Diffuse alveolar hemorrhage due to valproic acid: Case report and review of the literature

Valproic acid (VPA) is one of the most frequently used antiepileptic drugs for the treatment of focal and generalized epilepsies, absence seizures, and Lennox-Gastaut syndrome (LGS). VPA has been demonstrated to have a negative effect on both the intrinsic and extrinsic coagulation systems and controversy exists about the clinical relevance of such hematological abnormalities. We describe a case of reversible lung hemorrage due to VPA. In English-language literature only two other similar cases (one of which fatal) have been described so far

RIGHT PNEUMOTHORAX SECONDARY TO REMOVAL OF NASOGASTRIC TUBE

Malpositioning of the nasogastric tube into the airway is one of the most frequent complications and the consequences of improper positioning of the tube in the airways depend on several factors: creation or not of a pleuro-pulmonary fistula, introduction or not of drugs into the tube, the overall clinical condition of the patient. A pneumonia caused by instillation of drugs or a pneumothorax or a mediastinitis may precipitate a clinical situation already basically compromised

UNUSUAL FOREIGN BODY IN THE LEFT MAIN BRONCHUS

The paper present the images about a case of inusual foreign body in the left main bronchus that was removed with a very risky maneuver

FATAL HEMORRHAGE DUE TO TRACHEAL-ESOPHAGEAL-AORTIC FISTULA IN A PATIENT WITH DOUBLE AORTIC ARCH

We report a case of a18-year-old male with double aortic arch who underwent surgery for bleeding from a left bulbar cavernous angioma of the medulla oblongata. A tracheostomy tube was positioned but after several days the patient died because of a tracheo-esophageal fistula with left aortic arch erosion due to the decubitus of the tube cuf

A rare case of intestinal carcinoid tumour. Clinical considerations and therapeutic approach

I tumori carcinoidi sono un gruppo di neoplasie prevalentemente a basso grado di malignità per l’aspetto eterogeneo delle cellule tumorali, a lenta crescita e con scarsa tendenza a metastatizzare a livello linfonodale e alla diffusione sistemica (fegato, ossa, polmone), ma il meccanismo neoplastico risulta irreversibile e progressivo. Tendono a manifestarsi nei due sessi con uguale frequenza, con un intervallo tra l’inizio dei sintomi e la dia- gnosi che è in media di 4-5 anni, con prognosi buona per le localizzazioni appendicolari e colo-rettali (sopravvivenza a 5 anni del 85-95%), peggiore a lungo termine per le altre localizzazioni tipo ileale e linfonodale (soprav- vivenza a 5 anni del 40-65%) e pessima in corso di secondarietà epatiche (sopravvivenza a 5 anni del 18%). La localizzazione gastrointestinale costituisce la maggioranza di tale tipo di neoplasie (55-60%), con localizzazioni più frequenti a livello dell’appendice, dell’ileo distale a par- tenza mesenteriale e del colon-retto; in rarissimi casi può originare da un diverticolo di Meckel. Con un caso clinico particolare di carcinoide dell’ultima ansa ileale con metastasi linfonodale marginale peritumorale, riscontro occasionale durante una colecistectomia tradizionale, gli Autori hanno voluto riportarne sia le caratteristiche fisiopatologiche e cliniche, sia quelle di trattamento

Use of Tachosil in splenectomy in patients with clotting and blood composition disorders

Splenectomy in patients suffering from onco-haematological conditions presents clotting-related problems which make correct haemostasis more difficult. Using operative haemostasis during splenectomy for onco-haematological conditions as a starting point, the authors report their personal clinical experience of the use of Tachosil, comparing it with other similar products and drawing some personal CONCLUSIONS: To complete their reflexions on clotting problems during splenectomy in the course of onco-haematological diseases, the comparison with its use in oncological pathologies in other parenchymas, such as the kidney and liver, which also present operative haemostatic difficulties of a technical nature, is pointed out and the soundness of the results indicated. The cases of 3 patients suffering from severe clotting disturbances and treated with splenectomy and 1 patient suffering from clear cell renal carcinoma and subjected to nephrectomy in which Tachosil was used as an aid to haemostasis are reported. In the light of these cases, it can be stated that, albeit with the persistence of difficulties related to the changed clotting capacities resulting from the basic disease, the use of Tachosil has proved effective as an aid in haemostasis and suggests the validity of its use in elective and emergency splenectomy, in these types of patien