Exchanging One Tunnel for Another?

Science (New York, N.Y.). Apr, 1992  |  Pubmed ID: 17787931

Now for the Hard Ones

Science (New York, N.Y.). Apr, 1992  |  Pubmed ID: 17787933

Mononeuropathies Examination Diagnosis and Treatment

Journal of Clinical Neuromuscular Disease. Sep, 1999  |  Pubmed ID: 19078549

New Approaches to the Management of Peripheral Vertigo: Efficacy and Safety of Two Calcium Antagonists in a 12-week, Multinational, Double-blind Study

Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. May, 2002  |  Pubmed ID: 11981396

To evaluate the efficacy and safety profile of one 30-mg nimodipine oral tablet taken three times per day (one tablet with breakfast, one with lunch, and one with dinner) or one 150-mg cinnarizine verum oral capsule taken once each day with dinner for 12 weeks.

[Retroperitoneal Sarcomas: a Single Center Experience]

Cancer Radiothérapie : Journal De La Société Française De Radiothérapie Oncologique. Sep, 2008  |  Pubmed ID: 18434228

To analyse the management and clinical outcome of patients treated for retroperitonal soft tissue sarcoma and to identify prognosis factors.

A Prospective Multicentre Study of Mycophenolate Mofetil Combined with Prednisolone As Induction Therapy in 213 Patients with Active Lupus Nephritis

Lupus. Jul, 2008  |  Pubmed ID: 18625634

Mycophenolate mofetil (MMF) with prednisolone has been associated with high remission rates when used as induction treatment for lupus nephritis. This prospective, multicentre, cohort study investigates the efficacy and safety of this regimen over 24 weeks in 213 Chinese patients with active lupus nephritis (Classes III, IV, V or combination). Baseline activity index (AI) was 6.91+/-3.33 and chronicity index (CI) was 1.9+/-1.2. The remission rate was 82.6% at 24 weeks (complete remission, 34.3%; partial remission, 48.4%). There were significant (P<0.01) improvements in kidney function shown by reductions in proteinuria, serum albumin, serum creatinine and creatinine clearance, as well as in systemic lupus erythematosus disease activity index (SLEDAI) scores. Independent risk factors influencing remission were pathological classification (including Class V and III or Class V and IV nephritis) and elevated serum creatinine at baseline (OR 2.967, 95% CI: 1.479-6.332, P=0.001 and OR 1.007, 95% CI: 1.002-1.011, P=0.001, respectively). Patients with concomitant membranous features on biopsy had a lower remission rate than those with Class III and IV nephritis (66.7% vs 87.3%, P=0.002). Renal biopsy was repeated in 25 patients following treatment. There was a transition to less severe pathological morphologies in majority of subjects. Infections were monitored throughout treatment: eight patients (3.8%) experienced bacterial infections, whereas herpes zoster occurred in seven patients. Nine patients (4.2%) suffered from gastrointestinal upset, which resolved without discontinuation of MMF. One patient became leucopenic, whereas another died from active disease unrelated to kidney symptoms. MMF combined with prednisolone is an effective and well-tolerated induction treatment for patients with active lupus nephritis and for controlling SLE systemic activity.

Manson's Triple Error

Parasite (Paris, France). Sep, 2008  |  Pubmed ID: 18814729

The author discusses the significance, implications and limitations of Manson's work. How did Patrick Manson resolve some of the major problems raised by the filarial worm life cycle? The Amoy physician showed that circulating embryos could only leave the blood via the percutaneous route, thereby requiring a bloodsucking insect. The discovery of a new autonomous, airborne, active host undoubtedly had a considerable impact on the history of parasitology, but the way in which Manson formulated and solved the problem of the transfer of filarial worms from the body of the mosquito to man resulted in failure. This article shows how the epistemological transformation operated by Manson was indissociably related to a series of errors and how a major breakthrough can be the result of a series of false proposals and, consequently, that the history of truth often involves a history of error.

Long Survival in a Patient with Brain Metastases from Breast Cancer

Clinical Medicine. Oncology. 2008  |  Pubmed ID: 21892271

The incidence of brain metastases (BMs) is apparently rising in patients with advanced breast cancer, possibly due to better therapeutic approaches for control of metastatic growth in other organs. Occurrence of BMs severely affects quality of life and is associated with dire prognosis. In this short report we describe the clinical case of a 47 year old woman, with BMs from breast cancer diagnosed in May 2001. The patient was treated with whole brain irradiation and radiosurgery, with initial control of BMs. Due to previous radiotherapy fields and doses, further local treatments are not feasible anymore. Since September 2006, the patient has been receiving systemic therapy with Lapatinib at the dose of 1500 mg/die continuously, with a good control of cerebral, liver and nodal metastasis after one year of treatment (September 2007). Her quality of life is acceptable, her Karnofsky Performance Status (KPS) is more than 70%, and she takes care of her family, and has not experienced neuro-cognitive dysfunction.

ABVD Associated with Imatinib for Coexisting Chronic Myeloid Leukaemia and Relapsed Hodgkin Lymphoma

Leukemia Research. Oct, 2010  |  Pubmed ID: 20605208

Janus-headed Communication Promotes Bacterial Cooperation and Cheating: is Quorum Sensing Useful Against Infections?

Virulence. Sep-Oct, 2010  |  Pubmed ID: 21178478

In a detailed spatially explicit simulation study (Czárán & Hoekstra, 2009) we have shown that quorum sensing (QS)--the ability of bacteria to detect the local density of their clonemates in their immediate neighbourhood--might have evolved in synergism with cooperative behavior, i.e., the production of "public goods" like virulence factors for the common benefit of the cooperators, in spite of the fact that both cooperation and QS communication can be cheated (exploited) by mutant strains. In particular, we found that 1) cooperation requires an effective kin selection mechanism to operate, which is automatically supplied by the limited mobility of bacteria; 2) QS communication extends the scope for cooperation considerably, and cooperation maintains the selective advantage of QS communication, even if 3) different types of cheaters are always present and coexistent with "honest" phenotypes in a quasi-equilibrium. These predictions are validated by experimental results and field data by now, and medical applications of the results have been suggested.

The Direct Cost of Patients with Multiple Sclerosis: a Survey from Italian MS Centres

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. Dec, 2011  |  Pubmed ID: 21505911

Multiple sclerosis (MS) is a chronic progressive disease of the CNS causing disability and neurological symptoms that carry a substantial burden. Previous Italian studies appear outdated, and investigation on the burden of recently marketed drug treatments should provide further economic evidence for policy makers. The objective of the study was to investigate patterns of care, resource consumption and direct medical cost of MS, in the perspective of the public health-care provider. Ten MS experts from public centres extracted and reported data of all MS patients seen during 2009, using a detailed questionnaire. The data of 8,326 MS patients were analysed: the course was relapsing-remitting in 5,376 (62%), secondary progressive in 1,798 (23%) and primary progressive in 691 (9%); 461 (6%) had a clinically isolated syndrome. The EDSS score was 0-3.5 in 5,118 (61%) patients, 4-6.5 in 2,408 (29%) and 7-9.5 in 800 (10%). The average cost of diagnosis (N = 694) was 1,236 €/patient with large variations between centres due to the chosen diagnostic setting. The average direct medical cost for biological disease-modifying drugs (bio-DMD) was 10,444 €/patient/year (cost/patient by primary drug: 9,501 € for interferon (IFN)-beta1a-im; 8,553 € for IFN-beta1b; 11,255 € for IFN-beta1a-sc44; 9,883 € for IFN-beta1a-sc22; 8,174 € for glatiramer acetate (GA); 21,817 € for natalizumab) and 3,151 € for non-bio-DMD. The cost of diagnosis is largely influenced by care setting, due to local health-care provision patterns. The annual medical cost/patient is largely driven by the cost of drugs (89.2% of total); GA represents the least expensive bio-DMD in the Italian health-care setting.

Interreality: the Experiential Use of Technology in the Treatment of Obesity

Clinical Practice and Epidemiology in Mental Health : CP & EMH. 2011  |  Pubmed ID: 21559236

FOR MANY OF US, OBESITY IS THE OUTCOME OF AN ENERGY IMBALANCE: more energy input than expenditure. However, our waistlines are growing in spite of the huge amount of diets and fat-free/low-calorie products available to cope with this issue. Even when we are able to reduce our waistlines, maintaining the new size is very difficult: in the year after the end of a nutritional and/or behavioral treatment obese persons typically regain from 30% to 50% of their initial losses. A possible strategy for improving the treatment of obesity is the use of advanced information technologies. In the past, different technologies (internet, virtual reality, mobile phones) have shown promising effects in producing a healthy lifestyle in obese patients. Here we suggest that a new technological paradigm - Interreality - that integrates assessment and treatment within a hybrid experiential environment - including both virtual and real worlds - has the potential to improve the clinical outcome of obesity treatments. The potential advantages offered by this approach are: (a) an extended sense of presence: Interreality uses advanced simulations (virtual experiences) to transform health guidelines and provisions in experiences; (b) an extended sense of community: Interreality uses virtual communities to provide users with targeted - but also anonymous, if required - social support in both real and virtual worlds; (c) real-time feedback between physical and virtual worlds: Interreality uses bio and activity sensors and devices (smartphones) both to track in real time the behavior/health status of the user, and to provide targeted suggestions and guidelines. This paper describes in detail the different technologies involved in the Interreality vision. In order to illustrate the concept of Interreality in practice, a clinical scenario is also presented and discussed: Daniela, a 35-year-old fast-food worker with obesity problems.

Measurement of Atherosclerosis Markers in Patients With Periodontitis: A Case-Control Study

Journal of Periodontology. Nov, 2011  |  Pubmed ID: 22060049

Objective: Periodontitis is suggested to enhance the process of vascular inflammation leading to atherosclerosis. The present study explores the effect of periodontitis in relation to the clinical and ultrasound markers of carotid atherosclerosis. Methods: Sixty systemically healthy patients over 45 years of age (30 with chronic periodontitis and 30 without periodontitis) were studied in a university dental school. Traditional cardiovascular risk factors for atherosclerosis were evaluated. Carotid intima-media thickness (IMT) was assessed by ultrasound. Results: The IMT of the internal carotid was 0.77 and 0.81 mm, respectively, with no statistically significant differences between the two groups (p=0.538). There were significant differences in the presence of carotid atheroma plaques and the severity of periodontitis (p=0.003). In the logistic regression analysis, significant differences in terms of age and periodontitis were recorded in relation to the presence of atheroma plaques in the carotid intima. Conclusion: The severity of periodontitis was seen to influence the presence of carotid atheroma plaques.

Pneumocoele After Cochlear Implantation

Cochlear Implants International. Jun, 2011  |  Pubmed ID: 22333322

OBJECTIVE AND IMPORTANCE: Scalp pneumocoele is a rare complication of cochlear implantation surgery. We present the largest case series to date; consisting of four cases over 8 years from one centre. The presentation, diagnosis, and management of each case are reviewed. Previously unreported complications of pneumocoeles are highlighted. CLINICAL PRESENTATION: Three of our four cases, consisting of two adults (aged 53 and 81 years) and one child (aged 26 months), developed scalp pneumocoeles within the first 3 months of implantation. Another child (aged 10) developed pneumocoele 7 years after surgery. The common diagnostic features include a soft, non-tender, fluctuant swelling over the receiver/stimulator package. In all cases, pneumocoeles were triggered by Valsalva's or Toynbee's manoeuvres. Complications include infection (case one) and reduction in cochlear implant (CI) function (cases three and four), secondary to displacement of the receiver/stimulator package or electrode displacement. Intervention/technique: Diagnosis is made from clinical history and examination. Aspiration results in reduction of pneumocoeles. This is not necessary for smaller pneumocoeles as they may resolve spontaneously. Additional investigations may reveal complications of pneumocoeles, such as X-rays for implant displacement, and inflammatory marker to detect signs of infection. To prevent the recurrence of pneumocoeles, patients are advised to avoid Valsalva's or Toynbee's manoeuvres. There were no recurrences of pneumocoeles. CONCLUSION: Post-cochlear implantation pneumocoeles can be associated with harmful complications such as infection and CI dysfunction. The mechanism of pneumocoele formation is discussed, and strategies for its prevention are examined.

Pituitary Carcinoma Recurrent to the Lumbar Intradural Extramedullary Space: Case Report

The Journal of Spinal Cord Medicine. Feb, 2012  |  Pubmed ID: 22333938

CONTEXT: Pituitary tumors are rare, and pituitary carcinomas are rarer still. Prognosis is poor, with less than 50% of patients surviving past 1 year after diagnosis. In this case of spinal metastasis from an adrenocorticotropic hormone-secreting pituitary carcinoma, the intradural extramedullary metastases recurred in the same lumbar area 6 years apart. FINDINGS: Fourteen years prior to presentation in our clinic, a 48-year-old woman was diagnosed with pituitary adenoma which was treated with resection followed by radiation. Eight years later, an intradural extramedullary spinal drop metastasis at L2-L3 was again treated with resection and radiation. Three years later, magnetic resonance imaging (MRI) revealed a mass encasing the right carotid artery, which was treated for 1 year with chemotherapy using temozolomide (Temodar). Three years later, MRI showed intradural extramedullary metastases at the L3-L4 intervertebral disc space and behind the L3 vertebral body; treatment was again resection followed by radiation. Back pain and weakness resolved after surgery and her neurological examination returned to baseline. There was no evidence of recurrence 1 year after surgery. Conclusion/clinical relevance: In this unusual case, this pituitary carcinoma metastasized twice in 6 years to virtually the same intradural extramedullary lumbar region. Surgical resection of these masses aided in relieving neurological symptoms and prolonging life.

Tobacco Addiction and The Risk of Upper Aerodigestive Tract Cancer in A Multicenter Case-Control Study

Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology. Feb, 2012  |  Pubmed ID: 22337537

BACKGROUND: While previous studies on tobacco and alcohol and the risk of upper aerodigestive tract (UADT) cancers have clearly shown dose-response relations with the frequency and duration of tobacco and/or alcohol, studies on addiction to tobacco itself as a risk factor for UADT cancer have not been published, to our knowledge. The aim of this report is to assess whether smoking addiction is a risk factor for UADT SCC risk in the multicenter case-control study (ARCAGE) in Western Europe independent of tobacco smoking or alcohol drinking intensity or duration.METHODS: The analyses included 1,905 ever smoking UADT SCC cases (871 oral cavity/oropharynx, 814 hypopharynx/larynx, 127 esophagus, and 93 overlapping oral cavity/pharynx) and 1,489 ever smoking controls. The addiction variables included first cigarette after waking up, difficulty refraining from smoking in places where it is forbidden, and cigarettes per day. Odds ratios (OR) and 95% confidence intervals (95% CI) for UADT cancers with addiction variables were estimated with unconditional logistic regression, adjusting for center, age, sex, education level, alcohol consumption, and tobacco smoking.RESULTS: Among current smokers, 76.47% of cases were categorized in the highest addiction level, whereas 54.69% of controls were in that category. The participants who smoked their first cigarette within 5 minutes of waking up were two times more likely to develop UADT SCC (OR = 2.22, 95% CI 1.57-3.15) than those who smoked 60 minutes after waking up. A higher modified Fagerstram score, reflecting greater tobacco addiction, was associated with an increased risk of UADT SCC among current smokers, but not among former smokers.CONCLUSION: We observed that time to first cigarette after waking up was associated with UADT SCC risk, regardless of heavy smoking or alcohol drinking behaviors. These results are consistent with residual effect of smoking that was not captured by the questionnaire responses alone. Cancer Epidemiol Biomarkers Prev; 21(3); 1-9. ©2012 AACR.

Race and Risk of Large Bowel Polyps in Younger and Older Patients

Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology. Feb, 2012  |  Pubmed ID: 22337553

PIVKA-II Plasma Levels As Markers of Subclinical Vitamin K Deficiency in Term Infants

The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. Feb, 2012  |  Pubmed ID: 22280352

Abstract Background: As the vitamin K content of human milk is low and the newborn infant's stores of vitamin K are small, vitamin K deficiency with hemorrhage in the newborn is a worldwide problem. Proteins Induced by Vitamin K Absence (PIVKA-II) are the inactive under-?-carboxylated forms of vitamin K-dependent clotting factors and they could be useful in predicting subclinical vitamin K deficiency (VKD). Objectives: To demonstrate that PIVKA-II are earlier markers of subclinical VKD than Prothrombin time (PT) in exclusively breast fed newborns. Methods: A prospective, controlled, randomized study, including 53 term newborns receiving vitamin K prophylaxis (0.5 mg im) at birth, was performed. At 30 days newborns were divided into three groups (G) receiving respectively: 25 ?g/die of vitamin K (G I), 12 ?g/die (G II) or placebo (G III). PIVKA II and PT were measured on 30th and 90th days of life. Results: G III and GII showed a significant increase in PIVKA II from 30 to 90 days of life respectively from 2.6 to 4.7 (p = 0.001) and from 2.3 to 3.5 (p<0.001). No significant changes were found in GI. PT showed no significant changes among groups. Conclusions: PT is a less sensitive marker than PIVKA II. Oral supplementation with 25 ?g/die avoids an increase of PIVKA II. Despite increased PIVKA II do not mean an impending occurrence of bleeding, they highlight a subclinical VKD and its relative risk.

Clofarabine, Cyclophosfamide, and Etoposide for the Treatment of Relapsed or Resistant Acute Leukemia in Pediatric Patients

Leukemia & Lymphoma. Feb, 2012  |  Pubmed ID: 22303898

ABSTRACT Clofarabine is a promising, new chemotherapeutic agent that is active in the treatment of pediatric acute leukemia. Forty children ( 16 AML, 24 ALL), aged 1-20 years (median 7.6 years) with relapsed or refractory Acute Lymphoblastic Leukemia (ALL) or Acute Myeloid Leukemia (AML) were treated because of resistance to first line treatment (5) , or for first (22) , second (11), or third relapse (2) . They received clofarabine (40 mg/m(2)/day) associated with etoposide (100 mg/m(2)/day) and Cyclophosphamide (440 mg/m(2)/day) administered as 1 or 2 induction cycles (5 days of chemotherapy) in an attempt to reach complete remission (CR) or CR without platelet recovery (CRp). This was followed by 1 to 3 consolidation cycles (4 days of chemotherapy) for a maximum of 4 cycles. Seven (44%) out of 16 and 10 (42%) out of 24 evaluable children with AML and ALL respectively, responded to treatment. The most common adverse events were infections and gastrointestinal and hepatic toxicity. Thirteen (76%) out of 17 responders underwent SCT. 24-month OS was 25%, while it was 59% among patients who responded to the first induction cycle. Our study suggests that this drug regimen is well tolerated and can be effective in heavily pretreated relapsed or refractory pediatric patients with acute leukemia.

Cox-2 Expression in Gingival Biopsies From Periodontal Patients is Correlated With Connective Tissue Loss

Journal of Periodontology. Feb, 2012  |  Pubmed ID: 22324469

Objectives: The objective of this study was to compare cyclooxygenase-2 (COX-2) protein expression in gingival biopsies from chronic periodontitis patients, gingivitis patients and individuals with no periodontal disease (control group) and to establish its relationship with clinical variables and connective tissue loss in lamina propria. Material and Methods: A cross-sectional and analytic study was conducted in 108 gingival biopsies from 52 patients with chronic periodontitis, 39 with gingivitis and 17 with no periodontal disease. All biopsies were processed for conventional histopathological study, immunohistochemical determination of COX-2 protein expression and automatic quantification of connective tissue by image analysis. Results: The protein expression of COX-2, mainly produced by plasma cells and monocytes, was significantly related to the presence of periodontal disease, bleeding index, intensity of inflammatory infiltrate and loss of connective tissue in lamina propria of gingival biopsies (p<0.01, Spearman test). COX-2 expression was also directly correlated with attachment loss (p<0.05, Spearman test). Conclusion: COX-2 protein expression is higher in patients with gingivitis and chronic periodontitis than in non-periodontal patients and is inversely correlated with the amount of connective tissue in lamina propria as determined by image analysis. This finding suggests that COX-2 participates in mechanisms and pathway signalling related to the destruction of fibrillar support structures of the periodontium.