A comparison of bipolar disorders in children in Italy and the United States.

BACKGROUND: The clinical presentation of bipolar disorders, though clearly recognized in adolescents, remains controversial in younger children and across cultures. The aim of this study was to compare the clinical presentation of bipolar disorders in Italian and American children between ages 5 and 12 years. METHODS: Sixty-seven children from six outpatient programs were enrolled (Italian sample: n=40; American sample: n=28) between January 2010 and June 2011. Children and their parents were interviewed by experienced clinicians using the Washington University in St. Louis Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present, Lifetime Version (WASH-U K-SADS). RESULTS: Italian children scored significantly higher on ratings of "elevated mood" (p=0.002), whereas American children scored significantly higher on ratings of "flight of ideas" (p=0.001) and "productivity" (p=0.001). Rates of comorbidity were different between groups. LIMITATIONS: Data were acquired from several sites in Italy as compared to from a single American site. Medication and educational information were not systematically collected. Furthermore, the sample collected may only reflect characteristics of a less severely ill group of bipolar children. CONCLUSIONS: Our comparison of Italian and American children with early onset bipolar disorders found that the phenotype of bipolar spectrum disorders is largely shared across cultures, although psychiatric comorbidities differed.

Patterns of regional sympathetic nerve traffic in preascitic and ascitic cirrhosis.

Overactivity of the sympathetic nervous system and portal hypertension are key factors in the development of ascites in cirrhosis. The sympathoexcitation that characterizes the more advanced stages of liver diseases is less clearly defined in preascitic cirrhosis. We measured sympathetic nerve traffic to skeletal muscle (peroneal nerve) and to skin districts by microneurography in (1) 12 Child class A cirrhotic patients with clinically significant portal hypertension (portal pressure gradient > 10 mm Hg, 14.8 +/- 1.2 mm Hg, mean +/- SEM) but without actual or previous ascites, (2) 16 Child class C cirrhotic patients with tense ascites, and (3) 10 patients with mild congestive heart failure, a condition paradigmatic of a marked sympathetic activation. Muscle sympathetic nerve traffic was markedly increased in Child class C subjects as compared with controls (23.9 +/- 1.6 bursts/min, P <.01) and superimposable to that recorded in heart failure patients (52.9 +/- 4.7 vs. 60.3 +/- 2 bursts/min, P = not significant). Muscle sympathetic nerve traffic was also increased in Child class A subjects (41.6 +/- 2 bursts/min, P <.01 vs. controls) although to a lesser extent (P <.05 vs. Child class C patients). Skin sympathetic nerve traffic was within the normal range in all patients. Neurohormones were all markedly increased in Child class C subjects. Only norepinephrine was increased in Child class A patients. Our data show that sympathetic nerve traffic activation (1) is already detectable in Child class A cirrhosis when clinically significant portal hypertension is present but ascites never developed and (2) is not generalized because although muscle traffic is increased, skin traffic is within normal range. The role of drugs modulating sympathoactivation should be investigated in preascitic cirrhosis.

Treatment of autonomous thyroid nodules: value of percutaneous ethanol injection.

OBJECTIVE: Percutaneous injection of alcohol was recently proposed as an alternative to surgical and radioiodine treatments of autonomous thyroid nodules. The purpose of this study was to determine the value of this procedure and to define its limitations and indications when used for this purpose. MATERIALS AND METHODS: Thirty-one patients with autonomous thyroid nodules underwent a cycle of treatment with percutaneous injection of ethanol in multiple sessions (three to seven) on alternate days depending on the diffusion of the ethanol in the nodule. Fifteen patients were hyperthyroid, and 16 were euthyroid but had inhibited secretion of thyrotropin. The treatment results were evaluated by thyroid scintigraphy and sonography, by triiodothyronine, thyroxine, and thyrotropin assays, and by a thyrotropin-releasing hormone stimulation test 6 months after the end of treatment. Baseline scintigraphy demonstrated exclusive radionuclide uptake in the nodule in 29 patients and partial uptake in the extranodular tissue in two. The volume of the nodules ranged from 0.8 to 34.0 ml (mean +/- SD, 11.8 +/- 8.8 ml). Patients were monitored clinically for 24 hr after each session of ethanol injection to evaluate complications. Fifteen patients underwent a second cycle of ethanol injection when the results 6 months after the first cycle were unsatisfactory. The mean +/- SD follow-up was done at 26.9 +/- 12.3 months. RESULTS: Scintigraphy showed recovery of extranodular uptake of radionuclide in 72% of patients with nodules less than 13 ml in volume (maximum diameter [mean +/- SD], 2.7 +/- 0.7 cm; range, 1.4-4.0 cm) after one cycle of treatment and in 83% after two cycles. Among subjects with larger nodules, radionuclide uptake returned to normal in 9% after one cycle of treatment and in 9% after two cycles. For hyperthyroid patients, levels of thyroid hormones returned to normal in 69% after one cycle and in 77% after two cycles, and levels of thyrotropin returned to normal in 38% after one cycle and in 69% after two cycles; normal levels of thyrotropin were achieved in 93% of the euthyroid patients after one cycle of treatment and in 100% of these patients after two cycles. Symptoms resolved in 73% of the hyperthyroid subjects after the first cycle of treatment and in 93% of these subjects after the second. No important complications were observed; the most common side effects were acute pain at the injection site, referred pain, fever, transient dysphonia (< 12 hr), local hematoma, palpitations, and sinus tachycardia. CONCLUSION: Our results show that percutaneous injection of ethanol is appropriate therapy for autonomous thyroid nodules less than 13 ml in volume. The treatment should be considered successful when levels of thyroid hormones and thyrotropin return to normal. Nodule size appears to be the most important determinant of the success of the treatment. No complications that required termination of the treatment occurred.

Ultrasound in the follow-up of young patients with malignant ovarian tumors after conservative surgery.

Ultrasound examinations were performed us a step in the follow-up of 62 patients previously treated with conservative surgery for malignant ovarian tumors. With a minimal follow-up period of 36 months (range 36-129) 12 recurrences of disease were observed in nine patients. When compared to other routine follow-up procedures, ultrasound examination proved to be the most effective procedure in the monitoring of these patients, correctly detecting ten recurrences. Physical and gynecological examinations detected seven, tumor marker measurements detected six and chest X-rays detected one. Ultrasound examination was 83% sensitive, 99% specific and 99% accurate in the detection of recurrent disease. In four recurrences leading to death, the diameters of the tumors at first detection were 25, 50, 50 and 100 mm, significantly higher (p = 0.03) than in seven recurrences followed by complete response of the tumor (range 15-35 mm, median 30 mm). Ultrasound appears to be superior to physical and gynecological examination in early detection of recurrence; considering that smaller burdens of tumor at the time of recurrence seem to imply a better prognosis, ultrasound should be considered us a useful additional procedure in the follow-up of these patients.

[Circumvallate nephro-cystostomy]. / La nefrocistostomia circonvallare.

Circumvallate nephro-cystostomy (CNC) provides a subcutaneous connection of a nephrostomy and a cystostomy catheter thus allowing spontaneous micturition. This procedure is suitable for those patients affected by an obstructive nephropathy where it was not possible to insert a double "J" stent or where surgical treatment was not allowed. Patients affected by debilitating disease benefit from these procedure by avoiding problems connected with daily handling of catheter, examples are medications at the insertion site or possible dislodgement of a nephrostomy catheter added to the psychological problems related to carry the urine collection bag. A number of 13 patients have been treated with this method, 5 had monolateral CNC, 8 had bilateral CNC for a total of 21 procedures. All but one cause of ureteral obstruction were neoplastic, the exception being a patient with necrosis of the ureter subsequent to major vascular surgery. CNC had a residence time ranging from 1, 5 to 25 months with an average of 9.8 months. Only in 2 cases it was necessary to remove CNC due to recurrent cystitis and orchitis due to bladder irritation by a cystostomy catheter and for an obstruction which could not be remedied in a patient with necrosis of the ureter. The most important complication, i.e. obstruction, occurred in 4 cases. In the above mentioned case CNC was removed after 9 months of proper performance. In the other 3 cases obstruction occurred after 2, 3, 18 months and in all this cases obstruction was easily removed. Besides obstruction only minor malfunctions were experienced and the procedure was very well tolerated by all patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Circumvallating nephrocystostomy. A new approach to the treatment of obstructive nephropathy.

For patients with obstructive nephropathy in whom a double J stent cannot be positioned, we have developed a new procedure which we call "circumvallating nephrocystostomy" (CNC). The method involves subcutaneous connection of a nephrostomy catheter and a suprapubic bladder catheter, which is inserted percutaneously. A total of 13 procedures have been performed in 9 patients (4 bilateral and 5 unilateral CNC); eight were cancer patients and one had ureteral necrosis. The CNC was in place for 44 days to 24 months. It was necessary to remove the CNC in one case because of obstruction and in another because of orchitis and recurrent cystitis. Two patients had obstruction of the CNC after 3 and 18 months, respectively, but in these cases the obstruction was treated successfully. Our results are encouraging enough to suggest CNC as a possible alternative to surgery in selected patients.

Cirrhosis: diagnosis with sonographic study of the liver surface.

To find an objective sonographic sign of cirrhosis, the authors used a small-parts probe to examine the liver surface for irregularities that corresponded to those of nodular regeneration. Fifty healthy subjects were examined to assess the pattern of a sonographically normal-appearing liver surface. A second group of 75 patients, mainly with suspected diffuse chronic liver disease, was examined with particular attention to the most commonly described sonographic signs of cirrhosis, and laparoscopy and biopsy were also performed. The liver surface was examined in a third group of 225 patients with cancer in whom metastases had been demonstrated sonographically. A diagnosis of cirrhosis was made with sonography when surface irregularities were observed that were comparable to the anatomic abnormalities of a cirrhotic liver surface. An examination of the liver surface gave the best diagnostic rate for cirrhosis (88%). There were seven false-negative results, but in five of them no surface nodularity could be seen at laparoscopy, and the diagnosis was made only on the basis of histologic studies; there was one false-positive result. This study indicated that ultrasonography might be a reliable method to follow up patients with chronic liver disease that may progress to cirrhosis.

Neuroblastoma during acute lymphoblastic leukemia in remission.

Neuroblastoma was diagnosed in a child after a 20-month remission of a pre-B acute lymphoblastic leukemia (ALL). Clumps of atypical cells suggestive of neuroblastoma were seen in the bone marrow. They were positive for monoclonal antibody (MoAb) UJ13A (neuroblastoma cells) and negative for MoAb T29/33 (anti-leucocyte common antigen CD45) with immunocytochemical staining. A right paravertebral mass displacing the kidney was demonstrated by abdominal echotomography, and serum vanilmandelic acid was slightly increased. Despite specific chemotherapy against neuroblastoma and after a transient clinical improvement, the patient died 7 months later of disseminated disease. Immunocytochemical staining on cells frozen at diagnosis of leukemia with MoAb UJ13A and T29/33 was unable to demonstrate neuroblastoma cells and showed the pattern usually observed in leukemia (UJ13A- and T29/33+).

Ataxic hemiparesis syndrome: clinical and CT study of 20 new cases and review of the literature.

20 new cases of ataxic hemiparesis syndrome (AHS) are reported and the findings compared with those of published cases. AHS may be due to lesions either of the brainstem or of supratentorial structures, where motor fibers run together with the cerebro-cerebellar pathways. Specific syndromes related to the lesion site cannot be identified from the clinical signs. Ischemic infarct is the most frequent cause of the syndrome, but hemorrhagic, neoplastic and demyelinating lesions have also been reported.

[The role of computerized tomography in primary malignant tumors of the nasopharynx. Observations on 20 cases]. / Il ruolo della tomografia computerizzata nei tumori maligni primitivi della rinofaringe. Osservazioni su 20 casi.

20 patients, with primary tumors of the nasopharynx have been studied over 3 years by CT with a second generation equipment. All cases were bioptically confirmed and 13 undifferentiated carcinomas, 4 differentiated epidermoid carcinomas, 1 adenoid-cystic carcinoma, 2 lymphomas were found. In every case, the CT provided a direct visualization of the lesion and correctly evaluated the extranasopharyngeal spread. This allowed a better T staging by classifying as T3 4 patients previously evaluated, on a clinical and radiological basis, as T2. Moreover, CT showed a circumscribed lesion on the right wall of the nasopharynx in a patient who resulted negative at clinical and radiological examination, and guided the biopsy which resulted positive for tumor. HCT, with a 100% positivity, is a better diagnostic tool with respect to posterior rhinoscopy and conventional radiology, respectively 95% and 88% positivity in the series of the authors. Finally CT was very helpful in therapy planning and post-irradiation follow-up.

[Light production from intensifying screens (theoretical and experimental aspects)]. / La produzione di luce negli schermi di rinforzo. Aspetti teorici e sperimentali.

The authors show the results of an experimental study on the light conversion efficiency of the absorbed energy from an incident X-ray beam by different kinds of intensifying screens. They stress that the absolute speed curves drawn for each intensifying screen, express (in the energy range 10 to 100 keV) the light output for an incident X-ray of a certain energy value. In this way, the knowledge of the X-ray tube emission spectra for a fixed kVp allows to forecast with good accuracy, the light output and the emerging spectra from an intensifying screen. They emphasize the importance of the K-edge (K shell electrons binding energy) as a factor affecting the phosphors behaviour both for what concerns the radiation filtration and the light conversion efficiency of the absorbed radiation.

[Epidural venography in the diagnosis of lumbar disease (author's transl)]. / La flebografia epidurale nella diagnostica strumentale delle lombo-sciatalgie.

80 patients with back pain and sciatalgia were studied by plain-film of lumbosacral spine, radiculography and epidural phlebography; 30 of them were surgically controlled. Radiculographic and phlebographic specimens were compared and phlebography showed more sensibility and specificity in the study of extradural pathology. The analysis of the phlebographic alterations suggested a semeiologic criterion we think that could be usefully used in the study of osteoligamentous lesions in lumbosacral spine.