[Multiple primitive lipoma of the transverse mesocolon: a rare disease]. / Lipoma primitivo multiplo del mesocolon: una patologia rara.

The Authors describe a case of multiple lipomatosis of the mesocolon and, after a careful review of the literature, they examine particular findings and discuss diagnostic difficulties, anatomopathological features and treatment. Intraabdominal lipoma is very rare and presents difficulties in diagnosis, both for aspecific symptoms and for the unusual site which does not allow early identification. As it is a tumor which arises from primitive and totipotent mesenchymal cells, radical surgery is the only therapeutic option. The correct diagnosis depends on histological testing which can differentiate the lesion from other mesenchymal tumors.

[Endoscopic prosthetic treatment of the esophagojejunal leaks after total gastrectomy: clinical experience]. / Il trattamento endoscopico protesico delle fistole anastomotiche esofago-digiunali dopo gastrectomia totale per cancro dello stomaco: esperienza clinica.

The Authors, on the basis of their experience on the use of self-expanding prostheses in abdominal surgery, report on the use of these prostheses in two patients who, having undergone a gastrectomy for cancer, developed a fistula of the esophago-jejunal anastomosis. Given recent data from literature, using a prosthesis for an anastomotic fistula may be a valid alternative to a second operation, which, apart from obvious difficulties, has a high mortality rate in patients in weakened general health conditions. In these cases, after the application of a stent, excellent results can be obtained and, after some days, the patients can begin a semi-liquid diet, then proceeding to a semi-solid diet, improving quality of life; in addition, within a reasonable time span, after the healing of the fistula, the prosthesis can easily be removed by endoscopy.

[Caroli's disease: literature review and characteristics of a clinical case]. / La malattia di Caroli: revisione della letteratura e particolarità di un caso clinico.

The Author's report the case of the simple form of Caroli's disease, a rare malformation, and review literature pointing out the difficulty of an early diagnosis, because disease can be silent for a long time too and it is identified for complication. Today, imaging, endoscopy and interventionist radiology are the most valid tools for a correct diagnosis and treatment, above all in a case of emergency, when other therapeutic solutions are not possible.

Combined antegrade and retrograde ureteral stenting: the rendezvous technique.

Ureteral stenting is a routine procedure in endourology. To increase the success rate in difficult cases, it may be helpful to use the rendezvous technique, a combined antegrade and retrograde approach. We performed 16 urological rendezvous in 11 patients with ureteral strictures or urologic lesions. The combined approach was successful in all patients, without morbidity or mortality. In our experience the rendezvous technique increased the success rate of antegrade ureteral stenting from 78.6 to 88.09% (p > 0.05). This procedure is a valid option in case of failure of conventional ureteral stenting.

Embryologic and acquired anomalies of the inferior vena cava with recurrent deep vein thrombosis.

Anomalies of the inferior vena cava theoretically favor venous stasis and development of deep vein thrombosis. We report two cases of repeated deep vein thrombosis in patients with embryologic and acquired anomalies of the inferior vena cava, in which hypercoagulability syndrome was ruled out.

[Endovascular repair of abdominal aortic aneurysm: helical CT findings]. / Follow up post-procedura delle endoprotesi aorticho. Rilievi ocn TC spirale.

Endovascular repair of infrarenal abdominal aortic aneurysms is currently widely diffuse. Imaging plays a major role in the preprocedural patient evaluation, implantation of stent-graft, and patient follow-up. The aim of this paper is to describe the more frequent findings that can be seen in CT examinations after endovascular repair of infrarenal abdominal aortic aneurysm. We discuss CT findings related to the aneurysm (size, exclusion with complete perigraft thrombosis, back-filling of aneurysm sac via branch vessels) and to the device (dislocation, rotation, kinking, device expansion, patency/thrombosis, device disruption). We also show some examples of incorrect assembly of the modular components of the stent-graft.

[Clinical and etiopathogenetic evaluation of a rare cause of spontaneous pneumoperitoneum and volvulus of the ileum: pneumatosis cystoides intestinalis. Report of a case]. / Valutazioni cliniche ed etiopatogenetiche su una rara causa di pneumoperitoneo spontaneo e volvolo dell'ileo: la pneumatosi cistica intestinale. A proposito di un caso.

A case of pneumatosis cystoides intestinalis with pneumoperitoneum and volvulus complications is reported. After careful examination of the literature, etiopathogenic, pathophysiological and clinical features of the disease are analyzed by the Authors, also in the light of recent findings. Major diagnostic and therapeutic implications are discussed regarding possible complications requiring a different therapeutic approach. PCI, a lesion which can be benign, primary or secondary in many conditions, may be characterized by the presence of spontaneous pneumoperitoneum which only requires a careful, but not aggressive therapy, unlike other complications such as volvulus or intestinal occlusion which, instead, require timely surgical action. The Authors describing the therapy adopted, highlight the positive role of the enteral nutrition (NE) and oxygen therapy in the clinical course of the disease.

[Description and preliminary clinical assessment of a digital chest radiographic system with selenium detector (Thoravision)]. / Descrizione e valutazione clinica preliminare di un sistema radiografico digitale del torace con rivelatore al selenio (Thoravision).

The authors describe an innovative digital chest imaging system (Thoravision, Philips Medical System) based on a selenium detector directly converting X-rays in electric charges detectable by electrometers, amplified and digitalized to be sent to the imaging processor. The study was performed on a series of up to 7000 digital chest X-ray examinations and a sample of 173 cases was selected on the basis of particular diseases and pathologic patterns. In the latter case, digital and conventional radiographic techniques were compared. According to this analysis, the digital system was slightly superior in detecting anatomical details, small pleural effusions (3 cases) and slight low contrast interstitial pathologic changes, mainly in apical (12 cases) and retrocardiac (19 cases) lung areas. The conventional screen-film system better showed small hilar calcifications (2 cases). From the protection viewpoint, at equivalent entrance doses, .15-.26. Gy/cm2 of dose-area product (DAP) values were reported with the digital system, using a tension of 150 kV in orthogonal projections, which are considerably lower than .25-.70 Gy/cm2 measured with the conventional technique. Moreover, Thoravision permitted to perform up to 100 exposures/hour, using a phantom, and 15-20 digital chest examinations/hour, versus the average 12-15 with the conventional screen-film system. The initial results are very encouraging from the clinical and cost-effectiveness viewpoints, thanks to higher Thoravision productivity and to exam optimization, even though wider and prolonged experience plus a careful study of diagnostic accuracy, sensitivity and specificity in each group of chest conditions is advisable, to assess the real innovative impact of this digital chest imaging system.

[Nonspecific osteomyelitis in childhood and adolescence. The contribution of imaging diagnosis]. / Osteomieliti aspecifiche dell'infanzia e dell'adolescenza. Contributo della diagnostica per immagini.

Nonspecific osteomyelitis in children and adolescents can be diagnosed in patients 2 to 16 years old and may present as acute, subacute or chronic. During the last 9 years, 40 pediatric patients (aged 2 to 16 years) affected with extra-axial inflammatory bone lesions were examined. The series of cases was then reviewed. This work was aimed at investigating the role of various imaging modalities: conventional radiology (CR), bone scan with technetium-99 methylene diphosphonate (99mTc-MDP), scintigraphy with technetium-esamethylpropylenaminoxima labelled leukocytes (99mTc-HMPAO), computed tomography (CT) and magnetic resonance imaging (MRI) were used to detect the lesions, to make a differential diagnosis and to assess different disease stages. As for acute osteomyelitis (6 patients), CR showed a lytic lesion, periosteal new bone and soft tissue swelling in 4/6 patients; no abnormalities were demonstrated in the other two. Bone scan, CT and MRI depicted bone involvement. CT and MRI also showed inflammatory lesion spread to surrounding soft tissue. 99mTc-HMPAO scintigraphy was not performed in acute osteomyelitis, because of technical difficulties in performing the exam promptly; thus, the early diagnosis of lesion nature was made with bone biopsy. As for subacute osteomyelitis (23 patients), 99mTc-HMPAO scintigraphy was performed in 8/23 patients and proved to be a highly sensitive method, showing cell clusters and confirming the diagnosis of inflammatory lesion. MRI showed a focal area of intermediate-low signal intensity on T1-weighted sequences, with small focal intralesional areas of low intensity, a low-signal perifocal rim and diffusely low signal of surrounding bone marrow. T2-weighted images showed high signal intensity in both the abscess lesion and bone marrow, the latter probably due to edema. In 5 patients, a paramagnetic contrast agent (Gd-DTPA) was administered during MRI and showed inhomogeneous enhancement of both the inflammatory lesion and surrounding bone marrow. As for chronic osteomyelitis (7 patients), MRI was performed in 5/7 patients. In 4 patients the lesion appeared as a low-signal area on T1-weighted images while T2-weighted images showed an inhomogeneous high-signal area. In the same patients, 99mTc-HMPAO scintigraphy was always positive. In patient 5, the lesion was represented by a low-signal area on both T1 and T2-weighted images, while 99mTc-HMPAO was negative. Therefore, in chronic osteomyelitis, both MRI and 99mTc-HMPAO were useful in detecting both spinal and peripheral bone involvement, which was in some cases asymptomatic at first observation CR, CT (3/4) and MR (4/4) findings extra-axial localizations were similar to those in subacute-chronic forms.

[Vascular compression syndrome of the duodenum. Diagnostic and therapeutic update]. / La sindrome da compressione vascolare del duodeno. Attualità diagnostiche e terapeutiche.

Superior mesenteric artery syndrome is an uncommon clinical condition. A case of duodenal vascular compression and a review of the literature are reported in order to clarify the pathophysiology of the disease. Diagnostic values of hypotonic duodenography and angiography are emphasized. Although, the significance of long-term pH monitoring and gastric emptying for preoperative study and its importance in follow-up after the surgical treatment are evaluated.

Mediastinal pseudotumor due to passage of ascites through the esophageal hiatus.

Ascites can extend from the peritoneal cavity into the posterior mediastinum through the esophageal hiatus. This mediastinal fluid can simulate the appearance of a mediastinal tumor. Demonstration of hiatal hernia and continuity between the thoracic and abdominal fluid assist in establishing the correct diagnosis.

CT findings in hepatic involvement by Echinococcus granulosus.

The CT findings in hepatic involvement by Echinococcus granulosus are described. Pathognomonic signs of the hydatid nature of a cystic lesion are visualization of the cystic wall on plain CT, calcification of the cyst wall, daughter cysts, and membrane detachment.