[Communication and interpersonal skills in medicine: an educational intervention in hospital]. / Le abilità comunicativo-relazionali in medicina: un percorso formativo in ambito ospedaliero.

The present paper is aimed to describe methods and results of an educational intervention on doctor-patient communication. The intervention was addressed to 26 hospital physicians and lasted 20 hours, and it was formulated according to patient-centred model. At the end of the intervention, participants referred satisfaction for the course, and the proportion of doctors with patient-centred style was higher compared to the one of the initial assessment (Z Wilcoxon=2,236; p=.02). No associations were found between communicative-relational style and sociodemographic variables. For hospital physicians, three main topics seems require future interventions: the communication of bad news, the management of own emotions, the influence of context's factors on doctor-patient relationship.

Lump on the scalp of a child arising over a previous parietal fracture: growing skull fracture or post-traumatic lipoma?

A young girl was referred to our Institution for the appearance of a painless soft swelling in the right parietal region of the scalp. In the same site, the patient had a parietal bone fracture 1 year ago. In the suspicion of a growing skull fracture, the patient underwent radiological investigations. Ultrasound showed a soft, poorly vascularised swelling with parenchymatous content. The skull X-ray showed an apparent healing of the previous fracture. CT scan and MRI confirmed the correct healing of the fracture and described the presence of a lipomatous mass. The mass was surgically removed and histology confirmed the diagnosis of encapsulated lipoma. The postoperative period was uneventful, with no evidence of infections or recurrence in the 6-month follow-up.

Multidisciplinary Management of an Orbitocranial Penetrating Injury by a Pencil in a Paediatric Patient - A Case Report.

Rationale: Orbitocranial penetrating injuries can accidentally occur in children while handling pencils and can cause severe sequelae such as ocular damage, brain lesion, intracranial haemorrhage, and infections. Patient Concerns: We report the case of a 7-year-old child with an orbitocranial penetrating injury by a pencil, initially gone undetected, that caused a direct damage to the optic nerve. Diagnosis: Computed tomography scan with contrast detected the foreign body and the presence of a lesion of the left internal carotid artery. Treatment: Angiography was performed to treat the vascular lesion and to prevent haemorrhage. Subsequently, a craniotomy was performed to assist the extraction of the pencil from the entry wound and to remove residual fragments. Outcomes: Left eye vision was lost. The 1-year follow-up was uneventful. Take-away Lessons: Operative angiography is mandatory before the surgical extraction of the orbitocranial penetrating injury in case of documented intracranial vessel damage.

Chronic nonbacterial osteomyelitis involving the mandible: A case report.

INTRODUCTION: Chronic nonbacterial osteomyelitis (CNO) or chronic recurrent multifocal osteomyelitis (CRMO), is a very rare condition of unknown aetiology. It is characterised by focal sterile inflammatory disease with prolonged, self-limiting and recurrent episodes. CASE PRESENTATION: We report the discovery of this very rare disease following a mandibular abscess in a 10-year-old female. We initially focus on the difference between the preoperative orthopantomography and the maxillofacial computed tomography and magnetic resonance images obtained, and then on the improvement of strategies for correct diagnosis and treatment of this disease. DISCUSSION: Bone pain and localised swelling can occur in a single bone or can spread to soft tissue and adjacent bone; areas commonly affected by CMRO include the metaphyseal plates of the long bones, as well as the spine, clavicle and, rarely, the maxillofacial area. The clinical presentation of CMRO includes pain, functional impairment, and swelling, similar to our case. CONCLUSIONS: We report a very rare case of this unifocal mandibular disease in a child who presented for an abscess and was then diagnosed and treated for CNO.

Preoperative and postoperative voice in Tis-T1 glottic cancer treated by endoscopic cordectomy: an additional issue for patient counseling.

Radiotherapy contends with endoscopic surgery for the role of treatment of choice for Tis-T1 glottic cancer. The amount of vocal cord to be surgically removed logically depends on the surface and deep extension of the neoplasm. Thus, a prerequisite for proper management includes an analysis of the voice changes after each of the progressive types of cordectomy described in the European Laryngological Society Classification. Between January 1998 and December 2000, 89 patients with glottic cancer (8 Tis, 63 T1a, 18 T1b) underwent different types of endoscopic cordectomy. Perceptual analysis (GRBAS scale); objective analyses of jitter, shimmer, and noise-to-harmonics ratio; and subjective (Voice Handicap Index) evaluation of voice were performed in 51 patients. Statistical evaluation of preoperative and postoperative objective results by analysis of covariance, as well as perceptual and subjective data, showed significant voice improvement after type I and II cordectomies, with the voice attaining nearly normal parameters. By contrast, after type III, IV, and V cordectomies, the vocal outcome was not significantly different from the preoperative pattern. It can therefore be concluded that type I and II resections, whenever indicated, are adequate procedures even for professional voice users. By contrast, accurate counseling is mandatory before type III, IV, and V cordectomies.

Analysis of recurrences in 322 Tis, T1, or T2 glottic carcinomas treated by carbon dioxide laser.

An endoscopic approach to early glottic carcinoma is considered a sound treatment for both previously untreated lesions and selected recurrent lesions. Between January 1988 and December 2000, we treated 322 patients by CO2 laser at a single institution; 37 had Tis, 191 T1a, 55 T1b, and 39 T2 lesions (mean follow-up, 77 months; range, 6 to 180 months). Kaplan-Meier curves showed a 5-year overall survival rate of 88%, a determinate survival rate of 99%, a disease-free survival rate of 81%, a rate of ultimate local control with laser alone of 91%, and a laryngeal preservation rate of 97%. Univariate and multivariate analysis showed that the only factor that statistically affected endoscopic control was lateral extension of the tumor with involvement of the bottom of the ventricle (hazard risk ratio, 4.0; 95% confidence interval, 1.71 to 9.35). The 58 recurrences were classified according to their location compared with the site of the primary tumor as follows: 14 in the same area (group A), 27 in adjacent subsites with superficial spreading or multifocal distribution (group B), and 17 in adjacent sites by submucosal diffusion to the visceral spaces, cartilaginous framework, or extralaryngeal tissues (group C). For each group, we analyzed the rate of patients who underwent salvage by endoscopic or open neck procedures and the rate of laryngeal preservation. Recurrences in groups A and B were endoscopically treated in 86% and 74% of cases, respectively. By contrast, in group C no patient was endoscopically cured, and there was a low laryngeal preservation rate (47%). The pathways of spread in recurrent carcinoma are therefore the single most important factor in predicting its endoscopic curability.