Polysplenia. Description of a case

A clinical and hemodynamic study of a case of polysplenia, with typical left bilateral symmetry, anomalies of systemic venous drainage and defect of the endocardial cushions. A brief revision of the literature is given and the embriological and clinical concept of the left bilateral symmetry is discussed.     

Lymph node inflammatory pseudotumor. Description of a case

A case of inflammatory pseudotumor of lymph node in a 56-year-old man is described. The awareness of this benign reaction pattern is of great importance for differential diagnosis with many nodal lesions.     

Ulcerative colitis associated with Weber-Christian panniculitis and musculitis: a case report

A case of 22-year-old man suffering from ulcerative colitis, in whom Weber-Christian panniculitis and musculitis occurred simultaneously, is reported. He had suffered from ulcerative colitis for 7 years and he again had bloody stools 1 month before being admitted. Two weeks before admission, large (2-4 cm) subcutaneous tumors appeared. Weber-Christian panniculitis, musculitis, and active stage ulcerative colitis were diagnosed. All the symptoms went into remission after steroid therapy. The possibility of the existence of a common antigen in enterobacterial wall, colonic epithelium, and adipose tissue was suggested.     

Jaundice caused by estro-progestinic agents. Description of a case

A case of oestroprogestinic icterus is reported. The potential toxicity of these drugs, which have now been in use for twenty years in medical and non-medical practice, on liver parenchyma is discussed. Such treatment should be carried out only under the attentive, constant control of a physician who should not neglect liver function in his examination.     

The Emperor's New Clothes syndrome. Description of a new epidemic

In 1971, F. Gross, inspired by "The Emperor's new clothes" (H.C. Andersen--1835), published in the New England Journal of Medicine, a report of an endemic polysystem disease: the emperor's clothes syndrome. In the first place, it touches students or physicians who fear losing their prestige. From personal observations, we describe a new epidemic of this disease whose radiological image is the main vector. By this comment, we wish to attract the attention to the danger of giving a diagnosis uniquely on the basis of the complementary examinations. We want to underline the importance of the medical history and physical examination. All clinical or radiological data, all biological phenomenons are subject to variable interpretation. There exist statistical methods to estimate the sensitivity, the specificity and the clinical value of a test.     

Friedreich's disease, diabetes and pregnancy. Description of a case

Birth of an infant at term to a diabetic woman with a severe form of Friedreich's disease is reported. The aetiopathogenesis of the cardiac deformities that led to the death of the child on day seven of life is discussed.     

Leptospirosis. Description of a clinical case and review of the literature

Leptospirosis is a world-wide diffused anthropozoonosis due to many strains of Leptospira. Initial symptoms may be mild, although in many cases severe systemic symptoms, including high fever, hypotension, etc. may be present since the beginning. In these latter circumstances, the diagnosis of leptospirosis can be very difficult because of the complexity of clinical picture especially when the history is lacking or incomplete. A case report of a 45 year-old man admitted to the hospital after severe jaundice and fever of unknown origin associated to altered mental status, renal failure and hypoxemia is presented. Because of the presence of septic shock and severe respiratory failure, the patient was transferred to the intensive care unit. The diagnostic hypothesis, based on clinical history, was confirmed by laboratory tests (leptospiral IgM antibodies detection). Therapeutical approach with the use of selected antibiotics (penicillin 24,000,000 U for day) and therapy of septic shock led to improvement of the patient's clinical conditions who was then transferred to a regular medical ward.     

Acute carbamazepine poisoning treated with plasmapheresis. Description of a clinical case

A case of severe Carbamazepine poisoning initially misdiagnosed is reported. Treatment consisted in plasmapheresis (3.5 liters exchanged) repeated for 3 consecutive days, in conjunction with activated charcoal and advanced life support. It was obtained a rapid decay in Carbamazepine plasmatic level (with rebound phenomenon only after first treatment day) and a contemporary improvement in clinical conditions. The patient was discharged without complications after 6 days stay in ICU. Taking pharmacokinetic characteristics into account, it is suggested that plasmapheresis may be useful in this kind of poisoning.     

Sarcoid-like hepatic granulomas, associated with gastric neoplasia. Description of a case

Giant cell granulomas in liver biopsies is a relative common finding. Among the many causes of granulomatous lesions of the liver primary biliary cirrhosis and sarcoidosis are the most frequently diagnosed. On the other hand sarcoid-like granulomatous reaction can be encountered associated to malignant tumours. Purpose of the present paper is to describe a case of a sarcoid-like reaction of the liver associated to gastric adenocarcinoma. The patient was a 66 yr old man who underwent gastrectomy for a signet-ring cell adenocarcinoma. Pathological anamnesis was unremarkable. Liver function tests were within normal limits. Chest x ray was normal. A liver biopsy was performed during surgery as the liver presented an irregular surface. On histology giant cell granulomas with sarcoid-like features were seen in the hepatic parenchyma. Same reaction was present in the perigastric lymph nodes. The patient died immediately after surgery due to massive pulmonary embolism. No autopsy was performed. Among the possible diagnoses primary biliary cirrhosis, sarcoidosis and paraneoplastic sarcoid-like granulomatous reaction were considered. Primary biliary cirrhosis and sarcoidosis were excluded on the basis of the past clinical history of the patient, that was unremarkable; furthermore liver function tests performed preoperatively were within normal ranges. Thus paraneoplastic sarcoid-like reaction involving the liver was regarded as the most likely diagnosis.     

Complete neurological recovery following prolonged cardiac arrest. Description of a clinical case

The therapy of fibular ligament ruptures is still a controversial subject. Reports on healing processes following operative or conservative treatment have been verified hitherto by means of clinical examinations and stress tests. The MRT, as a highly sensitive non-invasive method, allows exact documentation of the ligament structures in the ankle joints. This technique was used in a randomized clinical trial over a 6-month period. The 29 patients (ages 17-51 years) had recent ligament rupture [admission criteria: clinical signs of trauma, talar tilt in anteroposterior stress radiographs (15 kp) > or = 10 degrees, talar shift > or = 10 mm] were examined with regard to ligament healing during functional therapy with AIRCAST pneumatic leg braces. Within the first week an MRT was done for verification of ligament injury. Treatment was conservative and functional: lower leg cast for 2 weeks and subsequent mobilization with protection provided by an AIRCAST brace. Follow-up examination was 3 months after injury, taking the form of clinical examination, a-p-radiographs with stress tests, and MRT. In all patients both clinical and radiological examination confirmed that ligament structures had healed, as was also verified by MRT.