Phlegmon of the face and neck: a case report.

Deep face and neck infections are potentially life threatening if they are not diagnosed in time and then treated quickly. This report describes a case of face and deep neck infection, associated with a semi-impacted and decayed wisdom tooth in a cardiopathic, immunosuppressed patient suffering from, diabetes, hypothyroidism, osteoporosis, breathlessness, chronic bronchitis, with oral, cutaneous and vaginal erythematous lichen, Cushing's Syndrome, penicillin allergy, subjected to past hypophysectomy. The swelling was, first of all, treated in urgency, with an intravenous antibiotic therapy and, immediately afterwards, the phlegmonous infiltration linked to the avulsion of the lower third molar was surgically drained. The patient was then treated with intravenous multiple antibiotics, with the aim of eradicating the predominating bacteria that was encountered in the microbiological culture test. A complete remission of the pathological picture was obtained .

[Effects of surgical repair of first degree varicocele on gonadal function and testicular atrophy]. / Effetti della correzione chirurgica del varicocele di 1o grado sulla funzione gonadica e sul trofismo testicolare.

Varicocele is one of the main causes of male infertility. This pathology, in fact, is responsible for progressive anatomical and functional testicular damage. Constant monitoring of subjects suffering from varicocele is therefore necessary. In the present study, we evaluated the effect of varicocele surgical treatment on seminal parameters, testicular growth and pregnancy rate in patients with grade I varicocele. We operated on 47 patients with left grade I varicocele associated with sperm abnormalities and with testicular hypotrophy. A high ligation of the internal spermatic vein and all its collaterals was performed in all patients. The postoperative follow-up showed a significant improvement in seminal parameters (motility, morphology and sperm count) and in testicular volumes. Moreover, a pregnancy rate of 58% was observed. These results confirm the observations of other investigators and suggest that surgical therapy of varicocele is capable of improving seminal parameters, of reversing varicocele-related testicular hypotrophy and of achieving high pregnancy rates even in patients with grade I varicocele.

[Radioimmuno-guided surgery (RIGS) in breast disease]. / La chirurgia radioimmunoguidata (RIGS) in patologia mammaria.

Radioimmunoguided surgery is a new technology capable of detecting minimal neoplastic lesions using radiocolloids. We used this technique in two fields: to detect sentinel lymph nodes in breast cancer and to remove non-palpable breast lesions. Radioimmunoguided surgery was employed in 135 women; in 32 for sentinel lymph nodes and in 103 for radioguided occult lesion localization using a radioactive tracer (Technetium Tc99m) injected subdermally for sentinel nodes, or near to the non-palpable lesions under US guidance. In our experience these two applications of radioimmunoguided surgery are useful and accurate for determining the nature of lesions and for providing definitive treatment in a single surgical intervention.

Surgical approach to nipple discharge: a ten-year experience.

BACKGROUND AND OBJECTIVES: The actual relationship between malignancy and secreting breast has not yet been extensively verified, mainly in patients with nipple discharge but without evidence of a breast lump. This study was carried out in 1,251 consecutive patients to evaluate the reliability of cytology combined with galactography in order to assess the relationship of malignant and premalignant lesions with discharge without the presence of a breast lump. METHODS: Those patients with bilateral discharge were approached endocrinologically, whereas the patients (433) with unilateral secretion were evaluated by cytology, mammography, fine needle biopsy, and galactography. Of 194 patients without a breast lump, 94 with positive cytology were surgically treated after mammogalactography. Surgical treatment included ductgalactophorectomy in 53, segmentectomy in 23, microdochectomy in 13, and mastectomy in 5 patients. RESULTS: Pathologic findings showed a solitary papilloma in 49 cases, minimal breast cancer in 20, fibrocystic disease in 11, papillomatosis in 7, lobular cancer in 5, and, finally, a duct ectasia in 2. CONCLUSIONS: In the patients with secreting breast but without lump, cytological analysis in addition to galactography seems to be useful in identifying minimal breast cancer and in detecting premalignant lesions like papillomatosis.

Surface characterisation of collagen-based bioartificial polymeric materials.

An electron spectroscopy for Chemical Analysis (ESCA) characterization of films based on collagen-poly(vinylalcohol) blends, cross-linked by dehydrothermal treatment is reported. The semiquantitative analysis indicates a remarkable enrichment of collagen in the surface with respect to its initial percentage utilized to prepare the blends.

Protective effects of IRFI-016, a new antioxidant agent, in myocardial damage, following coronary artery occlusion and reperfusion in the rat.

The new free radical scavenger IRFI-016 [2(2,3-dihydro-5-acetoxy 4,6,7-trimethyl-benzofuranyl) acetic acid] was assessed in a rat model of myocardial injury induced by 1 h of left coronary artery occlusion followed by 30 min of reperfusion. Myocardial ischaemia plus reperfusion (MI/R) produced severe cardiac necrosis, neutrophil infiltration in the jeopardized tissue, increased serum creatine kinase (CK) and ST segment of the electrocardiogram (ECG), lowered the pressure rate index (PRI), increased serum levels of tumour necrosis factor (TNF-alpha) and caused a decrease in the survival rate. Administration of IRFI-016 (100 and 200 mg/kg i.p.) 30 min before occlusion resulted in a significant protective effect in post-ischaemic reperfusion. Compared with untreated rats, IRFI-016, in particular the dose of 200 mg/kg, caused a reduction of the necrotic zone whether the necrotic area was expressed as a percentage of the area at risk (55 +/- 4% in the MI/R vehicle group and 24 +/- 2.5% in the MI/R treated group; p < 0.001) or as a percentage of the total left ventricle (23 +/- 3.4% in the MI/R vehicle group and 8 +/- 2.1% in the MI/R treated group; p < 0.005), reduced the myeloperoxidase activity, an index of neutrophil infiltration in the necrotic area (from 4.8 +/- 0.8 to 1.6 +/- 0.4 U/g tissue; p < 0.005), reduced the serum levels of TNF-alpha (from 216 +/- 13 to 45 +/- 7 U/ml; p < 0.001), blunted the rise of the ST segment of the ECG (from 0.47 +/- 0.13 mV in the vehicle group to 0.3 +/- 0.18 mV in the treated group; p < 0.001), reduced the loss of CK (from 220 +/- 15 to 88 +/- 13 IU/ml of blood; p < 0.001) and improved the depressed PRI (from 56 +/- 4% to 78 +/- 3% mm Hg/beats/min; p < 0.005). Finally, IRFI-016 significantly enhanced the survival rate evaluated at the end of the experiment. The results strongly indicate that IRFI-016 is a promising drug for cardiac ischaemia and reperfusion.

Effect of fluvoxamine on the pharmacokinetics of imipramine and desipramine in healthy subjects.

The effect of the selective serotonin reuptake inhibitor fluvoxamine (100 mg/day for 10 consecutive days) on the kinetics of a single oral dose of imipramine (50 mg) and desipramine (100 mg) was investigated in 12 healthy subjects. Compared with a control session, treatment with fluvoxamine caused a significant prolongation of imipramine half-life (from 22.8 +/- 6.4 to 40.5 +/- 5.0 h, means +/- SD, p < 0.01) and a marked decrease in imipramine apparent oral clearance (from 1.02 +/- 0.19 to 0.28 +/- 0.06 L/h/kg, p < 0.0001). No significant changes in desipramine kinetics were observed during fluvoxamine treatment. These findings indicate that, at the dosage tested, fluvoxamine markedly inhibits the demethylation of imipramine without affecting significantly the CYP2D6-mediated hydroxylation of desipramine.

Carbamazepine coadministration with fluoxetine or fluvoxamine.

To study the potential interaction between carbamazepine (CBZ) and selective serotonin reuptake inhibitors, fluoxetine (20 mg/day) and fluvoxamine (100 mg/day) were administered for 3 weeks to eight and seven epileptic patients, respectively, on chronic CBZ treatment. No significant changes in steady-state plasma concentrations of CBZ and its active metabolite, carbamazepine-10,11-epoxide (CBZ-E) occurred, suggesting that CBZ metabolism is probably not affected by fluoxetine or fluvoxamine administration.

Fluvoxamine-induced alterations in plasma concentrations of imipramine and desipramine in depressed patients.

The effect of fluvoxamine maleate, 100 mg/day for 10 days, on plasma concentrations of tricyclic antidepressants was studied in 15 depressed patients on maintenance therapy with imipramine (7 pts.) or desipramine (8 pts.). In the subgroup treated with imipramine, plasma levels of imipramine increased significantly (p < 0.001) during fluvoxamine coadministration, while levels of desipramine were not modified. Addition of fluvoxamine to patients on a stable desipramine dosage regimen resulted in a slight, but statistically not significant, increase in desipramine plasma concentrations. These results suggest that fluvoxamine is a potent inhibitor of imipramine demethylation, while it has a weak effect on the hydroxylation of desipramine.

[Palliative treatment in neoplastic jaundice. Personal experience]. / Il trattamento palliativo dell'ittero neoplastico. Esperienza personale.

The palliative treatment of biliary duct neoplastic obstruction represents a problem of great importance and frequently can't leave out of consideration patients clinical conditions and phase of neoplastic disease. Authors, in this article refers their experience on palliative treatment of neoplastic jaundice and indications for surgical or endoscopic treatment. Their experience shows that surgical palliation must be performed in patients with preoperative instrumental investigations without "surgical risk", this vouches for a better quality of life than endoscopic procedure performed with diffuse neoplastic disease and in patients with surgical risk.

[Artificial nutritional approach in the palliative treatment of esophageal cancer]. / Approccio nutrizionale artificiale nel trattamento palliativo del cancro esofageo.

Authors, after to linger over necessity of artificial nutritional approach in patients with inoperable esophageal cancer, emphasize the various moments and condition where is right to operate. In conclusion, they wish the increase of early diagnosis, one and only to guarantee appraisable results.

[Relations between allergic rhinitis and otitis media with effusion. The role of the Eustachian tube]. / Rapporti tra rinite allergica ed otite media con effusione. Il ruolo della tuba di eustachio.

It was recently observed that otitis media with perfusion (OME) occurs in 35-50% of children suffering from allergic rhinitis. The main pathogenetic mechanism was identified as the dysfunction of the eustachian tube (ET) following its impairment during nose allergy infection. As a result of this dysfunction, the tympanic cavity is affected by: accumulated secretion, proliferation of germs and changes of the hypersecretion of the lining mucous. The long-term persistence of these secretions may damage the normal functions of the ossicular chain and thus the transmission of sounds, leading to the onset of hypoacusis which may interfere negatively with the child's mental-physical development.

[An assessment of middle ear involvement in children with allergic rhinitis: a comparison with chronic hypertrophic adenoiditis]. / Valutazione della compromissione dell'orecchio medio in bambini affetti da rinite allergica: confronto con adenoidite cronica ipertrofica.

The allergic inflammation may contribute to the development of otitis media with effusion (OME). For this reason we have examined two groups of children: the first (group A) formed by 12 children with allergic rhinitis, the second (group B) by 15 children with hypertrophic adenoids. We have found respectively: pathologic otoscopy in 75% and 93% of cases; pathologic tympanometry in 83% and in 90%; pathologic audiometry in 60% and in 83%. This values are not significant according to a statistic analysis. Instead, the degree of compromission has been significant: in fact 16% of the children belonging to group A had a retracted and atelectatic eardrum in comparison with 33% of the children belonging to group B. Also tympanometry has confirmed this aspect: in fact 33% of group A showed type C and B tympanograms in comparison with 77% of group B. Besides, audiometry has confirmed the presence of hearing loss in the subjects with tympanometry of type C and B, belonging to both groups. For this reason the allergic rhinitis, because it may cause OME, must be treated in order to limit the negative effects of allergic nasal obstruction on the functionality of the middle ear.

[Gastro-esophageal reflux and asthma. Clinical experience]. / Reflusso gastro-esofageo ed asma. Esperienza clinica.

Gastroesophageal reflux (GER) may contribute to the persistence of asthma and may be triggered and/or exacerbated by treatment with bronchodilatory and cortisone drugs. For this reason, GER should be suspected in patients with asthma non-responsive to treatment. In fact in this series 24 hour pH monitoring revealed GER in 7 out of 9 (77%) patients with persistent asthma. The use of a personally developed diagnostic protocol permitted the identification of various situations in 4 patients who completed the study: one coincidental association, one GER caused by theophylline and constituting the main cause of the bronchial obstruction.

[Bronchoreactivity induced by physical exercise and methacholine in children with rhinitis and allergic asthma. A comparative study]. / La broncoreattività indotta da esercizio fisico e da metacolina in bambini con rinite ed asma allergico. Studio comparativo.

Bronchial provocation tests (TBP) allow to detect airways hyperreactivity in asthmatics. Twenty asthmatic children and sixteen rhinitics underwent a standard methacholine challenge and a free running exercise test on two separate days. Metacholine challenge pointed out bronchial hyperreactivity in 90% of the asthmatics. An exercise induced bronchospasm occurred in 70% of them. TPB resulted positive also in 18% of the rhinitics. Our study confirms diagnostic usefulness of the TBP and a good correlation between both tests.