Two Cases of Arnold-Chiari Malformation with Respiratory Failure

Arnold–Chiari malformation is defined as downward displacement of the brainstem and cerebellum through the foramen magnum. It has different clinical presentations and four subtypes. It is known that downward migration of posterior fossa components through the foramen magnum and associated lower cranial nerve palsy and brainstem compression can cause respiratory failure. Acute respiratory failure could mark the onset of the disease. Posterior fossa decompression performed to treat primary disease can improve the central sleep abnormalities. As respiratory failure is rarely seen, this paper presents two cases of Arnold–Chiari malformation with respiratory failure.

Bilateral Panuveitis at Etanercept Initiation for Juvenile Idiopathic Arthritis

Introduction: Uveitis is a well-known extra-rheumatological manifestation of juvenile idiopathic arthritis (JIA). Tumor necrosis factor has been used to treat uveitis associated with inflammatory diseases. A new onset uveitis under anti-TNF therapy is uncommon. Case presentation: A 12-years-old male, affected since the age of six years, by a severe form of polyarticular JIA. When etanercept was started, he presented panuveitis bilaterally, so we switched to infliximab with good response. Conclusions: The TNF soluble receptor could be considered as a possible promoter in inducing endogenous new onset uveitis in JIA.

Copio (Baschi-Montecchio, Terni). Un avamposto etrusco sulla sinistra del Tevere Presentazione dei risultati delle indagini di superficie (maggio - giugno 2015)

This paper attempts to demonstrate the importance of the archaeological area of Copio, in province of Terni (Italy). Discovered for the first time in the 1980 by the local historian then mentioned in 2001 and in 2003 in two different archaeological publications, the site of Copio started to arouse interest for its position, lying on a hilltop above one of the most interesting pre-Roman necropolis of Umbria (Vallone di San Lorenzo). The link between the well-known necropolis and Copio is today well-accepted. The aim of this paper, based on a field-walking survey and the analisys of the archaeological finds, is to demonstrate the importance of this area during the pre-Roman period as a commercial bridgehead linked to Volsinii. Strategically lying only one km to east from the Tiber, it should have enjoyed this important and commercial path for the local trade moving goods in incoming and outcoming.

Telesia Archaeological Project: Indagini nella basilica e nel foro (2014-2015)

The Telesia Archaeological Project is an initiative that will make a significant contribution to thi historical and archaeological knowledge of the urban area of the Roman city of Telesia, located near Benevento (S. Salvatore Telesino). The first and second season of the Telesia Archaeological Project (2014-2015), conducted under the supervision of the Archaeological Superintendence, and thanks to the indispensable collaboration of a private landowner, provided results of great scientific interest. There was the possibility to investigate part of a significant building of imperial age, richly decorated, identified with the basilica of the city. It was possible to establish, in addition, that this large building (36 by 21 m ca) was opened, through a great brick colonnade, to the forum, localized in summer 2015 with certainty for the first time. The extraordinary large double colonnade (porticus duplex), 9 meters wide, covering the entire façade of that public building, was erased in the fifth century AD, probably after two earthquakes that seriously damaged the city in 346 and 375 AD.

Spondylodiscitis as Complication of Transrectal Ultrasonography-guided Prostate Biopsy: a Case Report

A 61-year-old man presented with high fever, and severe back and abdominal pain following transrectal ultrasonography (TRUS)-guided prostate biopsy. Diagnosis of spondylodiscitis and psoas abscesses was made based on MRI images of the lumbar tract of the spine. Six-month broad-spectrum antibiotic treatment and immobilization with a girdle overcame the disease without any relapse at the 1-year follow-up. Spondylodiscitis after TRUS-guided prostate biopsy is a rare event, which is not yet included as a major complication of the procedure. It is probably due to the presence of fluoroquinolone-resistant bacteria in faeces. It is, therefore, important to highlight this possibility and to stress the use of targeted antibiotic prophylaxis after rectal flora swabbing with selected antibiotics at sufficient concentrations to be effective.

A Rare Cause of Chronic Low Back Pain

Objectives: Autosomal dominant osteopetrosis (ADO) is a rare genetic disease characterized by increased bone mass and density due to defective bone resorption. The aim of this case study is to present the clinical and radiographic features of a 22-year-old male patient with ADO and to serve as a reminder that this rare disease should be considered in the differential diagnosis of chronic low back pain. Materials and methods: A 22-year-old patient with ADO is presented in this case report. Results: Clinical and radiographic features of the patient were consistent with ADO. Conclusions: ADO should be taken into consideration in differential diagnosis of low back pain.

Breast Carcinoma with Choriocarcinomatous Differentiation; a Rare Case

Objectives: Breast carcinoma with choriocarcinomatous differentiation is a rare entity, generally presenting with high-grade disease and an aggressive clinical course with overall survival of less than a year Case: A 69-year-old woman with a diagnosis of pT1N0M0 invasive ductal carcinoma with choriocarcinomatous differentiation received six cycles of adjuvant chemotherapy and is still disease free on the 23rd month after diagnosis, showing a better prognosis than most other cases reported in the literature. Conclusion: The reason for the poor prognosis for this type of breast carcinoma remains unclear. Standard chemotherapeutic agents administered for breast carcinoma may be used for choriocarcinomatous differentiation.

Guillain-Barré Syndrome with Absent Brainstem Reflexes: a Case Report

A 41-year-old man was admitted to an intensive care unit following respiratory arrest. One day prior to admission, he had complaints of nausea and pain involving lower limbs. On the night of admission he developed diplopia, dysphagia, and rapidly progressive quadriparesis. He developed respiratory failure requiring mechanical lung ventilation 24 hours later. On the fifth day of hospital stay the patient became comatose with absent brainstem reflexes and appeared to be brain dead. The cerebrospinal fluid showed albuminocytological dissociation. The electroencephalogram revealed an alpha rhythmical activity. The electrophysiological evaluation revealed an inexcitability of all nerves. Guillain-Barré syndrome was suspected. With supportive treatment the patient had a remarkable recovery and now is able to independently conduct his daily activities.

Editorial: European Journal of Case Reports in Internal Medicine

Modern medicine began in the last half of the nineteenth century when doctors started practising the scientific method at the bedside. However, in his presidential address to the Association of American Physicians in 1979 James Wyngaarden postulated that the clinical scientist was an endangered species. Several reasons for this have been suggested, including “the seductive incomes that now derive from procedure-based specialty medicine”. Others have suggested that it is simply because the things left to be discovered at bedside have become exhausted, and that all the big medical advances will now be made by high-powered institutions.

Development of Myasthenia Gravis in Systemic Lupus Erythematosus

Objectives: To perform a literature review and estimate MG incidence in an SLE cohort. Materials and methods: We searched MEDLINE and PubMed for case reports of SLE and MG. We also calculated MG incidence within our clinical SLE cohort (females only). Results: Eleven articles met our criteria, providing 13 SLE patients who developed MG. The majority were female (84.6%), with the average ages of 25.6 and 33.5 years at diagnoses of SLE and MG, respectively. In 380 SLE female patients followed for 2,850 person-years, one MG case occurred. Conclusion: MG in SLE is a rare event.

Il «Castellazzo» di Monte Iato in Sicilia occidentale (PA) Quinta e sesta campagna di scavo. Aggiornamenti dal territorio

From May 15th to 30th and 15th to 30th September 2015 took place the fifth and sixth excavation campaign at the Castellazzo of Monte Iato. The presence of 15 participants made it possible to deepen the research significantly and ex-pand the surface area of investigation. It is completely emptied a room already identified in previous campaigns and provided new information about the relationship with the existing cemetery. Part of a burial in a supine position was destroyed by the installation of wall 20. Traces of another turret projecting from the walls have been discovered in the east and another section of the inner walls (15) was fully exposed. A gate, between two towers, is the first entry traced so far, on the north-eastern side of the plateau. The archaeological materials found confirm the characteristics and type of construction. Being a military camp of ephemeral nature, although active at least 30 years, objects such as arrowheads and crossbow quarrels, knives, buckles and harnesses for horses have been found. One of the environments has been interpreted as an area where gaming took place because of the presence of four dice in ivory, glasses and different coins, in addition to the greater extent than the other environments found. Among the findings are reported a glass weight with a cufic inscription dated to the mid-twelfth century and two bronze coins dated in 15th centu-ry.

The Herculaneum Graffiti Project: Initial Field Season, 2014

This article describes the goals and activities for the first field season of The Herculaneum Graffiti Project. Our project fo-cuses on documenting and digitizing to make more broadly accessible the first-century handwritten wall-inscriptions, also called graffiti, in Herculaneum. Following an overview of the presence of ancient graffiti in Herculaneum, this report details the methodology we used to locate and document the inscriptions and the preservation status of ancient graffiti in each insula, or city-block, of the excavations. We further describe the preliminary results of the project’s documentation efforts. We are currently studying, processing, and digitizing these inscriptions and contributing them for inclusion in the Epigraphic Database Roma and EAGLE, the Europeana network of Ancient Greek and Latin Epigraphy. We conclude with a brief mention of development of The Ancient Graffiti Project, the digital resource and search engine devoted to ancient handwritten inscriptions.

Psychiatric manifestations of sporadic Creutzfeldt-Jakob disease simulate depressive disorder with psychotic symptoms

Creutzfeldt–Jakob disease (CJD) is a rare and fatal neurodegenerative disorder with a broad spectrum of early clinical manifestations, comprising neurological and psychiatric symptoms. The authors report the case of a patient admitted with a diagnosis of depressive disorder with psychotic symptoms, with post-mortem confirmation of CJD and discuss how CJD’s clinical heterogeneity can lead to misdiagnosis of the disease. Despite CJD’s unique pathogenesis, its kaleidoscopic presentation justifies the integrated investigation of patients with psychiatric symptoms, avoiding restrictive diagnosis.

“Saved by the Pacing Catheter”: Gigantic Right Atrial Thromboembolus as a Cause of Pulmonary Embolism

Pulmonary embolism (PE) related to the presence of right heart thromboemboli entails a higher mortality rate than PE alone. Furthermore, right heart thromboemboli are often associated with deep venous thrombosis. The most effective therapy for haemodynamically stable patients remains unknown, although recent data suggest that thrombolytic therapy is associated with a better outcome. We describe the case of an 83-year-old woman, hospitalized with PE consequent to right heart thrombus-in-transit, in whom investigation revealed a concomitant deep venous thrombosis. She required thrombolysis, given the high mortality risk that is traditionally associated with this clinical entity.

Dose-Adjusted Beta-Lactam Antibiotic-Induced Encephalopathy in a Patient with End-Stage Renal Impairment: A Case Report

Introduction: Despite adherence to current guidelines regarding dose adjustment and drug-level monitoring, beta-lactam-induced encephalopathy can still occur in the setting of chronic renal impairment. Case Report: We report what we believe is the first case of piperacillin- and tazobactam-induced encephalopathy in a patient with pre-existing cefepime-induced encephalopathy in the context of end-stage kidney disease despite adequate dose adjustment for renal impairment.