Flu-like syndrome, bronchoconstriction and fever caused by 5-methoxypsoralen: the first case report and literature review.

Photochemotherapy with psoralens and UVA (PUVA) is a very effective therapeutic option based on the interaction of a photoactive drug and light usually employed for the treatment of psoriasis and of other skin disorders, such as atopic dermatitis, vitiligo, and cutaneous lymphoma. The psoralens most widely used for oral PUVA are 8-methoxypsoralen (8-MOP) and 5-methoxypsoralen (5-MOP), tricyclic furocoumarins naturally present in a large number of plants. The chemical formula and the molecular composition of 5-MOP and 8-MOP present only slight differences, however these are sufficient to make them two different chemical compounds capable of different reactions and interactions. PUVA is generally well tolerated, but adverse events may occur. Besides the photosensitizing effect, which represents the therapeutic basis of PUVA, the commonest side effects complained of by the patients after oral intake of psoralens are nausea, vomiting, anorexia (mainly for 8-MOP), insomnia, anxiety, headache. Although very rarely or exceptionally, a series of potentially serious side effects has also been referred: while anaphylaxis has been reported due to both oral 5-MOP and 8-MOP, exanthematous drug reaction, urticaria, bronchoconstriction, asthma exacerbation, drug fever and flu-like symptoms such as headache, fatigue, muscle aches have been published related to 8-MOP intake only. To our knowledge, in fact, none of the above mentionated symptoms have been associated to oral 5-MOP in literature. Our report describes a case of fever, bronchoconstriction and flu-like syndrome in a patient during PUVA therapy with oral 5-methoxypsoralen

Management of iatrogenic subclavian artery rupture: two case reports

Bleeding of the branches of a subclavian artery can be a life-threatening condition. Subclavian artery bleeding can lead to tracheal obstruction, hemothorax, respiratory failure, hemorrhagic shock, and death if not diagnosed early and treated promptly. Injury to the subclavian artery occurs in multiple different manners including blunt, penetrating, or iatrogenic trauma. Here we reported two cases of injury of the branches of the right subclavian artery (RSA); one following a central venous catheterization and the other following a thoracic drainage tube placement. Herein we describe two endovascular treatment options used in the management of rupture of a subclavian artery. The proximal tract of the subclavian artery and its main branches is also considered a 'border territory' between interventional vascular radiology and interventional neuroradiology because it gives rise to branches both cervical and to the upper limbs

Evaluation of postoperative pain after gynecologic surgery: a dedicated form

Introduction:Aim of this study is to evaluate the prevalence and intensity of postoperative pain and to find pain-related factors in women undergoing gynecologic surgery, using a dedicated form. Methods: The sample is divided into three groups, according to the type of surgical access (transversal laparotomy TL, longitudinal laparotomy LL, vaginal VAG). Each patient received postoperative painkillers according to hospital therapy protocols. Postoperative pain episodes that have been recorded during the first three days after surgery (days 0,1,2)) were studied. Pain intensity was measured using Numerical Rating Scale (NRS). Results:The 64% of operated women complained at least one episode of pain during the three days after surgery. Among women complaining pain, its intensity was moderate for the 89% (NRS 4-7) and it was severe only in few cases (11%), mainly in the VAG group. The due-hour painkillers administration was associated to a lower percentage of pain episodes if compared to the "rescue doses". Conclusions: Pain control is important to promote safe surgery. A dedicated form is useful to assess this vital sign. The results present a detailed pictureof this extremely subjective symptom and they suggest how to improve the analgesic therapies when necessary

STRUCTURAL-CHANGES OF THE SOLEUS AND THE TIBIALIS ANTERIOR MOTONEURON POOL DURING DEVELOPMENT IN THE RAT

The morphological development of motoneuron pools of two hindlimb muscles of the rat, soleus (SOL) and tibialis anterior (TA), was studied in rats ranging in age between 8 and 30 postnatal days (P8-P30). Motoneurons were retrogradely labelled by injecting a cholera toxin B subunit solution directly into the muscles. This resulted in extensive labelling of motoneurons as well as their dendritic trees. The distribution of cross sectional areas of neuronal somata was determined for both muscles at various ages. Somal size increased considerably between P8 and P12, whereas growth was moderate between P12 and P20. The size distribution of SOL motoneurons was bimodal from P20, whereas the size distribution of TA motoneurons remained largely unimodal. The morphological development of the dendritic tree was studied qualitatively.The development of dendritic arborization within the SOL and the TA motoneuron pool showed major differences. The arborization pattern of dendrites of TA motoneurons was basically multipolar at all ages. In contrast, dendrites of SOL neurons tended to line up with the rostro-caudal axis and became organized in longitudinal bundles from P 16 onwards. The relatively late appearance of dendrite bundles in the soleus motoneuron pool suggests that they might be related to the fine-tuning of neuronal activity rather than patterning of motor activity. The occurrence of dendrite bundles in SOL and not in TA motoneuron pools suggests that they may be related to the different afferent organization of this postural muscle or to its tonic activation pattern