Improving fiberoptic intubation in the conscious patient using the new Janus mask / Mejora del procedimiento de intubación con fibra óptica y paciente despierto con la nueva máscara Janus

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[Neuromuscular and vascular hamartoma of the small intestine. Report of a clinical case and review of the literature]. / L'amartoma neuromuscolare e vascolare dell'intestino tenue. Presentazione di un caso clinico e revisione della letteratura.

We present the case of a 50-year old patient, operated on for three adjoining annular strictures in the jejunum with proximal dilatation. He presented with a one-year history of recurrent cramping in the upper abdomen and vomiting, with two episodes of intestinal obstruction. Microscopic examination of the stricture revealed, in the submucosa, disorganised fascicles of smooth muscle derived from the muscularis mucosae, bundles of non-myelinated nerve fibres with scattered abnormal ganglion cells and haemangiomatous vessels. The pathological findings observed were similar to those described as neuromuscular and vascular hamartoma, a rare stricturing condition of the small intestine. Many authors have questioned the hamartomatous nature of this disorder, since identical features may be seen in Crohn's disease, in ischaemic enteritis, in radiation enteritis and in non-steroidal antiinflammatory drug-induced small intestinal strictures. On the basis of a review of the 5 previously described cases and of our own experience, we believe that neuro muscular and vascular hamartoma of the small bowel should be considered as a distinct entity if histological hallmarks of Crohn's disease are absent, in patients with no history of gastrointestinal disease, or of chronic ingestion of non-steroidal antiinflammatory drugs.

Transcutaneous PO2 response to transient arterial occlusion in peripheral vascular disease detected by heating power oximeter.

Transcutaneous PO2 (TcpO2) was measured in 30 patients with peripheral arterial obstructive disease (PAOD) and in 30 age-matched controls in the hand and foot using a heating power electrode oximeter (HP-E). The HP-E was connected with a software modified monitor to simultaneously record changes in arterial stasis in the skin (TcpO2 mm Hg) and in the underlying tissue 3.5 to 4 mm from the HP-E (TcpO2 mW). In the hands of patients with PAOD, the following was found, lower mean values of the rest flow (R-F) and of the recovery area (Rc-Ar); delayed appearance of both a PO2 decrease after the start of stasis (ODT) and the increased value after the cuff deflation (ORT); and little relevance of flow changes in the tissues under the HP-E. In the foot homolateral to the obstructive lesion, the hemodynamic effects of the stasis were not consistently a result of circulatory insufficiency. In light-medium PAOD the correlation was more significant with the walking-free distance (WFD). However in severe PAOD, the perfusion was usually depressed and the variable values tended to flatten. This study confirmed the diagnostic reliability of this test in PAOD patients. Furthermore simultaneous exploration of two microvessel levels increased its diagnostic possibilities.

High-resolution computed tomography in evaluation of cochlear patency in implant candidates: a comparison with surgical findings.

High-resolution computed tomography (HRCT) is important in the evaluation of cochlear implant candidates. This study examines the accuracy of radiological assessment of cochlear patency in relation to findings at the time of surgery. Older and newer HRCT methods and attending and senior radiologist interpretations are compared in a large series of cochlear implant patients. Subjects were 50 adults (22 to 74 years) and 31 children (2.4 to 11.7 years) who received either a 3M/House or a Nucleus 22-channel cochlear implant. Attending radiologist reports were obtained by chart review and the scans were re-reviewed for this study by a senior radiologist. Accuracy in detecting cochlear ossification ranged from 86.4 per cent for attending radiologists, with all HRCT scans, to 94.7 per cent for the senior radiologist with newer HRCT scans. False positives were rare, but false negatives did occur. Overall, best results were obtained with newer HRCT scans and a senior radiologist. Knowledge of the presence and extent of cochlear ossification is important to the implant surgeon and for patient counselling. Technical guidelines and a check list for interpretation of results are presented.

Congenital hepatic dysplasia from cytomegalovirus.

The Authors report on a case of liver dysplasia in a four-month-old infant affected by prenatal cytomegalovirus infection. Immunologic, histologic and ultrastructural studies suggest an embryopathic origin of the lesions.

[Splenic metastases of pulmonary carcinoma. Apropos of a clinical case]. / Metastasi spleniche da carcinoma polmonare. A proposito di un caso clinico.

A case of single splenic metastasis from large cell anaplastic carcinoma of the lung is described. The patient first underwent pulmonary lobectomy and then splenectomy. He is still alive 42 months after the first operation and 41 after the second. The case herein described is rather uncommon, due to the rarity of single splenic metastases, and the long survival of the patient. The latter point strongly suggests an aggressive surgical approach to single metastases, even if primary tumor has extremely poor prognosis.

Hyperplastic polyp of the stomach simulating hypertrophic pyloric stenosis.

We describe a rare case of hyperplastic polyp of the stomach having its clinical origin in the neonatal period and initially stimulating hypertrophic stenosis of the pylorus. After this neoformation, which almost completely obstructed the pylorus, was endoscopically removed, vomiting ceased and a rapid weight gain was observed. It is known that tumors are a rare cause of gastric outlet obstruction if compared with hypertrophic stenosis of the pylorus. However, our experience suggests that in the case of atypical symptoms, the investigations should be extended, especially to endoscopic examination of the upper digestive tract.

[Acute disseminated histiocytosis X. Presentation of a case]. / Istiocitosi x acuta disseminata. Presentazione di un caso.

The AA. report a case of acute, diffuse histiocytosis X with an unfavourable course observed in a child of 33 months. The histological diagnosis, formulated on the basis of specimen taken from a skin nodule, was confirmed by ultrastructural observation of Birbeck bodies in the cytoplasm of proliferating Langerhans cells.

[Celiac disease in insulin-dependent diabetes mellitus and insulin-independent diabetes mellitus]. / Studio della malattia celiaca in corso di diabete mellito insulino dipendente e di diabete insulino indipendente.

The IgA antigliadin antibodies AGA title was detected in 37 patients with IDDM, mean age 32.59 +/- 14.71, where mean duration of disease was 8.76 +/- 9.62 years, and 29 patients with NIDDM, mean age 55.31 +/- 14.71, where disease lasted 11.5 +/- 5.55 years. A group of 51 normal pts. was employed as control. In IDDM group 2 cases on 37 showed high AGA title (case n. 1 and n. 2) but just the case n. 1 where IDDM lasted 16 years, showed an histologic picture of coeliac disease (partial villous atrophy), while in the case n. 2 where IDDM was at the onset, the histologic picture was normal. The increase of AGA title in the IDDM at the onset is rarely associated with coeliac disease, but it seems to be an aspecific response. Viceversa an increased AGA title is in IDDM for greater than 1 years often associated with coeliac disease. In NIDDM no high AGA title was found. The prevalence of coeliac disease in our patients with IDDM was 1:37 and we suggest that diabetics be screened routinely for antigliadin antibody.

[Osteomatosis of the skin. Presentation of 2 cases]. / Osteomatosi della cute. Presentazione di due casi.

Osteomatosis cutis. Report of two cases. The AA. reported two cases of osteomatosis cutis in a child three years old and in a girl sixteen years old. In both cases there was no history of previous trauma and acne. Microscopic study revealed islands of true bone, having lamellar configuration, periosteum, marrow cavities with endosteum, lacunae and canaliculae. No other calcified tissue and cartilage were seen.

[Osteoclastoma-like giant cell tumor of the lung]. / Tumore a cellule giganti osteoclastosimili del polmone.

Osteoclastoma-like giant cell tumor of lung. A case of osteoclastoma-like giant cell tumor of the lung is reported. This is an unusual tumor too described in the heart, thyroid, skin, soft tissues and pancreas. AA. studied the tumor's structure and are of opinion that it concerns a primitive nonepithelial neoplasm of the lung.

[Syndactylia associated with multiple malformation syndromes. Observation of a new symptomatologic complex in 3 brothers]. / In tema di sindattilia associata a sindromi plurimalformative. Osservazione di un nuovo complesso sintomatologico in tre fratelli.

Hand and feet malformations are often part of complex malformation associations. The present paper reports on a family whose three sibs (two males and one female) are affected with symmetric soft tissue syndactyly involving both fingers and toes, fifth finger clinodactyly, a pattern of dysmorphism including down slanting palpebral fissures, long flat nasal saddle, out turned nostril openings ("Greek warrior helmet"-like profile), dysplastic teeth, and, in addition, severe growth retardation, microcephaly, severe mental deficiency with immaturity of cerebral activity of EEG, hypergonadotropic hypogonadism and some skeletal anomalies. All cases show large secondary constriction in one of the chromosome 1 pair (1qh+).

[Intracoronary thrombolytic treatment with urokinase in myocardial infarct: clinical angiographic findings and effects on left ventricular function]. / Trattamento trombolitico intracoronarico con urochinasi nell'infarto miocardico: rilievi clinico-angiografici ed effetti sulla funzione ventricolare sinistra.

The effect of selective intracoronary thrombolysis was studied in 27 patients with evolving myocardial infarction. In the acute phase, angiography demonstrated complete occlusion in 22 cases (81,5%) (group A), and incomplete stenosis with diminished distal blood flow in 5 cases (18,5%) (group B). Urokinase was infused into the infarct-related coronary artery at a rate of 8000 u/min u/min until reperfusion was obtained and subsequently at a rate of 2-4000 u/min for 20-40 min. In group A, coronary recanalization was achieved in 18 of 22 patients (81,8%) (group A1), while in 4 patients (group A2) the procedure was unsuccessful. Group B patients showed no angiographic modifications following fibrinolytic therapy. Left ventricular function was studied during the acute phase (before and after therapy) in 9 patients; 22 patients were studied immediately after thrombolysis and before hospital discharge. Preliminary studies of patients in group A1 after reperfusion showed a decrease in telediastolic pressure from 18,9 to 24,4 mmHg and an increase in ejection fraction from 0,40 to 0,43 (p = ns). No modifications in these parameters were observed in group A2 or B. Follow-up examination of group A, revealed an increase in ejection fraction from 0,40 +/- 0,12 to 0,50 +/- 0,15 (p less than 0,05) and a decrease in the length of the akinetic segment from 6,49 +/- 2,4 to 4,40 +/- 1,35 (p less than 0.05). In group B, the ejection fraction increased from 0,41 +/- 0,06 to 0,50 +/- 0,04 (p less than 0.05) and the length of the akinetic segment decreased from 7,52 +/- 2,0 to 3,38 +/- 1,14 (p less than 0.05). On the contrary, in group A2, ejection fraction diminished from 0,39 +/- 0,06 to 0,34 +/- 0,07 and the length of the akinetic segment remained unchanged. Our results suggest that: A) coronary artery thrombosis is frequent in evolving myocardial infarction B) selective intracoronary thrombolysis and subsequent reperfusion of the infarcted area is readily obtainable with urokinase infusion C) no significant acute modifications of left ventricular function were observed D) 2-3 weeks after initial treatment, patients in which recanalization of an occluded vessel was achieved (group A1) and patients that presented with subocclusive stenosis and reduced blood flow (group B), showed an improvement in left ventricular function and a reduction in the akinetic area.

[Case report of microencephalia]. / Uber einen Fall von Mikroenzephalie.

A case of microencephalia diagnosed in a 34-year-old Sardinian woman is reported. The macroscopic and histologic features of this rare lesion are described in detail. Some interesting histologic patterns to the hypothesis of a very early encephalic developmental arrest are discussed.