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Epidemiological and clinical aspects of Brucella suis infection in 17 workers from a pork processing plant in Argentina occurring between January 2014 and July 2015 are presented. All patients reported working 9 h daily without adequate personal protection garment. Blood cultures were positive for Brucella spp. in 14 of the 17 patients (82.3%). All isolates were identified as B. suis biovar 1. Although fever, sweats, asthenia, myalgia and hepatic involvement were the most frequent clinical manifestations, an unusually high incidence of respiratory involvement was found. From 13 patients in which chest radiography was performed, four (30%) had radiological abnormalities, including lobar pneumonia in two cases (one with pleural effusion) and interstitial involvement in other two. The high frequency of respiratory involvement in our series makes necessary to consider brucellosis in the differential diagnosis of respiratory diseases in pork processing plant employees.

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The objective was to assess the knowledge about ischaemic stroke among selected groups of persons at high risk for stroke. Outpatients referred to 3 hospital ultrasound departments in the Marche Region (Italy) were asked to answer a questionnaire. Data were collected on: (1) demographic characteristics; (2) risk profile determined using Coppola et al.'s scoring system; (3) knowledge about symptoms, risk factors, part of the body injured and best referral option for stroke. Of the 352 respondents, around 52% were unable to report even one warning symptom of stroke, while 58.4% of participants at increased risk did not know any risk factors. Only 64.5% identified the brain as the part of the body injured by stroke. Only 59.4% considered the Emergency Department as the best referral option in the event of stroke. This study confirms poor knowledge about stroke in our study population, particularly in subjects with increased stroke risk.

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Case of a 58-year-old patient diagnosed as having mycosis fungoides (MF) who presented with sensory ataxia, limbs weakness and neurophysiological and laboratory signs indicative of autoimmune chronic mixed axonal-demyelinating sensory-motor polyradicular neuropathy. The possibility that MF may be associated with an immunomediated peripheral neuropathy, even in the absence of a direct invasion of the nerves and widespread visceral involvement, should be considered.

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Piriformis syndrome (PS) is an unusual cause of sciatica that, because of the lack of strict diagnostic criteria, remains a controversial clinical entity. The diagnosis of PS is still primarily clinical because no diagnostic tests have proven to be definitive. We report the case of a 30-year-old woman, affected by a severe scoliosis, who developed a persistent buttock pain resembling that of PS. The clinical suspicion was confirmed by magnetic resonance imaging (MRI) of the pelvis, which showed an enlargement of the left piriformis muscle with an anterior isplacement of the sciatic nerve. The role of MRI in the diagnosis, clinical definition, and therapeutic approach to PS is discussed.

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To evaluate the efficacy and safety of gabapentin in the treatment of muscle cramps, we engaged an open-label trial with a group of 30 patients with frequent (> 5 cramps/week), stable, long-lasting cramps, associated with different diseases. Gabapentin was effective in reducing the frequency and severity of muscle cramps and associated sleep disturbances (clinical outcome measures) within the first 2 weeks of medication at 600 mg/d. At the 1 month control (mean dosage, 825 +/- 35 mg), almost every patient had responded to treatment and two thirds experienced a total remission of symptoms. After 3 months of therapy (mean dosage, 892 +/- 180 mg), cramps disappeared in 100% of patients and this benefit persisted as long as 6 months. Additionally, we evaluated in 10 patients the Cramps Threshold Frequency (CTF) (neurophysiological outcome measure) before and during gabapentin treatment. Gabapentin significantly increased the CTF, returning it to normal values. With the limitation of an open-label methodology, our clinical and neurophysiologic experience suggests that a gabapentin dose of 600-1200 mg/d would be helpful in the treatment of muscular cramps.

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In recent years, two simple non-invasive tests, sympathetic skin response (SSR) and RR interval variation (RRIV) have been used to assess autonomic function (Wang et al., 1994; Drory et al., 1995; Chassande et al., 1996; Bordet et al., 1996; Spitzer et al., 1997). Their easy performance by an electromyographic (EMG) machine and successful clinical correlation (Shahani et al., 1990) have made them routine in autonomic assessment in several EMG laboratories. More recently QT dispersion on electrocardiogram (ECG) has been shown to have increased in patients with diabetic neuropathy and several autonomic dysfunctions (Wei et al., 1995; Lengyel et al., 1997; Langen et al., 1997; Axelrod et al., 1997). In order to evaluate the diagnostic value of the RR interval variation, sympathetic skin response and QT dispersion combined, we performed the three tests on a group of 37 patients with several peripheral neuropathies with and without clinical signs of dysautonomia. All patients were studied using an electromyograph (EMG). The results of the SSR, RRIV and QT dispersion combined have shown abnormal values in all patients with neuropathy and clinical dysautonomia and in some patients without clinical signs of dysautonomia, suggesting a subclinical autonomic dysfunction. The principal finding of this study is that the evaluation of the RRIV, SSR and QT dispersion combined may contribute to the assessment of dysautonomia in patients with somatic neuropathy and that they may be currently performed by an electromyograph.

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We report a case of "myokymia-cramp syndrome", a rare and benign disease consisting of muscular cramps in the upper and lower limbs associated with generalized myokymias. In our patient, cramps had been present since adolescence and had increased in frequency and duration during the last 3 years, occurring about 8 or 9 times a day. Cramps were mainly nocturnal and also precipitated by walking; a previous treatment with carbamazepine did not improve the symptoms. Gabapentin therapy proved to be very satisfactory in relieving muscular cramps with a relatively low dosage (600 mg/day) and without any remarkable side effects. The possible interpretation of the mechanism involved in gabapentin induced relief of cramps is discussed. Gabapentin should be considered as a safe alternative treatment for muscular cramps.

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