[Ulcero-necrotic and lymphoproliferative naso-paranasal lesions in cocaine abuse]. / Lesioni ulceronecrotiche e linfoproliferative naso-paranasali da abuso di cocaina.

In this work are reported two clinical cases of cocaine abusers with destructive lesions of nasal-paranasal cavities. The clinical presentation and the absence of a positive history of drug addiction led to a differential diagnosis between lymphoma, idiopathic median line granuloma and Wegener granulomatosis. Biochemical and serological examinations did not prove conclusive. The diagnosis was finally formulated on the basis of the documented presence of cocaine in the biological fluids. Emphasis is placed in the difficulty of obtaining a reliable case history in this type of patients. Moreover, the Authors point out that it is advisable to test for drugs in the biological fluids prior to undertaking time-consuming diagnostic procedures for pathologies which are extremely rare in the West countries.

Clinical and molecular analysis of spinal muscular atrophy in brazilian patients

As amiotrofias espinhais progressivas (SMAs) constituem as doenças degenerativas de origem genética letais mais comuns do sistema nervoso central e mais freqüentes dentre as doenças autossômicas recessivas após a mucoviscidose. A incidência estimada das SMAs e de aproximadamente 1:10.000 nativivos. Clinicamente, as SMAs säo classificadas em mais grave (doença de Werdnig-Hoffmann, tipo I), intermediária (tipo II) e tardia e benigna (doença de Kugelberg-Welander, tipo III). O gene para os três tipos de SMAs foi mapeado no cromossomo 5q11.2-13.3. Foram identificados dois genes candidatos na mesma regiäo: SMN (sobrevida do neurônio motor) e NAIP (proteína inibidora de apoptose neuronal). Estudamos ambos genes em 87 pacientes brasileiros (20 tipo I, 14 tipo II e 53 tipo III) pertencentes a 74 famílias, utilizando as técnicas de PCR e SSCP. Foi encontrada deleçäo nos exons 7 e/ou 8 do gene SMN em 69 por cento das famílias: 16/20 na tipo I, 9/12 na tipo II e 26/42 na tipo III. Dentre as 51 famílias com deleçäo, 44 tiveram deleçäo no exon 5 do gene NAIP foi encontrada em 7/20 na tipo I, 2/12 na tipo II e 1/42 na tipo III. Näo foi encontrada deleçäo nos genes SMN e NAIP nos 112 progenitores, 26 irmandades assintomáticas e 104 controles normais. Näo houve correlaçäo entre deleçäo de um ou ambos genes com a gravidade do quadro clínico.

Incremental diagnostic value of dipyridamole echocardiography and exercise thallium 201 scintigraphy in the assessment of presence and extent of coronary artery disease.

BACKGROUND: The incremental diagnostic information of two noninvasive tests for the detection of coronary artery disease (CAD), dipyridamole echocardiography, and exercise 201Tl myocardial scintigraphy was assessed in a series of 102 patients with ordered logistic regression and receiver-operating characteristic curves. METHODS AND RESULTS: Patients were selected from those referred to our cardiovascular centers with the clinical suspicion of CAD. After clinical evaluation, all patients underwent both noninvasive tests during hospitalization 2 weeks before coronary arteriography. The coronary arteriogram was used as a gold standard: CAD was defined as the presence of one or more vessels with 50% or greater narrowing of the luminal diameter. Clinical data were 73.0% +/- 5.7% accurate in the prediction of CAD. The addition of dipyridamole echocardiographic data to the clinical model yielded a diagnostic accuracy of 88.3% +/- 4.3% (p < 0.00001), whereas the addition of thallium scintigraphic parameters to the clinical model improved diagnostic accuracy to 93.8% +/- 2.6% (p < 0.00001). A significant increase in accuracy to 97.2% +/- 1.4% was achieved when thallium scintigraphic data were added to the clinical and dipyridamole-echocardiographic model (p < 0.00001). CONCLUSION: Both noninvasive methods for detection of CAD, DET, and ETS showed a good diagnostic accuracy especially when tests-derived parameters were combined with clinical data by means of relative logistic models; nevertheless the ETS model showed a higher sensitivity in comparison with the DET model, essentially in presence of a lower extent of CAD.

Enhanced sensitivity for detection of coronary artery disease by addition of atropine to dipyridamole echocardiography.

Dipyridamole echocardiography test (DET) has gained acceptance due to its safety, feasibility, diagnostic accuracy and prognostic power. The main limitation of the test is a less than ideal sensitivity in some patient subsets, such as those with limited coronary artery disease. Atropine with dipyridamole might theoretically combine to become a synergistic ischaemic stress test, by increasing myocardial oxygen demand through chronotropic stress and by reducing flow supply through a shortening of the diastolic interval under maximal coronary vasodilation. The aim of this study was to assess the effects of the addition of atropine to DET. Three hundred and twenty-one patients (age = 58 +/- 9 years), referred for testing in the echo lab, were initially studied by DET. Of these, 151 were stopped during or within the 2 min following dipyridamole infusion because of achievement of a predetermined end-point: obvious echocardiographic positivity (n = 137), severe chest pain (n = 3), diagnostic ST segment changes (n = 7) or limited side effects (n = 4). In another three cases, atropine was not given due to a history of glaucoma or severe prostatic hypertrophy. In the remaining 167 patients with a negative DET test, atropine (0.25 mg intravenously, repeated every min up to a maximum of 1 mg, if necessary) was added, starting 3 min after the end of the dipyridamole infusion. The dipyridamole-atropine echo test (DETA) was positive in 32 and negative in 135 patients, and no major side effects occurred in any patient.(ABSTRACT TRUNCATED AT 250 WORDS)

[The doses absorbed by the patients and the exposure of the operators in dental radiodiagnosis]. / Dosi assorbite dai pazienti ed esposizione degli operatori nella radiodiagnostica odontoiatrica.

The present paper reports an updated dosimetry of dental radiology since it presents the data relative to 7 radiological techniques. The doses to 9 organs were measured on a Randoman phantom using TLD (4 in each chosen cavity) for lenses, tongue, cervical vertebrae (C2), thyroid, ovaries, uterus and testes. The examinations were subsequently repeated after applying X-ray shields to the phantom. The main conclusions follow: a) local doses are never negligible but can be really high, especially for tongue (1.880 mGy), thyroid (1.011 mGy), and C2 (0.699 mGy); b) X-ray shields for lenses, ovaries, uterus and testes have proven to be unnecessary; in a more general context, X-ray shields should be evaluated by the Health Physics Dept., especially relative to radiation leaks from the X-ray tube. As for the thyroid, X-ray shields have proven very useful but can result in repeated acquisitions because of possible interference with the radiological image; c) technicians' risk, in the present experimental conditions, does not exceed the threshold values recommended by Italian laws. At any rate, the use of fixed or mobile shieldings should always be evaluated while keeping in mind the specific working conditions in radiology departments.

[Subscapular elastofibroma (elastofibroma dorsi)]. / Elastofibroma sottoscapolare (elastofibroma dorsi).

The Authors describe a case of elastofibroma in its typical location; the most interesting aspect of this lesion is the microscopic appearance. The benignity of this lesion is absolute, from the clinical and microscopic points of view.

[The surgical therapy of normally functioning multinodular goiter: our experience]. / La terapia chirurgica del gozzo multinodulare normofunzionante: la nostra esperienza.

Surgical treatment of multinodular goiter is still now discussed: total versus subtotal thyroidectomy. Advantages of partial thyroidectomy are the low incidence of laryngeal nerve injury and the low risk of hypoparathyroidism. Disadvantages are the increased recurrent disease, the risk of carcinoma, the elevated possibility of laryngeal nerve lesions and permanent hypoparathyroidism after reoperations. Own experience regarding 401 thyroid operations is reported; 60 patients were operated for multinodular goiter; 48 subtotal and 12 total thyroidectomy were performed. Among those 1 (1.65%) inferior laryngeal lesion and 1 (1.65%) permanent hypoparathyroidism occurred. Anatomic knowledge and correct surgical procedure give a reduction in the mobility of total thyroidectomy which in selective case can be considered the treatment of choice.

Natural history of dysgerminoma.

Data on 56 patients with pure dysgerminoma are discussed. Forty-nine patients were classified as having new disease or were to have reassessment of disease, and seven cases were to be restaged (one with and six without clinical evidence of disease). Of new and reassessment cases, 44 patients underwent lymphography, 16 underwent peritoneoscopy with diaphragmatic inspection and 30 had peritoneal cytologic testing performed. Positive lymphography resulted in restaging in 31.6% of patients. Diaphragmatic inspection was always negative. Peritoneal cytologic testing was positive for malignant cells in three patients and worsened the stage in one. Pathologic staging of disease was as follows: Stage IA, 24; Stage IB, one Stage IC, one; Stage III peritoneal disease, two. Stage III retroperitoneal disease, 12; Stage III peritoneal and retroperitoneal disease; four. The 5-year relapse-free survival rates were 91% in patients with pathologic Stages IA, IB, and IC; 74% in those with Stage III retroperitoneal disease, and 24% in patients with Stage III peritoneal disease or peritoneal plus retroperitoneal disease. The results indicate that the prognosis is excellent for patients with Stage I and Stage III retroperitoneal disease whereas peritoneal involvement is associated with a poor prognosis.

Are retroperitoneal lymph node metastases a major problem in endometrial adenocarcinoma? Diagnostic and prognostic assessment with lymphography.

The results of foot lymphography in 295 patients with endometrial carcinoma observed from 1968 to 1978 at two institutions are reported. One hundred and eighty-two were new cases, 61 were recurrences, and 52 were patients who underwent restaging diagnostic procedures without clinical evidence of disease. The incidence of lymphatic spread was correlated with the clinical stage, the pathologic stage, and the extent of recurrent disease. In fact, in the 182 new cases, at clinical stage, the pathologic stage, lymphography was positive in 8.9% of patients at Stage I, 28.6% at Stage II, 57.1% at Stage III, and 66.6% at Stage IV disease; at pathological stage, lymphography was positive in 8% of patients at Stage I, 14.8% at Stage II, 39.3% at Stage II, and 53.3% at Stage IV disease. There was lymph node involvement in 47.5% of the 61 pretreated patients. Finally, in 52 pretreated patients with no evidence of disease, the incidence of lymph node involvement was 7.7%. In new cases, metastases were found only in the pelvic nodes in 56.2% of the patients and only in the para-aortic nodes in 9.5%; in 34.3%, both chains were simultaneously involved. The five-year survival rate for patients at Stage I, II, and III disease with positive lymphography was 35% as compared with 73% for negative cases. In patients at Stage I and II, the difference of survival was equal to 24%. The reliability of the results is confirmed by the concordance with the data of the literature on histologic involvement, by the first radiologic-pathologic comparison, and by the clinical course of the positive cases. Lymphography is of unquestionable value for an appropriate staging and for a correct plan of treatment.

[Papillosphincteroplasty and wirsungsphincteroplasty. Immediate and late results]. / Papillosfinteroplastica e wirsungsfinteroplastica. Risultati immediati e a distanza

Immediate and long-term results in 250 PSP operations associated with WSP in 116 cases are reported. Complications and failures are described and evaluated, while their causes and possible connection with the type of operation employed are explained. Examinations carried out in the assessment of long-term results are described and justified. It is felt that both operations are to be recommended. WSP, in particular, is considered a useful innovation in surgical repair of the bilopancreatic juncture.

[Our experience with total gastrectomy for treatment of gastric carcinoma]. / La nostra esperienza in tema di gastrectomia totale per il trattamento del carcinoma gastrico

A personal series of cases in which surgical management was employed in the treatment of stomach cancers is presented. Total resection is recommended as a method of choice, followed by reconstruction of oesophago-intestinal continuity by interposing an excluded jejunal loop.