Istiocitoma fibroso maligno. Caso clinico

L’istiocitoma fibroso maligno è un sarcoma aggressivo dei tessuti molli, che compare più frequentemente nei muscoli degli arti e nella cavità addominale o nel retroperitoneo di giovani adulti. È di difficile diagnosi pre-operatoria e ha una prognosi sfavorevole in alcuni casi. Questo lavoro riporta il caso di un paziente di 94 anni con istiocitoma ad origine cutanea e sottolinea l’importanza della diagnosi precoce ai fini della curabilità

Insolita causa di addome acuto in paziente adulto: l’ileo biliare

L’ileo biliare è una condizione morbosa rara descritta tra le complicanze della litiasi della colecisti. È causa dell’1-3% delle ostruzioni meccaniche del piccolo intestino. Interessa più frequentemente pazienti di età compresa tra 63 e 85 anni. La diagnosi pre-operatoria è generalmente posta con ritardo variabile da 1 a 10 giorni per l’assenza di una sintomatologia specifica. Caso clinico. Gli Autori riportano il caso di un uomo di 50 anni in cui è stata posta diagnosi di occlusione meccanica del piccolo intestino da voluminosa concrezione litiasica. L’occlusione ileale è stata dimostrata con la TC. Il paziente è stato sottoposto in urgenza ad intervento chirurgico, in un unico tempo, di enterolitotomia, colecistectomia e riparazione della fistola duodenale. Il decorso clinico è stato regolare e il paziente è stato dimesso in XIV giornata. Discussione. Nel nostro caso la diagnosi di ileo biliare è stata posta con un ritardo di 5 giorni. L’ecotomografia del fegato e delle vie biliari non è stata in grado di visualizzare la colecisti. La diagnosi è stata posta con la TC che si conferma gold standard diagnostico. Conclusioni. Lo stato clinico del paziente influenza la strategia chirurgica. Nel nostro paziente, considerato a basso rischio, è stato possibile l’intervento chirurgico in un unico tempo. La procedura in due tempi, enterolitotomia e successiva colecistectomia con riparazione della fistola, va riservata ai pazienti ad alto rischio

Voglio misurare l'odio

The author proposes a reflection on the experience of psychological and clinical listening in different and complexes situations in which individual’s and couple’s difficulty, such as the symptom, tells about an intrapsychic conflictuality that can be shown in separated couples through an acted and dramatized conflict inside consultation setting, while in psychological infertility cases it seems to find in the body the scene of this expression. A conflict that, in any case, asks to be mentalized and decoded by clinical’s listening. L'autrice propone una riflessione sull'esperienza di ascolto psicologico e clinico in situazioni diverse e complesse, in cui il disagio individuale e di coppia, così come il sintomo, raccontano di una conflittualità intrapsichica che, nel caso di coppie separate, si esprime manifestamente nel conflitto agìto e drammatizzato nella cornice della consultazione, mentre nei casi di sterilità psicogena sembra trovare nel corpo il suo luogo di espressione. Un conflitto che, in ogni caso, chiede di essere mentalizzato e decodificato dall'ascolto del clinico

Adenoma villoso del duodeno: un caso clinico

I tumori dell’intestino tenue sono forme rare di neoplasia rappre - sentando soltanto l’1% di tutte le lesioni del tratto gastroenterico. Le forme benigne si manifestano come adenomi che, sviluppandosi a livello duodenale, tendono a localizzarsi in prossimità della papilla presentando spiccata tendenza alla degenerazione maligna. In questo lavoro gli Autori riportano il caso di una donna di 55 anni affetta da un adenoma villoso del duodeno a localizzazione periampollare

El uso de expansores tisulares en cirugía reconstructiva : descripción de un caso clínico

Los expansores tisulares son instrumentos empleados frecuentemente en cirugia reconstructiva humana, pero su uso en cirugia veterinaria es extremadamente infrecuente. Este articulo pretende presentar algunos aspectos generales de su uso en cirugia humana, discutir sus posibles usos en cirugia veterinaria y descubrir su utilizacion con exito en un caso clinico

La rappresentazione del rapporto tra utenti e sistema sanitario: I modelli culturali dei medici di medicina generale - The representation of the relationship between users and healthcare system: Cultural models of general practitioners

The present research study explores the emotional and symbolic representation of the Italian healthcare system and specifically of general medical services reported by a group of Italian general practitioners. General medicine is recently affected by a structural change which could be sustained also by a cultural revolution, however this revolution seems to be oriented to expected values without a clear methodology which promotes and accompanies this cultural change. The present study deals with the lack of practices due to these unrealized expected values and assumes that for intervening it is necessary knowing the existing culture before thinking to change it. Interviews to 36 general practitioners were analyzed by Emotional Text Analysis (AET). Results highlight a factorial space characterized by five clusters. According to respondents’ perspective, healthcare problems refer to two large issues characterized by powerlessness of general practitioners to intervene. On the one hand, there is health emergency, dealt with by first aid and emergency medicine. On the other hand, there is chronicity, especially affecting the elderly, which is dealt with by other workers (nurses, private family assistants, social workers) who care patients at home and replace physicians. The general practitioners’ work is difficult because of many different reasons; but the central theme is the lack of absolute power – based on morality and consciousness – which leads to the perception of catastrophic consequences for medical profession and the physician-patient relationship. Often, general practitioners are in their offices and are not able to go to patients’ home, therefore they cannot create care relationships based on trust and dependence which allow useful and trustworthy interventions. In sum, the core theme emerging from data refers to the general practitioners’ perceived lack of personal and trust-based relationships with patients

Mucosa associated lymphoid tissue lymphoma of the thyroid gland: a case report and literature review = MALT linfoma della tiroide: caso clinico e revisione della letteratura

Mucosa associated lymphoid tissue (MALT) lymphomas are low-grade, non-Hodgkin’s B cell lymphomas, mainly occurring in the gastrointestinal tract, but also in other tissues. We describe the management of a patient with hypothyroidism, tracheoesophageal compressive symptoms and chest tightness affected by a thyroid MALT lymphoma. The patient underwent debulking thyroidectomy and temporary tracheostomy in order to reduce dysphonia and dysphagia, followed by adjuvant chemotherapy and subsequently radiation therapy. A CT scan performed at the end of radiotherapy 6 months after surgery revealed remnants of residual tissue from the thyroidectomy without any pathological findings. I linfomi MALT sono dei linfomi non-Hodgkin a cellule B a basso grado che in genere insorgono a livello del tratto gastrointestinale, ma anche in altri tessuti. Descriviamo in questo articolo il management clinico-chirurgico di un paziente con ipotiroidismo, sintomi da compressione tracheo-esofagea e senso di oppressione toracica, affetto da linfoma MALT della tiroide. Il paziente è stato sottoposto a parziale asportazione della massa tiroidea e tracheostomia allo scopo di ridurre i sintomi compressivi ed in seguito a trattamento chemioterapico e radioterapico. L’esame TC effettuato una volta conclusa la radioterapia, circa 6 mesi dopo l’intervento, ha evidenziato gli esiti della tiroidectomia parziale in assenza di altri reperti patologici

La cultura dei servizi di accoglienza migranti in Italia. Una ricerca esplorativa [The culture of migrant reception services in Italy. An exploratory research]

Italy has a long history of immigration, which has become part of the country’s landscape in a complex and varied way, and has led to significant changes in important contexts such as in the school, the work place, and in the provision of welfare services. And yet, immigration policies still consist in emergency measures that do not recognize the phenomenon in its long -standing and structural dimension. In addition, public opinion is concerned as a result of the alarmist distortion of this issue, as shown by the gapbetween data on immigration and perceived immigration. Since in this research we take into consideration collusively shared experiences, these misunderstandings can not be corrected by providing more information on the real data; we posit that the emotional scope must be recognized in order to address this issue. In particular, we asked ourselves how this context -changes brought by immigration, public opinion, and government policies -is repre sented within the migrant Accordingly, we interviewed a group of reception staff from the Roman area on the type of service that they think they are offering. The results show how, in their experience, this complex reality of immigration is not evoked: the experience within the services is isolated from the Italian narrative and context. However, the voice of migrants and their point of view, emerge as a resource within these services, as openness rather than isolation

La relazione che organizza il contesto sanitario: domanda dell’utenza e risposta dei servizi sanitari, nel territorio e nell’ospedale - The relationship which organizes the healthcare context: users’ demand and response of healthcare services, in the territory and the hospital

Our intent is to present citizens’ demand of health care services in Italy through a research structured in three studies. We used the Emotional Text Analysis (ETA) to lead the three s tudies: the first study regarded the citizens’expectations of the healthcare services, the second study regarded the point of view of the hospital personnel (medical doctors and nurses), the third regarded the point of view of the General Practitioners onthe health care services. These three studies are briefly presented. Data and outcome of an Assumed Similarity Test applied to all experimental subjects of the three studies in order to make a comparison among them, are also presented. The findings of the Emotional Text Analysis show that citizens, potential users of health services, center their requests on their individual subjectivity, and seek answers both to their suffering and to the feeling of alienation that characterizes the being sick feeling that makes them go to a medical doctor. For their part, general practitioners and hospital doctors immediately transform this subjective feeling in an objective medical diagnosis. Here a first gap emerges between patient’s demand and medical response, leavingthe possibility of an alliance on the diagnosis in order to jointly fight the disease. It has long been in place though a change that has expelled the patient also from sharing the diagnostic process, increasingly taken from self-centered dynamics within the healthcare system. This widens the gap between the request of the citizens and the response of the health services, that contributes to that conflictual growth to which defensive medicine gives a dysfunctional answer. The Assumed Similarity Test contributes to the interpretation of the health care dynamic identified in the Emotional Text Analysis; particularly in regard to the unfolding conflict, given by the hypothesis emerging from the data analysis, that a feeling of closeness for the hospital personnel goes along with an emotional stance of overpowering the othe

The relationship between health care users’ demand and the health care system’s response: a research on change observed in the health care system, in the hospital and in the territory

The present research study aims at exploring the representation of the health service within a group of hospital physicians and nurses. The objective is to identify how the symbolic dynamic of hospital workers shapes their own praxis. The texts of interviews with 25 hospital workers have been subjected to Emotional Text Analysis (ETA). Five clusters emerge from the analysis where the topic of giving life and avoiding death is central and where the hospital assumes a thaumaturgical and basically omnipotent role. This is in conflict with recognizing the limitations of therapy. Only in the background the culture of curing the patients appears, characterized by aggressive reactivity towards the crisis which leads patients to emergency intervention because crises are ascribed to deviances frommedical prescription. Emergency intervention is ultimately the kind of intervention which the hospital believes it is capable to provide. Another problem is the lack of filters provided by bureaucratized general practitioners, whose cooperation would be essential, but who are supposed to have no longer the necessary relationship with their patients