Acute motor axonal polyneuropathy after a cisatracurium infusion and concomitant corticosteroid therapy.

A 40-yr-old male was admitted to the intensive care unit following blunt chest trauma. He had multiple rib fractures, bilateral pneumothoraces, and acute respiratory failure requiring mechanical ventilation. Sedation was achieved with midazolam and morphine, and later with propofol. The patient was paralysed with a continuous infusion of cisatracurium 1.42-5.75 micro g kg(-1) min(-1). Methylprednisolone 125 mg i.v. every 12 h was also started. After discontinuation of the cisatracurium infusion 7 days later, the patient manifested a flaccid quadriplegia with absence of deep-tendon reflexes. No sensory deficits were observed. Electromyography (EMG), repetitive nerve stimulation testing, and single fibre EMG (SFEMG) were performed at regular intervals after stopping cisatracurium. Clinical symptoms and electrophysiological examinations supported the diagnosis of acute motor axonal polyneuropathy related to concomitant administration of cisatracurium and corticosteroid therapy.

[Follow-up after radical prostatectomy in prostatic cancer. CT: normal findings]. / Follow-up dopo prostatectomia radicale per neoplasia. TC: aspetti normali.

We retrospectively reviewed the CT findings of 18 patients submitted to radical prostatectomy for prostate cancer. CT follow-up studies showed the bladder base in retropubic location in all 18 patients. Two patients had local recurrences, while no evidence of local recurrence was found in 16 patients. The following CT findings were observed in the latter group: a) bladder to rectum adhesion in 2 cases (13%); b) a complete transverse bar of soft tissue density between bladder and rectum in 9 cases (57%); c) an incomplete rectovesical bar in 6 cases (40%). The transverse bar was already apparent on the first pelvic CT scan performed within two weeks in 3 cases for surgical complications. In two local recurrences some dense tissue was demonstrated distorting rectovesical lateral triangle fat. To conclude, since a complete or incomplete horizontal bar of soft tissue structures is usually depicted in the rectovesical space, these structures should not be misdiagnosed as local tumor recurrences.

[Inguinal hernioplasty after Shouldice]. / Ernioplastica inguinale secondo Shouldice.

The authors review their two-year experience of hernioplasty using a modified version of Shouldice's technique which includes the employment of a polyglyconate monofilament. Although the series of patients is chronologically limited, the findings appear to confirm that this is a valid alternative to other techniques proposed to date for treating inguinal hernia.

[Rhabdomyosarcoma. Presentation of a case with abdominal localization]. / Il rabdomiosarcoma. Presentazione di un caso a localizzazione addominale.

The Authors report a case of rhabdomyosarcoma observed in a 17-year-old boy. They emphasize that this rare form has an extremely rapid evolution, and in this case was also in an unusual site and of abnormal size. The difficulty of an early diagnosis and the impossibility of radical surgery are also underlined.

[The suprainguinal approach in surgery on the internal saphenous vein for varices of the lower limbs]. / La via di accesso soprainguinale nella chirurgia della vena safena interna per varici degli arti inferiori.

The authors report their experience relative to 134 patients with lower limb varices surgically treated. An upper inguinal incision of the skin was employed to approach the saphenofemoral junction, obtaining by this means an aesthetic suture, with better asepsis and lower incidence of local complications.

[Soft-tissue sarcomas of the limbs at high risk of malignity. Current role of surgery and conservative treatment]. / Sarcomi ad alto rischio di malignità dei tessuti molli degli arti. Ruolo attuale della chirurgia e trattamento conservativo.

The authors discuss the role of surgical treatment in patients with highly malignant soft tissue sarcomas in the limbs. A careful analysis is made of different therapies on the basis of the results obtained by the authors and those reported in the literature. The anatomic classification of lesions is based on functional anatomic compartments, defined as intra- or extracompartmental. If a lesion was within an intrafascial compartment, all the muscles with intact fascial sheaths have up till now been removed "en bloc" to obtain radical margins. Many authors now think that all manifest disease be removed with a generous soft tissue margin on all sides to ensure adequate local treatment. Amputation has commonly been performed for extracompartmental lesions, but a multinodal treatment programme, including limb-sparing resection and tumour-bed radiation, should now be considered if possible in the management of these tumours.

[Mesenteric fibromatosis in Gardner's syndrome]. / La fibromatosi mesenterica nella sindrome di Gardner.

The paper reports a case of mesenteric fibromatosis with familial polyposis, an association which was diagnosed as Gardner's syndrome, and highlights the complications connected to mesenterial desmoid tumours. In addition, the importance of radical surgical therapy of these neoplasias is underlined. Lastly, it is hypothesised that full screening of patients affected by familial polyposis might show a greater incidence of association between widespread polyposis and pathological changes attributable to Gardner's syndrome.

[Carcinoma of the parathyroid glands. Apropos of a case associated with thyroid struma]. / Carcinoma delle paratiroidi. A proposito di un caso associato a struma tiroideo.

The paper reports a case of carcinoma of the parathyroid associated with thyroid struma and underlines the difficulties of intraoperative diagnosis and the surgical approach which should be adopted on the basis of this finding. Often the diagnosis of the malignant nature of the neoplasia is based on the possible appearance of local or distant recurrence rather than histological examination.

[Indications, value and limits of surgical therapy in the treatment of cancer of the gallbladder]. / Indicazioni, valore e limiti della terapia chirurgica nel trattamento del cancro della colecisti.

The authors analyze different therapeutic modalities for gallbladder can and discuss indications, value and limitations on the basis of the results obtained by their own experience on 13 cases as well as literature data.