[Necrotizing fasciitis of soft tissues: role of diagnostic imaging and review of the literature]. / La fascite necrotizzante dei tessuti molli: ruolo della diagnostica per immagini e revisione della letteratura.

PURPOSE: We retrospectively reviewed the diagnostic imaging findings (radiography, CT and US) of our cases of necrotizing fascitis of soft tissues looking for signs that could be useful for early and accurate diagnosis. MATERIAL AND METHODS: May 1991 to February 1998 we examined 130 patients with progressive necrotizing soft tissue infections; in 32 of them (22-84 years old) the retrospective pathologic diagnosis was necrotizing fascitis. Involved sites were the limbs (26/32), the cervical region (5/32) and the perineal region (1/32). Nineteen patients were submitted to conventional radiography, also for soft tissue studies. US was performed in an emergency setting in all the 32 cases, by a selected group of US operators particularly skilled in this kind of soft tissue condition. Contrast enhanced CT was performed in 9 cases. RESULTS: B-mode and Doppler US yielded useful and reliable information for prompt and correct diagnosis. Particularly these techniques showed changes in subcutaneous adipose tissue (28/32), fascia (18/32) and muscle (15/32). We found a good correlation between tissue changes as shown at US and histologic findings, but US missed changes in subcutaneous soft tissue and muscle in 11 cases (3/32 and 8/32, respectively) with subsequent histologic confirmation. Contrast enhanced CT better defined the extent of disease and possible complications, especially in sites that are difficult to study with US. DISCUSSION AND CONCLUSIONS: Early diagnosis and proper treatment are the key issues affecting the chances of recovery for patients with necrotizing fascitis. The clinical suspicion of this condition calls for prompt intervention with effective diagnostic protocols. B-mode, and sometimes color Doppler, US and contrast enhanced CT, together with appropriate laboratory tests, can provide useful information for precise diagnosis and proper treatment.

Medial fractures of the femoral neck in the elderly treated by SEM bipolar prosthesis.

The authors present 335 cases of medical fracture of the femoral neck in the elderly patient (mean age 80.5 years) treated by SEM type bipolar prosthesis. A total of 93 patients (28.3%) were followed-up for a total of 98 hips submitted to surgery (5 bilateral) after a mean period of 42 months, minimum 12 months, maximum 96. Clinical follow-up included these parameters: pain, movement, walking, according to Merle D'Aubigné. Radiographic follow-up consisted in standard views and maximum adduction and abduction. Pain was present in 49% of cases, although it did not significantly invalidate movement (quotients 6 and 5 in 96% of cases); in 60% of the cases there were problems with walking mostly due to the general conditions of the patient. Wear phenomena in the acetabulum were present in 32 hips (32.6%) with no correlation with clinical data. Dynamic x-rays showed that only 31% of the implants maintained intraprosthetic movement. What emerges from the study is the importance of adequate measurement of the prosthetic cupola to improve acetabular fit.

[The disease of beta 2-amyloid deposition in the differential diagnosis of juxta-articular subchondral geode lesions]. / La malattia da depositi di beta-2 amiloide nella diagnosi differenziale delle lesioni geodiche subcondrali iuxta-articolari.

Beta-2 amyloidosis deposition is a new type of amyloidosis recently observed in long-term hemodialysis patients. One of the major osteoarticular complications of this disease is the appearance of subchondral bone cysts. In this paper the radiologic features of such radiolucencies are described and the criteria are outlined of the differential diagnosis from the geodes found in other arthropathies or para-physiologic conditions. The importance of the status of the joint space is stressed: on the basis of its patterns, arthropathies may be grouped as follows: inhomogeneous space narrowing in degenerative arthritis; homogeneous space narrowing in inflammatory arthritis; normal or nearly normal joint space if there is no/not-prevalent involvement of articular cartilage.

[Esophago-jejunal anastomosis using an end-to-end anastomosis stapler. Clinico-radiologic study of early complications in 75 cases]. / L'anastomosi esofago-digiunale con E.E.A. Stapler. Studio clinico-radiologico delle complicanze precoci su 75 casi.

Personal experience with 75 consecutive cases of terminolaterale oesophagojejunal anastomosis by EEA Stapler is reported. A total of 6 intraoperative technical problems were encountered (8%) and consisted either of incomplete suturing of the anastomosis or stapling of the jejunal wall. Postoperative radiology revealed 5 dehiscences (6.6%) and 1 stenosis (1.33%). One patient with dehiscence died (1.33%) of septic complications. One dehiscence of the afferent jejunal stump and minor pleuropulmonary complications were observed in 3 cases. After a brief review of the literature, it is concluded that oesophagojejunal anastomosis by EEA Stapler produces a low incidence of postoperative complications such as the dehiscence, stenosis or bleeding.