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Acute severe injuries such as sepsis, trauma, severe hemorrhage, major surgery or cardiac arrest account for most of the ICU admission. Thanks to advances in life support tools and knowledge, to technical progress, a majority of patients now survive the first days of their injury but are then exposed to the development of ICU-acquired infections that are associated with significant morbidity and mortality [1, 2]. The increasing burden of nosocomial infections and the emergence of multidrug resistant bacteria call to urgent progress in preventive treatment of ICU-acquired infections. Although the prolonged use of invasive medical devices and the selection of resistant bacteria remain important determinants of ICU-acquired infections, there is increasing evidence that some acquired immune dysfunctions might contribute to the increased susceptibility to secondary infections despite recovery from the primary insult.

Background Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache with cranial autonomic symptoms (SUNA) are primary headache syndromes. A growing body of literature has focused on brain magnetic resonance imaging (MRI) evidence of neurovascular compression in these syndromes. Objective The objective of this article is to assess whether SUNCT is a subset of SUNA or whether the two are separate syndromes and clarify the role of neurovascular compression. Method We describe three new SUNCT cases with MRI findings of neurovascular compression and critically review published SUNCT/SUNA cases. Results We identified 222 published SUNCT/SUNA cases. Our three patients with neurovascular compression added to the 34 cases previously described (16.9%). SUNCT and SUNA share the same clinical features and therapeutic options. At present, there is no available abortive treatment for attacks. Lamotrigine was effective in 64% of patients; topiramate and gabapentin in about one-third of cases. Of the 34 cases with neurovascular compression, seven responded to drug therapies, 16 patients underwent microvascular decompression of the trigeminal nerve (MVD) with effectiveness in 75%. Conclusions We suggest that SUNCT and SUNA should be considered clinical phenotypes of the same syndrome. Brain MRI should always be performed with a dedicated view to exclude neurovascular compression. The high percentage of remission after MVD supports the pathogenetic role of neurovascular compression.

Klinefelter’s syndrome (KS) is associated with specific neurobehavioral features and personality traits. The aim of our study was to investigate fluid intelligence, personality traits and personality disorders (PD) and possible correlations with testosterone in a cohort of adult KS patients. We analyzed 58 adult KS patients with the classic 47, XXY karyotype. The Structured Clinical Interview for axis II disorders was used to assess DSM IV personality disorders. Personality traits were assessed using MMPI-2. Fluid intelligence was tested by using Raven’s Standard Progressive Matrices (SPM) Test. Testosterone blood concentration was measured by CMIA. PD prevalence was 31%. Four altered MMPI scales (Social Responsibility, Dominance, Ego Strength and Repression) were found in more than 40% of patients. Overcontrolled hostility and MacAndrew Alcoholism Scale-Revised scales were altered in the PD− group only. Biz-Odd Thinking and Post-Traumatic Stress Disorder scale were associated with the presence of personality disorder. The raw SPM score was 44 ± 10.8 without any significant correlation with testosterone. No significant difference in mean age, SPM raw score and MMPI score was observed between eugonadal, hypogonadal and treated patients. Most KS patients had average fluid intelligence. PD prevalence was higher than in the general population. Testosterone was not correlated with fluid intelligence, personality traits or PD, but a reduction in marital distress was observed in treated patients. This could suggest that testosterone therapy can improve physical symptoms and this effect could also improve relationship abilities and wellness awareness.

Resume Introduction La maladie de Whipple est une affection multisystemique liee au bacille non cultivable Tropheryma whipplei. Nous rapportons un cas trompeur de “sarcoidose” devenant “maladie de Whipple” avec endocardite. Observation Le diagnostic de sarcoidose a ete porte chez un patient de 61 ans sur des donnees cliniques, radiographiques, endoscopiques et histologiques. La reponse initiale a la corticotherapie a ete bonne mais le patient restait dependant de 35 mg/j de prednisone. L’apparition d’un syndrome inflammatoire clinique et biologique majeur a fait douter du diagnostic. Le diagnostic d’une endocardite a hemocultures negatives, sans possibilite de “decapitation” par antibiotherapie prealable a ete pose, avec mise en evidence echographique d’une masse arrondie de 1 cm de diametre appendue a la grande valve mitrale avec insuffisance mitrale grade 2. Les autres causes d’endocardites a hemocultures negatives ont ete ecartees. La maladie de Whipple a ete envisagee et le diagnostic retenu sur la positivite d’une biopsie duodenale en PCR pour Tropheryma whipplei, l’histologie restant negative. Un traitement par gentamycine et amoxicilline en intra-veineux a ete poursuivi 3 semaines, remplace par cotrimoxazole oral. L’echographie transoesophagienne de controle ne montrait plus la masse mitrale. Le patient, sous cotrimoxazole, sevre depuis 13 mois de prednisone, reste asymptomatique. Conclusion Ce cas illustre les difficultes de diagnostic differentiel entre sarcoidose et maladie de Whipple, mais aussi l’importance de cette distinction.

The aim of this study was to compare intravenous regional anesthesia (IVRA) and brachial plexus block (BPB) for intra-operative analgesia in dogs undergoing pancarpal arthrodesis (PA). Twenty dogs scheduled for PA were intramuscularly sedated with acepromazine (0.03 mg/kg), general anesthesia was intravenously (IV) induced with thiopental (10 mg/kg) and, after intubation, maintained with isoflurane in oxygen. In 10 dogs (GIVRA) IVRA was performed on the injured limb administering 0.6 ml/kg of 0.5% lidocaine. In 10 dogs (GBPB) the BPB was performed at the axillary level with the help of a nerve stimulator and 0.3 ml/kg of a 1:1 solution of 2% lidocaine and 1% ropivacaine was injected. During surgery fentanyl (0.002 mg/kg IV) was administered if there was a 15% increase of HR and/or MAP compared to the values before surgical stimulation. All the standard cardiovascular and respiratory parameters were continuously monitored during surgery. The duration of surgery and the time of extubation were recorded. Data were compared with a 1-way ANOVA test (P0.05). No patients required fentanyl administration during surgery. All the recorded parameters were similar in the two groups. The two techniques were similar in providing intra-operative analgesia in dogs undergoing orthopaedic surgery.

Incorporation of labeled palmitate into triglycerides of incubated human placenta slices was investigated. Anaerobiosis reproduced by incubation in cyanide-containing buffer accelerated glucose disappearance from the solution and slightly decreased palmitate incorporation into tissue triglycerides. Inhibition of glycolysis by addition of sodium fluoride caused an almost complete cessation of glucose disappearance from the buffer and a marked decrease of palmitate incorporation into triglycerides. Glucose removal was greater when cyanide and fluoride were added to the medium than fluoride alone; however, triglyceride synthesis from palmitate did not show a parallel increase. It is concluded that fatty acid esterification by the placenta is resistant to anoxia but requires a functioning glycolytic pathway to produce α-glycerophosphate to which fatty acids are joined. The necessity of other energy-yielding processes was suggested by the lack of increase in esterification when the effects of cyanide and fluoride were compared to the effect of fluoride alone; since the combination of the two inhibitors actually increased glucose uptake from the medium, they probably increased glycerophosphate availability for esterification also.

Twelve control and nine gestational diabetic mothers (GDM) and their infants were studied at birth. All GDM were obese. The criteria for selection of control mothers were a negative family history for diabetes, a normal oral glucose tolerance test, and the presence of obesity. The mean birth weights of the infants were not significantly different. All infants received a 3-hour oral glucose tolerance test (OGTT), completed within the first 24 hours of life. Glucose, serum immunoreactive insulin and growth hormone levels were determined. The mean glucose values obtained at the time of delivery revealed no significant differences between the GDM and the control mothers or between the infants of gestational diabetic mothers (IGDM) and the normal control infants. At birth, the mean seruni insulin levels of the GDM and the IGDM were both significantly higher than were their control GDM and IGDM. The OGTT was performed between 0 and 21 hours after birth and after a 4-hour fast. The mean fasting blood glucose level of the IGDM was significantly lower than that of the control infants, p≤.02. However, during the OGTT, the normal control infants showed a disposal of glucose similar to the IGDM. No evidence of hyperinsulinemia was observed in either the control infants or the infants of gestational diabetic mothers. The mean growth hormone values for the infants at the time of delivery revealed no significant differences between the two study groups. During the OGTT, the IGDM had significantly higher mean growth hormone values at both 60 and 120 minutes.

Oral glucose tolerance tests (GTT) were performed periodically in 15 women who had shown abnormal tolerance to glucose in the third trimester, but who had normal tolerance after delivery. Five received a combination of norethindrone, 1 mg, and mestranol, 0.05 mg, as an oral contraceptive cyclically; 10 who practiced other methods of contraception served as controls. Abnormal glucose tolerance recurred in all five women while they were taking the oral contraceptive agent. After cessation of contraceptive therapy, GTT remained diabetic in three cases; GTT temporarily improved, but became abnormal again in the fourth. The fifth patient was lost to follow-up observation after discontinuing contraceptive pills. Three out of the 10 controls showed deterioration of the GTT. Screening tests for diabetes should be performed in the third trimester of pregnancy, or early during contraceptive treatment, as an attempt to identify women with latent diabetes and exclude them from hormonal birth control.

Human placental slices were incubated in a buffer solution containing glucose and glucose-1-C 14 with and without insulin. No metabolic effect of insulin on glucose disappearance from the media or incorporation of C 14 label into CO 2 , total lipids or various lipid fractions could be demonstrated. When placental slices were preincubated in alloxan in an attempt to inhibit insulin degradation; an insulin effect on glucose disappearance was not observed. The study does not support the hypothesis that insulin indirectly influences the fetus by an effect on placental glucose metabolism.

Serial plasma diamine oxidase (DAO) titers and urinary pregnanediol and estriol excretions were measured in 41 pregnancies complicated by diabetes mellitus. Thirty-six per cent of the plasma enzyme titers were abnormally low in the Class A and 68 per cent in the combined Class B, C, and D diabetic pregnancies. All infants in the Class A diabetic group were born alive while there were 4 stillbirths in the Class B, C, and D diabetic patients. In each pregnancy resulting in a stillbirth, the plasma DAO curves were abnormally low from early pregnancy. Urinary pregnanediol excretions were within the normal range in each of the cases studied. In common with plasma DAO, urinary estriol appeared to correlate with the severity of the diabetic state. However, as with the plasma enzyme, abnormally low urinary estriol excretion was frequently associated with live births. It is our concept that low plasma DAO pregnancies represent fetuses at continuous “high risk”.

Background Cephalalgiaphobia is the fear of having a headache attack during a pain-free period that may induce patients to use analgesic in the absence of pain to prevent headache and to improve their performances. This study aims at assessing if cephalalgiaphobia is related to migraine frequency or medication overuse, and if it is per se a predictor of increase in migraine frequency. Methods This is a pilot prospective cohort study on 126 consecutive migraineurs referred to a tertiary Headache Centre. A headache specialist collected data regarding migraine features, frequency and medications at baseline (T0) and 2 years later (T1). Cephalalgiaphobia was investigated at T0 and T1 through a score determined by a 4 items questionnaire. Results Moderate-high migraine frequency was associated with higher risk of cephalalgiaphobia (p Conclusions Cephalalgiaphobia may represent a high-frequency migraine feature and may play a role in chronicization. Therefore, it should be better investigated by clinicians and treated or prevented in order to reduce the risk of disability and the increase in migraine frequency.

We investigated whether in human subjects, the pattern of coupling between the spontaneous fluctuations of heart period (HP) and those of systolic blood pressure (SBP) differs among wake-sleep states. Polysomnographic recordings and finger blood pressure measurements were performed for 48 h in 15 nonobese adults without sleep-disordered breathing. The cross-correlation function (CCF) between the fluctuations of HP and SBP at frequencies

Background Previous studies suggest that patients with Chronic Daily Headache (CDH) have higher levels of anxiety and depressive disorders than patients with episodic migraine or tension-type headache. However, no study has considered the presence of psychiatric comorbidity in the analysis of personality traits. The aim of this study is to investigate the prevalence of psychiatric comorbidity and specific personality traits in CDH patients, exploring if specific personality traits are associated to headache itself or to the psychiatric comorbidity associated with headache. Methods An observational, cross-sectional study. Ninety-four CDH patients with and without medication overuse were included in the study and assessed by clinical psychiatric interview and Mini International Neuropsychiatric Interview (M.I.N.I.) as diagnostic tools. Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Hamilton Depression Rating Scale (HAM-D) were afterwards administered. Patients with and without psychiatric comorbidity were compared. Further analyses were made by splitting the whole group according to the headache diagnosis and the presence or not of medication overuse. Results Psychiatric comorbidity was detected in 44 patients (46.8%) (group A) and was absent in the remaining 50 patients (53.2%) (group B). Mood and anxiety disorders were the most frequently diagnosed (43.6%). In the overall group, mean scores of MMPI-2 showed a high level in the so-called neurotic triad; in particular the mean score in the Hypochondriasis subscale was in the pathologic area (73.55 ± 13.59), while Depression and Hysteria scores were moderate but not severe (62.53 and 61.61, respectively). In content scales, score in Health Concern was also high (66.73). Group A presented higher scores compared to Group B in the following MMPI-2 subscales: Hypochondriasis (p = .036), Depression (p = .032), Hysteria (p Conclusions The so-called “Neurotic Profile” reached clinical level only in CDH patients with psychiatric comorbidity while a high concern about their general health status was a common feature in all CDH patients.