Biomechanical evaluation of scapular girdle in patients with chronic arm lymphedema.

The presence of arm lymphedema can induce alterations in motor functions and posture. Using an optoelectronic system (ELITE 2002), we evaluated these alterations during a set of tests involving walking, resting and fatigue. The results of our biomechanical analysis demonstrated a limited range of motion of the affected arm, particularly a reduction in swinging during walking tests, and in shoulder retroposition and abduction movements for all patients. After repeated cyclical movements, premature fatigue appeared in the pathological arm. Lymphedema does not appear to cause alterations to the posture of the spine in our study, but drooping of the shoulder homolateral to the lymphedema can occur. This kind of investigation, which is quick, easy, and comfortable for patients with lymphedema, can be a useful method to evaluate functional capacity, thus allowing a quantitative assessment of the loss of function and the optimizing of the rehabilitative protocol.

Neuroendocrine, immunohistochemical, and ultrastructural study of pineal region tumors.

Thirteen patients with tumors in the pineal region were submitted to pre- and post-operative blood sampling (08:00, 14:00, 20:00, and 02:00 hr) for three or four consecutive days. A single cerebrospinal fluid (CSF) sample was collected at surgery, and melatonin levels determined. In all patients, serum and CSF beta subunit of human chorionic gonadotrophin (betaHCG), carcino embryonic antigen (CEA), and alpha-fetoprotein (AFP) levels were measured. Histology revealed four pineocytomas, one pineoblastoma, four germinomas, one immature teratoma, one pilocytic astrocytoma, one lymphoma, and one meningioma. Serum and CSF levels of serological biomarkers were normal, except for one of the germinoma cases. In most patients, alteration either in the circadian rhythm or in the melatonin concentration was observed before surgery. In benign neoplasms the circadian rhythm was conserved. In pineoblastoma, lymphoma, and three out of four germinomas, melatonin concentrations were undetectable. In one case of germinoma, melatonin levels were high, with the circadian rhythm being abolished. According to conventional histology, all germinomas were similar. Therefore, in a rare case of pineal germinoma with high melatonin levels, the tissue was subjected to an in depth investigation (immunohistochemical and ultrastructural) in order to determine the pathology and the possible differences from the other typical germinomas. Results were compared to those provided from other pineal neoplasms. Electron microscopy examination detected the presence of clusters of intermediate filaments and numerous electrondense granules only in the case of a germinoma producing melatonin.

Acute pneumocephalus: an unusual complication of thoracotomy.

The authors describe a iatrogenic cerebrospinal fluid fistula into the pleural cavity, a rare and unusual complication of thoracic surgery. The importance of considering this diagnosis in patients who suffer from headache and altered mental status after thoracotomy and the early surgical repair of this potentially fatal complication are stressed.

[A new cold sterilization chemical. I. Chemical characterization and mechanism of action]. / Un nuovo sterilizzante chimico a freddo. Nota I. Caratteristiche chimiche e meccanismo di azione.

The equilibria relative to a cold sterilizer and their interactions were studied to verify how many active compounds were present in solution. Microbiological activity derived from chlorine, hydrogen peroxide and peroxymonosulfate which could react also with chloride ions present in biological fluids, developing active chlorine.

Posttraumatic diffuse cerebral lesions. Relationship between clinical course, CT findings and ICP.

One hundred and fifty patients with posttraumatic diffuse cerebral lesions were reviewed. Criteria of inclusion were immediate coma and CT appearance of diffuse lesions, that were classified as follows: (a) Diffuse axonal injury (70 cases): patients with normal CT scan (50 cases) and patients with shearing injury (focal hemorrhages in corpus callosum, basal ganglia and brain stem; gliding contusions) (20 cases); (b) Diffuse brain swelling (80 cases): reduced or absent lateral ventricles, absence of 3rd ventricle and basal cisterns. Many of these patients had either subarachnoid haemorrhage or subdural blood effusion. Clinical course and mortality rate were in a ranking order in the considered groups. Patients with normal CT had a less severe coma and a better outcome than patients with shearing injury and diffuse brain swelling. There was evidence of high intracranial pressure in 75% of the patients with brain swelling, whereas no patient with normal CT had ICP elevation. Diffuse axonal injury represents a primary posttraumatic diffuse lesion. Secondary vascular involvement, due to hypoxia, shock and other unknown causes, is responsible for the appearance of vasoparesis, hyperemia and diffuse brain swelling.

A case of optic nerve oligodendroglioma associated with an orbital non-Hodgkin's lymphoma in adult. Case report.

The Authors report a case of optic nerve oligodendroglioma associated with an orbital non-Hodgkin's lymphoma. Its peculiar clinical aspects and neuroradiological appearance are discussed.