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A 28-year-old neuromuscular patient chronically treated with nocturnal noninvasive ventilation developed pulmonary lobar atelectasis and daytime hypoxemia. Twenty four-hour 5L/min oxygen was begun, while mechanical cough assist aids were applied for seven days. In the following three days, treatment with nebulized Dornase alpha (rhDNase) b.i.d. was tested, without any significant improvement. On 11 and 13th days rhDNase was instilled by flexible bronchoscopy. A rapid resolution of the atelectasis was observed with relief of hypoxemia, without significant side effects. On day 16 the patient was discharged without oxygen requirements. In non-intubated neuromuscular patients with atelectasis who do not respond successfully to non-invasive treatments intrabronchial instillation of rhDNase may safely help to improve airway clearance.

ABSTRACT: The aim of this study was to evaluate the role of ageing on variability of airflow obstruction and on the specific pattern of nocturnal exacerbations ('morning dipping' of peak [...]

Two young boys with Duchenne muscular dystrophy, who had contracted 2009 pandemic influenza A/H1N1 (pH1N1), had been treated with antibiotics and steroids without significant improvement. One of them showed severe scoliosis. After hospitalization chest CT scan revealed extensive pulmonary bilateral segmental atelectasis. Their clinical and radiological findings rapidly improved when a sequential respiratory physiotherapy protocol was adopted that consisted of the application of multiple sessions of high-frequency chest wall oscillations, each one followed by mechanically assisted coughing manoeuvres. The protocol was well tolerated, effective, easy to apply and special positioning was not required. Fifteen days after treatment initiation both patients clinically recovered. This treatment can be very helpful for neuromuscular patients, particularly when scoliosis prevents conventional respiratory physiotherapy.

Lateral hypothalamus (LH) stimulation in cats which do not spontaneously attack rats, produces an attack pattern which may be divided into 3 main stages: the first, defined as exploratory time (ET), begins with an environmental search and culminates in orienting towards the prey; in the second, defined as attack time (AT), the cat stalks the rat; the last is the biting stage in which the cat seizes and kills the prey by biting its head and neck. The effects of ventral tegmental area (VTA) stimulation on the latency of the whole sequence and on the different stages of the attack pattern were studied. VTA activation resulted in a significant decrease of biting latency, due to the reduction of exploratory time. Moreover, a significant period of prey fixation, seldom present during LH stimulation alone, was observed after VTA-LH co-stimulation. Sulpiride injection caused the disappearance of VTA effects on the predatory pattern. The results indicate that VTA activation induces a decrease in behaviour related to exploration of the environment, and an increase in the focusing of attention on the prey, which seems an important component in the regulation of the predatory pattern. Pharmacological evidence indicates that the VTA effect is mediated by the mesolimbic-mesocortical dopaminergic (DA) system.

Both in acute and chronic cats, focal paroxysmal activity evoked in the ventro-basal complex of the amygdala has been inhibited by substantia nigra conditioning stimulation, to a greater extent, than by caudate nucleus activation. Injection of kainic acid into substantia nigra resulted in the disappearance of the caudate inhibition. It is suggested that the final control, exerted by the striatum on the amygdaloid seizures, occurs by means of the substantia nigra.

Entopeduncolar or nigral injection of kainic acid determines an early decrease of the evoked amygdaloid paroxysmal activity and a later increase of the after discharge duration. This biphasic effect is likely due to the structural analogy of the drug with monosodium glutamate, a neuroexcitant amino acid. The data suggest that the basal ganglia exert a tonic control on the amygdaloid activity.

The effect of claustrum (CL) stimulation on the spontaneous unitary activity of ipsi and contralateral frontal oculomotor neurons, was studied in chloralose-anaesthetized cats. A total of 205 units was bilaterally recorded in the medial oculomotor area, homologous of the primate “frontal eye fields” 127 neurons were identified as projecting to the superior colliculus; for 33 of these last units stimulation of the ipsilateral CL provoked an excitatory effect lasting 10–25 ms and appearing with a latency of 5–15 ms; on 8 units the excitatory effect was followed by an inhibition lasting 100–250 ms. Ninety-eight of the 127 neurons were also tested through activation of the contralateral CL: 13 cells showed an excitatory effect lasting 10–35 ms and appearing with a latency of 20–50 ms. In three of the thirteen units the excitatory effect was followed by an inhibition lasting 100–150 ms. Complete section of the corpus callosum abolished the contralateral CL effect, suggesting the existence of a direct claustro-contralateral oculomotor cortex pathway running through the corpus callosum. The results could support the hypothesis that the CL may play a role in the bilateral control of the visuomotor performance.

Chemical stimulation of the dopaminergic nigro-striatal system induces circling behaviour also in animals in which an extensive telencephalic lesion has been performed. In order to avoid the effects linked to chemical stimulation, we have studied the circling behaviour means of electrical stimulation of the caudate nucleus in chronic cats with cortical lesions. The rôle of the motor cortex on the circling behaviour is emphasized.

The effects of substantia nigra stimulation on the rage reaction evoked by hypothalamic activation were studied. The reference value of the rage reaction was the latency of the hissing, which was constant in all animals when hypothalamic stimulation was performed with the same parameters. Simultaneous activation of substantia nigra and hypothalamus determined a significant decrease in hissing latency. The influence of the substantia nigra on the affective components of the aggressive behavior is underlined.

Both in acute and chronic cats entopeduncular stimulation inhibits, to a greater extent than caudate activation, focal paroxysmal activity in the ventro-basal complex of the amygdala. Lesion of entopeduncular neurons, by means of kainic acid injection, induces a decrease of the caudate inhibitory effect. It is suggested that neostriatal control of the amygdaloid seizures occurs partly through the globus pallidus.