Agenesis of the gallbladder.

Agenesis of the gallbladder is a rare anomaly that is usually asymptomatic, but sometimes the patients may have symptoms compatible with a biliary disorder like cholelithiasis. Its preoperative diagnosis is often difficult, especially if dysplastic cyst is associated and simulates the gallbladder. When the diagnosis is doubtful its confirmation and treatment of dysplastic cyst require open surgery, careful dissection of the common bile duct to avoid biliary lesions and intraoperative ultrasonography or cholangiography to be performed to exclude other associated anomalies. The Authors describe the case of agenesis of gallbladder and dysplastic cyst associated and comment on its clinical, diagnostic, and therapeutic aspects.

[Ecographic evaluation of the vitality/fertility in the hepatic hydatidosis as indication for pericistectomy]. / Valutazione ecografica della vitalità/fertilità nell'idatidosi epatica come indicazione alla pericistectomia.

Hepatic hydatidosis is still now a frequently observed pathology and the total pericistectomy, for surgical difficulties, often request a subtotal pericistectomy with complications such as biliary fistula, haemorrhage and subphrenic abscesses. The Authors reconsidered their hepatic hydatidosis cases to evaluate the indication to the surgery that in their opinion, should have to consider first of all the functional state of the cysts. Infact, only the vital and the fertil ones, less frequent even if rarely found, should have indications to the surgery, because more likely complicated. The dead and steril ones, instead being asymptomatic, should go under periodic control, since destined to degeneration and calcification. Are also compared the pre-surgery data with the parasitologic exam, to evaluate ETG reliability to determine the functional state of the cyst. Twenty one cysts out of 76 were operated correctly because vital/fertile and in 19 of these the ultrasound indications were correct (90.5%). 55 didn't have indications to the surgery since dead/steril and for 51 (92.7%) the ultrasound indication was correct. So we can say that morphological ultrasound data permitted a correct surgery indication for 70 cyst's on their functional state (93.4% of total). In this way the post-operative complication were reduced of 5%. The Authors found morphologic and/or functional ultrasound error for 6 cysts (7.9%), and in only 3 cases (3.9%) the error were both morphological and functional Infact we believe that a ultrasound morphologic classification should have a functional corrispective for the surgical indication So only the unilocular and multivescicular cysts, vital and fertil one, should have indication to the surgery. On the contrary the solid ones should have an ultrasound follow up and treated by chemotherapy if necessary.

Tumoral calcinosis: a case report.

Tumoral calcinosis is a rare tumour-like mass characterized by soft tissue calcification of obscure aetiology. A case of tumoral calcinosis is presented here, and its clinical, radiological and pathological features are described. The differential diagnosis versus hydatid cyst is discussed. Diagnosis is possible with imaging techniques but histopathological study is essential to establish it with certainty. Complete surgical excision appears to be the only effective treatment.

[Obstructive jaundice caused by hepatocellular carcinoma]. / Ittero ostruttivo da epatocarcinoma.

The Authors take a hint from recent observation of two patients with hepatocellular carcinoma presenting with obstructive jaundice to analyse the litterature and their clinical cases. They conclude that in the evolution of hepatocellular carcinoma can be found "early" or "late" jaundice. The latest is hepatocellular and/or obstructive jaundice and it is harbinger of fatal prognosis because of a big hepatocelluar carcinoma that has invaded biliary tree and/or liver failure by concomitant cirrhosis. The "early" jaundice appears when the tumor is still small and it is always obstructive due to intrabile duct tumor growth. This kind of jaundice has a good prognostic meaning because, together with imaging techniques, permits an early diagnosis of the hepatocellular carcinoma necessary for satisfactory palliation or occasional cure.