Selective cranial multineuritis in severe COVID-19 pneumonia: two cases and literature review.

OBJECTIVE: To report two cases of cranial multineuritis after severe acute respiratory syndrome caused by coronavirus-2. METHODS: Patients' data were obtained from medical records of the clinical chart of dell'Angelo Hospital, Venice, Italy. RESULTS: The first patient is a 42-year-old male patient who developed, 10 days after the resolution of coronavirus-2 pneumonia and intensive care unit hospitalization with hyperactive delirium, a cranial multineuritis with asymmetric distribution (bilateral hypoglossus involvement and right Claude Bernard Horner syndrome). No albumin-cytologic dissociation was found in cerebrospinal fluid; severe bilateral denervation was detected in hypoglossus nerve, with normal EMG of other cranial muscles, blink reflex, and cerebral magnetic resonance with gadolinium. He presented a striking improvement after intravenous human immunoglobulin therapy. The second case is a 67-year-old male patient who developed a cranial neuritis (left hypoglossus paresis), with dyslalia and deglutition difficulties. He had cerebrospinal fluid abnormalities (albumin-cytologic dissociation), no involvement of ninth and 10th cranial nerves, diffuse hyporeflexia, and brachial diparesis. DISCUSSION: Cranial neuritis is a possible neurological manifestation of coronavirus-2 pneumonia. Etiology is not clear: it is possible a direct injury of the nervous structures by the virus through olfactory nasopharyngeal terminations. However, the presence of albumin-cytological dissociation in one patient, the sparing of the sense of smell, and the response to human immunoglobulin therapy suggests an immune-mediated genesis of the disorder.

Elective tracheostomy during COVID-19 outbreak: to whom, when, how? Early experience from Venice, Italy.

PURPOSE: The need for prolonged invasive mechanical ventilation in COVID-19 patients is placing the otorhinolaryngologist in front of an increasing request for tracheostomy. Nowadays, there is uncertainty regarding the timing of tracheostomy, the prognosis of these patients and the safety of healthcare workers. The aim of this study is to evaluate the efficacy and safety of tracheostomy placement in patients with COVID-19. METHODS: A retrospective cohort study on 23 COVID 19 patients, to analyse the timing of tracheostomy, the risk factors associated with in-hospital death and the infection of the involved health care workers. Early tracheostomy was defined as ≤ 10 days and late ones > 10 days. RESULTS: The mortality rate of COVID-19 patients admitted to ICU that underwent tracheostomy was 18%. The overall mortality of patients admitted to ICU was 53%. The univariate analysis revealed that early tracheostomy, SOFA score > 6, and D-dimer level > 4 were significantly associated with a greater risk of death. At the multivariate analysis SOFA score > 6 and D-dimer level > 4 resulted as significant factors for a higher risk of death. No health care workers associated with tracheostomy are confirmed to be infected by SARS-CoV2. CONCLUSION: We suggest to wait at least 14 days to perform tracheostomy. In patients with SOFA score > 6 and D dimer > 4, tracheostomy should not be performed or should be postponed. Optimized procedures and enhanced personal protective equipment can make the tracheostomy safe and beneficial in COVID-19 patients.

Mediastinal staging in lung cancer: a rational approach.

Mediastinal staging is generally performed by the use of imaging techniques such as CT (Computed Tomography) and PET (Positron Emission Tomography), mini-invasive techniques, as TBNA (Transbronchial Needle Aspiration), EBUS-TBNA (Ultrasound-Guided Transbronchial Needle Aspiration), EUS-FNA (Endoscopic Ultra Sound Fine-Needle Aspiration), and/or surgical techniques as mediastinoscopy, thoracoscopy, mediastinothomy. Each of these techniques provides different sensitivity, specificity and predictive value: all these characteristics need to be well considered and adequately used to achieve the best possible outcome, best exploitation of available resources and least discomfort for the patient. Particularly, indicators which may suggest the need for further examination of mediastinum, following a negative CT and PET, will be discussed in this review; need for surgical confirmation after negative TBNA will be considered, also.

[Significance of the study of bile salts in acute and chronic liver disease]. / Significato del dosaggio dei sali biliari nelle epatopatie acute e croniche.

The diagnostic value of fasting and after meal test total bile acid determination in control subjects and in patients suffering from chronic persistent and active hepatitis, fatty liver and cirrhosis has been evaluated with fluorimetric method. Our results demonstrated the good sensitivity of determination of bile acids after meal test in evaluating the different forms of liver damage.

[Bile salts, copper, ceruloplasmin in meal test]. / Sali biliari, rame, ceruloplasmina in corso di "meal test".

Biliary salts determination after meal test is an useful liver function test. We evaluated both biliary salts and copper-ceruloplasmin after meal test in different liver diseases. Copper-ceruloplasmin determination does not seem to be useful in the diagnosis of liver diseases because copper has only partial hepatic clearance.