Abstract. A case of an incidental endoscopic finding of pneumatosis cystoides intestinalis in the large bowel is presented. Diagnosis was verified by fine needle aspiration cytology. Basic facts about this uncommon entityare reviewed with an emphasis on endoscopic differential diagnosis. CASE REPORT / KAZUISTIKAPneumatosis cystoides intestinalis is a rare gastrointestinal condition, in the majority of cases an incidental finding which represents a differential diagnostic challenge for endoscopist, radiologist, pathologist and physician. Case reportA 51-year-old man underwent colonoscopy elsewhere for diarrhoea and slight haematochezia and he was then referred to our endoscopy unit for supervision because of finding several polyps in the hepatic flexure region. During colonoscopy we found several sessile polyps clustered in streaks, covered with normal mucosa, quite firm on probe palpation (Fig 1 and 2). Biopsy attempts just unroofed normal mucosa away, but polyps disappeared during the puncture and suction with a cytology needle. This typical endoscopic picture led us to suspicion of pneumatosis cystoides intestinalis. Material aspirated from cysts was smeared on cytology glass. Microscopically, two cell populations were visible -epithelial cells of colonic mucosa, arranged in a honeycomb pattern and numerous multinucleated giant cells of foreign body type (Fig 3) and this confirmed our suspicion.The patient was symptom-free at that time, no pathology was found on abdominal plain X-ray. DiscussionPneumatosis cystoides intestinalis is a rare condition characterized by the presence of gas-filled pseudocysts in the wall of gastrointestinal tract. This condition can be combined with the presence of gas in omentum, mesentery, peritoneal cavity, retroperitoneum and portal venous system (2,6,25,28). The first cases of pneumatosis cystoides intestinalis were described by DuVernoi in the 18th century in postmortem studies (cited from ref. 27).Aetiology and pathogenesis of pneumatosis cystoides intestinalis are not clearly known -intraluminal pressure, bacterial flora, intraluminal gas and muco-

Hiccups can be an uncommon side effect of anti-parkinsonian therapy, recently reported in the literature. In these reports, dopamine agonists (DAs) (pramipexole, piribedil, and pergolide) 1,2 seem to play a causative role as hiccups began increasing the dose and subsided when the drug was stopped. In the first case, 2 hiccups started with pramipexole 3 mg per day and ended after drug discontinuation; another patient had hiccups after piribedil 100 mg per day 2 which stopped after tapering the dose to 50 mg per day, whereas in another case pergolide was associated with hiccups at high and not at low doses. 3 Very recently also levodopa (L-dopa) intake 500 mg per day lead to severe hiccups in an old patient with de novo parkinsonism 1 and some cases were also described in the past in a French vigilance survey 4 after L-dopa therapy.Here we report a case of prominent hiccups after a first low-DAs dose intake. This 62-year-old man with a history of arterial hypertension developed a mild progressive tremor of the right arm and some months later a sense of heaviness of the right lower limb. One year later, resting tremor, bradykinesia with rigidity, a stooped posture, and hypomimia became evident. Brain MRI scan was normal whereas DaTScan Spect showed a mild left basal ganglia deficit. He was given a diagnosis of Parkinson's disease (PD), Hoehn-Yahr stage I, and received as initial therapy pramipexole 0.18 mg tid. After few days he developed hiccups, which kept increasing in the next days with mild nausea that persisted almost 10 days even after discontinuation. He was then switched to ropinirole slow release 2 mg od but again hiccups developed immediately and the drug was stopped once again, while hiccups lasted 1 week. No symptomatic therapy was successful in treating these intractable hiccups. Finally, rasagiline 1 mg od was started and a few days later (L-dopa) 100 mg (levodopa-carbidopa) tid was added with no side effects seen. On therapy, both tremor and bradykinesia improved significantly and disappeared completely at next follow-up after 3 and 6 months and also stooped posture fully responded to (L-dopa) treatment. At 9 months follow-up he is still hiccupsfree.In this case, a strict relationship between hiccups and DAs intake seems likely as hiccups disappeared after drugs were stopped. Hiccups are a common phenomenon but its physiopathology still remains unclear. 5 Very probably a dopaminergic pathway could be involved even if both dopaminergic agonist (pramipexole) 6 and antagonist (neuroleptics) drugs are reported to be useful in its treatment or in having a causative role. 7 A proposed hypothesis is that D3 dopamine receptors with an effective and prolonged stimulation by DAs can be involved in generating this symptom. 2,8 Another option could be via serotonergic pathways with a 5-HT1a or 5-HT1d receptors stimulation, as both ropinirole and pramipexole share a mild agonist effect on these receptors 9 and this patient also had a mild nausea or finally, a combined effect of both the DAs and 5HT pathways in pr...

Critical periods and degrees of regeneration in injured olfactory bulbar projection neurons (mitral cells) were examined in adult rats whose lateral olfactory tracts (LOTs) were transected at different postnatal (P) days. After the LOTs were transected at P7, P10, and P14, a retrograde fluorescent tracer, Fluoro-Gold (FG), was injected into the posterior olfactory cortex (the olfactory tubercle and the piriform cortex), a target brain region of mitral cells, 5 weeks after the transection. FG (+) mitral cells were observed in P7 LOT-transected bulbs and some of P10 LOT-transected bulbs but not in P14 LOT-transected bulbs. Neuron numbers of regenerated FG (+) mitral cells in P2 LOT-transected adult rats decreased to approximately 70% of the normal values (actually counted number: 804±46; stereologically estimated number: 49 700±4300), and 100% of these rats were demonstrated to exhibit olfactory discriminative ability in our previous study. Meanwhile, the numbers in P7 LOT-transected adult rats further decreased to approximately 40% of the normal values, and 78% of these rats showed olfactory discriminative ability. We conclude that the critical periods of spontaneous regeneration of the LOT are between P0 and P10 and that the proportions of regenerated mitral cells decreased as rats became older.

The lateral olfactory tract (LOT) is a central olfactory pathway, and efferent projections from the olfactory bulb are conveyed to the olfactory-related cortical structures via the LOT. The purpose of the present study is to determine the exact site of the LOT causing functional impairment in animals. After ablation of the right olfactory bulb, rats received rostrocaudal transection injuries on the left LOT at different levels between the olfactory bulb and the middle cerebral artery. Olfactory function of LOT-transected rats was studied by examining their olfactory ability to discriminate between the smell of water and cycloheximide solution, a strong repellent for rodents. Rats were divided into two groups based on their olfactory discriminative abilities. The olfaction positive (+) group achieved 83% ± 1% correct responses and the distances of the LOT-transected sites from the middle cerebral artery of this group ranged between 0.8 and 2.4 mm (n = 8). The olfaction negative (-) group achieved 48% ± 1% correct responses and the distances of the LOT-transected sites from the middle cerebral artery ranged between 2.5 and 4.2 mm (n = 10). From these data, we concluded that the site of the LOT critical for olfactory function is located approximately 2.5 mm from the middle cerebral artery.