General anesthesia and cervical anesthesia. What changes in carotid surgery

Carotid surgery must be preventive; therefore cerebral protection procedures have been the centre of interest for a decade. Nowadays local cervical block anaesthesia seems to have changed the terms of the problem allowing achieve the aim of "no risk surgery". Therefore we considered our 16 year experience (352 carotids operated on 290 patients). Since 1990 we employed cervical block anaesthesia. In order to ratify as much as possible the two groups of comparison, considering that we adopted some exclusion criteria, we compared the results of the first hundred carotids that underwent surgery with general anaesthesia and the first hundred operated using cervical block anaesthesia. Since we adopted cervical block anaesthesia there was no need of intra-operative monitoring systems because we considered exclusively the patients' clinical answer to preclamping. The use of shunt decreased from 9% to 3%. Surgery performed in cervical block anaesthesia gives a positive impression. This is due to the fact that there is not only a significant reduction of the morbidity rate, especially from a neurologic point of view, but also a reduction of the post-operation hospital stay. Furthermore there is also a better organization of the surgical phases. Direct monitoring of the cerebral function allows a precise analysis of the peri-operatory neurological events. In conclusion our study suggests that cervical block anaesthesia allows clinical benefits for the patient as far as safety is concerned being also more convenient under the economic point of view

Mutation analysis of the SPG4 gene in Italian patients with pure and complicated forms of spastic paraplegia

Mutations in the SPG4 gene are the most common causes of hereditary spastic paraplegia (HSP) accounting for up to 40% of autosomal dominant (AD) forms and 12-18% of sporadic cases. The phenotype associated with HSP due to mutations in the SPG4 gene tends to be pure. There is increasing evidence, however, of patients with complicated forms of spastic paraplegia in which SPG4 mutations were identified. A cohort of 38 unrelated Italian patients with spastic paraplegia, of which 24 had a clear dominant inheritance and 14 were apparently sporadic, were screened for mutations in the SPG4 gene. We identified 11 different mutations, six of which were novel (p.Glu143GlyfsX8, p.Tyr415X, p.Asp548Asn, c.1656_1664delinsTGACCT, c.1688-3C>G and c.*2G>T) and two exon deletions previously reported. The overall rate of SPG4 gene mutation in our patients was 36.8% (14/38); in AD-HSP we observed a mutation frequency of 45.8% (11/24), in sporadic cases the frequency was 21.4% (3/14). Furthermore, we found a mutational rate of 22.2% (2/9) and 41.4% (12/29) in the complicated and pure forms, respectively. The results underlie the importance of genetic testing in all affected individuals

Adapted physical activity for the promotion of health and the prevention of multifactorial chronic diseases: The Erice Charter

The Erice Charter was unanimously approved at the conclusion of the 47th Residential Course "Adapted Physical Activity in Sport, Wellness and Fitness: New Challenges for Prevention and Health Promotion", held on 20-24 April 2015 in Erice, Italy, at the "Ettore Majorana" Foundation and Centre for Scientific Culture, and promoted by the International School of Epidemiology and Preventive Medicine "G. D'Alessandro" and the Study Group on Movement Sciences for Health of the Italian Society of Hygiene, Preventive Medicine and Public Health. After an intense discussion the participants identified the main points associated with the relevance of physical activity for Public Health, claiming the pivotal role of the Department of Prevention in coordinating and managing preventive actions. The participants underlined the importance of the physicians specialized in Hygiene, Preventive Medicine and Public Health. The contribution of other operators such as physicians specialized in Sport Medicine was stressed. Further, the holders of the new degree in Human Movement and Sport Sciences were considered fundamental contributors for the performance of physical activity and their presence was seen as a promising opportunity for the Departments of Prevention. Primary prevention based on recreational physical activities should become easily accessible for the population, avoiding obstacles such as certification steps or complex bureaucracy. The Sport Doctor is recognized as the principal referent for preliminary physical evaluation and clinical monitoring in secondary and tertiary prevention actions based on adapted physical activities. Developing research in the field is essential as well as implementing higher education on physical activity management in Schools of Public Health