Intratumoral haemorrhage causing an unusual clinical presentation of a vestibular schwannoma.

We present a case of an elderly woman with no history of audiological disease with sudden onset of visual and hearing deficits associated with systemic clinical signs. On examination she had impairment of right CNs from V to X. CT and MR imaging demonstrated a cystic vestibular schwannoma with a rare intralesional fluid-fluid level correlated to a recent bleed. We include high quality MR images to show the acute impairment of the cranial nerves next to the tumour after acute bleeding. Our case report includes a voxel-based morphometry (VMB) analysis of the tumour that, as far as we know, has never been done before for such a tumour. VBM analysis was performed to calculate the hypothesized volume changes after the acute bleed which likely resulted in a sudden increase in the overall size of the tumour resulting in atypical clinical signs and symptoms due to the establishment of a mechanical conflict with the adjacent cranial nerves.

Cavernous haemangioma of the external auditory canal: clinical case and review of the literature.

Although benign vascular lesions are frequent in the head and the neck region, clinical evidence of cavernous haemangioma of the external auditory canal is extremely rare; when present, the lesion invades the middle ear space. Herein, a rare case of a soft mass filling the external auditory canal, not involving the tympanic membrane, in a symptomatic 59-year-old male is described. Clinical and audiological characteristics, imaging studies and surgical treatment with histological evaluation are reported, which led to a diagnosis of a cavernous haemangioma. This is only the seventh case described in the literature, to date, not involving the tympanic membrane and the middle ear space. In addition, a review has been made of the relevant literature with respect to epidemiology, presentation, evaluation, pathology, and management options for haemangiomas arising in the external auditory canal.

Risk factors for otitis media with effusion: case-control study in Sicilian schoolchildren.

OBJECTIVE: To identify the prevalence and demographic, maternal and child risk factors for otitis media with effusion (OME) in Sicilian schoolchildren and analyse the results with reference to the review of the literature. METHODS: Associations of possible risk factors with prevalence of otitis media with effusion (OME) were studied in a cohort of 2097 children, aged 5-14 years. In order to determine OME, otoscopy and tympanometry were performed at 3-monthly intervals beginning at term date. Sixteen epidemiologically relevant features were inventoried by means of standardized questionnaires and skin tests were performed. Univariate analysis was performed to examine the association between determinants and occurrence of OME; multivariate logistic regression analysis was made to investigate the joint effect of atopy and other determinants on OME. RESULTS: Prevalence of OME resulted 6.8% (143/2097) and it was most strongly associated with atopy (P<0.0001; or=12.67; 95% CI=8.78-18.27). Other factors significantly associated with the prevalence of OME were snoring (P<0.0001), previous history of acute otitis media (P<0.001) and of recurrent URTIs (P<0.0001), mother's no schooling (P=0.01) and no breastfeed (P=0.05). No significance was found for school type, economic status of the family, family size, family history of presence of allergy and of ear disease, mother's work status, smoking parents and birth history. Moreover on multivariate logistic regression analysis it resulted that age, positive URTI's history and smoking exposure were found to be significant (P<0.0001). CONCLUSIONS: OME during infancy is a common and multifactorial disease; as most of the risk factors associated with its etiology and pathogenesis, are modifiable, their modification should represent the reasonable primary care intervention leading to a decrease in OME prevalence.

Origen de la atención farmacéutica en España: El Congreso de Ciencias Farmaceuticas de Alcalá de Henares de 1995 / Origin of pharmaceutical care in Spain: The Congress of Pharmaceutical Sciences de Alcalá de Henares, 1995

La profesión farmacéutica se encuentra en pleno proceso de cambio, pasando de una orientación en exclusiva dirigida al producto (medicamento), a una actividad más amplia, orientada además al paciente y al uso racional del medicamento, entendido como la adecuación de las garantías de calidad, seguridad y eficacia del medicamento a cada concreto paciente a través del seguimiento farmacoterapéutico. Esta nueva conceptualización de la dispensación farmacéutica se materializa mediante la implantación de nuevos servicios profesionales enmarcados en la nueva filosofía de la práctica denominada Atención Farmacéutica (AF). Los orígenes de esta filosofía se pueden incardinaren la aparición de la Farmacia Clínica (EEUU, años 60) y en la publicación, en 1990, del artículo Opportunities and responsibilities in Pharmaceutical care firmado por los profesores americanos Hepler y Strand. A partir de ahí comenzó un desarrollo de esta filosofía de la práctica que, existe unanimidad en ello, tiene sus orígenes en España en 1995, en el V Congreso de Ciencias Farmacéuticas, que tuvo lugar en la Universidad de Alcalá de Henares (Madrid). El objetivo de trabajo es analizar la situación de la práctica farmacéutica en la última década del siglo XX en España y el origen de la AF en el Congreso de 1995(AU)

The pharmacy profession is in the process of change, from an exclusive orientation led to the product(drug), to a broader activity, in addition to patient-oriented and rational drug use, defined as the adequacy of quality assurance , safety and efficacy for each individual patient through drug therapy monitoring. This new conceptualization of pharmaceutical dispensing is implemented through the introduction of new professional services framed in the new philosophy of the practice known aspharmaceutical care (AF).The origins of this philosophy can incardinate in the appearance of Clinical Pharmacy (USA, years 60)and in the publication, in 1990, Article Opportunities and Responsibilities in Pharmaceutical care signed by the American professors Hepler and Strand. From there began a development of this philosophy of practice, there is unanimity about it, has its origins in Spain in 1995 at the V Congress of Pharmaceutical Sciences, held at the University of Alcalá de Henares (Madrid). The objective is to analyze the situation of pharmacy practice in the last decade of the twentieth century in Spain and the origin of AF in the Congress of 1995(AU)

The role of atopy in otitis media with effusion among primary school children: audiological investigation.

The objective of this study was to evaluate the role of atopy in otitis media with effusion (OME) in children attending primary school in western Sicily focusing on the audiological characteristics among atopic and non-atopic subjects suffering from OME. A total of 310 children (5-6 years old) were screened by skin tests and divided into atopics (G1) and non-atopics (G2). The samples were evaluated for OME by pneumatic otoscopy, tympanogram and acoustic reflex tests. The parameters considered were: documented persistent middle ear effusion by otoscopic examination for a minimum of 3 months; presence of B or C tympanogram; absence of ipsilateral acoustic reflex and a conductive hearing loss greater than 25 dB at any one of the frequencies from 250 Hz through 4 kHz. A total of 56 children (18.06%) resulted to be atopics while 254 were non-atopics. OME was identified in 24 atopic children and in 16 non-atopic children for a total number of 40 children; the overall prevalence rate was 12.9% (42.85% for G1 and 6.30% for G2). OME was bilateral in 28 children (70%), with a significative difference between G1 (79.17%) and G2 (56.25%). The prevalence of B tympanogram was 70.59%, corresponding to 79.07% for G1 and 56% for G2. The mean air conduction pure tone was, respectively, 31.97 dB for G1 and 29.8 dB for G2. The prevalence value of OME in atopic children, also supported by the higher predominance of bilaterality, B tympanogram and hearing loss among this group, could suggest the important role of allergy in the pathogenesis of OME.

Arteriovenous malformation of the base of tongue in pregnancy: case report.

Arteriovenous malformation of the head and neck is a rare vascular anomaly but when present is persistent and progressive in nature and can represent a lethal benign disease. An unusual case is presented of an arteriovenous malformation of the base of tongue in a 32-year-old primigravida at 23.2 weeks of gestation with a history of haemoptysis. The patient was admitted to hospital with 10.7 g/dl of haemoglobin and 32.1% of haematocrit but due to recurrent massive haemoptysis, in the next few days, dropped to 6.7 g/dl of haemoglobin and 20.2% of haematocrit which required immediate blood transfusions. To maintain the upper airways patent the patient underwent tracheostomy; during angiography, showing an arteriovenous malformation with its feeding arteries (lingual artery, internal maxillary artery, and maxillary artery) embolization was made without a significant blood flow reduction. After surgical ligation of the external carotid artery, on the right side, the patient was readmitted for further angiographic evaluation, which confirmed complete occlusion of the carotid artery but, at the same time, revealed the integrity of the arteriovenous malformation perfusion on account of a new feeding artery (left lingual artery). A new superselective catheterization of the lingual artery was performed but due to the effect of progesterone, which causes smooth muscle relaxation and leads to arteriovenous malformation dilatation and rupture, the primigravida again presented haemoptysis. In agreement with the gynaecologists, the patient was given betamethasone to induce foetal lung maturation, and induction of labour was planned at 26 weeks, and a healthy baby was delivered naturally. Over the following days, the patient had no further haemoptysis and so far clinical examination showed no evidence of the original mass (slight haemorrhagic suffusion of the right anterior amygdala region).

Inflammatory myofibroblastic tumor of the larynx. Case report.

Inflammatory myofibroblastic tumors (IMT) of the larynx are uncommon lesions that easily may be misinterpreted as malignant epithelial or mesenchymal spindle cell neoplasms. When located in the upper airway, IMTs tend to be less aggressive, but have the potential for local invasion and recurrence. The authors describe a rare case of IMT in a 47 year old man, occurring in the vocal fold who underwent surgical treatment five times, because of its higher recurrence rate.

Inflammatory myofibroblastic tumor of the larynx. Case report / Inflammatory myofibroblastic tumor of the larynx. A case report

Los tumores miofibroblásticos inflamatorios (TMI) de la laringe son lesiones poco frecuentes que fácilmente pueden ser confundidos como neoplasias malignas de células epiteliales mesenquimales. Cuando están localizadas en las vías aéreas superiores, los (TMI) tienen tendencia a menor agresividad, pero tienen el potencial de invasión local y recurrencia. Los autores describen un caso raro de TMI en un hombre de 47 años localizado en el pliegue vocal, que necesitó cinco intervenciones quirúrgicas, a causa de su proporción de alta repetición

Inflammatory myofibroblstic tumors (IMT) of the larynx are uncommon lesions that easily may be misinterpreted as malignant epithelial or mesenchymal spindle cell neoplasms. When located in the upper airway, IMTs tend to be less aggressive, but the potential for local invasion and recurrence. The authors describe a rare case of IMT in a 47 year old man, occurring in the vocal fold who underwent surgical treatment five times, because of its higher recurrence rate

Newborn hearing screening project using transient evoked otoacoustic emissions: Western Sicily experience.

OBJECTIVE: To study the incidence of congenital sensorineural hearing loss in all newborns introducing a screen test with a protocol no expensive, with a good "screen sensitivity" that could let an earlier identification of hearing impairment beginning early intervention by 2 months of age and increasing the probability of having language development within the normal range of development. METHODS: The study was conducted in Sciacca hospital from the beginning of 2003 to our days and was carried out with transient evoked otoacoustic emission using the criteria for PASS or RETEST and considering eventual prenatal and perinatal risk factors. All the newborns were divided into four groups each one with its personal secondary step program. RESULTS: In the years 2003-2004 the number of the newborns in Sciacca hospital was: 538 for 2003, 653 for 2004 with a total of 1191; all these infants were divided in three groups: resident in Sciacca, resident in the Sciacca borderlands and resident out of the district of Sciacca. The coverage (percentage of the target population who undergo the screen) was of 90% in the 2003 (483 newborns) and of 90% in the 2004 (585 newborns) with two cases of congenital sensorineural hearing loss identified. The incidence of sensorineural hearing loss, in the District of Sciacca, was estimated to be 2.07/1000 in 2003 and 1.70/1000 in 2004. CONCLUSIONS: The higher incidence of sensorineural hearing loss in our study is due to a high prevalence of consanguineous marriage in Sicily that was shown to be linked with hearing impairment. The "sensitivity value" was 95% at the first step but became 99% after the second step with a few number of false positive (0.74%). All the infants with a diagnosis of sensorineural hearing loss began a rehabilitation program before the age of 5 months and they have a good speech development and speech intelligibility.

Frontal sinus osteoma and palpebral abscess: case report.

Osteomas of the paranasal sinuses are slow-growing, benign tumours most frequently found in the frontal sinus with an incidence that varies from 47% to 80% of the cases; there are often no symptoms and they are diagnosed by chance during an x-ray examination. The symptoms are usually headaches and those secondary to ocular or neurological complications. The therapy to be preferred is surgery. The authors describe a case of frontal osteoma complicated by frontal sinusitis and palpebral abscess.

Frontal sinus osteoma complicated by palpebral abscess: case report.

Osteomas of the paranasal sinuses are slow-growing, benign tumours most frequently found in the frontal sinus with an incidence that varies from 47% to 80% of the cases; there are often no symptoms and they are diagnosed by chance during an X-ray examination. When there are symptoms, they are usually headaches and ocular or neurological complications. The treatment of choice is surgery. A case of frontal osteoma complicated by frontal sinusitis and by a palpebral abscess is described.

Surgical treatment of the distal anterior cerebral artery aneurysms.

A series of eleven patients with aneurysms of distal anterior cerebral artery, microsurgically operated and submitted to accurate neuropsychological testing, is reviewed. Of these, ten patients had an aneurysm at the bifurcation of distal ACA into pericallosal and callosomarginal branches and only one patient had an aneurysm at the beginning of the fronto-polar artery. All our patients were operated by an interhemispheric approach, that was associated in 3 cases to a pterional approach in order to clip a second aneurysm in other location. The postoperative grade was satisfactory in any of the eleven patients. The aneurysms of distal ACA may be surgically obliterated through a variety of approaches but the exposure via the interhemispheric fissure is used by many neurosurgeons. In our experience the interhemispheric approach allows the exposure of feeding artery and the control of proximal vessel without morbidity. Some authors have modified the interhemispheric approach to improve, in their opinion, surgical exposure, introducing partial resection of anterior portion of corpus callosum, used, by them, especially for the aneurysms just beneath the genu of corpus callosum. Although resection of the anterior 2.5 cm of the corpus callosum can be performed without causing any neurological deficit, as reported by the same authors, the use of this technique might not be necessary. The present paper deals with current surgical techniques and their modification for the treatment of distal anterior cerebral artery (ACA) aneurysms.

Pituitary abscess. A case report and review of the literature.

The pituitary abscess is a rare pathology which presents an high mortality and morbidity. The diagnosis of pituitary abscess has to be excluded in case of tumoral hypophyseal syndrome; a correct diagnosis leads to an early treatment and to a decreasing of the mortality and morbidity. Antibiotics have to be associated to neurosurgical treatment in order to reduce the pre- and post- operative infectious complications. A case of pituitary abscess is reported: the preoperative diagnosis has been based on the clinical symptoms (visual field defect and meningeal syndrome) and on the neuroradiological images (CT, MRI).

Helicobacter pylori in gastroduodenal diseases: rapid identification by endoscopic brush cytology.

Previous reports showed Helicobacter pylori (H. pylori) in type B gastritis-affected stomachs. This study was carried out to compare H. pylori staining effectiveness on biopsy to brush cytology. Tissue and brush parallel samples of gastric mucosa with abnormal or normal appearances were examined: 57.6% H. pylori-positive pieces from the antrum and 19.2% from the body were found, versus 65.3% and 25% H. pylori-positive brush smears, respectively. H. pylori resembling organisms were mainly related to chronic and acute antral inflammations and were often associated with higher amounts of round-shaped cocco-bacteria. In addition, H. pylori direct stain on brushing is proposed as the most rapid and reliable method for the routine diagnosis of Helicobacter pylori infection, in both ulcer or nonulcer gastritis.

Subarachnoid hemorrhage from multiple neurofibromas of the cauda equina: case report.

The authors report a case of spinal subarachnoid hemorrhage caused by neurofibromas of the cauda equina. An examination of the literature revealing 13 similar cases and an analysis of this case showing three neurofibromas of the cauda equina prompted an hypothesis emphasizing the origin of bleeding and the difficulties associated with a correct diagnosis.

HBcAg identification in the placental cytotypes of symptom-free HBsAg-carrier mothers: a study with the immunoperoxidase method.

In this study the presence of HBcAg in placental tissue of symptom-free HBsAg-carrier mothers has been determined by the immunoperoxidase technique. The presence of HBcAg in the major placental cytotypes was mostly limited to the trophoblastic lineage. Moreover the activated macrophages with their strong cytoplasmic reaction to the antigen phagocytosis play a remarkable role in the immune response. Because there are continuous channels that link the human amnion through the trophoblastic lineage, including the endovascular trophoblast with maternal decidual vessels, a functional exchange system may be considered valid. This would influence the transmission of infection.