Rottura diaframmatrica con erniazione intratoracica del fegato. Presentazione di due casi clinici

Gli Autori presentano due casi di rottura diaframmatica da trauma chiuso toraco-addominale, con erniazione intratoracica del fegato, conseguenti ad incidente della strada. La diagnosi preoperatoria è stata posta mediante esecuzione di esame TC. Al momento dell’intervento si è optato per l’accesso laparotomico, mediano per un paziente e bisottocostale per l’altro, che ha permesso la riparazione diretta della lesione diaframmatica e una adeguata gestione delle lesioni associate, presenti in entrambi i casi. Non si è fatto uso di materiale protesico e la ricostruzione del diaframma è avvenuta in sutura a punti staccati in materiale non riassorbibile. Nella nostra esperienza la riparazione della lesione diaframmatica è sempre stata possibile attraverso un approccio laparotomico e senza l’ utilizzo di materiale protesico. Riteniamo che, in questi casi, l’approccio migliore sia proprio quello laparotomico che permette non solo la riparazione della lesione diaframmatica, ma anche la gestione delle lesioni associate. Utilizziamo in genere una sutura a punti staccati in materiale non riassorbibile per lacerazioni di minor entità e una continua, se possibile in doppio strato, per quelle più grandi

Pterygomaxillary extension of orbital pseudotumor. Case report

Lo pseudotumore orbitario è un’ infiammazione benigna, aspecifica e idiomatica, localizzata nell'orbita e con eccezionale estensione alla base cranica. La sua eziopatogenesi non è conosciuta, definirne la natura istologica è importante per un corretto trattamento. Riportiamo un raro caso di pseudotumor orbitario con estensione nella fossa infratemporale discutendone gli aspetti clinici e terapeutici

Corneo–conjunctival leukoplakia: histology and confocal microscopy

Purpose: To explore corneo-conjunctival leukoplakias using in vivo confocal microscope and to compare images to histology and impression cytology specimens. Methods: Twenty-nine patients affected by corneo-conjunctival leukoplakia, after evaluation with slit lamp exam, were investigated with the Heidelberg Retina Tomograph II, Rostock Cornea Module. Subsequently a diagnostic excision or impression cytology of the cornea and/or conjunctiva was performed. Results: Histology identified seventeen Pterygia, six Pingueculas, two limbal stem cell deficiency (LSCD), one suture-related corneal vascularization, one cicatricial Pterygoid and two corneal intraepitelial neoplasias (CIN). Confocal microscopy was compared to histopathologic sections and impression citology specimens. In all patients typical white colour of lesions was attribuable to a different degree of reactive hyperkeratosis. The main pathological features were visible on our confocal microscopy images: infiltration of conjunctival tissue surrounding lesions, vascularization, cellular morphology and activity, changes in extracellular matrix and modifications of limbar architecture. Conclusions: Confocal microscopy may be a useful aid for diagnosis and follow up in primitive and secondary corneo-conjunctival lesions. However the ability to provide high resolution, real-time images of the full thickness of the living human cornea and conjunctiva is strictly dependent on surface transparency and additional studies are required to establish exact correlations between confocal microscopy images and histopatology

Tłuszczak wrzecionowatokomórkowy oczodołu – opis przypadku nietypowej patologii oczodołu

Spindle cell lipoma is a rare and distinct variant of soft tissue tumour characterised by spindle cells in which the fat content may be scarce or absent. Most spindle cell lipomas arise as a subcutaneous mass of the neck, shoulders or back. Rarely, they can also be found in unusual sites, such as the oral cavity, larynx, bronchus, breast, and extremities. Localisation of spindle cell lipoma in the orbit has been described in a few cases. We report here on a case of an orbital mass surgically excised in an adult male and discuss the differential diagnosis with other soft tissue tumours with a lipomatous component, such as lipomatous haemangiopericytoma, a rare variant of haemangiopericytoma.Tłuszczak wrzecionowatokomórkowy jest rzadką i odrębną odmianą guza tkanek miękkich, która cechuje się obecnością komórek wrzecionowatych o małej zawartości tłuszczu lub pozbawionych tłuszczu. Większość tłuszczaków wrzeciono-watokomórkowych występuje w postaci podskórnego guza okolicy szyi, ramion lub pleców. Rzadko spotyka się je w nietypowych lokalizacjach, takich jak jama ustna, krtań, oskrzela, sutek lub kończyny. Opisano kilka przypadków tłuszczaków wrze-cionowatokomórkowych umiejscowionych w oczodole. W niniejszej pracy opisano przypadek guza oczodołu u dorosłego mężczyzny leczonego chirurgicznie i omówiono różnicowanie z innymi guzami tkanek miękkich z komponentą tłuszczową, takich jak obłoniak ze zróżnicowaniem tłuszczakowatym (lipomatous haemangiopericytoma), rzadka odmiana obłoniaka

Incidence and Characteristics of Adverse Events after COVID-19 Vaccination in a Population-Based Programme

Compliance with vaccination is linked to its safety. In Italy, a plan to identify people who could be at an increased risk of adverse events (AEs) was defined so they could be vaccinated in a protected setting. We conducted an audit to describe the process of AE risk assessment and occurrence in the Reggio Emilia Province in Italy in people who received any of the four COVID-19 vaccines currently used in Italy. Incidence of AEs was calculated by dose and type of vaccine and type of setting (standard vs. protected). After 182,056 first doses were administered, 521 (0.3%) AEs were reported. Most of the AEs were non-serious (91.4%) and non-allergic (92.7%). The percentage of AEs was similar in both settings: 0.3% in the standard setting and 0.2% in the protected setting. However, the incidence of AEs was higher among those who had an allergist visit than among those who did not (IR 666.7 vs. 124.9). All deaths (1.6/100.000) occurred in standard settings and after the Pfizer and Moderna vaccines. The incidence of AEs was lower after the second dose (IR 286.2 vs. 190.3), except for mRNA vaccines, for which it was higher after the second dose (IR 169.8 vs. 251.8). Although vaccination in a protected medical setting could reassure patients with a history of allergies to be vaccinated, allergy history and other anamnestic information is not useful in predicting the risk of COVID-19 vaccine-related AEs in the general population

Safety of omalizumab for chronic urticaria during pregnancy: a real-life study

Background Managing a pregnant patient with chronic spontaneous urticaria (CSU) is often challenging. Recent data have shown that most CSU treatments in pregnant patients are second-generation H1 antihistamines (sgAHs), while data on the safety of omalizumab are scant.Objectives To evaluate, in a routine clinical practice setting, the efficacy and safety of omalizumab in patients with severe CSU refractory to sgAHs who either became pregnant during treatment or who started the drug during pregnancy.Methods We conducted a retrospective study of women aged >= 18 years who were pregnant, who received one or more doses of omalizumab at any time during their pregnancy or who were taking omalizumab at the time of, or in the 8 weeks before, conception.Results Twenty-nine pregnant patients were evaluated: 23 (79%) conceived a child while taking omalizumab (group A), while 6 (21%) started omalizumab treatment during pregnancy (group B). Among patients in group A, we observed 23 births (21 liveborn singletons and 1 liveborn twin pair) and 1 miscarriage. Fifteen (65%) patients discontinued omalizumab after confirming their pregnancy, while eight (35%) were exposed to omalizumab during their entire pregnancy. In group B, omalizumab was introduced at a mean (SD) 10.83 (3.60) weeks' gestation and all patients were exposed to it until the end of pregnancy. In this group, there were seven liveborn infants (five singletons and one twin pair). No adverse events, pregnancy complications or congenital anomalies in newborns were recorded in either group.Conclusions Omalizumab for CSU treatment before and during pregnancy does not appear to have negative effects on maternal or fetal outcomes.Omalizumab is a recombinant humanized IgG1K monoclonal antibody that selectively binds to human IgE. Data on chronic spontaneous urticaria treatment choices and their safety with regard to conception, pregnancy and pregnancy outcomes are limited. Our study showed that omalizumab exposure in women who started omalizumab therapy during pregnancy, or who took the drug at the time of conception and continued therapy throughout pregnancy, does not seem to be associated with an increased risk of adverse events (AEs), pregnancy-related AEs or AEs in newborns