Cardiac hypertrophy and heart failure: from the case to review of literature

In response to an increased workload due to physiological or pathological stimuli, the heart may undergo a process of growth with increased muscle mass called cardiac hypertrophy. It is a particular mechanism of long term compensation used by the heart to adapt permanently to a greater workload. Although, through its peculiar structural, molecular and metabolic characteristics, in early stage the hypertrophy allows to maintain an adequate cardiac function, after a variable period of time, the same characteristics promote the evolution to contractile dysfunction and heart failure. The latter represents an important cause of death and so the cardiac hypertrophy increases the cardiovascular morbidity and mortality. In this paper we report a rare case of extremely high degree of concentric cardiac hypertrophy, with a heart weight of 1050 g and longitudinal diameter of 16.5 cm, transverse diameter of 16 cm and antero-posterior diameter of 9 cm. The thickness of the left ventricle free wall was 4.2 cm, of the septum 4.3 cm and at the apex level 3.5 cm. These data, compared with those described in scientific literature, indicate the exceptional nature of our necropsy finding of a huge cardiac hypertrophy. The analysis of the pathogenetic mechanisms, which may determinate the fatal event in case of cardiac hypertrophy, shows that in the described case the death cause can be the onset of heart failure in presence of cardiomegaly

Cognitive fluctuations in connection to disgraphia a comparison of Alzheimer's disease with dementia Lewy bodies

Background: The purpose of the present study was to examine the relationship between cognitive impairment and the performance of handwritten scripts presented as “letter-writing” to a close relative by patients with dementia Lewy bodies (DLB), as fluctuations of the symptoms phase, and in a matched group of patients with Alzheimer’s disease (AD). The degree of writing disability and personal, spatial, and temporal orientation was compared in these two groups. Design and methods: Fourteen simple questions, designed in a form that could be utilized by any general practitioner in order to document the level of cognitive functioning of each patient, were presented to 30 AD patients and 26 DLB patients. The initial cognition test was designated PQ1. The patients were examined on tests of letter-writing ability. Directly after the letter-writing, the list of 14 questions presented in PQ1 was presented again in a repeated procedure that was designated PQ2. The difference between these two measures (PQ1 – PQ2) was designated D∆. This test of letter-writing ability and cognitive performance was administered over 19 days. Results: Several markedly strong relationships between dysgraphia and several measures of cognitive performance in AD patients and DLB patients were observed, but the deterioration of performance from PQ1 to PQ2 over all test days were markedly significant in AD patients and not significant in DLB patients. It is possible that in graphic expression even by patients diagnosed with moderate to relatively severe AD and DLB there remains some residual capacity for understanding and intention that may be expressed. Furthermore, the deterioration in performance and the differences noted in AD and DLB patients may be due to the different speed at which the process of the protein degradation occurs for functional modification of synapses. Conclusion: Our method can be used as part of neuropsychological tests to differentiate the diagnosis between AD and DL

Work-related allergic rhinitis: a contemporary review of the literature

Adverse health effects have been reported in workers exposed to inhaled allergens. Allergic rhinitis is a heterogeneous disorder that significantly affects daily activity, work productivity, sleep, learning, and quality of life in all generations. Occupational-ly-related hazards which contribute to the development of allergic rhinitis represent an important avoidable cause of morbidity. The occupational exposure to chemicals or biological agents is the cause of high incidences of allergic rhinitis and this risk is high when the organization and preparation are inadequate and there is a lacking or insufficient information, education and communication. The prevalence of work-related rhinitis, which encompasses both occupational rhinitis and work-exacerbated rhinitis, is estimated to be 31-61%. Data on occupational rhinitis itself are scarce. Although work-related asthma and allergies are a huge burden for society, investigation of oc-cupational exposures in early work life using an unexposed reference group is rare. Occupational allergic diseases are likely to worsen or become intractable as a result of continuous exposure to high concentrations of causative antigens, and are socioeco-nomically important diseases with which the patients might sometimes lose jobs due to work interruptions. It is important to adequately assess, communicate and manage risks in occupational chemical exposure settings with the aim to protect workers and the necessity to introduce periodic health examinations programs focusing on workers to monitor health and well-being and improve working conditions and the working environment

Legal medical consideration of alzheimer’s disease patients’ dysgraphia and cognitive dysfunction: a 6 month follow up

Background: The purpose of this study was to investigate the ability of Alzheimer’s disease (AD) patients to express intentions and desires, and their decision-making capacity. This study examines the findings from a 6-month follow-up of our previous results in which 30 patients participated. Materials and methods: The patient’s cognition was examined by conducting the tests of 14 questions and letter-writing ability over a period of 19 days, and it was repeated after 6 months. The difference between these two cognitive measures (PQ1 before–PQ2 before), tested previously and later the writing test, was designated DΔ before. The test was repeated after 6 months, and PQ1 after–PQ2 after was designated DΔ after. Results: Several markedly strong relationships between dysgraphia and other measures of cognitive performance in AD patients were observed. The most aged patients (over 86 years), despite less frequency, maintain the cognitive capacity manifested in the graphic expressions. A document, written by an AD patient presents an honest expression of the patient’s intention if that document is legible, clear, and comprehensive. Conclusion: The identification of impairment/deficits in writing and cognition during different phases of AD may facilitate the understanding of disease progression and identify the occasions during which the patient may be considered sufficiently lucid to make decisions. Keywords: cognition, intentions, unfit to plead, consen

Early diagnosis of cardiovascular diseases in workers: role of standard and advanced echocardiography

Cardiovascular disease (CVD) still remains the main cause of morbidity and mortality and consequently early diagnosis is of paramount importance. Working conditions can be regarded as an additional risk factor for CVD. Since different aspects of the job may affect vascular health differently, it is important to consider occupation from multiple perspectives to better assess occupational impacts on health. Standard echocardiography has several targets in the cardiac population, as the assessment of myocardial performance, valvular and/or congenital heart disease, and hemodynamics. Three-dimensional echocardiography gained attention recently as a viable clinical tool in assessing left ventricular (LV) and right ventricular (RV), volume, and shape. Two-dimensional (2DSTE) and, more recently, three-dimensional speckle tracking echocardiography (3DSTE) have also emerged as methods for detection of global and regional myocardial dysfunction in various cardiovascular diseases, and applied to the diagnosis of subtle LV and RV dysfunction. Although these novel echocardiographic imaging modalities have advanced our understanding of LV and RV mechanics, overlapping patterns often show challenges that limit their clinical utility. This review will describe the current state of standard and advanced echocardiography in early detection (secondary prevention) of CVD and address future directions for this potentially important diagnostic strategy

Terapia farmacologica e suicidio: l’esperienza del Gabapentin e della Quetiapina. Considerazioni medico-legali basate su una meta-analisi

Riassunto Il Gabapentin e la Quetiapina sono due farmaci appartenenti a due categorie farmaceutiche diverse e presentano diverse indicazioni terapeutiche. Essi condividono la negativa caratteristica di essere legati ad un possibile coinvolgimento in episodi di suicidio. Inoltre il recente uso off-label del Gabapentin per la terapia dei disturbi bipolari ha fatto sì che entrambi i farmaci possano essere impiegati per trattare la stessa patologia, aprendo la possibilità di una loro associazione nei pazienti refrattari alla monoterapia, con l’eventualità che i singoli effetti collaterali si sommino. Obiettivo di questo lavoro è stimare, attraverso l’analisi della letteratura scientifica disponibile, il legame esistente tra l’assunzione di Gabapentin e/o Quetiapina ed il rischio di ideazione e/o comportamenti suicidari, individuare un possibile meccanismo d’azione che possa spiegarlo e valutare il possibile utilizzo di questi farmaci come mezzo per porre in atto il suicidio. Il medico nel prescrivere Gabapentin o Quetiapina deve essere consapevole dei rischi che essi comportano e ne deve fornire al proprio paziente una completa informazione che gli consentano di prestare un consenso consapevole alla terapia. Inoltre, attraverso visite regolari, deve porre in atto un attento monitoraggio durante tutto l’arco del trattamento che gli consenta di rilevare segni di allarme e stabilire tutti gli accorgimenti, comportamentali e terapeutici, che permettano di ridurre o prevenire il rischio di comportamenti suicidari nei pazienti. Tutto ciò risulta ancor più importante alla luce della possibilità di una terapia di associazione con i due farmaci, sulla quale non esistono studi specifici. La gabapentine (Gabapentin) et la quétiapine (Quetiapina) sont deux médicaments appartenant à des catégories pharmaceutiques différentes ayant des indications thérapeutiques distinctes. Ils ont en commun la caractéristique négative d’être liés à une augmentation possible du risque de suicide. En outre, la prescription non conforme de médicaments (off-label use) comme la gabapentine, récemment choisie a fait que les deux médicaments peuvent être utilisés pour le traitement des troubles bipolaires, ouvrant la possibilité de faire prendre les deux aux patients jugés réfractaires à la monothérapie : le risque est que l’effet secondaire de l’un se somme à celui de l’autre. Grâce à l’analyse de la littérature scientifique, l’objectif de cette étude est : d’évaluer la relation entre l’assomption de la gabapentine et de la quétiapine et le risque d’idéation suicidaire et/ou de passage à l’acte ; d’identifier un mécanisme d’action pouvant expliquer ce risque ; évaluer l’usage de ces médicaments comme moyen de passage à l’acte dans la crise suicidaire. Le médecin qui prescrit la gabapentine (Gabapentin) ou la quétiapine (Quetiapina) doit être conscient de leurs risques et doit en informer le patient le plus complètement possible afin que ce dernier puisse donner, en toute conscience, un son consentement à la thérapie. En outre, par le biais de consultations régulières, le médecin doit effectuer un monitorage attentif du traitement pour détecter les signaux d’alarme et trouver les échappatoires, comportementales et thérapeutiques, pour réduire ou prévenir le risque suicidaire chez les patients. Tout cela est plus important encore, vu la possibilité de l’association de deux médicaments sur laquelle il n’existe aucune étude spécifique. Gabapentin and Quietiapina are two drugs belonging to two different pharmaceutical classes thus offering different therapeutic indications. They both share the negative feature of being related to a possible implication in suicidal events. Moreover, the latest off-label use of Gabapentin for the bipolar disorders therapy has allowed the use of both these drugs in the treatment of the same pathology, thus opening the possibility of their combination in treating those patients refractory to single-drug therapy. By doing in this way, there is the possibility of joining their separate side effects. The aim of this study is to assess, through the analysis of the available scientific literature, the tie between the administration of Gabapentin and/or Quietiapina and the risk of conceiving and/or practicing suicidal behaviours so that to recognize a possible action mechanism able to explain such behaviours. In this way researchers intend to estimate the possible use of these drugs as a means to commit suicide. When prescribing Gabapentin or Quietiapina, physicians must be aware of the risks of these drugs so that to accurately inform patients who have to give their conscious assent to the therapy. Moreover, through regular visits, caregivers have to implement an attentive monitoring throughout the whole therapy time in order to spot any signs alerting all possible therapeutic procedures necessary to prevent or reduce the risk of suicidal behaviours in patients. All these considerations appear to be more important in the light of the possibility of a therapy combining these two drugs, which has not yet been specifically studied

Maltrattamento o maltrattamenti? Dati preliminari dell’adattamento italiano del Childhood Trauma Questionnaire Short Form

El maltrato psicológico sostenido en el tiempo daña el desarrollo psico-evolutivo de los niños. Una herramienta que detecta maltrato emocional es el CTQ-SF (Cuestionario de Traumas de la Niñez, forma corta) y puede ser usado en el ámbito médico legal y psicojurídico para facilitar el diagnóstico de "abusos psicológicos y emocionales".The psychological abuse if sustained over time damages the psycho-evolutionary development of child. A tool that detects emotional abuse is the CTQ-SF (Childhood Trauma Questionnaire Short Form) and could be used in medical and psycho-legal office to facilitate the diagnosis of “psychological and emotional abuse.”L’abuso psicologico se prolungato nel tempo danneggia lo sviluppo psico-evolutivo del minore. Un strumento che rileva l’abuso emozionale è il CTQ- SF (Childhood Trauma Questionnaire Short Form) e potrebbe essere utilizzato in ambito medico legale e psico-giuridico per facilitare la diagnosi di “abuso psicologico ed emozionale

Delirio omicidiario condiviso nelle coppie di serial killer

Riassunto I serial killer che agiscono in coppia rappresentano un’eventualità statisticamente molto rara. Frequentemente fra i due membri della coppia si va strutturando progressivamente un delirio comune che porta i soggetti a reiterare insieme le azioni omicidiarie. Questo quadro clinico prevede che un soggetto definito dominante, denominato “Induttore” o “Caso primario”, influenzi un soggetto più debole, denominato “Indotto”, arrivando ad imporgli il suo sistema delirante. Il soggetto debole della coppia sovente non proviene da una sottocultura criminale, né è portatore di alcuna patologia psichiatrica che giustifichi la sua adesione alle azioni del soggetto dominante. La sindrome è stata descritta per la prima volta alla fine dell’800 da Lasègue e Falret e denominata “Folie à deux”; nel DSM IV-TR è nota come Disturbo Psicotico Condiviso. Le coppie di serial killer maggiormente rappresentate statisticamente sono quelle formate da due uomini, seguono le coppie miste e infine le coppie femminili. Il legame esistente tra i due membri può essere amicale, amoroso o di parentela. Nonostante il “Caso primario” risulti dominante all’interno della coppia, non bisogna trascurare l’apporto del soggetto debole al delirio omicidiario condiviso: infatti, secondo la logica peculiare di una relazione complementare patologica, entrambi gli agenti hanno un ruolo necessario e funzionale al perdurare della relazione stessa. Anche l’individuo apparentemente più passivo e sottomesso ha un ruolo attivo nella costituzione del delirio omicidiario condiviso. Les tueurs en série qui agissent en couple sont très rares d’un point de vue statistique. Le plus souvent, entre les deux membres du couple, un délire commun apparaît progressivement, conduisant ces sujets à réitérer ensemble les passages à l’acte homicidaire. Ce cadre clinique prévoit qu’un individu, défini comme dominant et nommé « Inducteur » ou « Cas primaire », influence un individu plus faible, nommé « Induit », en lui imposant son système délirant. Le plus souvent, le membre du couple le plus faible ne provient pas d’une sous-culture criminelle et ne souffre d’aucun trouble psychiatrique qui justifierait son adhésion aux actions de l’individu dominant. Le syndrome a été décrit pour la première fois par Lasègue et Falret à la fin du XIXème siècle et nommé « folie à deux » ; le DSM-IV TR parle de « trouble psychotique partagé ». Les couples de tueurs en série les plus représentés d’un point de vue statistique sont composées de deux hommes, puis par un homme et une femme et, enfin, par deux femmes. Le lien entre les deux membres de ces couples peut être de type amical, sentimental ou de parenté. Bien que le « Cas primaire » soit dominant dans le couple, il ne faut pas négliger la contribution de l’individu faible au délire homicidaire partagé : en effet, sur la base de la logique particulière d’une relation complémentaire pathologique, les deux acteurs jouent un rôle majeur et fonctionnel à la continuité de la relation. Même l’individu apparemment le plus passif et soumis joue un rôle actif dans la formation du délire homicidaire partagé. Serial killers acting in pair represent an event which is statistically very rare. A sort of common delirium gradually structured between the two members of the pair, brings them to reiterate their homicidal actions. This clinical situation provides that a person described as dominant and called “inducer” or “primary” or “principal” imposes on another person knows as “the secondary”, “acceptor” or “associate” who gets to share the delirium of the “inducer”. The secondary person does not often come from a criminal subculture and does not have any psychiatric pathology which can justify his/her compliance to the actions of the “inducer”. This syndrome described for the first time at the end of the 19th century by Lasègue and Falret was called “Folie à deux”. In the DSM-IV-TR is known as Shared Psychotic Disorder. These pairs of serial killers statistically more representative are those made up of two men, or a man and a woman or two women. Between the two members there may be a friendly, loving or relationship tie. Even if the “inducer” is dominant within the pair, the contribution given by the “acceptor” to the shared homicidal delirium must not be neglected. In fact, according to the peculiar logic of a relationship completely pathological , both members of the pair have a functional and necessary role in the persistence of the relationship itself. Also the person seemingly more passive and subjected has an active role in the structure of the shared homicidal delirium

Stress, lutto e modificazione dei parametri immunitari

Gli autori in questo articolo riportano un’estesa panoramica in tema di stress, lutto e sistema immunitario. Oltre a citare importanti studi che dimostrano la correlazione tra di essi, vengono altresì esplorati campi pionieristici (ipnosi e cancro – la teoria di Hamer) di un certo interesse che prometterebbero sviluppi futuri. Peraltro, lo studio affronta le possibilità di monitoraggio delle modificazioni immunitarie in caso di danno biologico psichico indiretto permanente, risarcibile in caso di morte di un congiunto (Corte Costituzionale Sent. 24-27 Ott. 1994 n° 372). Les auteurs font référence à une vaste littérature sur le stress, le deuil et le système immunitaire. Ils mentionnent non seulement les études les plus importantes qui montrent une corrélation parmi ces aspects, mais explorent aussi d’intéressantes filières pionnières (hypnose et cancer – la théorie de Hamer) promettant des développements futurs. D’autre part, l’étude aborde la question du monitorage des modifications immunitaires dans le cas du dommage biologique psychique indirect permanent, indemnisé suite à la mort d’un conjoint (Cour Constitutionnelle, jugement du 24-27 Octobre 1994, n°372). The authors of this article refer a large survey about stress, mourning and immune system. Besides mentioning important studies proving a correlation among these elements they also refer about an interesting survey about some pioneering fields (hypnosis and cancer, Hamer's theory) which could be particularly important for future developments. Furthermore, this study faces the possibility of monitoring immune modification in case of indirect permanent psychic biological damage repayable in case of a relative 's death (Corte Costituzionale Sent.24-27 ott. 1994 n.372)

Work-related noise exposure in a cohort of patients with chronic tinnitus: analysis of demographic and audiological characteristics

Work-related noise exposure is one of the major factors contributing to the development of adult-onset hearing loss and tinnitus. The aim of this study was to analyze, in patients with chronic tinnitus and long-term occupational noise exposure, (A) characteristics of hearing loss, tinnitus, comorbidities, demographic characteristics and a history of work-related noise exposure and (B) differences among individuals employed in occupations with high and low risk of developing work-related noise-induced hearing loss (NIHL). One hundred thirty six patients with chronic tinnitus and at least a 10 year-long working history were divided into two groups based on the risk of their profession to induce NIHL. Individuals employed in jobs at high risk for NIHL were mostly males and exhibited a poorer hearing threshold, more evident in the left ear. Tinnitus was mostly bilateral; the next largest presentation was left-sided; patients described their tinnitus as buzzing or high-pitched. Correlation between age, length of tinnitus and worse hearing was found. Patients with a higher degree of hearing impairment were mostly males and were more likely to have a family history of hearing loss and at least one cardiovascular comorbidity. Our study shows some differences in individuals with tinnitus and a history of a profession associated with increased exposure to NIHL compared to those without such a history