EPILEPTIC SEIZURES AS THE FIRST MANIFESTATION OF FAHR'S SYNDROME.

INTRODUCTION: Hypoparathyroidism is a rare endocrine disorder, leading to complications affecting the kidneys, the eyes, the cerebrum (Fahr's syndrome, epilepsy, parkinsonism, cognitive impairment), and the heart. CASE REPORT: We present the case of a 24-year old male that presented to our clinic for generalized tonic-clonic seizures increasing in frequency for the last year or so. Furthermore, he was diagnosed with subcapsular cataract of both eyes and had intraocular lens implant surgery 12 years ago. CT scan performed at admission showed calcium deposits on the dentate nuclei, basal ganglia, thalamus, cerebellum and bilateral subcortical fronto-parietal white matter compatible with Fahr's disease. The results of the laboratory tests were normal except for hypocalcemia, hyperphosphoremia and low intact parathormone (iPTH). The patient was diagnosed with primary hypoparathyroidism which led to Fahr's syndrome. The patient was prescribed oral medication including calcium carbonate, calcidiol, magnesium orotate and levetiracetam. The follow-up after three months revealed a seizure free status and normalization of magnesium, calcium, and phosphorus levels. CONCLUSION: Fahr's syndrome can be a cause of epileptic seizures and should be considered in the clinical approach to an epileptic patient, especially in children, teenagers, and young adults.

Brain-heart axis--Review Article.

UNLABELLED: There has been a large confirmation over the last decades that stroke may produce cardiac changes (echocardiographic, electrocardiographic, enzymatic). In ischemic stroke, systolic dysfunction is associated with a high risk of mortality during hospitalization. A recent study demonstrated that cardiac diastolic dysfunction could also accompany acute stroke besides the systolic dysfunction already pointed out by previous studies, being a predictive marker of acute cerebrovascular events. Increased sympathetic activity is contributory, inducing a reversible cardiac myocyte damage and cardiac enzyme surges. Some of the most frequent electrocardiographic abnormalities in stroke are ST segment abnormalities and various tachyarrhythmias (especially atrial fibrillation) and bradyarrhythmias. One can infer the importance of careful and continuous electrocardiographic monitoring of the stroke patient in order to identify these quite frequent electrocardiographic alterations, as it is well known that death due to cardiac arrhythmias is common among acute stroke patients. In order to increase the diagnostic yield, a high level of NTproBNP (N-terminal of the prohormone brain natriuretic peptide) may be used as a discriminant for the patients with a higher probability of cardiac arrhythmias and mortality at presentation, during hospitalization and on the long term. In such patients, cardiac monitoring techniques are more likely to reveal abnormalities. A high BNP level may have potentially important management implications as it may signal a worse prognosis and may prompt the undertaking of certain therapeutic measures. This review summarizes the possible pathological mechanisms of heart-brain connections and their clinical and therapeutical implications. ABBREVIATIONS: AF = atrial fibrillation, ECG = electrocardiography, HRV = heart rate variability, cTn = cardiac troponin, SAH = subarachnoid hemorrhage, CK-MB = creatine kinase-MB, BNP = brain natriuretic peptide, NT-proBNP = N-terminal of the prohormone brain natriuretic peptide, ANP = atrial natriuretic peptide, mRS = modified Rankin Scale, NIHSS = the National Institutes of Health Stroke Scale.

Favourable 5-year postdischarge survival of comatose patients resuscitated from out-of-hospital cardiac arrest, managed with immediate coronary angiogram on admission.

AIMS: On-admission coronary angiogram (CA) with angioplasty (percutaneous coronary intervention, PCI) may improve survival in patients resuscitated from out-of-hospital cardiac arrest (OHCA), but long-term survival data are scarce. We assessed long-term survival in OHCA patients managed with on-admission CA and PCI if indicated and compared survival rates in patients with/without acute coronary syndrome (ACS). METHODS: Retrospective single-centre study including patients aged ≥18 years resuscitated from an OHCA without noncardiac cause, with sustained return of spontaneous circulation, undergoing on-admission CA with PCI if indicated. ACS was diagnosed angiographically. Survival was recorded at hospital discharge and at 5-year follow up. Survival probability was estimated by Kaplan-Meier survival curves. RESULTS: A total of 300 comatose patients aged 56 years (IQR 48-67 years) were included, 36% with ST-segment elevation. All had on-admission CA; 31% had ACS. PCI was attempted in 91% of ACS patients and was successful in 93%. Hypothermia was performed in 84%. Survival to discharge was 32.3%. After discharge, 5-year survival was 81.7 ± 5.4%. Survival from admission to 5 years was 26.2 ± 2.8%. ACS patients had better survival to discharge (40.8%) compared with non-ACS patients (28.5%, p=0.047). After discharge, 5-year survival was 92.2 ± 5.4% for patients with ACS and 73.4 ± 8.6% without ACS (hazard ratio, HR, 2.7, 95% CI 0.8-8.9, p=0.1). Survival from admission to 5 years was 37.4 ± 5.2% for ACS patients, 20.7 ± 3.0%, for non-ACS patients (HR 1.5, 95% CI 1.12-2.0, p=0.0067). CONCLUSIONS: OHCA patients undergoing on-admission CA had a very favourable postdischarge survival. Patients with OHCA due to ACS had better survival to discharge at 5-year follow up than patients with OHCA due to other causes.

Fetal electrocardiogram enhancement in abdominal recordings: recording setup analysis.

The fetal electrocardiogram (fECG) obtained from the abdominal signals, to monitor the wellbeing of the fetus, is a weak signal, recorded by placing electrodes on the maternal abdomen surface. When recording the abdominal fECG, the main problem is to separate the fECG from the background noise, including the maternal electrocardiogram (mECG) and/or the power line interference (PLI), this leading to an improved fECG signal to noise ratio (SNR). This paper proposes and evaluates three types of recording configurations, having different reference location, and analyzes the performance of each recording setup, based on the corresponding SNRs, quantitatively evaluated. The fECG extraction is carried out in order to evaluate the performance of each proposed configuration.

Monitoring the fetal heart rate variations by means of time-variant multivariate analysis.

The analysis of the fetal heart rate (fHR) is important in detecting the fetal distress related with hypoxic episodes, noticed sometimes during the uterine activity, which can severely affect the fetus. Occasional synchrony between the fHR and the maternal heart rate (mHR) was reported and the mHR shows some variations during pregnancy and labor, especially when the contractions are very strong. The current study proposes a new strategy to investigate the relations between the fHR, the mHR and the uterine activity, by applying the time-variant Partial Directed Coherence (tvPDC).

Psychoemotional features of a doubtful disorder: functional dyspepsia.

OBJECTIVE: To delineate the psychological profile of individuals prone to FD-like symptoms (FDLS). METHOD: A triple questionnaire of 614 items (including psychological and medical ones) was given to 10192 respondents, the results were analyzed by means of Cronbach alpha, and Chi square test, together with an ad-hoc designed method that implied ranking and outliers detecting. RESULTS AND CONCLUSIONS: FDLS appears to be an accompanying feature of many (if not most) human emotions and are more frequent in anxious, timid, pessimistic, discontent, irascible, tense, success-doubting, unexpected-dreading individuals, bothered by persistent thoughts and tormented by the professional requirements and the lack of time. A higher degree of specificity might have: chiefly fear of failure, susceptibility, and tension, secondarily emotivity, fear of unpredictable events, sense of insufficient time, preoccupation with authority factors, and tendency to endure unacceptable situations, and also faulty patience and lack of punctuality. Rumination appears to be the psychological tendency most strongly associated with FD. Nocturnal epigastric pain seems to indicate a submissive nature but a rather responsibilities-free childhood, while early satiety is associated with inclination to work and responsibility and preoccupation with self-image. The superposition of FD symptoms with biliary and esophageal symptoms cast a doubt over the distinctness and even the materiality of the various functional digestive disorders.

Psychoemotional features in irritable bowel syndrome.

OBJECTIVE: To delineate the psychological profile of individuals with irritable bowel syndrome (IBS). METHOD: A triple questionnaire of 614 items (including psychological and medical ones) was given to 10192 respondents and the results were analyzed by means of Cronbach alpha and Chi square test, together with an ad-hoc designed method that implied ranking and outliers detecting. RESULTS AND CONCLUSIONS: Anxiety and depression are general psychological tendencies unspecifcally linked with IBS. Among the features with a relatively more specific correlation with IBS, tension has the strongest association, followed by the inclination to endure unacceptable situations, preoccupation for health, and susceptibility, and then by fear of failure and sense of demanding profession. IBS individuals readily accept a subordinate position, which may be connected to their history of tyrannical parents, and also to their preoccupation for authority factors. The sense of being treated unfairly by the authority persons during the school years nuances this last feature. Some features that bring some nuances to this psychological portrait are: contemplative nature and analyzing tendency, preoccupation with health issues, a reserved, unsociable, and precautious nature, clinging to known circumstances.

Questionnaire about psychology/disease correlation-I.

RATIONALE: The existing personality inventories are exploring too general psychological features so that the possible psychology/disease associations might be leveled out. OBJECTIVE: We attempt to build a tool to explore the possible correlation between certain psychological features and the most common internal disorders. METHOD: We have used two questionnaires containing many pairs of synonymous items (necessary for assessing the consistency of the answers). The items are divided into four main domains: preoccupation for the basal conditions of existence (health/ disease/ death, fear, money, lodging); interaction with other people; action, will/ volition, self-assertion; and preoccupation with the exterior. In this first article we are presenting the correlations between items of the first domain, based on the answers from our first 3138 respondents. RESULTS AND DISCUSSION: The concern about health is best reflected by general formulations. The desire for security is best expressed by items combining the worry about money and dwelling, and worst by items reflecting the eagerness to gain, keep or judiciously spend money. Among the various fears, those of future, darkness, and loneliness are better indicators of security concern. In assessing the anxiety about safety/ security, specific worries are more revelatory than the general ones. Precaution and inclination for order are the best indicators for the aspiration to stability. Poorer ones are the desire for cleanliness and the tendency to attachment. Health and security concerns seem to be consistently linked. The consistency evaluating system will be based upon pairs of synonymous items correlated with a10(-200) or less error probability.

Questionnaire about psychology/disease correlation - II.

OBJECTIVE: To further evaluate the adequacy of the items in our questionnaire aimed at unraveling the possible correlations between psychological features and internal disorders. This paper is dedicated to the items exploring the individual's interaction with other people. METHOD: The items are divided into several subdomains. For each subdomain, we have calculated the correlations between the items of the respective subdomain (inner associations) and with the items in other subdomains (outer associations) by means of chi square test or Fisher exact test as dictated by statistical reasons. We examined the answers from our first 10192 respondents. RESULTS AND CONCLUSIONS: Many inter-item correlations are the consequence of higher or lesser degrees of synonymy. Those within a given subdomain confirm the adequate allocation of items. Those bridging different subdomains may point either to incorrect assignments, or to semantic inclusion relations. Other results are not explicable by semantic similarity, and probably reveal psychological subtleties, such as: most individuals have a sense of undeservedness when badly treated by other people; those easily hurt by insults and humiliations have a propensity to timidity and/or emotivity; the subjects who shun conflicts are more prone to persistent thoughts, brooding people are more sensitive and more prone to conflicts, injustice-indignant people frequently get into conflict although they declare to be bothered by dissent etc. But at the heart of all the PFs in the Interaction-with-other-people domain there seems to be the sense of being undervalued, which should probably be the key issue to be addressed by any therapeutic interventions for diseases psychoemotionally determined by disturbed interpersonal relationships.

Abdominal fetal ECG enhancement by event synchronous canceller.

Abdominal signals (ADS) recorded from pregnant women represent an important tool for monitoring the fetal heart rate (FHR) variability and the well-being state of the fetus, mainly because it has the advantage of being noninvasive. Thus, no risk is given during recording either for the mother or for the fetus, but complex signal processing steps are necessary, mainly due to the presence of the maternal ECG in the ADS, in order to achieve a clean fetal electrocardiogram (fECG). The paper presents an improved application of the Event Synchronous Canceller (ESC) for maternal electrocardiogram (mECG) suppression. An adaptive mECG template which also includes the P and T waves is considered for the ESC algorithm. ESC is able to perfectly separate the mECG even though the fetal beats overlap with the maternal QRS complex (mQRS). The algorithm is applied both on real ADS recorded during pregnancy and on simulated ADS data; the latter now uses simulation of all signal and noise components, including the fetal and maternal ECG. The modified ESC shows good results in extracting a cleaned fECG signal that can help in reducing the inconsistency in interpretation of FHR. Thus the false positive diagnosis regarding the health status of fetus is strongly reduced.

Initial stability of cervical spine fixation: predictive value of a finite element model. Technical note.

The purpose of this study was to generate a validated finite element (FE) model of the human cervical spine to be used to analyze new implants. Digitized data obtained from computerized tomography scanning of a human cervical spine were used to generate a three-dimensional, anisotropic, linear C5-6 FE model by using a software package (ANSYS 5.4). Based on the intact model (FE/Intact), a second was generated by simulating an anterior cervical fusion and plate (ACFP) C5-6 model in which monocortical screws (FE/ACFP) were used. Loading of each FE model was simulated using pure moments of +/- 2.5 Nm in flexion/extension, axial left/right rotation, and left/right lateral bending. For validation of the models, their predicted C5-6 range of motion (ROM) was compared with the results of an earlier, corresponding in vitro study of six human spines, which were tested in the intact state and surgically altered at C5-6 with the same implants. The validated model was used to analyze the stabilizing effect of a new disc spacer, Cenius (Aesculap AG, Tuttlingen, Germany), as a stand-alone implant (FE/Cenius) and in combination with an anterior plate (FE/Cenius+ACFP). In addition, compression loads at the upper surface of the spacer were investigated using both models. As calculated by FE/Intact and FE/ACFP models, the ROM was within 1 standard deviation of the mean value of the corresponding in vitro measurements for each loading case. The FE/Cenius model predicted C5-6 ROM values of 5.5 degrees in flexion/extension, 3.1 degrees in axial rotation (left and right), and 2.9 degrees in lateral bending (left and right). Addition of an anterior plate resulted in a further decrease of ROM in each loading case. The FE/Cenius model predicted an increase of compression load in flexion and a decrease in extension, whereas in the FE/Cenius+ACFP model an increase of graft compression in extension and unloading of the graft in flexion were predicted. The current FE model predicted ROM values comparable with those obtained in vitro in the intact state as well as after simulation of an ACFP model. It predicted a stabilizing potential for a new cage, alone and in combination with an anterior plate system, and predicted the influence of both loading modality and additional instrumentation on the behavior of the interbody graft.