Trigeminal neuralgia as unusual isolated symptom of fungal paranasal sinusitis in patients with haematological malignancies.

A sinonasal infection is a frequent complication in patients with haematological malignancies, and may represent a challenge in terms of differential diagnosis between a bacterial or fungal infective process and tumour localization. A timely and correct diagnosis in these patients is critical and, therefore, may require consultation of specialists outside of haematology; an incorrect diagnosis which underestimates the seriousness of the infection can be fatal. Symptomatic trigeminal neuralgia resulting from direct compression or perineural invasion from malignancy is not uncommon in the literature. However, trigeminal neuralgia as an isolated symptom at the onset of a bacterial or invasive fungal sinusitis is rare and risks going unnoticed. The authors herein describe three cases of patients affected by acute myeloid leukaemia or lymphoma in which an invasive fungal sinusitis appeared at the onset as an isolated trigeminal neuralgia, with pain located along the distribution area of the second branch of the trigeminal nerve. Only after referring these patients to a neurologist for a host of neurological exams it was possible to confirm a diagnosis of secondary maxillary sinus fungal involvement.

[Role of color Doppler in the evaluation of the hyperfunctioning thyroid nodule treated with ethanol injection]. / Ruolo del color Doppler nella valutazione del nodulo iperfunzionante della tiroide trattato con alcolizzazione.

Color Doppler gives us the possibility to study autonomous thyroid nodules and their qualitative and morphological aspects and allows us to hit session by session the most vascular area of the nodule with alcohol (Percutaneous ethanol injection). The use of color gives an easier flowmeter analysis reducing its time of performance. Today this method with the latest up to date echographs can provide very good clinical pathology at relatively low costs. We studied 18 patients, with autonomous thyroid nodules. They were all treated by percutaneous echo-guided ethanol injection (PEI). Before the beginning we make sure that the rest of the thyroid gland may function normally. The color Doppler test was carried out by using the multidisciplinary ecotomograph AU 560 CFM supplied with a linear probe 7.5 mHz, AL 35 by Esaote Biomedica. Before the PEI treatment, with the eco color Doppler test we noticed that the hot nodules clearly presented a higher vascularization compared to the remaining parenchyma. The vascularization was more evident in the peripheral area of the nodule even if few signs of flow were present inside the nodule. During a 24 months followup, 10 patients showed an important reduction and sometimes even the extinction of the intranodular flow signs followed by a clear reduction of the nodule's volume.

[Flow quantification with magnetic resonance: preliminary results with phase contrast technique]. / Quantificazione del flusso con Risonanza Magnetica: risultati preliminari con tecnica con contrasto di fase.

This study investigated the accuracy of phase contrast MRI in blood flow measurements; both in vitro and in vivo studies were carried out. Five normal volunteers (3 women and 2 men, age range: 24 to 30 years) were examined with MR angiography (MRA) and a flow measurement sequence. A 2D phase contrast sequence, with retrospective cardiac gating was also acquired with the following imaging parameters: TR/TE/FA (26/9.3/20 degrees ), field of view 150 mm, matrix 96 x 128; 4 averages. VENC value (cm/s) was chosen according to the examined region. The total acquisition time ranged 3 min 25 sec to 4 min 38 sec. The sequences were acquired on a plane perpendicular to the vessel direction, using MIP-reconstructed MRA images as a scout view. The results are the same as those obtained with other techniques, in the common carotid artery (Vmax = 70.7 cm/s; Vmin = 18.8 cm/sec; flow = 348 ml/min), internal carotid artery (Vmax -54.4 cm/sec; Vmin = 18 cm/sec; flow = 236 ml/min) and vertebral artery (Vmax = 51.7 cm/sec; Vmin = 17.5 cm/sec). The resistance index could always be calculated and exceeded 0.7 in all cases. In conclusion, MRA is an accurate technique for blood flow measurements, in particular with cardiac gating, which permits measurement optimization according to the different cardiac cycles.