No abstract

Surgical resection is recommended in patients with recurrent thymoma. Local recurrence and total resection of the recurrent tumor are associated with excellent prognosis. A poor prognosis may be anticipated in the presence of distant recurrence and when radical surgical treatment is not done.

Early diagnosis by CT of the neck and chest suggest a rapid indication of surgical approach to DNM. Ample cervicotomy associated with mediastinal drainage via large thoracotomic incision is essential in managing these critically ill patients and can significantly reduce the mortality rate for this condition, often affecting young people, to acceptable values.

No abstract

Although in most of the cases the placebo response appears to be unpredictable, several factors have been considered in order to explain the placebo analgesic effect. For example, it is widely recognized, albeit with little empirical evidence, that placebo analgesia is more likely to occur after a successful analgesic therapy. On the basis of this assumption, we tested the placebo response in a population of patients who were treated with buprenorphine the day before for relieving postoperative pain. However, due to the high variability of opioid responsiveness, buprenorphine was effective in some patients and poorly effective in some others. Similarly, buprenorphine produced respiratory depression with a large variability, ranging from mild depression to no effect. We found that the placebo analgesic response depended on the buprenorphine analgesic effectiveness of the previous day. Analogously, we found that a placebo respiratory depressant response was more pronounced in those patients with a respiratory depressant response to buprenorphine on the day before, irrespective of the analgesic effectiveness. These specific effects suggest that (1) the placebo effect is experience-dependent; (2) the mechanisms underlying placebo analgesia and placebo respiratory depression are independent from each other and, by considering the role of endogenous opioids in placebo analgesia, might involve different subpopulations of opioid receptors.

A sonographic study was conducted to analyze changes of the flexor tendons in patients with trigger fingers. We evaluated thickness and echotexture of the flexor tendons of the fingers in 54 patients with 66 symptomatic digits using 10 and 13 MHz "small parts" transducers; the results were compared with those observed in 20 normal controls. Images were obtained on the volar surface of the hand, at the head of metacarpals, and at the base of first phalanx, where the first annular pulley of the digital canal is located and where the changes occurring during passive assisted extension of the fingers were evaluated. Normal tendons were 2.9 to 4.4 mm thick (mean, 3.71 +/- 0.46) and had fibrillar echotexture. Patients had tendons ranging from 3.8 to 6.7 mm (mean, 5.41 +/- 0.94); the difference from controls was highly significant (P < 0.001). A cyst was attached on the volar surface of the involved tendons in 15 cases. Diffuse thickening of the synovial sheath was present in 20 tendons, whereas 17 tendons had irregular internal echotexture. Extension movements caused changes in shape of both cysts and peritendinous envelopes. In conclusion, sonography seems able to identify a variety of pathologic changes affecting tendons in these patients and may help both to explain the pathophysiology of their clinical situation and guide therapeutic decisions.

No abstract

No abstract