Eosinophilic vasculitis: an inhabitual and resistant manifestation of a vasculitis

A 55-year-old woman was referred because of diffuse pruritic erythematous lesions and an ischemic process of the third finger of her right hand. She was known to have anaemia secondary to hypermenorrhea. She presented six months before admission with a cutaneous infiltration on the left cubital cavity after a paravenous leakage of intravenous iron substitution. She then reported a progressive pruritic erythematous swelling of her left arm and lower extremities and trunk. Skin biopsy of a lesion on the right leg revealed a fibrillar, small-vessel vasculitis containing many eosinophils.Two months later she reported Raynaud symptoms in both hands, with a persistent violaceous coloration of the skin and cold sensation of her third digit of the right hand. A round 1.5 cm well-delimited swelling on the medial site of the left elbow was noted. The third digit of her right hand was cold and of violet colour. Eosinophilia (19 % of total leucocytes) was present. Doppler-duplex arterial examination of the upper extremities showed an occlusion of the cubital artery down to the palmar arcade on the right arm. Selective angiography of the right subclavian and brachial arteries showed diffuse alteration of the blood flow in the cubital artery and hand, with fine collateral circulation in the carpal region. Neither secondary causes of hypereosinophilia nor a myeloproliferative process was found. Considering the skin biopsy results and having excluded other causes of eosinophilia, we assumed the diagnosis of an eosinophilic vasculitis. Treatment with tacrolimus and high dose steroids was started, the latter tapered within 12 months and then stopped, but a dramatic flare-up of the vasculitis with Raynaud phenomenon occurred. A new immunosuppressive approach with steroids and methotrexate was then introduced. This case of aggressive eosinophilic vasculitis is difficult to classify into the usual forms of vasculitis and constitutes a therapeutic challenge given the resistance to current immunosuppressive regimens

L\u2019infiltrazione miometriale nei tumori dell\u2019endometrio: criteri di valutazione ed errori in tomografia computerizzata.

L\u2019infiltrazione miometriale nei tumori dell\u2019endometrio: criteri di valutazione ed errori in tomografia computerizzat

Endovascular treatment of proximal bilateral iliac limb dislocation and kinking following endovascular abdominal aortic aneurysm repair

We report the case of a 69-year-old man with a late type 1b endoleak due to proximal migration of both iliac limbs 5 years after endovascular repair of an abdominal aortic aneurysm. The endovascular method used to correct bilaterally this condition is described. Final angiographic control shows patency of the stent-graft without signs of endoleak

La malattia infiammatoria pelvica ( PID ): contributo della TC.

La malattia infiammatoria pelvica ( PID ): contributo della TC

Telementoring during endovascular treatment of abdominal aortic aneurysms: a prospective study.

PURPOSE: To explore the use of telementoring for distant teaching and training in endovascular aortic aneurysm repair (EVAR). METHODS: According to a prospectively designed study protocol, 48 patients underwent EVAR: the first 12 patients (group A) were treated at a secondary care center by an experienced interventionist, who was training the local team; a further 12 patients (group B) were operated by the local team at their secondary center with telementoring by the experienced operator from an adjacent suite; and the last 24 patients (group C) were operated by the local team with remote telementoring support from the experienced interventionist at a tertiary care center. Telementoring was performed using 3 video sources; images were transmitted using 4 ISDN lines. EVAR was performed using intravascular ultrasound and simultaneous fluoroscopy to obtain road mapping of the abdominal aorta and its branches, as well as for identifying the origins of the renal arteries, assessing the aortic neck, and monitoring the attachment of the stent-graft proximally and distally. RESULTS: Average duration of telementoring was 2.1 hours during the first 12 patients (group B) and 1.2 hours for the remaining 24 patients (group C). There was no difference in procedural duration (127+/-59 minutes in group A, 120+/-4 minutes in group B, and 119+/-39 minutes in group C; p=0.94) or the mean time spent in the ICU (26+/-15 hours in group A, 22+/-2 hours in group B, and 22+/-11 hours for group C; p=0.95). The length of hospital stay (11+/-4 days in group A, 9+/-4 days in group B, and 7+/-1 days in group C; p=0.002) was significantly different only for group C versus A (p=0.002). Only 1 (8.3%) patient (in group A: EVAR performed by the experienced operator) required conversion to open surgery because of iliac artery rupture. This was the only conversion (and the only death) in the entire study group (1/12 in group A versus 0/36 in groups B + C, p=0.31). CONCLUSIONS: Telementoring for EVAR is feasible and shows promising results. It may serve as a model for development of similar projects for teaching other invasive procedures in cardiovascular medicine

Recidive di tumori ovarici : utilit\ue0 della TC.

Recidive di tumori ovarici : utilit\ue0 della TC

Clinical value of computerized tomography (CT) in assessment of recurrent uterine cancers.

Fifty-one patients with a clinically suspected relapse of uterine cancer were evaluated with computerized tomography (CT) in the Departments of Obstetrics/Gynecology and Radiology of the University of Pavia. The accuracy of these scans was always compared with biopsy results (31 cases) or clinical outcome (20 cases). To evaluate the role CT played in the treatment of each patient we divided the results of these examinations into "Confirmative" (when there was clinical evidence of a tumor) and "Diagnostic" (when physical examination and conventional radiologic techniques were inconclusive). Overall diagnostic accuracy was 92%, specificity 80%, and sensitivity 92%. The authors found that CT provides information that is useful for planning treatment and for avoiding unnecessary surgical exploration when a tumor is clinically evident; furthermore, CT was found to be better than conventional diagnostic means in doubtful cases, especially those in which post-therapeutic pelvic fibrosis was not extensive (correct diagnosis is 15 of 19 cases)

Code-switching used by Sacha Stevenson in Tonight Show and Sarah Sechan on Net Tv

INDONESIA: Penelitian ini menyelidiki penggunaan jenis dan fungsi alih kode yang digunakan oleh Sacha Stevenson sebagai bintang tamu di Tonight Show dan Sarah Sechan di NETV. Tonight Show dan Sarah Sechan dua talk show populer di NET TV. Dalam rangka untuk mencari jenis dan fungsi alih kode yang digunakan oleh Sacha Stevenson di Tonight Show dan Sarah Sechan di NET TV, penulis menggunakan deskriptif kualitatif. data dalam bentuk percakapan. Pengumpulan data dilakukan dengan mengumpulkan data dari video berdasarkan urutan dan kontekspercakapan. Hasilnya menunjukkan bahwa jenis alih kode yang ditemukan di kedua sumber yang intra-sentential alih kode, antar-sentential alih kode dan membangun kesinambungan ke speaker sebelumnya lambang atau tag-switching. Fungsi alih kode yang ditemukan di kedua sumber data meliputi kesulitan dalam berbicara bahasa Indonesia mengurangi atau menghindari wajah dan meningkatkan prestise untuk dilihat sebagai orang yang berpendidikan dan menutupi ketidakmampuan berbicara bahasa Indonesia. Penelitian ini tidak dapat melakukan wawancara langsung dengan Sacha Stevenson. Oleh karena itu, Hal ini dapat memberikan kesempatan bagi peneliti lain untuk menemukan alasan menggunakan kode-switching yang digunakan oleh Sacha Stevenson yang dapat dengan diterapkan dengan mengamati dan mewawancarai dia segera. ENGLISH: This research investigates the use of types and functions of code-switching used by Sacha Stevenson as guest star in Tonight Show and Sarah Sechan on NETV. Tonight Show and Sarah Sechan are two popular talk shows in NET TV. In order to find the type and the function of code-switching used by Sacha Stevenson in Tonight Show and Sarah Sechan on NET TV, the writer uses descriptive qualitative. The data is in the form of conversation. The data collection was done by collecting the data from videos based on the sequence and the context of the conversation. The result shows that the types of code-switching found in both sources are intra-sentential code-switching, inter-sentential code-switching and establishing continuity toward previous speaker emblematic or tag-switching. The functions of code-switching found in both data sources are covering the difficulty in speaking Indonesian are reducing or avoiding face and increasing prestige to be viewed as an educated person and covering inability in speaking in Indonesian. This research cannot do a direct interview to Sacha Stevenson. Therefore, It can give chance to other researchers to find the reason of using code-switching used by Sacha Stevenson which can by applied by observing and interviewing her immediately