[Usefulness of implantable loop recorder in the diagnosis of undetermined syncope. Report of a clinical case]. / Utilità del "loop recorder" impiantabile nella diagnosi della sincope di natura indeterminata. Descrizione di un caso clinico.

In this paper we describe the case of a 42-year-old man who presented with rather infrequent episodes of syncope. In view of this symptomatology, he had been repeatedly hospitalized and submitted to a complete diagnostic workup inclusive of brain computed tomography, head-up tilt test, repeated Holter monitoring, and electrophysiologic evaluation. Unfortunately, none of these tests allowed the formulation of a precise diagnosis. When, owing to further episodes of syncope, the patient came to our observation, after an inconclusive new series of noninvasive tests, we decided to implant an insertable loop recorder. This device revealed that a phase of severe bradycardia lasting 53 s, with 15 s of complete asystole, occurred during symptoms thus allowing us to diagnose the cause of syncope.

Acute thymic involution in fetuses and neonates with chorioamnionitis.

Chorioamnionitis represents the leading cause of preterm birth and related pathologic conditions as well as of fetal death and frequently occurs in symptom-free mothers. Recent radiologic findings have indicated that thymus size is significantly reduced in preterm infants born to mothers with subclinical, histologically proven chorioamnionitis. However, an accurate morphologic description of the thymus gland in fetuses and neonates with chorioamnionitis is lacking, although it is known that infection and other stress processes may cause lymphocyte depletion in the thymuses of infants and older babies (acute stress involution). We describe morphologic modifications in the thymus of fetuses with histologically proven chorioamnionitis and newborn infants with chorioamnionitis and proven sepsis. The main findings included (1) decreased organ volume (ANOVA, P < .0024); (2) reduced corticomedullary ratio (P < 10(-6)); (3) significant changes in the relationship between thymic parenchyma and thymic interstitial tissue with resulting increased organ complexity (P = .03); (4) severe reduction of thymocytes; and (5) other degenerative processes such as monocyte/macrophage infiltration of Hassall's bodies. These results indicate that chorioamnionitis, with or without sepsis, is associated with significant morphologic modifications in the thymus. We wish to note that the described thymic pathology is only one aspect of the fetal systemic inflammatory response syndrome with which chorioamnionitis is associated.

Prenatal diagnosis of cloacal anomaly.

The authors present a case of prenatal diagnosis of cloacal anomaly, characterized by the presence of oligohydramnios and cystic pelvic mass with changing features during observation. Postnatal study confirmed the presence of a recto-cloacal fistula, with a high confluence of the urinary, genital and intestinal systems. Both parents had a chromosome 9 inversion (p11q13), but the child was chromosomally normal.

Thrombophlebitis and varicosis syndrome in pregnancy.

Venous stasis of the lower limbs is common in pregnancy; the thromboembolic complications are 1 in 1000 and become reduplicated in puerperium. The management of 13 patients with deep venous thrombophlebitis of the lower limbs during pregnancy, the fetal outcome and delivery were evaluated retrospectively. The delivery indications were the classic ones. Therapy was administration of calcium heparin and an angio-protector like diosmina. Good results, whether fetal outcome or mother morbidity in puerperium, were obtained.

Isolated atrial inversion in situs inversus: a rare anatomic arrangement.

Isolated atrial inversion in situs inversus is a rare congenital cardiac malformation. Its physiology resembles transposition of great vessels, and the best option for its surgical treatment is the atrial switch operation. In this article, we present a case of isolated atrial inversion in concordance with visceral situs inversus diagnosed at birth by echocardiography and cardiac catheterization, which was successfully treated at 8 months of age by a Senning procedure.

Idiopathic isolated coronary ostial stenosis: a rare lesion with particular clinical and surgical implications.

Isolated coronary ostial stenosis is an unusual condition, most often atherosclerotic in origin. Only few cases have been reported as idiopathic. The clinical profile of the latter patients suggests that this group may represent a distinct clinical entity, with peculiar diagnostic and therapeutic features. We present our experience concerning six patients with isolated idiopathic coronary ostial stenosis, who successfully underwent transaortic left main ostioplasty with autologous pericardial patch fixed in glutaraldehyde. A review of previous reports in regard to the surgical management of coronary ostial disease is presented.

[Clinical use of a GnRH analogue in a depot preparation (leuprolide acetate) in patients with surgical indication for uterine fibromyoma]. / Impiego clinico di un analogo GnRH in preparazione depot (leuprolide acetato) nelle pazienti affette da fibromiomi uterini con indicazione chirurgica.

During 1992 and 1993, twenty-eight women with uterine leiomyomata received GnRH-agonist (leuprolide acetate) for 3 months before hysterectomy or myomectomy. The decrease in uterine volume and secondary anemia with its collateral effects were assessed, then surgical and post-surgical advantages were assessed too. The real advantages of this treatment are studied and distinguished from theoretic advantages.

Labour management. Our experience.

We report a retrospective analysis of 1202 deliveries assisted by the same medical team, evaluating the clinical management of labour and the resulting type of delivery. Examination of the data revealed a gradual reduction in the number of deliveries treated pharmacologically accompanied by a reduction in the incidence of operative deliveries from 16% to 6%. Statistical analysis of the data using X2 test demonstrated a clear correlation between the administration of oxytocin and the incidence of operative deliveries (p less than or equal to 0.001). We believe that the indiscriminate use of oxytocin in labour should be avoided and that the pharmacological and operative management of labour requires precise clinical indications.

[Routine articulator mounting in orthodontic diagnosis]. / Montaje en articulador como rutina en el diagnóstico ortodóntico.

The importance of mounting cast on articulator during different stages of orthodontic treatments: diagnosis, treatment planning, case presentation and actual treatment, it is clearly defined. It is highlighted the paramount importance to have a precise occlusal concept to comparison with a clinical case.

Montaje en articulador como rutina en el diagnóstico ortodóntico. / [Routine articulator mounting in orthodontic diagnosis]

The importance of mounting cast on articulator during different stages of orthodontic treatments: diagnosis, treatment planning, case presentation and actual treatment, it is clearly defined. It is highlighted the paramount importance to have a precise occlusal concept to comparison with a clinical case.

Montaje en articulador como rutina en el diagnóstico ortodóntico / [Routine articulator mounting in orthodontic diagnosis]

The importance of mounting cast on articulator during different stages of orthodontic treatments: diagnosis, treatment planning, case presentation and actual treatment, it is clearly defined. It is highlighted the paramount importance to have a precise occlusal concept to comparison with a clinical case.

[Caliceal diverticula]. / I Diverticoli caliciali

The Authors describe a case of calycial diverticulum which came under their observation, discussing the aetiopathogenetic and anatomopathological factors and the mechanisms supporting this pathological event. They conclude that it must be considered as of congenital origin and generally treated with conservative therapy, limiting the use of demolitive surgical therapy solely to cases of deep and diffused alteration of the kidney.