Introduction: Diencephalic storm is characterized by extreme episodic catecholamine release in the presence of a stressor and it is usually refractory to standard antihypertensives. The treatment of choice during the crisis is propofol and the best preventative measure is to remove the stressor (i.e. ventilator). Case presentation: A 32-year-old male sustained 2nd and 3rd degree burn to 25 percent of the body surface area that included a severe inhalation component. The patient was admitted to the Burn Intensive Care Unit at the Arnold Luterman Regional Burn Center in Mobile, AL. The patient had frequent episodes (3-5 per day) of severe agitation that were accompanied by extreme tachycardia of > 200 beats per minute and hypertension (280/140). The inciting event was often endotracheal suctioning, but less noxious stimulation also resulted in similar episodes. During these episodes, the patient had significantly elevated catecholamine levels that improved after extubation. The patient’s symptoms were refractor to standard antihypertensives but immediately resolved when given propofol. Further episodes of the diencephalic storm were treated successfully with propofol. Once the patient was removed from mechanical ventilation, there were no further episodes. Conclusion: Diencephalic Storm may be difficult to diagnose due to a lack of familiarity with this rare entity. Any patient with severe agitation combined with the effects of episodic large catecholamine surges should be considered to have Diencephalic Storm. The standard immediate treatment is propofol due to the lack of responsiveness of standard antihypertensives and the removal of the stressor.

The spleen is an organ commonly injured in abdominal trauma of the upper left quadrant and until just under two decades the first choice was always splenectomy; however, based on new research and clinical experience, there is a tendency to preserve the spleen as much as possible, precisely because of its immune function and risk of infection. On the basis of the trauma and of the patient’s anamnesis, after an objective examination, the primary ABCDE evaluation, the Eco-FAST, and if necessary also the CT scan (with contrast), it is possible to choose between surgical (OM) and non-surgical (NOM) management: in the first hypothesis are included total or partial splenectomy surgery, raffia, direct hemostasis through drugs or devices with hemostatic-adhesive action, and laparoscopy; in the second hypothesis are included treatments such as controlled nutrition, rest, anticoagulant drug therapy (and antibiotic, if necessary), and angioembolization (exclusive or accessory to a NOM). In particular, in the last few years, a dual interpretation has emerged on the findings necessary to favour splenectomy (total or partial) over angioembolization. From the best clinical practice emerges therefore the answer to the question at hand, namely that the patient is a candidate for angioembolization if 1) is hemodynamically stable (with systolic blood pressure > 90 mmHg, heart rate < 100 bpm, and transfusion of < 3 units of blood in 24 hours) or stabilizable (positive response to rapid infusion of 1000-2000 cc of crystalloids-Ringer Lactate-with restoration of blood pressure and heart rate values in the range of hemodynamic stability); 3) there is no open trauma to the abdomen or evidence of vasoconstriction (cold, sweaty skin, decreased capillary refill) or obvious intestinal lesions or perforative peritonitis or high-grade lesions to the spleen or peritoneal irritation or signs of exsanguination or contrast blush or effusion (exceeding 300ml) detected by Eco-FAST. This preference is optimal concerning both the risks of postoperative infection and immunological risks; finally, age and head trauma, compared to the past, seem to be no longer discriminating conditions to favour splenectomy regardless. Splenic immune function is thought to be preserved after embolization, with no guidelines for prophylactic vaccination against encapsulated bacteria. Other clinical signs finally, however, might argue for discontinuation of NOM treatment in favour of a surgical approach: 1) need to transfuse more than 3 units of blood or simply the need for transfusion in 24 hours to maintain a maximum systolic blood pressure greater than 90 mmHg, correct anaemia less than 9 g/100 ml, or a hematocrit less than 30%; 2) persistence of paralytic ileus or gastric distension beyond 48 hours (despite a nasogastric aspiration); 3) increased hemoperitoneum (on ultrasound or CT); 4) aggravation of the lesion evidenced by ultrasound and/or CT (so-called “expansive” lesions); and 5) subsequent appearance of signs of peritoneal irritation. A complete understanding of post-embolization immune changes remains an area in need of further investigation, as do the psychological and mental health profiles of the surgical patient.

Purpose: This research addresses the topic of anxiety, phobic and obsessive disorders. In this research, the theme is addressed to the psychopathological investigation of personalities, according to the PICI-2TA model (Perrotta Integrative Clinical Interviews, version 2-TA), the PAD-Q (Perrotta Affective Dependency Questionnaire), the PSM (Perrotta Sexual Matrix), the PDM-Q (Perrotta Defence Mechanisms Questionnaire) and the PHEM model (Perrotta Human Emotions Model), in order to design a direct and functional psychotherapeutic protocol to manage the psychopathological process in the shortest time possible, according to the principles of efficiency, effectiveness and economy, trying to reduce the symptomatology until the total regression by the fifth-tenth session. Methods: Clinical interview and administration of the PICI-2, the PAD-Q, the PSM, and the PDM-Q. Results: In the male group, aged 18-36 years, there were 8 people, of whom 6 (75%) reacted to the total resolution of the neurotic symptomatology described between the fifth and ninth sessions, while only 2 (25%) said they felt their neurotic symptoms had subsided. In the male group, aged 37-54 years, there are 5 people, of whom 4 (80%) reacted to the total resolution of neurotic symptomatology described between the fifth and ninth sessions. In the male group, aged 55-72 years, there were 6 people, of whom 4 (66.6%) reacted to the total resolution of neurotic symptoms described between the ninth and tenth sessions. In the female group, aged 18-36 years, there were 22 people, of whom 18 (82%) reacted to the total resolution of neurotic symptoms described between the fifth and ninth sessions. In the female group, aged 37-54 years, there were 13 people, of whom 9 (69.2%) reacted to the total resolution of neurotic symptoms described between the fifth and ninth session. In the female group, aged 55-72 years, there were 11 people, of whom 8 (72.7%) reacted to the total resolution of neurotic symptoms described between the fifth and ninth sessions. Conclusions: The research showed that the PPP-DNA protocol, for neurotic disorders, was effective in the total population sample for 74.36%, for the fractionated male population sample for 73.86% and for the fractionated female population sample for 74.86%, with resistance to change identified in adverse conditions of family, environmental, socio-cultural and temporal type (of duration of neurotic symptomatology), however able to promote an attenuation of the symptomatology suffered by at least 50%.

The current case is one of the rare clinical presentations of the brachial artery pseudo aneurysm presentation in children Pseudo-aneurism is one of the late complications of a missed or untreated arterial injury. The diagnosis is suggested in the presence of clinical signs such as: an expending, ill-defined mass with or without pulsation; bruit, pain, paresthesia, or paralysis due to nerve compression. Although plain X-Rays may show a nonspecific soft tissue mass, arteriography is essential in defining differentiating pseudo aneurisms from other soft masses. We report a case of a 10years old boy with a history of a stab injury in a well vascularized left cubital fossa region. The physical examination revealed a soft tissue mass with eroded skin. Ultrasound and MRI findings were respectively of an infected soft tissue mass and probable malignant soft tissue mass. Open biopsy was planned but surgical finding revealed a pseudo aneurism of the left brachial artery before its bifurcation. Brachial arterial lesion was repaired blood flow reestablished with clinical improvement.