[Value of cardiac scintigraphy using thallium dipyridamole in the preoperative diagnosis of vascular diseases]. / Validità della scintigrafia cardiaca al tallio dipiridamolo nello studio preoperatorio dei pazienti vascolari.

The authors assess the value of cardiac scintigraphy using thallium dipyridamidole in the preoperative examination of vascular patients. Data from the literature indicate the real possibility of cardiac complications in major vascular surgery. These complications, which range from simple arrhythmias to lethal myocardial infarctions, have an incidence of 0.5-2% in aortic surgery, 0.6-3% in peripheral revascularisation increasing to 2.6-8.3% in distal revascularisation, although they are less important in carotid surgery. From January 1993 to March 1994 cardiac risk was evaluated in 44 patients due to undergo major vascular surgery using cardiac scintigraphy with thallium dipyridamidole. The test was negative in 14 cases. The presence of one or more redistribution areas was observed in 23 cases, and a fixed zone in 7 cases. In line with the proposals made by Eagle, the authors conclude that it is necessary to restrict the indications for this test to those cases presenting at least two risk factors.

[A Morgagni-Larrey hernia. A case report]. / Ernia di Morgagni Larrey. Segnalazione di un caso.

The paper reports a case of Morgagni-Larrey hernia observed by the authors. The etiopathogenesis is described and the importance of surgery is underlined even in asymptomatic cases in order to ensure a benign postoperative outcome.

The significance of adult hematuria: 1,000 hematuria evaluations including a risk-benefit and cost-effectiveness analysis.

Between March 1976 and June 1985, 1,000 consecutive adults with asymptomatic gross or microscopic hematuria in the absence of proteinuria were evaluated urologically. Lesions that could account for the hematuria were detected in 88.3 per cent of the patients. Life-threatening lesions were diagnosed in 9.1 per cent of the patients, while lesions requiring at least observation were present in 22.8 per cent. The incidence of life-threatening lesions increased with age, with a sharp increase after age 50 years. Life-threatening lesions were more common in men (13.6 per cent) than in women (4.9 per cent). In general, as the degree of hematuria increased so did the yield of life-threatening lesions; however, there was no "safe" lower limit of hematuria. Of the patients with life-threatening lesions 18.6 per cent had at least 1 urinalysis with less than 3 red blood cells per high power field within 6 months of the diagnosis. The direct medical cost of a hematuria evaluation was $777. The difference in direct medical costs to diagnose and treat localized versus metastatic genitourinary cancer was $48,070 in 3 matched pairs of patients. In this study group 77 of 84 patients (92 per cent) diagnosed with genitourinary cancer had localized disease. A hematuria evaluation was cost-effective for all groups studied. A literature-based estimate of the life-threatening risks of diagnostic studies applied to the study data resulted in a 1.1 per cent life-threatening risk per hematuria evaluation. For all categories studied, except for women less than 40 years old with microscopic hematuria, the risk of a hematuria evaluation was less than the incidence of life-threatening lesions discovered as a result of the evaluation. Asymptomatic hematuria, whether gross or microscopic, is a significant finding and warrants evaluation from a risk-benefit and cost-effectiveness standpoint.