[Traumatic lesions of the pancreas: diagnosis and treatment]. / Le lesioni traumatiche del pancreas: diagnosi e trattamento.

The diagnosis and treatment of traumatic lesions of the pancreas are difficult. The deep anatomical location of the organ, the lack of truly accurate non-invasive diagnostic investigations and the frequent initial scarcity or absence of specific symptoms, often mean that a clinical assumption based on the dynamics of the trauma is fundamental for a rapid, correct diagnosis. The state of the main pancreatic duct is the most important element in establishing the prognosis and guiding the treatment, and should therefore be accurately defined before or during surgery. If the Wirsung duct is intact, even when radiological, clinical and laboratory signs indicate a pancreatic lesion, conservative treatment can be attempted. On the contrary, if there is evidence of a lesion of the duct, surgery is mandatory, bearing in mind that pancreatic resections involving removal of the portion of the gland distal to the lesion have a lower incidence of complications than do reconstructive and/or anastomotic procedures and are therefore to be preferred. Nevertheless, in selected cases, especially in young patients, Roux-en-Y pancreaticojejunostomy can avoid the risk of functional insufficiency, sparing large tracts of otherwise sacrificed glandular tissue. Only the more serious complex lesions of the head of the pancreas also affecting the duodenum require pancreaticoduodenectomy.

[Venereal perihepatitis: Fitz-Hugh-Curtis syndrome]. / La periepatite venerea: sindrome di Fitz-Hugh-Curtis.

A case of Fitz-Hugh-Curtis syndrome (venereal perihepatitis) is reported. This syndrome is observed almost exclusively in women as a complication of genital gonococcal or chlamydial infections. A sudden, acute biliary-type pain generally characterizes the disease; only a few cases present symptoms related to associated genital infection. The real clinical incidence of venereal perihepatitis is quite high; in fact, a lot of the emergency admitted patients diagnosed with biliary colic or acute cholecystitis as a matter of fact suffer from this syndrome. If haematological investigations, ultrasonography and cholangiography do not confirm a suspected biliary lithiasis, it will be needed to investigate the genital tract. After clinical and ultrasound examinations, neisseria gonorrhoeae and chlamydia trachomatis must be sought in vaginal and cervical secretions and serum antichlamydial antibodies level is to be sought too. Through these examinations, the venereal perihepatitis can usually be diagnosed. In uncertain cases laparoscopy can be useful: in fact, it can reveal the typical violin-string-like adhesions between the anterior liver capsule and the anterior abdominal wall, and, in the same session, it allow to resect them. Tetracycline, doxycycline and, more recently, ofloxacine gave good results in the syndrome's treatment.

[Bacteriologic monitoring in a surgical department with emergency services. Epidemiologic analysis and study of sensitivity to antibiotic therapy]. / Monitoraggio batteriologico in una divisione chirurgica con servizio d'urgenza. Analisi epidemiologica e verifica di sensibilità alla antibioticoterapia.

The two year experience with 2091 biological cultures and the related antibiograms has been reported on the basis of a prospective, computerized study. The incidence of germs coming from each fluid collected has been analyzed as well as the sensibility to various antibacterial drugs. The gram negative such as Escherichia Coli, Enterococcus, Pseudomonas, Proteus, Klebsiella, Serratia and Enterobacter resulted more frequently isolated; in addition a revival of gram positive strains (Staphylococcus, Streptococcus) was noted too.

[Lobular carcinoma of the breast with neuroendocrine differentiation. Study of a case]. / Il carcinoma lobulare della mammella a differenziazione neuroendocrina. Studio di un caso.

A breast tumor with morphologic features of neuroendocrine differentiation and containing large amounts of estrogen receptor protein was associated with areas of typical infiltrating lobular carcinoma. The neuroendocrine areas were argyrophilic, NSE positive and ultrastructurally did not show dense granules. Results of flow cytometric analysis revealed aneuploid nuclear DNA.