A pilot study of the effect of pantothenic acid in the treatment of post-operative ileus: results from an orthopedic surgical department.

OBJECTIVES: Post-operative ileus can also occur in other types of surgery not strictly related to abdomen. The objective of this study was to investigate the efficacy of pantothenic acid administration to stimulate intestinal peristalsis in case of post-operative ileus and estimate the most effective dose. This vitamin can be used for the treatment of chronic atonic intestine or for chronic constipation, but therapeutic indications are not precise in these conditions. PATIENTS AND METHODS: This pilot study has used patients divided in groups treated in post-operative period with physiological solution for patients in control group (Placebo) and Dexpantenolo, which is a derivative in alcohol of pantothenic acid, for all the actively treated patients. The treatments were administered intravenously during the second and third post-operative day, according to the treatment schedule. RESULTS: 60 patients were recruited and they were allocated to five treatment groups or one control group. For males, the median time of the first bowel evacuation was 90 hours while for females the median time was 84 hours (p=0.891). For patients who received a spinal anesthetic, the median time was 72 hours, while for those who received a peridural anesthetic the median time was 96 hours (p=0.571). Between six treatment groups, instead, there is a significant difference between the median times from the operation to the first bowel evacuation (p<0.001). Linear regression model obtained using as outcome evacuation hours after surgery show that only variable which significantly affects time between operation and the first bowel evacuation is treatment dose (Beta = -0.868, p<0.001). DISCUSSION: This study would seem to indicate that pantothenic acid is effective for treatment of post-operative intestinal ileus; there is a dose response relationship between pantothenic acid and the decreasing time from surgical operation to first bowel evacuation. However, this study is preliminary; further studies are necessary, preferably randomized and with a larger number of patients.

Primary antiphospholipid syndrome: two case reports, one with histological examination of skin, peripheral nerve and muscle.

Two cases of primary antiphospholipid antibody syndrome are reported. One patient presented multiple abortions and epilepsy. The second patient was affected by a brain vascular accident, with a residual hemiparesis. Both cases showed livedo reticularis in arms, NMR evidence of diffuse lesions of the white matter, high serum levels of anticardiolipin antibodies and cardiopathy. Lupus anticoagulant was also found in the serum of the first patient, and cortisone and antiaggregants enabled her to reach term in a fifth pregnancy after four miscarriages. In the other case histological examination of specimens of skin, peripheral nerve and skeletal muscle revealed occlusive, non arteriosclerotic vasculopathy and an absence of inflammatory lesions. Histological study has rarely been performed in primary antiphospholipid syndrome but suggests that the mechanism of thrombosis is not vascular; in our subjects it revealed findings similar to those in Sneddon syndrome.

Evaluation of the influence of illiteracy on neuropsychological performances by elderly persons.

The aim of the present study was to verify the role of the primary notions acquired in early school in the formation of a general strategy in elaboration of information. For this purpose we selected a tiny rural village in southern Italy which comprises a substantial number of elderly persons having very little formal schooling. These subjects were screened using a test battery composed of classic neuropsychological tests and reaction-time tests. In the subjects studied we observed a significant correlation between the amount of education and the neuropsychological performances, although no such correlation existed for reaction times. Subjects having little schooling (up to 3 years) performed better than the illiterate persons on the Constructional Apraxia test and on the Raven Matrices. However, the reaction times were similar in these groups. On this basis we claim that reaction-time tests might form a basic tool in evaluating cognitive performances of persons with very little schooling. Further, the primary notions learned during the first few years of schooling induce an improvement in mental strategies that is well-preserved in the normal aging process.

Sensory-motor hereditary neuropathy with early onset. A case report.

The early onset sensory motor hereditary neuropathy (HSMN) can be divided into two forms: the early onset type (HSMN type III or Dejerine-Sottas) and the congenital hypomyelinating neuropathy (CHN). In both cases, abnormalities of myelination are present in peripheral nerves. Symptoms include hypotonia, weakness, hypotrophy, and areflexia. Skeletal changes may be present. In CHN symptoms may be present at birth and are rapidly progressive. Many authors actually consider the two forms different. The diagnosis is based only on clinical and neuropathological criteria. Here we report a case with a typical phenotype of HSMN type III but with peripheral nerve bioptic findings suggesting a CHN.

Supraspinal influences on recurrent inhibition in humans. Paralysis of descending control of Renshaw cells in patients with mental retardation.

The recurrent inhibition of alpha motoneurons was studied in 8 mentally retarded subjects (age 16-35 years), six of whom also had non-pyramidal or extrapyramidal motor alterations, manifesting as rigid and inflexible voluntary and/or postural movements. Despite a similar degree of mental retardation (Raven spatial general intelligence test), the other 2 cases showed much more modest changes in motor behavior. At rest, recurrent inhibition on soleus motoneurons was normal in all patients. In the 6 cases exhibiting more severe motor abnormality, the changes in Renshaw cell excitability, which occur during postural or voluntary contractions in normal subjects, were not found. This expressed the lack of supraspinal influences on Renshaw cells in these patients. On the other hand, supraspinal modulating influences on Renshaw cells were virtually normal in the remaining 2 patients. The absence of excitability changes of recurrent inhibition to postural or voluntary movements is discussed in relation to the abnormality of motor behavior observed in these patients. In addition, since paralysis of adaptive changes of recurrent inhibition has so far only been described in spastic subjects, the present study demonstrates that the descending pathways, which control recurrent inhibition gain, are different from those which, when damaged, lead to spasticity. Finally, our results indicate that the changes in motor behavior often associated with mental retardation cannot be regarded merely as the consequence of defective motor learning.

Archaic reflexes in normal elderly people.

The AA. have considered the incidence of some primitive reflexes in the "normal" old people. 120 subjects have been examined (60 M and 60 F) between the 70 to 90 age-group. The patients have been selected on the basis of the absence of neurologic disorders, psychiatric and systematic or dysmetabolic diseases. All the subjects undergo a standard neurologic examination. Results show that the examined reflexes can be present in normal old people. These signs seem to be related to the physiological ageing of the nervous system.

[Memory. Cognitive, anatomic and pathologic models]. / La memoria. I modelli cognitivi, le basi anatomiche, la patologia.

This overview deals with the neuropsychology of memory. First cognitive models proposed for primary and secondary memory are reported, particularly the working memory theory and episodic/semantic distinction are discussed. Briefly the modern point of view about the anatomical bases of memory functions are reported with stressing above all the role of limbic structures. Lastly the pathology of both primary and secondary memory is dealt with, trying to abstract the clinical features of different syndromes.

The idiopathic hypereosinophilic syndrome. Clinical, electrophysiological and histological study of a case.

A case of idiopathic hypereosinophilic syndrome (HES) is reported. The disease started at the age of 31, with polyneuropathic-like symptoms and disorders of the gastrointestinal tract. Hypereosinophilia and leukocytosis were observed. Instrumental investigation of the digestive tract showed esophagitis, a peptic ulceration, signs of chronic rectocolitis. Charcot-Leyden crystals were present in feces. Peripheral nervous system changes were seen with EMG and nerve conduction studies. Muscle biopsy findings were in agreement with the electrophysiological data and showed inflammatory abnormalities. Qualitative histology and teased nerve fiber studies of sural nerve indicated axonal degeneration. Protein substances derived from eosinophils degranulation may account for the disturbances observed in various systems and organs.