[Esophageal leiomyoma: ultrasonographic endoscopic diagnosis]. / Leiomioma dell'esofago: diagnosi ecoendoscopica.

Leiomyoma is the most frequent benign neoplasia of the esophagus. It is generally diagnosed, accidentally during a radiologic examination (filling defect with clear and regular margins) or endoscopically (sessile, hemispheric, covered by pink mucosa). Recently, to the above conventional exams, endoscopic ultrasonography has been added allowing to identify the single layers of the esophageal wall, thus furnishing useful informations on the morpho-structural characteristics of the leiomyoma. From October '94 to May '96, at the Endoscopy Service of the Institute of Oncology of the University of Messina, 12 patients, 8 males and 4 females, ranging from 39 to 69 years of age (median age 55.4) underwent EUS for suspect leiomyoma. An Olympus EU-M20 echoendoscope was used with a radial scan transducer of 12 Mhz. In 8 patients the leiomyoma was located in the III mid-esophagus, while in 4 patients the III inferior portion was interested. The Authors observed lesions ranging in size from 0.5 to 2.5 cm. In their experience, a suspect of leiomyoma represents a good indication for an endoscopic ultrasonography, which shows high sensitivity and specificity.

Effectiveness of leukocyte filters in reducing tumor cell contamination after intraoperative blood salvage in lung cancer patients.

OBJECTIVES: In an effort to reduce allogeneic blood transfusions in patients undergoing elective surgery for lung cancer, we investigated the effectiveness of a method of processing shed blood with an automated device for intra operative blood salvage (IOBS) and filtration with a 3rd-generation polyester filter to remove tumor cells. METHODS: Sixteen patients were operated on for different types of lung cancer. We searched for malignant cells in pre- and postprocessed shed blood employing density gradient centrifugation, staining of cytospins with hematoxylin-eosin, and antibodies to human cytokeratins. RESULTS: In 9 out of 16 cases (56%), neoplastic cells were detected in prefiltration samples, but none were found in postfiltration cytospins. CONCLUSION: IOBS combined with appropriate filtration could be a very useful and safe tool in reducing allogeneic blood transfusion in cancer patients.

[Usefulness of a protocol for carotid sinus massage in supine and erect postures in patients with syncope without other cardiovascular or neurological diseases]. / Utilità di un protocollo di massaggio del seno carotideo in clino ed ortostatismo in pazienti con sincope senza altre patologie cardiovascolari o neurologiche.

BACKGROUND: Carotid sinus massage is a first level test when investigating the cause of syncope. It is normally performed in the supine and erect positions. However, there is no standard complete protocol. So we have devised a new protocol to evaluate the utility of carotid sinus massage in different postures and the influence of patients age on the response. METHODS: Two groups of subjects were selected: a group of 167 patients (mean age 50 ys +/- 18, 105 males, 62 females) with a history of syncope without cardiovascular and neurological disease and 20 asymptomatic control subjects (mean age 52 ys +/- 13, 11 males, 9 females). Carotid sinus massage was performed supine, just after passive tilt, after 5 minutes of tilt and just after passive return to supine. If a pause > 3" was detected, the protocol was repeated after atropine i.v. injection. DEFINITIONS: Borderline vasodepressor: blood pressure reduction > 30 but < 50 mm Hg without symptoms; vasodepressor: blood pressure reduction > 50 mm Hg or > 30 mm Hg with symptoms like dizziness, vertigo or syncope; cardioinhibitory: pause > 3"; mixed: cardioinhibitory with blood pressure reduction > 30 mm Hg after atropine. RESULTS: Carotid sinus massage gave all informations in the supine position in 14 (12%) patients, after passive tilt in 67 (57%), after 5 minutes of tilt in 30 (26%), and after return to supine in 6 (5%). The responses were: 13 (8%) borderline vasodepressor, 32 (19%) vasodepressor, 2 (1%) cardioinhibitory, 70 (42%) mixed, 50 (30%) negative. Positive responses were more frequent in patients over 45 years (90% versus 43%). In the control group only 3 (15%) positive responses were elicited (2 borderline vasodepressor, and 1 vasodepressor, all in subjects over 45). CONCLUSIONS: This protocol for carotid sinus massage evidenced positive responses in 70% of patients with syncope without cardiovascular and neurological disease; cardioinhibitory responses are rare (2%); positive responses are more frequent in patients over 45 years; the protocol specificity was 85%.

Pleural mesothelioma associated with non-Hodgkin's lymphoma.

Occupational exposure to asbestos has been associated with an increased incidence of lung and gastric cancers, mesotheliomas, and myelolymphoid malignancies. A new observation of a patient with indirect exposure to asbestos who developed mesothelioma and plasmacytoid lymphocytic non-Hodgkin's lymphoma is described. This report and the previously described stimulation of B lymphocytes by asbestos suggests that the association of mesothelioma with lymphoid and plasma cell malignancies is not merely a coincidence.

[Arrhythmia in the course of myocardial infarct. Our year's experience in a coronary unit]. / Le aritmie in corso di infarto del miocardio

Personal experience with arrythmia in 57 out of 132 cases of myocardial infarct treated over a period of one yr. in a coronary unit. The ECG and biohumoral enzyme pictures gave clear indications of infarct in all 132 cases. The various types of primary stimulus formation or conduction arrhythmia observed in these 57 patients are examined in relation to the site and extent of infarct. The treatment modalities are described. Mortality was less than 10 per cent in the entire series, with 3 per cent deaths due to serious rhythm disturbances. It is concluded that the introduction of coronary units has primarily contributed to the reduction of infarct deaths by their effective treatment of arrhythmia. Earlier admission to such units would lead to further reductions in mortality.