Diagnostic role of internal mammary lymph node involvement in tuberculous pleurisy: a multicenter study.

BACKGROUND AND OBJECTIVES: Diagnosis of tuberculous pleurisy (TP) may be challenging and it often requires pleural biopsy. A tool able to increase pre-test probability of TP may be helpful to guide diagnostic work-up and enlargement of internal mammary lymph node (IMLN) has been suggested to play a potential role. The aim of the present investigation was to assess role of IMLN involvement in TP in a multi-centric case-control study, by comparing its prevalence and test performance to those observed in patients with infectious, non-tuberculous pleurisy (NTIP), and in controls free from respiratory diseases (CP). METHODS: A total of 419 patients, from 14 Pulmonology Units across Italy were enrolled (127 patients affected by TP, 163 affected by NTIP and 129 CP). Prevalence, accuracy and predictive values of ipsilateral IMLN involvement between cases and control groups were assessed, as well as concordance between chest computed tomography (CT scan) and thoracic ultrasound (TUS) measurements. RESULTS: The prevalence of ipsilateral IMLN involvement in TP was significantly higher than that observed in NTIP and CP groups (respectively 77.2%, 39.3% and 14.7%). Results on test performance, stratified by age, revealed a high positive predictive value in patients aged ≤50 years, while a high negative predictive value in patients aged >50 years. The comparison between CT scan and ultrasound showed moderate agreement (Kappa=0.502). CONCLUSIONS: Evaluation of IMLN involvement plays a relevant role in assessing the pre-test probability of TP. Considering the increasing global prevalence of mycobacterial infections, a tool able to guide diagnostic work-up of suspected TP is crucial, especially where local sources are limited.

Practical management of pleural empyema.

Empyema is defined as pus in the thoracic cavity due to pleural space infection and has a multifactorial underlying cause, although the majority of cases are post-bacterial pneumonia. Despite treatment with antibiotics, patients with empyema have a considerable morbidity and mortality due at least in part to inappropriate management of the effusion. Timely diagnosis of pleural space infection and rapid initiation of effective pleural drainage represent fundamental principles for managing patients with empyema. Ultrasound is particularly useful to identify early fibrin membranes and septations in the pleural cavity conditioning treatment strategy. Empyema and large or loculated effusion with a pH < 7.20 need to be drained. Thoracoscopy has largely been used in pleural effusion due to lung infection. Whereas the efficacy of video-assisted thoracic surgery (VATS) in empyema management has been evaluated in several retrospective studies showing favourable results, less is known about the role of medical thoracoscopy (MT) in pleural infection. MT, appears to be safe and successful in multiloculated empyema treatment. It is also lower in cost and in frail patients is better tolerated than VATS which requires tracheal intubation.

Reference values and repeatability of inspiratory capacity for men and women aged 65-85.

The inspiratory capacity (IC) has recently gained importance because it may signal the occurrence of dynamic hyperinflation at rest or during exercise by reflecting changes in the end expiratory lung volume (EELV). However, reliable predicted values for IC are not currently available. The aim of the study was to generate predictive equations for reference values of IC in adults aged 65-85 living in Italy and to determine its limits of the within test-session repeatability. From the control group (n=429) of the SARA study data base, 241 (161 females) never smoked, non-obese (BMI<30 kg/m2) healthy subjects aged 65-85 who were able to correctly perform at least two manoeuvres of IC were selected. A model that incorporated age, height and body mass index as significant predictors in either sexes produced predicting equations for IC with a coefficient of determination of r2=.36 and .34 for females and males, respectively. Ninety per cent of all the subjects were able to keep the second highest IC within 200 ml (<9%) from the best IC. No significant gender difference was found for IC repeatability. We provided the equations for deriving reliable IC reference values that can be applied in the elderly people living in southern Europe. In this population IC showed limits of the within-session repeatability similar to those accepted for other spirometric indices such as FEV1 and FVC.

Rhinopharyngeal angiofibroma in the pediatric age group. Clinical-statistical contribution.

The authors had the chance of treating two cases of rhinopharyngeal angiofibroma before the age of puberty, and were thus stimulated to re-examine the incidence of such neoplasms in the pediatric age group, i.e. under 12 years of age. From their clinical statistical studies, and in the light of their personal experience, they were able to make the following observations. 12.9% of angiofibromas occur by the age of 12 years. These tumours present a shorter period of symptomatological evidence with respect to those which occur later. They are histologically characterized by a greater richness of cellular and vascular components with respect to those of a fibrous nature. Among the equipment used in radiology, computerized axial tomography showed itself extremely useful. The paralateronasal path is the most commonly used among surgical paths, as it is able to throw more light on tumour. The frequency with which the neoplastic mass relapses during operation is proportionally greater the earlier the primitive tumour occurs.

Sudden deafness in children.

The authors present a report of 38 cases of sudden deafness (SD), observed in the Bambino Gesù Hospital in Rome. Twenty-six cases were due to infective causes, such as mumps, meningitis, measles, varicella or to physical trauma. The other 12 cases were defined as idiopathic (ISD) on the basis of their anamnestic and clinical findings. The etiological, prognostic and therapeutic aspects are discussed.

Dysontogenetic neoplasms of the thyroid gland in infancy: two case reports.

Two rare cases of benign dysontogenetic neoplasms of the thyroid gland in pediatric age are presented, which were observed at the E.N.T. department of the Bambino Gesù Hospital of Rome, and successfully operated. The first case turned out to be a dysembryoma, classified as monodermic because of its origin from derivatives of only one germinal layer, the entoderm. The second case, a teratoma, presented a high seric concentration of AFP as the consequence of the synthetic activity of the share of embryonal epatic tissue present in the neoformation. Criteria to distinguish thyroid from cervical teratomata and to classify the different types of dysontogenetic neoplasms are discussed. The usual clinical and pathological manifestations of teratomas of the neck in infancy are mentioned. The necessity of a prompt surgical removal and of pre- and postoperative thyroid function studies is mentioned.

The pathogenesis of chronic recurrent parotitis in infants: a study of 93 cases including an analysis of the vascular and glandular changes before and after parasympathectomy.

Ninety-three cases of infantile chronic recurrent parotitis are recorded. Fifty-three cases were treated with parasympathectomy which was carried out at 2 levels. Good results were achieved in 79.1% of patients. The paper describes the use of the Doppler examination to study the effects of operation on the physiology of the parotid.

Otologic impairments in achondroplasia: a nosologic assessment.

The AA report a clinical and radiological study performed in 18 achondroplastic patients in order to achieve a nosological settlement of the otological impairments. They found two main otological syndromes; one, a congenital dysplasic syndrome, showing permanent conductive or sensory-neural hearing loss due to malformations of the middle ear or of the inner ear; the other, an inflammatory tubal tympanic syndrome with transient conductive hearing loss, which is relatively frequent in achondroplastic patients, but seems not related to the main disease.