[Symptomatic angiomyolipoma of the kidney: report of 2 cases]. / Agiomiolipoma sintomatico del rene: descrizione di due casi.

Renal angiomyolipoma is an uncommon benign tumor composed of adipose tissue, dysplastic blood vessels and smooth muscle. The tumor may occur as a distinct entity or in association with tuberous sclerosis. The diagnosis is usually easy but a malignant neoplasm can not always be excluded. Tumors smaller than 4 cm are mostly asymptomatic and usually do not need to be treated. For larger lesions a treatment is advisable especially in case of symptoms because of the risk of a severe hemorrhage. The treatment should be as conservative as possible and nephrectomy preformed only when a malignant tumor can not be excluded or in cases of life-threatening hemorrhage or widespread infiltration or complete destruction of the kidney. Today the treatment of choice should be embolisation and on second line resection of the lesion. Two cases of symptomatic angiomyolipoma are presented. Both cases are treated by radical nephrectomy.

[Ultrasonography of the neonatal hip: state of the art and perspectives]. / Ecografia dell'anca neonatale: stato dell'arte e prospettive.

Since the first studies by Graf, medical interest for neonatal hip sonography (US) has grown, till the redefinition of the name itself of the pathologic condition, which has been recently renamed developmental dysplasia of the hip. After briefly reviewing our personal series of patients (18,388 hips studied from March, 1986, through June, 1995, with 2.81% positives according to Graf, 0.65% of them with subluxated hips), several issues are discussed relative to US of the neonatal hip in the study of dysplasia, namely: 1) technique, 2) measurements, 3) unstable hips, 4) screening, 5) protocols, 6) perspectives. Relative to the technique, Graf's method is currently the method of choice because it is easy to perform (single scanning) and repeatable, different from what other authors, particularly Novick and Harcke, suggested; they use a dynamic approach with more scans and different stress tests. Moreover, in Graf's technique, special attention is paid to the need for correct measurements, which phase was criticized by Couture who complained of its claimed complexity. Hip measurements are an important step in the study of this condition thanks to the information they yield the physician who can thus customize the therapy. The problem of the unstable hip and focal ligament laxity is discussed, which is hypothesized to be a possible cause of hip dysplasia misdiagnosis; according to Graf and Tönnis, this condition is related mostly to hormonal factors and has no actual clinical importance in the possible evolution to a pathologic condition. US of the neonatal hip must be set in a general screening program for newborns to be carried out by the 6th week of life to achieve optimal recovery in positive newborns, without limiting it to supposedly at risk groups. Moreover, the cost-benefit ratio of US screening is emphasized, provided that both medical staff and units are used correctly. A working diagnostic-therapeutic protocol is needed to plan standard epidemiologic guidelines for all physicians nationwide. Finally, we report on an initial study for new applications of US to the neonatal hip with an original computer software for automatic measurement of Wiberg's angle in the newborn, which might help predict the development of early juvenile coxarthrosis.

[Echographic anatomy of the newborn hip and high-resolution equipment: internal capsular stria and perichondrial gap]. / Anatomia ecografica dell'anca neonatale e apparecchi ad alta risoluzione: stria capsulare interna e buco del pericondrio.

The use of high-resolution US equipment in the examination of the newborn hip allowed the evaluation of a thin echogenic stripe (the internal capsular stripe), which defines laterally the acetabular hyaline cartilage. By means of an anatomo-histological preparation the echogenic stripe can be related to either the capsular circular fibres or the interface between the latter and the hyaline cartilage. The internal capsular stripe, together with the echogenic synovial stripe, precisely delimit the whole acetabular hyaline cartilage. Furthermore, in many babies high-resolution US sometimes fails to demonstrate Graf's "perichondral gap", so that an accurate anatomic knowledge of the hip becomes necessary in the evaluation of acetabular labrum.

[Echography of the hip of the newborn infant]. / Considerazioni in tema di ecografia dell'anca neonatale.

The authors report on their experience with 2164 US exams of the hip performed over last year on newborns, according to Graf's technique. The babies were divided into 2 groups at first examination: risk/no risk. We considered as risk factors: a positive family history, malposition in utero, abnormalities at birth, and being one of twins. Hips 2a+ and 2a- according to Graf were grouped as "borderline hips" (BLH), extrapolating them from negative and positive cases. BLH have generally shown a tendency to spontaneous normalization, although worsening of the condition was observed in 7.9% of cases. A high incidence of positivity (5.1%) was observed in the no-risk group, versus 9% in the risk group. Moreover, there was low agreement between clinical examination and US findings: the need for US screening is therefore pointed out, not only to promptly detect a decentered hip, but also to prevent the development of juvenile coxarthrosis in case of dysplasia. Premature babies were also studied, and those underweight for their gestational age: the incidence of positive subjects in this group (4.5%) was not higher than that found in the no-risk group (5.1%). We report on the phases of hip normalization as related to stage and therapy. Graf's technique, besides being at present the only reproducible one, represents a method common to all radiologist which allows hip measuring and staging.

[CT after myelography in complete spinal cord blocks]. / La TC post mielografia nei blocchi midollari totali.

In each patient (two meningiomas, two lymphomas, one spine fracture) myelography demonstrated only the lower level of the block, but not enough contrast medium leaked past the block to allow myelographic identification of the upper level. On the contrary, thanks to its high power of contrast resolution, CT immediately after myelography clearly outlined the subarachnoid space both below and above the level of the block. Descending myelography was therefore not necessary. Moreover, CT also revealed associated bone and soft tissue lesions, in two cases, providing a more accurate diagnosis. It is therefore concluded that combined myelography+CT can provide complete diagnosis of spinal blocks and any associated lesions.

[Echography in hip dysplasia in neonates and infants. Echographic anatomy, technic and case material]. / L'ecografia nella displasia dell'anca del neonato e del lattante. Anatomia ecografica, tecnica e casistica.

The value of hip joint sonography in newborns and unweaned infants is the latest development in the diagnosis of hip dysplasia. Knowledge of the sonographic anatomy makes accurate examination and staging according to Graf's tables possible. Since sonography is non-invasive it can be used for screening and check-up, thus reducing the use of radiography. A personal series of 250 patients is presented.

[Computed tomographic detection of a small bowel carcinoid]. / Computertomographischer Nachweis eines Dünndarmkarzinoids.

Carcinoid tumors are localized in the terminal ileum, in the appendix, in the stomach-duodenum and the colon. The local infiltrative process provokes an intense fibro-sclerotic reaction in the mesentery. In 30% of the cases they cause metastases in the lymph nodes, in the liver and seldom in the lungs. We describe a patient with symptoms of incomplete obstruction who had a mass in the right abdominal quadrant. CT showed an ileal tumor with fibro-sclerotic infiltration of the mesentery, typical of carcinoid tumor, and metastases in cardiophrenic angle nodes.

[Computer tomography aspect of afferent loop syndrome]. / Aspetto TC della sindrome dell'ansa afferente.

Obstruction of the afferent loop may develop in patients who had a Billroth type II gastrectomy. The obstructed loop has a characteristic CT appearance. Four cases of afferent loop syndrome demonstrated by CT are described.

Adrenal hemorrhage in the newborn.

Massive adrenal hemorrhage of the newborn is a rare phenomenon. The pathogenesis is still unclear; massive hemorrhage has been observed in newborns after difficult and prolonged deliveries or placental bleeding, and in small prematures with intrapartum anoxia. The authors report a newborn operated on the fifth day of life after its general condition had deteriorated progressively. A retroperitoneal hematoma had formed subsequent to rupture of one suprarenal gland. After surgical removal of the hematoma, the child recovered fully.

[Sonography for the demonstration of investigation of dilatation of the main pancreatic duct (author's transl)]. / Wertigkeit der Sonographie zur Feststellung und Abklärung von Erweiterungen des Pankreashauptganges.

Amongst 284 sonographic examinations of the pancreas, dilatation of the main duct was found in nine instances. Six cases were due to chronic pancreatitis and three to tumour. In all the six cases due to chronic inflammation, the cause of the dilated duct could be demonstrated sonographically. Only one of the tumours was recognised. Simultaneous dilatation of the biliary tree was found in inflammatory and malignant lesions.