Primary aldosteronism due to adrenocortical adenoma with concurrent ileum carcinoid tumor: case report

Primary aldosteronism (PA) with synchronous carcinoid syndrome is extremely rare occurrence. In this article, we describe a case of PA due to adrenocortical adenoma ("aldosteronoma") and concurrent malignant carcinoid tumor of ileum. The patient was treated with synchronous right adrenalectomy and resection of the ileum. This case is an example of concomitant presence of two types of tumors, effectively managed surgically. We report a case of a nonclassical form of multiple endocrine neoplasia type 1 (MEN 1) syndrome.

Autologous serum skin test reactivity and basophil histamine release test in patients with nasal polyposis: preliminary results

An eosinophilic inflammatory process is generally observed in patients suffering from nasal polyposis (NP), however its onset has not yet been defined. It has been suggested that immune activation of inflammatory cells may be the cause. The aim of this study is to verify whether autoantibodies and/or histamine-releasing factors are present in the serum of patients suffering from NP. In fact, we assume that autoantibodies and/or histamine-releasing factors, as already demonstrated in chronic idiopathic urticaria and asthma, may be involved in the pathogenesis of NP. In this case-control analytical study 40 patients with NP and 27 control subjects underwent the in vivo autologous serum skin test (ASST). The sera from 6 patients suffering from NP and 9 control group subjects, who had all been previously studied and randomly selected, underwent basophil histamine release assay from normal donor as a pilot study. The ASST showed positive results in 55% of patients suffering from NP versus 8% of the control group (p= .00006), the basophil histamine release test (BHRT) turned out positive in all patients tested and in 11% of the control group. We found a weak positive correlation between the percentage of histamine release and the wheal diameter. ASST reactivity is very frequent in patients suffering from NP, thus suggesting the presence of histamine-releasing factors in the blood stream. The BHRT was positive in the serum of all patients, thus suggesting the presence of anti-FcepsilonRI, anti-IgE autoantibodies and/or other histamine-releasing factors, the presence of which can play a role in triggering and maintaining the eosinophilic inflammatory process in NP.

Renin-angiotensin-aldosterone system in patients with sleep apnoea: prevalence of primary aldosteronism

Obstructive sleep apnoea (OSA) is a sleep disorder characterized by recurrent episodes of oxygen desaturation during sleep, representing an independent risk factor for cardiovascular disease, such as myocardial infarction, stroke, congestive heart failure and resistant hypertension. Several neurohormonal mechanisms have been suggested to account for blood pressure increases, such as sympathetic nervous system hyperactivity, oxidative stress, renin—angiotensin—aldosterone system (RAAS) activation, endothelin system activation, and endothelial dysfunction. The aim of this study was to evaluate the behaviour of RAAS and the presence of primary aldosteronism (PA) in these patients and possible correlations between RAAS and the severity of OSA. From October 2007 to November 2008 we studied 325 consecutive newly diagnosed hypertensive patients; 71 patients (21.8%) presented with clinical signs of sleep disorders, evaluated also through a specific questionnaire (Epworth Sleepiness Scale). In hypertensive patients with sleep disorders, 53 patients were affected by OSA; in this group 18 patients were affected by PA (five with aldosterone-producing adenoma (APA) and 13 with bilateral hyperplasia (IHA)); obesity was also demonstrated (BMI >" xbd="961" xhg="938" ybd="2430" yhg="2403"/> 30 kg/m2). Overall, in patients with OSA PRA levels correlated positively with apnoea/hypopnoea index (AHI; r = 0.35; p<0.01), and in all groups the waist circumference and the neck circumference were correlated positively with AHI ( r = 0.3 p<0.02 and r = 0.3 p<0.03, respectively). We revealed a high prevalence of PA in patients with OSA, and we can conclude that patients with hypertension and OSA, especially those who are newly diagnosed, must be evaluated for PA.

[Phlegmons of the neck: our experience with 7 cases]

Phlegmons of the neck originate from infectious diseases of head and neck. Odontogeneous inflammation of the oral cavity is most frquently primary lesion, followed by sinusitis, otitis, as well as radiation therapy and surgical procedures. Phlegmons of head and neck can drain into the spaces among the muscles, aponevrosis, organs inside the neck like sublingual space, lateral pharyngeal space, retro-pharyngeal space or pre-vertebral space. We hereby report our experience with 7 patients treated from 2001 to 2005.

Full control of sodium vapor density in siloxane-coated cells using blue LED light-induced atomic desorption

We propose and experimentally implement a method, based on light-induced atomic desorption, for controlled generation of large sodium densities in siloxane-coated cells, kept at room temperature. An array of blue LEDs is used to desorb sodium atoms from the cell walls. The required atomic vapor density is achieved and stabilized by controlling the LED power through the feedback given by the sodium fluorescence. We show that sodium densities corresponding to about 400 K can be obtained and kept stable for a long time with less than 6 mW of LED light power. Moreover, this technique allows for precise vapor density modulation with a frequency of tenths of hertz, which is not possible using traditional heating methods.

Percutaneous balloon catheter closure of a patent foramen ovale in a patient with pulmonary disease, profound hypoxemia, and normal right heart pressures

Right-to-left intracardiac shunting across a patent foramen ovale (PFO) has been reported in patients with pulmonary embolism, right ventricular (RV) infarction, positive pressure ventilation with positive end-expiratory pressure, heart failure with left ventricular assist devices, cardiac tamponade, and unilateral diaphragmatic paralysis. The primary driving force for these shunts is a reduction in the compliance of the pulmonary bed or right ventricle; right atrial pressure is usually elevated and pulmonary hypertension is frequently present. Significant shunting and hypoxemia are unusual in the absence of these diseases. We encountered a patient with normal pulmonary pressures, severe hypoxemia, pulmonary disease, and intracardiac shunting across a PFO in whom it was difficult to determine how great a role intracardiac shunting was playing in his hypoxemia. To assess this, we performed percutaneous balloon catheter occlusion of the PFO, using transthoracic echocardiography with contrast to confirm closure of the PFO. Therapeutic balloon occlusion has been reported in severe hypoxemia due to shunting across a PFO in a patient with RV infarction. Our case is unique, however, in two respects. First, this patient had normal right-sided cardiac pressures and normal RV function and, thus, no obvious driving force for a significant right-to-left shunt. Second, transthoracic echocardiography with contrast was used before and after balloon inflation to confirm closure of the PFO. This technique helped to answer the important clinical question of whether surgical closure of the PFO in this patient with both lung disease and intracardiac shunting would significantly improve his oxygenation.

[A case of recurrent pharyngocele: treatment and literature review]

Congenital or acquired pharyngocele is a rare disease characterized by a herniation of the pharyngeal mucosa through a "locus minoris resistentiae" of the lateral wall of the pharynx. Generally the pharyngocele does not present specific clinical signs or symptoms which makes it necessary to resort to radiological examination for the diagnosis. Our case is particular for primitive bilaterality and the single and median recurrence eight years later. After surgical excision the symptoms completely disappeared. The radiological examinations following surgery were negative.

[A case of lymphoepithelial cyst (branchial cyst) in an elderly patient: diagnosis differential, treatment and literature review]

We present a case of lateral cervical cyst stressing the difficulties about the diagnosis. The international guidelines for the management of lateral neck cysts in the over 40s' age group are taken in consideration. Our case is a 74 years old male patient with a 6 month history of a cervical swelling. We consider this case rare for the age of patient and the absence of malignancy.

Optical recording in Rb loaded-porous glass by reversible photoinduced phase transformations

We report reversible phase transformations in Rb loaded-porous glass irradiated with weak laser light which allow us to realize image storage on it. The effect is due to photo-induced changes of Rb distribution inside the glass pores, where atomic photodetachment and confinement produce either formation or evaporation of Rb nanoclusters. These processes depend on light frequency and intensity making controllable by light the porous glass transparency. We demonstrate that porous glass doped with Rb can be used as a support to record a light pulse for a long time as well as to remember the order of light colors in an illumination sequence.

Light induced atomic desorption from dry-film coatings

We report the first experimental evidence of nonthermal light induced atomic desorption (LIAD) from octadecyltrichlorosilane dry film. The experiment has been made with Rb confined in a coated cell kept at room temperature. A detailed study of the main features of LIAD effect has been made by varying intensity and wavelength of desorbing light. A discussion about the differences and similarities with other organic films that were studied first is reported. This result is important as it expands the list of materials showing such an effect and increases the possibilities to get suitable light controlled atomic sources for spectroscopy and applications. In particular, we plan to exploit this feature in a Fr magneto-optical trap apparatus.

Assessment of three year experience of a strategy for patient selection and timing of operation in the management of acute thoracic and lumbar spine fractures: a prospective study

BACKGROUND

The purpose of this article is to report experience gained over three years of the use of a protocol for patient selection and timing of operation for acute thoracic and lumbar fractures.

METHOD

At admission, all patients underwent neurological and imaging exams. All patients with a spinal cord lesion scored as ASIA A at any level inferior to T10 and as ASIA B, C or D at any level, were categorized as emergency and operated on within eight hours from trauma. ASIA A cases in the T1-T10 tract and ASIA E cases at any level were treated in the ordinary operative work schedule.

FINDINGS

Ninety-four patients with surgically treated lumbar or thoracic fractures took part in this study. On the imaging studies, 12 patients were classified as A, 50 as B and 32 as C following the AO classification. At the neurological exam, 39 patients were scored as ASIA A, nine as B, six as C, two as D and 38 as E. At follow-up, of the 39 patients scored as ASIA A, 13 (33%) improved at least one grade and of the 17 scored as ASIA B, C or D, 11 (64.7%) improved. None of the 38 patients scored as ASIA E deteriorated.

CONCLUSIONS

The findings show that the strategy in the protocol was safe and followed by satisfactory rates of neurological outcome. Larger prospective studies, preferably randomized, are needed to establish definitively its place in the management of patients with spinal injury.

Reversible light-controlled formation and evaporation of rubidium clusters in nanoporous silica

We observe reversible light assisted formation and evaporation of rubidium clusters embedded in nanoporous silica. Metallic nanoparticles are cyclically produced and evaporated by weak blue-green and near-infrared light, respectively. The atoms photodetached from the huge surface of the silica matrix build up clusters, whereas cluster evaporation is increased by induced surface plasmon excitation. Frequency tuning of light activates either one process or the other and the related changes of glass transparency become visible to the naked eye. We demonstrate that the porous silica, loaded with rubidium, shows memory of illumination sequences behaving as a rereadable and rewritable optical medium. These processes take place as a consequence of the strong confinement of atoms and particles at the nanoscale.

[Cancer of the male breast]

BACKGROUND

Male breast cancer is a rare type of neoplasm, being 1% of all breast tumors. An increasing relevance is given to genetic factors. Familiarity is present in 10% of cases reported in literature. Gynecomastia is frequently associated. Personal experience about this pathology is compared with the most recent data of the literature.

METHODS

Nine cases of male breast cancer observed among 519 breast tumors operated between 1982 and 1997 are reported. Etiologic and prognostic aspects, surgical and complementary therapy of breast cancer in man are examined and the high rate of II-III stage patients, mostly ER+ and PR+ is underlined. Diagnosis is reached by ultrasonography and mammography, after an accurate clinical examination and confirmed by cytology after needle biopsy. The choice operation is total mastectomy with axillary lymphadenectomy according to Patey.

RESULTS

According to our experience, 5 patients died for non neoplastic pathology, 1 patient lost at follow-up, 3 patients still alive after 66, 60 and 12 months respectively.

CONCLUSIONS

Male breast cancer is similar to the female one, but characterized by a higher hormone receptors positivity. Our survival data have no statistic significance. It is still discussed if prognostic difference between men and women is present or not.