[Pulmonary physiopathology in scleroderma: study of respiratory function in 86 patients]. / La fisiopatologia polmonare nella sclerodermia: esame della funzionalità respiratoria in 86 pazienti.

OBJECTIVE: To contribute to an early diagnosis of pulmonary involvement in scleroderma by evaluating the correlation between respiratory symptoms and functional respiratory data observed. PATIENTS AND METHODS: 86 patients affected by scleroderma, 76 women and 10 men, age 14-75, underwent lung function tests, blood gas sample, CO diffusing capacity in setting and supine position, respiratory drive measurement through P0.1 and evaluation of the respiratory muscles efficiency with Maximum Inspiratory Pressure (MIP). RESULTS: Data obtained suggested us to divide our patients in four different groups: first group where both spirometric data and pulmonary diffusion were normal; a second group with a clear reduction of pulmonary diffusion likely due to the reduction of vascular bed; a third group where we observed a restrictive ventilatory impairment due to the reduction of the compliance and a reduction of the pulmonary diffusion likely related to interstitial damage; finally, a fourth group where beside a restricted spirometric outline we have detected a more accentuated reduction of pulmonary diffusion likely due to pulmonary hypertension. Moreover, our study has highlighted a progressive decrease of MIP and Maximum Voluntary Ventilation (MVV) shifting from the first to the fourth group, suggesting reduction of the muscular efficiency with an increase of P0.1 index of activity in the respiratory drive. CONCLUSIONS: The results could explain the dyspnea often reported by the patients affected by scleroderma even without spirometric alteration.

[Possible effects of non invasive mechanical ventilation on respiratory drive and muscles]. / Possibili effetti della ventilazione meccanica non invasiva su drive e muscolatura respiratoria.

OBJECTIVE: To evaluate whether long-term Non-Invasive Mechanical Ventilation (NIMV) might have an effect on respiratory drive and respiratory muscles strength, measuring mouth occlusion pressure (P0,) and maximal inspiratory pressure (MIP). PATIENTS AND METHODS: 20 consecutive patients with hypercapnic respiratory failure underwent measurements of dyspnea, respiratory drive and respiratory muscles strength before hospital treatment with NIMV; those patients who showed significant improvement of gas-exchange continued home ventilation for a period of four weeks, and were readmitted to hospital for re-evaluation of Borg's scale for dyspnea, P0,1 and MIP. RESULTS: Data obtained show a mild reduction of P0,1 and a significant improvement of respiratory muscles strength, with satisfactory dyspnea relief. CONCLUSIONS: We conclude that unloading respiratory muscles through mechanical ventilation results in better muscle performance in the long-term that could act, together with normalization of gas-exchange, on neuromuscular respiratory drive and contribute to dyspnea relief.

[Aneurysm of the anterior inferior cerebellar artery (AICA). 18th case in the literature]. / Aneurisma dell'arteria cerebellare anteriore inferiore (AICA). XVIII caso della letteratura.

The AA. report the case of an anterior inferior cerebellar artery aneurysm (XVIIIth in world literature). Reviewing literature on the subject, they recall anatomical and clinical variations of AICA aneurysms, and report surgical techniques usually employed.

[Lumbosacral extraspinal ependymomas. Review of literature and report of an operated case]. / Ependimomi extraspinali lombo-sacrali: revisione della letteratura e presentazione di un caso operato.

The extradural lumbosacral localization represents for ependymomas an exceptional event full of interest both from an etiopathogenetic point of view and from a clinical one. Extradural ependymomas develop in two characteristic sites: with an anterior or presacral expression in the retro-rectal pelvic area; posterior in the intergluteal space below the lumbo-sacral fascia. The possibilities of a correct diagnosis are based essentially on radiographical examinations and CAT which supply useful factors, but not peculiar to the lesion. The Authors describe a case of posterior "extradural lumbo-sacral ependymomas" which is added to the 36 already reported.