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PRIMARY OBJECTIVE: To investigate the type of emotional and behavioural impact that having a parent with a severe acquired brain injury (ABI) has on children during the first period of adjustment. METHODS AND PROCEDURE: The study involved 25 couples in which one of the spouses was affected by ABI, and their 35 children (3-14 years). The children attended three sessions with a psychologist aimed at identifying their spontaneous playing and relational behaviour by means of a grid created on the basis of ICD-10 criteria. Both members of each parental couple attended a session with the psychologist, and were administered the Dyadic Adjustment Scale, the 36-item Health Survey and the Caregiver Burden Inventory. RESULTS: 63% of the children showed signs of emotional suffering, the presence of which was underestimated by their parents on the basis of the psychologist's assessments. The variables that correlated most closely with the children's psychological condition were related to the quality of their parents' relationship. CONCLUSIONS: Our findings confirm the need for early interventions aimed at both parents and their children in order to investigate the children's emotional-affective situation, and favour an understanding of their discomfort by their parents.

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This paper reports an 8-yr retrospective study on the effects of an uninterrupted procedure of transition of 73 adolescents with Type 1 diabetes from the Paediatric to the Adult Clinic held in the same hospital. Interviewed patients had a mean age of 21.0+/-0.95 yr at transition. Patients were satisfied with the information received before transition (100%), and appreciated being introduced to the adult physician prior to being transferred (92%), and having found their paediatrician during the first visit at the Adult Clinic (100%). Consensus for transition was attained after 2-4 consultations in 66.6% of patients. Seventy-nine percent of patients considered 20 yr of age as an appropriate age to be transferred. Patients confirmed to have found at the Adult Clinic: privacy (85%), confidentiality (95%), short waiting times (78%), informal atmosphere (100%), and the same consultant (100%). Only 3% of patients tried to go back to the Paediatric Clinic but they were discouraged. Clinic attendance rate ranged between 92 and 100%. We consider that the key factors for a successful process of transition from a Paediatric to an Adult Clinic are: age at transfer around 20 yr, smooth movement within the same hospital, consensus of patients and their parents, prior personal contact with the adult physician, paediatrician attendance at the first visit at the adult service and his unambiguous role against all attempts to go back to the paediatric service and, finally, the availability of the same physician at out-patient clinic visits.

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In the last two years we discovered that three of our patients with type 1 diabetes mellitus (0.8%) suffered an unexpected worsening in their glycemic control due to a reduction of their insulin dosage in favour of some "alternative" diabetes treatments using herbs, vitamins, fantastic diets and trace elements prescribed by non-medical practitioners. The first patient, a 6.6 year old boy, was admitted to hospital because of a severe ketoacidosis with first degree coma as a result of his parents having reduced his insulin dosage by 77% and replacing the insulin with an ayurvedic herbal preparation (Bardana Actium Lapp). The second patient, a 10.4 year old boy, was admitted to hospital after his teachers noticed that he appeared tired, thinner and polyuric. During hospital admission for mild ketoacidosis the mother, reluctant at first, finally confessed that her son was under the care of a "clinical ecologist". Having identified several food allergies this "clinical ecologist" had placed the child on a spartan diet of bread, water and salt, and had reduced his insulin dosage by 68%. The third patient, a 21 year old male, upon transfer to the Adult Diabetic Center, reported that he had been under the care of a pranotherapist for several years. The pranotherapist had prescribed a cellular nutrition preparation (called "Madonna drops"), a meditation program and also a 50% reduction in his insulin dosage. During this period his HbAlc values had increased from 6.4% to 12%. Current orthodox diabetes treatments are considered unsatisfactory by many people and it is thus not surprising that they search for "miracle" cures. It is important, however, that hospital staff do not ridicule the patients or their parents for trying these alternative therapies. Nevertheless, it would be useful for staff to discuss in advance these "therapies" with patients, highlighting their ineffectiveness and strongly discouraging cures that call for a reduction or elimination of the insulin treatment.

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In order to investigate the organic and psychogenic components of post-concussive syndrome (PCS), the subjective complaints, the cognitive findings and the Minnesota Multiphasic Personality Inventory (MMPI) profiles of 53 consecutive mild head injury patients (MHI) with persistent PCS were evaluated. The results seem to suggest the presence of two groups: in the first, minimal lesional signs were associated with more prolonged loss of consciousness (LC) and post-traumatic amnesia (PTA), as well as an MMPI profile not indicative of a neurotic state, whereas in the second the absence of any lesional sign was associated with shorter LC and PTA duration, as well as evidence of neurotic MMPI scores. A female prevalence was observed in the first group and a male prevalence in the other one.

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Neuropsychological follow-up was studied in 70 consecutive head-injured subjects aged over 50 years. Diffuse deterioration (28%), moderate deterioration (25%) and dementia (21%) were the most frequent sequelae. Analysis of correlations between neuropsychological sequelae and trauma variables showed that: (1) mild trauma did not necessarily imply good prognosis and could be followed by very severe consequences; (2) duration of post-traumatic amnesia was correlated with coma duration but not with neuropsychological outcome; (3) on the whole, no prognostic predictor of the outcome was found.

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In the rabbit the myelinated fibres with the largest diameter originating from the sciatic nerve distribute mainly into the peroneal nerve, even though there is no difference in the density of myelinated fibres of the representative unit between the sciatic nerve and its branches. The distribution of the myelinated fibre diameters is unimodal in the sciatic nerve, but bimodal both in the peroneal and tibial nerves. The quotient axon diameter/fiber diameter (g ratio) shows a different trend between the sciatic nerve and the branches originating from it. Except for the peroneal nerve, the increase of the axon calibre corresponds to the reduction of the relative myelin sheath thickness and therefore to the reduction of internodal distance. The results show that the sciatic nerve and its terminal branches in the rabbit have morphometrical characteristics that are peculiar and differ from those of the other rodents.

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The methodological approach used in this study is to characterize the number, the density and the diameter distribution of myelinated fibers (MFs) and unmyelinated fibers (UMFs) in sciatic nerve and its main branches of pigeon. The results have shown that the fiber composition is quite variable because in pigeon there are relatively MF with thin myelin sheaths and MF with thicker sheaths. Our data suggest that morphometric analysis could represent a helpful methodological approach to better characterize these systems.

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The unusual case of a patient with goiter and left faciobrachiocrural paresis due to right temporoparietal infarction is reported. Cerebral angioscintigram and arteriography showed a brachiocephalic and right subclavian stenosis secondary to compression by an extended thyroid nodule.

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An unusual case concerning a patient with akinetic mutism (AM) due to spontaneous bilateral anterior cerebral artery occlusion is reported. Brain CT scan revealed the presence of mild low density foci presenting an irregular enhancement, which followed the distribution of mesial frontal gyri and paracentral lobulus, bilaterally. Right and left carotid angiographies showed bilateral occlusion of the anterior cerebral artery. Our case is characterized by an exclusive localization of the infarction in the frontal cortex. This finding suggests that a limited damage involving the anterior cerebral arteries territory could be, on its own, responsible for the AM syndrome.

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A 27-year-old man presented disturbances of gait and language, quickly followed by intellectual deterioration, tetraplegia, anarthria and myoclonus. Histological examination of a cerebral biopsy showed not only cortical changes consistent with the diagnosis of Creutzfeldt-Jakob disease, but also many amyloid-plaques with variable morphology. The diagnostic interpretation of the case particularly as to concern his relationship to s.c. Gerstmann-Strüssler syndrome is discussed.

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