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Background: Orofacial granulomatosis (OFG) is characterized by granulomatous inflammation of the soft tissues of maxillofacial region. We explored OFG patients from 10 different Italian centers and summarized the most recent literature data., Methods: A review of patients with OFG was carried out. An extensive online literature search was performed to identify studies reporting diagnosis and management of OFG., Results: Thirty-nine patients were recruited between January 2018 and February 2020. Most of them (97.4%) displayed involvement of the lips, and 28.2% suffered from Melkersson-Rosenthal syndrome. Two patients received diagnosis of CD and one patient of sarcoidosis, suggesting secondary OFG. Oral aphthosis and cervical lymphadenopathy were also described. The mean diagnostic delay was 3.4 years. Histological evaluation was performed in 34/39 patients (87.2%); non-caseating granulomas were found in 73.5% of them. Neurological symptoms (28.2%), gastrointestinal symptoms in absence of overt inflammatory bowel disease (IBD) (20.5%), and atopy (35.9%) were also identified. Therapeutic approaches varied among the centers. Steroids (51.3%) were used with good or partial results. Anti-TNF-α and anti-IgE monoclonal antibodies were used in 6 (15.4%) and 1 (2.6%) patients, respectively, with variable results. Surgery was the choice for 2 patients with good response., Conclusions: OFG is a rare and neglected disease showing multiple clinical phenotypes. While early diagnosis is crucial, management is difficult and highly dependent on the expertise of clinicians due to the lack of international guidelines. There is a need to establish registry databases and address challenges of long-term management., (© 2021 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Hymenoptera venom allergy is an epidemiologically underestimated condition and a major cause of morbidity worldwide. Preventing future allergic reactions in patients who experience a systemic reaction is based on the correct management of the emergency followed by an accurate diagnosis, prescription of adrenaline autoinjectors, and, where indicated, specific venom immunotherapy. Some epidemiological studies highlight our poor knowledge of this disease and the frequent inadequacy of its management. Moreover, they emphasize the importance of such a life-saving treatment as specific immunotherapy. The availability of high-quality hymenoptera venom extracts for diagnostic and therapeutic use has dramatically improved the prognosis and quality of life of allergic patients. Subcutaneous venom immunotherapy is currently the most effective form of allergen-based immunotherapy, with a carry-over effect lasting up to several years after its interruption. This report on the management of hymenoptera venom-allergic children and adults was prepared by a panel of Italian experts. The main objective of this consensus document is to review the scientific evidence related to diagnosis, therapy, and management of patients allergic to hymenoptera venom. Thus, we can improve our knowledge of the disease and promote good clinical practices. The present document provides practical suggestions for correct diagnosis, prescription of emergency therapy and immunotherapy, and strategies for patient care.

Angioedema due to C1--inhibitor deficiency may be hereditary (HAE) or acquired (AAE). AAE is a very rare condition, whose prevalence is possibly underestimated, as it is often unrecognized. AAE usually occurs after the fourth decade of life, and it is commonly associated to an underlying disease, mainly lymphoproliferative disorders. We report a 74-years old woman with recurrent episodes of angioedema involving upper airways in which diagnosis was obtained a long time after symptoms onset. A concomitant B cell leukaemia was also diagnosed This report stresses the importance of the recognition of AAE: a delayed diagnosis is indeed associated to the risk of severe life-threatening episodes, unresponsive to the usual therapy of common form of angioedema. AAE should be considered as a possible diagnosis in subjects with adult onset of angioedema: a careful clinical history is basic, since the clinical features and the time-course are often suggestive of the disease.

A case of IgD myeloma that began with high paraproteinaemia, BJ proteinuria of type and 40% marrow plasmacellular infiltration is reported. These onset data suggested a large tumoral mass and hence a poor prognosis. On the other hand, after subjecting the patient to 4 polychemotherapy cycles (alkeran and prednisone) CM disappeared from serum and urine and bone lesion progression stopped. It is also stressed that this from presents clinical (frequent extra-osseous growth, presence of amyloidosis), laboratory (severe anaemia, renal insufficiency, BJ proteinuria) and particular prognostic features.

The clinical case of a 67-year-old woman admitted for abdominal pain whose interpretation created difficulties but which corresponded substantially to the pain encountered in intestinal occlusion associated with diabetes mellitus and increase in amylasemia is reported. After decrease, 48 hours after hospitalization, necropsy revealed extensive acute pancreatitis associated with infarction of the small bowel to occlusion of the superior mesenteric artery.

Eleven patients suffering from seriously hypoxaemic chronic respiratory insufficiency with slight hypercapnia have been assessed. A comparison between the results obtained with continuous oxygen therapy carried out with a Ventury mask and that done with the Ventimask was made in the case of each patient. Distribution of O2 with the Ventimask made it possible to obtain higher average pO2 levels than with the Ventury mask.

A study was conducted on 20 patients with isolated or multiple patches of doubtful significance in the framework of neoplastic or infectious pathologies or in the presence of probably infectious diffuse or localised pulmonary infiltrations in immunodepressed patients or those in whom broad spectrum antibiotic treatment had failed. Percutaneous needle aspiration and sterile brushing was performed for the purpose of bacteriological examination in all patients. The result showed the clear superiority of needle aspiration (75% positive) over sterile brushing (25%). The first method is therefore recommended for use in the diagnosis of so-called "difficult" lung pathologies.

The diagnostic efficacy of percutaneous needle biopsy (PNB) was assessed in 220 lung tumour patients. The results obtained prove this diagnostic technique to be extremely sensitive even though personal experience suggests that slight complications (pneumothorax, homophthoe) may occur.

The role of echography in the study of the thorax is evaluated: after reporting the technical limits due to the peculiar anatomy of this region, personal experience is presented. This method extremely precise to define the solid or liquid nature of tightly adherent to the chest wall lesions, but it is non specific to assess their benign or malignant behaviour. Ultrasounds have their on limits in drawing the extension of such lesions; these limits have been overcome by CT and MR. Finally the usefulness of the method in studying the diaphragm and its pathology is briefly described.

Pulmonary and extrapulmonary tuberculosis is still encountered in clinical practice, sometimes in forms that are difficult to categorize nosographically. In this study, the therapeutic efficacy of the 6 main antitubercular drugs (rifampicin, streptomycin, isoniazide, ethambutol, kanamycin, para-aminosalicylic acid) in 20 patients with early TB of the lungs was assessed on the basis of antibiogram findings. Para-aminosalicylic acid was found to be the least effective; isoniazide, rifampicin and streptomycin were reasonably so; both kanamycin and ethambutol were extremely effective.

Endobronchial metastases account for about 5% of autoptic findings in patients with multiple secondary locations. Five cases are reported of patients with malignant neoplasms in various organs with metastases to the trachea and the large bronchi without involvement of the pulmonary parenchyma and therefore with negative radiographic and CT scan findings.

An in vitro analysis was conducted to investigate the hypothetical antibacterial and antimycotic activity of the common anesthetic gases (halothane, enflurane, isoflurane, methoxyflurane) in view of the clinical absence of bronchopulmonary pathology after inhalation narcosis despite the many risk factors involved. For this purpose scalar dilutions of the four gases were prepared on cultures of Klebsiella pneumoniae and Candida albicans and the antibacterial action of the gases was tested in vitro. Even with the weaker concentrations used, halothane and methoxyflurane totally inhibited both microorganisms. Enflurane had less effect on Klebsiella p. and almost none on Candida. Isoflurane, a new halogen ether anesthetic was found to have an excellent inhibitory effect. In conclusion it is hypothesised that the anesthetic gases considered might have an in vivo antibacterial activity considering the experimental results obtained in vitro.

The long-term, epidural administration of morphine and marcaine (bupivacaine) in 12 patients suffering from bronchogenic carcinoma of the pulmonary apex and consequent Pancoast's syndrome has been examined. In 75% of cases the technique provided satisfactory results and the administration system was well tolerated by the patient.

The usefulness of ultrasonic studies for guiding the needle during biopsy of solid lesions or evacuation of saccate effusions and empyemas. Is a explained possible diagnostic protocol is then proposed which includes the ultrasonic examination in the diagnostic approach to parietal, mediastinic or diaphragmatic lesions.

Goodpasture's syndrome is characterised clinically by the association of haemoptysis and haematuria and is therefore the expression of lesions localised in two different apparatus, the respiratory and the renal, with an autoimmune type mechanism (production of circulating antibodies against the glomerular and alveolar basal membrane). A case of Goodpasture's syndrome in a male of 28 is reported in which the two basic clinical signs were not in evidence, making differential diagnosis more complicated.

Although the immunofluorescence technique has mostly been applied to renal diseases, it may be of use in the examination of lung tissue. Immunofluorescence tests on bronchial bioptic samples can show: 1) presence of IgE, IgA, IgM, IgG and complement factors; 2) their location on the bronchial mucosa; 3) their relationships with epithelioid cells, mast cells and plasma cells. Patients with atopic asthma were examined. Bioptic samples were taken from the main bronchi and treated by immunofluorescence. Cellular positivity was found for IgE, IgA, IgM and complement components.