Listeria Monocytogenes: an uncommon pathogen of cervical necrotizing fasciitis.

The aim of this paper is to present a unique case of neck-necrotizing fasciitis caused by Listeria Monocytogenes in a young woman, successfully treated by surgery and IV antibiotic therapy. Necrotizing fasciitis is a rare, rapidly progressing and potentially life-threatening infection that infrequently occurs in the head and neck region. Pathogens involved in necrotizing fasciitis are heterogeneous and include aerobic and anaerobic bacteria. To the best of our knowledge, this is the only case of neck necrotizing fasciitis caused by Listeria Monocytogenes studied in literature so far.

Usefulness of endoscopic ultrasonography in preoperative gastric cancer staging: diagnostic yield and therapeutic impact.

OBJECTIVES: To evaluate the diagnostic yield of endoscopic ultrasonography in loco-regional staging of gastric cancer in our medium and to determine the impact of this technique on later therapeutic management. MATERIAL AND METHODS: This is a retrospective study carried out on patients histologically diagnosed with gastric adenocarcinoma who had been referred for endoscopic ultrasonographic examination. The technique results were compared with those obtained from surgical samples and/or from exploratory laparoscopy- laparotomy. We compared the initial therapeutic decision based on conventional diagnostic techniques with the final therapeutic management based on the endoscopic ultrasonography results. RESULTS: Forty-six patients with gastric adenocarcinoma were included in the study (a reference exploration was available in 36 cases). Diagnostic precision was 70% in stage T, while in stages T1, T2, T3 y T4 was 100, 38, 82, and 100%, respectively. The sensitivity and specificity to differentiate T1-2 from T3-4 was 94 and 85%, respectively. We could not identify factors associated with obtaining a correct diagnosis in staging T. Diagnostic precision was 72% for stage N (N0: 58%; Nx 88%). The presence of free perigastric fluid was identified in 7 cases; the presence of peritoneal carcinomatosis was later confirmed in 5 of these. The result of endoscopic ultrasonography led to a modification in the subsequent therapeutic management in 13 patients (28%). CONCLUSIONS: Endoscopic ultrasonography is a useful technique for loco-regional staging of gastric adenocarcinoma, which may have important implications in the therapeutic management of these patients.

Utilidad de la ecoendoscopia en la estadificiación preoperatoria del cáncer gástrico: rentabilidad diagnóstica e impacto terapéutico / No disponible

Objetivos: valorar la rentabilidad diagnóstica de la ecoendoscopiaen la estadificación locorregional del cáncer gástrico ennuestro medio y determinar el impacto de la técnica sobre el manejoterapéutico posterior.Material y métodos: estudio retrospectivo realizado en pacientesdiagnosticados histológicamente de adenocarcinoma gástricoque habían sido remitidos para la realización de ecoendoscopia.Se comparó el resultado de la técnica con el estudio final obtenidoen la pieza operatoria y/o laparoscopia-laparotomía exploradora.Se comparó la decisión terapéutica inicial basada en los resultadosde las técnicas diagnósticas convencionales, con el manejo terapéuticofinal basado en el resultado de la ecoendoscopia.Resultados: se incluyeron en el estudio 46 pacientes conadenocarcinoma gástrico (en 36 de los cuales se disponía de exploraciónde referencia). La precisión diagnóstica fue del 70%para el estadio T, y para T1, T2, T3 y T4 del 100, 38, 82 y100%, respectivamente. La sensibilidad y especificidad para diferenciarel estadio T1-2 del T3-4 fue del 94 y 85% respectivamente.No se identificaron factores relacionados con la obtención deun diagnóstico correcto en la estadificación T. La precisión diagnósticafue del 72% para el estadio N (N0: 58%; Nx 88%). En 7pacientes se identificó la presencia de líquido libre perigástrico, en5 de los cuales se confirmó posteriormente la existencia de carcinomatosisperitoneal. En 13 pacientes (28%) del resultado de laecoendoscopia se derivó una modificación en el manejo terapéuticoposterior.Conclusiones: la ecoendoscopia es una técnica útil en la estadificaciónlocorregional del adenocarcinoma gástrico, lo quepuede tener importantes implicaciones en el manejo terapéuticode estos pacientes(AU)

Objectives: to evaluate the diagnostic yield of endoscopic ultrasonographyin loco-regional staging of gastric cancer in ourmedium and to determine the impact of this technique on latertherapeutic management.Material and methods: this is a retrospective study carriedout on patients histologically diagnosed with gastric adenocarcinomawho had been referred for endoscopic ultrasonographic examination.The technique results were compared with those obtainedfrom surgical samples and/or from exploratory laparoscopylaparotomy.We compared the initial therapeutic decision basedon conventional diagnostic techniques with the final therapeuticmanagement based on the endoscopic ultrasonography results.Results: forty-six patients with gastric adenocarcinoma wereincluded in the study (a reference exploration was available in 36cases). Diagnostic precision was 70% in stage T, while in stagesT1, T2, T3 y T4 was 100, 38, 82, and 100%, respectively. Thesensitivity and specificity to differentiate T1-2 from T3-4 was 94and 85%, respectively. We could not identify factors associatedwith obtaining a correct diagnosis in staging T. Diagnostic precisionwas 72% for stage N (N0: 58%; Nx 88%). The presence offree perigastric fluid was identified in 7 cases; the presence of peritonealcarcinomatosis was later confirmed in 5 of these. The resultof endoscopic ultrasonography led to a modification in thesubsequent therapeutic management in 13 patients (28%).Conclusions: endoscopic ultrasonography is a useful techniquefor loco-regional staging of gastric adenocarcinoma, whichmay have important implications in the therapeutic managementof these patients(AU)

[Effect of Helicobacter pylori eradication on patients with functional dyspepsia]. / Efecto del tratamiento erradicador para Helicobacter pylori en pacientes con dispepsia funcional.

OBJECTIVE: This study evaluated Helicobacter pylori eradication therapy in terms of symptomatic response in patients with functional dyspepsia. On the other hand, we analyzed the importance of histologic findings as a predictor of treatment response. In particular, we studied whether antral gastritis (which is associated with peptic ulcer) may predict a greater symptomatic response to Helicobacter pylori eradication in functional dyspepsia. PATIENTS AND METHODS: This prospective, randomized, single-center trial included 48 patients with functional dyspepsia and Helicobacter pylori infection (27 women and 21 men, mean age 37 +/- 13.5 years). Twenty-seven patients received a 10-day course of rabeprazole, amoxicillin, and clarithromycin (eradication group), followed by 20 mg of rabeprazole for 3 months. Twenty-one patients received 20 mg of rabeprazole for 3 months (control group). Patients were followed up over a 1-year period. All patients completed the Dyspepsia-Related Health Scale Questionnaire, which studies four dimensions: pain intensity, pain disability, non-pain symptoms, and satisfaction with dyspepsia-related health. RESULTS: There was significant symptomatic improvement (p < 0.002) after 6 and 12 months, which was similar with both treatments. In the multivariate analyses, eradication therapy and less severe symptoms before treatment were the only independent factors. The symptomatic response to Helicobacter pylori eradication after 6 months was significantly greater as compared to control therapy (p = 0.01) in patients with antral gastritis and in the non-pain symptoms dimension of the questionnaire. CONCLUSIONS: Both treatments proved to be clinically beneficial in patients with functional dyspepsia. We observed a tendency to greater symptomatic benefit with Helicobacter pylori eradication therapy when compared to control treatment in patients with functional dyspepsia and in a population with a high prevalence of this infection. There is a tendency to symptomatic benefit with Helicobacter pylori eradication therapy in patients with antral gastritis.

Efecto del tratamiento erradicador para Helicobacter pylori en pacientes con dispepsia funcional / No disponible

Objetivo: este estudio ha tenido un doble objetivo: por unlado, evaluar el efecto del tratamiento erradicador para Helicobacterpylori en la respuesta sintomática de pacientes diagnosticadosde dispepsia funcional y, por otro, determinar si los hallazgoshistológicos podían servir como predictor de la efectividad dela terapia. En particular, se trató de averiguar si la presencia degastritis antral (la que se asocia a la enfermedad ulcerosa péptica)podría predecir una mayor respuesta sintomática al tratamientoerradicador en los pacientes con dispepsia funcional e infecciónpor Helicobacter pylori.Pacientes y métodos: estudio prospectivo, monocéntrico yaleatorizado, que incluyó a 48 pacientes con dispepsia funcional einfección por Helicobacter pylori (27 mujeres y 21 hombres, conedad media de 37 ± 13,5 años). Veintisiete pacientes recibieronel tratamiento erradicador (rabeprazol, claritromicina y amoxicilinadurante 10 días, seguido de 20 mg/día de rabeprazol 3 meses)y 21 el tratamiento control (20 mg/día de rabeprazol 3 meses).Los pacientes fueron seguidos durante un año. Todos rellenaronel Cuestionario de calidad de vida asociada a dispepsia, queevalúa cuatro apartados: intensidad de los síntomas habituales, intensidaddel dolor de estómago, incapacidad debida al dolor y satisfaccióncon la salud.Resultados: existió una mejoría significativa (p < 0,002) enlos síntomas de los pacientes, tanto a los 6 como a los 12 mesestras el inicio del tratamiento, que además fue común a las dospautas de tratamiento. En el análisis de regresión lineal múltiple,los efectos del tratamiento erradicador y de tener una sintomatologíamenos intensa antes de recibir el tratamiento, fueron los dosúnicos factores independientes de forma significativa. La respuestaal tratamiento erradicador a los 6 meses fue significativamentemayor que con el tratamiento control (p = 0,01) en los pacientescon gastritis de predominio antral y en el apartado concreto de lossíntomas habituales. Conclusiones: ambos tratamientos producen una mejoríasintomática significativa en los pacientes con dispepsia funcional.Se observa una tendencia hacia un beneficio sintomático mayorcon el tratamiento erradicador respecto al control en pacientescon dispepsia funcional y en un medio con elevada prevalencia deinfección por Helicobacter pylori. Existe una tendencia hacia lamejoría sintomática con el tratamiento erradicador en los pacientesque tienen una gastritis de predominio antral

Objective: this study evaluated Helicobacter pylori eradicationtherapy in terms of symptomatic response in patients withfunctional dyspepsia. On the other hand, we analyzed the importanceof histologic findings as a predictor of treatment response.In particular, we studied whether antral gastritis (which is associatedwith peptic ulcer) may predict a greater symptomatic responseto Helicobacter pylori eradication in functional dyspepsia.Patients and methods: this prospective, randomized, single-center trial included 48 patients with functional dyspepsiaand Helicobacter pylori infection (27 women and 21 men,mean age 37 ± 13.5 years). Twenty-seven patients received a10-day course of rabeprazole, amoxicillin, and clarithromycin(eradication group), followed by 20 mg of rabeprazole for 3months. Twenty-one patients received 20 mg of rabeprazole for3 months (control group). Patients were followed up over a 1-year period. All patients completed the Dyspepsia-RelatedHealth Scale Questionnaire, which studies four dimensions:pain intensity, pain disability, non-pain symptoms, and satisfactionwith dyspepsia-related health.Results: there was significant symptomatic improvement (p <0.002) after 6 and 12 months, which was similar with both treatments.In the multivariate analyses, eradication therapy and lesssevere symptoms before treatment were the only independent factors.The symptomatic response to Helicobacter pylori eradicationafter 6 months was significantly greater as compared to controltherapy (p = 0.01) in patients with antral gastritis and in thenon-pain symptoms dimension of the questionnaire.Conclusions: both treatments proved to be clinically beneficialin patients with functional dyspepsia. We observed a tendencyto greater symptomatic benefit with Helicobacter pylori eradicationtherapy when compared to control treatment in patients withfunctional dyspepsia and in a population with a high prevalence of this infection. There is a tendency to symptomatic benefit withHelicobacter pylori eradication therapy in patients with antralgastritis

Extraintestinal manifestations of Crohn's disease: prevalence and related factors.

BACKGROUND: Patients with inflammatory bowel disease may suffer one or more extraintestinal manifestations during the course of their condition, these being more frequent in Crohn s disease. The aim of our study was to evaluate the prevalence of extraintestinal manifestations in patients with Crohn s disease in our healthcare area, and to assess the relationship between its presence and diverse clinical-evolutionary variables. MATERIAL AND METHODS: Extraintestinal manifestations in 157 patients diagnosed with Crohn s disease in our center were retrospectively studied. The clinical-evolutionary characteristics of this population were compared with respect to the presence or absence of different extraintestinal manifestations. RESULTS: Seventy-two patients (46%) presented at least with one extraintestinal manifestation. Thirty-one percent were colitis-related manifestations (22% rheumatologic, 13% muco-cutaneous, 4% ophthalmologic), 11% cholelithiasis, 8% nephrolithiasis, 3% thromboembolic illness, and other manifestations were less frequent. Fourteen percent presented with more than one extraintestinal manifestation. Rheumatologic and muco-cutaneous manifestations were significantly more frequent in patients with disease confined to the colon. Cholelithiasis was significantly associated to those over 40 and also to males. Nephrolithiasis was also significantly associated to those over 40, and thromboembolic illness was linked to females. CONCLUSIONS: forty-six percent of patients with Crohn s disease presented at least with one extraintestinal manifestation. Thirty-one percent presented with colitis-related manifestations, rheumatologic and muco-cutaneous manifestations being the most frequent, whereas hepatic manifestations were infrequent. Rheumatologic and muco-cutaneous manifestations were more frequent in patients with disease confined to the colon.

Manifestaciones extraintestinales de la enfermedad de Crohn. Prevalencia y factores relacionados / Extraintestinal manifestations of Crohn's disease: prevalence and related factors

Introducción: los pacientes con enfermedad inflamatoria intestinalpueden sufrir a lo largo de su evolución una o más manifestacionesextraintestinales, siendo estas más frecuentes en la enfermedadde Crohn. El objetivo de nuestro estudio fue valorar laprevalencia de las manifestaciones extraintestinales en los pacientescon enfermedad de Crohn en nuestro medio y la relación existenteentre su presencia y diversas variables clínico-evolutivas.Material y métodos: se recogieron de modo retrospectivolas manifestaciones extraintestinales de 157 pacientes diagnosticadosde enfermedad de Crohn en nuestro centro. Se compararonlas características clínico-evolutivas de esta población con respectoa la presencia o ausencia de las distintas manifestacionesextraintestinales.Resultados: setenta y dos pacientes (46%) presentaban almenos una manifestación extraintestinal. El 31% eran colíticas(22% articulares, 13% cutáneo-mucosas, 4% oculares), 11% colelitiasis,8% litiasis renal y 3% enfermedad tromboembólica. Otrasmanifestaciones presentaban una menor frecuencia. El 14% presentaronmás de una manifestación extraintestinal. Las manifestacionesarticulares y cutáneo-mucosas fueron significativamentemás frecuentes en la localización colónica. La colelitiasis se asociabasignificativamente con la edad mayor de 40 años y el sexomasculino. La litiasis renal se asociaba significativamente con laedad y la enfermedad tromboembólica con el sexo femenino.Conclusiones: el 46% de los pacientes con enfermedad deCrohn presentaron al menos una manifestación extraintestinal. El31% presentaban manifestaciones colíticas, siendo las articularesy cutáneo-mucosas las más frecuentes, mientras que las hepáticasfueron infrecuentes. Las manifestaciones articulares y cutáneomucosasfueron más frecuentes en la localización colónica

Background: patients with inflammatory bowel disease maysuffer one or more extraintestinal manifestations during thecourse of their condition, these being more frequent in Crohn'sdisease. The aim of our study was to evaluate the prevalence ofextraintestinal manifestations in patients with Crohn's disease inour healthcare area, and to assess the relationship between itspresence and diverse clinical-evolutionary variables.Material and methods: extraintestinal manifestations in 157patients diagnosed with Crohn's disease in our center were retrospectivelystudied. The clinical-evolutionary characteristics of thispopulation were compared with respect to the presence or absenceof different extraintestinal manifestations.Results: seventy-two patients (46%) presented at least withone extraintestinal manifestation. Thirty-one percent were colitisrelatedmanifestations (22% rheumatologic, 13% muco-cutaneous,4% ophthalmologic), 11% cholelithiasis, 8% nephrolithiasis,3% thromboembolic illness, and other manifestations wereless frequent. Fourteen percent presented with more than one extraintestinalmanifestation. Rheumatologic and muco-cutaneousmanifestations were significantly more frequent in patients withdisease confined to the colon. Cholelithiasis was significantly associatedto those over 40 and also to males. Nephrolithiasis was alsosignificantly associated to those over 40, and thromboembolic illnesswas linked to females.Conclusions: forty-six percent of patients with Crohn's diseasepresented at least with one extraintestinal manifestation.Thirty-one percent presented with colitis-related manifestations,rheumatologic and muco-cutaneous manifestations being the mostfrequent, whereas hepatic manifestations were infrequent.Rheumatologic and muco-cutaneous manifestations were morefrequent in patients with disease confined to the colon

[Neck and thorax multifocal rhabdomyoma. A case report and review of the literature]. / Rabdomioma multifocal cervical y torácico. Descripción del caso y revisión de la literarura.

We present one rare case of multifocal rabdomyoma in the cervical region and chest. We describe the presentation, clinical, special tests done for the diagnosis and localization. Therefore we present the type of the treatment and evolution post therapy. We review the literature.

DNA aneuploidy in colorectal adenomas. Role in the adenoma-carcinoma sequence.

INTRODUCTION: Aneuploidy has been observed in 6-27% of lesions known to be precursors of colorectal cancer, such as adenomas or ulcerative colitis. It has been suggested that aneuploidy may predispose to malignancy in these cases. However, its role in the adenoma-carcinoma sequence has not been definitely established. The objective of this study was to assess the incidence of aneuploidy in colon adenomas, as well as to study its possible role in the adenoma-carcinoma sequence. MATERIAL AND METHODS: The study was performed on a series of 57 large bowel adenomas measuring 10 mm or more, collected from 54 consecutive patients. All specimens were obtained either by endoscopic or by surgical resection. There were 49 adenomas with low-grade dysplasia, two with high-grade dysplasia, two intramucous carcinomas, and four microinvasive carcinomas. A flow cytometric DNA analysis was performed in fresh specimens following Vindelov's method. RESULTS: Aneuploid DNA was detected in five out of 49 low-grade dysplasia adenomas (10%), in all four high-grade dysplasia adenomas or intramucous carcinomas (100%), and in three out of four microinvasive carcinomas (75%). The association between aneuploidy and high-grade dysplasia adenomas, intramucous, or microinvasive carcinoma was statistically significant (p < 0.001). No association was found between aneuploidy and any of the following features: age, gender, clinical symptoms of patients, and size or location of adenomas. CONCLUSIONS: The incidence of aneuploidy in this series was 10% in low-grade dysplasia adenomas, and 87% in high-grade dysplasia adenomas or carcinomas, and this difference was statistically significant. These findings suggest that aneuploidy may play a role in the adenoma-carcinoma sequence.

Rabdomioma multifocal cervical y torácico. Descripción del caso y revisión de la literatura / Cervical and thoracic multifocal rabdomyoma. A case report

Se presenta un caso infrecuente de rabdomioma multifocal con una localización cervical y otra torácica no aparecida anteriormente en la literatura.Se describe la forma de presentación, las técnicas exploratorias realizadas para llegar a su diagnóstico y localización; el tratamiento utilizado así como la evolución inmediata posoperatoria y seguimiento.Por otro lado, se expone una revisión bibliográfica de lo existente hasta ahora en relación a este tipo de tumor, con esta peculiar y poco frecuente forma multifocal de presentación, y las diferentes localizaciones descritas por otros

We present one rare case of multifocal rabdomyoma in the cervical region and chest. We describe the presentation, clinical, special tests done for the diagnosis and localization. Therefore we present the type of the treatment and evolution post therapy.We review the literature

Aneuploidía del ADN en adenomas colónicos. Papel en la secuencia adenoma-carcinoma / DNA aneuploidy in colorectal adenomas. Role in the adenomacarcinoma Sequence

Introducción: en patología benigna de intestino grueso precursora del cáncer colorrectal, como adenomas o colitis ulcerosa, se ha observado aneuploidía en el 6-27% de los casos y se ha sugerido que su presencia predispone al desarrollo de malignidad. Sin embargo, su papel en la secuencia adenoma-carcinoma no se ha demostrado de forma concluyente. El objetivo de nuestro trabajo fue valorar la incidencia de aneuploidía en adenomas colónicos,con y sin signos de malignidad, y estudiar su posible papel en la secuencia adenoma-carcinoma. Material y métodos: el estudio se realizó en una serie de 57 adenomas de intestino grueso, de 10 o más milímetros, recogidos de forma consecutiva de 54 pacientes. Las piezas se obtuvieron en todos los casos mediante resección endoscópica o quirúrgica. En 49 casos se trataba de adenomas con displasia de bajo grado, en doscasos de adenomas con displasia de alto grado, dos adenocarcinomas intramucosos y en otros cuatro de adenocarcinomas microinvasivos. El estudio del ADN se realizó en la pieza operatoria en fresco mediante citometría de flujo utilizado el método de Vindelov.Resultados: se detectó ADN aneuploide en cinco de los 49adenomas con displasia de bajo grado (10%), en los cuatro adenomas con displasia de alto grado o adenocarcinomas intramucosos (100%) y en tres de los cuatro adenocarcinomas microinvasivos (75%). Se observó asociación significativa entre el hallazgos deaneuploidía y displasia de alto grado, adenocarcinoma intramucoso o microinvasivo (p < 0,001). No se apreció asociación entre la existencia de aneuploidía y la edad de los pacientes, sexo, sintomatología clínica, tamaño ni localización de los adenomas. Conclusiones: en adenomas colónicos la incidencia de aneuploidía fue del 10% cuando se trataba de adenomas con displasia de bajo grado y del 87% cuando presentaban displasia de alto grado o adenocarcinoma siendo la diferencia estadísticamente significativa. Estos hallazgos sugieren que la aneuploidía juega un papel en la secuencia adenoma-carcinoma

Introduction: aneuploidy has been observed in 6-27% of lesions known to be precursors of colorectal cancer, such as adenomas or ulcerative colitis. It has been suggested that aneuploidy may predispose to malignancy in these cases. However, its role in the adenoma-carcinoma sequence has not been definitely established.The objective of this study was to assess the incidence of aneuploidy in colon adenomas, as well as to study its possible role in the adenoma-carcinoma sequence. Material and methods: the study was performed on a series of 57 large bowel adenomas measuring 10 mm or more, collected from 54 consecutive patients. All specimens were obtained either by endoscopic or by surgical resection. There were 49 adenomas with low-grade dysplasia, two with high-grade dysplasia, two intramucous carcinomas, and four microinvasive carcinomas. A flow cytometric DNA analysis was performed in fresh specimens following Vindelov´s method. Results: aneuploid DNA was detected in five out of 49 lowgrade dysplasia adenomas (10%), in all four high-grade dysplasia adenomas or intramucous carcinomas (100%), and in three out of four microinvasive carcinomas (75%). The association between aneuploidy and high-grade dysplasia adenomas, intramucous, or microinvasive carcinoma was statistically significant (p < 0.001). No association was found between aneuploidy and any of the following features: age, gender, clinical symptoms of patients, and size or location of adenomas. Conclusions: the incidence of aneuploidy in this series was 10% in low-grade dysplasia adenomas, and 87% in high-grade dysplasia adenomas or carcinomas, and this difference was statistically significant. These findings suggest that aneuploidy may play a role in the adenoma-carcinoma sequence

Gastrointestinal bleeding and small bowel amyloidosis.

Amyloidosis commonly affects the gastrointestinal tract but it rarely causes severe symptoms. We describe here a case of small bowel amyloidosis presenting severe bleeding. The diagnosis was made by histopathological study of the surgical specimen. No other sites of amyloid deposition were found. The only predisposing condition found in this case was a prostate cancer.

[Gastrointestinal anisakiasis. Study of a series of 25 patients]. / Anisakiasis gastrointestinal. Estudio de una serie de 25 pacientes.

INTRODUCTION: Infection with the parasite Anisakis simplex is common in Japan and northern European countries. The number of reported cases in Spain has increased since the first description in 1991. The aim of the present study was to evaluate the incidence, clinical patterns, histopathological lesions, treatment, and outcome of Anisakis simplex infection in our environment. MATERIAL AND METHOD: Cases of gastrointestinal anisakiasis diagnosed in our center from December 1999 to January 2002 were studied. Only patients with detection of the parasite in oral endoscopy or the surgical specimen and those with elevated levels of specific IgE to Anisakis simplex, a clinical picture compatible with anisakiasis, or a history of raw fish intake were included. Epidemiological, clinical and laboratory data, as well as diagnostic, histopathologic and therapeutic features, and outcome in these patients were recorded. RESULTS: Twenty-five cases of gastrointestinal anisakiasis were diagnosed during the study period, representing an incidence of 3.87 cases per 100 000 inhabitants/year. All the patients had ingested raw anchovies. Two groups were observed. The first group was composed of 10 patients with a gastric form of the infection, in which the main symptom was epigastralgia (90%). Oral endoscopy was performed in all patients and the parasite was detected in five (50%). The second group was composed of 15 patients with intestinal involvement in which the main manifestations were symptoms mimicking appendicitis (80%). The most frequent finding of laparotomy and/or imaging tests (abdominal ultrasonography, intestinal transit, abdominal CAT) was terminal ileitis (80%). Seven patients underwent surgery: intestinal resection was performed in four with detection of Anisakis simplex in three. Eosinophilic infiltration was found in all surgical specimens. Treatment was symptomatic in most of the patients and outcome was favorable in all. CONCLUSIONS: Infection with Anisakis simplex should be investigated in patients with abdominal pain after intake of raw fish, ileitis of unclear origin, or eosinophilic gastroenteritis.

Nasolacrimal stents in the management of epiphora: medium-term results of a multicenter prospective study.

PURPOSE: To evaluate in a prospective multicenter setting the clinical utility of polyurethane stents in the percutaneous management of epiphora. MATERIALS AND METHODS: Patients (N = 163; age range = 22-85 y, mean = 52 y; 29 men, 134 women) with severe epiphora had stents (n = 183) inserted under fluoroscopic guidance in 180 lacrimal systems (unilateral = 146; bilateral = 17) to treat complete (n = 172) or partial (n = 8) obstruction of the nasolacrimal duct or sac. The junction between sac and duct was the most frequent location (n = 102), followed by the sac alone (n = 48), and the duct alone (n = 30). The etiology of the obstruction was idiopathic in 113 cases (63%) and chronic dacryocystitis in 67 (37%). The set designed by Song was used in all patients and the original technique was slightly modified by the authors. All patients were treated on an outpatient basis. Average time of the procedure was 14 minutes (range = 3-70 min). RESULTS: Initial technical success rate of stent placement was 97%. Resolution of epiphora was complete in 175 eyes and partial in five. On follow-up (mean = 450 d; range = 8-730 d), 157 of 183 stents remained patent (85.8%). Of the 24 obstructed, 19 were easily withdrawn and 17 of these patients remained asymptomatic for a mean of 15 months (secondary patency rate = 89.5%). CONCLUSIONS: The procedure is simple and safe. It can be performed on an outpatient basis and the original technique could be improved with some technical modifications. It is well tolerated by patients and may be considered as a valid alternative technique for the resolution of epiphora.

Parotid gland carcinoma: 1987 and 1997 UICC T classifications compared for prognostic accuracy at 5 years.

In order to compare the correlation of 1987 and 1997 UICC T categories with the survival rate in parotid gland carcinoma, 134 patients attending the ENT clinics at the University of Ferrara (from 1970 and 1993) and Firenze (from 1970 to 1990) were analyzed by means of survival analyses (Kaplan-Meier and Cox algorithms). This study demonstrated that both systems showed a significant correlation with the survival rate, but T 1997 resulted in a more reliable prognostic value by means of a higher odds ratio. We conclude that the newer (1997) UICC T category better defines the prognosis for cancer of the parotid gland and should have a higher impact on the clinical evaluation of patients.

Cervical necrotizing fasciitis.

Necrotizing fasciitis is a severe soft tissue infection that results in necrosis of the fasciae and subcutaneous tissues; the infection can quickly prove fatal. Although involvement of the head and neck is rare, causes are usually odontogenic or pharyngeal but can also be insect bites, local trauma, burns or surgery. We present a clinical case of a 31-year-old Italian woman with cervical necrotizing fasciitis having an uncommon presentation. While under treatment, the patient's husband was admitted for necrotizing fasciitis of the medial fasciae of his left leg subsequent to an insect sting. The causes, diagnosis and treatment of necrotizing fasciitis are reviewed.

[Gas gangrene due to Clostridium septicum in a patient with an occult colonic neoplasm. A case report and review of the literature]. / Gangrena gaseosa por Clostridium septicum en un paciente con neoplasia de colon oculta. Presentación de un caso y revisión de la literatura.

A case of gaseous gangrene by Clostridium septicum associated with colorectal cancer is presented. The patient evolved rapidly towards septic shock and death. Autopsy showed occult neoplasm and pelvic and retroperitoneal myonecrosis. An exceptional finding was that of myocarditis in which thick gram-positive bacilli were identified. A review of the literature was carried out regarding the pathogenesis and clinical manifestations of this disease. The association of colonic neoplasm and Clostridium septicum may be related with the sensitivity of the cells of this neoplasm to the toxins of the microorganisms. The usefulness of this cytotoxicity is being tested in the therapeutic reduction of tumoral mass. With respect to clinical attitude, all the authors agree on the need for clinical suspicion as to the possible existence of occult colon neoplasm in individuals with septic shock by gaseous gangrene with no obvious entry site. Diagnosis is performed by imaging techniques with barium enema and if this is normal colonoscopy is carried out. Emergency treatment consists in laparotomy with resection of the neoplasm and debridement of the area accompanied by hyperbaric oxygen and antibiotics.

[The problem of lymph nodes in malignant epithelial tumors of the parotid gland]. / Il problema linfonodale nei tumori epiteliali maligni della parotide.

Cervical lymph-node treatment in parotid gland epithelial malignancies is still debated. According to Literature, three different strategies (surgery, radiotherapy, "wait and see") have all been proposed theoretically, particularly when dealing with N0 cases. The present study was designed to evaluate the results of different lymphonode treatment strategies in 57 parotid gland carcinomas followed at the ENT Clinic of the University of Ferrara. The most frequent hystological patterns appeared to be the adenoidcystic carcinoma (33.3%) and the mucoepidermoid tumor (21.1%). Total parotidectomy was the treatment of choice in all cases. Ipsilateral neck dissection was performed in 14 cases (24.5%), 5 cases being N0. In 27 patients (47.4%) postsurgical radiotherapy was applied: in 7 cases on T and in 20 on both T and N.T recurrences were 7, while those of N and of both T and N were respectively 2 and 2. No occult metastases were found in N0 dissected patients. The results obtained led the Authors to the following conclusions: -neck dissection is fundamental in treatment of clinical adenopathies in any parotid gland malignancy: -postsurgical radiotherapy on the neck is the treatment of choice in all N0 carcinomas except in cases of acinic cell and mucoepidermoid carcinomas, where a "wait and see" policy seems to be more suitable.