Autonomic dysfunction and endothelial changes in migraine sufferers.

AIM: The aims of this study were: 1) to quantify endothelial function by flow-mediated dilation (FMD) and atherosclerotic vascular lesions by intima-media thickness (IMT) in migraine sufferers without any of the common atherosclerotic risk factors, comparing them with paired controls; 2) to evaluate their potential autonomic function impairment; and 3) to seek any correlations with vascular modifications. METHODS: Twenty patients suffering from migraine and 20 matched controls were studied, using echo-color-Doppler imaging to measure IMT in the carotid district and FMD of the brachial artery in the non-dominant arm. Autonomic function was studied using the Tilt, Lying-to-Standing, Valsalva, Hand grip, Deep breath, Stroop and Sweat tests. RESULTS: Migraine sufferers had lower FMD and higher IMT values than controls. The former also had autonomic changes revealed by the Tilt, Valsalva, Hand Grip, Deep Breath and Stroop tests, which correlated with their reduced FMD. CONCLUSION: Autonomic dysfunctions modify vascular reactivity in migraine sufferers and this type of change can probably determine endothelial dysfunction and intima-media thickening.

A new model of pharmacovigilance? A pilot study.

This multicenter study tested the actuation of a new model of pharmacovigilance, focused on three pharmacological wide-used categories (non-steroidal anti-inflammatory drugs, NSAID, oral anticoagulants, and antihypertensive drugs). Besides the traditional way of pharmacovigilance, an active investigation was performed, using a phone-structured interview. Patients discharged from the participating hospitals were included into the study, if their prescribed therapy included some of the above drugs and after informed consent. Three hundred subjects were interviewed, 100 for each pharmacological category. For a period of six months after patient's discharge from the hospital, a traditional pharmacovigilance survey was carried out. About 30 days after discharge from the hospital, patients were interviewed by the medical staff and data recorded. NSAID group stratification evidenced a significant percentage of severe haemorrhage among the patients who were using acetylsalicylic acid (ASA) as antiaggregant (6.8%) compared to the patients who were using non-ASA NSAID, at therapeutic dosage (1.8%). From this data, it seems that the active pharmacovigilance model was able to better highlight a real problem for the NSAID category, in particular it evidenced a pharmacological subclass (ASA) more prone to cause ADR than expected from literature data related to whole pharmacological class. Given the required economical effort, this pharmacovigilance method could take place as a selected tool when pharmacovigilance signals from the international databases become consistent or for new wide-used drugs, to screen potentially dangerous pharmacological subclasses, normally "hidden" because of a "camouflage" among ADRs of the entire pharmacological class.

The ABILHAND questionnaire as a measure of manual ability in chronic stroke patients: Rasch-based validation and relationship to upper limb impairment.

BACKGROUND AND PURPOSE: Chronic hemiparetic patients often retain the ability to manage activities requiring both hands, either through the use of the affected arm or compensation with the unaffected limb. A measure of this overall ability was developed by adapting and validating the ABILHAND questionnaire through the Rasch measurement model. ABILHAND measures the patient's perceived difficulty in performing everyday manual activities. METHODS: One hundred three chronic (>6 months) stroke outpatients (62% men; mean age, 63 years) were assessed (74 in Belgium, 29 in Italy). They lived at home and walked independently and were screened for the absence of major cognitive deficits (dementia, aphasia, hemineglect). The patients were administered the ABILHAND questionnaire, the Brunnström upper limb motricity test, the box-and-block manual dexterity test, the Semmes-Weinstein tactile sensation test, and the Geriatric Depression Scale. The brain lesion type and site were recorded. ABILHAND results were analyzed with the use of Winsteps Rasch software. RESULTS: The Rasch refinement of ABILHAND led to a change from the original unimanual and bimanual 56-item, 4-level scale to a bimanual 23-item, 3-level scale. The resulting ability scale had sufficient sensitivity to be clinically useful. Rasch reliability was 0.90, and the item-difficulty hierarchy was stable across demographic and clinical subgroups. Grip strength, motricity, dexterity, and depression were significantly correlated with the ABILHAND measures. CONCLUSIONS: The ABILHAND questionnaire results in a valid person-centered measure of manual ability in everyday activities. The stability of the item-difficulty hierarchy across different patient classes further supports the clinical application of the scale.

[Ambulation after fracture of the femur: recuperation in Parkinsonian and hemiplegic patients]. / Deambulazione dopo frattura del femore: recupero in pazienti parkinsoniani ed emiplegici.

One hundred and twenty-seven patients with femour fractures were studied with the aim of verifying the possible influence of Parkinson's disease and hemiplegia on ambulation recovery. Participating in this study were 31 patients with Parkinson's disease, 36 patients with hemiplegia and 60 patients without any neurological damage. After rehabilitation, 61.1% of hemiplegic, 40% patients without neurological damage and 29% of parkinson disease patients reached the same ambulation capacity level present before the fracture. Patients suffering from Parkinson disease showed an important loss of ambulation which was statistically significant compared to the control group. The loss of deambulatory capacity was not statistically significant in hemiplegic group. According to the authors' opinion, this result depends on correlated damages or on poor collaboration typically present in patients with Parkinson disease.

[Telethermographic effects and a comparative clinical assessment of the treatment of shoulder periarthritis using ultrasound]. / Effetti teletermografici e valutazione clinica comparata del trattamento di periartrite di spalla mediante ultrasuoni.

The aim of this study was the instrumental evaluation of ultrasound therapy in patients with periarthritis of the shoulder, with regard to studies that show doubts about the real effectiveness of the antiinflammatory action of ultrasound. Two groups of subjects were studied, periarthritis versus normal patients. Clinical evaluation and instrumental measures (telethermography) were performed before and after ultrasound therapy. These data were statistically analyzed and constant variations were found, according to clinical evaluation of the patients. Therefore results of this study demonstrated a real influence of ultrasound therapy on periarthritis of the shoulder.

[Fatigue during muscle work at variable traction angles]. / Affaticamento in corso di lavoro muscolare ad angoli di trazione variabili.

Using computerized surface EMG signal analysis, authors point out that muscle fatigue onset depends not only by exercise frequency and external load but also by mechanical arrangement of muscle insertions and this onset is faster if contraction is concentric. Therefore selective muscle training programs must contemplate this phenomenon.