Brain fat embolism. A report of two cases and a brief review of neuroimaging findings.

Fat embolism syndrome [FES] is an uncommon but serious complication of traumatic injures, which can follow a wide range of other surgical and medical conditions and can manifest with a collection of respiratory, hematological, neurological and cutaneous symptoms. FES should be suspected in all cases of traumatic injures with altered mental status following a period of normal neurological function, especially after orthopedic fixation of long bone fractures. Neurological symptoms must not be related to the initial trauma. The objective of this study was to describe the characteristics of FES and to correlate the neuroradiological findings with the clinical symptoms and the outcome of two cases of cerebral FES which occurred in two young men after bone fractures of the extremities without cranial traumatism. Both patients were studied by brain computed tomography (CT) and by brain magnetic resonance (MR). While Cerebral CT was inadequate to the diagnosis, Cerebral MR, performed 48 hours after injury, showed several focal areas of pathological signal in the white matter of the subcortical, periventricular and centrum semiovale regions, as well as in the basal ganglia and cerebellum. The neuroradiological findings of the two patients were compared with their clinical symptoms and outcome. The patient with the worst prognosis showed more lesions on MR and a restricted diffusion on DWI-MR, due to cytotoxic edema, whereas the patient with the better outcome showed lesions due to vasogenetic edema without any restricted diffusion. Cerebral MR and DW-MR are sensitive indicators for the early diagnosis of FES and can give a vast amount of information on the prognosis and future outcome.

[Seminal vesicle cysts (and ejaculatory duct cysts) with ipsilateral renal agenesis. Report of five cases and review of the literature]. / Cisti delle vescichette seminali (e del dotto eiaculatore) con agenesia renale omolaterale. Descrizione di cinque casi e revisione della letteratura.

Cystic malformations of the pelvic seminal tract associated with ipsilateral renal agenesis are rare. The cause of this malformation is a maldevelopment of the mesonephric duct between the 4th and 13th weeks of gestation. Usually the disease is discovered in the late second and in the third decade of life, at a time of great sexual activity. Accumulation of fluid in the seminal tract with insufficient drainage leads to complaints like chronic prostatitis, to perineal discomfort and to disturbances of sexual sphere. For the diagnostic evaluation, ultrasound studies (suprapubic and transrectal) are very useful. Treatment should be restricted to symptomatic cases only. The treatment modality ranges from conservative medical treatment to surgical excision. Five cases are presented. Four are treated conservatively and one is treated by transurethral aspiration and alcohol injection.

[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.