Effects of the abrupt switch from solution to modified-release granule formulation of valproate.

BACKGROUND: A new modified-release (MR) granule formulation of valproate (VPA) has been recently developed for the treatment of children with epilepsy. It consists of tasteless microspheres that can be sprinkled on soft foods and easily swallowed. There are no data on the effectiveness of this formulation in pediatric age. AIM OF THE STUDY: To evaluate the effects of the abrupt switch from solution to VPA MR granules in children undergoing chronic treatment. METHODS: We enrolled children receiving VPA solution as sole or adjunctive therapy and switched them to MR granules at identical dosages. VPA blood level, treatment efficacy (clinical and EEG data), tolerability (adverse reactions), palatability, ease of administration, and compliance were evaluated before switching (T0) and after 4 weeks (T1). RESULTS: Out of 112 enrolled children, 108 (96.4%) completed the evaluation. We observed no significant differences between the patients at T0 and T1 in VPA blood levels, treatment efficacy, tolerability, and compliance. MR granules were judged more palatable (P < 0.05) and easier to administer (P < 0.05) than solution by children and parents. At 6-month follow-up, all patients continued to use MR granules. CONCLUSION: Modified-release granule formulation of VPA may be a reliable alternative to solution for its convenience of use.

Spectral analysis of visual potentials evoked by pattern-reversal checkerboard in juvenile patients with headache.

Changes in visual evoked potentials, mainly affecting the amplitude of the major positive wave, are referred to by many authors and are related to the pathophysiological basis of primary headache. We performed both transient pattern-reversal visual evoked potentials and spectral analysis by means of fast Fourier transform of 8-Hz steady-state pattern-reversal visual evoked potentials in 34 children affected with migraine (14 with aura, 20 without aura), and compared them with 14 patients with tension-type headache and 10 healthy subjects. The amplitude of the response to the transient stimulation (P100) was higher and the latency shorter in the patients with headache compared with the controls, but the difference was not statistically significant. The absolute power of the first harmonic (1F) obtained by the spectral analysis of the steady-state stimulation was increased in all the patients with headache compared with the controls, and the increase was significant in patients with migraine. These data seem to confirm the hypothesis of abnormal processing of visual input in migraineurs and could be interpreted as neurophysiological support for the theory that different headache types are related conditions. Furthermore, the spectral analysis of steady-state pattern-reversal visual evoked potentials could be proposed as a test to diagnose migraine.

Is aging a real risk factor for urological pathologies in men and women?

OBJECTIVE: With the progressive aging of the population in industrialized countries, urological pathologies are also increasing and creating a socio-sanitary problem for the community. To investigate this problem we retrospectively analyzed a heterogeneous sample of 283 patients, 134 males and 149 females who attended our urodynamics laboratory. METHODS: The female patients were subdivided into 6 categories and the male patients into 7 categories according to their urodynamic diagnoses. Their age distributions were compared with those of the population of the region of Lazio in Italy in order to calculate the "risk tendency". RESULTS AND CONCLUSIONS: The most frequent pathologies in males were bladder outlet obstruction (BOO) associated or not with detrusor overactivity (DO), and in females it was cystocele associated or not with DO or obstruction. There is a significant increase in these urological pathologies in older people. The relative risks for the females increase from age 20-29, stabilize at around 50 to 69 years and decline thereafter. The risk approximately doubles every ten years of age from 20 to 50. At ages 50-69 the risk is about 8 or 9 times higher than the risk at age 20-29 and double that of women aged over 70 years. The risk for the males also approximately double for every ten years of age. Men aged 60-69 have about 25 times the risk of these pathologies than men aged 20-29, and in the oldest men, those over 70 years, the risk is almost 40 times as high.

[Rational approach to the patient with urination disorders caused by cervico-urethral obstruction]. / Approccio razionale al paziente con disturbi minzionali da ostruzione cervico-uretrale.

Benign prostatic hypertrophy is the most frequent cause of cervico-urethral obstruction in adults. The symptomatology is complex and varied, and includes both irritative and obstructive symptoms. A number of methods are used to evaluate-quantify obstruction caused by benign prostatic hypertrophy. A series of tests are traditionally used to identify disorders caused by altered vesical filling (LUTS) and the degree of obstruction (BOO). An analysis of the various methods generally allows the most suitable treatment to be commenced. This critical review aimed to identify the real value and specificity of each method in relation to the possibility of quantifying the degree of cervico-urethral obstruction.

[Does the neurologic assessment have a decisive role in the early diagnosis of urinary disorders of uncertain etiology? A case of spinal chordoma]. / La valutazione neurourologica ha un ruolo decisivo nella diagnosi precoce delle disfunzioni minzionali a patogenesi incerta? Un caso di cordoma spinale.

The Authors report a rare case of detrusor areflexia due to a sacral column chordoma characterized as initial symptomatology, by dysuria and recurrent urinary tract infections. The patient was treated for a long time in a symptomatic way by her physicians. The Authors while discussing the case, underline the importance of an accurate differential diagnostical framing in patients with voiding and/or anorectal dysfunctions of uncertain nature. This framing must exclude those voiding pathologies of neurological origin which are frequently evinced merely by an aspecific voiding symptomatology of dysuric or irritative nature.

[Urothelial neoplasia as a late complication of transitional-cell carcinoma of the bladder]. / La neoplasia uroteliale come complicanza tardiva del carcinoma transizionale della vescica.

We evaluated the long term incidence of lower urinary tract neoplasms in patients with primary transitional bladder carcinoma. 8 patients had lower urinary tract neoplasm after a median elapse of time of 44 months (range 28 to 70). In 5 patients wa present vesicoureteral reflux. All the patients were undergone trial of BCG after the first recurrence of bladder carcinoma. We suppose that the vesicoureteral reflux may be the possible cause of ureteral neoplasm onset. Because of patients with primary bladder tumors are at the risk for lower urinary tract neoplasm, we suggest the need regular and continuous monitoring in case of frequent recurrence of transitional cell carcinoma of the bladder.

Visual evoked potentials and serum magnesium levels in juvenile migraine patients.

Changes in visual evoked potentials and decreased intracellular magnesium levels have been separately described in patients affected by migraine both during the attacks and in the interictal periods. An inverse correlation between increased P100 amplitude and lowered serum magnesium levels was found in children suffering from migraine with and without aura in a headache-free period. A 20-day treatment with oral magnesium pidolate seemed to normalize the magnesium balance in 90% of patients. After treatment, the reduced P100 amplitude confirmed the inverse correlation with the serum magnesium level. These data seem to suggest the hypothesis that higher visual evoked potential amplitude and low brain magnesium level can both be an expression of neuronal hyperexcitability of the visual pathways related to a lowered threshold for migraine attacks.

HPV typing of cervical squamous lesions by in situ HPV DNA hybridization: influence of HPV type and therapy on the follow-up of low-grade squamous cervical disease.

Papanicolaou (Pap)-stained cervical specimens from 160 squamous lesions were processed for the detection of human papillomavirus (HPV) DNA by an in situ hybridization (ISH) assay. Three biotinylated HPV DNA probes were employed, each containing HPV genotypes 6/11, HPV genotypes 16/18, or HPV genotypes 31/35/51. The HPV etiology of 86 lesions was ascertained (53.8%). In 74 out of 135 (58.8%) HPV-typed low-grade squamous intraepithelial lesions (SILs), HPV 6/11 was found in nine (6.6%), HPV 16/18 in 46 (34.2%), and HPV 31/35/51 in 19 lesions (14.1%); in 11 out of 18 HPV-typed high-grade SILs (61.1%), seven lesions (38.9%) were typed for HPV 16/18 and four (22.2%) for HPV 31/35/51. Of seven invasive carcinomas, only one (14.3%) reacted with the HPV 16/18 DNA probe. A cohort of 124 low-grade SILs were followed cytologically for a year. The results of this study are discussed in light of HPV type association and therapy.

Early increase precedes a depletion of VIP and PGP-9.5 in the skin of insulin-dependent diabetics--correlation between quantitative immunohistochemistry and clinical assessment of peripheral neuropathy.

Diabetic neuropathy affects both sensory and autonomic peripheral nerve fibres. Vasoactive intestinal polypeptide (VIP) is present in autonomic fibres which modulate sweat secretion, while calcitonin gene-related peptide (CGRP) is localized to cutaneous sensory fibres. In this study, immunohistochemistry and image analysis were used to assess changes of VIP and CGRP, and of the pan-neuronal marker protein gene-product (PGP)-9.5, in skin biopsies of 18 patients affected by type 1 diabetes (age range 18-46 years) and from seven aged-matched controls. Patients were divided into three groups: group 1 (n = 6), with diabetes for 6 months to 3 years; group 2 (n = 5), with the disease for 5-10 years; and group 3 (n = 7), with diabetes for more than 10 years. VIP immunoreactivity (IR) and PGP-9.5-IR were significantly reduced around sweat glands (P < 0.005) in groups 2 and 3. Epidermal CGRP-IR and PGP-9.5-IR were significantly reduced in group 3 (P < 0.05). Twenty-eight per cent (5/18) of all patients showed high VIP-IR around sweat glands (> 95 per cent confidence limits of controls) and all of these patients had diabetes for less than 3 years. Conversely, 55 per cent (10/18) of patients had low VIP-IR (< 5 per cent confidence limit of controls). The latter, compared with the former, showed a significantly longer duration of diabetes (Fisher exact test P = 0.002), presence of clinical autonomic neuropathy (Fisher exact test P = 0.04), and a reduced sural nerve conduction velocity (Fisher exact test P = 0.04). These results suggest that quantitative immunohistochemical analysis of peptide-containing cutaneous nerves allows an objective evaluation of nerve fibre alterations at early stages of diabetes than is currently possible with neurophysiological functional tests.

Plasmid analysis in PPNG strains isolated in Italy.

Italian reports of PPNG strains are rare. In this paper we report the plasmidial characteristics of two strains: one harbouring 3.2 and 2.6 Mdal plasmids and the other 24.5, 4.5 and 2.6 Mdal plasmids. Restriction analysis was carried out on plasmids transferred to E. coli by transformation for "Africa" and conjugation for "Asia" plasmid.

[Radiculopathy and the organization of health services: applicability verification of a technic for analyzing time factors in diagnostic procedures]. / Le radicolopatie e l'organizzazione dei servizi sanitari: verifica dell'applicabilita' di una tecnica per l'analisi temporale dei processi diagnostici.

The PERT is a SPR (Reticular Programation System) based on statistic-mathematic models. Since some years they are applied to productive processes to increase the efficiency and effectiveness. They all have a same base structure which is the net that is composed by the logical succession of the event and the activity which has the part of the project. Determining the minimum time (to), the maximum one (tp) and the more frequent time (tm) of each activity and applying the statistic method PERT, one gets the probable duration (te) of every activity and the critical path of the net is placed in evidence. This is formed by the chain of those activities whose duration determines the total duration of the project. The Authors have desired to verify the applicability of SPR even to the "medical industry" and, more precisely, to the diagnostic process for the verification of radiculoneuropathy. Such pathology affects a large part of the active population. The diagnostic process in this case comprises besides an accurate neurological and clinical examination of the patient, also the x-ray exam, the electromyography, the Computed Tomography (CT) and the Magnetic Resonance Imaging (MR) exam. These last two investigations gives an increase of diagnostic accuracy. With the collaboration of the physicians of the diagnostic Service, the Authors have measured in every step of the diagnostic procedure the waiting time of 48 patients with low back pain. Applying the PERT method, it has been possible to put in evidence in the net the critical activities. They are such that their duration time determines the probable duration of the whole diagnostic process. Such duration in this case it corresponds to 91 days with a standard deviation of 33 days. The delay of any critical activity causes a lealy of the whole route. This delay influences negatively on the patient's health. Besides it determines an economic damage to the system because a relation cost/time exists. The systems of reticular programmation have as objective not only the one of improving the programmation and the control of the processes, but also the attainment of an optimum cost/time ratio, varying in a way that the total cost of the realization of the process is minimum. They represent a useful criterion to direct Quality Assurance (Q.A) in the local political sanitary context, within the bounds of organization of technical - scientific quality. An accurate application of the Q.A. should modify besides the duration of the critical activities.

[Computerized axial tomography and electromyography in vertebral and spinal cord pathology]. / Tomografia assiale computerizzata ed elettromiografia nella patologia vertebro-midollare.

Fifty patients with lumbar spinal disease, 47 of them with disk herniation, were studied preoperatively using both electromyography and computerized tomography (CT), in order to verify the mutual diagnostic significance and accuracy of these techniques. Electromyographic studies provided correct informations regarding the level of the lesion in 41 patients with 1 mistaken level and 8 false negatives, without indicating the nature of involved pathologies. The specific nature of the lesions was correctly indicated by CT studies in 43 patients with 4 incorrect diagnoses and 3 false negatives, without defining the functional loss produced by the lesions. Using electromyography and CT together, first electromyographic studies to establish the spinal level to investigate principally with CT, the diagnostic accuracy can improve because of the decrease of the false negatives.