[Ovarian cyst in a case of female pseudohermaphroditism in a patient with male phenotype]. / Cisti ovarica in paziente a fenotipo maschile e pseudoermafroditismo femminile. Caso clinico.

Female pseudohermaphroditism is an intersexual state distinguished by virilized external genitals and secondary sex characters in a XX subject. We report a case of female pseudohermaphroditism diagnosed later on the discovery of an abdominal mass, then revealed to be an enormous ovarian cyst. Hormonal dosages suggested the presence of partial surrenalic b-hydroxylase deficiency. For this reason the clinical picture was considered expression of an adreno-genital syndrome, displayed as female pseudohermaphroditism with Prader stage V virilization.

[Synchronous and metachronous tumours of colon cancer. A review of 5 years of experience (1999-2004)]. / I tumori sincroni e metacroni del colon-retto. Revisione di 5 anni di attività (1999-2004).

The authors report on 30 synchronous cancer (19%) and 9 metachronous cancer (5.7%) observed in 5 years (1999-2004) in 158 patient operated for colon cancer, defining metachronous cancer a tumor arisen at least 6 months after the first one or further then 5 cm from the anastomosis of the first colon resection. International case records report an incidence of 0.6-14% for synchronous cancer and 1-8% for metachronous cancer. The incidence of synchronous cancer is increasing for the presence of more oncogenic factors in the environment, for the improvement in radiology and endoscopy, for the raise of medium life. In accord with other authors, they show that the main risk factor for the developing of metachronous cancer is the coexistence of colon adenomas at the moment of the diagnosis of the tumor. The various incidence percentages can be explained by different way of diagnosis and classification.

[Different approaches for medical or surgical management of Crohn's disease: the importance of the classification of Vienna]. / Modalità di approccio chirurgico nei pazienti con morbo di Crohn: inquadramento secondo la classificazione di Vienna.

The Vienna classification of Crohn's disease provides defined criteria for a phenotypic classification of the disease, considering that phenotypic parameters reflect the contribution of both genetic and environmental factors to the expression of disease. The classification includes mainly three criteria as part of the natural course of disease: age at the diagnosis, location and behaviour and it provides distinct definitions to categorize Crohn' patients into 24 subgroups. In this study we attempt to define the clinical importance of the Vienna classification and the possibility to optimize medical care of Crohn's disease according to patient subgroups. Early age at the diagnosis is associated with a greater prevalence of a family history, greater small bowel involvement, more complicated stricturing disease and a higher frequency of surgery. Surgery is based on exact knowledge of location: L1 patients might profit the most from resective surgery, L4 patients from strictureplasty. Stricturing behaviour (B2) might be the most appropriate subgroup for surgical treatment. Penetrating behaviour (B3) is confirmed as an important risk for early postoperative recurrence; patients in the penetrating behaviour group (i.e. fistulas) have a specific indication for immunosuppressive or anti-tumour necrosis factor-alpha therapy.

A case of bilateral breast cancer and Graves' disease.

We report a case of bilateral breast cancer associated with Graves' disease characterized by a large goiter and complicated by a severe ophthalmopathy. The hyperthyroidism was treated initially with methimazole and then with thyroidectomy, the ophthalmopathy with intravenous steroids combined with orbital radiotherapy. The breast tumors underwent surgical resection followed by chemotherapy. We describe this case because of the well-known association between breast cancer and thyroid disease, particularly of the autoimmune type, the causes of this being still unclear. Recent literature on this topic is reviewed, discussing the possible role of the Na(+)-I(-) symporter and anti-TPO antibodies.

Doppler enhancement after intravenous levovist injection in Crohn's disease.

Although transabdominal bowel sonography (TABS) has been proposed as a reliable tool to assess increased bowel wall thickness (BWT), the most common sonographic pattern in patients with Crohn's disease (CD), its accuracy is limited in the diagnosis of CD. We therefore tried to assess whether color Doppler enhancement with Levovist, a galactose-based intravenous sonographic contrast agent able to enhance the arterial Doppler signal, increases TABS accuracy. Thirty-one patients with ileal CD, diagnosed by endoscopy and enteroclysis, and 20 healthy volunteers were examined with conventional TABS. Color Doppler of the intramural enteric vessels was then performed before and after intravenous injection of Levovist. Twenty-two CD patients had a BWT >4 mm, and 16 of them presented with active disease. Two of the remaining nine CD patients, all with BWT <4 mm, presented with active disease. By means of color Doppler we identified six patients with inactive disease, normal BWT, and normal basal Doppler signal intensity, who showed an enhanced Doppler signal in intramural vessels after contrast agent bolus. Four of these patients, identified only by color Doppler after Levovist injection, relapsed within 6 months. In our experience, sensitivity and specificity of TABS, integrated with additional stimulated acoustic emission mode, were 96.7% and 100%, respectively. The use of Levovist in color Doppler increases the accuracy of TABS in CD diagnosis and follow-up.