Access to health services for undocumented immigrants in Apulia.

This paper, part of a larger epidemiological study carried out between 2004 and 2010, analyzed immigrants frequenting the largest Apulian regional hospital (Bari Policlinico). Our aim was to evaluate the perception on the part of undocumented immigrants of their rights of access to the National Health Care services and whether this privilege is actually utilized. An anonymous multi-language questionnaire was distributed to all patients with STP (code number for temporary presence of foreigners) at the immigrant outpatient Infectious Diseases Clinic of Bari from June 2009 to June 2010. Questions were related to nationality, date of arrival in Italy, use of health facilities in the 2 years prior to the compilation of the questionnaire, and their understanding of STP. The patients were also screened for infectious diseases (HIV-Ab, HBsAg, HCV-Ab, VDRL, TPHA and Mantoux). A total of 256/272 patients completed the questionnaire; the meaning of STP was unknown to 156/256 (60.9%) patients, only 54/256 (21%) knew the exact meaning of STP and only 42/54 (76.6%) of the latter knew how long STP was valid. Moreover, 128/256 (50.7%) were aware that doctors from the emergency unit were not allowed to notify police regarding presence of illegal immigrants. Regarding clinical data 3% were HIV+ (8/256), 5% (13 patients) positive for TPHA, 5% for HBsAg, 2% were HCV (five patients). A >10 mm diameter infiltrate of Mantoux test was noted for 44% of patients. A lower prevalence than expected for infections such as HIV, HBV or HCV was noted for immigrants compared to data from their countries of origin. At present, large-scale political solutions to the challenges of facilitating access to health facilities for undocumented immigrants are lacking in Italy. The development of communication systems is fundamental to improving access to health services and to creating links between immigrants and the healthcare system.

Late presentation and loss to follow-up of immigrants newly diagnosed with HIV in the HAART era.

To compare clinical characteristics and therapeutic management of newly HIV-diagnosed immigrants to natives. Patients with a first HIV diagnosis from 1996 to 2010 were included. Of 716 new diagnoses, 85 (12 %) were immigrants. Migrants were younger, more frequently females and sexually infected, less likely to voluntarily request testing, and less HCV-coinfected. Late presenters (CD4 <350 or AIDS) were 76 % among migrants versus 56 % in natives (p = 0.006) with an increasing trend over time. HAART was initiated in 76.5 % of natives and 72.4 % of immigrants; the number/type of adverse events and treatment discontinuation were similar. Immigrants received more NNRTIs-based regimens. A similar proportion of patients reached virological suppression at month 1-3-6 after HAART initiation, but 43 % of immigrants versus 27 % of natives resulted lost to follow-up (p < 0.001). Diagnosis of HIV was often delayed among migrants, who also presented a higher rate of lost to follow-up.

Ossification of the ligamentum flavum in a Caucasian. Case report.

There have been few reports of ossification of the yellow ligaments causing spinal cord compression in Caucasian population. This disease is described mainly in Japanese patients and is termed as "Japanese disease". We describe the case of a 58-year-old Caucasian male with progressive paraparesis. Radiographic features were suggestive of ossification of the yellow ligaments in the lower thoracic level causing spinal cord compression. Early decompressive laminectomy and removal of the ossified ligament resulted in a marked clinical improvement. The etiological hypothesis, epidemiological, histological, clinical and radiological features of this disease are reviewed.

Primary leptomeningeal melanomatosis: early leptomeningeal enhancement on MRI.

One unusual case of primary leptomeningeal melanomatosis is presented. The patient, 53-year-old male, was admitted to our observation for 1 month history of psychasthenia and amnesia. Despite several polyspecialistic clinical, neuroradiological and cytological examinations, conclusive diagnosis was made only with a biopsy of leptomeningeal nodule. The present case allows as to identify 2 stages in the evolution of primary diffuse leptomeningeal melanomatosis. The initial phase is characterized by slight mental impairment without hydrocephalus; during the later phase there is severe, diffuse neurological impairment and both CT and MRI show hypercaptation of the intracranial leptomeninges and multiple, leptomeningeal tumoral nodules.

The chain of survival. A review in year 2000.

Worldwide about 1 in 1000 adults every year has a sudden cardiac arrest in out-of-hospital. That means 350,000-400,000 persons in the USA alone, 60,000 persons in Italy. Over 70% of times sudden cardiac arrest occurs at home, the remaining 30% in public settings. The chain of survival concept emphasizes four links associated with survival after sudden cardiac arrest corresponding each with a set of actions that have been done as soon as possible--the early access, the early CPR, the early defibrillation, the early ACLS; in order to develop strength in each link, separate specialized programs are needed, but all of the links must be well connected. The Utstein Style was developed by a task force who suggested a series of recommendations as a starting point for more effective exchange of information about out-of hospital cardiac arrest. The Utstein Style includes a glossary of terms, a template for reporting data from resuscitation studies on cardiac arrest, definitions for time points and time intervals related to an intervention in a resuscitation attempt, definitions of clinical items and outcomes that should be included in reports, and recommendations for the descriptions for how different EMS systems are organized.

Cavernous angioma of the VIIIth cranial nerve. A case report.

We report a case of a 24-year-old woman affected by a cavernous angioma of the right VIIIth cranial nerve associated with a venous angioma. The malformation was diagnosed by MRI, performed in relation to an acute onset of right anacusia. The case report is indicative that, even if unusual, an acute onset of an cerebellopontine angle syndrome can be subsequent to a bleeding cavernous angioma. This occurrence must be kept in mind in the differential diagnosis of the cerebellopontine angle tumors.

Desmoplastic fibroma of the skull. Case report and review of the literature.

BACKGROUND AND PURPOSE: We present a rare case of desmoplastic fibroma of the skull. Desmoplastic fibroma is a distinctive and rare neoplasm of bone that histologically and biologically mimics desmoid soft tissue tumor. Only 6 cases have been reported in the skull and none of these was diagnosed by MRI. CLINICAL PRESENTATION: A 64 year-old woman, operated on in June 1991 for left mastectomy due to a ductal adenocarcinoma and again in October 1994 for a left frontal metastatic adenocarcinoma, was admitted in our Department of Neurosurgery because a control cerebral MRI had detected a diploic lesion, isointense on T1-weighted images and hyperintense on T2, with moderate enhancement, localized in a right parietal site. Neurological examination was negative. The lesion was surgically removed and a cranioplasty was performed. Histological diagnosis was desmoplastic fibroma. Twelve months after treatment she has no neurological symptoms or signs of cerebral lesions (MRI) or systemic metastasis (total body CT). CONCLUSION: In the literature the number of desmoplastic fibroma is too small and the follow-up period too short to permit any conclusions regarding the aggressiveness of the tumor.

Aneurysms of the posterior cerebral artery: do they present specific characteristics?

A series of 7 cases of PCA aneurysm treated between 1978 and 1992 were analytically reviewed together with 79 cases culled from the literature. In comparison to those localized elsewhere, PCA aneurysms are more frequently large, more frequently present with tumour-like symptoms and appear at an earlier age. Surgical outcome was evaluated in relation to clinical onset, site and size of the aneurysm, the surgical procedures adopted for excluding it and pre-operative clinical grading appeared to influence outcome. The fact that site, size and surgical technique do not significantly influence prognosis is probably due to the rich collateral flow present in the areas fed by the posterior cerebral artery. The authors conclude that, clinically speaking, PCA aneurysms should be considered as a separate group.

Spinal cord ischemia diagnosed by MRI. Case report and review of the literature.

The purpose of this paper is to report a case of medullary ischemia diagnosed by MRI and to determine any MRI characteristics that may be useful for the diagnosis in the light of the published data. The patient was a 60 year-old male with hypertension and diabetes, referred to us for flaccid paraparesis and sphincter disorders of acute onset. Physical examination revealed, beside flaccid paraparesis, both superficial and deep hypoesthesia at L1 level and greater on the right. MRI showed a small area of signal hyperintensity on T2 weighted images and in proton density localized in the posterior part of the spinal cord at the level of T12 body. The patient was treated with oral antidiabetic, antiaggregant and antihypertensive drugs as well as neuromotor rehabilitation, and his clinical conditions improved; a control MRI, six months later, showed disappearance of the previous finding and only mild medullary atrophy at the level of the lesion. Medullary ischemia has been observed in a variety of pathological conditions (inflammatory, neoplastic, traumatic degenerative and iatrogenic), and most frequently involves the dorsal portion of the spinal cord. Four clinical-pathological manifestations of medullary ischemia have been described: infarction from occlusion of the anterior spinal artery; "patchy" or "lacunae infarction"; "transverse ischemic infarction"; selective ischemia in the regions of the posterior spinal arteries. A review of the literature yielded 61 cases of spinal ischemia diagnosed by MRI for a total number of 80 MRI scans, 12 of which were long-term controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Ependymoblastoma: a clinical review.

Ependymoblastoma is a malignant rarely reported neuroectodermal tumor. The authors describe a further case of cerebral ependymoblastoma and examine the clinical-prognostic aspects of this tumor in the light of the published data.

ETCO2 monitoring during low flow states: clinical aims and limits.

End-tidal carbon dioxide concentration in the expired air (ETCO2) is measured with different technologies. ETCO2 allows the global evaluation of three main body functions: metabolism, circulation and ventilation. If two of these parameters are held constant, changes in ETCO2 reflect a variation of the third. Thus, ETCO2 is now widely used as a reliable monitoring device in various clinical settings. In the past years several studies proposed ETCO2 as a noninvasive monitor for the evaluation of therapeutic efforts during low-flow states, and especially during cardiopulmonary resuscitation. However, recent laboratory and clinical investigations demonstrated that various pharmacological and physical interventions may influence ETCO2. Especially, the use of the CO2 generating buffer NaHCO3 increase and alpha-adrenergic agents constantly decrease ETCO2. Thus, although ETCO2 remains a necessary tool during anaesthesia, it may loose the potential for prediction of survival when monitoring the resuscitative efforts during cardiopulmonary resuscitation.