Compartment syndrome of the hand with acute bullous eruption due to extravasation of computed tomography contrast material.

This article presents a case of an 80-year-old woman with severe hematoma and consequently a compartmental syndrome of the hand complicated with acute bullous eruption due to extravasation of contrast material. Compartment syndrome of the hand has been linked to a number of various etiologies. Failure to adequately diagnose and treat compartment syndromes of the hand can lead to irreparable functional loss. In the majority of the cases extravasation results only in minimal swelling or erythema. However, severe skin necrosis, ulceration and compartment syndrome may occur with extravasation of large volumes. Compartment syndrome was diagnosed, and the patient underwent immediately fasciotomy. After fasciotomy we weekly followed up our patient with medications and after she regained the full use of the hand. We report this case to assess the importance of a careful evaluation of the intravenous administration site and close monitoring of the patient during contrast material injection to obtain minimal or prevent every kind of extravasation injuries.

Description of columellar defects and its tridimensional remedial techniques.

Columella is an important facial component and provides support and projection to the tip of the nose. Columella defects may cause significant aesthetic and functional deformities. We present our case-load of 2007: 61 patients operated in that year had been carried out and concluded. Surgical techniques for the correction of columellar defects were classified as "open tip" and "closed tip". Then, depending on the defect, it was possible to intervene on different structures. Of the 61 patients who underwent corrective surgery, only 6 (<10%) maintained or presented again, after a temporary improvement, with the columellar defect at the end of the follow-up. For all the other patients, the final outcome was more than satisfactory. A very good aesthetic result was obtained with no functional complications. In fact, nose functionality is supported by medial crura, laid one upon the other, providing considerable resistance to the columella.

Peripheral lymphocyte subsets and other immune aspects in Rett syndrome.

A possible role of the immune system in the pathogenesis of some neurologic disorders, including infantile autism, was recently postulated. This observation prompted the authors to investigate some immunologic aspects in a group of patients with Rett syndrome, a disorder still not completely clarified but with some points of commonality with infantile autism. Humoral and cell-mediated immunity were investigated in 20 females with Rett syndrome. Peripheral lymphocyte subsets revealed a reduced percentage of CD8+ suppressor-cytotoxic cells in all of the patients with Rett syndrome, resulting in an increased CD4+/CD8+ ratio. In addition, 15 (75%) of the 20 patients had low levels of natural killer cells. Soluble interleukin-2 receptor was elevated in the youngest patients. Antineuronal and antimyelin ganglioside antibodies were absent, as were antinuclear antibodies, antistriated muscle antibodies, and antismooth muscle antibodies. Immunoglobulin fractions and complement were normal for age in all of the patients.

Rett syndrome: photographic evidence of rapid regression.

Rett Syndrome is known to occur in females, around the second year, with loss of hand use, onset of stereotypes and acquired microcephaly. Such regression is often very rapid, but this has never been documented. In one of our patients, photographs taken at different times clearly demonstrate the rapid progression of first symptoms. Moreover, in the present case, the occurrence of a febrile illness, which preceded the onset of the neurological picture, support the hypothesis that environmental factors may trigger the onset of Rett Syndrome in genetically predisposed subjects.