Bedside ultrasonography of musculoskeletal complications in brain injured patients.

INTRODUCTION: The aim of this study was to evaluate the role of bedside ultrasonography (US) in early diagnosis of musculoskeletal complications (MSC) of acquired brain injuries, to describe its incidence and US features in a neurorehabilitation setting. MATERIALS AND METHODS: All 163 patients admitted in tertiary-level neurorehabilitation unit with diagnosis of stroke or severe brain injury (SBI), with symptoms or signs of musculoskeletal pathology, underwent bedside US. RESULTS: MSC were diagnosed in 51.5%. In 86.9% US clarified diagnosis and/or modified therapeutic approach. Shoulder pain was observed in 27.6%. US showed a shoulder subluxation in 73.3% and a frozen shoulder in 8.8% of painful shoulders. In all the cases rotator cuff abnormalities were noted. Wrist-hand syndrome was observed in 29.4%. US showed mild effusion in wrist joints and tendon sheaths and subcutaneous edema without significant vascularity. Neurogenic heterotopic ossification was observed in 1.8%. US demonstrated the "zone phenomenon" or heterogeneously hypoechoic mass with low resistance vessels within the lesions. Contractures and spasticity were observed in 18.4%. US allowed reliable guidance for Botulinum toxin A injection. Relapsing osteoarthritis and acute arthritis were diagnosed in 15.3% and 7.3% respectively. Patients with MSC had lower Functional Independence Measurement (FIM) and Katz index scores in discharge (p < 0.04 and p < 0.0294 respectively) and more length of hospital stay (p = 0.0024). DISCUSSION: Musculoskeletal pathology frequently complicates the course of acquired brain injuries and it delays functional recovery. Bedside US is a cheap and sensitive diagnostic tool and it can aid clinicians to define diagnosis and to choose therapeutic approach.

[The use of interferon-beta in the treatment of essential mixed cryoglobulinemia]. / Impiego dell'interferone beta nel trattamento della crioglobulinemia mista essenziale.

The authors report two cases of essential mixed cryoglobulinemia (EMC) manifested by purpura, fatigue and arthralgia. After a corticosteroid treatment which proved a complete failure, beta-interferon therapy was started. This caused rapid improvement of the clinical picture without relevant side effects.

[A case of beriberi on the threshold of the year 2000]. / Un caso di Beri-beri alle soglie del 2000.

The authors report a case of beriberi due to a deficit in thiamine, which became apparent in a young Chinese woman with polyneuropathy, distal oedema and epigastralgia. Parenteral administration of thiamine lead to the virtually complete resolution of symptoms.

[Echographic diagnosis of diffused liver diseases: histologic correlations]. / La diagnostica ecografica nelle epatopatie diffuse: correlazioni istologiche.

A personal series of 53 patients is reviewed. The patients were subjected to echography of the liver together with clinical and histological studies after closed biopsy. The cases are analysed and grouped according to stage and severity of the liver condition encountered. All groups showed a good match between echographic and clinicohistological results. The main echographic criteria for liver disease are summarised and illustrated in the light of personal experience and the data published in the most recent literature.

Mitral valve prolapse as a risk factor for TIA. A study with echocardiography and dynamic ECG.

The present study has been devoted to the analysis of 120 patients presenting with reversible focal cerebral ischemia without conventional signs of cardiopathy and/or relevant atherosclerotic disease. In 77% of the patients vascular risk factors, such as hypertension or hyperlipemia, were present. In 23% of the patients, no abnormal finding was discovered at clinical, hematochemical and cardiological examinations. In these patients a further cardiological evaluation was performed with echocardiography. Dynamic electrocardiography was performed in 52 patients. Echocardiography and dynamic electrocardiography revealed the occurrence of 6 cases of mitral valve prolapse (MVP), 2 cases of frequent premature ventricular beats, and 1 proximal atrial arrhythmia. All 6 cases of MVP were detected in the subgroups of patients without vascular risk factors. In our patients younger than 45 years, the relative frequency of MVP attains 21.5%. This study confirms that MVP has to be regarded as a risk factor for focal cerebral ischemia in young patients.

[Guacetisal in the treatment of acute and chronic bronchopneumopathy]. / II guacetisal nel trattamento delle broncopneumopatie acute e croniche.

30 patients of senile age suffering from acute and chronic bronchopneumopathies, the latter in acute phase, have been treated with guacetisal, a new pharmacological substance with anti-inflammatory, fluidifying and bechic properties. The therapeutic results, obtained with 1.2 g suppositories, were definitely positive in a high percentage of case (83.3%).