Color Doppler sonography patterns related to histological findings in Graves' disease.

The aim of this work was to correlate color duplex sonography (CDS) patterns and thyroid histology in hyperthyroid Graves' disease (GD) patients. Sixteen patients with relapsed GD were studied. Before starting a new cycle of medical therapy with methimazole in decreasing doses for 3 to 6 months (baseline study), the patients underwent functional, autoimmune, and CDS studies. The same studies were carried out again just before surgery (presurgical study) after medical therapy had produced a normalization of thyroid hormone serum levels. The thyroid glands were histologically examined and their patterns were compared with CDS patterns. Thirty-three normal subjects were used as a control group. At baseline, 6 patients (group I) had intraparenchymal homogeneous vascular color spots or diffusely distributed over the parenchyma lobe or in areas alternating with avascular zones (CDS-A pattern). In 8 patients (group II) the thyroid had vascular bands with avascular or poorly vascularized parenchymal areas (CDS-B pattern). In 2 patients, the 2 patterns were present in the same thyroid (A-B pattern or mixed pattern). In these 2 patients the histological aspects were more similar to the CDS-B pattern than the CDS-A pattern. The 2 groups of patients differed in the velocity of systolic peak (VP) that was significantly higher in group I than in group II. In the presurgical study, no changes relative to CDS patterns were observed in patient groups I and II. The VP did not show any appreciable modifications in either group of patients. The thyrotropin-stimulating antibodies (TRAb) returned to normal levels in group II, but not in group I. The 2 CDS patterns, observed in the baseline study, were histologically characterized either by a richly vascularized parenchyma with prevalent endothelial hyperplasia (parenchymatous goiter, CDS-A) or by fibrotic septation with prevalent vascular intimal hyperplasia (CDS-B). In conclusion, this CDS study in GD patients showed 2 distinct vascular patterns. The thyroid glands were histologically characterized by either a richly capillary vascularized parenchyma (parenchymatous goiter, CDS-A aspect) or by fibrotic septation with prevalent intraseptal arteriolar-like hyperplasia (fibrous goiter, CDS-B aspect). Such differences may be secondary to a different duration of hyperthyroidism and/or intensity of TRAb thyroid stimulation.

Ampullary somatostatinoma. An immunohistochemical and ultrastructural study.

Two new cases of ampullary somatostatinoma are reported. In one case the tumor is associated with an increase in somatostatin-positive cells in the adjacent duodenal mucosa. Both tumors show a predominant glandular pattern with many psammomatous calcified bodies. Such bodies seem to arise by calcium phosphate encrustation of intraluminal cellular debris. The neoplastic cells contain two distinct types of intermediate filaments: the first is located along the plasma membrane and reacts to keratin antiserum; the other, appearing as paranuclear aggregates, reacts to neurofilament antiserum. The neoplastic cells show signs of intestinal differentiation (microvilli, glycocalyceal bodies, filamentous core rootlets) as well as of neuroendocrine differentiation (secretory granules, whorls of neurofilaments).

[Primary lymphomas of the gastro-intestinal tract]. / I linfomi primitivi del tratto gastro-intestinale.

The authors considered a series of 13 patients undergone surgical operation for primary malignant lymphoma of digestive system, with gastric, gastro-jejunal, jejunal, ileal and colic localization. They examined diagnostic and therapeutic features and the follow-up data. According to literature, the authors remark the importance of roentgenology and endoscopy, that together with bioptic data may reach a definite and early diagnosis; an elective and wide surgical exeresis seems useful in early stages, showing a better prognosis and epithelial malignancies. IV stage patients, however, had a very poor survival; a quick management appears today the only factor affecting long-term results in these patients.

[Non-parasitic cysts of the liver (considerations on 10 surgically treated cases)]. / Le cisti non parassitarie del fegato (considerazioni su 10 casi operati).

The Authors report their experience concerning 10 cases operated on for non-parasitic cysts of liver, among which a case of multicystic liver and a biliary pseudocyst. They emphasize the necessity, in symptomatic patients, for a selective treatment, but, where possible, with complete removal of cystic wall. The interventions performed also include six typical hepatic resections (two right hepatectomies, one of which extended to the fourth segment, and four minor resections), which revealed to be an effective therapeutical means, exempt from significant postoperative complications.

[Lyophilized amino acids versus solutions of crystallized amino acids in total parenteral nutrition]. / Aminoacidi liofilizzati versus soluzioni di aminoacidi cristallizzati nella nutrizione parenterale totale.

The authors considered the possibility, for purposes of total parenteral nutrition, to use lyophilized amino-acids as an alternative to the traditional amino-acid solutions, and resolved to check their nutritional and metabolic effectiveness. For this purpose, they appraised some parameters concerning the proteic metabolism in two homogeneous groups of surgical patients, subjected to T.P.N., one with crystallized amino-acids in solution and the other with lyophilized amino-acids. The supply in glucides and in lipides was identic in both groups. It appears evident from the results that the lyophilized amino-acids not only show the advantage of being administrable in nutritional mixtures with reduced volume, but also represent a valid plastic source, and can surely replace the traditional commercial amino-acid solutions.

[Varicocele: cause of sub-fertility (therapeutic considerations)]. / Varicocele: causa di sub-fertilità (considerazioni terapeutiche).

The Authors examined the seminal liquid of 60 patients suffering from non-obstructive oligosperma after different treatments. On the basis of the results obtained, they emphasize the importance, after operation, of the medical treatment in the normohormonal varicocelic patients. They suggest the surgical treatment in the non-varicocelic subjects, in who an inversion of the veenous flux in an inside spermatic vein was ascertained.

[Carotid paragangliomas]. / I paragangliomi carotidei.

Three cases of carotid body paragangliomas are reported. The authors underline the critical diagnostic role of carotid arteriogram whenever such disease is suspected. Surgical treatment can lead to good results even in malignant forms. In the latter, treatment should be completed with radiotherapy.

Intravenous feeding in hepatectomized patients.

Ten patients, undergone major hepatic resections, treated with parenteral hyperalimentation in the postoperative period, were studied. Considered parameters were: free plasma amino acid levels and daily nitrogen balance. By comparing the trends of parameters under study with a group of patients, also hepatectomized but not treated with T.P.N., the importance of a high energetic and plastic post-operative intake is outlined. T.P.N. following major hepatic surgery appears particularly useful when the quality of the exogenous Nitrogen intake is carefully selected.

[Blood amino acid pattern in thyreopathic patients. (pre- and post-operative analysis)]. / Il pattern aminoacidemico in pazienti tireopatici. (Analisi pre- e post-operatoria).

On the basis of the effects, demonstrated in vitro, of the thyroid hormones on the amino-acidic metabolism at cellular level, the Authors analysed the aminoacidogram of 15 thyreopathic patients. They remarked significant preoperative modifications of some amino-acids, coming back to standard values after operation. The authors think the preoperative modifications are to be ascribed to thyreopathy, whereas the postoperative ones depend on the surgical trauma.

[Popliteal aneurysm (therapeutic considerations)]. / L'aneurisma popliteo (considerazioni terapeutiche).

The authors show a case of popliteal artery aneurysm they had the opportunity to observe. In consideration of the high percentage of surgical failures; recorded in the treatment of the complicate forms, they point out the importance of precocious diagnosis. The Authors think the termino-terminal arterial anastomosis after aneurysmectomy has very limited indications.

[Intrahepatic calculosis]. / La calcolosi intraepatica.

After a short synthesis of the elements characterising intrahepatic calculosis, and evaluation of the five cases considered, the value of cholangiography (both intravenous and instrumental) and of radio-scintiscanning with Bengal Rose marked with I131 in pre-operative diagnosis is stressed. The intra-operative use of choledochoscopy in conjunction with cholangiography is recommended. With regard to treatment, it must ensure removal of the calculi and create an ample biliodigestive communication (papillectomy or, even better, hepaticojejunostomy on excluded Roux loop) in order to prevent recurrences. In order to visualise the intrahepatic branches of the bile ducts, the removal of the hilar plaque is advised, possibly combined with sagittal scissurectomy or mobilisation of the 4th segment. In conclusion it is asserted that correctly performed surgical treatment is the only means of offering permanent cure.