Not just a matter of weight: A case report of ECMO treatment in a severely obese patient.

The ELSO Guidelines list a BMI ≥ 40 kg/m2 among the relative contraindications to give ECMO treatment in SARS - COV2 patients. We describe a case of a 52-year-old with BMI 50.21 kg/m2, admitted to the intensive care unit (ICU) with severe respiratory conditions and successfully treated with extracorporeal membrane oxygenation (ECMO). The application of veno-venous (VV) ECMO will evolve as far as we understand the pathophysiology of the COVID-19 disease and will probably have a determinant role in management of patient with refractory hypoxemia, whose ventilation management is difficult, even in case of severe obesity.

Risk of mycosis fungoides in psoriatic patients: a critical review.

Psoriasis has been controversially associated with risk of non-Hodgkin lymphoma (NHL) and mycosis fungoides (MF). Also patients who developed MF after systemic treatment for psoriasis have been reported, and some authors suggested that the association between MF and psoriasis is not infrequent. We performed an extensive literature review in order to examine the risk of developing MF in psoriatic patients with a systematic search of the English-language databases. An increased risk for lymphoma overall in psoriatic patients has been found only by three out of seven studies. The risk of developing MF in psoriatic patients has been investigated by different studies in different populations and with different methodologies presenting bias and limitations, and it seems reasonable that misclassification between psoriasis and MF may explain the association reported. In contrast to the large number of psoriatic patients treated with biologicals, only 27 case reports of MF after biological therapy for psoriasis have been reported, and in 10 cases, the initial psoriasis diagnoses were then revised as MF. A true association between MF and psoriasis is possible, but the real incidence and prevalence are still unknown. The reported higher risk of developing MF in psoriatic patients should be reconsidered in the light of the bias of misclassification and the low magnitude reported in previous studies. There is not enough evidence to support a causal relation among biological therapies and MF in psoriatic patients.

Treatment of nodular facial angiofibromas in tuberous sclerosis, using ultrapulse carbon dioxide laser.

Tuberous sclerosis (TS) is a genodermatosis characterized by facial angiofibromas (FAs). These tumours cause aesthetic disfigurement and obstruction of vision, and haemorrhage when traumatized, which can lead to emotional distress and relationship difficulties. We report the case of a 35-year-old patient with extensive TS-associated FAs that were treated with an ultrapulse carbon dioxide laser (UPCDL). UPCDL laser seems to be a easy, useful and convenient tool for the treatment of nodular FAs, which provides good aesthetic results, and a positive response from patients, who report high levels of satisfaction with the results. Minimal recurrence of the tumours occurred during long-term follow-up, and these were successfully treated with UPCDL. It is not yet possible to correct the genetic alterations underlying TS, but UPCDL treatment is a convenient tool to improve the facial appearance of patients with severe FAs.

Influence of climatic variables on acute myocardial infarction hospital admissions.

BACKGROUND: Seasonal peaks in acute myocardial infarction (AMI) incidence have been widely reported. Weather has been postulated to be one of the elements at the basis of this association. The aim of our study was to determine the influence of seasonal variations and weather on AMI hospital admissions. METHODS: We correlated the daily number of AMI cases admitted to a western Sicily hospital over twelve years and weather conditions on a day-to-day basis. Information on temperature, humidity, wind force and direction, precipitation, sunny hours and atmospheric pressure was obtained from the local Birgi Air Force base. A total of 3918 consecutive patients were admitted with AMI over the period 1987-1998 (2822 men, 1096 women; M/F: 2,58). RESULTS AND CONCLUSIONS: A seasonal variation was found with a significant winter peak. The results of multivariate Poisson analysis show in both sexes a significant association as regards the incidence relative ratio between the daily number of AMI hospital admission and minimal daily temperature and maximal daily humidity. The incidence relative ratios (95% confidence intervals) were, in males, 0.95 (0.92-0.98) (p<0.001) as regards minimal temperature and 0.97 (0.94-0.99) (p=0.017) as regards maximal humidity. The corresponding values in females were respectively 0.91 (0.86-0.95) (p<0.001) and 0.94 (0.90-0.98) (p=0.009). Environmental temperature, and also humidity, may play an important role in the pathogenesis of AMI. These data may help in understanding the mechanisms whereby AMI events are triggered and in organizing better the assistance to ischemic patients throughout the year.

Hemorrhage from primitive rectal varices in patient with idiophatic thrombosis of portal vein: case report.

INTRODUCTION: Rectal varices, primitive or secondary to hypertensive or thrombotic disorders of mesenteric-portal circle, represent an uncommon cause of lower digestive bleeding. The presence of rectal varices associated to idiopathic venous portal thrombosis represents a distinct nosologic entity, with important clinical and therapeutic problems related to it. CASE REPORT: Patient of young age, with positive anamnesis for primitive rectal varices, admitted to our department for a serious recttorragy. The laboratory underlined moderate anaemia and the endoscopy documented the presence of multiple rectal varices, without evident signs of bleeding; the endoscopy documented the presence of two esophageal small varicose cords F1. The hepatobiliary sonography and the portography showed the massive thrombosis of the portal vein. The new serious episode of rectal bleeding induced us to subject the patient to a surgical operation of Hartmann recto-sigmoid resection. CONCLUSION: Because of the slight number of reported cases of primitive rectal varices and because of the scattering of many dates it is difficult to draw an univocal diagnostic and therapeutic algorithm. Clinical framing and subsequent therapeutic approach rise often up from personal experience rather than well defined guidelines. The treatment is controversial, time by time many therapeutic options are reported either conservative or interventionist. The failure of conservative therapy and the recurrent episodes of bleeding give indication to surgical treatment, that is represented by Hartmann colonic resection and/or the porto-systemic shunts in the cases of portal hypertension; in our case we made colonic resection sec. because of lapsed performing status of the patient.

[Electro-acupuncture and trophic ulcer]. / Elettroagopuntura ed ulcere trofiche.

Electroacupuncture was used in the treatment of 50 cases of tropic ulcer of the lower extremities, including 34 following phlebitis, by stimulation with a Roccia VTM apparatus at voltages and frequencies up to the patient's tolerance threshold. The needles stimulation was maintained for a maximum of 7 hr. A cure was obtained in all cases, including those where the ulcers were inveterate and resistant to routine forms of management.

[Sulpiride and experimental gastric lesions]. / Sulpiride e lesioni gastriche sperimentali.

The Authors have conducted some research on the action of Sulpiride in animals which had been previously obliged to search into the gastric lesion caused by the compulsion. According to them above drug determines a reduction of the quantity of animals affected from gastric lesion and attenuates in other animals the entity of the gastric lesion.

[Hyperbaric therapy and experimental peritonitis]. / Iperbarismo e peritoniti sperimentali.

The AA, report about the action explicate by the hyperbaric treatment on the evolution of the experimental peritonitises from hurt of the digestive tube. In their opinion the AA, a hyperbaric daily treatment of an hour at two ATA exercises a protection about evolution of the peritoneal syndrome.