General practitioners' management of symptomatic uncomplicated diverticular disease of the colon by using rifaximin, a non-adsorbable antibiotic.

OBJECTIVE: Symptomatic uncomplicated diverticular disease of the colon (SUDD) is generally managed by gastroenterologists rather than General Practitioners (GPs). The aim of this study was to assess the efficacy of the treatment of SUDD with rifaximin, a non-absorbable antibiotic, in a primary care setting by GPs. PATIENTS AND METHODS: This retrospective, observational study investigated the use of rifaximin at a dose of 400 mg b.i.d. for 5, 7 or 10 days monthly, up to 3 months. The symptoms were reported by the patients using a visual analogic scale (VAS) of 0-10. RESULTS: 286 SUDD patients were enrolled (44.4% of men, average age 70.92±10.98). Respectively, 15 (5.2%) patients received the treatment for 5 days, 205 (71.7%) for 7 days and 66 (23.1%) for 10 days. After three months, a significant reduction of VAS score was observed in almost all symptoms assessed: 135 (47.2%) patients reported no abdominal pain (p<0.001) and 23 (8.1%) reported no symptom. Adverse events related to the treatment were recorded in 3 (1.04%) patients, all of them mild and not requiring interruption of the treatment. Acute diverticulitis occurred in 9 (3.1%) patients, but only 2 of them [0.7% (n=2)] underwent surgery due to complicated diverticulitis. Analysis within the different treatment groups (5, 7 and 10 days) shows that rifaximin treatment is effective in reducing the severity of symptoms in almost all groups except for the constipation in the 5-day group. CONCLUSIONS: Rifaximin can be effectively used by GPs in real-life for the management of SUDD.

Episodes of flushing, dyspnea and hypertension after carotid stenting for severe carotid stenosis.

INTRODUCTION: Carotid angioplasty and stenting (CAS) is a treatment option for carotid stenosis in high surgical risk patients. As it implies instrumentation of the carotid bulb, baroreceptors dysfunction may be provoked with consequent hemodynamic instability. REPORT: An 83-year-old woman treated by CAS presented with episodes of flushing, dyspnea and palpitations accompanied by transitory desaturation, hypertension, agitation and anxiety. Symptoms started 12h after the procedure. Each episode lasted 10 min. Five episodes in 3 days were observed. DISCUSSION: A dysfunction of the carotid baroreceptors and chemoreceptors was hypothesized.

Can MR imaging diagnose adult-onset Alexander disease?

BACKGROUND AND PURPOSE: In recent years, the discovery that mutations in the glial fibrillary acidic protein gene (GFAP) were responsible for Alexander disease (AD) brought recognition of adult cases. The purpose of this study was to demonstrate that MR imaging allows identification of cases of AD with adult onset (AOAD), which are remarkably different from infantile cases. MATERIALS AND METHODS: In this retrospective study, brain and spinal cord MR imaging studies of 11 patients with AOAD (7 men, 4 women; age range, 26-64 years; mean age, 43.6 years), all but 1 genetically confirmed, were reviewed. Diffusion and spectroscopic investigations were available in 6 patients each. RESULTS: Atrophy and changes in signal intensity in the medulla oblongata and upper cervical spinal cord were present in 11 of 11 cases and were the diagnostic features of AOAD. Minimal to moderate supratentorial periventricular abnormalities were seen in 8 patients but were absent in the 3 oldest patients. In these patients, postcontrast enhancement was also absent. Mean diffusivity was not altered except in abnormal white matter (WM). Increase in myo-inositol (mIns) was also restricted to abnormal periventricular WM. CONCLUSIONS: Awareness of the MR pattern described allows an effective selection of the patients who need genetic investigations for the GFAP gene. This MR pattern even led to identification of asymptomatic cases and should be regarded as highly characteristic of AOAD.

Chronic alcohol use and first symptomatic epileptic seizures.

OBJECTIVE: To establish whether chronic alcoholism and alcohol consumption are risk factors for developing a first symptomatic epileptic seizure. METHODS: Multicentre case-control study of 293 patients (160 men, 133 women) with a first seizure symptomatic (either acute or remote) of head trauma, stroke, or brain tumour, matched to 444 hospital controls for centre, sex, age (+/-5 years), and underlying pathology. RESULTS: The risk of first seizure in alcoholics was no higher than in non-alcoholics for men (odds ratio 1.2, 95% confidence interval 0.4 to 3.2) or women (1.5, 0.1 to 54.4). The odds ratio (both sexes) was 1.2 (0.8 to 1.7) for an average intake of absolute alcohol of 1-25 g/day, 0.9 (0.5 to 1.5) for 26-50 g/day, 1.6 (0.8 to 3.0) for 51-100 g/day, and 1.4 (0.5 to 3.5) for >100 g/day. CONCLUSIONS: We found no evidence of an association between alcohol use or alcoholism and a first symptomatic seizure.

[Systemic lupus erythematosus and pregnancy. Report of a clinical case]. / Lupus eritematoso sistemico e gravidanza. Presentazione di un caso clinico.

After a review of the literature, we present a case of a twice-pregnant patient who, affected by SLE, had successful outcomes for the conceptuses with a therapy based on cloroquine first and corticosteroids subsequently. The two pregnancies, however, seemed to be correlated with the temporary exacerbation of disease activity.

24-hour study of gastric acidity in normal subjects and in cholecystectomized patients using continuous pH monitoring.

The circadian pattern of gastric acidity was assessed in 53 normal subjects and in 33 patients with prior cholecystectomy using continuous pH monitoring. The 24-hour and nocturnal median pH values were significantly higher in cholecystectomized patients than in controls (p less than 0.03 and p less than 0.001, respectively). In the operated group there were higher median pHs also in the after-dinner (p less than 0.003) and after-lunch (p less than 0.01) periods, while no difference between the two populations was observed after breakfast. The percentage of 24-hour pH readings above 4.0 units was markedly higher (p approximately 0) in postcholecystectomy patients. We conclude that circadian gastric acidity is reduced in cholecystectomized patients with respect to healthy subjects, both in nocturnal and postprandial states. Episodes of duodenogastric reflux may be responsible for this, but impaired acid production related to advanced age (14 patients were more than 60 years old) or to fundic chronic atrophic gastritis (5 cases) may also account for the elevation of pH values in our postcholecystectomy patients.

Comparison of the effects of placebo, ranitidine, famotidine and nizatidine on intragastric acidity by means of continuous pH recording.

The effects of single daily doses of placebo, nizatidine 300 mg, ranitidine 300 mg and famotidine 40 mg, given at 22.00 h, have been compared in 16 patients with healed duodenal ulcers. Each of them underwent the above treatment on four separate occasions. The three H2 receptor antagonists showed a significantly higher acid inhibition than placebo (p less than 0.003) throughout the whole 24-hour period. Famotidine turned out to be more effective than nizatidine (p less than 0.02) in reducing circadian acidity, while there was no difference between ranitidine and nizatidine. The effects of the three H2 blockers on overnight acidity (from 23.00 to 07.00) were similar to each other, whereas both famotidine (p less than 0.003) and ranitidine (p less than 0.02) produced more anacidity than nizatidine during the morning hours (from 07.00 to 12.00). The time period elapsed in consecutive minutes above 5.0 pH units during drug-related events was significantly longer with both famotidine (p less than 0.01) and ranitidine (p less than 0.01) compared to nizatidine. Therefore in the recommended dosages for clinical use the acid suppression of nizatidine was significantly shorter-lasting than that of both ranitidine and famotidine. The major change is represented by the lack of carryover effect of nizatidine on morning acidity.

[Evoked potentials in 3 cases of dystrophia myotonica with neuropathic variant]. / Studio dei potenziali evocati in tre casi di distrofia miotonica con variante neuropatica.

3 patients with Myotonic Dystrophy (MD) and associated leg motor neuropathy, confirmed in two of them by biopsy of one branch of lateral popliteal nerve, were studied with Multimodality Evoked Potentials. Abnormalities of VEPs and BAEPs, in agreement with literature, were found in all patients. Median SEP peripheral conduction velocity, N9-N13 and N13-N20 conduction time were normal. On the contrary, all patients showed reduced lower limb SEP peripheral conduction velocity niloutstanding normal nerve biopsy. These results suggest in MD neurological abnormalities occur outside muscular system, too.

Parasympathetic function in Huntington's disease.

Parasympathetic function in 7 Huntington's chorea patients with a duration of the disease ranging from 1 to 20 years, was evaluated by studying R-R intervals during quiet and deep breathing and Valsalva manoeuvre. All 7 patients were free of neuropathy, orthostatic hypotension, heart or lung disease and had had no medication for at least 15 days prior to hospitalization. Seven normal subjects served as controls. On the whole, the responses of the Huntington's chorea patients were not significantly different from those of the controls. Abnormal responses to all the tests were received in only one patient and a low R-R variability during deep breathing in the youngest patients. Unlike other Central Nervous System degenerative disorders, in Huntington's disease parasympathetic autonomy seems to be sufficiently preserved.

Central and peripheral involvement in hemodialysed subjects: neurophysiological and nephrological relationships.

Nerve conduction velocity and visual evoked potential studies were conducted in 31 patients with chronic renal failure undergoing periodic hemodialysis. The results indicate damage to the central nervous system, such as delayed P100 wave, even in the absence of clinical signs, and to the peripheral nervous system, such as distal sensorimotor neuropathy. The degree of peripheral involvement correlates with the duration of dialysis and with some blood chemistry values but not with the evoked potential parameters. There is no correlation between central and peripheral nervous damage, which presumably points to a difference in pathogenesis.

Parasympathetic assessment in Parkinson's disease.

There is little evidence of autonomic dysfunction in PD, although autonomic disturbance was included in the original description by J. Parkinson. In addition, there are no data for de novo PD patients. We selected 14 de novo parkinsonians (seven men and seven women), aged 62.7 +/- 8.2 years, with mild disease (stage 1 through 2 on the Hoehn and Yahr's scale), without history of diabetes, heart disease, or alcoholism, and without neuropathy or orthostatic hypotension. Fourteen age- and sex-matched normal persons were controls. We found a highly significant difference in the respiratory sinus arrhythmias during deep breathing (p less than 0.01); the basal heart rate, the respiratory sinus arrhythmias during quiet breathing, and the Valsalva ratios did not differ statistically, however. In the absence of neuropathy and orthostatic hypotension and in the presence of normal Valsalva ratios, we believe that the abnormality found by us may apply only to parasympathetic dysfunction, perhaps at a central level. In addition, the abnormality seems to be independent of stage and therapy.

Hereditary motor neuropathy, distal type: electrophysiological and pathological studies of a case.

A case of HMN, distal type transmitted as autosomal dominant is described. Clinical findings appear to be consistent with a peroneal muscular atrophy, indistinguishable from HMSN types I and II. The electrophysiological data reveal a pathological involvement of the anterior horns, whereas sensory and motor conduction are normal. A muscle biopsy showed neurogenic atrophy, while the morphology of the sural nerve was normal.

Occurrence of pituitary adenoma in craniofacial fibrous dysplasia: a neuroendocrine and neuroradiological case study.

An 18 year old man with fibrous dysplasia of bone and several endocrine abnormalities was investigated. Laboratory tests showed high levels of prolactin, TSH and GH and low levels of testosterone and LH. TRH and GnRH showed normal responsiveness of the pituitary in spite of the high hormonal levels. The circadian rhythms disclosed no abnormalities of hypothalamic control. The neuroradiological study revealed pathological tissue but no positive sign of a pituitary adenoma, although the sella turcica polytomograms did suggest erosion of the floor. Our data are compatible with the presence of a mixed adenoma or adenomas of the pituitary. We emphasize the importance of a correct study, including neuroradiological and neuroendocrine investigations, in patients with fibrous dysplasia of bone.