Deep venous thrombosis and abortion: an unusual clinical manifestation of severe form of pectus excavatum.

Pectus excavatum is a chest wall malformation with a strong psychological and aesthetic impact. Rarely, pectus excavatum patients can show respiratory or cardiac symptoms occurring mainly during physical exertion. We report a case of a 34-year-old pregnant woman with a severe degree of pectus excavatum who developed serious cardiovascular disease resulting in spontaneous twin abortion at the twenty-first week of gestation. Cardiovascular disease was resolved after open surgical correction of pectus excavatum. This case shows how a tardive diagnosis and a delayed surgical approach for pectus excavatum can lead to severe consequences.

Comparison of ketamine-dexmedetomidine-methadone and tiletamine-zolazepam-methadone combinations for short-term anaesthesia in domestic pigs.

Cardiorespiratory effects, quality of induction, depth of anaesthesia and quality of recovery were compared in pigs anaesthetised with 8 mg/kg ketamine, 20 µg/kg dexmedetomidine and 0.2 mg/kg methadone (KDM, n = 18) or 8 mg/kg tiletamine-zolazepam and 0.2 mg/kg methadone (TZM, n = 9). Anaesthesia with KDM was partially reversed in nine animals with 0.2 mg/kg atipamezole (KDMat). Sedation was observed earlier in the TZM group (47.2 ± 25.3 s) than the KDM group (91.5 ± 37.4 s). Sternal and lateral recumbency were achieved earlier in the TZM group (76.3 ± 36.5 s and 132.1 ± 30.5 s, respectively) than in the KDM group (149.1 ± 58.7 s and 249.2 ± 84.0 s, respectively). PaO2, SaO2 and PaO2:FiO2 were lower in the TZM group (68.7 ± 4.1 mmHg, 93.4 ± 1.4% and 327.2 ± 19.9 mmHg, respectively) than in the KDM group (80.4 ± 5.9 mmHg, 95.7 ± 1.0% and 380.4 ± 25.6 mmHg, respectively). Fshunt and P(A-a)O2 were higher in the TZM group (24.0 ± 11.8% and 31.4 ± 3.8 mmHg, respectively) than in the KDM group (13.4 ± 3.2% and 20.7 ± 7.4 mmHg, respectively). Times from drug injection to first head movements, sternal recumbency and standing/walking were significantly shorter in the KDM group (45.1 ± 10.5, 48.4 ± 12.6 and 54.4 ± 17.8 min, respectively) than in the TZM group (57.8 ± 11.4, 93.1 ± 14.2 and 165.7 ± 56.6 min, respectively). The median recovery score was higher in the TZM group than in the KDMnoat and KDMat subgroups. Both drug combinations provided adequate anaesthesia for minor procedures lasting about 30 min, but TZM was associated with a poor recovery and oxygenation.

Glide video laryngoscope for the management of foreign bodies impacted at the hypopharyngeal level in adults.

BACKGROUND: Cricopharyngeal foreign bodies (FBs) impaction in adults is a common clinical problem; without treatment, the sequelae may be lethal due to local and/or mediastinal infection. When direct laryngoscopy and flexible fiberoptic endoscopy are ineffective, rigid endoscopy is the method of choice requiring general anesthesia. The new video laryngoscopes represent a great advancement in the assessment of the laryngeal inlet. Aim of the study was to assess the feasibility of identifying and removing FBs impacted at crycofaringeal and upper oesophageal sphincter by the video laryngoscope. METHODS: In a period of 30 months, on an urgent basis, we systematically assessed by GlideScope® video laryngoscope all adult patients with a diagnosis of impacted crycofaringeal upper esophageal FB, after unsuccessful removal attempts in the otolaryngology or gastroenterology unit. RESULTS: Twenty-six consecutive patients were evaluated. In conscious sedation by video laryngoscope 17 FBs were identified and removed from the hypopharynx or upper esophageal sphincter. In 9 patients rigid endoscopy in general anesthesia and tracheal intubation was necessary to remove FBs impacted beyond the upper esophageal sphincter. CONCLUSION: In our experience video laryngoscope, because of the magnified vision, the better patient comfort and no requirement of general anesthesia, represents a great improvement in identifying and removing in conscious sedation even small and thin foreign bodies not recognized by radiological and otolaryngology examination and not readily detected by direct endoscopy.

Concomitant high gene copy number and protein overexpression of IGF1R and EGFR negatively affect disease-free survival of surgically resected non-small-cell-lung cancer patients.

BACKGROUND: Insulin-like growth factor 1 receptor (IGF1R) represents a novel molecular target in non-small-cell-lung cancer (NSCLC). IGF1R and epidermal growth factor receptor (EGFR) activation are essential to mediate tumor cell survival, proliferation, and invasion. This study investigates the prognostic role of IGF1R and EGFR in surgically resected NSCLC. MATERIALS AND METHODS: IGF1R and EGFR copy number gain (CNG) were tested by fluorescence in situ hybridization (FISH) and protein expression by immunohistochemistry (IHC) in 125 stage I-II-IIIA NSCLC patients. RESULTS: Fourty-six tumors (40.3%) were IGF1R FISH-positive (FISH+), and 76 (67.2%) were EGFR FISH+. Tumors with concomitant IGF1R/EGFR FISH+ were observed in 34 cases (30.1%). IGF1R and EGFR FISH+ were associated with SCC histology (p = 0.01 and p = 0.04, respectively). IGF1R and EGFR protein over-expression (IHC+) were detected in 45 (36.0%) and 69 (55.2%) cases, respectively. Tumors with concomitant IGF1R/EGFR IHC+ were detected in 31 (24.8%) patients. IGF1R/EGFR FISH+ and IGF1R/EGFR IHC+ were significantly associated (χ(2) = 4.02, p = 0.04). Patients with IGF1R/EGFR FISH+ and IGF1R/EGFR IHC+ were associated with shorter disease-free survival (DFS) (p = 0.05 and p = 0.05, respectively). Patients with concomitant IGF1R/EGFR FISH+/IHC+ had a worse DFS and overall survival (p = 0.005 and p = 0.01, respectively). The multivariate model confirmed that IGF1R/EGFR FISH+/IHC+ (hazard ratio (HR), 4.08; p = 0.01) and tumor stage (II-III vs I) (HR, 4.77; p = 0.003) were significantly associated with worse DFS. CONCLUSIONS: IGF1R/EGFR FISH+ correlates with IGF1R/EGFR IHC+. IGF1R/EGFR FISH+/IHC+ is an independent negative prognostic factor for DFS in early NSCLC. These features may have important implications for future anti-IGF1R therapeutic approaches.

Totally cervical thymoma from the orthotopic thymus.

Totally cervical thymoma is extremely rare and usually arises from ectopic thymic tissue. We report a case of a B1 thymoma localized in the neck, misdiagnosed for a decade as a thyroid nodule. Fine needle aspiration biopsy led to a preoperative suspicion of the correct diagnosis. The tumor was resected intact through a cervical collar incision, along with the upper thymic horn from which it originated. A pathogenetic hypothesis was formulated.

A simple method to detect complement receptors using baker's yeast: Y C rosettes.

A technique is described to identify complement-receptor-bearing cells, using serum-treated baker's yeast as a ligand. The method consists of incubation of heat-killed baker's yeasts with fresh AB normal serum, freezing, thawing, and washing of the particles, followed by mixing with the cells. Serum is required to coat the yeasts for the rosette formation. Experiments designed to establish the serum factors responsible for the attachment of the particles to cells show that heat inactivation, chelating agents, or anti-C3 treatment prevent rosette formation. This is taken as evidence that yeasts (Y) are coated with complement (C) to compose the reagent for the YC rosette technique. The application of this technique to twenty-five normal individuals demonstrated that a mean of 11.6 per 100 lymphocytes (+/- 4.3) form rosettes; absolute number: 275 (+/- 160) rosette-forming lymphocytes per mm3. Either AB or autologous fresh serum can be used to coat the yeasts. A combined technique for YC plus E rosettes can be performed allowing the identification and enumeration of four populations of lymphocytes: (a) those having receptors for sheep erythrocytes, (b) complement-receptor-bearing lymphocytes, (c) those having both receptors (D lymphocytes), and (d) non-rosette-forming non-phagocytic cells.