Pervasive refusal syndrome or anorexia nervosa: a case report with a successful behavioural treatment.

PURPOSE: Pervasive refusal syndrome (PRS) is a rare psychiatric disease that affects children. It was first described by Lask in 1991 (Arch Dis Child 66:866-869, 1991). Recently, Otasowie and Collaborators reported a systematic review about PRS. Despite this, PRS has not yet been classified in DSM-5 and ICD-11 and the lack of evidence-based treatment makes this syndrome a real challenge for clinicians. The aim of this paper is to present our experience through the description of a case report and its treatment. METHODS AND RESULTS: The case reported is a girl aged 11 years that fits the clinical picture described in the literature of PRS. In previous reports, behavioural treatment was not used or appreciated; our case adds new knowledge regarding the PRS diagnosis and the successful behavioural treatment during hospitalization, which we describe in all its phases. CONCLUSION: PRS is a rare, life-threatening syndrome; it would be extremely important to have an official and evidence-based treatment guide. LEVEL OF EVIDENCE: Level V, case report.

Spondylodiscitis after bilateral sequential lung transplantation in a patient with cystic fibrosis.

We report the case of a 24-year-old woman with cystic fibrosis in whom spondylodiscitis developed after bilateral sequential transplantation. The diagnostic work-up included magnetic resonance imaging, computed tomography-guided disk biopsy, histological examination, and cultures of disk specimens. The infective organism was D group Streptococcus and the patient was successfully treated with intravenous piperacillin followed by oral ampicillin. To our knowledge, this is the first reported case of spondylodiscitis after lung transplantation.

[Experience of 10 years with the surgical treatment of lung cancer in elderly patients]. / Esperienza di dieci anni nel trattamento chirurgico del cancro del polmone nel paziente anziano.

The surgical treatment of lung cancer in elderly patients is correlated with a lot of complications that in most cases are cardiopulmonary type; for this reason, in past times these patients were left out of the surgical treatment. Today, the progress of surgical, diagnostic and anesthetic techniques permit to execute pulmonary resections in patients older than 70 years too. The aim of this study is to evaluate postoperative complications and long-term and long-term survival in patients under and over the age 70. Between January 1990 and June 2000 we have assessed 172 patients with lung neoplasm. We have divided patients in two groups: those younger than 70 years of age (group 1, n = 119) and those older than 70 years of age (group 2, n = 53). Postoperative mortality for group 2 was 7.5% and for group 5.1%. The overall postoperative complication rate for group 2 was 30.2% and for group 1 10.9%. Within group 1 main complications have been of surgical type (61.5%) while in group 2 medical type (cardiopulmonary), with higher frequency in patients ASA 3 or ASA 4. The mortality at 12 months for non-neoplastic causes was 10.2% for group 2 and 2.5% for group 1. On the contrary, the mortality at 12 months for neoplastic causes was 8.2% for group 2 and 6.7% for group 1. We haven't noticed an important correlation between the extension of the resection and the recurrence of disease. The survival at 3 years was 46.5% for group 1 and 41% for group 2 and associated with neoplastic causes.

[Treatment of malignant pleural effusion by pleurodesis with talc]. / Trattamento del versamento pleurico maligno mediante pleurodesi con talco.

In some types of cancer (breast, lung) a malignant pleural effusion may be present during the evolution of the neoplastic disease in more than 50% of cases. The main therapeutic option for palliative purposes in these cases is chemical pleurodesis with talc. The aims of this study were to report on our experience with the use of pleurodesis with talc in the treatment of patients affected by malignant pleural effusions and to analyse the results in the short and mean term. Over the period from January 1998 to December 1999, 16 patients were included in the study. The causes of the pleural effusion were a pleural mesothelioma in 1 patient and pleural metastases in 15 patients (from lung and breast cancers in 62%). We treated 14 of these patients with talc poudrage and 2 patients with talc slurry. The talc was applied under video-assisted thorascopic management in 15 patients, while in 1 patient the talc was injected via the thoracic drainage tube. Two patients died within the first month as a result of progression of the neoplastic disease and one patient was withdrawn from the study owing to failure to collaborate. Of the other 13 patients, 11 (84%) had a total or partial response to the pleurodesis; in 9 of these patients (69.2%) the response remained stable until death, while in 2 patients the pleural effusion reappeared after 3 and 5 months, respectively. Failure of the pleurodesis occurred in 2/13 patients owing to reappearance of the pleural effusion within the first month.

Giant leiomyoma of the oesophagus and cardia. Diagnostic and therapeutic considerations: case report and literature review.

A case of giant leiomyoma of the oesophagus and cardia is presented. Magnetic resonance imaging was particularly useful for assessing the relationship of the tumour to the neighbouring structures. Radical resection was performed by partial oesophagogastrectomy with intrathoracic oesophagogastrostomy. Giant oesophageal leiomyomas present a diagnostic and therapeutic challenge because of their size and the possibility of malignant behaviour.