Nearly all amputees continue to feel their missing limb as if it still existed, and many experience chronic phantom limb pain (PLP). What is the origin of these sensations? There is currently a broad consensus among investigators that PLP is a top-down phenomenon, triggered by loss of sensory input and caused by maladaptive cortical plasticity. We tested the alternative hypothesis that PLP is primarily a bottom-up process, due not to the loss of input but rather to exaggerated input, generated ectopically in axotomized primary afferent neurons in the dorsal root ganglia (DRGs) that used to innervate the limb. In 31 amputees, the local anesthetic lidocaine was applied intrathecally and/or to the DRG surface (intraforaminal epidural block). This rapidly and reversibly extinguished PLP and also nonpainful phantom limb sensation (npPLS). Control injections were ineffective. For intraforaminal block, the effect was topographically appropriate. The suppression of PLP and npPLS could also be demonstrated using dilute lidocaine concentrations that are sufficient to suppress DRG ectopia but not to block the propagation of impulses generated further distally in the nerve. PLP is driven primarily by activity generated within the DRG. We recommend the DRG as a target for treatment of PLP and perhaps also other types of regional neuropathic pain.

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BackgroundAcute poisonings particularly through pesticides have become a major public health concern in Albania during the last decade.FindingsThe number of fatalities due to aluminum phosphide intoxications was more than doubled during a five year-period from 2009 to 2013, and a cluster of suicides perpetrated with Phostoxin was registered. Several factors are accountable for such a phenomenon, including the fact that aluminum phosphide agents are freely available in the Albanian market, their price is extremely low and they are sold without any legal restriction. The mass media unfortunately warranted an emulating effect to dramatic intoxications, which gained by such means the notoriety of a secure lethal weapon.ConclusionsOur experience with more than three hundred intoxications with aluminum phosphide agents in the last five years, showed that a considerable delay from the moment of exposure (mainly through ingestion) to specialized medical help seeking, created a considerable obstacle for a successful treatment of cases, and eventually for the survival of patients. The lack of a specific antidote adds further challenges to all these exposures. The need for public health policies aiming at prevention, awareness, and possibly the substitution of Phostoxin or other aluminum phosphide pesticides with less dangerous agents is formulated.

The relationship between vitamin D status and asthma has been subject to several studies in the last decade. Epidemiological data suggest that incidence of asthma and atopic diseases increased significantly in most Westernized countries. The significant variation between countries suggests that besides genetic factors, environmental aspects play a role in the pathogenesis of atopy. The prevalence of hypovitaminosis D is high in many industrialized countries. In addition to its relationship with bone metabolism, vitamin D is recognized as an immunomodulator, with important effects on both adaptive and innate immunity. Correlations between vitamin D status and asthma have been formulated, with a considerable interest in assessing whether this vitamin protects against or reduces asthma morbidity. In this review, we discuss recent findings regarding vitamin D status throughout Europe and its influence over asthma and allergic rhinitis prevalence. Geographical latitude and dietary habits may explain the lower prevalence of allergic disease in Albania. We also consider the effects of vitamin D supplementation in allergic disease. Several clinical trials are under way and their results are needed in order to make definitive recommendations about the optimal dose of vitamin D for prevention and treatment of asthma and allergic disease.

Study Design Case study. Objectives We report the case of a 58-year-old Caucasian man, who presented with a 4-month history of increasing low back pain and gait difficulty. Objective neurologic examination revealed a severe paraparetic symptomatology without any sphincter involvement. Methods Spinal magnetic resonance imaging (MRI) showed an extradural mass formation situated dorsally at the level of thoracic vertebrae T2 to T4. Results A laminectomy was performed with total removal of the mass; histology suggested a highly vascularized lesion with lobular architecture, which seems a very rare case, compatible with a capillary hemangioma. Conclusions A careful follow-up for the next 4 years, including control MRIs every postoperative year, showed a very good neurologic condition of the patient and no recurrence on imaging findings.