Contained rupture of a mycotic infrarenal aortic aneurysm infected with Campylobacter fetus.

Mycotic abdominal aortic aneurysms (MAAAs) are rare entities accounting for 0.65-2% of aortic aneurysms. Campylobacter fetus has a tropism for vascular tissue and is a rare cause of mycotic aneurysm. We present a 73-year-old male patient with contained rupture of a MAAA caused by C. fetus, successfully treated with endovascular aortic repair (EVAR) and antibiotics, which is not previously described for this aetiology. Although open surgery is the gold standard, EVAR is nowadays feasible and potentially represents a durable option, especially in frail patients

Brain Dynamics of Action Monitoring in Higher-Order Motor Control Disorders: The Case of Apraxia

Limb apraxia (LA) refers to a high-order motor disorder characterized by the inability to reproduce transitive actions on commands or after observation. Studies demonstrate that action observation and action execution activate the same networks in the human brain, and provides an onlooker’s motor system with appropriate cognitive, motor and sensory-motor cues to flexibly implementing action-sequences and gestures. Tellingly, the temporal dynamics of action monitoring has never been explored in people suffering from LA. To fill this gap, we studied the electro-cortical signatures of error observation in human participants suffering from acquired left-brain lesions with (LA+) and without (LA–) LA, and in a group of healthy controls (H). EEG was acquired while participants observed from a first-person perspective (1PP) an avatar performing correct or incorrect reach-to-grasp a glass action in an immersive-virtual environment. Alterations of typical EEG signatures of error observation in time (early error positivity; Pe) and time-frequency domain (theta band-power) were found reduced in LA+ compared with H. Connectivity analyses showed that LA+ exhibited a decreased theta phase synchronization of both the frontoparietal and frontofrontal network, compared with H and LA–. Moreover, linear regression analysis revealed that the severity of LA [test of upper LA (TULIA) scores] was predicted by mid-frontal error-related theta activity, suggesting a link between error monitoring capacity and apraxic phenotypes. These results provide novel neurophysiological evidence of altered neurophysiological dynamics of action monitoring in individuals with LA and shed light on the performance monitoring changes occurring in this disorder

Prediction of rehabilitation induced motor recovery after stroke using a multi-dimensional and multi-modal approach

Background: Stroke is a debilitating disease affecting millions of people worldwide. Despite the survival rate has significantly increased over the years, many stroke survivors are left with severe impairments impacting their quality of life. Rehabilitation programs have proved to be successful in improving the recovery process. However, a reliable model of sensorimotor recovery and a clear identification of predictive markers of rehabilitation-induced recovery are still needed. This article introduces the cross-modality protocols designed to investigate the rehabilitation treatment’s effect in a group of stroke survivors. Methods/design: A total of 75 stroke patients, admitted at the IRCCS San Camillo rehabilitation Hospital in Venice (Italy), will be included in this study. Here, we describe the rehabilitation programs, clinical, neuropsychological, and physiological/imaging [including electroencephalography (EEG), transcranial magnetic stimulation (TMS), and magnetic resonance imaging (MRI) techniques] protocols set up for this study. Blood collection for the characterization of predictive biological biomarkers will also be taken. Measures derived from data acquired will be used as candidate predictors of motor recovery. Discussion/summary: The integration of cutting-edge physiological and imaging techniques, with clinical and cognitive assessment, dose of rehabilitation and biological variables will provide a unique opportunity to define a predictive model of recovery in stroke patients. Taken together, the data acquired in this project will help to define a model of rehabilitation induced sensorimotor recovery, with the final aim of developing personalized treatments promoting the greatest chance of recovery of the compromised functions

EEG indices of performance monitoring activity and error predictability: embodying the actions of an avatar in immersive virtual reality

Electro-cortical signatures of performance errors are thought to indicate the need for top-down control. Mid-frontal Theta oscillatory activity (4-8Hz) is a well-established marker of committed or observed errors. By combining EEG and immersive virtual reality, we reported that observing errors in reach-to-grasp actions of an avatar seen from a first-person perspective elicited greater theta oscillations over fronto-central electrodes (Pavone et al., 2016). Previous studies on committed or observed errors used sequences of trials were erroneous actions were less frequent than correct actions (e.g. 30% vs 70%). Therefore, it was not possible to disentangle whether the activation of the performance system was due to error per se or to surprise/novelty effect associated with rare and less predictable events. To address this issue, we recorded the EEG signal of 20 participants observing correct or erroneous actions performed by an avatar. Importantly, at variance with Pavone et al, (2016) the proportion of erroneous vs correct actions was 70% vs 30%. The results show that observation of erroneous actions enhanced Theta power compared to correct actions. Our data suggest that error per se, and not its percentage of occurrence, triggered the activity of the performance monitoring system, likely with the aim of flexibly adapting actions to the challenges of the external environment

Effect of caerulein on pituitary response to TRH in humans.

The effect of caerulein (100 ng/kg/h X 1 h) on basal as well as on thyrotropin-releasing hormone (TRH)-stimulated prolactin and thyroid-stimulating hormone (TSH) secretion was studied in healthy male volunteers. The peptide did not change the basal levels of prolactin and TSH. However, during the infusion of caerulein, prolactin response to TRH was significantly increased whereas the TSH response was decreased. These data, showing an action of caerulein (a frog peptide which mimics the biological actions of cholecystokinin) on prolactin and TSH release, suggest that cholecystokinin may be involved in the physiological control of human pituitary secretion

Epanchement pleural d 'origine hépatique

L'hydrothorax hépatique constitue une complication de l'état terminal d'une cirrhose hépatique et provient du passage de l'ascite par des défauts du diaphragme. Une fois le diagnostic d'épanchement d'origine hépatique retenu, un traitement diurétique et une restriction sodée sont indiqués. La thoracentèse permet de soulager la dyspnée, mais la mise en place d'un drain pleural est à éviter. Selon l'évolution, une stratégie interventionnelle est à entreprendre jusqu'à la discussion quant à l'indication à la transplantation hépatique

Video-assisted right supradiaphragmatic thoracic duct ligation for non-traumatic recurrent chylothorax

BACKGROUND: Chylothorax is an uncommon disorder with respiratory, nutritional and immunological manifestations. Surgical management is indicated in case of recurrence or failure after conservative treatment. We report our experience with video-assisted right-sided supradiaphragmatic thoracic duct ligation for non-traumatic, non-postoperative persistent or recurrent chylothorax. PATIENTS AND METHODS: The medical records of six patients operated at our institution between 1999 and 2004 were retrospectively reviewed. A right-sided chylothorax was found in four patients, a left-sided in one, and a bilateral in one. Three patients developed chylothorax after chemotherapy and chest irradiation for malignant diseases (lymphoma in two patients and breast cancer in one), one in the context of lymphangioleiomyomatosis, one due to a non-diagnosed lymphoma, and one after heart transplantation. RESULTS: The mean operative time was 102 min, with an average length of hospital stay of 14 days. Persistent cessation of chylous effusion within 7 days after surgery was observed in 5/6 patients without recurrence during a mean follow-up time of 41 months. One patient with undiagnosed mediastinal lymphoma required re-operation and thoracic duct ligation on day 8 by right-sided thoracotomy due to persistent chylothorax. No 30-day mortality was recorded. Two patients presented postoperative complications including respiratory insufficiency requiring mechanical ventilation in one, and chylous ascites development requiring peritoneo-venous LeVeen shunting in one patient. CONCLUSIONS: Recurrent or persistent non-traumatic chylothorax may be successfully treated by video-assisted right supradiaphragmatic thoracic duct ligation