[Multimodal treatment complications of post-cholecystectomy intrahepatic lithiasis. Case report]. / Complicanze del trattamento multimodale della calcolosi intraepatica nel colecistectomizzato. Case report.

The Authors presents a case of post-cholecystectomy intrahepatic lithiasis. They focalized their attention to the complications of multimodal treatment.

Space occupying lesions of parotid gland. Comparative diagnostic imaging and pathological analysis of echo color/power Doppler and of magnetic resonance imaging.

Aim of the study was to evaluate the role of echo color/power Doppler and magnetic resonance imaging in the diagnosis of space occupying parotid lesions, in the attempt to establish criteria for differential diagnosis between benign and malignant types. The study population comprised 49 patients (23 male, 26 female), age range 30-85 years, with a space occupying lesion of the parotid gland. Each lesion was carefully studied with ultrasound integrated with colour/power doppler and magnetic resonance imaging; patients were then submitted to echo-guided needle-biopsy and surgical excision. A preliminary evaluation by means of ultrasound revealed the site, size of lesion, echostructure and borders. Echo colour/power Doppler and magnetic resonance imaging can play a very important role both in diagnosis and pre-operative surgical planning of parotid lesions, although cost and availability, the former to be recommended vs. magnetic resonance imaging, which is poorly accessible, expensive, and not always accepted by the patients.

[Liposarcoma of the leg]. / Liposarcoma dell'arto inferiore.

The Authors report an interesting case of liposarcoma of the leg and review the international Literature. Moreover, a particular analysis of different aspects such as anatomy, clinic, diagnosis and treatment has been carried out.

[Benign tumors and pseudotumors of temporo-mandibular joint: radiologic aspects]. / Tumori benigni e pseudotumori dell'articolazione temporo-mandibolare: aspetti radiologici.

Benign tumors and tumor-like lesions that involve temporo mandibular joint are very rare. Those more frequent are osteochondroma, chondroma, osteoma, pigmented villonodular synovitis and synovial chondromatosis. The Authors report six cases of patients affected by these pathologies in which imaging, such as TC, MRI and/or ortopantomography have been useful to have a diagnosis.

[Spontaneous rupture of duodenum: case report and review]. / Rottura spontanea del duodeno: presentazione di un caso clinico e revisione della letteratura.

Although rare, injuries of the duodenum increased in frequency during the past ten years. Careful attention must be paid to them, especially in blunt trauma of the abdomen and lower thoracic regions. Often they occur along with lesions of other related structures in polytraumatized patients. X-rays are the most important mean used in diagnosis. Early diagnosis and surgical treatment are conditio sine qua non for successful results. Complete intraoperative inspection of the duodenum, careful suture of the perforation and a correct placement of drainage are essential for the prevention of postoperative complications. If the duodenal wall had lost its vitality, a gastrojejunal or duodenojejunal anastomosis or gastrostomy are performed; the duodenum is decompressed and drainage of the peritoneal cavity is established. In cases of associated injury of the pancreas or choledochus, the drainage of the extrahepatic bile duct is recommended. The Authors report a case of spontaneous rupture of duodenum in which all of the above mentioned procedures were used; they stress that only suspicion of a duodenum's rupture indicates an immediate laparotomy.

[Magnetic resonance and traditional radiology in the spine localizations of alkaptonuric ochronotic arthropathy]. / Risonanza magnetica e radiologia tradizionale nelle localizzazioni vertebrali dell'artropatia ocronotica alcaptonurica.

AIM: To study the spine alterations in alcaptonuria with traditional radiology and magnetic resonance (MR), comparing the results of the two techniques. PATIENTS AND METHODS: Five patients (4 males, 1 female, mean age 51 years) underwent the examinations. For the study with X-rays we performed anteroposterior and lateral scan and the images have been studied making reference to a radiographic score; it examines the alterations of the joint space and the presence of calcifications. MR scan, oriented in the three spatial planes, were performed using spin echo T1-weighted and spin echo T2-weighted sequences. RESULTS: Both MR and X-rays pointed out, in the cases with known diagnosis, the typical alterations of the ochronosis: narrowing of the articular spaces, even osseous ankylosis, calcifications of the discs, osteophytosis, multiple disc protrusions and reactive sclerosis of the articular surfaces, evident above all to dorso-lumbar tract; nevertheless MR has been more accurate than X-rays for individualizing the lesions and recognizing alterations, such as the thickness of the anterior longitudinal ligament. In the case of new diagnosis, the MR is fundamental to recognize typical signs of the ochronotic arthropathy not well detected by X-rays. CONCLUSIONS: Imaging techniques, first of all the MR, are essential in the differential diagnosis of ochronosis vertebral lesions with other articular diseases.

[The colecistectomy in primary sclerosing cholangitis: case report and review of literature]. / Indicazione alla colecistectomia nella colangite sclerosante primitiva: presentazione di un caso clinico e revisione della letteratura.

Primary sclerosing cholangitis (PSC) is an idiopathic chronic inflammatory condition affecting intra- and extra-hepatic biliary system. The aim of this study is to stress the importance of cholecystectomy in patients with PSC. Consideration should be given to performing a cholecystectomy in PSC patients with gallbladder adenomyomas or calculi, even asymptomatic; this happens in approximately 15% of cases.

[Appendiceal lithiasis: case report and review of literature]. / Calcolosi dell'appendice: caso clinico e revisione della letteratura.

Appendiceal calculi are found in a limited percentage of patients. They are in association to an elevated prevalence of necrotic appendicitis and perforation of the appendix. The Authors report a case of acute appendicitis associated to appendiceal lithiasis with perforation of the organ. They emphasize the possibility to perform a preventive appendectomy in case of incidental appendiceal lithiasis. Besides they consider the differential diagnosis of the calcified images located in the lower abdominal quadrants with the aid of the various imaging methods available today, particularity sonography and computerized tomography.

[A case of total spinal block during epidural anaesthesia]. / Un caso di blocco spinale totale durante anestesia peridurale lombare.

Most cases of total spinal block have been reported in the literature. The displacement of the catheter and the consequent dural perforation are the causes in large percentage of the patients (75%). The Authors describe this case for the importance of the causes and outcome of the patient. A 48 years old woman presented for hysterectomy for uterine fibromas. After having individualized the L3-L4 interspace, a test dose of 3 ml carbocaine 2% was injected. After that, the spinal block was obtained using ropivacaine 0.75% (total dose = 10 ml) injecting slowly, in following times, 5+5 ml of anaesthetic solution. The patient, perfectly conscious at first, presented a gradual increase of the difficulty in talking and breathing. Subsequently she showed a complete paralysis with loss of the consciousness, respiratory arrest, bilateral and symmetrical midriasis, as well as total areflexia. Endotracheal tube was placed. After eighty minutes from the end of the administration of the local anesthetic, spontaneous thoracic excursions appeared, even though of moderate ampleness, midriasis reduced. The patient recovered consciousness and sufficiently ventilated; therefore the endotracheal tube was removed.

[Anaesthesiologic problems about hyperthermic intraoperative intraperitoneal chemotherapy]. / Chemioipertermia intraperitoneale intraoperatoria: problematiche anestesiologiche.

The literature considers hyperthermic intraoperative intraperitoneal chemotherapy a safe and effective procedure for peritoneal carcinomatosis, but a technical improvement is necessary. Regional chemotherapy anticipates the "downfall" of tumoral cells in the peritoneum. The Authors considered 5 patients--female, age 27-45 years, ASA 2--operated of peritonectomy in ovaric neoplasia with peritoneal metastasis. The hyperthermic intraoperative intraperitoneal chemotherapy has been made at the end of the surgery with a hot solution (43 degrees C): 3000 ml of dextrose 1.5% with mytomicina C 25 mg e cysplatino 75 mg/m2. We considered variation of emodinamic parametres (blood pressure, central venous pressure, stroke volume, etc.) and biochemical parametres (Na, K, CI-, CO2, etc.). These parametres have been correlated with some complications: fistula, anastomotic leakage, pancreatitis and postoperative bleeding.

[Surgical methods in the management of urinary incontinence caused by genital prolapse: a review]. / Tecniche chirurgiche per l'incontinenza urinaria da prolasso genitale: contributo originale.

The authors, after of the different techniques mostly used in surgery to correct the urinary incontinence, illustrate their original technique adapted for UI caused by genital prolapse. At present, the Marchall-Marchetti-Krantz's and Goebell-Stoeckel's techniques are commonly used in this field. Since uterus lowering is the main cause of cystocele and subsequent urinary incontinence, their new technique has the principal purpose of holding the uterus permanently in it natural position. The authors limited experience is actually of only five cases; all the patients underwent an intervention of cystopexy according to their new technique described. The results obtained encourage and promote the usage of such a method, consenting them to go on with their experience.

Growth in congenital rubella syndrome and correlation with clinical manifestations.

Growth patterns, final stature, and clinical manifestations were studied in a review of the records of 105 patients with congenital rubella syndrome followed longitudinally. Of the patients (35 male, 51 female), 86 had achieved final heights. Three patterns of growth were observed: normal growth, growth consistently below the 5th percentile, and growth within the normal range or slightly below the 5th percentile followed by early cessation of growth and final height usually below the 5th percentile. Significant cognitive deficits were not observed in patients with normal growth patterns, except for one patient with profound mental retardation. The magnitude of the cognitive deficits was closely correlated with the degree of growth failure (p less than 0.001). We postulate that the rubella virus exerts its effect on somatic growth both in utero and postnatally, at a central and peripheral level, through multiple mechanisms.

Body composition in adolescents: estimation by total body electrical conductivity.

This comparative study, conducted on 28 boys and girls of widely varying fatness, was designed to validate a new whole-body composition method [total body electrical conductivity (TOBEC)], based on bioelectrical properties of the human body. A significant correlation [r = 0.911; standard error of the estimate (SEE) = 5.3 kg] was demonstrated between the transformed TOBEC scores (TOBEC0.5 X Ht) and lean body mass (LBM) determined by hydrodensitometry and corrected for individual variations in hydration (LBMd + W). TOBEC determinations also correlated well with 1) total body water determined by deuterium oxide dilution (r = 0.877; SEE = 4.5 liters), 2) total body potassium determined by means of a 4 pi whole-body counter (r = 0.860; SEE = 430.7 meq), 3) LBM derived from skinfold thicknesses (r = 0.850; SEE = 5.8 kg). The residuals of the regression between LBMd + W and TOBEC scores did not show any significant correlation with either the potassium or the water content of the LBM. The results indicate that TOBEC is a simple, rapid, reliable, and noninvasive technique for delineating changes in body composition that occur in children during growth.