Esthesioneuroblastoma treated with external radiotherapy. Case report.

Esthesioneuroblastoma is a rare tumour arising from the olfactory epithelium of the nasal vault which frequently invades the cranial base and orbit. Esthesioneuroblastoma has a bimodal age distribution between 11 and 20 years and between 51 and 60 years. Esthesioneuroblastoma accounts for approximately 1-5% of intranasal cancers. The case is reported of a 79-year-old female patient with a Kadish stage C tumour with a one-year history of headache, nasal obstruction, anosmia, rhinorrhoea and epistaxis. Aim of this study is to analyse the natural history, treatment and prognosis of this tumour, based on a review of the literature.

The management of hemodialysis arteriovenous fistulas in well functioning renal transplanted patients: many doubts, few certainties.

UNLABELLED: Vascular access (VA) for hemodialysis (HD) is one of the most important clinical problems in end-stage renal disease (ESRD) patients because it can limit a life support system and can influence long-term dialysis patient survival. Nevertheless, VA becomes useless after a successful renal transplant. Therefore, we wanted to evaluate the natural history of arteriovenous fistulas (AVF) in renal transplanted patients and the possibility of maintaining the fistula as patent or not. METHODS: A retrospective study was conducted to evaluate kidney transplant patients in our unit from April 1994 to April 2004. We studied 542 patients. RESULTS: There were 365 patients with a well functioning kidney. Eighty-six patients died. Ninety-one patients were put back on dialysis: 89 patients on HD and two patients on CAPD. Of the 365 patients with functioning kidney transplants, 198 patients demonstrated a patent fistula, while 167 patients had a closed fistula. One hundred and twenty-five patients had a spontaneous closure and 42 patients had a surgical closure. Of the 89 patients put back on dialysis, 49 patients used the previous AVF, while it was necessary to create a new VA in 40 patients. CONCLUSIONS: As demonstrated by the results of our study, after renal transplantation the possibility of spontaneous AVF closure caused by a thrombosis is not a rare event. The dilemma is whether to preserve a fistula that could be useful in case of restarting HD or to perform a systematic fistula closure because of cardiac output and cardiac failure risks. Concerning this question there is no consensus between different authors in the literature. In reviewing the literature and analyzing our data, we conclude that the definite indications for AVF closure in well functioning renal transplanted patients are heart failure, high flow fistula, VA complications and important aesthetic reasons. Routine AVF closure is not indicated until prospective and randomized studies can demonstrate the ability of this procedure to reduce the high incidence of cardiac morbidity and mortality that is present, even after renal transplantation.

[Temporary vascular access for haemodialysis: is infection still the most important complication?]. / L'accesso vascolare temporaneo per emodialisi: e' ancora l'infezione la complicanza da temere maggiormente?

BACKGROUND: Aging in the dialitic population currently shows the problem of vascular access for haemodialysis. The use of temporary catheters for haemodialysis has increased the risk of infections. DOQI guidelines underline this problem. We think that the thrombosis of central veins is a problem as important as infection. METHODS: In the last two years we studied prospectively 310 patients. 686 catheters for haemodialysis were placed. Infection, malfunctioning of catheters and thrombosis of central veins were studied. We compared femoral catheters with jugular catheters. Finally we studied by ultrasound the jugular vessels diameter and thrombi of jugular vein. RESULTS. Fever was present in 5.55% of patients with femoral catheters and in 5.84% of the patients with jugular catheters. The malfunctioning incidence in patients with femoral catheters was 22.75% and 8.76% in patients with jugular catheters with statistic difference. Ultrasound study of jugular veins showed thrombotic incidence of internal jugular vein in 20,8% of patients. CONCLUSIONS: We think that with correct management of catheters there is no difference in the incidence of fever in patients with jugular catheters versus femoral catheters. Probably jugular catheters have better performance than femoral catheters. We need controlled studies to better understand the problem of central vein thrombosis.

Which kind of vascular access for hemodialysis in pediatric patients?

The choice of vascular access in hemodialysis pediatric patients can be challenging, due to the small diameter of vessels. In the last 19 years, 38 arteriovenous fistulas (AVF) for hemodialysis have been created on 21 patients; 25 of them were radio-cephalic AVF. The evaluation of the vessels was, in the majority of cases, done by clinical criteria. A local anesthesia was used in all surgical procedures. The percentage of early AVF failure was 24%. Long-term AVF survival was 97%, 65% and 55% at respectively 1, 3 and 5 years. Our data indicate that even in pediatric patients the radio-cephalic fistula is the first choice surgical procedure.

Internal jugular vein thrombosis after positioning CVC in dialysis patients: The most common ultrasound patterns.

Frequently patients are started on hemodialysis after the placement of a central venous catheter (temporary or tunneled) in the internal jugular vein (IJV). Currenty this procedure is facilitated by ultrasound probes that improve the rate of success of catheter placement in vessels and diminishes the possible complications, minimizing the gap between nephrologists with wide surgical expertise and those with limited surgical experience. Stenosis and thrombosis of the subclavia vein are well documented complications derived from the placement of the venous catheter. Internal jugular vein thrombosis is not seen very often due to scarce clinical evidence. In our paper we have been able to systematically document various extrinsic thrombotic complications outside the central venous catheter, by use of ultrasound (periluminar or related to the vessel).

[Evaluation of the possible effects of phototherapy on the nonnutritive sucking patterns in newborn infants]. / Valutazione di eventuale incidenza della fototerapia sui patterns della suzione non nutritiva nel neonato.

The eventual incidence of the phototherapy on the patterns of the nonnutritive sucking in the neonate at term has been evaluated. The comparison between the two groups of newborns (those in phototherapy treatment and the control group), allowed us to make a conclusion that the phototherapy does not affect in a significant way the patterns of the nonnutritive sucking in the newborns at term, as it is shown from the evaluation of the t-student test p less than 0.01.

[The use of the computer in the neonatal intensive therapy unit: the current and prospective aspects]. / L'uso del computer in un'unità di terapia intensiva neonatale: attualità e prospettive.

The Authors assert that computer can give an adjunctive value to our abilities, improve the punctuality of own service, lighten the duties of routine (leaving free time for own-self or for adjournment). We have noticed a gradual but continuous increase of the use of the computer in the last years in hospital particularly in the Neonatology department and in the NICU, even because in these departments the data to compare are numerous. In the Brindisi's NICU since 1/7/1986 there has been a process of progressive increase of the use of the computer, based on three directions: filing data of the patients, computer-assisted management of the treatment of RDS, computer-assisted follow-up of the risk-baby, and management of the resources. Moreover are reported possibilities of future applications, as records of diagnosis and helped therapy, interface with medical equipment, linking with databank and with the hospital's mainframe.

[Care of small for gestational age infants: personal caseload]. / Assistenza al neonato piccolo per l'età gestionale: casistica personale.

The Guidelines for Perinatal Care define SGA or IUGR infants those with birthweight < 2500 g and below the tenth percentile for gestational age. In Brindisi's N.I.C.U. in the period from 1/07/1986 to 27/02/1992, 295 newborns were admitted with G.A. = 37.08 +/- 2.87 w (mean +/- s.d.), birthweight = 2013 +/- 505 g, length = 438 +/- 44 mm, head circumference = 307 +/- 31 mm. Among these 80.9% has been discharged in good conditions; 9.4% was discharged with some problems and 9.3% died. In hour Hospital the incidence of SGA at birth has been 1.83% in 1987, 2.13% in 1988, 2.1% in 1990 and 2.3% in 1991, in agreement with the literature's data. In the group of SGA infants, we have had 43.86% with symmetrical IUGR, 39.15% with asymmetrical and 16.98% with intermediate IUGR: In this study, besides, the Authors examine some of the main problems that affected the SGA newborns.

Scintigraphic evaluation of gastroesophageal reflux in newborns.

OBJECTIVES: This study was carried out to verify whether during neonatal stage gastroesophageal scintigraphy, may be useful not only to diagnose gastroesophageal reflux (GER), but also to detect pulmonary aspiration, at times responsible for respiratory symptoms frequently associated with GER. PATIENTS AND METHODS: Gastroesophageal scintigraphy was performed on 50 newborns admitted to NICU of Brindisi in the last two years who presented symptoms as cyanosis, apnoea, bradycardia, laringeal stridor, wheezing, not related to respiratory or cardiac problems, but suspected to be clinical suggestive symptoms of "pathological" GER. After administration of 99mTC mixed with the usual meal formula, we obtained a recording period of 60-90 minutes and a later recording at 4 and 24 hours to document radioactive material in lungs. RESULTS: Scintigraphy showed GER in 40/50 cases and despite frequent observation of respiratory symptoms (39/40 cases) in these newborns never radiation in pulmonary fields. CONCLUSIONS: Our results could indicate that scintigraphy, noninvasive and low in radiation, may be considered effective and reliable to diagnose GER in newborns. The absence of radiation in pulmonary fields could indicate that respiratory symptoms frequently associated with GER could depend on involuntary mechanism of vagal type and not on pulmonary aspiration.

[Multivariate analysis of prognostic factors and survival in patients with "glioblastoma multiforme"]. / Multivariate analysis of prognostic factors and survival inpatients with "glioblastoma multiforme".

PURPOSE: The aim of this study was to evaluate the survival of patients with "glioblastoma multiforme", to analyse the prognostic factors influencing the survival rate and to review recent results in the literature. MATERIALS AND METHODS: Seventy five patients underwent radiation treatment between May 1998 and April 2003. Among the factors under investigation we ascertained that sex, chemotherapy, conformal treatment, surgery, and the choice of the irradiation area (whole brain or only the involved field) did not influence the survival in a statistically significant manner. RESULTS: Whereas age and total dose were the 95% statistically significant variables. Hazard ratio of patients older than 58 years compared to younger patients was 1.69. The death risk was 69% in older than younger patients. A greater irradiation dose improved the survival with an increase of the median survival days. The total dose lower than 6000 cGy caused an increase of 81.8% in the death risk. The median survival from the diagnosis to the death was 14.7 months (446 days) and 1-, 2- and 3- year survival rate was 69.3%, 38.4%, and 14.7% respectively. CONCLUSIONS: The current medical literature and our experience attests that the use of temozolomide improves the survival of these patients.

[Electrocardiographic and echocardiographic changes during antihypertensive therapy]. / Modificazioni elettrocardiografiche ed ecocardiografiche durante terapia antipertensiva.

To investigate the changes of electrocardiographic and echocardiographic indexes of left ventricular hypertrophy (LVH) during antihypertensive therapy, 100 hypertensive patients, mean age 46 years, were studied in pretreatment condition and during 12 months of antihypertensive therapy. In pretreatment condition, 83 patients showed LVH by echocardiography (echo; left ventricular mass index greater than 130 g/m2) and 30 patients had LVH by electrocardiography (ECG) (Sokolow index greater than 35 mm). In comparison to echo index of LVH, Sokolow index showed a sensibility of 34% and a specificity of 88%. Both LV mass echo index and ECG index significantly decreased after 3 months but in different way. LV mass index mainly decreased after 12 months, whereas Sokolow index particularly decreased after 6 months, with no further changes in the subsequent months. After 12 months of therapy, the LV mass echo index normalized in 19% of the patients (16/83) and Sokolow index normalized in 57% (17/30). ECG sensibility and specificity, in comparison to LV mass echo, was 20% and 100%, respectively. Thus, ECG appears less sensitive than echo in the detection of LVH. During antihypertensive therapy ECG index of LVH normalized more precociously and to a greater extent than the echo index. However, the normalization of LVH by ECG does not necessarily mean that a complete anatomic regression of LVH has occurred.

Acute renal failure after massive ingestion of gliclazide in a suicide attempt.

Gliclazide, a sulfonlyurea class molecule, is used to control glycaemic levels in non-insulin-dependent diabetes mellitus. Acute and chronic toxicity studies, conducted in various animal species, have demonstrated a very low toxicity. We report a patient who developed acute renal failure due to acute tubular necrosis following a massive ingestion of gliclazide in an suicide attempt. The patient ingested 28 grams of gliclazide; the normal dose of gliclazide is 80 mg one or twice a day. At admission the patient was hypoglycaemia and in a few days became oliguric with an increase in the serum creatinine concentration, but with a normal blood urea nitrogen level. He underwent dialysis and ten days after ingestion of gliclazide, his renal function improved rapidly.