Parvovirus B19 associated acute cholestatic hepatitis.

There are few reports in the literature of hepatitis as a manifestation of Parvovirus B19 infection. We describe a case of Parvovirus B19 associated acute cholestatic hepatitis diagnosed based on a positive serologic test (IgM) and molecular detection of parvovirus B19 DNA in peripheral blood. Parvovirus B19 infection should be considered in the differential diagnosis of patient presenting with acute hepatitis of unknown etiology.

Unexpected delayed death after manual strangulation: need for careful examination in the emergency room.

The aim of this case report was to demonstrate the importance of detailed clinical assessment in victims of attempted manual strangulation, to prevent the occurrence of delayed death due to an airway collapse; and to provide an update on clinical management of these patients. An elderly male patient presented with a sore throat and speech impairment after attempting manual strangulation. Physical examination showed reddish skin of the neck, an extensive haematoma of the hard palate and anterior tongue. Flexible laryngoscopy failed to show any swelling of the hypopharynx or larynx. A few hours after presentation, the patient developed acute dyspnoea and died. Autopsy and post-mortem CT scan showed a haematoma in the thyro-epiglottal space. In conclusion, victims of manual strangulation can survive despite internal neck injury which can lead to delayed fatal airway collapse. This is because often there are few or no signs of assault, therefore medical evaluation should be thorough and timely. Sometimes immediate tracheotomy can be life saving.

Emergency radiology without the radiologist: the forensic perspective.

PURPOSE: The aim of this paper is to describe two cases from the authors' forensic archive database in which teleradiology was related to unfavourable outcomes. MATERIAL AND METHODS: Two patients underwent autopsy after unexpected death following road accidents. In one case, death was caused by multiple cervical fractures following minor neck injury in the presence of diffuse idiopathic skeletal hyperostosis. In the other case, death was due to delayed isthmic aortic rupture occurring after thoracic blunt trauma in a young adult. Both conditions were diagnosed at autopsy only. RESULTS: In both cases, the lethal outcome was due to the failure to obtain radiological reports of the X-rays performed in the emergency department. Radiological diagnoses could have been established by activating the teleradiology service which, according to the hospitals' teleradiology protocols, is available on demand in cases of emergency only, as selected by the physician requesting the service. CONCLUSIONS: These cases suggest the high risk of excluding the radiologist from the management of patients whose images are transmitted via a teleradiology system.

Topical immunomodulation under systemic immunosuppression: results of a multicentre, randomized, placebo-controlled safety and efficacy study of imiquimod 5% cream for the treatment of actinic keratoses in kidney, heart, and liver transplant patients.

OBJECTIVE: In this study the safety and efficacy of imiquimod 5% cream for the treatments of actinic keratoses in kidney, heart and liver transplant recipients is evaluated. BACKGROUND: Growing populations of organ transplant recipients face increased risk of developing actinic keratosis (AK) and skin cancer secondary to continuous systemic immunosuppressive therapy. Imiquimod 5% cream is an effective option for the treatment of AK, but the safety of topical immune stimulation in immunocompromised patients has not been widely evaluated. METHODS: A total of 43 patients in six European transplant centres applied two sachets of topical imiquimod or vehicle cream three times per week to a 100 cm(2) field. Dosing continued for 16 weeks regardless of lesion clearance. Patients were assessed for safety variables that included adverse events, local skin reactions, laboratory results, vital signs, dosage of immunosuppressive medication and indication of graft rejection. A blinded independent expert committee was responsible for safety monitoring and final safety assessment. RESULTS: No graft rejections or trends for a deterioration of graft function were detected. No meaningful trends were observed in laboratory results. Among patients randomized to imiquimod, the complete clearance rate was 62.1% (18/29); for vehicle patients, the complete clearance rate was 0% (0/14). Clinical clearance was confirmed histologically in all cases. CONCLUSIONS: Imiquimod appears to be a safe alternative for the treatment of multiple actinic keratoses in patients with solid organ transplants. Efficacy was within the range previously observed in nontransplanted populations.

Medicolegal reflections about a case of cardiac death after renal transplantation.

Cardiovascular disease is the most common cause of death in patients with renal transplant. Acute coronary syndrome due to coronary artery disease, and left ventricular hypertrophy leading to chronic heart failure account for the majority of sudden arrhythmic deaths after transplantation. Furthermore death with functioning graft represents the main cause of graft loss, particularly after the first post-transplantation year. Although cardiovascular disease leads to morbidity and mortality in renal transplant recipients, its pathogenesis is poorly understood. The high incidence of cardiovascular disease in patients after renal transplant is chiefly due to high occurrence and accumulation of traditional risk factors before and after transplantation. Hypertension, post-transplant diabetes mellitus and hyperlipidemia increase the risk for cardiovascular events. Also 'non traditional' risk factors are associated with cardiovascular disease. Moreover several immunosuppressive drugs interfere with the cardiovascular system. The authors present a case of cardiac death following renal transplant in a patient with history of cardiovascular disease prior transplantation. Initially treated by hemodialysis, after 3 years he received a cadaveric renal transplant. The post-transplantation period was without surgery complications, immunological or infectious, except for a scarce control of blood pressure. A month after the operation, the patient developed thrombophlebitis, plus extra-peritoneal swelling. After ten days in hospital he suddenly died. The aim of the manuscript is to remark on the legal relevance of patient's consensus to transplant. It is necessary to well inform patients of an operation's risks and complications. Furthermore, the exceeding demand with respect to organ availability raises ethical issues about organ allocation.

Follicular mucinosis successfully treated with isotretinoin.

We describe the case of a 33-year-old Caucasian male with follicular mucinosis successfully treated with isotretinoin. Follicular mucinosis is a primary idiopathic disease or a secondary, lymphoma-associated dermatosis. An effective standard therapy for this disease is unknown. In our case, isotretinoin led to a dramatic improvement of the skin lesions in about two weeks. To the best of our knowledge, the benefits of isotretinoin in the treatment of follicular mucinosis have never been reported previously. The efficacy of this drug could be mediated by a regulatory effect on the infiltrating cells and/or by a modulation of the target organ (skin) response to the infiltrating cells.

Multiple squamous cell carcinomas of the skin during long-term treatment with hydroxyurea.

Hydroxyurea is a chemotherapeutic agent used extensively for myeloproliferative disorders. Cutaneous side effects have been described during long-term hydroxyurea treatment. We described the occurrence of multiple squamous cell skin carcinomas in a patient treated with hydroxyurea for chronic myelogenous leukemia. The lesions were removed and the hematological therapy switched to busulfan. In a previously reported case, the development of cutaneous epithelial cancers required the discontinuation of hydroxyurea, in addition to the surgical excision of the neoplastic lesions. Since squamous cell carcinoma is a malignant cutaneous neoplasm that can metastatize, the surveillance of skin changes is advisable during hydroxyurea treatment.

Multicystic encephalomalacia in term infants.

The terms "multicystic encephalomalacia" and "subcortical leucomalacia" (SCL) are used to describe the presence of areas of necrosis that develop into cystic lesions inside the brain. These lesions are generally due to severe asphyxia and/or hypotension. The designation SCL can also be used to describe the extent and the seat of the lesion in the brain or to distinguish subcortical lesions from periventricular and/or combined ones. In this study we give an account of our experience with eight newborns admitted to our neonatal intensive care unit, who presented clinical-neurological alterations and encephalomalacic lesions whose presence was documented by ultrasonography.

[The lead concentration in the converted and special-formula milks used in infant feeding]. / Concentrazione del piombo nei latti adattati e speciali utilizzati nell'alimentazione del lattante.

In the last years a strict correlation between chronic exposure to low lead doses and neuropsychological impairment in first childhood is often reported in literature. The authors have measured and than compared the lead content of milk-based formulas, of special-formulas (hypoallergenic-protein formulas, lactose-free formulas, proteic-hydrolysate formulas) and soya formulas. 20 samples of milk-based formula, have been measured along with, 22 samples of special formula and 14 samples of soya formula. Lead mean concentration in milk-based formula was 73 +/- 139.11 microgr./l, whereas 23.95 +/- 13.76 microgr./l and 22.57 +/- 13.42 were measured in special formula and soya formula respectively. These results were compared with Student t-test and no significative difference was found. Lead mean concentration of milk-based formula was higher than that of special formula or soya formula. The authors hope milk-formula industry to have a more specific control on lead milk content for children feeding. In order to avoid possible toxic injuries in little infants, industry should certainly pay more attention both in supplying and in technological management of milk.

[Osteochondrodysplasia: nosologic assessment and report of 6 clinical cases]. / Osteocondrodisplasie: inquadramento nosologico e descrizione di sei casi clinici.

Osteochondrodysplasias represent an important group of disease affecting cartilage and/or bone. The clinical evidence of disarmoniuous low stature, of a disproportion between trunk and limbs length, of a big skull can suggest this diagnosis and the necessity to carry out all the instrumental investigations. The diagnostic suspect can be placed, some time, already in the neonatal period. The complexity of problems regarding the osteochondrodysplasias bearer child and his family requires a multidisciplinary approach. The Authors present a personal experience of six cases of osteochondrodysplasias observed in a period of fifteen years.

[An ovarian mass in childhood: a case report]. / Massa ovarica in età pediatrica: descrizione di un caso.

Ovarian tumors are a very heterogeneous group of neoplasms that rarely occur in pediatric age. When it happens, they are usually very malignant germ cell tumors such as embryonal carcinoma, endodermal sinus tumor or choriocarcinoma. We describe a case of a 14 years old girl who came to our observation because of an abdominal enlargement without others symptoms. The abdominal palpation revealed a big, round, painless mass from pelvic to epigastric region. A specific and accurate diagnosis was made by ultrasound. The histological examination of the surgical removed mass revealed a mucous cystadenoma that's a benign epithelial ovarian tumor.

[Lead concentrations in breast milk of women living in urban areas compared with women living in rural areas]. / Concentrazione del piombo nel latte materno di donne residenti in aree urbane rispetto a donne residenti in aree rurali.

In the last twenty years a great interest has grown up about the accumulation of lead in the environment, because many studies have found relationship between exposure to low lead doses and neuropsychological impairment of children. The Authors have measured and then compared the lead content of milk from women living in city-areas and women living in rural areas, not having professional lead exposure. 34 samples of women milk from the rural areas and 20 samples from the city areas were examined: the lead mean concentration of the rural areas milk samples was 45.62 microgr/l with a range from 0 to 425 microgr/l; the mean concentration of the city areas samples was 126.55 microgr/l with a range from 1 to 472 microgr/l. The data were compared with the Student t-test and the difference was statistically significant at p = 0.01. The Authors examine the correlations between environmental lead accumulation and increased lead concentration in woman milk, laying stress on the possible hazard to health and neuropsychological development of children, mostly of those living in urban areas with heavy road traffic and industrial activity.