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Rita Moretti, Elena Bernobich, Francesca Esposito, Paola Torre, Rodolfo M Antonello, Luisa De Angelis, Giuseppe BelliniMedicina Clinica, Ambulatorio Complicanze Internistiche Cerebrali, Dipartimento Universitario Clinici di scienze Mediche Tecnologiche e Traslazionali, Università degli Studi di Trieste, Trieste, ItalyAbstract: The coexistence of depression and cardiovascular disease (CVD) is regularly discussed, and much debated. There is strong evidence that there are pathophysiological mechanisms, particularly endothelial dysfunction, altered platelet aggregation, and hyperactivation of the thrombosis cascade, which coexist with hypothalamic-pituitary-adrenocortical axis dysfunction, and link depression to CVD. Therefore, depression should not be automatically considered to be a consequence of life impairment due to myocardial infarction or major stroke. Probably, it should be considered as one of the many other stressful events, or “genetic reactions to life”, which are risk factors for CVD development. This review will examine the significance of depression in clinical daily practice, its pathophysiology as a determinant in vascular events, and its real importance in, before, and after many CVD events.Keywords: depression, cardiovascular disease, stressful events, cardiovascular risks

Background: Laparoscopic appendectomy is widely performed by surgical residents, but its changing indications and outcomes have been poorly investigated. The aim of this study was to examine whether a difference exists in indications and outcomes between laparoscopic appendectomies performed by residents and those performed by experienced surgeons. Methods: Between 1999 and 2007, 218 laparoscopic appendectomies were performed and recorded. Data were analyzed to compare operations performed by residents with those by experienced surgeons in terms of indications for surgery and severity of disease. Moreover, laparoscopic appendectomies were thoroughly compared regarding outcomes and complications. Results: The residents had fewer conversions with laparoscopic appendectomy (8% vs 17%, P=0.04), and similar complication rates (12% vs 13%, P=0.16), compared with experienced surgeons. The median operating time was also comparable (67 minutes vs 60 minutes, P=0.23). However, patients operated on by residents had more emergencies (86% vs 70%, P=0.009), included more foreigners (27% vs 15%, P=0.03), and had intermediate to severe diseases, (81 vs 52%, P

Parkinson's disease is a progressive disorder of the nervous system that affects movement. It develops gradually, often starting with a barely noticeable tremor in just one hand. But, while tremors may be the most well-known sign of Parkinson's disease, the disorder also commonly causes a slowing or freezing of movement. The authors aim to reflect on different features of a poliedric structure, like Parkinson's disease, and try to help clinicians and students to reflect on these aspects that mainly interfere with the daily life experience of patients and caregivers. © 2013 by Nova Science Publishers, Inc. All rights reserved.

Freezing of gait (FOG) refers to transient episodes, usually lasting seconds, in which a patient is unable to initiate or continue locomotion, occurring on a background of relatively good ability to move and is best described by patients as "feet get glued to the ground." Freezing of gait is common in Parkinson's disease, with increasing prevalence as the disease progresses, but it has been commonly reported in pathologically proven progressive supranuclear palsy and vascular parkinsonism. Two types of freezing of gait have been recognized in patients affected by Parkinson's Disease, taking L-Dopa. The most common is an "off" -freezing of gait, which can be improved with L-Dopa or dopaminergic treatment, such as apomorphine. "Off" -freezing appears during an "off" state, when the patient is generally bradykinetic and rigid. In contrast, "on" -freezing is characterized by a worsening of symptoms as the dose of L-Dopa is increased, and by a general improvement, as the dose is decreased or, better said, modulated. The onfreezing of gait is related to abnormal execution of complex motor tasks such as repetitive, simultaneous, or sequential motor acts. Different Authors suggested that the primary underlying abnormality might be related to the inability to deliver, or hold a pre-programmed, continuous, and complex motor act, in response to an established and correct internal plan of action. Therefore, we hypothesized that PD- on freezing patients might be clinically well differentiated from the other clinical subtypes of PD and might present a specific cognitive impairment, different from that presented by PD patients, without on-FOG. We discuss these hypothesis, based on clinical studies and follow-up.

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The basal ganglia is traditionally composed by three groups of brain structures called the "striatum," "pallidum," and "substantia nigra," and an additional structure termed the "subthalamic nucleus" (STN). The striatum can be separated into two general components, the dorsal striatum, which consists of the caudate and putamen, and the ventral striatum, which consists of the nucleus accumbens, septum, and olfactory tubercle. In a similar manner, the pallidum can also be divided into multiple divisions, including a lateral or external segment of the globus pallidus (GPe), a medial or internal segment of the globus pallidus (GPi), and a portion that lies ventral and anterior to the anterior commissure, designated the ventral pallidum (VP). Finally, the substantia nigra is also composed of more than one component, a cell group rich in neuromelanin called the pars compacta (SNpc), which is responsible for the black appearance of the nucleus in gross specimens, and an unpigmented celI group known as the pars reticulata (SNpr). According to the simplest classification scheme, the nuclei within the basal ganglia can be subdivided into sets of "input," "output," and"intermediate" structures. Input structures include the caudate, putamen, and nucleus accumbens. Collectively, these input structures receive direct projections from nearly the entire cerebral cortex. These input structures then project to intermediate structures as well as output structures. The three principal output structures of the basal ganglia include the GPi, SNpr, and VP. For the most part, these output structures send their efferent projections to different subdivisions of the ventroanteriorventrolateral (VAIVL), mediodorsal (M,D), and intralaminar (IL) groups ofthalamic nuclei (particularly the centrum medianum and parafasicularis intralaminar nuclei (CM/PF). The VA/VL and MD nuclei of the thalamus, in turn, project largely back upon the cerebral cortex. Thus, one of the major features of basal ganglia anatomy is their participation in what has become known as cortical- basal gangliathalamo-cortical circuits (hereafter referred to as simply cortical-basal ganglia circuits). Many of these same cortical areas also contain cells that project directly to the STN and, thus, constitute a subthalamic path. We present the results of different studies on the topic, and discuss the effect in PD. © 2013 Nova Science Publishers, Inc. All rights reserved.