Central skull base osteomyelitis: a rare but life-threatening disease.

We present the case of a 70-year-old non-diabetic patient who presented to the emergency department with unrelenting otalgia. A severe otitis externa (OE) and mastoiditis were treated with broad spectrum antibiotics and surgical drainage. No bacteria was isolated from surgical samples. Because the otalgia persisted, a magnetic resonance (MR) was performed and showed an infiltrating process at the skull base. Biopsies failed to prove malignancy or granulomatosis. The patient's neurological state deteriorated. The suspicion of a skull base osteomyelitis (SBO) was raised and proven by CT-guided biopsies that grew Pseudomonas aeruginosa. Meropenem and ciprofloxacin, given for 8 weeks, lead to a fast clinical improvement and a full recovery. SBO is uncommon, often complicating severe OE. Pseudomonas aeruginosa is the main pathogen. Prompt diagnosis and adequate antibiotherapy are required to lower mortality and morbidity. The diagnosis may be delayed because of unawareness and large differential diagnosis including solid neoplasic tumours, malignant hemopathies and granulomatosis.

Lack of improvement in the modality of beta2 administration in pediatric departments: survey in Piedmont and Aosta Valley.

AIM: In recent years many consensus conferences of scientific societies have reaffirmed the advantages of metered dose inhalator (MDI) and spacer administration compared to classic aerosol in acute asthma and maintenance therapy. Faced with a more than convincing documentation, the practitioners have shown a controversial attitude concerning this type of administration. At the same time, as a general acceptance of its superiority there is an inexplicable lack of use. METHODS: This survey was carried out in 2006 and it involved pediatric hospital wards in Piedmont and Aosta Valley to evaluate the use of spacers in acute asthma in hospitalised children undergoing treatment. These results were compared to those obtained from another survey carried out in 2008 using identical questionnaires in the same departments in order to evaluate the implementation of such a practice. RESULTS: In the two years between one survey and the other no increase in the use of MDI and spacer has been detected, but, on the contrary, a consistent decrease. CONCLUSION: Notwithstanding the amount of evidence concerning its superiority compared to nebulisers MDI and spacer is not commonly used for asthma therapy yet. A "promotional" multidisciplinary intervention could play a determining role in the implementation of such a practice.