Sclerosing angiomatoid nodular transformation of the spleen associated with thrombocytopenia.

Sclerosing angiomatoid nodular transformation of the spleen, a recently described lesion of unknown pathogenesis, with a benign clinical course that is very often asymptomatic. Sclerosing angiomatoid nodular transformation may be a novo lesion or the final common pathway of various benign splenic conditions such as hamartoma, inflammatory pseudotumor and hemangioma. We report the case of a 68 year-old woman with thrombocytopenia and a splenic mass, diagnosed as sclerosing angiomatoid nodular transformation.

[The evolution of iliac artery surgery: vascular endoprostheses]. / Evoluzione nella chirurgia dell'arteria iliaca: le endoprotesi vascolari.

The Authors report their experience about vascular endoprostheses in iliac arterial stenoses and thromboses. Results are discussed in relation to technical difficulties and indications. The comparison between classic vascular surgery previously used, and the endovascular procedures recently adopted, leads the Authors to assert the validity of this last technique. However the need of precise indications based on radiological and angioscopic findings is stressed.

Dacron patch/tube graft: a preliminary study.

A Dacron patch/tube graft was developed specifically to avoid technical complications associated with lateral aortic anastomoses of medium-diameter grafts. This new prosthetic device has now been used in 15 patients without complications. It seems to be particularly useful in patients with thick-walled aortas.

[Vascular endoprosthesis. A new indication in the surgery of the iliac artery]. / Les endoprothèses vasculaires. Une nouvelle indication dans la chirurgie de l'artère iliaque.

We have used endoprosthesis (Palmaz Schatz) after balloon angioplasty of iliac arterial stenoses or thromboses, in order to increase the immediate patency and to prevent the recurrence of stenosis. Our series gathers 24 patients operated with endovascular procedures over a period of 2 years: 22 men, 2 women--extreme ages 42 to 78 years, average age 63.5 years--Clinical stage: 22 at stage I, 1 at stage III, 1 at stage IV. Arteriographic findings: 8 primary iliac lesions (6 stenoses and 2 thromboses), 11 external iliac lesions (stenoses). All these lesions were atheromatous. One of them had recurred after angioplasty. Usual technique: balloon angioplasty of the stenosis, assessment on a fluoroscopic screen and angioscopy of the result, decision to insert the Palmaz Stent if defects are seen on the image. Repatency of impassable lesions with a YAG laser was carried out in 2 cases. The indication of an endoprosthesis was established on the basis of the radiological image in 17 cases, of the angioscopic image in 4 and systematically in 10 cases of recurrence of stenosis, iliac thrombosis or associated surgery. Associated surgery: 2 femoropopiteal bypass grafts, 3 femorofemoral bypass grafts, 1 deep plasty, 1 superficial femoral recanalization with laser, 1 lymbar sympathectomy. Postoperative results: 1 death due to MI (78-year-old diabetic woman), 1 thrombosis treated with femorofemoral bypass. Middle-term results: after 6 to 24 months, average time lapse 13 months. The comparison of the ankle pressure indices and of the pre- and postoperative sonographic findings shows an indisputable hemodynamic improvement.

[Magnetic resonance imaging of the brachial plexus. Anatomy]. / Imaging con Risonanza Magnetic del plesso brachiale. Anatomia.

The brachial plexus is a difficult region to evaluate with radiological techniques. MR imaging has great potentials for the depiction of the various anatomical structures of the brachial plexus--i.e., spinal ganglion, ventral nerve rami root exit of the neural foramina, trunks and cords. Moreover, MR imaging, thanks to its direct multiplanarity, to its excellent soft-tissue contrast, and to its lack of motion artifacts, allows good evaluation of pathologic conditions in the brachial plexus, especially traumas and cancers. On the contrary CT, in spite of its high spatial resolution and good contrast, cannot demonstrate the anatomical structures of the brachial plexus. US detects superficial structures, and conventional radiographs depict only indirect changes in the adjacent lung apex and skeletal structures. From November 1989 to May 1990, 20 normal volunteers (15 males and 5 females; average age: 35 years) were studied with MR imaging. Multisection technique was employed with a dedicated coil and a primary coil. The anatomical structures of the brachial plexus were clearly demonstrated by T1-weighted sequences on the sagittal and the axial planes. T2-weighted pulse sequences on the coronal plane were useful for the anatomical definition of the brachial plexus and for eventual tissue characterization. The correct representation of the anatomical structures of the brachial plexus allowed by MR imaging with our standard technique makes MR imaging the most appropriate exam for the diagnosis of pathologic conditions in the brachial plexus, although its use must be suggested by specific clinical questions.

A modified allomone collecting apparatus.

A modified allomone collecting apparatus was designed that could be used under water with a scuba tank. This apparatus provides a simple method of obtaining naturally secreted chemicals from benthic marine organisms at scuba depths, for the first time without the necessity of using a bilge pump. Organic material from Sep-paks in the allomone collector confirmed the release of secondary metabolites from a soft coral into the surrounding water.

[Early postoperative enteral nutrition and total parenteral nutrition. Technics compared in patients undergoing radical surgery for carcinoma of the large intestine. Preliminary report]. / Nutrizione enterale precoce postoperatoria (NEPPO) e nutrizione parenterale totale (NPT). Tecniche a confronto in pazienti sottoposti a chirurgia demolitiva per carcinoma del grosso intestino. Nota preliminare.

A preliminary study has been carried out on 10 patients suffering from cancer of the colon and rectum, all subjected to radical surgery. The clinical effectiveness of two alternative techniques of postoperative artificial nutrition, EPEN and TPN, are compared. The results confirm that enteral nutrition is technically applicable and well tolerated in the immediate post-operative period in these patients; it also presents a lower cost, it is more manageable and present a lower incidence of complications compared to TPN while offering similar metabolic and nutritional results.

[Congenital hip dislocation. The clinico-echographic correlations]. / Lussazione congenita dell'anca. Correlazioni clinico-ecografiche.

The authors report their experience with US of the hip in 200 children aged 9 days to 8 months. All the children previously were under-gone physical examination. The sonographic study was carried out with Graf's method. The clinical-sonographic correlation proves the utility of US as a screening method able to show early morphological and functional alterations in the hip. US is thus suggested as a valid alternative to conventional methods to use in those cases where either plastering or surgery is required.

[Echography compared with conventional radiology in Osgood-Schlatter disease]. / L'ecografia a confronto con la radiologia tradizionale nella malattia di Osgood-Schlatter.

This paper was aimed at estimating sonographic (US) accuracy in patients with clinical suspicion of Osgood-Schlatter's disease. This disease affects the patellar tendon in its attachment to the tibial tuberosity; boys are affected more frequently than girls, and during adolescence. Its pathognomic signs are: focal soft-tissue swelling anterior to the tibial tuberosity, edema of the inferior infrapatellar fat pad, and swelling of the ligamentum patellae with loss of the interface between the latter and posterior soft tissue. A comparative study was carried out of the X-rays and US examinations of the knee in 21 patients with Osgood-Schlatter's disease; X-rays exams employed the double-shield and double-film box methods, to allow the contemporaneous evaluation of both skeletal and soft-tissue features. The results prove that the soft-tissue changes observed with X-rays can be correctly depicted also by US. Thus, in our opinion, US has proved to have the same diagnostic accuracy as X-rays, and could therefore become the first-choice examination in both the diagnosis and the follow-up of Osgood-Schlatter's disease.

[Cavernous hemangioma of the small intestine]. / Emangioma cavernoso del tenue.

The Authors report an uncommon cavernous hemangioma of the small bowel. Pathological and clinical features are compared with those of the literature. Considering the difficulty of diagnosis, they remark the importance of histological exam as the only reliable diagnostic tool and surgery as the only therapy.

Separation of the stereoisomers of an allenic E-type prostaglandin.

Enprostil (I) is a synthetic dehydro-prostaglandin E2 containing a chiral allene moiety which is unresolved relative to the four remaining chiral centers. The relative configuration of the four remaining chiral centers is consistent with that of the naturally occurring E series of prostaglandins. Thus, enprostil exists as enantiomeric pairs of two allenic epimers. An analytical procedure has been developed that separates the four optical isomers present in enprostil. This procedure involves, first, the acid-catalyzed dehydration of enprostil to its corresponding prostaglandin A analogue followed by derivatization with beta-naphthylsulfonyl-L-prolyl chloride. The resulting diastereomeric sulfonate esters are separated on an achiral silica gel high-performance liquid chromatographic column. This procedure has been applied to the analysis of both enprostil drug substance and enprostil formulated in a propylene carbonate solution from soft elastic gelatin capsules. An efficient procedure for the recovery of enprostil from the solution formulation is also described.