Search

Shape memory alloys (SMAs) are a very promising class of metallic materials showing promising nonlinear properties, such as pseudo-elasticity behavior, shape memory effect and damping capacity, due to high mechanical hysteresis and internal friction. SMA have been recently applied in the field of neuromuscular rehabilitation, designing some new devices based on the above properties. The paper discusses possible uses of these materials in the treatment of movement disorders, such as dystonia or hyperkinesia, where their dynamic characteristics can be the key issue. [ABSTRACT FROM AUTHOR]

Objective: The scope of this paper is to review the subtypes of transient ischemic attack (TIA) and minor stroke (mS) in which a surgical treatment is needed, discussing the importance and the timing of a multidisciplinary approach, in order to achieve an optimized management and prevent major strokes or other critical complications., Materials and Methods: The keywords "transient ischemic attack," "minor stroke," "surgical treatment," "vascular surgery," "heart surgery," "neurosurgery," and "multidisciplinary" were searched using MEDLINE, EMBASE, and Scopus. Relevant search results were discussed by the authors for references inclusion., Results: Notwithstanding that best medical therapy is usually the first choice for the most part of cases, there are specific but recurrent etiologies that must be properly recognized because of a potential surgical approach, even in urgency. In fact, symptomatic carotid stenosis, or particular cases of hemodynamic cerebrovascular events, should be promptly referred to vascular surgeon, since increasing evidences highlighted a benefit from an early artery revascularization. In addition, beyond arrhythmic causes, cardioembolic events due to bacterial endocarditis and atrial myxoma should be quickly diagnosed, possibly in emergency department, because they are a presumptive urgency for heart surgery. In addition to the above-mentioned conditions, in patients suffering from vertebrobasilar TIA or mS, clinicians should keep in mind the Bow Hunter disease, because surgical artery decompression can represent the only suitable treatment in selected cases., Conclusions: TIA and mS require a multidisciplinary in order to discuss therapeutic options, comparing risks and benefits and determining the best timing for an optimized management., (© 2023. Fondazione Società Italiana di Neurologia.)

Background and Purpose: The purpose of this study was to investigate the role of risk factors in predicting the variation in carotid atherosclerosis at ultrasonographic follow-up and, therefore, its role in the progression of large-vessel disease., Methods: This retrospective population study included all the outpatients that underwent at least two carotid ultrasonographies at our laboratory from 2001 to 2017. Demographic data, vascular risk factors, and the results at follow-up were analysed to determine if correlations exist between these risk factors and variation in carotid atherosclerosis., Results: Data from 600 patients (327 males and 273 females with a mean age of 67 years) were collected. The mean follow-up period was 49 months (range: 1-195). We analysed each demographic variable and risk factor to assess its correlation with a worsening of carotid atherosclerosis; previous myocardial infarction (2.594), previous carotid surgical treatment (2.368), and hypertension (1.85) were found to have the highest odds ratios, respectively. Furthermore, the sample was divided into specific subpopulations (diabetes, hypertension, and smoking), and an association was found between age and worsening stenosis., Discussion and Conclusions: Our results confirm the importance of carotid ultrasonographic follow-up in the monitoring and managing of large-vessel disease. Myocardial infarction, previous stroke, and previous surgical treatment were the strongest predictors of a worsening of carotid atherosclerosis. These findings suggest a strict follow-up is needed, even in the absence of significant carotid atherosclerosis at baseline.

Bezoars are masses of indigestible material which form in the stomach. Their genesis depends on the kind of food ingested, on the presence of anomalies of the small bowel and on psychiatric disturbs. Phytobezoar rarely causes bowel obstruction and its most frequent location is the ileocecal valve. The risk increases in those patients who have undergone gastric surgery or present a reduced masticatory ability. Moreover, the genesis can be also caused by endocrine disorders.

The number of circulating CD4+ T cells constitutively expressing CD25 (T regulatory, Treg) and natural killer T (NK T) cells, the two major lymphocyte populations that help to maintain immune homeostasis, was studied in 22 unselected myasthenia gravis (MG) patients, 16 healthy subjects and 24 patients with cancer, the latter as a disease model of a relative immune suppression status. Treg cells were assessed according to their intermediate or high level of expression of CD25, i.e., CD25int and CD25bright, and to the expression of HLA-DR, CD62L, CD45RO and CD152. There were no differences in the number of NK T cells and CD4+CD25bright cells among the three series of individuals. MG patients and healthy subjects had also similar numbers of CD4+CD25int cells. However, the whole CD4+ cell compartment in MG patients was in an activated status, as indicated by the higher level of expression of CD152. By contrast, and consistent with a relative immune suppression status, cancer patients had higher numbers of CD4+CD25int cells and larger proportions of HLA-DR expressing CD4+CD25int and CD4+CD25bright cells. Immunomagnetically purified CD4+CD25+ cells from MG, healthy subjects and cancer patients were anergic and suppressed the proliferative response of other T cells.

Tacrolimus (FK-506) is a calcium-calcineurin inhibitor, successfully used in transplant recipients. We report the successful use of tacrolimus as a single immunosuppressant in a patient who had developed myasthenia gravis (MG) during interferon alpha treatment. In this case, the coexistence of hepatitis C and type 2 diabetes mellitus contraindicated the use of both steroids and azathioprine, and cyclosporine A, although effective, had induced renal failure. Tacrolimus proved to be effective in the treatment of MG, was not significantly hepatotoxic, and was less nephrotoxic than cyclosporine., (Copyright 2002 John Wiley & Sons, Inc.)

Objectives: To investigate the characteristics of myasthenia gravis (MG) in older people and to evaluate the benefits of immunosuppressive treatments at this age., Background: Myasthenia gravis in older adults has not been extensively studied. In patients with disease onset after the age of 60, treatment mainly relies on medical therapy because thymectomy is generally not performed unless a thymoma is present., Methods: Of 837 myasthenic patients followed since 1978, we identified 172 cases with onset after age 60. All patients were treated with anticholinesterases. In the decade from 1978 to 1988, immunosuppressive therapy was performed mainly with corticosteroids (prednisone); since 1989, azathioprine alone or, more often, associated with prednisone, has been increasingly used in MG patients. Long-term outcome was evaluated in 149 cases with follow-up longer than 1 year. Remission, pharmacological remission, and marked improvement with reduction in drug dosage were considered good results., Results: Patients older than age 60 at onset of the disease were 20.5% of our series, male/female ratio was 1.9, age at onset ranged from 61 to 86 years, 87.2% patients had generalized disease, thymoma was detected in 37 patients (21.5%). Of 149 cases with sufficient follow-up data, 9 were in remission, 111 achieved good results, 3 died of MG, and 120 required immunosuppressive therapy at some time. Sixty-seven patients had been treated with prednisone for 0.5-16 years (mean, 5 years); good results were recorded in 51 patients (76.1%) and severe side effects in 12 (17.9%). Forty-six patients had received combined therapy with prednisone and azathioprine for 1 to 12 years (mean, 3.9 years); good results were recorded in 41 patients (89.1%) and severe side effects in six (19.5%). Seven patients had been treated with azathioprine alone for 1 to 4 years (mean, 2.3 years) with good results in five and with no side effects., Conclusions: The prognosis of MG in older people seems to be favorable, although full remission is rare and MG weakness, treatment side effects, and associated thymoma can contribute to mortality rate. In our experience, the combined therapy with prednisone and azathioprine was more effective than prednisone alone, and steroid-related side effects were more frequent than those related to azathioprine.

Plasma exchange (PE) is an easily applicable technique for rapid and massive removal of antibodies, and its beneficial role is well established in the management of myasthenia gravis (MG), an antibody-mediated disorder of the neuromuscular junction. PE is useful in myasthenic crisis, in most severe forms of MG before thymectomy, in the early postoperative period, and in cases of symptom worsening during tapering or initiation of immunosuppressive therapy. Clinical efficacy varies from 55% to 100%, and improvement rarely persists for more than 4-10 weeks; thus immunosuppressive therapy has to be associated. New apheretic techniques (double filtration plasmapheresis, immunoadsorption systems with staphylococcal protein A columns or thryptophan-polyvinyl alcohol gel columns) that allow the selective removal of IgG and anti-AChR antibody were recently used in the management of MG with positive effects. Whether their therapeutic effect and cost effect prove more favorable than those obtained by PE still must be demonstrated.