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Progettazione antincendio delle autorimesse
No full textIl libro presenta tre esempi pratici di progettazione antincendio di
autorimesse di varie dimensioni e complessità, riferiti a contesti che
frequentemente si riscontrano nell’attività professionale.
Gli esempi riguardano: 1) autorimessa condominiale di modeste dimensioni
e ridotta ventilazione, con approfondimenti sul dimensionamento delle vie di
esodo;
2) autorimessa condominiale di medie dimensioni, suddivisa in box poco
ventilati e con insufficiente resistenza al fuoco delle strutture; 3) autorimessa
di rilevanti dimensioni a servizio di un edificio direzionale, con infrastrutture
per la ricarica di veicoli elettrici.
Le stesse autorimesse sono prima esaminate secondo la regola tecnica di
cui al D.M. 01/02/1986, e poi alla luce del Codice di prevenzione incendi,
applicando tutte le misure di sicurezza antincendio previste, integrate o
sostituite ove necessario con le indicazioni della RTV introdotta con D.M.
21/02/2017. Sono inoltre fornite tabelle comparative delle differenze tra le
varie soluzioni progettuali.
Gli esempi sono strutturati in modo da fornire al tecnico gli strumenti
necessari per potersi confrontare in maniera sistematica con qualunque
situazione reale, individuando le misure di sicurezza antincendio ottimali che
il responsabile dell’attività dovrà adottare
Ocular Melanoma Presenting as Masquerade Syndrome
Get PDFA masquerade syndrome is an ophthalmological entity where a neoplasm mimics an inflammatory condition. Ocular melanoma (chiefly uveal) may present with symptoms suggestive of intraocular inflammation such as endogenous endophthalmitis. Ocular melanoma is most commonly found in middle-aged and older caucasian patients. One-third of all uveal melanoma cases present asymptomatically. Early diagnosis facilitates treatment before ocular melanoma reaches metastatic stage IV. Current therapy options for stage IV patients are palliative care and clinical trial participation.eed for clinicians to be aware of rare metastases at the time of diagnosis
Hypercalcemia and Extensive Chest Metastasis of Vulvar Squamous Cell Carcinoma
Get PDFA 73-year-old woman with a diagnosis of vulvar carcinoma submitted to curative surgery 5 years previously, presented to the emergency
department with prostration and vulvar haemorrhage. Although the gynaecological examination was unremarkable, she had a mass in the
left chest wall and hypercalcemia. A CT scan of the thorax revealed a voluminous left hemithorax mass invading the mediastinum, lung, pleura
and chest wall. Ultrasound-guided biopsy of the mass showed infiltration by a well-differentiated keratinizing squamous cell carcinoma
(SCC). This case report describes an extremely rare metastatic pattern in vulvar SCC concomitant with paraneoplastic hypercalcemia
Whipple's Disease as the First Manifestation of Chronic Lymphocytic Leukaemia
Get PDFWhipple's disease is a rare multisystemic infectious disease that can mimic lymphoproliferative disorders and must be considered in the differential diagnosis of febrile syndromes. The authors describe the case of a 55-year-old man who presented to the Emergency Department with dyspnoea and abdominal pain. He had a 2-month history of fever, night sweats, asthenia and unintentional weight loss. Upon clinical examination he had bilateral inguinal lymphadenopathy. Blood tests showed iron-deficit anaemia and high C-reactive protein. Abdominal ultrasound showed mesenteric and iliac adenopathies and hepatosplenomegaly. The patient was admitted to the Internal Medicine department for additional testing. Flow cytometry analysis of peripheral blood showed CD5-positive monoclonal B-cell expansion. Excisional biopsy of a retroperitoneal adenopathy guided by computed tomography showed periodic acid–Schiff-positive bacilli inside the macrophages, further identified as Tropheryma whipplei through polymerase chain reaction. Bone marrow biopsy showed a scarce positive CD5 lymphoid population and haematopoietic alterations related to infection. The patient started treatment for T. whipplei with complete symptom resolution. This is the first case describing the simultaneous diagnosis of Whipple's disease and chronic lymphocytic leukaemia in a patient with constitutional symptoms, fever and lymphadenopathies
Efficacy of Rituximab in Refractory Inflammatory Myopathy Associated With Coexistence of Behçet's Disease and Antiphospholipid Syndrome
Get PDFA 43-year-old Caucasian male initiated myalgias and loss of muscle strength in the upper and lower limbs, but especially at the shoulder and pelvic girdle. Creatinine phosphokinase was elevated seven-fold above the normal reference value and aldolase was slightly elevated. He had a previous diagnosis of Behçet's disease, antiphospholipid syndrome and hypertriglyceridaemia. At this time, he was on azathioprine 150 mg daily, colchicine 1 mg daily, warfarin and fenofibrate 200 mg daily. Fenofibrate was stopped and creatinine phosphokinase re-evaluated 2 months later, but it was higher, with persistent myalgias. By this time, prednisolone was restarted and the azathioprine dose reduced until it was discontinued. Nevertheless, 2 months after stopping azathioprine, the patient remained symptomatic and creatinine phosphokinase was persistently elevated. At this point, the authors requested myositis antibody testing to exclude overlap with a third autoimmune disorder, and Ro52 antibody was positive. Electromyography was normal. Magnetic resonance imaging of lower limb muscles was compatible with polymyositis. Muscular biopsy of the medial gastrocnemius revealed inflammatory myopathy. The authors proposed treatment with rituximab and after 3 months, the patient had clinically and analytically improved, with reduction of creatinine phosphokinase, without adverse reactions. As we can see in this case, rituximab could be a secure treatment for patients with idiopathic inflammatory myopathy without improvement on glucocorticoids plus another immunosuppressive agent. This patient has a rare overlap syndrome, since this is the first case of an association between inflammatory myopathy, Behçet's disease and antiphospholipid syndrome described in the literature
Autoimmune Hepatitis and Systemic Sclerosis: a Rare Association
Get PDFA woman in her early 40s, with a history of excessive alcohol intake, presented with purpuric, ulcerative lesions on the lower limbs. On examination, hirsutism and generalized stiffening and thickening of the skin were noted. Laboratory investigations revealed hyperbilirubinemia, hypergammaglobulinemia and positive anti-smooth muscle antibodies. Histologic examination of the skin was compatible with scleroderma. Histologic examination of the liver was suggestive of autoimmune and alcoholic hepatitis
When the Heart Triggers the Esophagus: Esophageal Spasm after Electrical Cardioversion
Get PDFIntroduction:“Esophageal spasm” is a generic term widely used to attribute unexplained non-cardiac chest pain and/or dysphagia to an esophageal motility disorder.
Patient and methods: The authors present the case of an 86-year-old male patient with complete dysphagia after an elective electrical cardioversion for atrial fibrillation. An upper endoscopy performed shortly after the onset of the clinical picture documented disordered esophageal contractions. The patient became asymptomatic within 12 hours of the administration of a spasmolytic therapy.
Results: To the best of our knowledge, this is the first report of esophageal spasm after an electrical cardioversion.
Discussion: The temporal correlation supports the explanation of a cause-effect relationship between the clinical presentation and the preceding procedure, thus providing elements for clinicians to recognize and treat this particular condition
Giant Cystic Mediastinal Lymphangioma
Get PDFCystic lymphangioma mainly occurs in children and develops from the lymphatic vessels. The present study reports the case of a 36-year-old female patient with a giant cystic mediastinal lymphangioma. She was asymptomatic and the diagnosis was accidental. Imaging studies are important for referral to the Cardio-Thoracic Surgery Department for surgical intervention in order to remove the lesion. It is important that in the case of an enlargement of the mediastinum observed in a thoracic X-ray, the possible diagnosis takes into consideration various hypotheses. Early diagnosis may prevent further growth and infiltration of structures that hinder the surgical approach
Purpura Fulminans: a Rare but Fierce Presentation of Pneumococcal Sepsis
Get PDFInfectious purpura fulminans (PF) is a rare presentation of disseminated intravascular coagulopathy (DIC) due to diffuse intravascular thrombosis and haemorrhagic infarction of the skin. PF can present in infancy/childhood or adulthood and usually presents as ecchymotic skin lesions, fever and hypotension. It is most commonly a consequence of sepsis related to Neisseria meningitidis, Streptococcus pneumoniae or Haemophilus influenzae. Despite aggressive management of sepsis with intravenous fluids, antibiotics, and conventional and nonconventional therapies, the condition still carries a mortality rate of 43%[1]. Streptococcus pneumoniae mostly presents with community-acquired pneumonia. We present a case of PF secondary to DIC related to Pneumococcal sepsis in an otherwise healthy and immunocompetent patient
Diffusion of emerging bipolar magnetic pairs in solar photosphere
Get PDFMagnetic element tracking has been widely used to study the transport and diffusion of the magnetic field on the solar photosphere. From the analysis of the displacement spectrum of these tracers, it has been recently agreed that a regime of super-diffusion dominates the solar surface. We present in this work the analysis of the diffusion of emerging new bipolar magnetic elements for different initial separation of the footpoints. The displacement spectrum for bipolar couples interestingly shows a similar behaviour with respect to the case where all magnetic pairs are considered. To understand how such peculiar diffusion in the solar atmosphere takes places, we compare the displacement spectrum exploring the initial maximum separation parameter