Urgency of micturition and detrusor contractility in men with prostatic obstruction and overactive bladders.

AIMS: In men with prostatic obstruction and detrusor overactivity (DO), to ascertain whether urgency of micturition affects bladder contractility. MATERIALS AND METHODS: We urodynamically assessed five groups of 20 men each who had bladder outflow obstruction (BOO) from benign prostatic enlargement-Groups 1 (with no DO and no urgency), 2 (with DO and no urgency), 3A (with DO and moderate urgency), 3B (with DO and severe urgency), and 4 (with DO, severe urgency and chronic ischemic cerebral lesions). Urgency was graded as moderate or severe by the ability to avert an urgent void at cystometry for > or =2 or <2 min, respectively. BOO was assessed by the "Abrams-Griffiths number" (AG) and bladder contractility by the parameters PIP and WF(max). RESULTS: AG did not differ significantly in Groups 2, 3A, and 3B, proved higher in such groups than in Group 1, and was nearly the same in Groups 1 and 4. PIP and WF(max) were significantly higher in Groups 2, 3A, and 3B than in Groups 1 and 4, had the highest levels in Group 3B, and did not differ significantly in Groups 1-4 and 2-3A. CONCLUSIONS: In DO patients with prostatic obstruction there seems to be a DO-related facilitation of bladder contractility. In the same patients, severe urgency of micturition might over-amplify (i.e., enhance a DO-related facilitation of) bladder contractility, provided there are no neurogenic (chronic ischemic cerebral) lesions.

Voiding urgency and detrusor contractility in women with overactive bladders.

AIMS: To check whether the contractility of overactive bladders would be affected by voiding urgency. METHODS: We urodynamically studied 100 women: 20 normal controls (group 1), 60 patients with idiopathic detrusor overactivity (DO), and 20 with neurogenic DO from intracerebral lesions. The idiopathic DO groups 2A (n = 20), 2B (n = 20), and 3 (n = 20) had moderate, severe, and no voiding urgency, respectively. The neurogenic DO group 4 had severe urgency. The delay time of urgent void at cystometry (2 minutes or more or, respectively, less than 2 minutes) defined moderate or severe urgency. Detrusor contractility was defined by the maximum bladder external voiding power (WF(max)). RESULTS: WF(max) was higher in the idiopathic DO patients than in the controls, had the highest values in group 2B, and did not differ significantly between groups 1-4 and 2A-3. CONCLUSIONS: We inferred from our data that idiopathic DO suggests a facilitation of voiding contractions and that such facilitation might be centrally amplified by severe urgency. This amplifying effect would probably be impaired in cases of neurogenic DO from intracerebral lesions.

Lexical and semantic factors influencing picture naming in aphasia.

Picture naming requires early visual analysis, accessing stored structural knowledge, semantic activation, and lexical retrieval. We tested the effect of perceptual, lexical, and semantic variables on the performance of aphasics in picture naming and assessed prevalence of natural categories vs artifact dissociations. Forty-nine aphasics were asked to name 60 pictures, from three natural (animals, fruits, and vegetables) and three artificial categories (tools, furniture, and vehicles). For each item visual (drawing complexity, image agreement), semantic (prototypicality, concept familiarity) and lexical variables (word frequency, name agreement) were available. The effect of these variables showed individual differences; altogether, visual complexity had little influence, whereas lexical and semantic variables were more influential. Name agreement was most important, followed by word frequency. On a multiple single case analysis 10 patients (20%) showed a natural/artificial category dissociation. Five of the six subjects faring better with artifacts were males, and all of four patients faring better with natural categories were females. Interpretations of this finding are discussed.

Limitations of the computerized laryngeal analyzer (CLA) in the assessment of the swallowing mechanism.

This study was devised to assess the repeatability of measurements obtained from the Computerized Laryngeal Analyzer (CLA), a commercial system which monitors global laryngeal activity through a piezoelectric transducer positioned at the level of the thyroid cartilage. Twenty-two healthy subjects (37+/-7 yr) were asked to repeat three consecutive times the deglutition of three types of bolus: dry (saliva only), liquid (10 ml water) and solid (1 cm(3) biscuit). The whole recording session was repeated 4+/-3 days apart. Two parameters were considered: amplitude and duration of the deglutition. Both intra- and inter-sessions repeatability were assessed by the standard error of measurement. The amplitude measurements were often found to be clipped at 100 mV, making duration the only parameter suitable for analysis. The duration was homogenous for the three types of bolus and no trend effect was found either intra- or inter-sessions. Inter-sessions repeatability was significantly lower than the intra-session one (P<0.05). As a practical implication, a change in duration >/=1 s (=65% of the observed mean value) between two separate measurements is required in order to be 95% confident that it is not due to chance alone. We conclude that the observed limitations in the measurements provided by the CLA system, in conjunction with its intrinsic characteristic of providing only an uncalibrated measurement of global laryngeal activity, seriously question the possibility of using the CLA system either as a diagnostic tool or as a substitute of the gold standard method (videofluorography).

Syntactic comprehension deficits in agrammatism.

Eleven agrammatic and 16 fluent aphasic patients were given a comprehension task consisting of simple, active and passive reversible sentences. The purpose of the study is to reconsider the comprehension disorders in agrammatism, and particularly of passive reversible sentences, to test to what extent Grodzinsky's trace deletion hypothesis (TDH) is generalizable to other types of NP-movement, and finally to ascertain whether the pattern of impairment observed in agrammatism differs from that of fluent aphasic patients. The study confirms that trace analysis may be selectively impaired in agrammatism. However, this deficit is not the only mechanism underlying comprehension disorders and cannot be said to occur in all agrammatic patients. Comprehension disorders also involve the processing of clitic object pronouns which also underly NP-movement. Finally, the impairment found in fluent aphasic patients differs, both in type and severity, from that of agrammatic patients, thus confirming the peculiar aspects of the agrammatic comprehension deficit suggested by Grodzinsky's TDH.

Peripheral plasma amino acid abnormalities in rehabilitation patients with severe brain injury.

OBJECTIVE: Acute severe brain injury causes an increased mobilization of amino acids from tissue. The plasma amino acid profile of patients undergoing rehabilitation after brain injury is unknown. This study was aimed at delineating the plasma amino acid profile of rehabilitation patients with brain injury. DESIGN: Peripheral plasma aminogram, lactate, pyruvate, glycerol, ketone body, and carnitine concentrations were determined in 11 patients with brain injury (34.6+/-15 years old, 60+/-16.8 days after injury) and in 8 controls. Resting energy expenditure and nitrogen balance were also determined. RESULTS: (1) All essential amino acids and about 50% of nonessential amino acids were significantly lower in brain injury patients than in controls (p < .05). (2) Plasma amino acids were lower irrespective of either energy and protein intake or nitrogen balance. (3) Total carnitine concentration and esterified/free carnitine ratio were higher in brain injury patients than in controls (p < .05). CONCLUSIONS: Rehabilitation patients with brain injury may have an important reduction of their plasma aminogram. Muscle tissue depletion and the persistence of a hypercatabolic state caused by subclinical infections, pressure sores, and immobility may contribute to this reduction.

[The evaluation of aphasic deficits for the definition of a targetted logotherapeutic treatment]. / Valutazione dei deficit afasici per la definizione di un trattamento logoterapico mirato.

The Aachener Aphasie Test (AAT) is the major German test for the diagnosis of aphasic disorders. The test is easy to use and is valid and reliable for the diagnosis of aphasia and its severity and to evaluate the recovery of the aphasic disorder after language rehabilitation. The AAT is, however, not sufficient to define cognitively sound logotherapeutic treatment. The use of tasks which are based on cognitive functional models allows the identification of specific processing levels that have been damaged by a cerebral lesion, and the definition of a focussed rehabilitation plan. In this paper, we will discuss the results of a cognitive neurolinguistic treatment in a patient who suffered of Broca's aphasia with agrammatism and phonological dyslexia.

[A computerized endurance test: efficacy of pelvic floor rehabilitation treatment in patients with stress incontinence]. / Test di endurance computerizzato: efficacia del trattamento riabilitativo del pavimento pelvico in pazienti affette da stress incontinence.

In the present study the authors wanted to transfer rigorous methods of study, already in use in other sectors (sports, medicine, isokinetic work, etc.) of the validity of interventions made and their effectiveness, into an "emerging" field, that of perineal rehabilitation. 15 female patients, aged between 35 and 45, affected by stress incontinence underwent a baseline clinico-instrumental evaluation of the perineal floor including a computerized test of endurance. The patients then embarked upon a standardized rehabilitative perineal training lasting a month and at the end underwent an identical evaluation as that performed at the outset. Statistical analysis of the results obtained showed an objective improvement in the parameters considered (endovaginal pressure and its variations during a series of intermittent static contractions) quantitatively supporting clinical evidence.

Imitating gesture learning in apraxic patients.

The authors studied a group of patients with ideomotor apraxia (IMA) to verify if these patients had some difficulties in gesture learning task in respect to non-apraxic patients and normal control subjects. The results show that learning difficulties are present in patients with IMA. Apraxic patients are not able to perform the gestures in the testing situation and non in everyday life; this fact would demonstrate that the motor pattern still exists in these patients but is inaccessible unless elicited by a strong stimulation.

Effects of intravenous high dose co-dergocrine mesylate ('Hydergine') in elderly patients with severe multi-infarct dementia: a double-blind, placebo-controlled trial.

A double-blind, placebo-controlled trial was carried out in 40 patients affected by multi-infarct dementia to see if a daily intravenous infusion of 3 mg co-dergocrine mesylate ('Hydergine') over 14 days would improve severely deteriorated elderly patients and shorten the latent period (3 months) which is observed when the drug is given orally. All the patients had severe mental impairment, psychological deficit or altered consciousness. A Hachinski score of 7 or more, and a cumulative score of at least 12 points on SCAG scale Items 1, 2 and 4 (anxiety/depression) and/or Items 5, 6 and 8 (alertness/confusion) were required for admission. After 1 week of intravenous infusion of placebo, patients were randomly allocated to treatment with co-dergocrine mesylate or placebo, from Day 1 to Day 14. The solutions were infused over a period of 2 hours. During the follow-up period from Day 15 to Day 21, the patients did not receive any treatment. Thirty-six patients (17 on co-dergocrine mesylate, 19 on placebo) completed the study. The results, as rated on the SCAG scale, indicated significant improvements, in favour of co-dergocrine mesylate, in cognitive dysfunction, mood depression, withdrawal and overall impression. Furthermore, the factor fatigue on the Nowlis scale and clinical global assessments by physicians also showed significant advantages of the co-dergocrine mesylate group over placebo. Nine out of 17 co-dergocrine mesylate patients complained of side-effects, usually experienced during infusion; they consisted mainly of nausea (6 patients), gastric discomfort (2 patients), and tremor, nasal congestion, flushing, hypotension and hypertension (1 patient each). Despite the appearance of side-effects, general tolerability was rated as 'good' by both physicians and patients. It is concluded, therefore, that intravenous high dose co-dergocrine mesylate treatment has a fast and clinically relevant effect on the key clinical symptoms of multi-infarct dementia.

[Deep cerebral lesions: neuro-rehabilitative aspects]. / Lesioni cerebrali profonde: aspetti neuroriabilitativi.

All 21 patients under rehabilitative care, who were followed by the authors, suffered from language and motor deficits, the latter being part of a deficient hemi-syndrome caused by deep vascular cerebral lesions, in both thalamic (8 patients) and basal ganglia (13 patients) sites. All subjects, on entry and 3 months after treatment, underwent a language test, routine tests, De Renzi-Vignolo's Token test and neuromotor evaluation, to study muscle tone, the presence of pathological synergies, sensitivity, active motility and functionality. On entry, patients with thalamic lesions had fewer problems than those with lesions of the basal ganglia at both symbolic and neuromotor levels. A better recovery of the functional capacities in the treatment period was thus achieved.

Pathological brain ageing: evaluation of the efficacy of a pharmacological aid.

The efficacy of a molecule active at metabolic, neurotransmitter and membrane levels was evaluated in a group of 20 patients with typical involutional symptoms, who came under the care of the rehabilitation therapist for their concomitant decrease of motor activities. All subjects were treated with 1.5 g/day L-acetylcarnitine per os for 6 months, and subjected to the evaluation of cognitive ability (MMS), depression (HDRS), and behavioral and self-sufficiency performances (SCAG), at baseline (t0), after 90 days (t1), and after 180 days (t2). Whereas the basal evaluation showed disorders at all levels, the treatment gave a statistically significant improvement of all performances at both t1 and t2, achieving an effective recovery of the patients' quality of life, an improved participation in family and social life, and a diminished inertness in motor activity, which was the reason why they were studied.

[Visual feedback on the maximal momentum of the voluntary tibio-tarsal dorsal flexion in hemiplegic patients]. / Studio di un feedback visivo sul momento massimo volontario di flessione dorsale della tibio-tarsica in pazienti emiplegici.

In both sides (healthy and plegic) of an hemiplegic group the evaluation of tibio-tarsic isometric torque (with and without the aid of a visual feed-back) was carried out. No significative differences in the "total biological work" during a series of ten contractions, in the two cases were found. A marked increase of the pin-point single contraction in the hemiplegic side was noted. A smoothing in the decrement of the total biological work during serial contractions was also found.

Evaluation of the effect of vincamine teprosilate on behavioural performances of patients affected with chronic cerebrovascular disease.

With a view to determining the efficacy of Teproside versus placebo in patients affected with cerebrovascular disease, 30 subjects, selected at the Montescano Medical Rehabilitation Centre, were randomly divided into two groups of 15 subjects each. After a two-week wash-out period, the first group was treated with placebo and the second with vincamine teprosilate (Teproside) at 120 mg daily, both for a period of 90 days. The assessment of each patient took place in two stages, one at the beginning and one at the end of treatment. It was performed according to both clinical criteria (including an interview with the patient and his family) and neuro-psychological criteria (memory tests, perceptive-spatial and logical functions tests). The data obtained showed a significant improvement of the behavioural performance, the mnemonic ability and the perceptive-motor activity in the Teproside group treated.

[Electroanalgesia by transcutaneous stimulation (TNS). Response to the naloxone test]. / Elettroanalgesia da stimolazione transcutanea (TNS). Risposta al test al naloxone.

The authors, after a review of the literature about TNS, suggest the comparison between three different TNS techniques from two points of view: A) Pain relief estimate; B) Response to Naloxone Test. To this purpose a impulse generator delivered a biphasic square-wave stimulus with duration of 0.40 msec and amplitude (peak to peak) to 130 mVolt, was used. TNS techniques used are so characterized 1) Frequency 80 Hz; Duration 30'; 2) Frequency 80 Hz; Duration over 120'; 3) Frequency 2/4 Hz; Duration over 120'. Although the techniques used for Group (1) provided the best numerical result in the evaluation of the pain relief, endorphine activity cannot be maintained owing to Naloxone Test negativity. Pain relief of (2) and (3) Group was statistically significant although not numerically at the same level of (1) Group. In the laters, on the contrary, positivity of Naloxone Test seems to hint at the activation of endorphine. This fact suggest to the authors hypothesis in the purpose to spot TNS site of action.