[Laryngeal schwannoma treated with CO2 laser]. / Schwannoma della laringe trattato con laser CO2.

Neurinoma is a benign capsulate tumor originating from the Schwann cells of all nerve fibers outside the central nervous system, the sole exception being the optic and olfactory nerves. These tumors favor the head and neck district but rarely affect the larynx. This work presents the case of a 73-year-old woman treated in the emergency room for an episode of acute dispnea. The patient's case history indicated that for more than 10 years she had the sensation of a foreign body in the hypopharynx and stomatolalia. Direct hypopharyngo-laryngoscopy with a flexible fiberoptic showed a rounded submucosa neoformation 3.5 cm in diameter at the level of the left aryepiglottic fold, blocking the opening of the laryngeal vestibule. Laryngeal motility was perfectly preserved. The decision was made for prompt exeresis of the neoformation under direct microlaryngoscopy with a CO2 laser. Post-operative follow-up showed that all laryngeal functions were preserved. Three months later, the patient was still symptom-free and direct examination of the larynx showed no signs of recurrence. Histological diagnosis indicated a laryngeal schwannoma. Surgical removal is the treatment of choice and can be performed by endoscopy or through an external approach depending on the site and size of the tumor. Different external approaches have been described such as the median thyrofissure, lateral pharyngotomy and lateral thyrofissure. In the present case, although the neoformation was quite large, the decision was made to perform an endoscopy resection with CO2 laser, without resorting to a tracheotomy, reducing post-operative recovery to a minimum and preserving all laryngeal functions.

Consequence analysis in LPG installation using an integrated computer package.

This paper presents the prototype of the computer code, Atlantide, developed to assess the consequences associated with accidental events that can occur in a LPG storage plant. The characteristic of Atlantide is to be simple enough but at the same time adequate to cope with consequence analysis as required by Italian legislation in fulfilling the Seveso Directive. The application of Atlantide is appropriate for LPG storage/transferring installations. The models and correlations implemented in the code are relevant to flashing liquid releases, heavy gas dispersion and other typical phenomena such as BLEVE/Fireball. The computer code allows, on the basis of the operating/design characteristics, the study of the relevant accidental events from the evaluation of the release rate (liquid, gaseous and two-phase) in the unit involved, to the analysis of the subsequent evaporation and dispersion, up to the assessment of the final phenomena of fire and explosion. This is done taking as reference simplified Event Trees which describe the evolution of accidental scenarios, taking into account the most likely meteorological conditions, the different release situations and other features typical of a LPG installation. The limited input data required and the automatic linking between the single models, that are activated in a defined sequence, depending on the accidental event selected, minimize both the time required for the risk analysis and the possibility of errors. Models and equations implemented in Atlantide have been selected from public literature or in-house developed software and tailored with the aim to be easy to use and fast to run but, nevertheless, able to provide realistic simulation of the accidental event as well as reliable results, in terms of physical effects and hazardous areas. The results have been compared with those of other internationally recognized codes and with the criteria adopted by Italian authorities to verify the Safety Reports for LPG installations. A brief of the theoretical basis of each model implemented in Atlantide and an example of application are included in the paper.

[Oropharyngeal angiolipoma: a case study]. / Un caso di angiolipoma orofaringo-ipofaringeo.

Angiolipoma is a histological variation of lipoma. It occurs in 17% of the cases of lipoma and the cervico-facial localization is quite rate. Indeed, in the literature 17 cases of angiolipoma have been presented in the head and neck region and none in the oropharygeal area. The present work reports a case of pedunculate angiolipoma in a 44-year-old male: the red-violaceous growth resting on the upper surface of the tongue--was 13 cm long and 1 cm in diameter. The implantation base corresponded to the left posterior-lateral wall of the oropharnyx, 1 cm below the lower tonsilar pole. A serreneoud loop was used to remove the angiolipoma in direct view, the patients mouth held open with an autostatic gag. Histologically it was a non infiltrating variant for which simple removal is curative and recurrences are rare. Viceversa, removal of the infiltrating type requires expanding there section edges to include surrounding tissues in an attempt to preventre currences which are quite frequent (occurring in approximately 50% of the cases).

The role of erythrocytapheresis in secondary erythrocytosis therapy.

In chronic respiratory insufficiency secondary erythrocytosis (SPC), causing pulmonary hypertension and dx ventricular insufficiency, is often noticed. An alternative therapy to phlebotomy for SPC is isovolemic large volume erythrocytapheresis performed with cell separator (CSE) in order to quickly remove a large volume of red blood cells (RBC) while saving plasma proteins and clotting factors. In order to evaluate the efficiency and safety of CSE in SPC we reported a retrospective analysis of our experience with 61 SPC patients: from April 1996 to May 1998 we performed 208 CSE using Haemonetics MCS3P (TAE protocol). Before every apheresis procedure we verified Hb (in median 18.8 g/dl), Ht (in median 58.4%), viscometry, coagulation test, EGA, PFR and ECG. 11 patients were treated with 1 CSE, 12 with 3, 29 with 4 and 9 with 5. The mean volume of RBC removed was 576 ml (range 426-800); Hb post CSE averaged 14.4 g/dl and Ht post CSE averaged 42.7%; hematic viscosity post CSE was significantly reduced while tissue oxygen tension increased: the improvement of symptomatology and hematochemical parameters was maintained on the average for 6.5 months. All the procedures were well tolerated and light side effects (paresthesias citrate-depending in 27 apheresis) were easily controlled. CSE, compared to phlebotomy, has the advantage of selectively removing RBC without loss of clotting factors, platelets and plasma proteins. Although CSE has relatively high costs we noticed a decrease of hospital recurrence (about 50-65%) in SPC patients treated with apheresis.

Diclofenac sodium in ureteral colic: a double-blind comparison trial with placebo.

A randomized prospective double blind study of the analgesic effect of 75 mg intramuscular diclofenac sodium (Voltaren), a potent prostaglandin synthetase inhibitor, versus placebo (saline solution) was carried out in 131 consecutive patients with acute ureteral colic. Diclofenac provided complete relief of pain 25 minutes after the injection in 59% of the cases, while placebo provided relief in 29% (p less than 0.01). Forty patients in the placebo group and seventeen patients in the diclofenac group needed an open injection of 75 mg diclofenac intramuscularly after 25 minutes due to persistent pain. Fifty-four of the fifty-seven patients treated with an open injection of diclofenac achieved complete relief of pain after 30 minutes. There were no side-effects of the treatment.