Petrous apex arachnoid cyst: a case report and review of the literature.

Cholesterol granuloma and cholesteatoma are the two most common destructive lesions of the petrous apex. Arachnoid cyst is much less common. These three expansile lesions are often indistinguishable on clinical grounds. Accurate pre-operative radiological diagnosis on computed tomography scan and magnetic resonance imaging is important in order to plan the appropriate treatment. Pre-operative radiological differential diagnosis between primary cholesteatoma of petrous apex and a intrapetrous arachnoid cyst remains a significant problem. The following aspects need evaluation for recognition of intrapetrous arachnoid cysts: 1) an awareness of their existence, 2) homogeneous signal on T1 and T2 weighted images, closely resembling cerebro-spinal fluid signal, 3) special heavily weighted T2 images on magnetic resonance imaging: fluid-attenuated inversion recovery imaging, 4) careful correlation of clinical-radiological data. Symptomatic arachnoid cysts are best treated with conservative drainage surgery through middle cranial fossa. A case of a petrous apex arachnoid cyst is reported which has been radiologically mistaken for a primary cholesteatoma and operated through an infratemporal fossa approach type B. The patient (40-year-old female) came to our attention with right trigeminal pain which had been present for one year and dizziness. Neurotologist and skull-base surgeons should include arachnoid cyst as a rare possibility in the evaluation and treatment of petrous apex cystic lesions.

Haemorheological and endothelial-dependent alterations in heart failure after ACE inhibitor, calcium antagonist and beta blocker.

The aim of our study was to evaluate endothelium-dependent dilatation induced by an ACE-inhibitor, calcium antagonist and beta blocker in patients suffering from heart failure (NYHA class II and III). We studied 34 patients (19M, 15F, mean age 76.96+/-8.82) in pharmacological wash-out for at least one week, divided into 3 groups: Group A (15 patients, 9M and 6F) taking ramipril (5 mg/die); Group B (10 patients, 6M and 4F) taking amlodipine (10 mg/die), Group C: (9 patients, 4M and 5F) taking carvedilole (25 mg/die). The groups were homologous for NYHA class and instrumental echographic parameters (mean EF=22.5+/-6.7 and mean sAPP 38.4+/-8.7). At the beginning and after 3 weeks of therapy, we performed a clinical and instrumental assessment; we studied endothelial function by determination of L-arginine and L-citrulline (amino acids of the nitric oxide metabolic pathway), the L-citrulline/L-arginine ratio (an index of NOS activity) and VCAM-1 (endothelial dysfunction index); haemorheological parameters (blood viscosity, plasma fibrinogen and erythrocyte morphology); coagulative/fibrinolytic parameters (PT, aPTT, fibrinogen and PAI-1). The results show that L-citrulline and L-arginine increase, while VCAM-1 decreases. The L-citrulline/L-arginine ratio increases in a statistically significant way. This trend is maintained in each group. These results demonstrate that the drugs used induce an improvement of endothelium-dependent dilatation. In addition, there is progressive haemorheological and fibrinolytic improvement, with a reduction of PAI-1 and blood viscosity.

[Ulcero-necrotic and lymphoproliferative naso-paranasal lesions in cocaine abuse]. / Lesioni ulceronecrotiche e linfoproliferative naso-paranasali da abuso di cocaina.

In this work are reported two clinical cases of cocaine abusers with destructive lesions of nasal-paranasal cavities. The clinical presentation and the absence of a positive history of drug addiction led to a differential diagnosis between lymphoma, idiopathic median line granuloma and Wegener granulomatosis. Biochemical and serological examinations did not prove conclusive. The diagnosis was finally formulated on the basis of the documented presence of cocaine in the biological fluids. Emphasis is placed in the difficulty of obtaining a reliable case history in this type of patients. Moreover, the Authors point out that it is advisable to test for drugs in the biological fluids prior to undertaking time-consuming diagnostic procedures for pathologies which are extremely rare in the West countries.

[Clinical test on the efficacy of lincomycin administered by aerosol in acute sinusitis]. / Esperienza clinica sull'efficacia della lincomicina somministrata per via aerosolica nelle sinusiti acute.

Twenty-seven patients with acute sinusitis have been treated with lincomycin by aerosol 600 mg once a day for 6 days. The evaluations have been made in accordance with resolution of the clinical symptoms and radiological pictures. The trial has shown a marked reduction of the symptoms after only 3 days of treatment and almost total disappearance at the final control. Lincomycin proved to be effective and well tolerated in all patients.

Brainstem auditory evoked potentials in the diagnosis of multiple sclerosis.

Brainstem auditory evoked potentials (BAEPs) have been investigated in 34 patients affected by multiple sclerosis. Abnormalities were found in 68% of the patients. Silent lesions of the brainstem were detected in 60% of the clinically definite and in 44% of the probable cases. The diagnostic value of these findings is discussed.