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Despite the high prevalence of epilepsy in brain tumors, long-term follow-up studies on tumoral epilepsy are lacking. Here we report the long-term follow-up results of the PERNO study (Project of Emilia-Romagna Region on Neuro-Oncology).

Background: Clinical and molecular factors are essential to define the prognosis in patients with glioblastoma (GBM). O6-methylguanine-DNA methyltransferase (MGMT) methylation status, age, Karnofsky Performance Status (KPS), and extent of surgical resection are the most relevant prognostic factors. Our investigation of the role of gender in predicting prognosis shows a slight survival advantage for female patients. Methods: We performed a prospective evaluation of the Project of Emilia Romagna on Neuro-Oncology (PERNO) registry to identify prognostic factors in patients with GBM who received standard treatment. Results: A total of 169 patients (99 males [58.6%] and 70 females [41.4%]) were evaluated prospectively. MGMT methylation was evaluable in 140 patients. Among the male patients, 36 were MGMT methylated (25.7%) and 47 were unmethylated (33.6%); among the female patients, 32 were methylated (22.9%) and 25 were unmethylated (17.9%). Survival was longer in the methylated females compared with the methylated males (P = 0.028) but was not significantly different between the unmethylated females and the unmethylated males (P = 0.395). In multivariate analysis, gender and MGMT methylation status considered together (methylated females vs. methylated males; hazard ratio [HR], 0.459; 95% confidence interval [CI], 0.242-0.827; P = 0.017), age (HR, 1.025; 95% CI, 1.002-1.049; P = 0.032), and KPS (HR, 0.965; 95% CI, 0.948-0.982; P < 0.001) were significantly correlated with survival. Conclusions: Survival was consistently longer among MGMT methylated females compared with males. Gender can be considered as a further prognostic factor.

Invasive disseminated neonatal aspergillosis is an uncommon disease, with only scattered reports in literature in the last few years. Here we report on a 25-week gestational age, 730 g at birth preterm female infant who developed on day-of-life 10 multiple cutaneous exhulcerative lesions in her right arm, trunk and abdomen. Early recognition and diagnosis of these lesions as a due to cutaneous initial symptom of cutaneous disseminated aspergillosis, as well as prompt treatment with Liposomal amphotericin B + Itraconazole, secured successful recovery from the systemic infection. Skin lesions healed without any surgical treatment. The infant was discharged in good health. Long-term follow-up at three years of age revealed normality of all neurodevelopmental and cognitive parameters. To our knowledge, this is one of the very few cases of survival, free from sequelae, for a preterm infant affected by neonatal cutaneous disseminated aspergillosis.

Cold metal forming is a versatile and very efficient technology in the manufacture of metal components. In cold metal forming processes high pressure is generated at the tool-workpiece interface, so that good lubrication is required to reduce wear. This improves tool life and the quality of products. The lubricants used in the forming processes usually contain appropriate basis oils with anti-wear (AW) and extreme pressure (EP) additives. In order to examine how wear occurs during cold metal forming, the SRV (Schwingung Reibung Verschleiss) reciprocating-sliding tribometer equipped with a cylinder-on-disc line- contact testing system was adapted and used to characterize lubricant behaviour. Friction coefficient and wear rate were determined under progressively increasing load conditions. The final worn volumes of the flat and the cylinder were evaluated by using optical microscopy methods. The measurement system was validated by replicate tests using some commercially available forming lubricants as reference in a load range of 100-1000 N. The oscillating tribo-test-rig can be used to characterize lubricants for cold metal forming processes by testing the combined effects of different additive systems and their interaction with contacting materials.

A new testing facility for a high-velocity, three-phase flow consisting of a gas flow loop and a jet impingement rig is described. Flow velocities between the nozzle and specimen have been determined through computational fluid dynamics (CFD) simulations and by particle image velocimetry. Tests were conducted on typical carbon steels (J55 and C95) that are used in tubings for the gas and oil industry. Flow conditions of a sweet gas condensate well have been applied. Mass-loss rates have been determined after testing times of between 4 h and 168 h using optical profilometry. Damaged surfaces were investigated using optical and scanning electron microscopy. The effects of material and flow velocity on the mass-loss rate have been investigated. Mass loss of specimens under given conditions is determined by siderite formation and increasing degradation of siderite layer by impacts of sand and fluid droplets. Degradation happens by erosion-enhanced corrosion. Normalized steel J55 behaves like a ductil...

Background: Theepidemiologic features of status epilepticus (SE) are still in the course of definition. Methods: We carried out an intensive survey of multiple sources of case material in the resident population of the health district of Ferrara, Italy, in 2003. Information was collected on age, gender, duration, seizure type and etiology of SE. Results: The age- adjusted annual incidence rate of SE was 27.2/100,000 (95% CI = 19.4–36.9) and it was higher in men (41.7/100,000, 95% CI = 26.9–61.7) than in women (12.3/100,000, 95% CI = 6.9–20.4). The incidence was higher in the elderly (older than 60 years, 39.2/100,000) than in younger adults in the age group 20–59 years (14.7/100,000). The age-specific incidence showed a bimodal distribution peaking in the youngest (0–4 years) and in the oldest age group (75+ years). Cerebrovascular disease was the most frequent etiologic factor (45%). Epilepsy had previously been diagnosed in 40% of the patients. The case fatality was 5%. Conclusions: The study found a higher incidence of SE than that expected on the basis of the previous European studies suggesting that the risk of SE in southern Europe is higher and more similar to that estimated in population studies in the United States. The case fatality was lower than that reported in previous South-European population studies despite the similar clinical features of the patients. Indirect evidence suggests that several factors related to the SE management could have positively influenced the outcome.

BACKGROUND Colonization by Candida species is the most important predictor of the development of invasive fungal disease in preterm neonates, and the enteric reservoir is a major site of colonization. We evaluated the effectiveness of an orally supplemented probiotic (Lactobacillus casei subspecies rhamnosus; Dicoflor [Dicofarm spa]; 6 x 10(9) cfu/day) in the prevention of gastrointestinal colonization by Candida species in preterm, very low birth weight (i.e., < 1500-g) neonates during their stay in a neonatal intensive care unit. METHODS Over a 12-month period, a prospective, randomized, blind, clinical trial that involved 80 preterm neonates with a very low birth weight was conducted in a large tertiary neonatal intensive care unit. During the first 3 days of life, the neonates were randomly assigned to receive either an oral probiotic added to human (maternal or pooled donors') milk (group A) or human milk alone (group B) for 6 weeks or until discharge from the NICU, if the neonate was discharged before 6 weeks. On a weekly basis, specimens obtained from various sites (i.e., oropharyngeal, stool, gastric aspirate, and rectal specimens) were collected from all patients for surveillance culture, to assess the occurrence and intensity of fungal colonization in the gastrointestinal tract. RESULTS The incidence of fungal enteric colonization (with colonization defined as at least 1 positive culture result for specimens obtained from at least 1 site) was significantly lower in group A than in group B (23.1% vs. 48.8%; relative risk, 0.315 [95% confidence interval, 0.120-0.826]; P = .01). The numbers of fungal isolates obtained from each neonate (P = .005) and from each colonized patient (P = .005) were also lower in group A than in group B. L. casei subspecies rhamnosus was more effective in the subgroup of neonates with a birth weight of 1001-1500 g. There were no changes in the relative proportions of the different Candida strains. No adverse effects potentially associated with the probiotic were recorded. CONCLUSIONS Orally administered L. casei subspecies rhamnosus significantly reduces the incidence and the intensity of enteric colonization by Candida species among very low birth weight neonates.

Background As yet, no population-based prospective studies have been conducted to investigate the incidence and clinical outcome of glioblastoma (GBM) or the diffusion and impact of the current standard therapeutic approach in newly diagnosed patients younger than aged 70 years. Methods Data on all new cases of primary brain tumors observed from January 1, 2009, to December 31, 2010, in adults residing within the Emilia-Romagna region were recorded in a prospective registry in the Project of Emilia Romagna on Neuro-Oncology (PERNO). Based on the data from this registry, a prospective evaluation was made of the treatment efficacy and outcome in GBM patients. Results Two hundred sixty-seven GBM patients (median age, 64 y; range, 29–84 y) were enrolled. The median overall survival (OS) was 10.7 months (95% CI, 9.2–12.4). The 139 patients ≤aged 70 years who were given standard temozolomide treatment concomitant with and adjuvant to radiotherapy had a median OS of 16.4 months (95% CI, 14.0–18.5). With multivariate analysis, OS correlated significantly with KPS (HR = 0.458; 95% CI, 0.248–0.847; P = .0127), MGMT methylation status (HR = 0.612; 95% CI, 0.388–0.966; P = .0350), and treatment received in a high versus low-volume center (HR = 0.56; 95% CI, 0.328–0.986; P = .0446). Conclusions The median OS following standard temozolomide treatment concurrent with and adjuvant to radiotherapy given to (72.8% of) patients aged ≤70 years is consistent with findings reported from randomized phase III trials. The volume and expertise of the treatment center should be further investigated as a prognostic factor.

Objectives – To identify early predictors of intractability in childhood and adolescence epilepsy. Materials and methods – We carried out a community-based case–control study using the incidence cohort of epileptic patients living in the district of Copparo, in the province of Ferrara, Italy. The comparative study was performed in 31 cases and 95 controls. Cases were patients who averaged at least 1 unprovoked seizure per month during an observational period of at least 2 years. Controls were subjects having achieved remission for at least 5 years regardless of current therapy. Results – Onset at age

A double-blind, placebo-controlled, parallel-group, multicentre study was conducted to evaluate the efficacy of pentoxifylline (Trental) in patients with multi-infarct dementia (MID) according to DSM-III-R criteria. Men and women aged 45 years or older, with a Hachinski Ischemia Scale scoreor = 7 and a Mini Mental State Examination (MMSE) score of 10-25 at entry, and computed tomographic evidence of vascular disease were enrolled. A total of 289 patients were randomised to receive either oral pentoxifylline 400 mg t.i.d. or placebo for 9 months, and efficacy was assessed every 3 months. The primary outcome variable was the difference in scores between the two treatment groups, as measured on the Gottfries, Bråne, Steen (GBS) scale. Secondary outcome variables included the scores achieved on the Sandoz Clinical Assessment Geriatric (SCAG) scale and MMSE, and a battery of psychological and other tests. The intention-to-treat analysis for patients completing the study (n = 239) showed a statistically significant difference in the total GBS score in favour of pentoxifylline (improvement of 3.5 points, p = 0.028). A significant difference in the total GBS score in favour of pentoxifylline was even almost achieved in the intention-to-treat analysis for all evaluable patients (n = 269, improvement of 2.1 points, p = 0.065). It is concluded that treatment with pentoxifylline is beneficial for patients with MID, the global results of the GBS and SCAG scales being reinforced by significant improvements in those subscales specific for intellectual and cognitive function.

Few studies have been carried out in the same area at different times, allowing an assessment of the incidence of epilepsy (E.), including all ages, over time. The available data on temporal trend show a decrease in E. incidence in childhood and an increase in the elderly. We sought to update the incidence of E. in the province of Ferrara, where a previous study estimated an incidence rate of 33.1 per 100,000, 35.8, if standardized to the European population. Newly diagnosed patients aged up to 14 years were drawn from a community-based prospective multi-source registry, and adult onset E. cases were collected through multiple overlapping sources of case collection. Cases were included and classified according to ILAE recommendations. During the study period (2007-2008), 141 newly diagnosed cases (66 men and 75 women) living in the study area were identified. The crude incidence rate was 46.1 per 100,000 person-years (95 % CI 39.0-54.5), 35.5 (95 % CI 28.0-43.0) if adjusted to the European population. The incidence of childhood and adolescence epilepsy was 57.0 per 100,000 person-years (95 % CI 33.8-90.0), lower than that reported in our previous study, and it was 44.8 (95 % CI 37.4-53.6) for adult onset E., which is significantly higher as compared to our previous study. The overall incidence of E. in northern Italy is stable over time. We detected a significant decrease in incidence of childhood and adolescence E. and an increase in adult-onset E. The burden of epilepsy will increase as the population continues to age.

The prediction of neurologic outcome in comatose patients after cardiac arrest (CA) has been investigated and the findings were summarized in a practice parameter of the American Academy of Neurology (1). These guidelines did not include the EEG as a reliable outcome indicator but recent studies on continuous EEG recorded during TH have re-evaluated the role of EEG (2–4). These studies underline the utility of a simplified classification system of EEG patterns and point to which pattern attains reliable predictive value both for good and bad outcomes. These reports are of high clinical relevance because, until today, the possibility of identifying early prognostic indicators of good outcome in patients surviving to CA has not been investigated. At the best of our knowledge, only few multicentre prospective studies (4–6) analyzed the prognostic value of EEG and SEP recorded in the same patient after CA as single predictor but none analyzed the diagnostic accuracy of the association of these two tests. We present the study protocol of Italian Multicentre Study about prognostic value of EEG and SEP in comatose patients after CA (ProNeCA) proposed by study group of “Intraoperative and Intensive Care Clinical Neurophysiology” of the Italian Society of Clinical Neurophysiology.

The frequency of multiple sclerosis (MS) in Italy and in other areas of the world seems to have increased over time, suggesting that some environmental factors operate in its etiology. We performed a retrospective, community-based case-control study on MS in order to verify the etiologic role of selected environmental factors. We found an association between MS and higher educational level, employment in public administration, past history of allergies, and infection at an early age with measles, rubella and whooping cough. Our data seem to confirm that exogenous factors play a role in the etiology of MS although some confounding variables could have accounted for the associations.

Intrasphenoid rupture of a non-traumatic aneurysm of the cavernous carotid artery is rare. We describe a patient in whom this condition manifested with epistaxis and led to the formation of a pseudoaneurysm occupying the right sphenoid sinus. The lesion recurred after repeated attempts at conservative endovascular therapy. Eventually the patient was treated with endovascular occlusion of the right internal carotid artery. Our report emphasizes the relapsing behaviour of a non-traumatic aneurysm of the cavernous portion of the internal carotid artery ruptured into the sphenoid sinus.

We present the case of an 87-year-old woman with history of hypertension, hypercholesterolemia, ischemic heart diseases, urinary tract infections, and cerebrovascular disease who experienced a transient clinical picture characterized by confusion, lethargy, and acute renal dysfunction in the course of urinary tract infection with Escherichia coli bacteremia. Escherichia coli bloodstream infection was associated with brain computed tomography (CT) and magnetic resonance imaging (MRI) patterns in which the lesion distribution was consistent with posterior reversible encephalopathy syndrome (PRES). Diagnosis of PRES was confirmed by demonstration of vasogenic edema on apparent diffusion coefficient (ADC) maps and near-complete resolution of clinical manifestations at discharge.

Relationships among Early Onset Neutropenia (EON), i.e. neutropenia in the first week of life, treated with Filgrastim, and subsequent colonization by Candida spp. with eventual systemic fungal infection in ELBW patients are not clear. We tried to analyze these features in a retrospective study on a selected population of a large tertiary NICU.By a database search, we identified a group of VLBW patients who were diagnosed a systemic fungal infection (SFI) during their stay in NICU (n=52), and divided them in two subgroups: those who had presented Early Onset Neutropenia (EON) and thus had been treated with a 3-day course of Filgrastim (n=14)(group A), and those who had not presented EON and thus had not undergone Filgrastim therapy (n=38) (group B). We investigated in both subgroups the following variables: neutrophil count monitoring during the first 2 weeks of life, colonization by Candida spp, day of onset of SFI, outcome. Statistical analysis was performed by Chi-square test, ANOVA and T-test using SPSS 8.0 for Windows.Absolute neutrophil number was obviously lower in group A at recruitment (354/mmc vs 2910\mmc, Chi-square = 9.776, p0.005), but became normal at the end of G-CSF treatment, thus detecting no significant differences between the two groups at day 8 (p0.12) and 14 (p0.34). The onset of SFI occurred significantly earlier ( 9.6 dol vs 14.6 dol., p0.004) in group A neonates. Fungal Colonization rate in the 2nd week of life was significantly higher in previously neutropenic patients (71% vs. 37%, p0.005), who had also a significantly higher number of sites involved (p0.003).Neutropenia in the first days of life in VLBW neonates, even if adequately and succesfully treated, heavily influences rates and severity of colonization by fungal spp., and is associated with an earlier onset of a SFI.

To investigate the effect of different population densities on gene transcription in the sea bream brain ( Sparus aurata ), the messenger RNA (mRNA) differential display (DD) technique was used to analyse gene expression. Sea bream were held at different densities, 6 or 26 kg m −3 , over a period of 14 days. We identified seven differentially expressed sequences of which one sequence was functionally identified. The S. aurata enolase gene homologue (S-enolase), pertaining to the alpha non-neuronal enolase group of the enzyme superfamily, was up-regulated in the brain of fish in the high-density population group. S-enolase mRNA expression was also found in other tissues including heart, liver and head kidney suggesting a ubiquitous nature. Furthermore, brain S-enolase mRNA is highly up-regulated 48 h after intra-peritoneal bacterial lipopolysaccharide (LPS) administration. Therefore, S-enolase gene expression is linked to the incidence of different stressors, density and infective agents, in the sea bream and may be a potential molecular biomarker for stress diagnosis in this fish.

Objectives: The etiology of epilepsy remains unknown in most cases. We sought to investigate the role of some pre-, peri- and postnatal factors in the etiology of idiopathic and cryptogenetic partial epilepsy. Methods: We carried out a community-based case-control study using the incidence cohort of epileptic patients living in the district of Copparo, in the province of Ferrara, Italy. The study was performed in 55 cases and 165 controls. A standardized questionnaire was used to collect information in face-to-face interviews. Results: Multivariate logistic regression analysis found that a personal history of febrile convulsions [odds ratio (OR) = 4.01, 95% confidence interval (CI) = 1.3–19.1] and a family history of seizures in first-degree relatives (OR = 4.5, 95% CI = 1.8–18.6) were independent risk factors for the condition under study. We failed to demonstrate an association between partial epilepsy and previously suggested perinatal risk factors. Conclusion: The findings of this study further support the hypothesis of a genetic propensity for seizures, which may be expressed early by the occurrence of febrile convulsions.

A prospective study in patients with a clinical acute isolated brainstem or spinal cord disorder was undertaken. The aim was to evaluate the predictive value of IgG intrathecal synthesis (through the detection of oligoclonal bands in CSF) and MRI lesions at presentation, for the subsequent progression to multiple sclerosis. Forty four patients took part in this study: 22 had a brainstem disorder and 22 a spinal cord disorder. After a mean period of 26 (SD 22) months, 30 patients (68.2%) developed clinically definite multiple sclerosis. The remaining 14 patients were followed up for more than seven years. Twenty six (59.1%) patients had oligoclonal bands in CSF, with a sensitivity of 80.0%, specificity of 85.7%, and a predictive value of 92.2%. Magnetic resonance imaging showed disseminated white matter lesions in 22 patients (50.0%), with a sensitivity of 60.0%, a specificity of 71.4%, and a predictive value of 81.7%. The difference between patients with multiple sclerosis and patients without the disease was statistically significant for the findings of an IgG intrathecal synthesis (P < 0.001). It was only borderline for the MRI findings (P = 0.052). Thus the detection of an intrathecal synthesis at presentation seemed to be a better prognostic indicator of the progression to multiple sclerosis in patients affected by acute isolated brainstem or spinal cord syndromes.

The Guillain-Barre syndrome (GBS) incidence has been updated in the area of the Local Health District of Ferrara, Unita Sanitaria Locale n. 31 (USL 31), Northern Italy, (where a previous survey found an average annual incidence of 1.26/10000 population) in order to verify a supposed increase in GBS occurrence. The updated mean annual incidence over the years from 1981 to 1993 (average resident population: 177235 inhabitants) was 1.87/100000 population (1.66/100000 when age-adjusted). The rate increased progressively in the four subsequent time intervals into which the study period was subdivided (from 1.09/100000 in the years 1981-1984 to 2.73/100000 in the years 1991-1993) with a significant temporal variation (0.025p0.05). The incidence was higher in the urban centres than in the rural zone of USL 31 (2.22/100000 and 1.10/100000; 0.025p0.05) and an increase of GBS risk in the urban area was found. The incidence showed an increase in the oldest age groups of the study population. These findings seem to confirm a slight increase of GBS risk in the area of Ferrara with particular reference to urban centres and elderly people.

Background: Previous descriptive surveys on multiple sclerosis (MS) in the province of Ferrara, northern Italy, carried out by our own epidemiological research group, pointed out that this area was not at lowmedium risk for MS. Objective: To verify the morbidity estimates and update the temporal trend of MS. Design and Methods: We used a complete enumeration approach by reviewing all the possible sources of case collection available in Ferrara for 1965 through 1993. We included all patients with definite and probable MS according to the criteria of Poser et al. Results: The mean annual incidence rate was 2.3 per 100 000 population (95% confidence interval, 2.0-2.6 per 100 000), 3.0 per 100 000 for women and 1.5 per 100 000 for men. On December 31,1993,249 patients (170 women and 79 men) suffering from definite or probable MS were living in the province of Ferrara, giving a crude prevalence rate per 100 000 population of 69.4 (95% confidence interval, 61.2-78.7), 90.8 for women and 46.0 for men. Conclusion: The data confirm that in Ferrara, MS occurs more frequently than previously suggested by the latitude-related epidemiological model, supporting the view that northern Italy is a high-risk area for the disease. While the prevalence rate is much higher than in our previous studies, probably owing to the increasing survival of the patients because of improving supportive care, the incidence rates, similar in magnitude to those observed in high-risk areas of northern and central Europe, have remained relatively stable over time.

We examined the etiopathogenetic role of preperinatal risk factors in the history of epileptic patients, identified in a previous descriptive study performed in Copparo, Italy. A community-based case control study of a group of epileptic patients with idiopathic generalized seizures was performed. The population consisted of 55 patients aged35 years as of December 31, 1988, residing in Copparo. Symptomatic patients were not included in the present study. The control sample consisted of 165 randomly selected healthy individuals, matched with patients for sex, age, and residence in the study area. The interview for detection of history of presumed risk factors was based on the Protocol of the Italian League Against Epilepsy. Obstetric, neurologic, and neonatal hospital charts were also reviewed. A family history of epilepsy, febrile seizures, and other perinatal factors (such as continual physical stress during pregnancy, maternal age35 years, and birth order3) were significantly more common in patients as compared with controls. Our data support the hypothesis of genetic propensity for generalized and febrile seizures, which may represent early expression of a low seizure threshold that subsequently develops into epilepsy.

It is generally agreed upon that the attacks of migraine with aura are indicative of abnormal cerebral perfusion, while the permanence of such perfusion abnormalities during the pain-free intervals of migraine remains debated. This study was aimed at assessing: 1) the presence of cerebral perfusion abnormalities also during the interictal phase and 2) the role of SPET with 99mTc HM-PAO to diagnose migraine. Twenty-eight patients (22 women and 6 men), diagnosed as having migraine with aura according to the International Headache Society (Headache Classification Committee criteria), were submitted to SPET studies, within 10 days of the last attack. 99mTc HM-PAO was used as perfusion tracer and a single head rotating gamma camera equipped with a high-resolution collimator was used for data acquisition. The qualitative analysis of SPET images showed slight hypoperfusion areas in 22 of 28 patients (79%). In 12 of 22 patients (55%) a regional correlation was observed between hypoperfusion areas and the neurologic symptoms of aura. The results of the present study are in agreement with the current physiopathologic interpretation of migraine with aura, confirming the instability of cerebral perfusion control, even with instrumental evidence of perfusion abnormalities in the interictal period. Moreover, SPET with 99mTc Hm-PAO seems to be a useful tool in the diagnostic assessment of migraine.

The epidemiological approach has undoubtedly contributed to our knowledge of Multiple Sclerosis (MS) by providing some etiological hypotheses in spite of the fact that a definitive basis for the conclusive resolution of its enigma is still lacking. Epidemiological studies have indicated that MS has an uneven geographical distribution and a changing incidence over time at least in several areas of the world: this suggests an etiological role of both genetic and environmental factors. The racial difference in disease risk, the results of familial and twin studies as well as the association between MS and some HLA markers, support the great importance of genetic factors. On the other hand, the evidence of temporal trends and the data from migrant studies seem to underline the etiological contribution of environmental factors. In the light of these results much of the present views have emerged interpreting the disease as caused by multiple factors acting at a susceptible age in genetically predisposed subjects.

We have explored the variability of P300 event-related potentials in patients affected by Hakim-Adams syndrome, with raised or intermittent intracranial pressure, treated with surgical cerebrospinal fluid shunting. The clinical utility of P300 is confirmed in the light of the improvement of neurophysiological data after the surgical procedure, parallel with amelioration of neuropsychological performances.

Six patients are described who developed a wide variety of neurological manifestations heralding systemic lupus erythematosus (SLE), which included epileptic seizures, stroke, peripheral polyradiculoneuro pathy similar to Guillain-Barre syndrome, transverse my elopathy and multifocal disorders with remitting course mimicking multiple sclerosis. The peculiarity of these cases was that the neurological disorders remained the only manifestations of SLE for many years and the nervous system appeared to be the main target even after the development of systemic SLE. In five patients the prognosis was favourable and corticosteroid treatment led to prolonged remission.

β Epidemiological surveys on Parkinson's disease that have been carried out in different parts of the world have suggested that the disease is uniformly distributed in white populations. The position with regard to the Mediterranean peoples is still controversial, because of the large variation of the frequencies observed in the different areas that have been investigated. We therefore studied the frequency of Parkinson's disease in the Local Health Service of Ferrara, northeastern Italy (mean population, 187 000). Based on 394 patients, the mean incidence per year for the period from 1967 through 1987 was 10.01/100 000. The incidence rate of Parkinson's disease among cases with early onset was found to be statistically higher in rural areas as compared with urban ones (6.32/100000 vs 3.11/100000). Moreover, the study revealed a significantly higher incidence rate among agricultural workers (20.6/100 000). These results would seem to give further support to the hypothesis of a possible causal role of environmental factors that are mainly linked to agriculture, most likely due to the continual exposure to toxic agents in this area. However, further studies, which are not exclusively epidemiological, are necessary before any conclusions may be drawn, because many confounding variables may account for the results from surveys of this type.

Summary Spatial span (Corsi's block-tapping test) and verbal span (Wechsler Digits Forward test) were measured in 877 children (434 boys and 443 girls) divided into 7 age groups, aged 4 to 10 years. A significant difference (p

Summary This study investigated the effects of stress imposed by PEG and NaCl on the photosynthesis and related parameters. Photosynthesis shows a greater decrease, as compared to the control, in plants treated with NaCl than in those treated with PEG. The ratio Ci/Ca is significantly lower in plants stressed with PEG and this indicates that the reduction of photosynthesis activity is mainly due to stomatal effects. Instead the ratio Ci/Ca obtained for seedlings stressed with NaCl is very close to that of the control. Since photosynthetic activity is significantly lowered, it means that in plants treated with NaCl parallel changes in stomatal and mesophyll conductance to CO2 occur.

Summary: Worldwide investigation of the epidemiology of epilepsy has suggested wide variations in the frequency of convulsive disorders. However, descriptive studies in general populations cannot be completely comparable because of a remarkable methodological dishomogeneity in definition of epilepsy, classification of seizures, and ascertainment, collection, and selection of the cases. The position with regard to the Mediterranean people was still little known, and the few studies presently available from Italy offer underestimates of epilepsy frequency owing to incompleteness in case-collection practices and lack of information about the incidence of the disease. Therefore, to verify the true frequency of epilepsy in our country, we performed a community-based epidemiologic study of convulsive disorders in the district of Copparo (population 45,153) in northern Italy. Based on 278 accepted cases with “active” epilepsy, the prevalence per 1,000 population on December 31, 1978, was 6.2 (6.4 if standardized to the Italian population). The average annual incidence for the period 1964 through 1978 was 33.1 per 100,000 (38.3 if standardized). These results, similar to those found in other Western countries, support the view that the frequency of epilepsy in Italy as a whole is higher than that indicated by the Italian studies previously published, and suggest that epilepsy is evenly distributed in Europe and the United States. Antecedents which could be considered potential causes of epilepsy were found in 39.6%, and in 39.1% of the prevalence and incidence cases, respectively; for both prevalence and incidence groups, perinatal brain injuries were the most frequent event. This high proportion of epileptic cases with underlying causes emphasizes the urgency of planning precautionary measures in Italy to improve prenatal and perinatal medical care. RESUME Les investigations faites dans le monde sur 1‘epidemiologic de L'epilepsie ont suggere L'existence de variations importantes dans la frequence des manifestations convulsives. Cependant les etudes descriptives dans les populations generates ne peuvent pas etre reellement comparables en raison de la grande variabilitye methodologique a la fois dans la definition de L'epilepsie, la classification des crises, L'appreciation, la collection et la selection des cas. La situation a cet egard des peuples mediterraneens etait encore peu connue, et les quelques tentatives actuellement dis-ponibles en Italie sousestiment la frequence de L'epilepsie a cause des lacunes dans le systeme de collection des cas et du manque D'information sur L'incidence de la maladie. Ainsi, pour verifier la frequence reelle de L'epilepsie dans notre pays, nous avons effectue une etude epidemiologique des manifestations convulsives dans le district de Copparo (45153 habitants), dans L'ltalie du Nord. Sur la base de 278 cas ayant une epilepsie “active”, la prevalence pour 1000 habitants, le 31 decembre 1978, etait de 6,2 (6,4 en la rapportant a la population italienne). L'incidence an-nuelle moyenne pour la periode de 1964 a 1978 etait de 33,1 pour 100 000 (38,3 en la rapportant a la population italienne). Ces resultats, semblables a ceux trouves dans D'autres pays occidentaux, confirment L'hypothese que la frequence de L'epilepsie en Italie est plus elevee que celle indiquee par les etudes ital-iennes anterieurement publicees, et suggerent que L'epilepsie a une distribution reguliere en Europe et aux Etats-Unis. Des antecedents considered comme causes possibles D'epilepsie ont ete trouves dans 39,6% de la prevalence et 39,1% de L'incidence des cas; dans les deux groupes les agressions cerebrales peri-natales etaient le facteur le plus frequent. Cette grande proportion de cas avec etiologie souligne L'urgence D'etablir un plan de mesures preventives en Italie pour ameliorer la prise en charge medicate prenatale et perinatale. RESUMEN Estudios mundiales sobre la epidemiologic de la epilepsia sugieren la existencia de amplias variaciones en la frecuencia de los desordenes convulsivos. Sin embargo, los estudios descriptivos en la poblacion general no pueden ser totalmente comparables debido a la notoria falta de homogeneidad en la definicion de la epilepsyia, la clasificacion de las crisis, la indagacion, el reclutamiento y la selection de los casos. La situation, con respecto a la poblacion mediterranea, era poco conocida y los escasos intentos realizados en Italia ofrecen subestimaciones en la frecuencia de la epilepsyia debido a lo incompleto de las tecnicas en la coleccion de casos y la falta de informacion acerca de la incidencia de la enfermedad. Para verificar la ver-dadera frecuencia de la epilepsyia en nuestro pais hemos realizado un estudio epidemiologico, basado en la co-munidad, de los trastornos comiciales en el distrito de Copparo (45.153 habitantes) en el norte de Italia. Basandose en 278 casos aceptados de epilepsyia “activa”, la prevalencia por 1.000 habitantes en el 31 de Diciembre de 1.978, resulto ser de 6.2 (6.4 si se estandariza para la poblacion italiana). El promedio de incidencia anual para el periodo 1.964 a 1.978 fue 33.1 por 100.000 (38.3 si se estandariza). Estos resultados, semejantes a los que se encuentran en otros paises occidentales, apoyan la opinion de que la frecuencia de la epilepsyia en Italia, en total, es mayor que la que se indica en los estudios italianos previamente publi-cados y sugieren que la epilepsia se distribuye uni-formemente en Europa y USA. Se encontraron antecedentes, potencialmente etiologicos, en el 39.6 y 39.1 por ciento de la prevalencia e incidencia, respectiva-mente; para los grupos de prevalencia e incidencia de las lesiones perinatales fueron el acontecimiento mas frecuente. Esta alta proportion de casos de epilepsyia con causas subyacentes subrayan la urgencia de plan-ificar las medidas preventivas en Italia, para mejorar la atencion medica pre y perinatal. ZUSAMMENFASSUNG Weltweite Untersuchungen uber die Epidemiologie der Epilepsie lassen grose Unterschiede in der Haufigkeit der Krampfleiden vermuten. Allerdings konnen deskriptive Studien in der Allgemeinbevolkerung nicht vollig miteinander verglichen werden, denn es bestehen bemerkenswerte methodologische Unterschiede in der Definition der Epilepsie, in der Anfallsklassifikation, in der Sicherheit, mit der Anfalle akzeptiert werden, in der Datensammlung und Selektion der Falle. Die Situation hinsichtlich der Mittelmeerbevolkerung war wenig bekannt und die wenigen zur Zeit verfugbaren Versuche aus Italien unterschatzen die Epilepsie-Haufigkeit. Das liegt daran, das die Praktiken der Fallerfassung inkomplett sind und eine Informationslucke uber die Inzidenz der Erkrankung besteht. Um die wirkliche Haufigkeit der Epilepsie in Italien zu bestimmen, wurde eine epidemiologische Studie der Krampfleiden im Distrikt von Copparo in Norditalien durchgefuhrt. Sie beruht auf den Daten einer Gemeinde mit einer Bevolkerung von 45.153 Menschen. Bei 278 verifizierten Fallen einer “aktiven” Epilepsie betrug die Pravalenz pro 1000 der Bevolkerung am 31.12.78 6,2 (6,4 nach Standardisierung fur die italien-ische Bevolkerung). Die durchschnittliche jahrliche Inzidenz fur den Zeitraum von 1964 bis einschlieslich 1978 betrug 33,1 pro 100.000 (38,3 nach Standardisierung). Diese Ergebnisse entsprechen denen anderer westlicher Lander. Sie unterstutzen die Auffassung, das die Frequenz der Epilepsie in Italien als Ganzes hoher ist als in den italienischen Studien, die bisher publiziert wurden, angenommen; sie zeigen ferner, das die Epilepsie gleich verteilt ist in Europa und in den USA. Begebenheiten, die als mogliche Ursachen der Epilepsie angesehen werden konnen, wurden bei 39,6% der Pravalenzund bei 39,1% der Inzidenzfalle gefunden. Fur beide, Pravalenzund Inzidenz-Gruppen waren perinatale Hirnverletzungen das haufigste Ereignis. Dieser hohe Anteil an Epilepsiefallen mit bekannter Ursache betont die Dringlichkeit, in Italien Vorsorgemasnahmen zu treffen, um die pranatale und perinatale arztliche Versorgung zu verbessern.

Neurological complications following vascular thrombotic crises are frequent and occur in sickle cell anaemia and its variants, but are less well recognized in thalassaemias. A case of beta-thalassaemia major is reported complicated by an ischaemic lesion involving the right cerebellar hemisphere. The probable pathogenesis is considered and the literature on the matter briefly reviewed. In agreement with other reports, the interference of risk factors provided by or occurring in association with multiple blood-transfusions is hypothesized. Consequently, caution is recommended in giving large blood-transfusions to thalassaemic patients.

A case of pure agraphia, due to an ischaemic lesion of the left superior parietal lobule, is reported. The neuropsychological analysis of writing performances suggests an aphasic nature of this patient's pure agraphia. The authors discuss the role played by diffuse and/or localized brain lesions in writing function, emphasizing that the left superior parietal lobule in man may be crucial for the sensorimotor linguistic integration needed for writing.