 11 fibroadenomas) was measured by flow cytometry. All normal tissue samples and 17/20 (85%) specimens from benign lesions exhibited a cytometrically diploid DNA distribution, 3/20 (15%) benign lesions an abnormal DNA content, and 35/54 (65%) carcinomas at least one aneuploid cell subpopulation. Furthermore, 9/54 (17%) tumors were characterized by the presence of more than one aneuploid cell subpopulation. The results also indicate that flow cytometry can be used to recognize lymph nodes infiltrated by aneuploid cells. Statistically significant correlations were evidenced between the occurrence of aneuploidy or the ploidy level measured as DNA index and the nodal infiltration status. The percentage of S cells can also be extracted from DNA content distribution histograms. Statistically significant differences (p less than 0.01) were also observed for the percentage of S cells between normal tissues (6.2 +/- 3.2 SD) and benign lesions (11.1 +/- 6.6 SD), normal tissues (6.2 +/- 3.2 SD) and aneuploid tumors (19.7 +/- 10.3 SD), benign lesions (11.1 +/- 6.6 SD) and aneuploid tumors (19.7 +/- 10.3 SD), and diploid (7.9 +/- 4.0 SD) and aneuploid tumors (19.7 +/- 10.3 SD).

[Body composition in chronic renal insufficiency in the primary anuric phase and after dialysis]. / La composizione corporea nell'insufficienza renale cronica in fase anurica prima e dopo dialisi.

Bioelectric impedance was analysed before and after dialysis to assess the body composition of 36 patients suffering from chronic kidney failure in fair nutritional condition: resistance values were used to quantify total body water and reactance values as dimensional indices of the intracellular spaces and cell mass. Before dialysis, total body water was significantly higher than that of healthy subjects comparable for height, sex, age and weight, while it was not possible to obtain direct data on the dimensions of the cell mass. After dialysis, total body water values normalised and the dimensions of the intracellular spaces and cell mass became almost comparable to those of the controls: data analysis shows that during treatment, weight loss occurs almost exclusively in the extracellular compartments of the organism. Notwithstanding the fact that the absolute values are similar to those of the controls, body composition did not normalise as relationships between the dimensions of the various sectors remain altered.

[The use of lyopholized dura mater in reconstructive surgery of mouth floor neoplasms]. / Impiego della dura madre liofilizzata nella chirurgia ricostruttiva dei carcinomi del pavimento orale

Lyophilised dura mater is proposed for the reconstruction of the mouth floor after surgical stripping in case of T1, T2 and T3 cancer, The features of this substance are described, along with the surgical modalities involved.

[Gorlin-Goltz syndrome with odontogenic keratosis. Report on a patient followed for 10 years]. / Sindrome di Gorlin-Goltz con cheratocisti odontogeniche. Presentazione di un paziente seguito per 10 anni.

A patient with Gorlin-Goltz syndrome (nevoid basal cell carcinoma syndrome) is described. This disease has an autosomal dominant inheritance pattern with complete penetrance and extremely variable expressivity. The case report seems to represent a new mutation. Gorlin-Goltz syndrome is characterized by a lot of symptoms primarily involving the skin, central nervous system, and skeletal system. In 90% of the patients, nevoid basal cell carcinoma syndrome is associated with recurring odontogenic keratocysts. Also our patient showed recurrent jaw and maxillary cysts, for this reasons he has been followed for 10 years to the Oral Pathology Service of Galliera Hospital.

[Gingival hypertrophy in I-cell disease (mucolipidosis II). A report of 2 nonfamilial cases. II]. / Ipertrofia gengivale nella I-cell disease (mucolipidosi II). Presentazione di due casi non familiari. Parte II.

Two nonconsanguineous patients affected by I-cell disease (mucolipidosis II) are reported. I-cell disease, an oligosaccharidosis, is characterized by severe psychomotor retardation, marked shortness of stature, coarse facies, gingival enlargement, generalized bone demineralization, periosteal cloaking of long bones visible in early infancy, a rapid deteriorating course, and death from heart failure or bronchopneumonia, usually by the age of 5 years. This disorder is the result of a deficiency of glycoprotein N-acetylglucosaminylphosphotransferase activity, necessary for proper intracellular processing of lysosomal enzymes. Inheritance is autosomal recessive. It received the name I-cell disease because of several granular inclusions in the cytoplasm of cultured fibroblasts and amniotic fluid cells observed under phase contrast microscopy. These granules represent altered lysosomes. The two patients, reported here, had a very marked gingival hypertrophy and, for this reason, were referred to the Oral Pathology Service of Galliera Hospital. A gingivectomy was performed on patient 2 to improve the mastication, but few months later gingival hypertrophy reappeared.

[Gingival "thickening" in malformation syndromes. I]. / "Ispessimento" gengivale nelle sindromi malformative. Parte I.

The etiology of generalized gingival enlargement is very heterogeneous. Pregnancy, drugs, systemic diseases, poor oral hygiene, and nutritional impairment can lead to gingival enlargement. This defect can also be presented in several malformation syndromes. Gingival fibromatosis, that may exist as an isolated abnormality or as part of a syndrome, is another condition with gingival enlargement. In this paper, the malformation syndromes with gingival hypertrophy and those with gingival fibromatosis are listed in tables.

Inguinal-scrotal hernias in young patients: is laparoscopic repair a possible answer? Preliminary results of a single-institution experience with a transabdominal preperitoneal approach.

OBJECTIVES: The laparoscopic trans-abdominal preperitoneal (TAPP) approach to inguinal hernia repair is well documented as an excellent choice in numerous studies, especially when conducted by an experienced surgeon. Its full list of specific indications is still under debate. Generally, the repair of scrotal hernias demands a higher level of experience on the part of the surgeon, irrespective of the applied surgical technique. In this report, we evaluate our preliminary experience of TAPP laparoscopic repair for inguinoscrotal hernias in young patients in a Community Hospital setting, focusing on the feasibility of the technique and the incidence of complications. MATERIALS AND METHODS: Between January 2008 and January 2009 a total of ten consecutive young patients at the "Civil Hospital" in Vittorio Veneto (TV), underwent TAPP laparoscopic repair of bilateral inguinoscrotal hernias. RESULTS: The overall mean operative time was 65 (+/-15) min. All procedures were performed on a day surgery basis. There were no conversions to open repair, no mortality/morbidity or relapsing hernias. The mean follow-up was 14 (+/-2) months. No patients reported severe pain at 10 days, There were no reports of night pain at 30 days. All patients had a return to physical-work capacity within 14 days. All patients were completely satisfied at the 3-month follow up. CONCLUSIONS: Analysis of the short-term post-operative outcomes of our experience enabled us to conclude that, in the proper setting, TAPP can be performed for inguinoscrotal hernia repair with an efficiency comparable to that of normal inguinal hernia repair.

Use of a fully automated injector for self-administration of follitropin alpha in an IVF/ICSI programme.

Recombinant FSH (r-FSH) used for ovarian stimulation can currently be self-administered either by a conventional syringe or by a pen device. This randomized controlled trial compares the efficacy and convenience of a new, more sophisticated and fully automated injection device (Softinject(trade mark)) with the conventional syringe for r-FSH self-administration. A total of 300 women needing ovarian stimulation for IVF/intracytoplasmic sperm injection were randomized to the automated injector or the conventional syringe group. Patients of both groups had ovarian stimulation with follitropin alpha after pituitary desensitization with a gonadotrophin-releasing hormone agonist. State anxiety score, overall pain score and pregnancy rate were chosen as the main outcome measures. Patients in the automated injector group showed lower state anxiety (P < 0.01) and overall pain (P < 0.01) scores and a comparable pregnancy rate per started cycle as compared with the conventional syringe group. They needed lower doses of r-FSH (P < 0.05) and their stimulation was shorter (P < 0.05). It is concluded that the use of a fully automated injector for r-FSH self-administration reduces pain and stress as compared with the conventional syringe. This device can be used for any subcutaneously administered drug employed in ovarian stimulation.

The effect of stimulus frequency on spinal and scalp somatosensory evoked potentials to stimulation of nerves in the lower limb.

The effect of variation in the stimulus frequency on spinal and cortical somatosensory evoked potentials (SSEPs) to common peroneal nerve stimulation at the knee (CPN-K) and tibial nerve stimulation at the ankle (TN-A) was studied in 11 healthy subjects. Six stimulus frequencies, 0.7, 1.5, 3.0, 5.0, 7.0 and 10.0 Hz, were used in random order. With increasing stimulus rate spinal responses remained unchanged. By contrast, early cortical responses became significantly reduced in amplitude or undetectable for stimulation frequencies above 3.0 Hz for the CPN-K and 5.0 Hz for the TN-A. In 2 subjects the configuration and the latency of CPN-K SSEPs were affected by stimulus frequency. Similar changes were not observed in TN-A SSEPs.

Self intra-cavernous injections as a successful treatment in pure neurogenic impotence.

The aim of our research is to investigate the success of the vasoactive intracavernous therapy in subjects suffering impotence only on a neurological basis. We have submitted 50 subjects to a multisciplinary study including P.B.P.I., intracavernous minitest plus V.S.S., M.M.P.I., B.C.R. latency, duration, aspect and an hormonal screening (SH, LH, PRL, F. TEST, 17 BE2). The patients, or their partners, were instructed in the technique of self intracavernous injection (S.I.C.I.) of vasoactive drugs. Papaverine alone was given to 37 patients in a mean dose of 20.8 +/- 11.7 mg. Other 13 patients were treated with papaverine plus phentolamine in order to obtain a full erection. Comprehensive results of the treatment were judged at 80% effective: only 10 patients discontinued self injection treatment, unable to perform this technique properly.

Pudendal nerve somatosensory evoked potentials in paediatrics: maturation aspects.

Pudendal nerve somatosensory evoked potentials (PN-SSEPs) were recorded in 21 healthy children (age range: 3.3-13.3 years). The dorsal nerve of the penis/clitoris was stimulated and SSEPs were recorded at spinal L1-D12 and at cortical Cz'-Fz. Morphology, latency and amplitude of the cortical SSEPs were evaluated. A cortical response was obtained in all but two subjects. Cortical SSEPs were broader and less defined in shape in the youngest subjects. There was a progressive shortening of the latency of the P and N components during growth. Spinal responses were obtained only in 6 cases. Nine subjects also underwent tibial nerve stimulation. Pudendal and tibial SSEPs differed in their degree of maturation.

[Submucosal cleft of the palate]. / Le schisi submucose del palato.

After a brief review of the literature, the evolution of the concept of submucous cleft palate is described and its clinical diagnostic and therapeutic aspects examined. In particular, it is emphasised that however rare, this condition is important as one of the main causes of velopharyngeal insufficiency and therefore overt rhinolalia. The report ends with the presentation of two classic clinical cases in which severe rhinolalia was satisfactorily cured by surgery.

H-reflex recovery curve and reciprocal inhibition of H-reflex of the upper limbs in patients with spasticity secondary to stroke.

The H-reflex recovery curve of the lower limb is considered a useful test for the diagnosis of spasticity, and recently the reciprocal inhibition of the H-reflex has proven to be abnormal in patients affected with spasticity. We studied the H-reflex recovery curve and the reciprocal inhibition of the H-reflex in the upper limb of a group of 33 patients with different degrees of spasticity secondary to stroke. Results were compared with those of 25 controls. The aim of this study was to investigate if the two tests showed any direct correlation with the degree of spasticity and, furthermore, with other clinical measures that are present in patients with spasticity as part of an upper motoneuron syndrome (i.e., changes in muscle tone, reflexes, force, etc.). The results showed an abnormality of both tests in most patients (decrease of the three phases of inhibition in the reciprocal inhibition test and increase of the late facilitation part of the H-reflex recovery curve), and these abnormalities seem mostly to be related to muscle tone, most important being the degree of correlation between tone and changes in abnormality of the H-reflex recovery curve (P < 0.03).