Primary hemorrhagic intramedullary melanoma. Case report with emphasis on the difficult preoperative diagnosis.

Primary melanoma of the central nervous system (CNS) is rare and primary spinal melanoma (PSM) is even more unusual. Preoperative diagnosis of melanocytic lesion as a PSM is difficult, because of the heterogeneous magnetic resonance (MR) signal intensity, due to hemorrhagic foci and melanin deposits. We describe the case of a 68 year-old male with a MR showing at Th8-Th9 level a well-defined intramedullary lesion; for the characteristics of hemorrhagic signal on MR and its association with a presumptive brain cavernoma, a preoperative diagnosis of intramedullary cavernous angioma was suspected. Pathological examination revealed a melanoma, and for the absence of other localizations outside the spinal cord, a diagnosis of primary spinal melanoma was established. The growth of PSM is slower and survival is longer than in the most common spinal metastasis from skin melanoma. Patients who undergo surgical excision, alone or associated with additional treatments, often show a long survival. We report this case to underline the importance and difficulties concerning the preoperative diagnosis of a hemorrhagic intramedullary lesion.

A new animal model for monitoring the early cerebral vasospasm after subarachnoid haemorrhage.

AIM: Spasm of cerebral arteries is a complication associated with subarachnoid haemorrhage. The aim of the present work is to find an experimental model of reliable, simple and in vivo monitoring of ''early'' basilar artery spasm after subarachnoid haemorrhage (SAH). Early spasm occurs within minutes of the SAH, its duration is approximately 1 hour. The need of different morphological and haemodynamic methods to evaluate experimental early spasm is reported. METHODS: To overcome intracranial surgical manipulations and biological of contrast and fixation media we designed a model that allows in vivo functional monitoring of basilar blood flow far away from the spasm without direct surgical and chemical interferences. Seventeen adult Burgundy rabbits were studied. RESULTS: Under homeostatic monitoring ''on-line'' carotid blood flow (carotid BF) .changes produced by SAH in cisterna magna of 12 (plus 5 sham treated) animals were studied from the common carotid artery after external carotid artery occlusion before, during SAH up to the end of the experiments. All the animals underwent digital subtraction cerebral panangiography (CPA) after SAH obtaining a significant increase of carotid BF only when basilar vasospasm was shown by CPA. CONCLUSIONS: Carotid BF increase during basilar vasospasm was defined ''functional. monitoring'' of early spasm.

[An experience with a mobile coronary care unit: from a study project to a permanent community service (author's transl)]. / L'unità coronarica mobile dell'Ospedale Regionale di Udine. Da progetto di studio a servizio permanente.

Mobile coronary care units and stratified systems for coronary care have received rather poor attention in Italy up until now. To evaluate advantages and disadvantages, organizational problems, costs, etc. of a mobile unit in an Italian community provided with a reference centre for acute coronary artery disease, a study project was started in 1977. The organization of such unit was based on that of the hospital in Belfast. The covered area (200,000 inhatitants) was carefully limited to keep delays at a minimum. A program of public education, stressing the necessity for early calls for medical intervention was developed. All calls were evaluated by a physician on duty in the CCU before intervention. The results of this experience, extended to four years, are reported showing that a Mobile Coronary Care Unit is valuable from a medical point of view, is economically sound and practical in a medium size Italian city such as Udine. According to this, the Mobile Coronary Care Unit was changed from a study project to a permanent community service.