[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.

[Evaluation of the micro-histological technique for blood clot paraffin embedding in diagnosis by fine-needle aspiration]. / Valutazione della tecnica microistologica per inclusione in paraffina del coagulo ematico nella diagnostica degli agoaspirati con ago sottile.

Since a certain amount of blood is nearly always present in the material obtained through needle-aspiration, we have considered it helpful to take advantage of this event, in order to increase the information which is drawn from this type of investigation. We have evaluated the material obtained by means of ultrasound guided fine-needle aspiration of 287 lesions of superficial and deep sites, and we have used 1) a microhistologic method, which employs formalin fixation and paraffin embedding of blood clot (while the blood acts as a support of cells and tissue fragments), and 2) the classic smear cytologic method. The percentage of diagnostic accuracy was similar using both methods, but the microhistologic method presented a few advantages, i.e. greater diagnostic reliability, and long preservation of the residual material, which can subsequently be used for further special stains. These considerations are particularly true for hepatic lesions, which are more than a half of all cases.

[Percutaneous needle aspiration biopsy in intrathoracic lesions]. / Agoaspirato percutaneo nelle diagnosi delle lesioni intratoraciche.

The authors report their experience of transthoracic needle biopsy of the lung based on 68 consecutive cases from 1984 to 1990. In 55 cases significant data has been found: in 44 cases the diagnosis was exact, instead in other 11 cases it was only indicative. The overall complications were 11.7% and in particular were as follow: pneumothorax in 5 cases, hemoptysis in 2 cases and a temporary Horner syndrome in one case. The authors conclude by confirming the utility of transthoracic needle biopsy of intrathoracic tumors in which there is not other way to obtain a diagnosis. This technique is reliable and its complications can be disregarded.

Spontaneous "primary biliary cirrhosis" in rabbits.

A syndrome resembling human Primary Biliary Cirrhosis (PBC) and occurring spontaneously in a strain of domesticated rabbits from the Faenza region in Italy, is reported. The syndrome is characterized by histological liver changes consisting of chronic non-suppurative destructive cholangitis and copper accumulation, biochemical and immunological abnormalities mainly represented by an elevation of serum alkaline phosphatase and a positive antimitochondrial antibody test. The abnormalities were not observed in newborn rabbits from the same area nor in control rabbits from the island of Sardinia. A toxic effect related to some environmental factor may be responsible for the disease. Alternatively, a continuous process of partial inbreeding among consanguineous animals may have resulted in a selection of a strain genetically predisposed to the development of PBC. Whatever the etiology, the domesticated Faenza rabbit proves to be an interesting animal model for a chronic nonsuppurative destructive cholangitis, very similar to the human disease known as PBC.