Magnesium sulfate for persistent pulmonary hypertension of the newborn.

BACKGROUND: Persistent pulmonary hypertension of the newborn (PPHN) occurs in approximately 1.9 per 1000 newborns and may be more frequent in developing countries. There is strong evidence for the use of inhaled nitric oxide (iNO) and extra corporeal membrane oxygenation (ECMO) in the treatment of PPHN. However, many developing countries do not have access or the technical expertise required for these expensive therapies. Magnesium sulfate is a potent vasodilator and hence has the potential to reduce the high pulmonary arterial pressures associated with PPHN. If magnesium sulfate were found to be effective in the treatment of PPHN, this could be a cost effective and potentially life-saving therapy. OBJECTIVES: To evaluate the use of magnesium sulfate compared with placebo or standard ventilator management alone, sildenafil infusion, adenosine infusion, or inhaled nitric oxide on mortality or the use of backup iNO or ECMO in term and near-term newborns (> 34 weeks gestational age) with PPHN. SEARCH STRATEGY: The standard search strategy of the Cochrane Neonatal Review Group (CNRG) was used. No language restrictions was applied. The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2006) and MEDLINE (1966 to April 20, 2007) were searched for relevant randomized and quasi-randomized trials. In addition the reference lists of retrieved articles were reviewed and known experts were contacted to obtain unpublished data. SELECTION CRITERIA: All randomised or quasi-random studies were eligible where one of the treatment groups received magnesium sulfate for PPHN. DATA COLLECTION AND ANALYSIS: Standard methods of the Cochrane Collaboration and the CNRG were used, including independent assessment of trial quality and extraction of data by each author. MAIN RESULTS: No eligible trials were found AUTHORS' CONCLUSIONS: On the basis of the current lack of evidence, the use of magnesium sulphate cannot be recommended in the treatment of PPHN. Randomised controlled trials are recommended.

[Contribution to the knowledge of pseudoneoplastic pathology of the breast. Cyto-steatonecrosis]. / Contributo alla conoscenza della patologia pseudoneoplastica della mammella. La citosteatonecrosi.

The authors, from the observation of a case of mammary fat necrosis (BFN), observe the problematic nature of this rare pathology, and describe the clinical anatomy and the main epidemiological, etiological, radiographical, and echographic aspects. They dwell upon the anatomical pathology phase of the fibrous substitution and the fibrosclerosis of the liponecrotic area, in which the BFN assumes a pseudoneoplastic importance, responsible for a clinical summary (hard nodule, of indistinct limits, with frequent cutaneous retractions), a radiography (opacity with faded and irregular or spicular outlines, with or without the thickening and the retraction of the skin above; stick-like or angular dentitrical microcalcifications) an echography ( hypoechogenous nodule that may or may not absorb ultrasounds) that are indistinguishable from those of a carcinoma, or are difficult to interpret in cases of granulomatous substitution not yet evolved into retracted fibrosis. They conclude by emphasizing the role of surgical excision biopsy, with an extemporaneous histological examination, the results of which decide either the immediate closure of the surgical incision, or the adoption of another type of operation.

[A case of giant fibroadenoma of the breast in adolescence]. / Su di un caso di fibroadenoma gigante della mammella nell'adolescenza.

Starting from a personal observation of a giant fibroadenoma of the breast in a girl aged 13, the authors review the possible causes of massive swelling of the breast in adolescence. Next, they analyze the salient anatomoclinical aspects of giant fibroadenoma, benign phylloid cystosarcoma, and virginal mammary hypertrophy. The conclude that the surgeon should do everything possible to arrive at the histological diagnosis of fibroadenoma intraoperative--that is, extemporaneously--in order to avoid treating as a malignancy a possible benign phylloid cystosarcoma.

[Doctrinal and clinical aspects of cancer of the male breast]. / Aspetti dottrinali e clinici del cancro della mammella maschile.

On the base of a recent observation of one case of male mamma carcinoma, the authors examine the generalities and the etiopathogenetic factors of this rare tumor, also on the base of the most recent acquisitions on hormonal receptors. Then they stop on the characteristics of clinical picture, and outline the high frequency of unfavourable events, at the first medical examination already. In the end they outline the elective treatment and the therapy for the recovery of the cases with metastasis and they present the results of the most qualified mondial casuistry.

[A-mode echography in surgery: a study of solitary thyroid nodules (author's transl)]. / L'ecografia A-mode in chirurgia. Studio dei noduli solitari della tiroide.

As part of their exploration of the possibilities afforded by A-mode ultrasonic investigation in several disorders of surgical interest, the authors report the results obtained in the study of solitary thyroid nodules. More precisely, after a brief explanation of ultrasonics, current apparatus for echography, and methods for echographic examination, they describe the semiological features exploited in A-mode echography: namely nodules with liquid content, mixed content, solid homogeneous content, and solid heterogeneous content. They conclude with considerations on the principles and indications of this diagnostic procedure in the light of their personal experience.

[A-mode echography in surgery. Study of nodular lesions of the breast]. / L'ecografia A-mode in chirurgia. Studio delle lesioni nodulari della mammella.

In the context of researches for studying the possibilities of ultrasonic A-mode research for a diagnosis of thyroid, mamma and abdominal organs affections, in this first part the authors make known the results obtained studying nodulary lesions. After a short notice about ultra-sounds, echoscopic apparati and methods for echoscopic research, they outline the semeiologic characters for echoscopic A-mode diagnostic and they stop on echoscopic obtained pictures: liquid crops, nodulary images with homogeneus echostructure scarcely ecogena and nodulary images with not homogeneus echostructure highly ecogena. Then they ended with some considerations about the principles and the indications of this method, in the light of personal experience.

[Pulmonary blastoma. (Personal case)]. / Il blastoma polmonare. (Contributo personale).

The authors give a detailed description of one case of pulmonary blastoma recently come to their observation. Then, after a review of pertinent literature, they discuss the more interesting aspects of this pulmonary pathology, namely its rarity, uncertain histogenesis, difficult diagnosis, and above all baffling prognosis. They conclude with an appeal for further contributions on this interesting subject, in the hope of understanding it better through the study of an adequate number of cases.

[A case of giant hamartochondroma of the lung]. / Su di un caso di amartocondroma gigante del polmone.

The authors present a case of pulmonary hamartochondroma of exceptional size, of which they give a clinical descrition and explain the surgical treatment. Next, aloso in the light of recent literature on the subject, they review the possible causes of this disorder in terms of several histopathogenetic hypotheses, and they discuss problems of differential diagnosis as well as the histopathological aspects of this rare, benign tumor of the lung. They conclude that even though malignant transformation of hamartochondroma is exceptional, these tumors should always be removed surgically as soon as they are diagnosed or reasonably suspected.

[Echinococcic cyst of the thyroid]. / Contributo alla conoscenza della cisti da echinococco della tiroide

The Authors, starting from observation of a hydatid cyst of the thyroid, make an examination of this very rare pathological occurrence. They then put forward and evaluate the fundamental problem linked to this localisation of hydatidosis, a problem which can be summed up as the lack of pathological identification of the clinical pattern and the consequent ease of making a diagnostic error. They conclude by stating that the sole differential diagnostic criterion in relation to other diseases that may be considered (cystic uninodular goitre, adenoma, epithelial cyst, haematic pseudocyst) consists in the simple recollection of the possible existence of this very rare localisation of the echinococcus.

[Extramucosal single-layer suture with multifilament stainless steel wires in surgery of the colon. Experimental research]. / La sutura monostrato extramucosa con fili di acciaio inossidabile multifilamentoso nella chirurgia del colon. Ricerche sperimentali

With a view to evaluating whether and how far a fuller case documentation may contribute to a better knowledge of the real possibilities of multifilament stainless steel wires in surgery of the colon, the Authors present and discuss the results they obtained during the course of experimental research on extramucosa single-layer sutures. In the light of their personal histological documents, they emphasize the absolute biological inertia of this suture material, a property which, together with the capacity of not suffering the colliquative action of germs, means that multifilament stainless steel wires can be given full rights of domicile in colon surgery.