Tracheal agenesis: management of the first 10 months of life.

Tracheal agenesis is a potentially lethal congenital anomaly, appearing only at birth. We describe a newborn preterm infant who presented with immediate respiratory distress and no audible cry. There was almost complete tracheal agenesis with a very short segment of distal trachea (only two tracheal rings) arising from the anterior wall of the esophagus, before dividing into the mainstem bronchi. The anomaly was unsuspected prenatally, as the scan showed pyloric atresia and complex congenital cardiac disease. Despite the patient's difficult course, with correction of the rare-associated malformations (cardiac and gastrointestinal tract anomalies), the fact that the child is lively and neurologically normal for her age, requires that we now consider the patency of the airway and the possibility of surgical correction, in accordance with a good quality of life.

[Strategies for the development of the quality of integrated home care]. / Strategie di sviluppo della qualità dell'assistenza domiciliare integrata.

Home Health Care (HHC) is a strategy to provide holistic care for elderly, chronic and terminal patients and for patients early discharged from hospitals. The aim of this article is to give some advice to ensure social and health integration, coordination of procedures and family participation in HCC. Moreover a framework to ensure organization of a HHC service is required and a guideline to define functions and responsibilities, human and physical resources and procedures to deliver health care is provided. The first stage of a HHC project must be an educational programme for the multidisciplinary team involved in home care. The common education is the strategy to improve Quality of a HHC service, involving medical and social workers in the definition of their own "criteria and standards" for organization, resources and procedures.

[High-resolution computed tomography in the study of congenital cystic adenomatoid malformation of the lung]. / La tomografia computerizzata ad alta risoluzione nello studio della malformazione congenita adenomatoide cistica del polmone.

Congenital cystic adenomatoid malformation of the lung is a rare condition requiring an early diagnosis and the accurate assessment of its site and extent since it can be surgically treated with excellent prognosis. This study enrolled 12 patients with suspected congenital cystic adenomatoid malformation examined with high-resolution CT (HRCT) under general anesthesia and after pulmonary hyperinsufflation, to investigate HRCT capabilities in the pathological and topographic characterization of the lesion. In 11 patients HRCT showed features suggestive of cystic adenomatoid malformation and histology confirmed the diagnosis (type I in 9 cases and type II in 2 cases). In contrast, in 1 case of extralobar pulmonary sequestration, only pathology could exclude an associated cystic adenomatoid malformation type III. In all patients HRCT assessed lesion site and extent accurately: the lesions involved only one lobe in 7 patients, whereas in the other 5 more lobes were involved, unilaterally (3/5) or bilaterally (2/5). Associated lesions were found in 6 patients (2 intralobar pulmonary sequestrations, 1 rhabdomyosarcoma, 3 pulmonary inflammations). HRCT allowed the finest anatomic structures to be identified and made it possible to acquire images without movement or reflected dysventilation, which meant better disease assessment and more correct treatment planning. In conclusion, the authors suggest HRCT in the study of cystic adenomatoid malformations and for all lung conditions in the pediatric age.

[Pulmonary lymphangioleiomyomatosis. Radiologic aspects and the diagnostic role of computed tomography]. / La linfoangioleiomiomatosi polmonare. Aspetti radiologici e ruolo diagnostico della TC.

Lymphangioleiomyomatosis (LAM) is an uncommon disease affecting women of reproductive capacity. It is characterized by non-neoplastic proliferation of smooth muscle in the lungs and, occasionally, in lymph nodes and in the thoracic duct. The patients present with dyspnea, chylous pleural effusion, pnx, and hemoptysis. The authors evaluated 4 patients with biopsy-proven LAM, by means of CT. In all cases, CT revealed small well-defined cystic air spaces with smooth and thin walls, scattered in the lungs. CT was very useful because it was more sensitive and specific than conventional radiography. The CT appearance of LAM distinctly differed from that of other diseases than can produce cystic air spaces in the lungs, such as UIP, eosinophilic granuloma, centri-acinar emphysema, and bronchiectasis. Our experience confirms the clinical usefulness of CT in diagnosing LAM.

A rapid method for the in vivo measurement of liver volume.

A method is described to calculate liver volume at US using real-time equipment. The method is based on the measurement of the 3 maximum diameters of the liver. Equations were derived by correlation vs CT volume measurement using the 3 diameters (multiple regression) or their product (simple regression) as independent variables in 20 subjects with and without liver disease. It is suggested that liver volume may be estimated as: y = -2364 + 89.2.(C-C) + 119.9.(A-P) + 59.6.(L-L) or y = 133.2 + 0.422.(C-C.A-P.L-L) where y is the volume (in ml), and C-C, A-P, and L-L are the 3 diameters (in cm). The two equations were validated in a second set of 22 subjects. US volume estimated according to Eq. 2 explained approximately 82% of the variance of the actual liver volume. The method is reproducible (interobserver variations less than 8%), rapid and easy-to-repeat. These features make it potentially useful in prospective longitudinal studies.

[Echotomography of pathological masses of the mediastinum. Indications and limits]. / L'ecotomografia nella patologia espansiva del mediastino. Indicazioni e limiti.

The authors refer to the application of sonography in the evaluation of mediastinal masses. In this pathology, sonography is useful if neither air nor bone tissue are present between the transducer and the mass. Sector scans are obtained through the transgiugular line, the intercostal spaces, the hepatic and splenic windows, the sternal notch. The diagnostic value is due to the possibility to define the solid or liquid content of the investigated masses.

[Mammary focal scleroelastotic lesion (author's transl)]. / La scleroelastosi focale mammaria.

Mammary focal scleroelastotic lesions are a newly recognized entity, with mammographic and macroscopic features simulating an infiltrating carcinoma but with benign microscopic features. The authors report two cases of this mammary lesion.