Posible especificidad de los síntomas tipo pánico inducidos por inhalantes: a propósito de un caso

La intoxicación aguda por inhalantes produce distintos síntomas psiquiátricos y se ha documentado daño orgánico cerebral por exposición crónica a los mismos. Describimos la aparición de un subgrupo específico de síntomas tipo pánico, tras la exposición a solventes volátiles, en una mujer de 36 años con historia de exposición profesional y adicción a los solventes volátiles que posteriormente desarrolló un trastorno de pánico comórbido con escasa respuesta al tratamiento antidepresivo. La paciente se evaluó mediante la administración del SCL-90-R, el WAIS y el test de Rorschach; también se le realizó RM de medio contraste. No se encontraron datos sólidos de daño cerebral, aunque sus síntomas de ansiedad cumplen criterios para el subtipo neurobiológico de trastorno de pánico no relacionado con miedo a asfixia. Este subgrupo de síntomas de ansiedad se atribuye al mecanismo de acción de los solventes volátiles, es decir, la neurotransmisión gabaérgica

Cauda Equina Enhancing Lesion in an HIV-Infected Patient. Case Report and Literature Review.

We report the case of an HIV-infected young men with neuro-toxoplasmosis localized in the spinal cord. The patient received chemotherapy and immunotherapy for Burkitt lymphoma one year before. At the time of the diagnosis of toxoplasmosis, he was on prophylaxis with trimethoprim and sulfamethoxazole and in complete remission of Burkitt lymphoma. The CD4+ T cell count was 270/μl and the HIV viremia was undetectable. These findings suggest that in this patient, the immunodeficiency promoting the neurologic toxoplasmosis arose more from previous immuno-chemotherapy than from the HIV-infection itself. On the whole, this case highlights that the risk stratification for opportunistic infections of HIV-infected patients should carefully consider their previous medical history and therapies received

Muscle magnetic resonance imaging in myotonic dystrophy type 1 (DM1) : Refining muscle involvement and implications for clinical trials

Only a few studies have reported muscle imaging data on small cohorts of patients with myotonic dystrophy type 1 (DM1). We aimed to investigate the muscle involvement in a large cohort of patients in order to refine the pattern of muscle involvement, to better understand the pathophysiological mechanisms of muscle weakness, and to identify potential imaging biomarkers for disease activity and severity. One hundred and thirty-four DM1 patients underwent a cross-sectional muscle magnetic resonance imaging (MRI) study. Short tau inversion recovery (STIR) and T1 sequences in the lower and upper body were analyzed. Fat replacement, muscle atrophy and STIR positivity were evaluated using three different scales. Correlations between MRI scores, clinical features and genetic background were investigated. The most frequent pattern of muscle involvement in T1 consisted of fat replacement of the tongue, sternocleidomastoideus, paraspinalis, gluteus minimus, distal quadriceps and gastrocnemius medialis. Degree of fat replacement at MRI correlated with clinical severity and disease duration, but not with CTG expansion. Fat replacement was also detected in milder/asymptomatic patients. More than 80% of patients had STIR-positive signals in muscles. Most DM1 patients also showed a variable degree of muscle atrophy regardless of MRI signs of fat replacement. A subset of patients (20%) showed a 'marbled' muscle appearance. Muscle MRI is a sensitive biomarker of disease severity alsofor the milder spectrum of disease. STIR hyperintensity seems to precede fat replacement in T1. Beyond fat replacement, STIR positivity, muscle atrophy and a 'marbled' appearance suggest further mechanisms of muscle wasting and weakness in DM1, representing additional outcome measures and therapeutic targets for forthcoming clinical trials. We refined the pattern of muscle involvement in DM1 by upper and lower body muscle magnetic resonance imaging (MRI), identifying the most frequent pattern of fat replacement and confirming that muscle MRI is a sensitive biomarker of disease burden in DM1. We also observed: STIR-positive muscles in 80% of patients preceding fat replacement, muscle atrophy in muscles unreplaced by fat, and progeroid muscle appearance supporting a premature muscle senescence. Our findings provide novel insights into the pathophysiological mechanisms of muscle wasting and weakness in DM1, and could represent additional outcome measures and therapeutic targets for forthcoming clinical trials

L'immagine medico-nucleare recettoriale guida la terapia del residuo post-chirurgico degli adenomi ipofisari non secernenti

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The integrated care pathway for melanoma: the Istituto Dermopatico dell'Immacolata experience in Rome

Introduction: The Integrated Care Pathway (ICP) represents a multidisciplinary outline of anticipated care, placed in an appropriate timeframe, to support patients with specific conditions or symptoms. The aim of this paper is to define the ICP for patients with melanoma referring to the "Istituto Dermopatico dell'Immacolata-IRCCS di Roma e Villa Paola" ("Center"). Methods and results: A multidisciplinary group (oncologists, dermatologists, surgeons, pathologists etc.) was defined as well as a facilitator to act as a link between all experts. The first step of ICP development was a review of current practice for patients with melanoma referring to the Center. This first step had the scope to define the multidisciplinary process map (a "picture" of the care plan) for patients with melanoma. The process map defined: i) the activities performed during delivery of care to the patients, ii) the responsibilities for these activities and iii) potential problem areas or opportunities for improvements. The process map formed the basis of the final ICP document. Conclusion: The adoption of melanoma ICP will allow the multidisciplinary group to ensure that clinical guidelines and available evidence are incorporated into everyday practice. (Oncology, HTA & Market Access

Molecular and Genetic Immune Biomarkers of Primary and Immune-Therapy Induced Hypophysitis: From Laboratories to the Clinical Practice

Hypophysitis is a rare and potentially life-threatening disease, characterized by an elevated risk of complications, such as the occurrence of acute central hypoadrenalism, persistent hypopituitarism, or the extension of the inflammatory process to the neighboring neurological structures. In recent years, a large number of cases has been described. The diagnosis of hypophysitis is complex because it is based on clinical and radiological criteria. Due to this, the integration of molecular and genetic biomarkers can help physicians in the diagnosis of hypophysitis and play a role in predicting disease outcome. In this paper, we review current knowledge about molecular and genetic biomarkers of hypophysitis with the aim of suggesting a possible integration of these biomarkers in clinical practice

Adult idiopathic occlusion of the foramina of Monro: diagnostic tools and therapy

BACKGROUND AND PURPOSE: The bilateral foramina of Monro occlusion is an extremely rare event in adults. To date, only six cases of adult hydrocephalus due to idiopatic obstruction of the bilateral foramina of Monro (including our patient) have been reported. METHODS: The authors describe the case of a 41-year-old man with a recent onset of motor hindrance which occurred specially while jumping or playing basketball, together with recent memory impairment, deceleration of thought, and asthenia. The patient was studied with fast spin echo (FSE) and steady-state free precession high-resolution 3D sequences (SSFP) together with a ventricular infusion test, and subsequently treated with endoscopic foraminoplasty. RESULTS: The presenting symptoms completely resolved. Follow-up magnetic resonance imaging (MRI) showed the patency of right Monro foramen, with gradually decreasing ventricular size and increase of subarachnoid spaces. CONCLUSIONS: These patients should be accurately studied before treatment. In fact, MRI has made it possible to know what a surgeon will exactly find on the operative field. In that way a correct surgical planning can be achieved

Immune checkpoint inhibitors (ICIs)-related ocular myositis

We present extensive clinical, serological, morphological and muscle imaging data of a 66-year-old man with isolated bilateral ptosis and external ophthalmoplegia secondary to Immune checkpoint inhibitors (Pembrolizumab). He had elevated CK level (>5000 UI/L). No facial, bulbar, proximal, distal or axial muscular weakness was observed. Electromyography (EMG) showed myopathic pattern, with spontaneous activity. Myositis specific antibodies and anti-striational antibodies were negative. Cardiac and respiratory functions were preserved. Skeletal muscle MRI was unremarkable, whereas extraocular muscles revealed bilateral hyperintensities in inferior rectus, medial rectus and superior oblique muscles in both T1 and STIR sequences, with mild muscle atrophy. Muscle biopsy showed endomysial inflammatory infiltrates, MHC-1 expression was observed in clusters of non-necrotic cells. CD56 positive cells were observed in perifascicular regions. Patient discontinued Pembrolizumab and received corticosteroid treatment with progressive clinical improvement and CK normalization. Our findings support this clinical entity, suggesting that isolated ocular myositis represents a subgroup of generalised myositis with predominant ocular symptoms

Replay to Influenza A (H1N1) in cerebrospinal fluid sample and encephalopathy by Sandoval-Guti\ue9rrez JM, Arcos M, Alva L, Volkow P, T Ferrari T, Qui\uf1ones F, V\ue1zquez-P\ue9rez J, Ormsby JE, Hanssen F, Res\ue9ndiz A, Alc\ue1ntara P, P\ue9rez Padilla R, Bautista E.

Abstract not availabl