Acute subcutaneous laterocervical emphysema and pneumomediastinum secondary to inferior third molar extraction

Subcutaneous laterocervical emphysema and pneumomediastinum are often due to head and neck surgery, but these are uncommon complications of dental procedures. The use of high-speed air-turbine headpieces during dental extractions is sometimes associated with this complication, making simple the spread of air under sublingual, submandibular, retropharyngeal, and parapharyngeal spaces, routes of communication to the mediastinum. Due to its rarity, it is not simple to recognize, often confused with other complications after oral surgery, such as allergic reaction, hematoma, and infections. We present a case of subcutaneous laterocervical emphysema and pneumomediastinum after inferior impacted third molar tooth extraction, self-limiting with a conservative therapy. We need to focus on this case because it is often misdiagnosed by physicians in emergency department as an allergic reaction. We also underline the importance of an empiric antibiotic therapy to prevent spreading of oral microorganism causing severe mediastinitis and sepsis. To avoid these complications, high-speed air-turbine headpieces should be used only when it is essential

Aspetti medico-legali dell'isterosalpingografia

Questo lavoro è infatti il risultato della continua ricerca e del confronto quotidiano tra il mondo della diagnostica per immagini e quello dei clinici che, ai nostri giorni, nelle immagini cercano spesso la conferma o i chiarimenti del dubbio diagnostico. (...) In particolare, la diagnostica per immagini dell’infertilità rimane ancora oggi una zona di confine tra l’interesse del ginicologo e quella del radiologo, che a seconda delle realtà nella quale operano, si trovano entrambi ad essere esecutori di un’attività che in passato non è mai stata chiaramente affidata per competenze all’uno o all’altro. Questo ha inevitabilmente portato a far diventare l’isterosalpingografia la “cenerentola” delle indagini radiologiche, lasciata, a seconda dei casi, nelle mani di radiologi con scarsa competenza ginecologica o di ginecologi con carente conoscenza delle tecniche radiologiche. (...) Questa raccolta si propone inoltre di seguire l’evoluzione che le tecniche di diagnostica per immagini hanno comportato per lo studio dell’apparato genitale, come l’utero e le salpingi. L’isterosalpingografia, tecnica di diagnostica radiologica è, accanto a tutta la radiologia scheletrica e toracica, indagine tra le prime realizzate. Rappresenta un “dinosauro” della diagnostica dell’apparato genitale femminile, che evolvendosi lentamente nel tempo, non si è tuttora estinto. È stata affiancata dalle tecniche ecografiche e anche in questo settore l’evoluzione tecnologica è andata di pari passo con quella diagnostica: il color Doppler, la sonosalpingografia ne sono esempi importati e attuali.

CT and MR findings in extramedullary haematopoiesis with biliary system encasement: a case report

Extramedullary haematopoiesis is the production of blood elements outside the bone marrow cavity. In our case computed tomography and magnetic resonance imaging revealed the presence of a rare localization of extramedullary haematopoiesis with encasement of the biliary system in a 59 years-old male Caucasian patient, with chronic myelofibrosis and hepatic failure’s symptomatology. Computed tomography detected the presence of homogeneous hypodense tissue around intra-hepatic bile ducts with minimal contrast enhancement, strongly suggestive for extramedullary haematopoiesis. Magnetic resonance confirmed the presence of a solid tissue surrounding the biliary tree, showing late enhancement after gadolinium administration suggestive for non-active lesion of extramedullary haematopoiesis. Final diagnosis was established by percutaneous biopsy

Diagnostic imaging of lung cancer after heart transplantation

Aims and Background In heart transplant recipients pulmonary neoplasms are among the most frequent solid tumors; they have a rapid and aggressive course, and therefore require an early diagnosis. We describe the role that diagnostic imaging plays in different diagnostic moments of this disease. Methods We evaluated the incidence and diagnosis of lung cancer in patients who underwent heart transplants at our institution. Taking into account the few different diagnostic imaging techniques (chest X-ray, high-resolution computed tomography [CT], staging CT and CT-guided biopsy) used in standard surveillance protocols or indicated by clinical symptoms, we evaluated their diagnostic accuracy, their efficacy in tumor staging, and their impact on the therapeutic choices. Results Seventeen neoplasms in a total of 712 patients were diagnosed (2.4%). In 16 of these 17 cases chest X-ray (routinely performed as follow-up in 11 cases, indicated by symptoms in 5 cases) was diagnostic. In another 11 cases chest X-ray was false positive. The diagnostic accuracy, sensitivity, specificity, positive and negative predictive value of chest X-ray was 98%, 91%, 98%, 50%, and 99%, respectively. Total-body CT correctly staged the tumors and provided information as to whether surgery was indicated or not (stage II or advanced). Conclusions Chest X-ray is still the surveillance radiological technique in heart transplant recipients. Considering its low specificity and sensitivity, we propose high-resolution CT imaging during follow-up to identify pulmonary lesions as soon as possible and enable a differential diagnosis with parenchymal inflammation. The use of CT-guided fine-needle biopsy and culture examinations permits to differentiate neoplastic from inflammatory parenchymal opacities. Use of CT in cancer staging is effective for subsequent treatment choices. </jats:sec

Effectiveness of a Single Education and Counseling Intervention in Reducing Anxiety in Women Undergoing Hysterosalpingography: A Randomized Controlled Trial

Hysterosalpingography (HSG) is generally considered a stressful and painful procedure; we aimed to evaluate whether a single education and counseling intervention could reduce women's distress and pain after undergoing HSG for infertility. Patients were randomized into control group (n = 108) and intervention group (n = 109). All patients filled the following questionnaires before and after HSG: Zung self-rating anxiety scale (Z-SAS), Zung self-rating depression scale (Z-SDS), and an ad hoc questionnaire designed to evaluate HSG procedure knowledge. Pain was scored using a visual analog scale. The intervention consisted in a 45-minute individualised session 48 h before HSG. We observed a reduction of anxiety and depression scores in the intervention arm compared to the control group. After controlling for potential confounding variables, intervention was an independent predictor of the difference of Z-SAS score before and after HSG. This is the first randomised controlled trial to assess the potential effectiveness of a single education and counseling intervention to lower anxiety in a diagnostic setting

Advanced native-kidney carcinoma in a heart- and kidney-transplanted patient: a case report

Malignancies are one of the leading causes of death in long-term surviving transplant recipients. Dose and prolonged durations of immunosuppressive regimens are considered the main cause, through a direct oncogenic effect and a renowned interaction on physiological anti-viral and anti-oncogenic immune response. Specific neoplasms are known to occur with different frequencies according to the transplanted organ. As a consequence, imaging screenings have been implemented in many graft surveillance programs, although a wide consensus on the timing and modality has not been concurred. There are little data available in the literature regarding incidence of de-novo malignancies in multi-organ recipients. We report the case of a 66-year-old man who developed a renal mass 10 years after a combined heart-kidney transplant