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To assess the association of body image dissatisfaction with two anthropometric indicators (body mass index and sum of skinfolds) in female adolescents and to identify the best predictor of body image dissatisfaction in this population.

Background: Leukoaraiosis (LA) is a common radiological finding in elderly, frequently associated with several clinical disorders, including unexplained dizziness. The pathogenesis of LA is multifactorial, with a dysfunction of cerebral microcirculation resulting in chronic hypoperfusion and tissue loss, with oxidative stress involved in this cascade. Objective: The aim of this study was to analyse some oxidative stress biomarkers in a cohort of LA patients. Method: Fifty-five consecutive patients (33 males, median age 75 years) with LA were recruited. In a subgroup of 33 patients with LA and unexplained dizziness, we have then performed an open study to evaluate if 60-day supplementation with a polyphenol compound may modify these biomarkers and influence quality of life, analysed with the Dizziness Handicap Inventory (DHI) scale. Results: At baseline, blood oxidative stress parameters values were outside normal ranges and compared to matched healthy controls. After the two months supplementation, we observed a significant decrement of advanced oxidation protein products values and a significant improvement of DHI. Conclusion: Oxidative stress biomarkers may be useful to detect redox imbalance in LA and to provide non-invasive tools to monitor disease status and response to therapy.

COPD is one of the leading causes of morbidity and mortality. Pharmacotherapy improves quality of life and reduces exacerbations although low adherence with prescribed treatments may represent a barrier to optimal disease management. The first objective of this paper is to report the distribution of COPD patients according to GOLD categories, in a sample of patients from a cohort study in an area of the Latium region in Italy. The second objective is to evaluate the agreement between the distributions of severity obtained from the HCPs and the experts included in the study board (Board). COPD patients were given a card to collect demographic and clinical data at baseline. Information in those cards was independently evaluated by HCPs and Board to include each patient into one of the four GOLD categories. In a sample of 187 stable COPD patients, 59% male, mean age 70 year, the distribution of GOLD categories according to the Board was: 6% A, 34% B, 2% C, and 58% D. A discrepancy in GOLD classification was observed between the study board and field-based HCPs, regarding more than 50% of the patients, with a clear trend to underestimate the frequency of patients in D level (21%) and to overestimate the frequency in C level (21%). These results describe for the first time the distribution of COPD patients in an Italian cohort according to the GOLD categories, with the highest frequencies in levels B and D. The misclassification from HCPs may impact the therapeutic approach and the clinical outcomes.

A modification in the water cycle is one of the most noticeable consequences of global atmospheric warming. Precipitation is a key point in the process and its temporal distribution is particularly important because it impacts on some extreme phenomena such as drought and flash floods, affecting also water resources management. This study presents an analysis of daily rainfall categories over a region of southern Italy in order to verify earlier report results which indicated a paradoxical increase in extreme rainfall, despite a decrease in the totals, in the Mediterranean basin. A set of daily homogenous precipitation series for the period 1916–2006 has been used in this study. Six daily rainfall categories have been considered: Light, 0–4 mm/day; Light-Moderate, 4–16 mm/day; Moderate-Heavy, 16–32 mm/day; Heavy, 32–64 mm/day; Heavy-Torrential, 64–128 mm/day; Torrential, 128-up mm/day. The analysis was performed considering all the region and separately five Rainfall Zones (RZs) characterized by different climatic conditions. Results showed, with some differences for the various RZs, that Light-Moderate, Moderate-Heavy and Heavy rainfall are the main contributors to the total annual rainfall. Moreover, the trend analysis through the Mann-Kendall test showed a decreasing trend of the higher categories and an increasing trend of the weaker categories. These analyses could be useful because changes in extreme events can impact natural environments and human activities, as well as human health and safety.

We previously reported that the combination of two safe proteostasis regulators, cysteamine and epigallocatechin gallate (EGCG), can be used to improve deficient expression of the cystic fibrosis transmembrane conductance regulator (CFTR) in patients homozygous for the CFTR Phe508del mutation. Here we provide the proof-of-concept that this combination treatment restored CFTR function and reduced lung inflammation (P<0.001) in Phe508del/Phe508del or Phe508del/null-Cftr (but not in Cftr-null mice), provided that such mice were autophagy-competent. Primary nasal cells from patients bearing different class II CFTR mutations, either in homozygous or compound heterozygous form, responded to the treatment in vitro. We assessed individual responses to cysteamine plus EGCG in a single-centre, open-label phase-2 trial. The combination treatment decreased sweat chloride from baseline, increased both CFTR protein and function in nasal cells, restored autophagy in such cells, decreased CXCL8 and TNF-α in the sputum, and tended to improve respiratory function. These positive effects were particularly strong in patients carrying Phe508del CFTR mutations in homozygosity or heterozygosity. However, a fraction of patients bearing other CFTR mutations failed to respond to therapy. Importantly, the same patients whose primary nasal brushed cells did not respond to cysteamine plus EGCG in vitro also exhibited deficient therapeutic responses in vivo. Altogether, these results suggest that the combination treatment of cysteamine plus EGCG acts ‘on-target’ because it can only rescue CFTR function when autophagy is functional (in mice) and improves CFTR function when a rescuable protein is expressed (in mice and men). These results should spur the further clinical development of the combination treatment.

Extreme ultraviolet and X-ray free-electron lasers (FELs) produce short-wavelength pulses with high intensity, ultrashort duration, well-defined polarization and transverse coherence, and have been utilized for many experiments previously possible only at long wavelengths: multiphoton ionization, pumping an atomic laser and four-wave mixing spectroscopy. However one important optical technique, coherent control, has not yet been demonstrated, because self-amplified spontaneous emission FELs have limited longitudinal coherence. Single-colour pulses from the FERMI seeded FEL are longitudinally coherent, and two-colour emission is predicted to be coherent. Here, we demonstrate the phase correlation of two colours, and manipulate it to control an experiment. Light of wavelengths 63.0 and 31.5 nm ionized neon, and we controlled the asymmetry of the photoelectron angular distribution by adjusting the phase, with a temporal resolution of 3 as. This opens the door to new short-wavelength coherent control experiments with ultrahigh time resolution and chemical sensitivity.

The main semiconductor oxides for gas sensing have been examined, describing the synthesis processes and the morphological and structural properties. The powders have been deposited as thick films through screen-printing technique to achieve gas sensors. The sensing layers have been studied with regard to semiconductor behaviour, surface barrier potential heights and gas sensing properties. The interaction of humidity with semiconductor oxides has been considered with the aim to compensate, using an algorithm, its effect in gas detection. Finally, nitrogen oxides monitoring, contemporaneously performed in several sites of Italy, has been described.

The main semiconductor oxides for gas sensing have been examined, describing the synthesis processes and the morphological and structural properties. The powders have been deposited as thick films through screen-printing technique to achieve gas sensors. The sensing layers have been studied with regard to semiconductor behaviour, surface barrier potential heights and gas sensing properties. The interaction of humidity with semiconductor oxides has been considered with the aim to compensate, using an algorithm, its effect in gas detection. Finally, nitrogen oxides monitoring, contemporaneously performed in several sites of Italy, has been described.

The increasing use of Internet in a variety of distributed multiparty interactions and transactions with strong real-time requirements has pushed the search for solutions to the problem of attribute-based digital interactions. A promising solution today is represented by automated trust negotiation systems. Trust negotiation systems allow subjects in different security domains to securely exchange protected resources and services. These trust negotiation systems, however, by their nature, may represent a threat to privacy in that credentials, exchanged during negotiations, often contain sensitive personal information that may need to be selectively released. In this paper, we address the problem of preserving privacy in trust negotiations. We introduce the notion of privacy preserving disclosure, that is, a set that does not include attributes or credentials, or combinations of these, that may compromise privacy. To obtain privacy preserving disclosure sets, we propose two techniques based on the notions of substitution and generalization. We argue that formulating the trust negotiation requirements in terms of disclosure policies is often restrictive. To solve this problem, we show how trust negotiation requirements can be expressed as property-based policies that list the properties needed to obtain a given resource. To better address this issue, we introduce the notion of reference ontology, and formalize the notion of trust requirement. Additionally, we develop an approach to derive disclosure policies from trust requirements and formally state some semantics relationships (i.e., equivalence, stronger than) that may hold between policies. These relationships can be used by a credential requestor to reason about which disclosure policies he/she should use in a trust negotiation.

The crystal and molecular structure of Tirofiban [N-(n-butanesulfonyl)-O-(4-(4-piperidinyl)-butyl)-(S)-tyrosine] is here reported. In the solid state the carboxylic group is in the anionic form while the piperidine molecule appear in the protonated form. By H NMR spectroscopy and potentiometric study three pKaare found: pKaCOOH=3.1(1), pKaNHPIP=11.6(1) and pKaNHSO2=13.8(1). The complexing ability of Tirofiban towards various metal ions (Cu(II), Ni(II), Co(II), Cd(II), Pb(II), Zn(II) and Ca(II)) is also determined by means of potentiometric studies. The prevailing species are [M(TirH)2]2+where the ligand coordinates the metal ion through carboxylic group, while the piperidine nitrogen is still protonated. The great stability of these complexes may be due to the presence of hydrogen bond interactions, as well as the formation of stacking interactions involving the phenyl ring of the tyrosine residue.

The crystallization and subsequent polymorphic transformation from the β to the α form of glycine has been studied using optical microscopy, X-ray diffraction, and Fourier transform infrared spectroscopy techniques. The crystal structure and morphology of β glycine have been determined, and the influence of solvent, solubility, and process scale on its solvent-mediated transformation to the α form was quantified. It is concluded that for the low solubility environments used in this study, the rate-determining step in the transformation process is the dissolution rate of the metastable β polymorph.

This paper explores the crystallization of glycine from aqueous solution within a variety of colloidal systems in which the dimension of the crystallization environment varies from micrometers to nanometers. The study focuses on the polymorphic outcome of crystallization experiments and the extent to which crystal size can be controlled. The appearance of the β and γ polymorphic forms is found to be related to the organization and functionality of the surfactants utilized as well as the supersaturation. Overall, it is noted that while macroemulsions may be used to generate particulates of controlled size, crystal growth in microemulsion and lamellar phases is not restricted to the dimensions of the aqueous domains.

Abstract.: Digital Libraries (DLs) introduce several challenging requirements with respect to the formulation, specification, and enforcement of adequate data protection policies. Unlike conventional database environments, a DL environment typically is characterized by a dynamic subject population, often making accesses from remote locations, and by an extraordinarily large amount of multimedia information, stored in a variety of formats. Moreover, in a DL environment, access policies are often specified based on subject qualifications and characteristics, rather than subject identity. Traditional authorization models are not adequate to meet access control requirements of DLs. In this paper, we present a Digital Library Authorization System (DLAS). DLAS employs a content-based authorization model, called a Digital Library Authorization Model (DLAM) which was proposed in previous work [1].

This contribution describes the kinetics of the solution mediated phase transformation between forms 1 and 2 of dihydroxybenzoic acid. It is shown how a combination of kinetic, morphological, and modeling data can be used to give a full description of the rate-determining process in such a transformation. Surprisingly, secondary nucleation is found to dominate the kinetic processes. Such a phenomenon is well-known in continuous crystallization but is reported here for the first time in a polymorphic phase transformation. This observation has significant consequences for process and product control in the pharmaceutical and specialty chemicals industries.

Changes in thyroid function are often described in elderly subjects; however, their pathophysiologic significance and the possible contributory role of both malnutrition and nonthyroidal illness are still debated. The aim of this cross-sectional study was to investigate thyroid function in relationship to some markers of the nutritional status in a group of healthy old subjects and in some centenarians living in nursing homes. Patients included 24 clinically healthy elderly women (age, 71 to 93 years), 24 clinically healthy centenarian women (age, 100 to 106 years), and 20 healthy young subjects (age, 22 to 33 years). Blood samples were drawn from each subject for the evaluation of thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4),reverseT3(rT3), autoantibodies against thyroglobulin (AbTg) and against thyroid peroxidase (AbTPO), and for the main humoral nutritional markers. TSH and thyroid hormones were assayed by fluoroimmunometric method; rT3 and thyroid autoantibodies by radioimmunoassay (RIA) and enzyme chemiluminescent immunometric assay, respectively. The mean values of TSH, FT3and FT4fell within the normal range in both groups. However, by comparison to old controls, in centenarian subjects, TSH levels were significantly lower, whereas rT3concentrations were slightly, but significantly, increased. Autoantibodies positivity was found in 4.16% of centenarians and in 10.4% and 13.6% of old and young controls. Thus, the incidence of thyroid autoantibodies was lower in centenarians than in old controls. Except for transferrin, lower than the normal range in centenarians, all of the other nutritional markers evaluated fell within the laboratory range of normality. Total cholesterol levels were significantly reduced in centenarians by comparison to old controls. Our results showed an age-related decline of the TSH levels and a significant increase of the rT3concentrations in centenarians by comparison to old controls. These findings may be related to an age-dependent reduction of the 5'-deiodinase activity rather than to important changes of nutritional markers.

Purpose To evaluate, on eye bank eyes, a new surgical approach aimed at removing a quadrant of the trabecular meshwork (TM), with an ab interno approach.Methods Gonioscopically controlled ab interno removal of the TM was done with a sub-retinal forcep on six human bank eyes. Serial histological sections were obtained from the treated and untreated part of each globe to assess the effect of the technique on intraocular tissues.Results Under the gonioscope, the TM was easily removed in strings of varying length. Histological examination showed, unexpectedly, that this resulted in a well-defined deep furrow in the middle of the trabecular region involving both the TM and the inner wall of Schlemm's canal. The operation created a direct communication between the anterior chamber and Schlemm's canal lumen without any evident damage to the outer canal wall and adjacent ocular structures such as the iris base and corneal endothelium.Conclusions Our small series on human bank eyes showed that the procedure involves both the TM and the inner wall of Schlemm's canal and is therefore called ab interno trabeculocanalectomy (AITC). The intraoperative findings and the histological evidence are encouraging, and suggest that the procecedure could have potential clinical application.

The aim of this review was to examine the evidence for age-related changes of the hypothalamic-pituitary-adrenal (HPA) axis in both physiological and pathological aging, on the basis of the many data in the literature, as well as of our personal findings. A statistically significant circadian rhythmicity of serum cortisol was maintained in elderly subjects, even if with a reduced amplitude of the 24 h fluctuations and a trend to an increase of the serum levels in the evening and at night-time, in comparison with young controls. Furthermore, an age-related impairment of HPA sensitivity to steroid feedback was present in elderly people. The occurrence of senile dementia amplified the changes already present in physiological aging. While the cortisol secretion was generally well maintained in aging, the adrenal production of dehydroepiandrosterone and of its sulfate (DHEAS) exhibited an age-related decline. Therefore, the cortisol/DHEAS molar ratio was significantly higher in elderly subjects and even more in demented ones, than in young controls. Due to the opposite effects of cortisol and DHEAS on the brain and particularly on the hippocampal region, the imbalance between glucocorticoids and androgens occurring in physiological and even more in pathological aging, may have adverse effects on the function of this region, whose key role in learning and memory is well known.

Abstract:  The paper describes the theoretical determination of the flow and the temperature distribution in a water natural circulation loop for passive conditioning of a big shelter for electronic components. A cylinder filled with phase change material in thermal connection with the inner of the shelter and with the ambient by a water natural circulation loop forms the system. The system operates in natural convection, consequently during the daytime the water flow in the exchanger is stopped because the external temperature is greater then the melting temperature. During the night the situation is reversed, thus the convective flow begins allowing the water circulating and exchanging heat with the ambient. The paper presents a simulation model which describes the flow and the temperature field of the water in the loop during the night. Moreover the theoretical values of temperature are compared with the experimental data obtained in a climatic chamber.

Aging is associated with a selective decline in circulating levels of dehydroepiandrosterone (DHEA) and its sulfate, with no major changes in cortisol secretion. In young subjects, serum levels of both DHEA and cortisol are regulated according to a circadian rhythm, and an age-related attenuation of DHEA, but not cortisol, circadian rhythmicity has been reported. Several trials have evaluated the effects of DHEA supplementation in elderly subjects, although the results are still controversial. However, no data are available on the 24-hour profile of DHEA circulating levels in elderly subjects with DHEA administration. In the present study, we evaluated the circadian rhythms of DHEA, cortisol, and the cortisol/DHEA molar ratio in old subjects treated with either placebo (old-PL) or a single 50-mg dose of DHEA (old-D), both administered orally at 0700 hours. For each variable, the circadian profiles were compared with those obtained in young control subjects. The group of young subjects displayed a circadian rhythm for both DHEA and cortisol serum concentrations but no rhythm for the cortisol/DHEA molar ratio. In the old-PL group, the circadian rhythm of DHEA was completely abolished, whereas significant rhythms for both cortisol and the cortisol/DHEA molar ratio were observed. Particularly, at each time point, the cortisol/DHEA molar ratio was significantly higher in these subjects versus the young group. In the old-D group, the circadian rhythm of DHEA was completely restored and was comparable to that observed in the young group. Analogous to the observations in young subjects, the profile of the cortisol/DHEA molar ratio in old-D subjects did not display any circadian rhythmicity, the values being almost completely comparable to those observed in young controls. Our data demonstrate that the circadian rhythm of DHEA is totally abolished in elderly subjects. A single 50-mg dose of DHEA administered orally at 0700 hours restores the circadian rhythmicity of serum DHEA and almost completely normalizes the 24-hour profile of the cortisol/DHEA molar ratio in old subjects without affecting the cortisol circadian rhythm.

The circadian organization of adrenal secretion was studied in 23 healthy elderly subjects, 23 elderly demented patients and 10 healthy young subjects, in order to investigate the relationships between the hypothalamic-pituitary-adrenal axis and some cerebral morphometric parameters. The cerebral morphometric analysis was performed in some subjects of the three groups by MRI. A significant increase in cortisol levels during evening and nighttime was found in both groups of the aged subjects. In elderly subjects, particularly if demented, the mean serum dehydroepiandrosterone sulfate (DHEAs) levels throughout the 24-hour cycle were significantly lower than in young controls. A significant reduction of the hippocampal and temporal volume and an enlargement of the lateral ventricles were found in aged subjects, these changes being significantly related to subjects’ age. Moreover, the hippocampal volume was positively correlated with the circadian mesor of DHEAs (i.e., the circadian rhythm adjusted mean) and with the cortisol nocturnal increase. Our data may suggest the existence of a link between the selective impairment of cortisol secretion and DHEAs levels, and the progression of hippocampal degeneration.

A link between neuroendocrine and immunological changes has been suggested in the pathophysiology of dementia of the Alzheimer's type (DAT). Healthy young and old subjects and patients with DAT were recruited to evaluate the chrononeuroendocrine organization of cortisol, GH, and melatonin (MLT) secretions. The study was carried out together with the evaluation of natural killer (NK) cell function: cytotoxic activity (NKCC) and TNF-? and IFN-? release after exposure to IL-2 (100 UmL). Moreover, a cerebral morphometric analysis of hippocampus and temporal lobe (MRI) was performed. The activation of hypothalamo-pituitary-adrenal (HPA) axis and the decrease of GH, and MLT nocturnal peaks were associated with normal NKCC and TNF-?IFN-? in healthy elderly subjects, whereas in DAT patients the same neuroendocrine changes occurred together with abnormal NKCC (spontaneous and IL-2IFN-?-modulated) and with alterations of TNF-?INF-? generation from NK. Moreover significant correlations among the increase of NKCC and TNF-? and the decrease of cognitive function were found in the DAT group. These correlations were associated with the impairment of nocturnal GH and MLT levels and with the relatively higher serum cortisol concentrations. Moreover, the impairment of cortisol suppression after dexamethasone (1 mg orally at 23:00) was significantly correlated with the increase of spontaneous release of TNF-? and with IL-2-modulated NKCC. Finally the imunoneuroendocrine alterations found in DAT were associated with the reduction of cerebral volume in hippocampus and temporal lobes. Taken together these data indicate that the immmunoneuroendocrine balance is maintained in physiological aging, whereas NK immune dysregulation in DAT could contribute to altering the neuroendocrine functions and to extend the progression of neurodegeneration and dementia.

Alterations of natural killer (NK) function can be involved in the neuroimmune mechanism of neurodegeneration in dementia of the Alzheimer's type (DAT). NK cell cytotoxicity (NKCC) and the generation and release of IFN-? and TNF-? (spontaneous and modulated by IL-2) from pure NK cells (CD 16, CD 56, CD 3?) were studied together with circulating IFN-? and TNF-? levels and cognitive function in 22 old patients with DAT and 15 healthy old subjects. Higher ( p< 0.001 ) IL-2 modulated NKCC (with IL-2 50 UmL and 100 UmL) was demonstrated in DAT patients (35 and 99 from baseline) than in healthy subjects (6 and 76 from baseline). Increased spontaneous and IL-2-induced release of IFN-? and TNF-? from NK cells were found in DAT patients compared to healthy subjects ( p< 0.001 ), whereas no difference of serum IFN-? and TNF-? was demonstrated between DAT and control groups. Significant negative correlations among the spontaneous release of IFN-? and TNF-? from NK and the decrease of the score of cognitive function (MMSE) were found in patients with DAT. In conclusion, alterations of NKCC control and NK-derived cytokine release in DAT could be involved in the neuroinflammatory mechanism related to the progression of neurodegeneration and dementia.

Objectivesthis study was undertaken to determine the late survival of patients operated successfully for abdominal aortic aneurysm (AAA) repair, to compare survival data with that of the age- and sex-matched general population, to identify the causes of late death, and to determine the factors influencing late survival.Materials and methodsa total of 187 consecutive patients underwent elective surgical AAA repair between January 1987 and December 1991. There were 11 postoperative deaths (early mortality rate 5.9%). The remaining 176 patients formed the basis of this cohort-based retrospective study. Six patients (3.4%) were lost to follow-up. Mean follow-up was 71 months.Resultsa total of 70 patients (39.8%) died during the study period. Coronary artery disease (CAD) and cancer were the two main causes. The survival rate at five years (71.6%) was lower than that of the sex- and age-matched general population (90.6%). Neither arterial hypertension nor CAD had any influence on late survival. In contrast, age and chronic renal failure were predictive variables of late survival.Conclusionsthe life expectancy of patients who undergo successful AAA repair is not as good as that of the age- and sex-matched general population. Late survival depends on the patients» age at the time of surgery and the existence of preoperative chronic renal failure.

A general calculation of the correction to the measured cross section in fixed-target experiments, due to the angular resolution of the incident beam, is carried out. A first-order expression in the incident solid angle ?O is explicity given, and shows that, in the TeV region, angular resolutions as accurate as 10-1 mrad are required for measurements within the cross-section forward peak.

A clone bearing the structural gene sacB, coding for the exoenzyme levansucrase, was isolated from a library of Bacillus subtilis DNA that was cloned in phage lambda charon 4A on the basis of the transforming activity of the chimeric DNA. This lambda clone also was found to contain the sacR and smo loci. Subcloning the sacB-sacR region in plasmid pBR325 resulted in a clone which directed levansucrase synthesis in Escherichia coli. The nucleotide sequence coding for the secreted protein was localized on the physical map of the cloned DNA.

Proton magnetic resonance spectroscopy (1H-MRS) is a non-invasive technique which has proved to be useful for monitoring various brain metabolites (N-acetyl-aspartate, choline, creatine-phosphocreatine, lactate). A total of 18 patients underwent a combined magnetic resonance imaging (MRI)/1H-MRS protocol in order to evaluate the distribution of the metabolites in the various stages of cerebral ischemia. Our results show a marked decrease of N-acetyl-aspartate and a large content of Lactate during the early phases, and a decrease in N-acetylaspartate, choline and creatine-phosphocreatine (Cr-PCr) during the chronic phase.

Botulinum-A toxin (botAtox) was used in the treatment of blepharospasm (BS), idiopathic hemifacial spasm (HFS), idiopathic spasmodic torticollis (ST) and apraxia of eyelid opening (AEO). The injection of 7.5–30 U botAtox per eye spread over 3 or 4 sites in the palpebral part of orbicularis palpebrae (OP) reduced palpebral spasm in 12/13 cases of BS and in 7/8 cases of HFS. The effect lasted for 14.5 weeks on average (range 4–30 weeks). Palpebral ptosis (lasting 1–3 weeks) was the most frequent side effect (16/107 eyes treated) but was not related to dose of botAtox or number of inoculation sites. Injection of 60–160 U botAtox into the sternocleidomastoid, trapezius and splenius capitis muscles reduced ST objectively in 1/4 patients for about 4 weeks. In the other patients the reduction or abolition of the hypertrophy of the previous hyperactive muscles was accompanied by persistence or rearrangement of the dystonia pattern, suggesting a change in the pattern of activity of the neck muscles after botAtox. 5 U botAtox per eye spread over 4 sites in the OP significantly reduced the frequency of the episodes of involuntary eyelid closure in 2 patients with AEO but not BS. The therapeutic effect lasted for 7 months after the first treatment and for 8 months after the second in a 46 year old woman with a 6 month history while the second patient (72 year old parkinsonian) has now completed her 3rd month of treatment.

The natural history and response to different treatments were assessed in 31 consecutive patients with blepharospasm (BS) and/or oromandibular dystonia (OMD). The mean age at onset was 52.4 years and there was a female preponderance of 2.5 to 1. Ocular symptoms preceded the onset of blepharospasm in more than 50% of the affected patients, whereas psychiatric and dental problems prior to the onset of focal dystonia were found in 10% and 13% of the cases respectively. Dystonia elsewhere, mainly in the craniocervical area, was found in 23% of patients and appeared to follow a somatotopic progression. The first 2–3 years of history were crucial for the spread of dystonia to other face and body parts. When OMD was the first symptom, a lower tendency of dystonia to progress elsewhere was observed. A putative cause was found in 14% of patients who showed clinical and radiographic evidence of basal ganglia or rostral brainstemdiencephalon lesions. The response to different drugs was inconsistent although transient improvement was induced by haloperidol in 6 patients, by L-Dopa plus deprenyl in 3 patients, by trihexyphenidyl in 2 patients and by clonazepam in 2 patients. One, apparently spontaneous, remission was observed. Botulinum A toxin was iniected in the orbicularis oculi of 8 patients affected by BS: moderate to marked improvement lasting 5 to 30 weeks (mean 14.5 weeks) was achieved in all cases; transient ptosis, lasting 1 to 3 weeks, occurred in 3 cases.

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