Two-year longitudinal follow-up of visual illusions and hallucinations in Parkinson's disease.

BACKGROUND: Previous longitudinal studies assessing visual hallucinations in Parkinson's disease (PD) have not specifically considered the respective evolution of visual illusions (VI) and visual hallucinations (VH), neither did they assess the role of ocular pathology on the evolution of those manifestations. OBJECTIVE: We aimed to determine whether VI evolve towards VH along the time in PD, and whether ophthalmological treatment may have a positive effect on the prognosis of those visuo-perceptive manifestations. METHODS: PD patients from a previous cohort [PD with VI (n = 26), PD with VH (n = 28), and PD without VI or VH (n = 28)] were contacted by phone 2 years later and questioned regarding the current presence of VI or VH, any current visual complaints, and the occurrence of any ophthalmological or antipsychotic treatment during the 2-year period, as well as any dopatherapy adjustment. RESULTS: Among PD-VI patients, 43% normalized, 48% remained PD-VI, 9% evolved towards coexisting VI and VH, and none converted to pure VH. Among PD-VH patients, 42% normalized, 32% remained PD-VH, 21% evolved towards coexisting VI and VH, and only 5% converted to pure VI. At follow-up, visual complaints remained greater among PD-VI and PD-VH compared to controls (p = 0.005). Among PD-VI and PD-VH who became control at follow-up, 35% received ophthalmologic treatment, 29% antipsychotic treatment, and 23% a dopatherapy reduction. CONCLUSION: PD Patients with VI do not necessarily evolve towards VH over time, and ophthalmological treatment may have a positive effect on the prognosis of those visuo-perceptive manifestations in PD similar to antipsychotic treatment and dopatherapy adjustment. TRIAL REGISTRATION: clinicaltrials.gov number NCT01114321.

Can POSSUM accurately predict post-operative complications risk in patients with abdominal Crohn's disease?

BACKGROUND: Although the majority of patients with Crohn's disease (CD) are young, they are often seriously ill when surgery is required. The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) is a risk prediction scoring system estimating 30-day complications. The primary endpoint was to evaluate POSSUM efficacy in this subgroup. The secondary endpoint was to determine any potential correlation between POSSUM, Harvey-Bradshaw Index (HBI), length of stay (LOS) and anastomotic leak. METHODS: All patients affected by abdominal CD who underwent elective and emergency surgery from 2006 to 2011 were prospectively enrolled in the study. POSSUM expected morbidity and mortality were compared to the observed outcomes (O/E ratio). Logistic regression analysis was performed to evaluate POSSUM and HBI adequacy. Correlation between POSSUM, HBI, LOS and anastomotic leak was investigated with linear regression analysis. RESULTS: One hundred twenty-three patients underwent abdominal surgery. The overall 30-day mortality rate estimated by the Portsmouth-POSSUM was 1.22% (95% confidence interval (CI) 0.4-3.6) while no deaths were observed (O/E = 0). The prediction regarding the post-operative complication rate was 22.04% (95% CI 11.1-51.2) and the observed overall morbidity rate was 21.95% (O/E = 0.99). The mean HBI score was 6.85 while LOS was 9.4 days. POSSUM and HBI were found to be significant predictors of post-operative complications at the univariate logistic regression analysis (OR 1.17 95% CI 1.06-1.30 and OR 1.25 95% CI 1.04-1.49, respectively). Linear regression analysis showed a significant correlation between POSSUM, HBI and LOS. CONCLUSION: POSSUM is precise in predicting post-operative complications in patients with abdominal CD. POSSUM correlates with HBI.

Asymptomatic and persistent elevation of pancreatic enzymes in an ulcerative colitis patient.

Azathioprine has been extensively used in the management of inflammatory bowel diseases. It might cause pancreatic damage in the form of either asymptomatic elevation in serum amylase/lipase or overt acute pancreatitis. Here we report the case of a 61-year-old patient with ulcerative colitis who had been treated with azathioprine for three years, achieving clinical remission. During treatment he presented an asymptomatic elevation of serum pancreatic enzymes, without any signs of pancreatitis at imaging. This evidence brought us to reassess the drug dosage, without achieving a normalization of biochemical analysis. Autoimmune pancreatitis was excluded. One year after the suspension of azathioprine, we still face persistent high levels of amylase/lipase. Normalization of enzymatic values in patients who develop intolerance to azathioprine, in the form of either asymptomatic elevation in serum amylase/lipase or overt acute pancreatitis, is usually achieved in about two months after stopping drug intake. Asymptomatic elevation in serum pancreatic enzymes in the absence of pancreatic disease is reported in the literature and defined as "Gullo's syndrome," but nobody of the subjects studied had been treated in the past with pancreatotoxic drugs. Might this case be defined as "benign pancreatic hyperenzymemia"?

Fecal detection of Mycobacterium avium paratuberculosis using the IS900 DNA sequence in Crohn's disease and ulcerative colitis patients and healthy subjects.

BACKGROUND AND AIM: Despite the increasing evidence of MAP/DNA isolation in Crohn's disease (CD), its potential pathogenetic role remains unclear. To further clarify the possible relationship between MAP and CD, we investigated the presence of IS900 DNA fragment in feces from Crohn's disease and ulcerative colitis (UC) patients and from healthy controls (HC). METHODS: Stool samples were collected from 31 CD, 20 UC, and 23 HC and stored at -20°C in 200-mg aliquots. DNA was extracted. MAP presence was detected with a specific PCR amplifying a 409-bp fragment from IS900. The specificity of PCR for IS900 was confirmed sequencing three positive products. Statistical analysis was performed using the Chi-square test. RESULTS: Twenty-one of 31 CD (68%), 13 of 20 UC (65%) and 11 of 23 HC (48%) were MAP-positive (CD vs. HC: p = ns; UC vs. HC: p = ns). With the limits of a small sample size, the IS900-positive percentage in CD and UC was higher than HC, although the difference was not statistically significant. CONCLUSIONS: The possibility to track the MAP presence in human feces represents a new approach to the "MAP hypothesis". Detection of MAP DNA in feces is very common, reaching very high prevalence both in CD and in UC and even in HC. Our findings seem consistent with a high prevalence of MAP asymptomatic infection among the general population and so the possible involvement of MAP in CD pathogenesis could be linked to a specific immune defective response.

IL23R, NOD2/CARD15, ATG16L1 and PHOX2B polymorphisms in a group of patients with Crohn's disease and correlation with sub-phenotypes.

Recent genomic research has identified interleukin-23 receptor (IL23R), nucleotide-binding oligomerization domain containing 2 caspase-activation recruitment domain 15 (NOD2/CARD15), autophagy related 16-like 1 (ATG16L1) and paired-like homeobox 2b (PHOX2B) as susceptibility loci for Crohn's Disease (CD). Our aim was to investigate these gene variants in a group of CD patients and to analyse the correlation to sub-phenotypes such as gender, smoking habits, disease behaviour at diagnosis, severity of disease and extra-intestinal manifestations. Nineteen patients with CD and 20 healthy controls were included in the study. The gene variants IL23R rs7517847 and rs11209026, NOD2/CARD15 rs2066845, PHOX2B rs16853571, ATG16L1 rs2241879 and rs2241880 were genotyped by PCR followed by sequencing. The frequency of the G risk allele of IL23R rs7517847 was found to be increased in patients with CD (42%) compared to that in control subjects (20%) [odds ratio (OR), 2.9; 95% confidence interval [CI], 1.06-7.9; P=0.03]. In addition, the homozygous condition GG was also associated with CD (OR, 8.70; 95% CI, 0.9-81.6; P=0.038). The analysis of correlation of genotype to sub-phenotypes showed an association of ATG16L1 rs2241879 with the lack of extra-intestinal manifestations (OR, 0.03; 95% CI, 0.002-0.45; P=0.006), and the patients defined as non-smokers displayed an increased frequency of the risk allele C (P=0.03). The present study confirms the association of the heterozygous and homozygous IL23R rs7517847 variant with CD and suggests an additive effect of smoking to the ATG16L1 rs2241879 C risk allele SNP, in the context of the multifactorial model established for the development of CD and a protective effect of the same allele against extra-intestinal manifestations.

Ten years' activity of the first Italian public hospice for terminally ill patients.

We present a review of the first 10 years of the hospice at the Geriatric Institute Pio Albergo Trivulzio of Milan, Italy's first public hospice for the admission of terminally ill patients. Over 1200 patients were admitted to the nine-bed hospice between October 1991 and December 2001, most of whom (63%) were referred by the Home Palliative Care Units operating in Milan. The hospice patients are elderly (nearly 60% are 70 or more years of age, median 72 years). Admission to the hospice was until the patient's death (74% of patients) after a brief time (4 weeks on average). From the very outset, we have striven to focus our attention on the daily application of the programmes of care inspired by the philosophy and practice of palliative medicine, i.e. the holistic approach and attention devoted to quality of life, multidimensional assessment, and the services of a multiprofessional team to provide, alongside medical and nursing assistance, psychosocial and spiritual support, bereavement support, etc. The continuing education of health workers and the systematic use of a clinical audit tool specifically designed for palliative care, are the two key elements which, in our judgement, have proved to be the most fruitful in reaching the objectives described above. These 10 years of the Pio Albergo Trivulzio Hospice have made a significant contribution towards defining a concrete Italian model which can be applied to the care of the terminally ill inpatient.

Desenvolvimento embrionário do Curimbatá Prochilodus lineatus (Valenciennes, 1836) (Cypriniformes, Prochilodontidae) / Embryonal development of the curimbatá Prochilodus lineatus (Valenciennes, 1836) (Cypriniformes, Prochilodontidae)

Através da análise da morfologia externa dos ovos e dos aspectos microscópicos de seus cortes histológicos, foram caracterizados 18 estádios durante o desenvolvimento embrionário do curimbatá Prochilodus lineatus, que ocorreu a uma temperatura média de 26 + 0,5 C e no período de 16 horas, desde a fertilizaçao até a eclosao das larvas.