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Aim. The aim of this paper was to investigate the behavior of a non-random sample of Italian chronic venous disorders (CVD) sufferers in the management of their complaints and to analyse the treatments recommended by phlebologists towards this problem. Methods. This was a cohort study as a part of a large CVD prevention programme. The sample was a non-random, cross-sectional sample of male and female patients selected through advertisements. Subjects described subjectively the presence of CVD complaints and the presence of CVD was then assessed conclusively by a specialist. Information about the different types of therapeutic intervention implemented before the examination or recommended by the specialist was collected. Each treatment option was related to socio-demographic variables, with particular reference to the region where patients lived, their family history and the severity of objective clinical signs. Results. The study analysed 31 659 subjects. In this sample, the most common manifestations of venous disease, especially in young women, were telangiectases; saphenous or non-saphenous varicose veins are slightly more frequent in males and subjects over 50 years of age. Medical or compression therapies were performed by a large portion of the population (>30%). Young people tend to prefer medical to compression therapy. In Southern Italy, medical therapy is widespread whereas in Central Italy compression stockings are only infrequently used. Specialists tend generally to prescribe conservative therapies for less severe forms of chronic venous insufficiency (CVI). Compression stockings seem to be gradually replaced by drug therapy, in particular products of natural origin. Among natural remedies, bioflavonoids are the most used ones, whereas among terpenes, topical aescine is the most widespread. Conclusion. The present study has demonstrated that in a large percentage of cases, Italian consumers suffering from problems related to venous insufficiency carry out conscious and informed self-medication.

In a previous transcranial Doppler (TCD) study, we demonstrated a decrease in blood flow velocity in the proximal tract of the middle cerebral artery (MCA) in patients with Alzheimer’s disease (AD). In these patients there was also an asymmetry in blood flow velocity which positively correlated with the cognitive asymmetry often seen in the early phase of AD. In this study we found a correlation between the absolute values and asymmetry indexes of MCA blood flow velocity with adjusted metabolic values and asymmetry indexes of the relative cortical frontotemporoparietal (FTP) areas, evaluated by FDG-PET, and with neuropsychological asymmetry indexes. Patients with prevalent visuospatial deficits (right hemisphere dysfunction) showed significant decreases in right MCA blood flow velocity and right FTP cortical glucose hypometabolism, whereas in patients with prevalent language deficits (left hemisphere dysfunction), these signs were observed on the other side. In AD patients, the decrease of blood flow velocity in MCA might be due to reduced metabolic demands in the temporoparietal cortical areas primarily affected by AD.

A 76-year-old woman had progressive memory loss for 2 years. Neurologic examination confirmed the memory deficit and also demonstrated ideative-ideomotor apraxia and visuospatial disturbances (Mini-Mental State Examination 17/30). A diagnosis of probable Alzheimer disease dementia (AD) was formulated. She showed us notebooks filled with drawings she had completed as a hobby, covering a period form before the illness (figure 1) to the present (figure 2). These sketches provide an inside into AD-related changes in creativity and visuospatial skills.1 Drawing performance is related to perceptual and executive dysfunctions in the visuospatial domain.

Background Despite its large clinical application, our understanding about the mechanisms of action of deep brain stimulation of the subthalamic nucleus is still limited. Aim of the present study was to explore cortical and subcortical metabolic modulations measured by Positron Emission Tomography associated with improved motor manifestations after deep brain stimulation in Parkinson disease, comparing the ON and OFF conditions. Patients and methods Investigations were performed in the stimulator off- and on-conditions in 14 parkinsonian patients and results were compared with a group of matched healthy controls. The results were also used to correlate metabolic changes with the clinical effectiveness of the procedure. Results The comparisons using Statistical parametric mapping revealed a brain metabolic pattern typical of advanced Parkinson disease. The direct comparison in ON vs OFF condition showed mainly an increased metabolism in subthalamic regions, corresponding to the deep brain stimulation site. A positive correlation exists between neurostimulation clinical effectiveness and metabolic differences in ON and OFF state, including the primary sensorimotor, premotor and parietal cortices, anterior cingulate cortex. Conclusion Deep brain stimulation seems to operate modulating the neuronal network rather than merely exciting or inhibiting basal ganglia nuclei. Correlations with Parkinson Disease cardinal features suggest that the improvement of specific motor signs associated with deep brain stimulation might be explained by the functional modulation, not only in the target region, but also in surrounding and remote connecting areas, resulting in clinically beneficial effects.

Functional imaging of the presynaptic dopaminergic activity using single-photon emission tomography (SPET) and iodine-123 labelled 2-beta-carboxymethoxy-3-beta-(4-iodophenyl)tropane ([123I]beta-CIT) is important for the assessment of disease severity and progression in patients with Parkinson's disease (PD). However, its capability to discriminate between different extrapyramidal disorders has not yet been assessed. The aim of this study was to evaluate the possibility of differentiating patients with PD and with progressive supranuclear palsy (PSP) by means of this method. The distribution of [123I]beta-CIT in the basal ganglia was assessed in six normal subjects, 13 petients with PD and five patients with PSP in whom the disease was mild. SPET images were obtained 24+/-2 h after i.v. injection of the tracer using a brain-dedicated system (CERASPECT). MR and SPET images were co-registered in four normal subjects and used to define a standard set of 16 circular regions of interest (ROIs) on the slice showing the highest striatal activity. The basal ganglia ROIs corresponded to (1) the head of caudate, (2) a region of transition between the head of caudate and the anterior putamen, (3) the anterior putamen and (4) the posterior putamen. A ratio of specific to non-displaceable striatal uptake was calculated normalising the activity of the basal ganglia ROIs to that of the occipital cortex (V3"). ANOVA revealed a global reduction of V3" in all ROIs of PD and PSP patients compared with normal controls (P