Valutazione dell'attività muscolare faringea attraverso elettromiografia di superficie nasofaringea in pazienti disfagici affetti da ictus ischemico acuto

La disfagia orofaringea è spesso presente durante la fase acuta di un ictus. Lo scopo di questo lavoro è stato quello di valutare se la registrazione elettromiografica di superficie tramite un elettrodo nasofaringeo può essere impiegata per testare l'attività muscolare del faringe nei pazienti con ictus acuto e se queste misurazioni elettrofisiologiche possono essere correlate con la valutazione clinica della deglutizione. Dal punto di vista clinico la severità del quadro è stata valutata mediante l'utilizzo della scala del National Institute of Health Stroke (NIHSS); la disfagia è stata valutata mediante il test di screening Gugging Swallowing Scale (GUSS); l'estensione della lesione ischemica alla TAC è stata misurata attraverso l'Alberta Stroke Programme Early CT Score (ASPECTS). Abbiamo valutato 70 pazienti di cui 50 disfagici (Dys+), e 20 non disfagici (Dys). Ciascun partecipante è stato sottoposto a un'elettromiografia di superficie registrata mediante un elettrodo NP costituito da un catetere di Teflon isolato in acciaio (lungo 16 cm e con un diametro in punta di 1,5 mm). L'elettrodo è stato inserito attraverso la cavità nasale, ruotato e posizionato approssimativamente 3 mm antero-inferiormente rispetto alla volta salpingo-palatina. Per ogni partecipante sono state registrate ed analizzate le risposte elettromiografiche di almeno quattro deglutizioni volontarie ripetute. La deglutizione induce sempre all'elettromiografia burst ripetitivi e polifasici di durata compresa fra 0,25 e 1 secondo, con un'ampiezza intorno ai 100-600mV. I disfagici hanno mostrano una maggiore durata del burst rilevato all'elettromiografia rispetto ai non disfagici, con una differenza statisticamente significativa (p < 0,001), ma non hanno mostrano differenze in termini di ampiezza del burst stesso (p = 0,775); quest'ultima invece era inversamente correlata con lo NIHSS score [r(48) = 0,31; p < 0,05)] e con lo ASPECTS score [r(48) = 0,27; p < 0,05]. Questi risultati suggeriscono che le registrazioni nasofaringee possono rappresentare un indice semi-quantitativo delle difficoltà deglutitorie secondarie a disfunzione faringea ed in particolare, i risultati dell'elettromiografia sarebbero indicativi di una ridotta motilità faringea durante la fase acuta di un ictus

Chronic paroxysmal hemicrania in paediatric age: report of two cases

Chronic paroxysmal hemicrania (CPH) is a rare primary headache syndrome, which is classified along with hemicrania continua and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) as trigeminal autonomic cephalalgia (TACs). CPH is characterised by short-lasting (2–30 min), severe and multiple (more than 5/day) pain attacks. Headache is unilateral, and fronto-orbital-temporal pain is combined with cranial autonomic symptoms. According to the International Classification of Headache Disorders, 2nd edition, the attacks are absolutely responsive to indomethacin. CPH has been only rarely and incompletely described in the developmental age. Here, we describe two cases concerning a 7-year-old boy and a 11-year-old boy with short-lasting, recurrent headache combined with cranial autonomic features. Pain was described as excruciating, and was non-responsive to most traditional analgesic drugs. The clinical features of our children’s headache and the positive response to indomethacin led us to propose the diagnosis of CPH. Therefore, our children can be included amongst the very few cases of this trigeminal autonomic cephalgia described in the paediatric age

Validation of the italian version of the Cluster Headache Impact Questionnaire (CHIQ)

Background: The Cluster Headache Impact Questionnaire (CHIQ) is a specific and easy-to-use questionnaire to assess the current impact of cluster headache (CH). The aim of this study was to validate the Italian version of the CHIQ. Methods: We included patients diagnosed with episodic CH (eCH) or chronic CH (cCH) according to the ICHD-3 criteria and included in the “Italian Headache Registry” (RICe). The questionnaire was administered to patients through an electronic form in two sessions: at first visit for validation, and after 7 days for test-retest reliability. For internal consistency, Cronbach’s alpha was calculated. Convergent validity of the CHIQ with CH features and the results of questionnaires assessing anxiety, depression, stress, and quality of life was evaluated using Spearman’s correlation coefficient. Results: We included 181 patients subdivided in 96 patients with active eCH, 14 with cCH, and 71 with eCH in remission. The 110 patients with either active eCH or cCH were included in the validation cohort; only 24 patients with CH were characterized by a stable attack frequency after 7 days, and were included in the test-retest cohort. Internal consistency of the CHIQ was good with a Cronbach alpha value of 0.891. The CHIQ score showed a significant positive correlation with anxiety, depression, and stress scores, while showing a significant negative correlation with quality-of-life scale scores. Conclusion: Our data show the validity of the Italian version of the CHIQ, which represents a suitable tool for evaluating the social and psychological impact of CH in clinical practice and research

Valutazioni istopatologiche degli effetti della Ranitidina nelle ustioni.

Jaworski Véronique. Site classé. In: Revue Juridique de l'Environnement, n°4, 2008. pp. 510-512

Gastric determinants of maximum satiety induced by standardized solid and liquid meal. An MRI study in non obese healthy subjects.

BACKGROUND: Gastric contribution to satiety has been mostly investigated by invasive methods and by the administration of liquid meals. Nonetheless, these conditions may alter the physiology of the stomach and do not reflect individual's alimentary habit, respectively. AIM: To study gastric determinant to satiety in a more physiological fashion by a non invasive method as MRI and by standardized solid (SM) and liquid (LM) meal. SUBJECTS AND METHODS: Ten healthy subjects (4 F; Age 22±3; BMI 23±1) underwent satiety tests by SM and LM on two separate occasions. Subjects were requested to maintain intake at regular rate (100 kcal/5 min). At five minute intervals, they scored their satiety using a graphic rating scale that combined verbal descriptors on a scale graded 0-5 (1=threshold, 5=maximum satiety). Kcal and time to reach maximum satiety (MS) were calculated. During the meal tests, a gastric 1.5 T MRI using a multi-receive parallel body-synergy-coil was performed. Three acquisitions were then recorded at baseline, maximum satiety and 120 min postprandially, in order to calculate total, proximal and distal gastric volumes at each time point. Also, residual volumes at 120 min were calculated and expressed as percentage respect to MS. Data are expressed as mean±SD. RESULTS: Kcals ingested and time to reach MS were significantly higher during SM (783±244 kcal; 44±14 min) than LM (630±353 p<0.01; 31±17 p<0.01). However, total, proximal and distal gastric volume were not different between the two meals (SM: 657±186, 110±40, 546±173 vs LM: 651±299, 143±64, 507±283). Correlation analysis between total and distal gastric volumes and kcal at MS revealed a more strong and significant correlation during LM (r=0.98, p<0.001; r=0.95, p<0.001) compared to SM (r=0.76, p<0.01; r=0.78, p<0.01). No correlations were found between proximal volumes and kcal at MS. Percentages of gastric retention at 120 min were significantly higher with SM than with LM in the distal stomach, but not in the proximal stomach (63±13 vs 38±14, p<0.01 and 14±5 vs 10±7 p=NS). In addition, a significant correlation between the percentage of gastric retention at 120min and MS was only observed by considering total and distal stomach with LM (r=0.73 and r=0.61, p<0.01, respectively). CONCLUSION: By using a non-invasive methodology we showed that a standardized SM is a reliable tool to assess maximum satiety in healthy subjects. The lack of correlation between proximal gastric volumes and Kcals ingested at maximum satiety is probably related to the different intragastric distribution and handling of the liquid and solid meal