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Objectives To report the results of a national survey aimed at quantifying the current level of diffusion of Levodopa/carbidopa intestinal gel (LCIG) in Italy. Methods Sixty Parkinson's Disease (PD) specialists in Italy were invited to complete a survey covering issues on clinical and practical aspects of LCIG therapy. Results Clinical features of 905 patients were collected retrospectively. The majority of centres reported the use of a multidisciplinary team, biochemistry testing, neurophysiological and neuropsychological tests before and after treatment, in addition to caregivers' training and patient's follow as outpatients. Most centres (60%) used internal guidelines for patient selection. The overall rate of adverse events was 55.1%. Weight loss, chronic polyneuropathy and stoma infection were the most frequently reported. 40% of centres used replacement therapy with Vitamin B12 and Folic acid from the start of LCIG and continued this for the duration of treatment. The rate of discontinuation was of 25.7% overall, with 9.5% of cases occurring in the first year. The main causes of withdrawal were device-related complications, disease progression (comorbidity, severe dementia) and caregiver and/or patient dissatisfaction. Conclusions In Italy LCIG infusion is managed in a uniform manner at a clinical, practical and organizational level even though the selection criteria are not standardized through the country. The high percentage of patients remaining on treatment in the short- and long-term follow-up confirms effectiveness of treatment, careful follow-up, and appropriate patient and caregivers training.

The Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) has been available in English since 2008. As part of this process, the MDS-UPDRS organizing team developed guidelines for development of official non- English translations. We present here the formal process for completing officially approved non-English versions of the MDS-UPDRS and specifically focus on the first of these versions in Italian. The MDS-UPDRS was translated into Italian and tested in 377 native-Italian speaking PD patients. Confirmatory and exploratory factor analyses determined whether the factor structure for the English- language MDS-UPDRS could be confirmed in data col- lected using the Italian translation. To be designated an 'Official MDS translation,' the Comparative Fit Index (CFI) had to be C0.90 relative to the English-language version. For all four parts of the Italian MDS-UPDRS, the CFI, in comparison with the English-language data, was C0.94. Exploratory factor analyses revealed some differ- ences between the two datasets, however these differences were considered to be within an acceptable range. The Italian version of the MDS-UPDRS reaches the criterion to be designated as an Official Translation and is now avail- able for use. This protocol will serve as outline for further validation of this in multiple languages.

We analyzed risk associated with exposure to pesticides and contact with livestock in 277 multiple myeloma (MM) cases and 2434 controls who participated in the multicentre European EPILYMPH study. Ever exposure to organic pesticides or contact with any species of livestock was not associated with an increase in risk of MM. However, risk associated with ever exposure to pesticides was elevated after adjusting for contact with sheep (OR= 2.0, 95% Cl 1.2 3.3). The finding of an excess risk associated with ever exposure to any pesticides after adjusting for contact with breeding animals is most likely due to chance. © PI-ME, Pavia 2011.

Cognitive impairment (CI) is a frequent feature associated with both early and advanced stages of Parkinson's disease (PD). An evaluation of cognitive functions is relevant to identify those parkinsonians at risk of developing dementia. In the present study, the Italian version of Parkinson's Disease-Cognitive Rating Scale (PD-CRS) assessing fronto-subcortical and cortical cognitive functions in PD was validated in 387 parkinsonians and was used to test the empirical validity of the item 1.1 (cognitive impairment) of the Italian version of MDS-UPDRS as screening tool for CI in PD. PD-CRS was free from floor and ceiling effect. The mean PD-CRS score was 76.1 (mean cortical score, 24.5 ± 4.6; mean subcortical score, 51.5 ± 17.5). The internal consistency was satisfactory (α = 0.89); corrected item-total correlation was 0.570 (naming) to 0.696 (working memory). The correlation between PD-CRS and part I-IV of MDS-UPDRS was weak. The low agreement between classification of PD sample into patients with mild cognitive impairment (PD-MCI), dementia (PD-D) and normal cognition (PD-NC) according to scores of item 1.1 and classification according to cutoff scores of PD-CRS for PD-MCI, PD-D and PD-NC indicated a poor empirical validity of item 1.1 of MDS-UPDRS as cognitive screening tool for CI in PD (Κ = 0.114; weighted Κ = 0.17; SE of Κ = 0.038; 95 % confidence interval from 0.040 to 0.1895). The Italian version of PD-CRS is an easy, consistent and valid tool for assessment of the cognitive cortical and subcortical impairments in PD. © 2013 Springer-Verlag.

Assessing the frequency of Wearing-Off (WO) in Parkinson's disease (PD) patients, and its impact on Quality of Life (QoL). METHODS: Consecutive ambulatory patients, who were on dopaminergic treatment for ≥ 1 year, were included in this multicentre, observational cross-sectional study. In a single visit, WO was diagnosed based on neurologist assessment as well as using the validated Italian version of a patient self-rated 19-question Wearing-Off Questionnaire (WOQ-19); WO was defined for scores ≥ 2. QoL was evaluated by the 8-item Parkinson's Disease Questionnaire (PDQ-8). RESULTS: 617 subjects were included, with a mean anti-Parkinson treatment duration of 6.6 ± 4.6 years, 87.2% were on levodopa treatment. Neurologists identified presence of WO in 351 subjects (56.9%), whereas 415 subjects (67.3%) were identified by the self-administered WOQ-19. In patients with a

Gli Autori hanno indagato sui rapporti fra concentrazione elettrolitica nel liquido sinoviale e la cronologia della morte, pervenendo alla conclusione di poter retrodatare in maniera soddisfacente la morte di un soggetto a breve termine da questa conoscendo il valore del potassio nel liquido sinoviale delle sue ginocchia. Viene altresì evidenziato come tale metodica di tanatocronologia presenta minori difficoltà tecniche rispetto ad altri metodi con medesima finalità quali, ad esempio, l’estrazione della 3-metossitiramina del putamem cerebrale e degli enzimi del testicolo.

Si è valutato sotto il profilo statistico l’andamento delle assenze per malattia del personale parasanitario di un Ente ospedaliero Generale Provinciale della Campania con 800 posti letto nel triennio 1977-78-79. Sono state evidenziate e discusse le principali anomalie e discongruenze nell’andamento delle assenze rispetto al prevedibile. Le malattie denunciate e/o accertate sono state considerate in relazione sia agli apparati interessati dai vari processi morbosi, sia alle categorie professionali esaminate. Si sono ipotizzati vari meccanismi all’origine dei comportamenti anomali e sono state altresì effettuate proiezioni statistiche sull’andamento del fenomeno nel successivo biennio.

Vengono presi in considerazione due casi di ferita d’arma da fuoco a canna corta nei quali la disposizione degli esiti cicatriziali sul corpo delle vittime era tale ingenerare dubbi nella ricostruzione delle modalità lesive, circa la traiettoria dei proiettili e la dinamica di ferimento. I casi prospettati dimostrano come la metodologia diagnostica deve armonicamente tener conto degli elementi di specifica, delle risultanze della documentazione clinica disponibile, delle indagini radiografiche e di ogni altro elemento che possa valere a delucidare la dinamica dell’evento lesivo. La ricostruzione in sede di perizia deve essere però critica anche nella verbalizzazione dei documenti medici in relazione alla frequente inesperienza nel riconoscimento delle lesioni di arma da fuoco.

Segnalata la carenza di una normativa specifica relativa alle armi subacque, il cui uso non risulta vincolato da alcuna disciplina di carattere restrittivo, gli AA. illustrano i risultati di prove di lancio sperimentali condotte con fucili subacquei per verificarne gli effetti lesivi sui bersagli al di fuori dell’acqua. Da tali risultati si ha dimostrazione della elevata potenzialità traumatica tali attrezzi che possono produrre, anche a distanza di diversi metri e a seconda delle loro caratteristiche balistiche, lesioni idonee a procurare la morte. Per tali motivi viene sottolineata la necessità di giungere ad una normativa specifica in merito che, pur non limitando l’attività sportiva, consenta di controllare la vendita e il porto di tali attrezzi.

We evaluated the congenital malformation rate in the progeny of the personnel of the Salto di Quirra military base in Sardinia.During 2011, we gathered questionnaire information on the reproductive history of 389 employees, more then 99% of those eligible for routine health surveillance.the observed congenital malformation rate (20.1 x 10(-3), 95% CI 6.3 - 33.8) was lower than that reported by the Italian Registries of Congenital Malformations, and it did not vary by exposure to radiofrequency, elf electromagnetic fields, and solvents, and by jobs associated with alleged exposure to nanoparticles or alpha radiation.Our findings suggest that the documented or alleged occupational exposures among the PISQ workforce did not increase the congenital malformation rate in the progeny.

Background The impact of deep brain stimulation (DBS) on cognitive and urinary disorders, falls, and eventually hospitalizations and mortality in Parkinson's disease (PD) is still debated. Objective We compared the rates of dementia, mild cognitive impairment (MCI), urinary incontinence, nocturia, falls, hospitalizations, and mortality in a cohort of PD patients undergoing DBS with a cohort of medically-treated patients chosen as controls. Methods We conducted a retrospective pilot study in six Italian DBS centers. 91 PD patients receiving DBS and 91 age- and gender-matched controls receiving the best medical treatment alone with a minimum follow-up of one year were enrolled. Clinical data were collected from baseline to the last follow-up visit using an ad-hoc developed web-based system. Results The risk of dementia was similar in the two groups while patients in the surgical cohort had lower rates of MCI, urinary incontinence, nocturia, and falls. In contrast, the risk of hospital admissions related to PD was higher in the surgical cohort. However, when excluding hospitalizations related to DBS surgery, the difference between the two cohorts was not significant. The surgical cohort had a lower number of hospitalizations not related to PD. The risk of death was similar in the two groups. Conclusion Despite a higher risk of hospitalization, patients receiving DBS had a lower rate of MCI, urinary incontinence, nocturia and falls, without evidence of an increased risk of dementia and mortality. Although these findings need to be confirmed in prospective studies, they seem to suggest that DBS may play a significant role in the management of non-motor symptoms and common complications of advanced PD.

Objectives We investigated the role of occupational exposure to specific groups of agrochemicals in the aetiology of lymphoma overall, B cell lymphoma and its most prevalent subtypes. Methods In 1998–2003, 2348 incident lymphoma cases and 2462 controls were recruited to the EPILYMPH case-control study in six European countries. A detailed occupational history was collected in cases and controls. Job modules were applied for farm work including specific questions on type of crop, farm size, pests being treated, type and schedule of pesticide use. In each study centre, industrial hygienists and occupational experts assessed exposure to specific groups of pesticides and individual compounds with the aid of agronomists. We calculated the OR and its 95% CI associated with lymphoma and the most prevalent lymphoma subtypes with unconditional logistic regression, adjusting for age, gender, education and centre. Results Risk of lymphoma overall, and B cell lymphoma was not elevated, and risk of chronic lymphocytic leukaemia (CLL) was elevated amongst those ever exposed to inorganic (OR=1.6, 95% CI 1.0 to 2.5) and organic pesticides (OR=1.5, 95% CI 1.0 to 2.1). CLL risk was highest amongst those ever exposed to organophosphates (OR=2.7, 95% CI 1.2 to 6.0). Restricting the analysis to subjects most likely exposed, no association was observed between pesticide use and risk of B cell lymphoma. Conclusions Our results provide limited support to the hypothesis of an increase in risk of specific lymphoma subtypes associated with exposure to pesticides.

The firearm identification through fired bullets involves the analysis of signs by studying their features. The aim of this paper is to propose a method based on the comparison of multilevel wavelet analysis applied to the digitalized images of the bullet surface.