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Tympanosclerosis and atherosclerosis seem to have a similar inflammatory origin despite the different tissues involved. We have investigated the possible relationship between tympanosclerosis and atherosclerosis by evaluating the incidence of tympanic plaques in patients with significant carotid disease.Between September 1(st) 2002 and April 30th 2003, we have evaluated all patients undergoing carotid surgery for significant carotid stenosis (group A). If at least 1/5 of the eardrum was occupied by plaques, then the case was considered positive. A control group of patients of similar age and no history of otological nor vascular pathologies was enrolled (group B). The 2 groups were compared statistically by Fisher's test and significance was set at p=0.05.Group A consisted of 84 patients. In this group 32 patients (38.1%) had tympanosclerosis; it was bilateral in 12 cases. Group B had 84 patients. In this group tympanosclerosis was present in 11 cases (13%). The difference between the 2 groups was statistically significant (p=0.005).More studies are needed before we can understand the cause of the association between these 2 pathologies. However early screening of atherosclerotic disease in patients with tympanosclerosis seems justifiable on the basis of the data of both the literature and the present study.

The ischemia-reperfusion syndrome, first described by Haimovici in 1960, is a severe complication following surgery for acute ischemia. We evaluated the incidence of this complication in 264 patients operated on between 1972 and 1981 (1st group) and compared it with another of 392 patients operated on between 1982 and 1991 (2nd group), our aim being to assess the effects of pharmacological prophyiaxis based on preoperative overhydration followed by an intra-arterial bolus of 250 ml 14/1000 HCO3-, containing 1 g dexamethasone and 2500 I.U. sodium heparin, injected into the femoral artery before suturing the arteriotomy. This regimen was based on the measurement of myoglobin and glutathione levels respectively carried out in two subgroups of 25 patients. The results of experimental ischemia-reperfusion syndromes induced in animal using radical scavengers and membrane-protective compounds were also taken into consideration. Following experimental research on sheep, 5 patients in the second group with very severe ischemia due to aortic occlusion received local dialysis in the extracorporeal circulation using hemodialysis or hemofiltration techniques. Mortality was 6.3% in the first group and 5.4% in the second, while the amputation rate was 3% and 1.8% respectively. The overall incidence of the reperfusion syndrome was 3% in the 1st period and 1.8% in the second. Our findings confirm the protective effect of hyper-hydration, radical scavengers and dexamethasone in the ischemia reperfusion syndrome, and indicate that local hemodialysis is a useful adjunct in very severe ischemia.

Angiosarcoma is a rare malignant tumor of the soft tissues (less than 1% of sarcoma). It may affect various parenchymae (bones, liver, breast), the soft tissues or the skin. In the latter case it may be associated with lymphedema. Onset in the arm is typical with postmastectomy lymphedema (Stewart-Treves syndrome). The forms occurring in limbs with chronic lymphedema not associated with mastectomy are much rarer, with a total of 38 cases occurring in patients with an average age of 46.8 years and with lymphedema present for an average of 20 years. The survival rate for 5 years is 16.6%. The case observed by us had the characteristic onset of the malignant neoplasm on a pre-existing "angiomatosis lymphangiomatosis" pattern also featuring angiographycally detected arteriovenous fistula.

The case examined was a multifocal diffuse glomus tumor covering most of the right leg of a 24-year-old woman. The lesion, present at birth, had never caused any symptoms. Macroscopically, it had a simulangiomatous aspect, whereas histologically it was identified as a glomangiomyoma. The Authors have examined 26 (46.4%) of the 56 cases of multiple tumors reported to date. Multiple glomus tumors are benign lesions, which generally appear at an early age (70% by the age of 20), with no clear distinction between the two sexes. The lesions usually occur on the upper limbs, which account for 80% of the cases. Pain is reported in half of the cases. There are 3 histological types: "sensu strictu" glomus tumor, glomangioma and glomangiomyoma; the glomangioma being the most frequent (80.8%) as compared to 19.2% for the glomangiomyomatosis type. No case of "sensu strictu" glomus tumor was observed.