Improving organ procurement travel practices in the United States: proceedings from the Michigan Donor Travel Forum.

There are significant risks and inefficiencies associated with organ procurement travel. In an effort to identify, quantify, and define opportunities to mitigate these risks and inefficiencies, 25 experts from the transplantation, transportation and insurance fields were convened. The forum concluded that: on procurement travel practices are inadequate, there is wide variation in the quality of aero-medical transportation, current travel practices for organ procurement are inefficient and there is a lack of standards for organ procurement travel liability coverage. The forum concluded that the transplant community should require that air-craft vendors adhere to industry quality standards compatible with the degree of risk in their mission profiles. Within this context, a purchasing collaborative within the transplant community may offer opportunities for improved service and safety with lower costs. In addition, changes in travel practices should be considered with broader sharing of procurement duties across centers. Finally, best practice standards should be instituted for life insurance for transplant personnel and liability insurance for providers. Overall, the aims of these proposals are to raise procurement travel standards and in doing so, to improve the transplantation as a whole.

[Wegener granulomatosis: a clinical case with parossistic positional vertigo due to involvement of the lateral semicircular canal]. / Su un caso di granulomatosi di Wegener esordita con vertigine parossistica posizionale da interessamento del canale semicircolare laterale.

The ear is involved in more than 20% of all cases of Wegener Granulomatosis (W.G.): such involvement takes place either through direct proliferation of the necrotic-granulomatosis tissue in the middle ear, or is a consequence of perieustachian tube infiltration from the rhinopharnyx. The inner ear is affected later and it is not clear as to exactly how. The present paper deals with the case of a 63-year-old woman who had a year been suffering from bilateral ear pain, and persistent otorrhea with typical signs of purulent chronic middle-ear otitis. During the course of the illness the patient complained of atypical paroxymal positional vertigo, compatible with cupulolithiasis of the semi-circular horizontal canal (as per E.N.G. recording). Transoral biopsy of the rhinopharynx and of the left nasal fossa revealed histopathological signs compatible with W.G.. In the light of post-mortem temporal bone studies performed by Friemann and Blatt on W.G. patients the present case could lead to further studies regarding the advancement of this pathological process within the middle and inner ears and the etiopathogenetic mechanisms involved. In particular, during the course of W.G., the appearance of benign paroxymal positional vertigo through cupulolithiasis of the semicircular horizontal canal may be justified: a) by the progressive involvement of the posterior labyrinth structures affecting the semicircular canals prior to the lateral canal and running on to the posterior canal; b) by the discovery of proteiform material in the labyrinthine fluids.

[Metastatic location in the temporal bone of a primary bladder carcinoma]. / Localizzazione metastatica all'osso temporale da carcinoma primitivo della vescica.

The authors on basis of literature point out, the relative shortage in human beings of metastatic locations to the temporal bone from primitive tumours to another seat. After an examination of the anatomopathological report they describe a case, occurred to their observation, of massive metastases to the temporal bone of bladder carcinoma painting out its exceptionality.