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Purpose: This study was undertaken to verify the effectiveness of compensatory postures, suggested on the basis of the type of dysphagia identified at videofluoromanometric (VFM) investigation to ensure safe oropharyngeal transit., Materials and Methods: Eighty-one patients with amyotrophic lateral sclerosis (ALS) underwent speech therapy assessment and VFM investigation of the swallowing process. In the event of altered transit, penetration or aspiration of contrast material into the airways, compensation postures for correction of the swallowing disorder were suggested and verified during VFM examination., Results: In 37 patients, contrast agent transport was preserved and safe; in 19, we observed penetration of the contrast agent into the laryngeal inlet without aspiration; in 24, there was aspiration (four preswallowing, eight intraswallowing, nine postswallowing, three mixed), whereas in one patient no transit was seen. Penetration without aspiration was resolved by coughing or throat clearing; aspiration was resolved in 13 patients by assuming the chin-tuck posture and in six by rotating the head; in five patients, it was not resolved. A hyperextended head posture proved to be effective to resolve lack of transit., Conclusions: By correlating morphological with functional data, VFM enables one not only to precisely characterise the dysphagic disorder but also to identify the most appropriate compensation posture for each patient and verify its effectiveness.

The objective of this study was to evaluate the potential role of newly developed, advanced magnetic resonance (MR) imaging techniques (spectroscopy, diffusion and perfusion imaging) in diagnosing brain gliomas, with special reference to histological typing and grading, treatment planning and posttreatment follow-up. Conventional MR imaging enables the detection and localisation of neoplastic lesions, as well as providing, in typical cases, some indication about their nature. However, it has limited sensitivity and specificity in evaluating histological type and grade, delineating margins and differentiating oedema, tumour and treatment side-effects. These limitations can be overcome by supplementing the morphological data obtained with conventional MR imaging with the metabolic, structural and perfusional information provided by new MR techniques that are increasingly becoming an integral part of routine MR studies. Incorporation of such new MR techniques can lead to more comprehensive and precise diagnoses that can better assist surgeons in determining prognosis and planning treatment strategies. In addition, the recent development of new, more effective, treatments for cerebral glioma strongly relies on morphofunctional MR imaging with its ability to provide a biological interpretation of these characteristically heterogeneous tumours.

In recent years, new technologies have become available for imaging small animals. The use of animal models in basic and preclinical sciences, for example, offers the possibility of testing diagnostic markers and drugs, which is becoming crucial in the success and timeliness of research and is allowing a more efficient approach in defining study objectives and providing many advantages for both clinical research and the pharmaceutical industry. The use of these instruments offers data that are more predictive of the distribution and efficacy of a compound. The mouse, in particular, has become a key animal model system for studying human disease. It offers the possibility of manipulating its genome and producing accurate models for many human disorders, thus resulting in significant progress in understanding pathologenic mechanisms. In neurobiology, the possibility of simulating neurodegenerative diseases has enabled the development and validation of new treatment strategies based on gene therapy or cell grafting. Noninvasive imaging in small living animal models has gained increasing importance in preclinical research, itself becoming an independent specialty. The aim of this article is to review the characteristics of these systems and illustrate their main applications.

Purpose: This study was performed to clarify the role of perfusion-weighted imaging (PWI) at 3 Tesla in the characterisation of haemodynamic heterogeneity within gliomas and surrounding tissues and in the differentiation of high-grade from low-grade gliomas., Materials and Methods: We examined 36 patients with histologically verified gliomas (25 with high-grade and 11 with low-grade gliomas). PWI was performed by first-pass gadopentetate dimeglumine T2*-weighted echo-planar images, and cerebral blood volume (CBV) maps were computed with a nondiffusible tracer model. Relative CBV (rCBV) was calculated by dividing CBV in pathological areas by that in contralateral white matter., Results: In high-grade gliomas, rCBV were markedly increased in mass [mean+/-standard deviation (SD), 4.3+/-1.2] and margins (4.0+/-1.1) and reduced in necrotic areas (0.3+/-0.3). Oedematous-appearing areas were divided in two groups according to signal intensity on T2-weighted images: tumour with lower (nearly isointense to grey matter) and oedema with higher (scarcely isointense to cerebrospinal fluid) signal intensity. Tumour showed significantly higher rCBV than did oedema (1.8+/-0.5 vs. 0.5+/-0.2; p<0.001) areas. In low-grade gliomas, mass (2.0+/-1.5) and margin (2.2+/-1.2) rCBV were significantly lower than in high-grade gliomas (p<0.001)., Conclusions: Three-Tesla PWI helps to distinguish necrosis from tumour mass, infiltrating tumour from oedema and high-grade from low-grade gliomas. It enhances the magnetic resonance (MR) assessment of cerebral gliomas and provides useful information for planning surgical and radiation treatment.

Cigarette smoking has been clearly linked to the most common causes of death in the elderly and contributes to the higher death rate and disability rate associated with many chronic illnesses that are common in this age group. The combination of smoking along with other risk factors like hypertension and diabetes increase high frequency disease, and disability as well as adding to an increase in mortality rate. In order to verify if a healthy lifestyle really favours longevity and how much smoking is incompatible with extreme longevity, we investigated the prevalence of smokers and the total smoking exposure of a sample of centenarians as regards residual survival and health conditions. Our sample consists of 157 centenarians selected among the registered residents of Rome: 39 males and 118 females (ratio = 1:3), mean age being 101.59 years (sd = 1.8). 83.8% of the centenarians have never smoked, 13.5% are former smokers, and 2.7% are active smokers. The average starting age of smoking was 21.2 years while the average age of quitting in former smokers was 65.7 years with an average of 44.7 smoking years (sd = 17.1). The average number of smoked cigarettes per day is quite low, less than 10 cigarettes. There seemed to be a significant difference (p < 0.001) in gender results in smokers: male centenarians were 46%, while female reached only 8.1%. Statistically significant higher prevalence of diseases illnesses were noted among centenarian smokers over the age of 65 (p < 0.02). Moreover Cox's regression has shown in centenarians a lower survival rate (p < 0.05) in smokers than in non-smokers. In conclusion, our study is evidence that smoking is for all, but some exceptional subjects, incompatible with successful aging and compromises life expectancy even in extreme longevity.

Aging is considered a product of an interaction between genetic, environmental and lifestyle factors. Are centenarians, who have almost arrived at the maximum life-span (120 yrs), free of cardiovascular disease or do they have an increased resistance? How many cardiovascular risk factors are present? We have studied a group of 148 centenarians selected from registered residents of Rome (average age 101.8 +/- 1.9; range 100-108). Their health was assessed through direct 1.5 hour interviews, conducted by physicians with geriatric training at the patient's residence, which includes geriatric assessment scales' submission. The prevalence of cardiovascular disease of our centenarians is 16.7%, represented by heart failure (8%), myocardial infarction (4.7%) and angina pectoris (4%). Among the cardiovascular risk factors, hypertension (31.1%) and hypercholesterolemia are the most frequent, while diabetes is not present. These data, compared with younger samples, point out a lower percentage of cardiovascular disease and risk factors. Moreover centenarians have always conducted a healthy lifestyle (Mediterranean diet, smoking abstention, physical activity, low levels of anxiety and depression). Finally, having identified the golden mean which allows us to carry out a programmed intervention for the prevention of cardiovascular risk factors and diseases, we will be able to increase longevity, allowing a larger number of subjects to reach the maximum human life-span.

Thirty-nine consecutive patients with subarachnoid hemorrhage (SAH) of unknown etiology were studied retrospectively. A significant relationship between arterial hypertension, blood on CT and angiographic spasm was found. The use of nimodipine was associated with a reduction of vasospasm. Antifibrinolytic agents did not increase the risk of ischemic complications. The prognosis was generally favorable.

Data concerning a preliminary study on the prognostic significance of inflammatory infiltration in cerebral metastases are reported. Seventeen cases of operated cerebral metastases have been studied to investigate their histotype and grade of necrosis, stromal reaction, and inflammatory infiltration. Finally, the results obtained are discussed in relation to the postoperative survival rate of the patients.

The Authors, on the base of Vackeneim's pathogenetic hypothesis about a case of post-traumatic bone bridges of the spine, describe three cases observed and examine the etiopathogenesis of this extremely rare pathology.

The result of a study of 100 cases of arterial hypertension with various aetiology is presented from a phonomechanocardiographic viewpoint. Findings suggest that irregularities in the apicocardiographic curve recorded in Pachon position, and particularly the "a" wave and the "a" index, are highly sensitive and provide an early warning of contractile deficiency of the left ventricle. The mechanism leading to the pathological appearance of the "a" wave is discussed.

A study of the behaviour of the a and telediastolic indices and systolic times in patients presenting the sequelae of myocardial infarction is reported. It is pointed out that the earliness of a and t index variations with respect to those of systolic times is an indication of the sensitivity of the investigation which offers invaluable pointers to subsequent treatment. It is also stressed that previous hypertension and/or coronaropathy are more important than the infarction itself in creating dyskinetic zones of the myocardium and, consequently, the haemodynamic changes observed with phonomechanocardiography.

The Authors submitted 53 randomly selected patients affected by systemic lupus erythematosus (SLE) to neurologic evaluation to investigate the prevalence of neurologic manifestations, establish relationships to clinical and epidemiological findings and antinuclear antibodies and/or lupus anticoagulant (LAC), as well as to assess the usefulness of electroencephalogram (EEG), saccadic eye movements (SEM) analysis, brain computerized tomography (CT). Twenty-two patients (41.5%) had nervous system involvement on anamnestic and/or clinical examination: there were seizures in 5 patients, headache in 3, involuntary movements in 3, psychosis in 2 and cerebrovascular disorders in 9. The patients were subdivided into 2 groups, with neuro-SLE and without neuro-SLE, according to clinical and/or anamnestic evidence of nervous system involvement. There were no differences between the two groups of patients regarding disease duration, disease activity, presence of antinuclear antibodies and/or LAC. EEG and/or SEM and/or brain CT abnormalities were found in 38 cases, 18 of which had no clinical evidence of neuro-SLE. Instrumental evaluation can thus document subtle nervous dysfunction and offers the possibility of classification into: a) non-neuro-SLE; b) subclinical neuro-SLE; c) overt neuro-SLE.