Oligoclonal bands in multiple sclerosis patients: worse prognosis?

INTRODUCTION: Cerebrospinal fluid (CSF) oligoclonal bands (OB) imply intrathecal immunoglobulin synthesis and B-cell immune process. There is scarce evidence of OB having a role in disease prognosis. The objective of the present study was to determine OB's prognostic value regarding disease progression. METHODS: Between January 1994 and January 2007, relapsing-remitting MS (RRMS) patients in which OB were determined were included. Demographic, clinical aspects and presence of OB were analyzed. We compared OB+ versus OB- patients regarding progression to expanded disability status scale (EDSS) of 6·0 and to secondary progressive MS (SPMS). Cox proportional hazard models were used to compare the outcome between groups. P values <0·05 were considered significant. RESULTS: One hundred and ninety-six patients were included. In 176 patients (90%), the CSF showed type II OB, 20 (10%) patients were OB negative. There were no differences between age, clinical presentation and EDSS at onset or in the immunomodulatory treatment received between OB+ and OB- patients. Sixty-two (31·6%) patients converted to SPMS during the follow-up, 59 (33·5%) were OB+ and 3 (15%) were OB-. EDSS of 6 was recorded in 56 (28·5%) patients during the follow-up; 54 (31%) were OB+ while only 2 (10%) OB- patients reached this outcome (reach SP phase, P = 0·032; HR: 2·2; 95% CI: 1·3-7·5 and EDSS of 6, P = 0·037; HR: 1·9; 95% CI: 1·3-8·5). CONCLUSION: We observed during the follow-up that OB- patients had a better prognosis and milder disability compared to OB+ patients.

[Mixed venous oxygen saturation monitoring in selected patients in heart surgery]. / Monitoraggio della SvO2 in pazienti selezionati in cardiochirurgia.

Continuous SvO2 was monitored in 25 patients undergoing cardiac surgery, selected by preoperative conditions, risk and perioperative indications. SvO2 trends were compared to cutaneous temperature, left atrial pressure and pulse oximetry. The results indicate a good correlation of all trends.

Etofenamate and transcutaneous electrical nerve stimulation treatment of painful spinal syndromes.

Thirty patients suffering from painful syndromes of the spine were admitted to a randomized controlled clinical trial. They were divided into two groups and treated either with transcutaneous electrical nerve stimulation (TENS), one application every other day, for 20 days or with TENS and an ointment containing etofenamate 10% gel, 3-5 cm daily on the day of TENS therapy, and the same dose twice daily on the other days. The associated therapy achieved, when compared with TENS alone, a statistically significant better outcome. Furthermore a marked improvement of symptoms was observed in a shorter period of time. Therapy was well tolerated and in only four cases mild, self-limiting, skin reactions were observed. On the basis of these results the use of etofenamate and TENS could represent a viable alternative to systemic nonsteroidal antiinflammatory drug therapy.

[Radical surgical correction of tetralogy of Fallot: comparison between the effects of isoproterenol in IPPV and spontaneous-ventilation after surgical treatment (author's transl)]. / Correzione radicale di tetralogia di Fallot: confronto degli effetti dell'isoproterenolol in IPPV e respiro spontaneo nel trattamento postoperatorio immediato.

The AA. studied 7 patients affected by Tetralogy of Fallot; their ages were between 4 and 20 years. At the end of the radical surgical correction we studied their haemodynamics. From the analysis of the data we found that using beta-agonist drugs (Isuprel 0.05 mcg x Kg x min) there were no change in the haemodynamic data when the patients were kept under positive pressure ventilation. In spontaneous ventilation we observed that the same data can raise the cardiac index of 22%, lower the total peripheral resistances (20%) and the pulmonary vascular resistances (8%) and the intrapulmonary shunt (8%).