Spontaneous Cervical Epidural Hematoma.

BACKGROUND: A 65-year-old woman was admitted to the emergency department for sudden onset of neck pain and dysesthesia of both upper limbs. The pain occurred spontaneously, without any history of recent trauma. Rapidly after her admission, she developed tetraparesia. The patient had a past medical history of long standing hypertension correctly controlled as confirmed at admission. Neurological examination confirmed the tetraparetic status with a sensory level at Th3. Moreover, a saddle anesthesia with impaired bladder control was observed. Cranial nerve examination and consciousness of the patient remained normal. Laboratory coagulation tests and platelets count were all within normal limits.

Self-directed deliberate practice with virtual fiberoptic intubation improves initial skills for anesthesia residents.

BACKGROUND: Fiberoptic intubation is a core skill in anesthesiology. However, this complex psychomotor skill is challenging to learn in the clinical setting. The goal of this study was to evaluate the Virtual Fiberoptic Intubation (VFI) software as an adjunct to the traditional fibreoptic intubation teaching. METHODS: After informed consent, 23 first year anesthesia residents with no previous experience of fiberoptic intubation were randomized to 2 groups. All subjects received an institutional didactic teaching session. The control group (N.=12) was taught by the usual didactic method only, while the VFI group (N.=11) had the same didactic teaching and also the opportunity to practice with VFI software for one week. Each resident was evaluated on their first oro- and nasotracheal fiberoptic intubations on a mannequin head. Each performance was evaluated by an expert bronchoscopist blinded to the previous type of teaching using a checklist score, a global rating scale (GRS) score and procedural time. RESULTS: The VFI group performed significantly better on the checklist and GRS scores compared to the control group for both the oral and nasal routes (all P<0.05). For procedural time, there was a trend towards faster performance in the VFI group compared to the control group for the oral route (P=0.05). There was no significant difference for procedural time between the VFI and the control groups when fiberoptic intubation was performed nasally (P=0.76). CONCLUSION: Self-directed practice using VFI software may improve the initial acquisition of fibreoptic intubation skills for anesthesia residents.

[The document of chemical risk assessment: experiences in small companies]. / Il documento di valutazione del rischio chimico: esperienze nelle piccole imprese.

Were examined 60 documents of chemical risk assessment of companies from 19 municipalities in the provinces of Siena and Grosseto. The review of evaluations was conducted initially by checking the internal coherence of the documents. What emerged was subsequently analyzed together with the staff who performed the inspection. Although in 12 companies has been declared the presence of carcinogens, in only 5 the evaluation of exposure have been done using measures, others have used models or other techniques. Overall assessment showed that only 8 out of 60 (13.3%) were wrote correctly.

Art glassware and sinonasal cancer: report of three cases.

In a multicenter study on the occupational etiology of sinonasal cancer (s.n.c.) carried out in Italy, we collected information about three cases which had arisen among glass workers: an adenocarcinoma, a melanoma, and a squamocellular carcinoma. The three men worked many years as mixers and/or batchers in artistic glass factories in Tuscany (Italy). We propose a possible etiological role of arsenic dust.