Anesthesia in Treacher Collins Syndrome for bone anchored hearing aid (BAHA) surgery.

Treacher Collins syndrome (TCS) is a rare genetic disor- der characterized by distinctive abnormalities of the head and face, affecting about one child in every 50000. Ab- normalities such micrognathia, cleft palate and cervical spine alterations are common and may represent an addi- tional risk in airway management for general anesthesia. As a matter of fact, difficult OTI prevalence in paediatric surgery rises from 1-2% to 50% when considering the subpopulation of paediatric patients with cervical spine diseases, as TCS ones. This article describes a case report of our anesthesiological management in bone-anchored hearing aid (BAHA) implant surgery in a 7-year-old fe- male Treacher Collins Syndrome patient born without the long process of the incus, the stapes and with hypoplasia of the oval window bilaterally. A careful preoperative evaluation and anesthesiological plan based on the use of videolaryngoscopy, routine practice in our centre, granted a successful outcome and no complications

in keeping with the spirit of the albertine statute constitutionalisation of the national unification

This chapter deals with the difficult process of constitutionalisation which characterised Italian Unification. Constitutionalisation is a long-term phenomenon which had the purpose of giving constitutional forms to the Nation. The promulgation of the Albertine Statute is more the start than the arrival of this phenomenon. The focus of this investigation is, therefore, to study the Constitution through its evolution paying particular attention to the process of legal integration within the structures of the Albertine Statute and to the amendment mechanisms of the constitutional text. The preamble of the Albertine Statute speaks of «perpetual and irrevocable fundamental law». The word «perpetual» meant the prohibition of revoking constitutional concession, while the word «irrevocable» was intended as a pact between the Sovereign and the Nation. Over the years, very few were the changes to the letter of the Albertine Statute. The interpretation and the practice represented the most important mechanisms of constitutional change (implicit constitutional changes). A primary role was acknowledged to non-written norms. In this perspective, it may well be said that the Italian Constitution consisted in something more than the written text and dwelt in the spirit and not in the letter of the Albertine Statute

On the interaction between imidazoles and zinc salts. The role of counterions and of substituents

The reactions between benzimidazole (L 1), 4-phenylmidazole (L 2), 4-methylimidazole (L 3), 2-phenylimidazole (L 4) and ZnX 2 (X = Cl, Br, l, NO 3, ClO 4, CH 3COO, CF 3COO, CF 3SO 3 or BF 4) have been investigated. 31 novel adducts were obtained and characterized by analytical (elemental analysis and conductivity measurements) and spectral (IR, far IR and 1H NMR) data. The ligands L 1, L 2, L 3 and L 4 behave always in the monodentate N-donor fashion yielding 2:1 (L 2ZnX 2, L = L 1 and L 4), 3:1 (L 3ZnX 2, L = L 2, L 3 and L 4), 4:1 (L 4ZnX 2, L = L 1, L 2, L 3 and L 4), 5:1 ([L 5Zn]X 2; L = L 1) and 6:1 derivatives ([L 6Zn]X 2, L = L 2). The behavior of the adducts in acetone and chlorinated solvents is also discussed. Comparison has been made with related complexes of imidazoles

From a tick in external auditory canal to pediatric Lyme disease

Lyme disease is an infectious disease caused by Borrelia Burgdorferi infection. It is a zoonosis transmitted by ticks and is common in Europe. Its clinical presentation in- cludes an early manifestation, which can cause local and systemic symptoms, and a late form. Erythema migrans, arthritis, facial palsy, meningitis and carditis are possible complications of the disease. We report a case of a 4-year child who presented with fever and upper and lower limbs maculopapular cutaneous rash. Left otoscopy showed the presence of a black, round-shaped foreign body attached to the postero-superior aspect of the exter- nal auditory canal (EAC), which was identified as a tick. Prompt removal of the tick was proposed. Considering the age of the patient, general anesthesia was indicated. After orotracheal intubation, the lesion was completely removed under microscopic vision. Subsequently, intra- venous antibiotic therapy was continued; the day after, the patient was transferred to a pediatric department where attentive monitoring and therapy were continued, with complete resolution of the symptoms