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Focal dystonia is characterized by involuntary muscle contractions that cause abnormal postures and/or twisting movements in a segment of the body. Motor symptoms have a major impact on disability in this condition, but the presence of pain represents an additional source of impairment and poor quality of life. Notwithstanding that pain occurs in up to 70% of patients with cervical dystonia and in a relevant proportion of subjects with focal dystonia of the limbs, it has received very little attention from researchers and controlled trials are scant. The aim of this review is to summarize the current knowledge on the clinical assessment and management of pain in focal dystonias. The search results will inform on the types of pain reported in focal dystonias, on the tools that are used to quantify pain and on the efficacy of pharmacological and non-pharmacological approaches. The collated data will hopefully improve the clinical management of focal dystonia and also stimulate future research on dystonia-associated pain. Optimization of the outcome indeed requires the identification and the management of all the factors that determine disability and hence relies on a multidisciplinary approach.

According to/After the conferences taken place on 30th October and on 18th December 2008, the company doctor functions have been enlarged: at present they include the duty of effectuating toxicological tests in order to find psychotropic and drug substances in some specific working classes, mainly in workers employed in public transports. Company doctors have the duty to report any possible positive matching in these workers'tests. From there, regulations in force are analyzed focusing to critical situations described in the complex and well articulated frame of reference.

Congestive heart failure represents the most common medical hospital discharge diagnosis, and can occur in patients with preserved indexes of left ventricular systolic function, even in absence of patent coronary or valvular heart disease. The present review examines the role of imaging techniques in the diagnosis and follow-up of these patients. Imaging of the heart has undergone dramatic advances with the development and refinement of new imaging modalities such as echocardiography, computed tomography, magnetic resonance and radionuclide emission tomography. The role of "low-tech" modalities such as chest roentgenogram is discussed. The possibilities offered by ultrasounds or magnetic resonance in tissue characterization are then compared with the actual capability of cardiac imaging in detecting myocardial tissue alterations (oedema, ischemia, myocarditis, etc.) and/or degeneration (fatty degeneration, fibrosis, amyloidosis, etc.). Finally, the potential use in modern clinical medicine of magnetic resonance spectroscopy and positron emission tomography to study myocardial metabolism and cellular function are discussed.

The continuity equation, applied to the flow convergence region (FCR), fournishes a simple alternative to calculate stenotic valve area. The flow rate in the FCR can be calculated by multiplying the hemispheric isovelocity surface area by the velocity of the isovelocity surface. Since according to the continuity principle the flow rate through any isovelocity surface equals the flow rate through the stenotic orifice, the stenotic orifice area can be calculated as: 2 pi r2Vr/Vm, where 2 pi r2 is the hemispheric isovelocity area, Vr is the velocity at the radial distance r from the orifice and Vm is the peak jet velocity. This study was designed to analyze the validity of application of the continuity equation to the FCR for estimating mitral orifice area by Dopler ultrasound. We studied 35 consecutive patients with rheumatic mitral stenosis. Three patients were excluded; the final study population consisted of 32 patients (8 men and 24 women; mean age 56 years). Nine patients were in normal sinus rhythm and 23 in atrial fibrillation. Doppler examination was performed from the apical approach within 24 hours of cardiac catheterization. On color Doppler image Vr was defined as the first aliasing limit (lowered to 38 cm/s to increase FCR r); r represented the maximal early diastolic distance between the first alias and the stenotic orifice in a direction parallel to that of the transducer; Vm was the early diastolic peak jet velocity by continuous wave Doppler.(ABSTRACT TRUNCATED AT 250 WORDS)

The Kramers ion Dy3+ has been shown to exhibit similar properties to Er3+ and the non-Kramers ions Tm3+ and Tb3+ in the lanthanide nicotinate dihydrates (LnND): (1) an almost Ising-like g-matrix, corresponding to a ground state with large amplitude of Mj = ± J, (2) purely magnetic dipole-dipole interaction between nearest neighbours, (3) great sensitivity of the g-matrix to the nature of the nearest neighbour ion.

The influence of an intense laser field on the quasienergy gap of a semiconducting crystal as developed in the presence of an exciting laser field is discussed. It is shown that the effect of the strong laser is of ‘‘dressing’’ the quasienergy gap in that it becomes modulated by the strong field amplitude. The consequence of this latter effect on the tunneling current between a semiconductor‐semiconductor junction is discussed. An application is made for a GaAs sample.

Experimental data of the photoacoustic signal behavior near the ferromagnetic resonance field are presented. The photoacoustic signal goes as ƒ−δ (ƒ > 100 Hz), where f is the modulation frequency. The δ values are positive and tend to one when the external magnetic field tends to the resonance field. A theoretical approach, based upon a thermally thick and optically opaque sample approximation, is proposed. Experimentelle Untersuchungen zum Verhalten des photoakustischen Signals in der Nahe des ferromagnetischen Resonanzfeldes werden mitgeteilt. Das photoakustische Signal variiert wie −δ (ƒ > 100 Hz), wobei ƒ die Modulationsfrequenz ist. Die δ-Werte sind positiv und nahern sich dem Wert eins, wenn sich das ausere Magnetfeld dem Resonanzfeld nahert. Eine theoretische Betrachtung wird vorgeschlagen, die auf der Naherung einer thermisch dicken und optisch undurchlassigen Probe beruht.

A simple microvibrating sample magnetometer (MVSM), particularly inexpensive, sensitive, and versatile has been developed. An alternating magnetic field superposed to a steady uniform magnetic field is applied to the sample. The sample undergoes a periodic motion around an equilibrium position, causing a pressure fluctuation within a closed gas cell which is detected as an acoustic signal by a microphone.

In this paper a piezoelectric detection of the photoacoustic signal in the microwave region using barium titanate as a detector is carried out. The results in the low modulation frequency (below 30 Hz) are fitted very well by White’s theory. For frequencies above 70 Hz a new and simple theory is presented. The effectiveness of this technique is demonstrated in the detection of the ferromagnetic resonance.

The Mossbauer linewidth broadening of superparamagnetic particles of ferric hydroxysulfate, near the point where the paramagnetic lines begin to appear, has been investigated as a function of temperature. This behavior is explained by a geometric picture of an assembly of magnetically ordered single‐domain particles whose magnetic moments move within an asymmetric double‐well potential. A relaxation model is presented which combines the conventional theory of superparamagnetism with an exponential distribution of energy barriers.

Superparamagnetic particles have been investigated by electron magnetic resonance. We have shown that the temperature dependence of the linewidth (above the freezing temperature) is sensitive to the pattern of particle size distribution. The behavior of the linewidth as a function of temperature is explained if we assume an anisotropic Dzyaloshinskii–Moriya type of interaction where the relaxation process occurs by a longitudinal component.

Congestive cardiomyopathy in 3 cases, in which occurrence of human Cytomegalovirus (CMV) infection was demonstrated, is described. In all cases significant rise in total CMV antibodies and in early antigen-antibodies was found: CMV was also isolated from urine and saliva in one, a 13 years old boy, and only from urine in the others two patients, 20 and 26 old men. Immunoglobulin M was raised only in the first case, in which CMV infection was likely in act: instead in the others two CMV infection was late primary or recurrent. The possibility of CMV infection as etiological agent of dilatative cardiomyopathy with congestive heart failure in this 3 cases is, in our opinion, strongly suggestive.

Three cases of peripartum cardiomyopathy (CMP PP) are presented. In our opinion this term is more correct than post-partum cardiomyopathy. The study was performed both clinically and hemodynamically; patients were followed up for a long period (in one case up to 14 years). Although there were consistent differences in the rise and development of the disease, the clinical and laboratory results could be put together clearly. In the light of this clinical experience, a wide revision of the literature on the topic was carried out, using the hypotrophic-hypokinetic forms of cardiomyopathy (congestive) as a comparison with peripartum cardiomyopathy, which seem to be clinically correlated.

The authors report on the casuistry of aorto-coronary by-pass operations they performed between April 1971 and December 1974, discussing the criteria which indicate the necessity of operating, the principles of the operative techniques, and the results obtained. Out of a total of 342 operated cases, there was an operative mortality (within 30 days) of 3% in isolated by-pass cases, and 4% if one includes associated operations. In 3,5% of patients, postoperative necrosis was present. Almost the same values were found in the smaller group (66 cases) which underwent urgent by-pass operations. The authors consider that the aorto-coronary by-pass operation is a very useful treatment, both for stable and unstable angina, as long as the anatomo-functional conditions exist.

Based on classifications proposed by Anglosaxon and French authors who were the first to become interested in the so-called cardiomyopathies of unknown origins, 41 cases clinically classified as hypotrophic-hypokinetic (congestive) cardiomyopathies are presented. After a period of clinical observation, 21 cases were studied hemodynamically, with ventriculography and coronaryarteriography, with phonocardiography (35 cases) and follow-up from some months to 6 years. Post mortem studies were performed in 6 patients, five of whom died of congestive heart failure or thromboembolism and one of sudden death. It was concluded that these entities are hypotrophic-hypokinetic cardiomyopathies with a clinical pattern of congestive heart failure and with unknown aethiologic factors. Treatment as far as indications and efficacy are discussed.

Organic nitrates are widely used in the management of patients with angina pectoris, and with increasing frequency for load reduction in patients with impaired left-ventricular function [1, 2]. The usefulness of isosorbide dinitrate (ISDN) was initially called in question because of extensive first-pass metabolism in the liver; ISDN is rapidly metabolized to isosorbide-2-mononitrate (IS-2-MN) and isosorbide-5-mononitrate (IS-5-MN) [3].

Doppler characteristics of normally functioning tilting disk prostheses in aortic position were studied in 55 patients (30 Medtronic-Hall and 25 Sorin) whose valvular function was considered normal using clinical and echocardiographic evaluation. Peak gradients, mean gradients and effective orifice area were estimated for different sizes of prostheses. The peak gradient calculated from maximal aortic velocity was 27.3 +/- 11.1 mmHg in Sorin and 21.1 +/- 9.7 mmHg in Medtronic-Hall valves; the mean gradients were 12.9 +/- 6.2 mmHg and 10.8 +/- 5.7 mmHg in Sorin and Medtronic-Hall valves respectively. The effective orifice area calculated by the continuity equation was 1.4 +/- 0.5 cm2 in Sorin and 1.5 +/- 0.57 cm2 in Medtronic-Hall prostheses; the performance index calculated as the ratio between functional area and manufactured area was 0.4-0.6 for Medtronic-Hall and 0.45-0.52 for Sorin prostheses. Prosthetic regurgitation was found in 64% of Sorin valves and 80% of Medtronic-Hall valves; prosthetic regurgitation was mild in 81% and moderate in 19% of cases. Doppler echocardiography is a reliable method for the characterization of the normal function of prosthetic aortic valves and provides information similar to cardiac catheterization.

The electrocardiogram of 27 patients with congestive cardiomyopathy (CMC), 15 with obstructive (CMO) and 13 with hypertrophic without obstruction (CMH) have been studied. Cardiac catheterization, angiography, coronary arteriography, and, in some cases, echocardiography, were performed. The study was carried out in an attempt to define certain patterns of each CM with emphasis on the ischaemic-like features, as infarct pattern, symmetrical T wave inversion, ST elevation, non-typical troubles of ventricular repolarization and on the electrophysiology of these findings. Suggestive for CMC were: (1) prolonged PR, (2) high frequency of arrhythmias and conduction defects, especially complete left bundle branch block with abnormal left axis deviation, (3) left atrial enlargement and ventricular hypertrophy. Suggestive for CMO: (1) low incidence of arrhythmias and conduction defects, (2) left atrial enlargement and ventricular hypertrophy. Infarct pattern, symmetrical T wave inversion and other ischaemic-like features were equally found in all groups of CM, without any statistical difference. Pathogenesis of cardiomyopathy, particularly of CMH, is discussed, carrying out a review of literature.

To verify the ability of Pulsed Doppler Echocardiography (PDE) to detect flow abnormalities in tricuspid insufficiency (TI), 27 normal controls and 83 heart patients (pts) were studied. The latter group underwent an invasive diagnostic evaluation. The PDE examination did not reveal any significant systolic flow alteration in the normal controls. However, in the heart patients, a systolic turbulence was recorded within the right atrium both on audio and on graphic system (Time Interval Histogram-TIH) in 28 cases. Angiography showed tricuspid regurgitation in 24 pts. The sensitivity of PDE was 92%, the specificity was 93% and the predictive value was 96%. There were two false negative and four false positive cases. In conclusion, Pulsed Doppler Echocardiography is a highly reliable technique for the qualitative diagnosis of tricuspid insufficiency in patients with acquired heart disease. Left-to-Right shunts, namely left-to-right atrium and left ventricle-to-right atrium, can create flow disturbances that mimic tricuspid insufficiency. No criteria were identified, which correlated well with the angiographic severity of the tricuspid regurgitation.

Congenital absence of the left pericardium, partial or complete, is an uncommon cardiac defect. Most patients affected by this abnormality are asymptomatic. Usually it is suspected on the basis of a chest X-ray showing a normal sized cardiac shadow projecting entirely to the left of the spine. Computed axial tomography confirmed the absence of the left pericardium detecting the interposition of the left lung between the ascending aorta and main pulmonary artery. The M-mode, two-dimensional, and Doppler-cardiographic findings of complete congenital absence of the left pericardium are described in two cases. Imaging seems to be not specific for this abnormality; however in both cases pulsed Doppler detected mild tricuspid and pulmonic valve regurgitation.

70 consecutive patients undergoing heart surgery for mitral valve disease were studied: at operation 6 of them exhibited left atrial thrombi (LAT). Dimension of the thrombi varied from a hazel-nut to an orange, 4 of them adhered to the posterior atrial wall, 2 of these obliterated the left atrial appendage, one partially and the other totally, invading also the left atrial cavity as far as mitral orifice. In 5 cases LAT appeared of old onset, possibly with recent apposition; in one case the thrombus was mainly recent. All the cases had been assessed preoperatively using M-mode and two-dimensional echocardiography: the diagnosis of LAT was made in 5 pts, the only thrombus missed was the one located in the left atrial appendage. Angiocardiography was performed in 4 pts, showing left atrial thrombi in one case. Two-dimensional echocardiography (2D E) demonstrated a high sensitivity by revealing LAT in 5 cases out of 6, with good definition of shape and location. The LAT appeared as echoproducing masse with well defined borders and "muscle" density in 4 cases; in 3 they were seen protruding into the atrial cavity and in one case they were seen located above the posterior mitral leaflet. M-mode revealed multiple echoes parallel to the posterior atrial wall in the first 3 cases, whereas in the fourth it provided no particular finding for the diagnosis. In the only case of recent onset LAT, 2DE showed a single strong echo, parallel to the posterior atrial wall both in long and short-axis views, separated from the atrial wall by an echo-free space of 1.5 cm. Similar features resulted at the M-mode echocardiography. In conclusion, 2DE with gray-scale has an high sensitivity for detecting LAT, in particular when thrombi are old and located in the left atrial cavity. Recent onset thrombi are more difficult to demonstrate and it is possible that the "fresh" component of an old thrombus is missed.

Fifty patients who suffered from an acute myocardial infarction at age 40 or below and underwent coronary arteriography, were studied from 8 to 184 months after the infarction (mean follow-up 56 months). Hyperlipidaemia (60%) and cigarette-smoking (82%) were the most common risk factors, while hypertension and diabetes mellitus were found in 10% of all patients. Thirty-seven patients had two or more risk factors. Preinfarction angina was present in 7 subjects. Death rate was 14% within five years and was related to the severity of symptoms. Out of the patients with normal coronary arteriogram (6 patients) or with a single vessel disease 21 were free of angina and 30 did not suffer a reinfarction. Out of 17 patients with two or more coronary vessel disease, angina was present in 14 and reinfarction was seen in 5.