[Increase in skin surface temperature in spinal anesthesia. Predictive value for probability of surgical tolerance]. / Hauttemperaturerhöhungen bei Spinalanästhesie. Prädiktiver Wert als Vorhersagewahrscheinlichkeit einer chirurgischen Toleranz.

BACKGROUND: Spinal anesthesia causes sympathetic blockade which leads to changes in the local temperature of the skin surface due to hyperemia. MATERIALS AND METHODS: These changes in skin temperature were used in a newly developed method for estimating the level of analgesia. A total of 11 patients who were scheduled for surgical procedures of the lower extremities with symmetrical spinal anesthesia were included in the clinical study. By means of an electronic digital multi-channel body temperature measurement device with eight high precision temperature sensors placed on defined dermatomes, patient skin temperature was continuously measured at 2 s intervals and documented before, during and for 45 min after spinal anesthesia. Simultaneously, a neurological pin-prick test was carried on at regular intervals every 2 min on the defined dermatomes to calculate the correlation between the effects of analgesia and corresponding changes in skin temperature. RESULTS: The analyzed correlations showed that there is a minimum of 1.05°C temperature difference before and after spinal anesthesia especially on the lower extremities (foot, knee, inguinal) of patient dermatomes. The collected data of varying temperature differences were systematically evaluated using statistical software which led to a deeper understanding of the interdependency between temperature differences at different dermatomes. These interdependencies of temperature differences were used to develop a systematic analgesia level measurement algorithm. The algorithm calculates the skin temperature differences at specified dermatomes to find the accurate level of analgesia and also to find the forward and reverse progresses of analgesia. The developed mathematical method shows that it is possible to predict the level of analgesia up to an accuracy of 95% after spinal anesthesia. CONCLUSIONS: Therefore, it can be concluded that systematic processing of skin temperature data, collected at defined dermatomes can be used as a promising parameter for predicting surgical tolerance. The objective is to improve this experimental method with an extended patient population study.

[Malignant pilomatrixoma of the face]. / Pilomatricoma maligno della faccia.

The authors report a case of malignant pilomatricoma of the right preauricular region in a 66 year old woman. This is a rare neoplasm and only 36 cases have been reported in the literature: 10 in the cervical-facial region and 15 of the scalp. There are problems in differential diagnosis with benign pilomatricoma, basal cell carcinoma, squamous cell carcinoma, parotid masses and the initial stages of cutaneous and subcutaneous cysts. Diagnosis of malignant pilomatricoma is essentially histological. It has a low degree of malignancy but tends to recur after surgery and to metastasize even leading to death. Treatment of choice is a broad surgical excision followed by periodic check-ups. Such exeresis was performed in the case presented and the patient is alive and in good health 67 months after surgery.

[Chronic tonsillitis in childhood: a bacteriological study in connection with benzathine penicillin treatment and the role of bacterial flora in tonsillar hypertrophy]. / Tonsillite cronica dell'età pediatrica: studio batteriologico in rapporto al trattamento con benzatin-penicillina e ruolo della flora batterica nell'ipertrofia tonsillare.

In this study the authors evaluated the importance of bacteriological study in the diagnostics of chronic tonsillitis in children and investigated the eventuality of modification in superficial as well as parenchymal tonsillar microflora brought about by preventive treatment with benzylpenicillin G. The study further aimed at revealing an eventual relationship between microflora and classic laboratory parameters (haemochromocytometric examination, leukocytic formula, VES, ASLO and urine analysis) as well as at evaluating the possibility of a correlation between the degree of tonsillar hypertrophy and microflora. The 100 patients studied had chronic tonsillitis, were between the ages of 4 and 12 and were all candidates for tonsillectomy. The subjects were divided into two groups of 50 patients each; one group had not had any antibiotic treatment for at least 30 days prior to the study, while the second group had undergone antibiotic treatment during the days or weeks immediately before the study and was administered benzylpenicillin G 24 hours prior to sampling. The superficial and intraparenchymal tonsillar tampon samples taken in both groups underwent bacteriological studies. The most frequently isolated bacteria was Haemophilus Influenzae (40% of the cases). A clear-cut prevalence of this bacteria was observed in those patients treated with benzylpenicillin G as opposed to those not treated. Haemolytic Group A Streptococcus was found almost exclusively in the tonsils of those patients not treated with antibiotics (14 out of 15 cases). Various degrees of tonsillar hypertrophy were observed although no sure correlation between the presence of the pathology and the bacteria found, either superficially or in the parenchyma, was established. Furthermore, no significant was revealed between the presence of superficial or intraparenchymal bacteria.