Cortese A.,C Mondino National Institute Of Neurology Foundation |
Franciotta D.,C Mondino National Institute Of Neurology Foundation |
Alfonsi E.,C Mondino National Institute Of Neurology Foundation |
Visigalli N.,C Mondino National Institute Of Neurology Foundation |
And 23 more authors.
Journal of the Neurological Sciences | Year: 2016
Combined central and peripheral demyelination (CCPD) is rare, and current knowledge is based on case reports and small case series. The aim of our study was to describe the clinical features, diagnostic results, treatment and outcomes in a large cohort of patients with CCPD. Thirty-one patients entered this retrospective, observational, two-center study. In 20 patients (65%) CCPD presented, after an infection, as myeloradiculoneuropathy, encephalopathy, cranial neuropathy, length-dependent peripheral neuropathy, or pseudo-Guillain-Barré syndrome. Demyelinating features of peripheral nerve damage fulfilling European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) electrodiagnostic criteria for CIDP were found in 23 patients (74%), and spatial dissemination of demyelinating lesions on brain MRI fulfilling the 2010 McDonald criteria for multiple sclerosis (MS) in 11 (46%). Two thirds of the patients had a relapsing or progressive disease course, usually related to the appearance of new spinal cord lesions or worsening of the peripheral neuropathy, and showed unsatisfactory responses to high-dose corticosteroids and intravenous immunoglobulins. The clinical presentation of CCPD was severe in 22 patients (71%), who were left significantly disabled. Our data suggest that CCPD has heterogeneous features and shows frequent post-infectious onset, primary peripheral nervous system or central nervous system involvement, a monophasic or chronic disease course, inadequate response to treatments, and a generally poor outcome. We therefore conclude that the current diagnostic criteria for MS and CIDP may not fully encompass the spectrum of possible manifestations of CCPD, whose pathogenesis remains largely unknown. © 2016 Elsevier B.V. All rights reserved.
Bonzini M.,University of Insubria |
Bertu' L.,University of Insubria |
Bertu' L.,University of Milan Bicocca |
Veronesi G.,University of Insubria |
And 3 more authors.
International Archives of Occupational and Environmental Health | Year: 2015
Objectives: Longitudinal studies have linked stress at work with a higher incidence of musculoskeletal pain. We aimed to explore the extent to which musculoskeletal pain is a cause as opposed to a consequence of perceived occupational stress. Methods: As part of the international cultural and psychosocial influences on disability study, we collected information from 305 Italian nurses, at baseline and again after 12 months, about pain during the past month in the low-back and neck/shoulder, and about effort–reward imbalance (ERI) (assessed by Siegrist’s ERI questionnaire). Poisson regression was used to assess the RR of ERI >1 at follow-up according to the report of pain and of ERI >1 at baseline. Results: Among nurses with ERI ≤1 at baseline, ERI >1 at follow-up was associated with baseline report of pain in the low-back (RR 2.7, 95 % CI 1.4–5.0) and neck/shoulder (RR 2.6, 95 % CI 1.3–5.1). However, there was no corresponding association with persistence of ERI in nurses who already had ERI >1 at baseline. Associations of ERI at baseline with pain at follow-up were weak. Conclusion: Our results suggest that the well-documented association between job stress and musculoskeletal pain is not explained entirely by an effect of stress on reporting of pain. It appears also that workers who report musculoskeletal pain are more likely to develop subsequent perceptions of stress. This may be because pain renders people less tolerant of the psychological demands of work. Another possibility is that reports of pain and stress are both manifestations of a general tendency to be aware of and complain about symptoms and difficulties. © 2014, Springer-Verlag Berlin Heidelberg.
Looking for lost occupational cancers: A systematic evaluation of occupational exposure in a case series of cutaneous squamous cell carcinomas in Italy [Alia ricerca dei "tumori professional! perduti": Valutazione sistematica dell'esposizione professionale in una serie consecutiva di carcinomi cutanei spinocellulari]
Bonzini M.,University dellLnsubria |
Facchinetti N.,University of Brescia |
Motolese A.,Ospedale di Circolo Fondazione Macchi |
Casa M.,Ospedale di Circolo Fondazione Macchi |
And 5 more authors.
Medicina del Lavoro | Year: 2013
Background: Cutaneous carcinomas are tumors with a potential occupational etiology due to exposure to established carcinogens such as polycyclic aromatic hydrocarbons (PAH), ionizing radiation, ultraviolet (UV) radiation and arsenic. The occupational origin of such neoplasms is hugely underestimated in Italy. Objectives: To asses the proportion of Squamous Cell Carcinomas (SCC) cases with a previous occupational exposure to carcinogens. Methods: We systematically evaluated occupational exposure in a series of consecutive cases, discharged in the period 2010-11 from the Dermatology Unit of Varese Hospital,Italy, with a histological diagnosis of SCC. Through a structured telephone interview we identified patients with a potential exposure to skin carcinogens. As a second-level step, an extensive evaluation by an occupational physician was performed to assess the occupational etiology in those selected cases. Results: 105 patients were identified (65 men). 15 male cases out of a total of 85 patients who did the telephone interview, revealed a potential occupational exposure; 7 cases were confirmed as occupational cancers after second-level evaluation (proportion of male occupational cases=13.2%). UV radiation and PAH were recognized as major causal agents. Applying those results to the national incidence data, we estimated a number of 700 annual occupational cases, 100-fold more than the cases currently evaluated by the Italian National Workers Compensation Authority. Conclusions: Our results revealed that occupational SCC is still at present a substantially "lost disease" in Italy. Greater attention and enhanced collaboration between specialists is thus needed to overcome this tendency.
Nicolini E.,Ospedale di Circolo Fondazione Macchi |
Martegani G.,Ospedale di Circolo Fondazione Macchi |
Maresca A.M.,University of Insubria |
Marchesi C.,University of Insubria |
And 7 more authors.
Nutrition, Metabolism and Cardiovascular Diseases | Year: 2013
Aim: The study was aimed to evaluate the influence of gender on left ventricular (LV) remodeling in metabolic syndrome (MetS). Methods and results: We enrolled 200 subjects without diabetes or overt cardiovascular diseases, never treated with anti-hypertensive drugs or statins: 60 men and 40 women with MetS matched by age, gender and 24h systolic and diastolic blood pressure (BP) with 60 men and 40 women without MetS. The patients underwent blood tests, 24h our BP monitoring, LV echocardiographic examination. LV mass indexed by eight2.7 was significantly greater in men and women with MetS than without MetS. Compared with women without MetS, women with MetS had significantly higher posterior wall thickness and relative wall thickness, greater prevalence of LV concentric remodeling/hypertrophy and lower indices of LV diastolic function, whereas all these parameters were not significantly different between men with and without MetS. MetS was an independent predictor of relative wall thickness and LV mass index in women, but not in men. Conclusion: The impact of MetS on LV remodeling is significantly influenced by gender: the effects of MetS are more pronounced in women, with development of LV concentric hypertrophy/remodeling and preclinical diastolic dysfunction. © 2012 Elsevier B.V.