We report a 73 years old man with a diagnosis of Paget Disease (PD) and symptomatic Multiple Myeloma (MM). Coexistence of MM and PD has rarely been described. PD mimics many of the features of bone destructive process in MM, making differential diagnosis more complicated. In addition, the presence of serious muscolo-skeletal and metabolic complications in both diseases makes management of patients difficult, worsening the prognosis. The comparison of these two diseases has led to the characterization of a common molecular mechanism represented by the receptor activator of nuclear factor-kB ligand (RANKL)/Osteoprotegerin signaling pathway. The improved comprehension of these mechanisms led to the development of new pharmacologic agents (bisphosphonates, cytokines inhibitors) effective for the treatment of these bone diseases.

Variations in continuous and discrete flight demands were investigated in a simulated flight mission measuring peripheral arterial tone ( PAT) from the tip of the finger. A total of 12 participants performed a computer-simulated agricultural flight task. They were required to fly over a specific lane of a simulated corn field ( continuous task) and change lanes in response to flags, which appeared at varying intervals ( discrete task). The difficulty of the flight task was manipulated by varying the airplane control ( single- vs. dual-axis control), while the difficulty of the discrete task was manipulated by varying the amount of lateral change signalled by the flag. PAT amplitude was lower in the difficult level of the continuous task and was further attenuated following the appearance of the flag only when a change in the flight position was required. These results suggest the potential utility of PAT as an on-line measure of the joint continuous and discrete demands of a flight mission.

Objective: To compare acute and chronic effects of l-dopa on bladder function in levodopa-naive Parkinson disease (PD) patients who had urinary urgency. Methods: We evaluated 26 l-dopa–naive PD patients at a university-based PD center with a first urodynamic session with a double examination: in the off treatment condition and 1 hour after acute challenge with carbidopa/l-dopa 50/200 mg; then, a chronic l-dopa monotherapy was administered (mean dose 300 ± 150 mg). Two months later, patients underwent a second urodynamic session with a single evaluation 1 hour after the acute carbidopa/l-dopa challenge. Results: The first acute l-dopa challenge significantly worsened bladder overactivity (neurogenic overactive detrusor contractions threshold [NDOC-t; 32% of worsening] and bladder capacity [BC; 22% of worsening]); on the contrary, l-dopa challenge during chronic administration ameliorated the first sensation of bladder filling (FS; 120% of improvement), NDOCT-t (93% improvement), and BC (33% of improvement) vs the values obtained with acute administration. An 86% significant improvement of FS in comparison with the basal value was observed. Conclusions: The acute and chronic l-dopa effects may be due to the different synaptic concentrations or to the activation of postsynaptic mechanisms obtained by chronic administration.

A 71-year-old-woman was admitted to the S. Eugenio Hospital for a history of progressively impaired standing and gait. Anamnesis revealed systemic hypertension, gastric polyposis and juvenile pulmonary tuberculosis. Neurological examination showed a severe truncal and gait ataxia, without any sensory-motor impairment. Motor and somato-sensory evoked potentials were normal. Brain Magnetic Resonance Imaging (MRI) showed minimal signs of chronic ischemia only at a supratentorial level. Cerebral Single Photon Emission Computed Tomography, spinal MRI, total body computed tomography, Esophagogastroduodenoscopy, and finally total body Positron Emission Tomography resulted negative for neoplasms. Oncological serum markers were negative. Serum antibody against Purkinje's cells (Anti-Yo) was detected and titer was 1 : 80, while normally it should be undetectable. Other autoantibodies (Anti-Hu, Anti-Ri) were undetectable. Two sessions of plasma exchange (PE) were thus performed, leading to a rapid, marked and durable improvement of standing and gait and to a reduction of the autoantibody, which became undetectable. No serious adverse effect was noted. Although no definite therapy for autommume cerebellar ataxia has been established, PE should be considered as one of the main therapeutic choices.

We ran two experiments to investigate whether peripheral arterial tone reflects changes in mental effort. Finger pulse wave amplitude, interpulse interval, and pulse variability in the mid- and high-frequency bands were recorded by means of a newly developed finger plethysmograph during both rest and cognitive performance. Using a modified version of the Sternberg memory task, we selectively manipulated either the difficulty of the task (Experiment 1) or the subjects' level of engagement in the task (Experiment 2). We found a significant difference in finger pulse wave amplitude between rest and task periods, suggesting that the measure reflects changes in sympathetic activity due to task engagement. In addition, our results suggest that reduced pulse wave amplitude, signaling vasoconstriction, occurs when subjects are investing effort.

Cyclic Vomiting Syndrome, Migraine, and Epilepsy: A Common Underlying Disorder? Letizia M. Cupini MD, Letizia M. Cupini MD Clinica Neurologica, Ospedale S. Eugenio, Università di Roma Tor VergataSearch for more papers by this authorFilippo M. Santorelli MD, Filippo M. Santorelli MD Medicina Molecolare, IRCCS Ospedale Bambino Gesù, Roma, Italy.Search for more papers by this authorCesare Iani MD, Cesare Iani MD Clinica Neurologica, Ospedale S. Eugenio, Università di Roma Tor VergataSearch for more papers by this authorGiuseppe Fariello MD, Giuseppe Fariello MD Istituto di Radiologia, IRCCS Ospedale Bambino Gesù, Roma, Italy.Search for more papers by this authorPaolo Calabresi MD, Paolo Calabresi MD Clinica Neurologica, Ospedale S. Eugenio, Università di Roma Tor VergataSearch for more papers by this author Letizia M. Cupini MD, Letizia M. Cupini MD Clinica Neurologica, Ospedale S. Eugenio, Università di Roma Tor VergataSearch for more papers by this authorFilippo M. Santorelli MD, Filippo M. Santorelli MD Medicina Molecolare, IRCCS Ospedale Bambino Gesù, Roma, Italy.Search for more papers by this authorCesare Iani MD, Cesare Iani MD Clinica Neurologica, Ospedale S. Eugenio, Università di Roma Tor VergataSearch for more papers by this authorGiuseppe Fariello MD, Giuseppe Fariello MD Istituto di Radiologia, IRCCS Ospedale Bambino Gesù, Roma, Italy.Search for more papers by this authorPaolo Calabresi MD, Paolo Calabresi MD Clinica Neurologica, Ospedale S. Eugenio, Università di Roma Tor VergataSearch for more papers by this author First published: 27 March 2003 https://doi.org/10.1046/j.1526-4610.2003.03078.xCitations: 18 Address all correspondence to Dr. Letizia Maria Cupini, Clinica Neurologica, Università di Roma Tor Vergata, Ospedale S. Eugenio, P.le Umanesimo 10, 00144 Roma, Italy. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume43, Issue4April 2003Pages 407-409 RelatedInformation