56 research outputs found
No signs of intracranial arterial vasoconstriction in transient global amnesia
No full textAbstract
BACKGROUND AND PURPOSE:
The current theories to explain the pathophysiology of transient global amnesia (TGA) involve epilepsy, migraine, and hippocampal ischemia which might be determined by venous congestion or arterial vasoconstriction triggered by Valsalva-associated maneuvers in susceptible individuals.
METHODS:
Seventy-five TGA patients [mean age 60.3 ± 8.0 years, 44 (59%) females] and 75 age- and gender-matched controls were enrolled into a case-control study and underwent extracranial and transcranial arterial echo-color Doppler sonography.
RESULTS:
Intracranial arterial obstructions of the posterior circulation were neither observed in TGA patients nor in controls. There was no significant difference between the two groups with regard to intima-media thickness of the common carotids (.73 ± .07 vs. .72 ± .06), cervical vessel atherosclerosis (13% vs. 15%), >50% intracranial stenosis of the anterior circulation arteries (3% vs. 3%), resistance index values of the vertebral arteries at rest and during Valsalva maneuver (.69 ± .08 vs. .67 ± .09) and pulsatility index values of the major intracranial arteries at rest and during Valsalva maneuver. No difference in all study items was found between patients assessed during or soon after the TGA episode.
CONCLUSIONS:
Extra-intracranial atherosclerosis does not play a pathogenic role in TGA and no supporting evidence for the arterial vasoconstriction hypothesis of TGA emerged from this study
Case Report: Middle lobe syndrome: a rare presentation in eosinophilic granulomatosis with polyangiitis
No full textBackgroundAntineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of disorders characterized by necrotizing inflammation of small- and medium-sized blood vessels and the presence of circulating ANCA. Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic ANCA-associated vasculitis, characterized by peripheral eosinophilia, neuropathy, palpable purpuras or petechiae, renal and cardiac involvement, sinusitis, asthma, and transient pulmonary infiltrates. Middle lobe syndrome (MLS) is defined as recurrent or chronic atelectasis of the right middle lobe of the lung, and it is a potential complication of asthma.Case presentationHerein, we describe a case of MLS in a 51-year-old woman, never-smoker, affected by EGPA, presenting exclusively with leukocytosis and elevated concentrations of acute-phase proteins, without any respiratory symptom, cough, or hemoptysis. Chest computed tomography (CT) imaging documented complete atelectasis of the middle lobe, together with complete obstruction of lobar bronchial branch origin. Fiberoptic bronchoscopy (FOB) revealed complete stenosis of the middle lobar bronchus origin, thus confirming the diagnosis of MLS, along with distal left main bronchus stenosis. Bronchoalveolar lavage (BAL) did not detect any infection. Bronchial biopsies included plasma cells, neutrophil infiltrates, only isolated eosinophils, and no granulomas, providing the hypothesis of vasculitic acute involvement less likely. First-line agents directed towards optimizing pulmonary function (mucolytics, bronchodilators, and antibiotic course) were therefore employed. However, the patient did not respond to conservative treatment; hence, endoscopic management of airway obstruction was performed, with chest CT documenting resolution of middle lobe atelectasis.ConclusionTo the best of our knowledge, this is the first detailed description of MLS in EGPA completely resolved through FOB. Identification of MLS in EGPA appears essential as prognosis, longitudinal management, and treatment options may differ from other pulmonary involvement in AAV patients
Surgical versus conservative management for subclinical Cushing syndrome in adrenal incidentalomas: a prospective randomized study.
No full textIF = 7.474
Abstract
Objective To compare the clinical outcome of patients with subclinical Cushing’s syndrome (SCS) due to an adrenal incidentaloma (the autonomous hypersecretion of a small amount of cortisol, which is not enough to cause clinically-evident disease) who underwent surgery or were managed conservatively.
Summary Background Data The most appropriate management of SCS patients is controversial, either adrenalectomy or close follow-up being recommended for their treatment.
Methods Over a 15-year period, 45 SCS patients were randomly selected to undergo surgery (n = 23) or conservative management (n = 22). All surgical procedures were laparoscopic adrenalectomies performed by the same surgeon. All patients were followed up (mean, 7.7 years; range, 2 - 17 years) clinically by two experienced endocrinologists 6 and 12 months after surgery and then yearly, or yearly after joining the trial, particularly monitoring diabetes mellitus (DM), arterial hypertension, hyperlipidemia, obesity and osteoporosis. The study endpoint was the clinical outcome of SCS patients who underwent adrenalectomy versus those managed conservatively.
Results: All 23 patients in the surgical arm had elective surgery. Another three patients randomly assigned to conservative management crossed over to the surgical group due to an increasing adrenal mass > 3.5 cm. In the surgical group, DM normalized or improved in 62.5% of patients (5 of 8), hypertension in 67% (12 of 18), hyperlipidemia in 37.5% (3 of 8), and obesity in 50% (3 of 6). No changes in bone parameters were seen after surgery in SCS patients with osteoporosis. On the other hand, some worsening of DM, hypertension and hyperlipidemia was noted in conservatively-managed patients.
Conclusions: Based on the results of this study, laparoscopic adrenalectomy performed by skilled surgeons appears more beneficial than conservative management for SCS patients complying with our selection criteria. This trial is registered with Australian Clinical Trials Registry number, ANZCTR12608000567325
Factors influencing the rising rates of adrenal surgery: analysis of a 25-year experience
No full textAbstract
Background Adrenal surgery has been radically changed by laparoscopy and it is reasonable to wonder whether the increase in the number of adrenalectomies is entirely justified.
There is still debate on the transperitoneal versus the retroperitoneal approach, the advantages and drawbacks of which are discussed here.
Methods Between 1983 and 2007, we performed 279 adrenalectomies in 264 consecutive patients, divided into two groups: before and after the advent of laparoscopic adrenalectomy (LA). We analyzed the factors that increased the number of adrenalectomies in recent years. The LAs were
further divided into three consecutive periods and the morbidity and conversion rates, and mean operating times were compared.
Results More procedures were performed after the advent of LA, i.e., 55 (19.7%) beforehand versus 224 (80.3%) afterwards, irrespective of the type of disease, for instance: incidentaloma, 17.6% versus 82.4% (p \ 0.0001); pheochromocytoma, 20.7% versus 79.3% (p\0.0001); Conn’s
disease, 19.8% versus 80.2% (p \ 0.0001); Cushing’s disease, 17.2% versus 82.8% (p\0.0001); cortical carcinoma, 30% versus 70% (p\0.001). Analyzing the three LA periods, operating times were the only statistically
significant variable (p\0.0001).
Conclusions The progressive increase in the number of adrenalectomies performed is due more to a better understanding of adrenal disease than to the availability of minimally invasive techniques. The choice of a laparoscopic
approach (trans- or retroperitoneal) should depend on the surgeon’s experience
Olfactory Testing and Gray Matter Volume: A Combined Approach to Predict the Conversion to Alzheimer
No full text: Background/Objectives: Olfactory decline is common in normal aging and frequent in neurodegenerative diseases such as Alzheimer's disease (AD). Therefore, it has been suggested as a marker for the Mild Cognitive Impairment (MCI) progression to AD. Although suggested, the relationship between olfactory deficits and cerebral atrophy in MCI conversion to AD is still debated. This study aims at investigating the olfaction-related morphological and behavioural alterations in MCI in order to understand whether they can predict the progression to AD. Methods: Twenty-seven MCI patients and thirty-five healthy controls (HCs) took part in the study, with follow-up showing conversion to AD in thirteen patients (converter-MCI, cMCI). The Burgarth Sniffin' Sticks Tests (threshold-TT, discrimination-DT, identification-IT) assessed the olfactory capacities. The Voxel-Based Morphometry (VBM) analysis investigated the atrophic patterns. Results: The Receiving Operating Characteristics analyses demonstrated that DT and IT could distinguish HC from MCI (DT Area Under Curve-AUC = 0.8; IT AUC = 0.8), as well as cMCI from sMCI (stable) patients (DT AUC = 0.7; IT AUC = 0.6), similarly to memory and executive functions tests. Olfactory performance positively correlated with memory tests in sMCI (all rhos ≥ 0.8, all ps < 0.01), whereas it positively correlated with executive functions in cMCI (all rhos ≥ 0.6, all ps < 0.05). VBM results revealed distinct atrophic patterns in cMCI, especially in the olfactory cortex, that were already present at the MCI diagnosis, before AD conversion. A larger volume of the olfactory cortex was associated with better memory and executive functions. Conclusions: Quantitative olfactory and morphological patterns represent non-invasive, predictive biomarkers of the MCI progression to AD; thus, their assessments at MCI onset allows earlier interventions for MCI patients
Multicentric aggressive unclassified hematopoietic neoplasm involving the placenta in a pregnant bitch
No full textHematopoietic neoplasms are common in dogs; however, their association with pregnancy has not been previously reported in veterinary medicine. This rare occurrence presents a variety of diagnostic, therapeutic, prognostic, and ethical challenges. We report a case of a 3-year-old pregnant Bernese Mountain Dog diagnosed with multicentric aggressive unclassified hematopoietic cancer associated with paraneoplastic hypercalcemia during pregnancy. The dog died 7 days after diagnosis, and at Day 36 of pregnancy before any treatment decision could be made. Post-mortem evaluation, including histology, immunohistochemistry, and clonality analysis, led to the diagnosis of an unclassified hematopoietic cancer affecting the uterus and placenta, with no evidence of fetal involvement. The placenta likely acted as a barrier, preventing neoplastic involvement of the fetuses. Alternatively, the pregnancy might have been too early for the hematopoietic neoplasm to affect the labyrinth zone of the placenta and the fetuses. The dramatic disease progression could be explained by compromised cell-mediated immunity during pregnancy. This immunodeficient state is induced by embryonic, maternal, and hormonal factors, which suppress the response to mitogens to prevent rejection of the placenta and the conceptuses. Thus, pregnant dogs might exhibit increased vulnerability to cancer and infectious diseases that rely on cell-mediated immunity for host defense
An EEG-fMRI Study on the Termination of Generalized Spike-And-Wave Discharges in Absence Epilepsy
No full textINTRODUCTION: Different studies have investigated by means of EEG-fMRI coregistration the brain networks related to generalized spike-and-wave discharges (GSWD) in patients with idiopathic generalized epilepsy (IGE). These studies revealed a widespread GSWD-related neural network that involves the thalamus and regions of the default mode network. In this study we investigated which brain regions are critically involved in the termination of absence seizures (AS) in a group of IGE patients.
METHODS: Eighteen patients (6 male; mean age 25 years) with AS were included in the EEG-fMRI study. Functional data were acquired at 3T with continuous simultaneous video-EEG recording. Event-related analysis was performed with SPM8 software, using the following regressors: (1) GSWD onset and duration; (2) GSWD offset. Data were analyzed at single-subject and at group level with a second level random effect analysis.
RESULTS: A mean of 17 events for patient was recorded (mean duration of 4.2 sec). Group-level analysis related to GSWD onset respect to rest confirmed previous findings revealing thalamic activation and a precuneus/posterior cingulate deactivation. At GSWD termination we observed a decrease in BOLD signal over the bilateral dorsolateral frontal cortex respect to the baseline (and respect to GSWD onset). The contrast GSWD offset versus onset showed a BOLD signal increase over the precuneus-posterior cingulate region bilaterally. Parametric correlations between electro-clinical variables and BOLD signal at GSWD offset did not reveal significant effects.
CONCLUSION: The role of the decreased neural activity of lateral prefrontal cortex at GSWD termination deserve future investigations to ascertain if it has a role in promoting the discharge offset, as well as in the determination of the cognitive deficits often present in patients with AS. The increased BOLD signal at precuneal/posterior cingulate cortex might reflect the recovery of neural activity in regions that are "suspended" during spike and waves activity, as previously hypothesized
Eight weddings and six funerals: An fMRI study on autobiographical memories
No full text“Autobiographical memory” (AM) refers to remote memories from one's own life. Previous neuroimaging studies have highlighted that voluntary retrieval processes from AM involve different forms of memory and cognitive functions. Thus, a complex and widespread brain functional network has been found to support AM. The present functional magnetic resonance imaging (fMRI) study used a multivariate approach to determine whether neural activity within the AM circuit would recognize memories of real autobiographical events, and to evaluate individual differences in the recruitment of this network. Fourteen right-handed females took part in the study. During scanning, subjects were presented with sentences representing a detail of a highly emotional real event (positive or negative) and were asked to indicate whether the sentence described something that had or had not really happened to them. Group analysis showed a set of cortical areas able to discriminate the truthfulness of the recalled events: medial prefrontal cortex, posterior cingulate/retrosplenial cortex, precuneus, bilateral angular, superior frontal gyri, and early visual cortical areas. Single-subject results showed that the decoding occurred at different time points. No differences were found between recalling a positive or a negative event. Our results show that the entire AM network is engaged in monitoring the veracity of AMs. This process is not affected by the emotional valence of the experience but rather by individual differences in cognitive strategies used to retrieve AMs
Data architecture framework for improving consumer awareness in food shopping experience
No full textNowadays, consumers are often influenced by retailers who prioritize economic objectives over the well-being of individuals and society. To address this issue, there is a need for tools that can help consumers make more informed and sustainable purchasing choices. This paper proposes a data architecture framework that can enable consumers to have a more aware and sustainable purchasing experience, particularly regarding food choices. The framework empowers consumers’ experience by providing access to integrated enabling technologies that promote sustainable, nutritionally complete, customized purchase choices and eating habits. Under the NEXTCART project’s framework, this paper aims to provide technological solutions that can help optimize and digitize the food supply chain, making it more environmentally, socially, and economically sustainable
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