Multiorgan paradoxical embolism in an elderly female with a patent foramen ovale: a case report.

Paradoxical embolism is an uncommon cause of arterial occlusion with a high mortality burden. Current evidence suggests that patent foramen ovale is the most important etiological factor of paradoxical embolism, by acting as a pathway for a thromboembolic material originating from the peripheral veins, passing through the lungs and entering the systemic circulation. Here we present a case of paradoxical embolism in the mesenteric and renal arteries associated with pulmonary embolism and deep vein thrombosis in an elderly woman with no predisposing risk factor. A diagnosis of paradoxical embolism was considered and the presence of a patent foramen ovale was consequently confirmed with a transesophageal echocardiography. Urgent thrombolysis saved the life of the patient. Paradoxical embolism represents an emergency and therefore prompt diagnosis and initiation of therapy may prevent adverse outcomes.

[Primary peritonitis in the newborn: a recently recognised disease]. / Peritonite primitiva in neonati. Una entità nosologica recentemente riconosciuta.

BACKGROUND DATA: Neonatal primary peritonitis (or autonomic bacterial peritonitis) is a diffuse peritoneal inflammation without any obvious visceral cause. It is a disease rarely described during the neonatal period. OBJECTIVE: The aim of the current study was to make the surgical community aware of it, in an attempt to help a prompt diagnose and to avoid any unnecessary surgery in patients admitted in Neonatal Intensive Care Unit (NICU). MATERIALS AND METHODS: It concerns the description of 7 cases of newborns affected by primary peritonitis during their hospitalization in the NICU, underlining their signs and symptoms along with all additional paraclinical tests and the final outcome. RESULTS: Primary peritonitis was identified in 7 neonates (5 females and 2 males). Despite the severity of their symptoms (e.g., abdominal sensibility, a long standing ileus etc.) none of them had sustained any surgery and the mortality was nil. CONCLUSIONS: Neonatal primary peritonitis should always be taken into account in such circumstances. The final outcome, despite the initial clinical severity, is favorable with the appropriate conservative therapy

Necrotizing fasciitis in childhood. Case report, and review of the literature.

INTRODUCTION: Necrotizing fasciitis (NF) is an aggressive and relatively rare soft tissue infection, involving the fascia and the subcutaneous tissue, with a rapidly fatal evolution. CASE REPORT: GE, an 8 year-old girl presented with edema and redness of the external genitalia. Twelve hours later, she became toxic while her redness extended in the abdominal wall and both upper thighs. CT of the abdomen was consistent with NF. She underwent prompt surgery (debridement and colostomy), followed by plastic reconstruction. CONCLUSION: Early suspicion and prompt aggressive surgery is the key of therapy in case of NF.