Case report. Fatal rhinocerebral zygomycosis due to Rhizopus oryzae.

A case of rhinocerebral zygomycosis due to Rhizopus oryzae, arising after trauma in a 53-year-old diabetic man, is reported. Diagnosis was based on histological and mycological examination. Fragments of the colonies were observed by scanning electron microscopy. This is the first case diagnosed in Tuscany.

[Use of PTFE membranes in the orbital floor fractures]. / L'uso delle lamine di PTFE nelle fratture del pavimento orbitario.

BACKGROUND: Because the orbital-malar complex has a peculiar anatomic constitution and position, it is at the third place for frequency of the fractures especially if we compare it with another skeleton's parts. Till now have been tested numerous materials with advantages but also some disadvantages used to rebuild the orbital floor. We thought it right to test a material with biocompatibility, easy handiness, chemical stability and elasticit, as PTFE membrane. METHODS: We studied 40 cases of both sexes (age between 19 and 70 years) of orbital-malar complex fractures: 14 with isolated fractures, 20 with complexes fractures and 6 politraumatized. They show various degree prolapse of the orbital contents in the maxillary sinus. We make clinic examination and orthoptic analysis by Hess's screen, test of forced traction, axial and coronal TC. In all patients, surgery approach and methodology of plate application were the same. RESULTS: All the floors had a optimal and immediate functional renewal; there wasn't any inflammatory reaction neither immediately nor after a two years follow-up. CONCLUSIONS: In conclusion, the results show a lot of clinical and practical advantages of the PTFE membrane: the extreme biocompatibility and the easy handiness, the ductility and the low cost.

Spontaneous onset of CSF otorrhea from a facial canal fistula in an adult: case report.

The purpose of this report is to describe a 64-year-old woman who presented an 8 month history of recurrent spontaneous cerebrospinal fluid leakage into the left middle ear. High resolution computed tomography and computed tomography cisternography showed only a mild protrusion of the tympanic segment of the left facial canal into the ipsilateral middle ear but no definitive fistula. At surgical exploration, cerebrospinal fluid leakage resulted from a fistula in the tympanic segment of the left facial canal. In conclusion, in the adult patient reported herein, the fistula leading to spontaneous CSF otorrhea was identified definitely only intraoperatively. Furthermore, although there were no signs or symptoms of facial nerve dysfunction, it was located in a rare site such as the second segment of the facial canal. When the clinical history, physical examination, and laboratory analysis are strongly suggestive for spontaneous CSF otorrhea, surgical exploration is mandatory even if neuroimaging evaluation is negative or questionable.

[Prevention, safety and prophylactic measures in occupational HIV infection in Italy, the European Union and the USA]. / Misure di prevenzione, sicurezza e profilassi nell'infezione occupazionale da HIV in Italia, Unione Europea e USA.

Numerous guidelines have been issued by Public Health institutions and related authorities in the last few years for the prevention of HIV infection among occupationally exposed workers. Our study was aimed at comparing the regulations and guidelines on this topic that have recently been adopted by Western countries, also taking into account the impact of the problem in current scientific literature. Health-care workers are the category with the highest risk for occupational exposure to HIV principally associated with accidental needlesticks, skin lesions and percutaneous injuries. In preventive and occupational medicine, Italy, the European Union and the USA have founded their recommendations on universal and specific precautions issued by the Center for Disease Control. Moreover, as long ago as 1990 the Italian Ministry of Health issued official guidelines for the prevention of occupational exposure to bloodborne pathogens. Post-exposure management is crucial for the protection of workers at risk. As a consequence of the failure of some monotherapeutic zidovudine treatments, different countries revised their guidelines and recommended the use of a combination of chemotherapeutic drugs for the post-exposure regimen. However, most of the currently available data are derived from efficacy studies of combined therapy on HIV-infected patients. Therefore, further experimental investigations are needed aimed at evaluating the short- and long-term effects of these treatments in the post-exposure protection of workers at risk for HIV infection.

[Endonasal dacryocystorhinostomy: a personal experience]. / La dacriocistorinostomia per via endonasale. Nostra esperienza.

Stenosis of the naso-lachrymal duct as a consequence of acute or chronic inflammation, trauma or congenital malformation is a relatively frequent lachrymal duct pathology. The symptoms include epiphora and intermittent tumefaction of the medial ocular canthus, indicative of a deficiency in lachrymal drainage. If such conditions do not respond to medical treatment, lavage and transcanicular probe, surgery proves necessary. Modern techniques for endonasal surgery place the otologist in the forefront in the surgical treatment of this disorder. Endonasal dacryocystorhinostomy (DCR) is indeed a valid alternative to traditional extra-nasal surgery; once exclusively the domain of the ophthalmologist. However, it does require a certain expertise in micro-endoscopic surgery. In most cases sophisticated equipment is not required and the procedure can be performed with just a few instruments: electric knives, scalpel and Citelli forceps. Endonasal DCR makes skin incisions unnecessary and makes it possible to reveal, and possibly, correct, any sequela subsequent to traditional DCR such as ethmoidal rhino-sinusitis or the presence of adhesions. In the present work 67 patients--24 with recurrence after traditional surgery--underwent endonasal DCR within the last 22 months and with an average follow-up of one year. Surgery was successful in 90% of the cases.

[Comparison of 2 materials in the reconstruction of the tympanic membrane. Our experience in 300 patients]. / Comparaison entre deux matériaux dans la reconstruction de la membrane tympanique. Notre expérience en 300 patients.

The authors evaluated the results obtained from the tympanic membrane reconstruction in 300 patients affected by simple, purulent or cholesteatomatous chronic middle ear otitis. In this tympanic membrane reconstruction they used: jugular vein strip of a calf and temporal muscle fascia in 150 cases. On pathological basis (simple, purulent and cholestéatomatous otitis) they used the overlay or the underlay method. In 5 years that follows, the materials (vein and fascia), if properly used, would give similar results. For such reasons the authors proposed: temporal muscle fascia autotransplantation with underlay method in partial myringoplasty; heterotransplantation of modelled jugular vein strip with overlay method in subtotal or total myringoplasty.

Adenocarcinoma of the sphenoid sinus. Case report.

We report a rare case of adenocarcinoma of the sphenoid sinus in which the very rarity of the site made for considerable uncertainty in the early diagnosis despite major neurological deficits at onset. Only the subsequent course of the tumor enabled us to identify the site in the sphenoid sinus, an atypical area surrounded by numerous neurovascular structures which, if involved, may give rise to a protean and nonspecific symptom-complex.

Incontinentia pigmenti and Behçet's syndrome: an unusual combination.

We describe an unusual case of a child who had had incontinentia pigmenti from birth and developed the clinical picture of Behçet's syndrome at five years of age. Among the various investigations performed, chemotactic activity of the polymorphonuclear leukocyte was found to be low. We discuss the possibility that there are common immunological abnormalities in the two syndromes.

[Chronic mononucleosis: a case of difficult diagnosis]. / Mononucleosi cronica: un caso di difficile diagnosi.

Here is referred the case history of a boy - age 6 yrs - who was hospitalised for a persistent high temperature with generalised limphonodes hypertrophy. The limphonode biopsy together with decreased NK activity and increased antiEAD and antiVCA antibodies allowed the diagnosis of chronic mononucleosis.