Atraumatic Subdural Hematoma in a Third-Trimester Gravid Patient.

Acute atraumatic subdural hematoma is a rare occurrence and there exist few case studies which describe suspected cases and causes for this condition. We present a case of a 36-year-old female at 32-week gestation who initially presented to the emergency department for evaluation of lower extremity cellulitis but had acute neurologic change while being in the ED. Computed tomography revealed a right subdural hematoma with midline shift and mass effect. The primary cause for the patient's subdural hematoma is unknown; however, this patient had several risk factors for developing an atraumatic subdural hematoma.

Addendum to 'Efficacy of music therapy treatment based on cycles of sessions: a randomised controlled trial' (Raglio et al., 2010).

OBJECTIVES: The aim of this paper is to provide further detail about the results of a randomised controlled study published in this journal (Raglio et al., 2010, 14, 900-904), in which we assessed the efficacy of music therapy (MT) on the behavioural disturbances in people with moderate-severe dementia. METHODS: Sixty patients were randomly assigned to the experimental (MT and standard care) and control group (standard care only). The experimental group received three cycles of 12 MT sessions each, three times a week. Each cycle of treatment was followed by one month of washout period, while the standard care activities continued over time. RESULTS: The impact of the treatment (12 MT sessions) was reliable on NPI global scores, as the interaction Time by Group was significant (F(1,49) = 4.09, p = 0.049). After the end of the treatment the NPI global scores of the experimental and control groups tended to become similar, as both groups worsened (Time effect: F(1,48) = 4.67, p = 0.014) and the difference between them disappeared (F < 1). Interaction Time by Group was not significant. CONCLUSIONS: The study confirms that active MT determines a positive response and can amplify and strengthen the efficacy of therapeutic interventions towards people with dementia.

The evaluation of music therapy process in the intersubjective perspective: the music therapy rating scale. A pilot study.

This study presents a tool (Music Therapy Rating Scale [MTRS]) to evaluate the progression of the relationship between the patient and the therapist during music therapy sessions. The rating scale was developed from an intersubjective framework and from an improvisational music therapy technique. It mainly consists of two behavioral classes: non-verbal communication (NVC) and sonorous-musical communication (SMC). Five levels for each class are given (from 0 to 4). Every 15 seconds, two sets of two music therapists coded the behaviors in seven sessions with different patients. The patients were seven children (four males; three females) aged 3-10 years (mean age = 6.28), diagnosed with Pervasive Developmental Disorder. The reliability indices were computed and there was a substantial agreement in the assessments of the video raters (non-verbal relationship: ρ = 0.70; sonorous-musical relationship: ρ = 0.77). A digital output of the program to use the MTRS is presented and clinical implications are discussed.

Efficacy of music therapy treatment based on cycles of sessions: a randomised controlled trial.

We undertook a randomised controlled trial to assess whether a music therapy (MT) scheme of administration, including three working cycles of one month spaced out by one month of no treatment, is effective to reduce behavioural disturbances in severely demented patients. Sixty persons with severe dementia (30 in the experimental and 30 in the control group) were enrolled. Baseline multidimensional assessment included demographics, Mini Mental State Examination (MMSE), Barthel Index and Neuropsychiatry Inventory (NPI) for all patients. All the patients of the experimental and control groups received standard care (educational and entertainment activities). In addition, the experimental group received three cycles of 12 active MT sessions each, three times a week. Each 30-min session included a group of three patients. Every cycle of treatment was followed by one month of wash-out. At the end of this study, MT treatment resulted to be more effective than standard care to reduce behavioural disorders. We observed a significant reduction over time in the NPI global scores in both groups (F(7,357) = 9.06, p < 0.001) and a significant difference between groups (F(1,51) = 4.84, p < 0.05) due to a higher reduction of behavioural disturbances in the experimental group at the end of the treatment (Cohen's d = 0.63). The analysis of single NPI items shows that delusions, agitation and apathy significantly improved in the experimental, but not in the control group. This study suggests the effectiveness of MT approach with working cycles in reducing behavioural disorders of severely demented patients.

With time on our side? Task-dependent compensatory processes in graceful aging.

Graceful aging has been associated with frontal hyperactivations in working- and episodic long-term memory tasks, a compensatory process, according to some, that allows the best normal elders to perform these tasks at a juvenile level, in spite of natural cortical impoverishment. In this study, 24 young and 24 healthy elderly participants were compared. Graceful aging was explored by investigating domains where most healthy elders perform like youngers (e.g. lexical-semantic knowledge) and tasks that are typically more challenging, like episodic long-term recognition memory tasks. With voxel-based morphometry, we also studied to what extent changes of fMRI activation were consistent with the pattern of brain atrophy. We found that hyperactivations and hypoactivations of the elders were not restricted to the frontal lobes, rather they presented with task-dependent patterns. Only hypoactivations and normal levels of activation systematically overlapped with regional atrophy. We conclude that compensatory processes associated with graceful aging may not necessarily be a sign of early saturation of executive resources, if this was to be represented by a systematic frontal hyperactivation, but rather they may represent the ability of recruiting new cognitive strategies. We discuss two possible approaches to further test this hypothesis.

Comparison of the music therapy coding scheme with the music therapy checklist.

The Music Therapy Checklist is useful for music therapists to monitor and evaluate the music therapeutic process. A list of different types of behaviors were selected based on results derived from applying the Music Therapy Coding Scheme. The use of a checklist to code the events with a recording method based on 1-min. intervals allows observation without data-processing systems and drastically reduces coding time. At the same time, the checklist tags the main factors in musical interaction.

A coding scheme for the evaluation of the relationship in music therapy sessions.

This study presents a coding system for observation and monitoring of changes in the interactive behaviour between patient and therapist during music therapy sessions. The coding scheme was developed from a psychodynamic framework and mainly consists of four behavioural classes: Verbal Communication, Nonverbal Communication, Countenance, and Sonorous Musical Communication. The 15 minutes in the middle of each videotape concerning the first active music therapy session--based on the sonorous musical improvisation--were coded. Subjects were children (4 boys; 3 girls) ages 3 to 10 years (M age = 6.3), diagnosed with Pervasive Developmental Disorder, and seven therapists. The method for data collection was continuous recording, applied through The Observer Video-Pro 5.0. For the reliability indexes there was a substantial agreement between assessments by video raters.

[Combined treatment of thymoma. State of the art and our experience]. / Trattamento integrato del timoma. Stato dell'arte e nostra esperienza.

Thymoma is the most common neoplasm of the anterior mediastinum and is frequently associated with paraneoplastic syndromes. Surgery is the first therapeutic option, but in advanced disease a multidisciplinary approach is feasible, because of chemosensitivity and radiosensitivity of the disease. The natural history of thymoma after surgery points to local recurrence. Adjuvant radiotherapy seems to improve local control and survival. Chemotherapy based on cisplatin plus anthracyclines could be performed in advanced and metastatic disease. The optimal sequence of chemotherapy, radiation therapy and surgery is yet to be defined. In our experience, primary chemotherapy seems to give best results in advanced thymoma with good tolerability.