A minimally invasive approach to pilonidal disease with endoscopic pilonidal sinus treatment (EPSiT): a single-center case series with long-term results.

BACKGROUND: Minimally invasive techniques for treating pilonidal disease are safe and effective alternatives to conventional surgery, with improved recovery time, cosmetic results, and pain control. The aim of this study was to evaluate the 5-year surgical outcomes of a single-center case series treated with endoscopic pilonidal sinus treatment (EPSiT). METHODS: We conducted a retrospective single-center analysis of all patients treated with EPSiT, by a single surgical team, from March 2015 to December 2019, for primary or recurrent pilonidal disease. The primary outcomes were recurrence, persistence and treatment failure. The secondary outcomes were postoperative pain, painkiller use, time off work, satisfaction, complications, wound healing time, time to persistence or recurrence. RESULTS: Forty-two patients underwent 46 EPSiT procedures [34 males, 8 females, median age 25 (IQR 13.75) years] for primary (47.8%) or recurrent pilonidal disease (52.2%). All patients completed the follow-up [median 62 (IQR 43) months]. The single procedure healing rate was 76.1%. The healing rate for the first procedures plus the second EPSiT procedure (performed in 4 cases) was 83.3%. Among the 46 EPSiT procedures, we recorded six cases of persistence (13.0%) and five cases of recurrence (10.9%) The median operative time was 32.5 (IQR 18.75) minutes, the median pain score (visual analog scale) in week 1 was 2 (IQR 2), and the median time off work was 4 (IQR 2) days. Four patients (8.7%) experienced complications: serosanguineous (n = 2) or seropurulent discharge (n = 2). The satisfaction rate was 95.7%. CONCLUSIONS: In our experience, EPSiT is safe, well accepted. and associated with a low level of postoperative pain, short hospitalization, short time off work, as well as optimal cosmetic results. Its failure rate is similar to that of excisional surgery.

Retroperitoneal lipoma. Unusual presentation with detrusor instability.

Retroperitoneal lipomas are a heterogeneous group of mesenchymal tumors. They are usually large and occur most frequently in the retroperitoneal, perineal and pelvic regions. Lipomas grow slowly surrounding the retroperitoneal and pelvic organs, with a displacement of bowel and vascular axis. A case of a 61-year-old male patient which referred urinary frequency, urgency and nocturia is presented. Urodynamics evidenced a detrusor instability in a low capacity bladder. CT scan demonstrated a bladder dome compression due to a huge retroperitoneal mass extending from the right hepatic lobe to the hypogastric region and the right thigh. Surgical complete resection was performed: histology demonstrated a lipoma with areas of well differentiated myxoid degeneration. After surgery the irritative urinary symptoms disappeared. This is the first case described in literature of detrusor instability due to bladder compression by retroperitoneal lipoma.

Prostatic small cell carcinoma diagnosed by tru-cut needle biopsy: discussion of clinico-pathological findings.

The small cell carcinoma is a neuroendocrine tumour characterised by an aggressive clinical course and a high mortality rate. It occurs most commonly in the lung. Small cell carcinomas originating in the genitourinary system have been diagnosed with increasing frequency in recent years, because of the use of immunohistochemistry. Prostatic small cell carcinomas present the same biological behavior and similar histological, immunohistochemical and ultrastructural features to small cell carcinomas of the lungs. We describe the clinico-pathological findings in a 65-year-old male patient with a diagnosis of prostatic small cell carcinoma, obtained by means of a tru-cut needle biopsy. We performed the immunohistochemical tests using neuron-specific enolase and chromogranin A antibodies, according to the literature. On the basis of our experience we stress the malignant features of small cell carcinoma and the difficulty in obtaining an early diagnosis and treatment because of the aggressive course of the lesion and the late symptomatology.

[Inflammatory pseudotumor of the bladder: etiopathologic and clinical features]. / Pseudotumore infiammatorio vescicale: aspetti etiopatologici e clinici.

The Authors present a case of inflammatory pseudotumour (IPT) of the urinary bladder occurring in a 57-year-old female patient, who was referred to our department with haematuria, stranguria and hypogastric pain. Ultrasonographic, radiological and endoscopic examinations showed a sessile, ulcerated, easily bleeding bladder formation; urinary cytology revealed no atypical transitional cells. Abdomino-pelvic computed tomography analysis showed thickening of the bladder walls and infiltration of the perivesical fat. Histopathologically, the formation was indicated as an inflammatory pseudotumour (IPT) of the bladder. The patient underwent TURB (transurethral resection of the bladder) and was discharged clinically healed on postoperative day 4. A one-year follow up revealed no evidence of recurrence. On the basis of their experience and a thorough review of the literature review, the Authors discuss the clinico-pathological features of IPT of the bladder and the possible factors involved in the malignant transformation of IPT. In conclusion, the benign nature of the lesion is stressed.

Bahren types III and IVa testicular vein anomalies as a reason for failure in left idiopathic varicocele retrograde sclerotherapy. Ontogenic discussion and clinical implications.

Left testicular vein anatomy has received more attention due to the presence of competent or incompetent venous valves and bypassing anastomoses, which are involved in venographic diagnosis and embolisation of varicocele. The left gonadal vein develops, in both males and females, between the 5th and 7th intrauterine weeks, being derived from the distal or postrenal portion of the left subcardinal vein. The varicocele aetiologic hypothesis leads to ontogenetic disturbances in the development of the secondary venous system. Retrograde testicular venography shows the precise anatomy of the left pampiniform plexus, while anterograde testicular venography identifies the presence of the valve and possible continence. In the present case sclerotherapy could not be achieved due to testicular vein anomalies. Sclerotherapy versus surgical high ligature of the left testicular vein in cases of left idiopathic varicocele with testicular vein anomalies is discussed.

[Thyroid nodules: comparison of preoperative and intraoperative needle aspirate and definite histological study]. / Noduli tiroidei: confronto tra agoaspirato preoperatorio, intraoperatorio ed esame istologico definitivo.

The need to discover malignancy is the most challenging dilemma in the management of thyroid nodules, the most common endocrine disorders, affecting 4-5% of the general population. Malignancies account for only 2-3% of cases. The aim of our study was to evaluate the predictive value of preoperative fine-needle aspiration cytology (FNAC) in surgical decision making by evaluating the final pathologic diagnosis and comparing it to the preoperative and intraoperative diagnoses. We conducted a prospective study of 30 thyroid resections. The mean age was 49 years (range: 27 to 68 years). Preoperative physical and laboratory examinations, presenting symptoms, imaging studies and predictive values of preoperative and intraoperative FNAC were analyzed. The consistency of the lesion was strongly predictive of malignancy, when "hard". Single lesions were also predictive of malignancy. The diagnostic accuracy of preoperative FNAC vs intraoperative FNAC vs frozen section histopathology was 90% vs 100% vs 96.7%; sensitivity: 91.6% vs 100% vs 100%; specificity: 90.5% vs 100% vs 94.7%, while the positive predictive value was 84.6% vs 100% vs 91.7%, and the negative predictive value 95% vs 100% vs 100%. Ultrasound-guided preoperative FNAC showed high specificity, sensitivity and accuracy in diagnosing malignancy in thyroid nodules. Intraoperative FNAC was more accurate than intraoperative frozen sections in diagnosing malignancy in thyroid nodules.

[Inverted papilloma of the bladder: observation of 3 clinical cases and discussion on their clinico-pathologic characteristics]. / Papilloma invertito della vescica: osservazione di tre casi clinici e discussione sui caratteri clinico-patologici.

Three cases of urothelial inverted papilloma, detected in two female patients aged 32 and 31 years, respectively and in one 67-year-old male patient, are described. Inverted papilloma is a benign lesion which occurs in the urinary epithelium with a 20% incidence in comparison with other urothelial tumours. The male:female ratio is 3:1. The histological structure of urothelial inverted papilloma is similar to that of inverted papilloma of the nasal and paranasal sinuses. It presents interanastomosed epithelial cords, with transitional cells, which develop in the tunica propria connective tissue. Some cells are distributed in such a way as to constitute vacuolated glandular-like structures. The histogenetic origin of the lesion from Home subtrigonal or Albarran subcervical glands is debatable. Recent aetiological hypotheses have claimed that the origin of the lesion may be related to Brunn's nest hyperplasia and/or to chronic urothelial inflammation. The latter hypothesis would currently appear to be the most accredited: immunostaining for cytokeratins would tend to support a urothelial inflammatory aetiology. In our cases, we achieved a definitive diagnosis of inverted papilloma only at histology, because of the specificity of the echotomography and cystoscopy findings. Urinary cytology revealed only a large number of inflammatory cells with anaplastic elements, but without any more detailed morphological description. We performed a transurethral resection of the bladder (TURB) in all three patients: routine follow-up showed the absence of inverted papilloma relapses. On the basis of the above-mentioned data and a thorough review of the literature, we attempt to assess and classify the clinico-pathological findings and the aetiological hypotheses of urothelial inverted papilloma. In addition, the benign nature of the lesion and any malignant transformation factors are discussed.

Interposition vein cuff in infrainguinal prosthetic bypasses.

The Authors describe the interposition vein cuff technique as an adjuvant method to infrainguinal prosthetic bypass grafts. The haemodynamic, mechanical and humoral factors thought to be involved in the beneficial effects of the vein cuff are herein discussed. The results of the main series suggest the use of this method particularly in patients without any available autologous vein conduit requiring a below-knee popliteal or crural reconstruction.

[Chronic viral hepatitis due to the hepatitis C virus (HCV): treatment experience with lymphoblast interferon-alpha]. / Epatite cronica da virus dell'epatite C (HCV): esperienza sul trattamento con interferone alfa linfoblastoide.

Ten patients affected with HCV-related chronic hepatitis received alpha lymphoblastoid-IFN, 3 mU i.m. TW, for 12 months. We obtained: 4 complete responses, 5 partial responses, 1 non-response (therapy stopped after 3 months). During the fourteen months follow-up, 4 patients (1 complete responder, 3 partial responders) relapsed.

[Role of the cerebral CAT examination in the diagnosis of neurotoxoplasmosis]. / Ruolo dell'esame TAC cerebrale nella diagnosi di neurotoxoplasmosi.

A case of central nervous system toxoplasmosis is reported. Attention is called to the diagnosis of this infection; moreover, the authors emphasize the importance of the TAC brain for the diagnosis and evaluation of the clinical evolution and response to the therapy.

[On the subject of leptospirosis. Description of a case]. / In tema di leptospirosi. Segnalazione di un caso.

The Authors report a case of leptospirosis. Stress is laid on the sporadicity of this infection in their region; attention is also drawn to the variety of the clinical expression of this disease.

[An animal model for the study of liver regeneration by magnetic resonance imaging]. / Modello animale per lo studio della rigenerazione epatica in Risonanza Magnetica per Immagini.

Liver regeneration after partial hepatectomy was studied in rats by means of magnetic resonance (MR) imaging and T1 relaxation time. Fourteen hepatectomized rats were compared to sham operated ones and to controls which had not undergone any surgical treatment. The animals were imaged at 0.5 T, and inversion recovery (IR) technique was employed at the T-null of liver before surgery. T1 was determined in vitro with spectroscopy. Regenerating rat liver exhibited a significantly high increase in MR signal intensity and T1 values (p less than 0.05) 24 hours after surgery, returning to baseline values at 2 weeks. Sham operated animals and controls did not exhibit significant changes in signal intensity from baseline values (p greater than 0.05). These findings suggest that MR imaging is able to detect the pathophysiological changes occurring in liver parenchyma during the regenerating process and to monitor different stages of the hyperplastic process.

[The epidemiology of non-A, non-B hepatitis (NANB). A review of the literature]. / Epidemiologia dell'epatite non-A, non-B (NANB). Revisione della letteratura.

Non-A, non-B hepatitis (NANB) is, after type B hepatitis, the most frequently encountered form of hepatitis. Parenteral transmission and apparently nonparenteral or "sporadic" forms are described. The epidemiology of this new form of hepatitis is examined in the light of personal experience and of reported data.

[Clinico-epidemiologic considerations in cases of acute viral non-A, non-B hepatitis (NANB)]. / Considerazioni clinico-epidemiologiche su una casistica di epatite virale acuta non-A, non-B (NANB).

Personal experience with a series of 69 cases of non-A, non-B viral hepatitis out of 164 cases of acute viral hepatitis observed at hospital admission between January 1985 and June 1988 is reported. Agreement is expressed with other Italian series as regards the incidence of sex, of the most involved age classes, of the most affected professional categories and of the incubation period of posttransfusional forms. The prevalence of sporadic forms over those transmitted intraparenterally and more prolonged course in icterus patients and in parenteral forms is pointed out.

[Induced pemphigus and brucellosis]. / Pemfigo indotto e brucellosi.

A case of induced pemphigus occurring in a patient affected with a brucellosis is reported with emphasis on the definitive remission of the pemphigus after antibiotic therapy against brucellosis and in the absence of corticosteroid treatment. Attention is also drawn to a possible autoimmune mechanism of the pemphigus triggered by brucellosis.

Purulent meningitis due to spontaneous anterior sacral meningocele perforation. Case report.

A 36 year old woman with anterior sacral meningocele developed a purulent meningitis secondary to the rupture of the meningeal sac into the rectum. The value of neuroradialogical studies, especially CT, is emphasized.

[Visceral leishmaniasis as an opportunistic infection. Our experience]. / La leishmaniosi viscerale come infezione opportunista. Nostra esperienza.

A case of visceral leishmaniasis in a female patient suffering from acute nonlymphoid leukaemia is reported. Stress is laid on the atypical nature of the clinical picture, falsified by the underlying disease, and attention is called to the behaviour of Leishmania as an opportunistic agent in the immunodepressed host.

[Pneumocystis carinii: laboratory diagnosis. State of the art]. / Pneumocystis carinii: diagnosi di laboratorio. Stato dell'arte.

In the light of the international literature and personal observation, the diagnostic techniques employed in Pneumocystis Carinii Pneumonia (PCP), a major opportunistic infection of acquired immunodeficiency syndrome (AIDS) are reviewed.

[Behavior of serum immunoglobulins in boutonneuse fever]. / Comportamento delle immunoglobuline sieriche in corso di febbre bottonosa.

The behaviour of serum immunoglobulins in 35 patients suffering from Mediterranean exanthematous has been studied. No particular quantitative or qualitative change lieve noted. Supported by the scanty and contrasting data in existing literature, it is maintained that aspecific immunological serum doses are of little use, but research is urged into specific antibodies by means of indirect immunofluorescence and the Elisa method.

[Hepatitis virus and pregnancy. Our experience]. / Virus epatite e gravidanza. Nostra esperienza.

The importance of perinatal infection in the mother-foetus transmission of HbsAg positive hepatitis is stressed. The role of type A hepatitis has no influence and that of the NANB is little known. The Authors maintain that in no case is the hepatitis virus a valid motive for the interruption of pregnancy, even when it occurs in the first months of gestation.