Percutaneous vesiculodeferentography in the diagnosis of male infertility: A review of our results and the data reported in the literature.

Vesiculodeferentography was used in the past to evaluate suspected cases of obstruction of the seminal ducts. Over the years, numerous attempts have been made to improve the technique used to perform this examination and to render it less invasive. Its use is currently indicated in selected cases, where it is combined with functional studies like seminal tract washout and followed by immediate interventions to correct the alterations revealed. Vesiculodeferentography includes collection of the contents of the seminal vesicles, which can later be used in vitro assisted fertilization procedures.

SommarioLa vesciculodeferentografia, esame utilizzato in passato nei casi di sospette ostruzioni delle vie seminali, è stato negli anni oggetto di numerosi studi allo scopo di migliorarne la tecnica di esecuzione e renderla meno invasiva. Attualmente è indicata solo in casi selezionati, in associazione a un'indagine funzionale quale il Seminal Tract Washout e prevedendo un contemporaneo ­ o in via subordinata, successivo ­ atto terapeutico.Ovviamente, peraltro, la procedura ­ ipso facto ­ prevede il prelievo di materiale dalla seminale e ciò può consentire una successiva procedura di fecondazione assistita in vitro.

Ultrasound and psoriatic arthritis - Review of the literature and general considerations.

The authors review the recent literature on the use of ultrasonography in psoriatic arthropathy. The results are discussed in light of the authors' experience and with reference to technological advances and processes.

Second generation ultrasonographic contrast agents in the diagnosis of neoplastic thyroid nodules.

To verify whether the use of second generation ultrasonographic contrast agents leads to an improvement in the differential diagnosis of thyroid nodules, twenty patients, eligible for uninodular goiter surgery were studied. All patients previously underwent complete hormonal profile, bidimensional thyroid ultrasonographic, Colour Doppler evaluation and 99 mTc scintiscan. All nodules were as well evaluated before and after sulphur-hexafluoride administration. Wash-in time, contrast agent intra-nodular flow and wash-out time were evaluated. These data were compared with the cytology and histology findings. On the basis of the histological examination we divided our study population in 2 groups: in the group of neoplastic lesions (4 follicular adenomas and 6 carcinomas) an early wash-in was observed, with an homogeneous peripheral pattern enhancement, a rapid centripetal progression and an extended persistence of the contrast agent inside the nodule. In 6 out of 10 cases of thyroid neoplasia a fast wash-out was observed. In the group of benign lesions, in the patients affected by nodular goiter, an intra-nodular perfusion as opposite to the healthy surrounding parenchyma was observed. Even though ultrasound contrast agent technique has a limited invasivity and is more expensive than Fine Niddle Aspiration (FNA), the preliminary data of this pilot study suggest that this method might prove useful, to differentiate benign from malignant thyroid nodules.

Small hyperechogenic nodules in thyroiditis: usefulness of cytological characterization.

Small hyperechogenic nodules occurring in thyroiditis frequently raise the question of their nature requiring additional evaluation. Given the scarcity of the studies addressing this issue, we have investigated whether cytopathological analysis of fine needle aspirates (FNA) of these lesions may be of diagnostic relevance. In this preliminary study, we submitted to cytopathological analysis 10 nodular lesions as well as the normal counter-lateral tissue. In none but one of the cases analyzed, the cytopathology was able to detect differences between the hyperechogenic models and the hypoechogenic parenchyma suggesting that these lesions bear no-clinical relevance. Therefore, FNA of these nodules is not advisable and should be limited to those with defined at risk clinical features.

Our experience in transrectal ultrasonography and biopsy in carcinoma of the prostate.

The Authors present a short review of the literature comparing transrectal ultrasound of the prostate (TRUS) and ultrasound guided biopsy and the results of 694 consecutive prostatic biopsies from their cohort. All the biopsies were US guided with an endorectal biplanar 5 MHz probe and transperineal samples were carried out with an 18 G needle (cutting length 22 mm) over the last 4 years. The histological exam showed 187 prostates affected by cancer while 112 had only inflammation. The operator's opinion, based on ultrasonography and integrated with a digital rectal exam (DRE) and a prostate specific antigen (PSA) blood test, was correct in 80% of the cases, with 90% sensitivity and 70% specificity. The positive prediction rate was 74% and the negative prediction rate was 89%.

Elastofibroma dorsi: ultrasound pattern in three patients.

Elastofibroma dorsi is a rare benign tumor with a prevalence in the female population. The tumor is composed of adipose and fibrous tissue. It is typically localized at the tip of the scapular and is more frequently bilateral. Even if there are only very few reports on this topic, the incidence of the tumor seems to be less rare than expected. Elastofibroma dorsi was identified in 1961 and the first study using diagnostic ultrasound technique was published in 1996, however, since then no other major work has been produced. The purpose of the paper is to present three cases of elastofibroma dorsi, all studied by ultrasound imaging, including color and power Doppler, and by fine needle aspiration biopsy. Furthermore, in one case i.v. contrast media (Levovist) was used, and in two cases a CT and MRI evaluation was also made. Surgical excision was not performed in any of the cases. The relevant follow up was performed by clinical and ultrasound tests. In all the cases the ultrasound pattern of the elastofibroma dorsi was very similar to the surrounding muscular tissue, and neither a clear cleavage surface nor a specific vascular pattern could be evidenced. The tumor was very difficult to define from the surrounding tissue, except for a more evident coarse pattern and the same happened for the CT and MR, where a layered pattern of fatty tissue was noted. In this small cohort the tumor was mainly monolateral. The ultrasound investigation, integrated with color and power Doppler permitted a correct diagnosis, which was confirmed by the fine needle biopsy. Therefore, the less expensive ultrasound diagnosis, as a major method of screening for elastofibroma dorsi, would seem to be a reasonable proposal.

Laparoscopic approach to cholecystocolic fistula: report of a case.

The development of a fistulous tract from the gallbladder is associated with gallstones in 90% of cases. Cholecystocolic fistula (CCF) accounts for 10 to 20% of all enteric biliary fistulas. The conventional treatment advocated is cholecystectomy and closure of the fistulous communication. In this report a case of a patient whose only complaint was severe diarrhea is described. CCF was demonstrated by barium enema. The patient was treated by laparoscopic surgery. The case history and laparoscopic approach to enteric biliary fistula are described.

[The pilonidal sinus: its surgical treatment, our experience and a review of the literature]. / Sinus pilonidalis: trattamento chirurgico, nostra esperienza e revisione della letteratura.

The authors report their experience in the surgical management of pilonidal sinus. During a 3-year period (1989-1991) 106 patients underwent primary closure. Average postoperative stay was 5.5 days, while mean healing time was 14.6 days. During the follow up, 3 patients developed a true recurrence (3.26%). After a critical review of the literature, the authors emphasize the importance of primary closure in the surgical treatment of pilonidal disease.

[Seminal vesicles: echographic findings in 244 subjects. Evaluation of anatomic data and correlations with pathologic prostatic-vesicular parameters]. / Le vescichette seminali: osservazione ecografica in 244 soggetti. Valutazione di dati anatomici e correlazione con parametri patologici prostato-vescicolari.

Over a 2-year period (1989-90), about 400 cases were examined (out of nearly 2,500 US examinations of the prostate), 244 of which had subsequent bioptic, surgical or autoptic confirmation. This paper reports the anatomic, clinical and pathologic data relative to the seminal vesicles of 244 subjects who underwent transrectal US of the prostate for different clinical indications. Our biometric values were slightly different from those reported in literature, the latter being based on autoptic findings. Agenesis and monolateral ectopia were confirmed to be extremely rare: 4 cases only (1.6%) in our series. A typical finding was the nearly perfect symmetry; in size and structure, of the two seminal vesicles in the same subject; as a matter of fact, a loco-regional pathologic condition was detected in all the patients (14) with asymmetry. A hundred per cent agreement was observed between the US patterns of the seminal vesicles and the prostatic patterns in case of acute/subacute prostatic inflammation involving also the 2 glands: this parameter can be used to follow the clinical course of the inflammatory process.

[Echo-guided needle biopsy of the thyroid. An assessment of 52 thyroid neoplasms found in 1042 consecutive patients]. / Agobiopsia ecoguidata della tiroide. Valutazione di 52 neoplasie tiroidee riscontrate in 1043 pazienti consecutivi.

The authors report on a series of 1,043 fine-needle biopsies of the thyroid performed under US guidance; the patients had been selected for thyroid pathologic conditions. Fifty-two neoplasms were observed (46 papillary carcinomas, 1 medullary carcinoma, 2 follicular carcinomas, and 3 metastases), which had been detected by cytology and confirmed by histology or autopsy. The authors focus on 46 cases of papillary carcinoma: their US features were studied which, through a correlation of variables, allow a quick and "safe" recognition of the type of carcinoma (papillary carcinomas account for nearly 60% of thyroid neoplasms). Tumor echogenicity and outline, and the presence/absence of calcifications were evaluated: in most cases, papillary carcinomas presented as focal lesions (alone or associated with other goiter lesions), with irregular and blurred outline, no hypo/anechoic halo and, in about 1/3 of the cases, with calcifications and colliquative areas. In 17% of papillary neoplasms, metastases to loco-regional nodes were observable at US; in 3 cases the carcinoma did involve a loco-regional node but there were no US signs suggestive of it. The incidence of neoplasms on the total of fine-needle biopsies is 4.9%, while in a previous series of 3,038 fine-needle biopsies, without US guidance, on clinically detectable lesions, the figure was about 2%.

[Solitary ulcer of the rectum: a report of a clinical case associated with rectal prolapse]. / Ulcera solitaria del retto: presentazione di un caso clinico associato a prolasso rettale.

Solitary ulcer of the rectum is an unusual condition occurring more often in young adults. Unfortunately the term is rather confusing, since the lesion may not necessarily be solitary, nor be confined to the rectum; moreover, it may be polypoid rather than ulcerating. The etiology is uncertain, but chronic constipation and fecal impaction could play a role. Today most authors believe solitary ulcer syndrome is a distinct clinical inflammatory manifestation associated with rectal prolapse. Surgical treatment of the prolapse is usually followed by a recovery of the solitary rectal ulcer.

[Gastric polyps: histogenetic considerations and therapeutic trends]. / I polipi gastrici: considerazioni istogenetiche ed orientamento terapeutico.

The Authors report their series of 86 patients with gastric polyps, observed from 1986 to 1989. Basing on the literature data the lesions were divided in A) inflammatory polyps, B) hyperplastic polyps, C) adenomatous polyps and 27, 49 and 10 lesions, were respectively found for each type. Particular attention was given to the association between intestinal metaplasia and gastric dysplasia for each type of polyp. A significant prognostic value as a precancerous lesion was recognized only to dysplasia. Therapeutic trend for each single polyp, based on the histologic type, is suggested.

[Transrectal echography and simultaneous uroflowmetry in the study of male urination. Considerations on 254 consecutive cases]. / Ecografia transrettale e uroflussometria simultanea nello studio della minzione maschile. Considerazioni su 254 casi consecutivi.

The authors report on a series of 254 consecutive male patients who underwent transrectal US, sometimes combined with uroflowmetry, for the study of micturitonal phase. 170 patients were studied with both techniques. In 118 patients, there was complete agreement between the two methods about presence and degree of flow obstruction; partial disagreement was observed in 48 patients and complete disagreement in 4. On 44/52 patients with partial/complete disagreement diagnostic cystouretrography was performed. Our results demonstrate high agreement between the two techniques, except in case of micturition deficit with columnar hypertrophic bladder and in obstructive pathologic conditions of anterior urethra.

[Endoscopic polypectomy and adenoma-carcinoma sequence of the large intestine. Considerations on personal case series]. / Polipectomia endoscopica e sequenza adenoma-carcinoma nel grosso intestino. Considerazioni su casistica originale.

Since the introduction of colonoscopic polypectomy, the management of colonic polyps has dramatically changed. What once was a major transabdominal operation now is a routine therapeutic endoscopic procedure. To test the hypothesis of the adenoma-carcinoma sequence histopathologic features of polypoid lesions are retrospectively evaluated. In our experience with 566 polypectomies 430 adenomatous polyps, 71 hyperplastic, 58 inflammatory polyps, and 4 juvenile lesions are reported. Only adenomatous polyps showed dysplasia. Overall, severe and moderate dysplasia was respectively observed in 6.7% and 23% of the adenomas. Infiltrating carcinoma was present in 2.2% of the cases. Villous adenomas showed high rates of severe dysplasia (37%) and invasive carcinoma (18%). Location and sex did not seem to have a role in the malignant potential of adenomas.

[Primary lymphoma of the thyroid gland. Review of the literature and presentation of a clinical case]. / I linfomi primitivi della tiroide. Revisione della letteratura e presentazione di un caso clinico.

Primary malignant lymphoma of the thyroid is a very uncommon disease and represents approximately 5% of all thyroid malignant neoplasms. The Authors report a case whose clinical and histopathological features are discussed and compared with those of previously published series. Primary malignant lymphomas raise a number of issues: abrupt onset, age and sex patterns, histological typing (virtually 100% of cases are non-Hodgkin lymphomas), differential diagnosis with either Hashimoto's chronic thyroiditis (often associated with thyroid primary lymphomas) or genuine anaplastic carcinoma of the thyroid. Routine histological study can be complemented by immunohistochemistry. The treatment of choose is total thyroidectomy plus radiotherapy in cases where radical surgery is possible, or radiotherapy alone which usually carries good results.