[Inguinal endometriosis. Case report and review of the literature]. / L'endometriosi inguinale. Case report e revisione della letteratura.

Endometriosis is a common gynaecological condition which affects women during their reproductive years. It is characterized by ectopic endometrial tissue responding to hormonal changes associated with menstrual cycle. Aetiology is unknown and symptoms are quite aspecific (dysmenorrhoea, pelvic pain, infertility or pelvic mass). Ultrasonography (US) and Magnetic Resonance Imaging (MRI) are accurate diagnostic exams but laparoscopy represents the gold standard in diagnosis and therapy (excision or ablation). Medical treatment pre or postoperatively may be useful prolonging the symptom free interval. In this paper we report the case of a young woman affected by an inguinal mass: diagnostic examinations and histological specimen revealed to be an endometrial focus. We review the literature focusing the diagnostic techniques and relationships between endometriosis and ovarian cancer (endometrioid and clear cell subtypes).

High grade phyllodes tumour of the prostate.

A case of malignant variant of prostatic phyllodes tumour in a 61-yr-old man is reported. This is an extremely rare neoplasm that closely resembles the not uncommon tumour of the female breast. Only 18 previous cases have been described. Although an initially benign clinical behavior has been presumed a high probability of local recurrence or aggressive behavior may occur.

Priapism as a complication of heparin therapy.

One case of priapism occurred during heparin therapy for a previous surgical operation to the knee is reported. The association between heparin and priapism is often recognized; abnormal platelet aggregation could play a role in the pathogenesis of this side effect. A part from the kind of surgical treatment performed, priapism as a complication of heparin therapy might be functionally more severe than priapism due to other etiologies. Our observation would confirm this statement.

[The prognostic indicators of a favorable clinical evolution in dilated cardiomyopathy]. / Indicatori prognostici di evoluzione clinica favorevole nella cardiomiopatia dilatativa.

Improvement in cardiac function and clinical status has been described in subgroups of patients with dilated cardiomyopathy (DCM), but predictors of favourable outcome have not been unequivocally established. In 33 patients with DCM followed up for a mean of 23 months (range 3-68) a full non-invasive and invasive diagnostic work-up, including endomyocardial biopsy, was performed. At the end of the follow-up, 13 patients (39%; Group A) showed a significant improvement in their clinical status (> or = 1 gain in NYHA functional class) and cardiac function (> 0.10 increase in echocardiographic ejection fraction), while 20 (61%; Group B) either stabilized or deteriorated (5 died and 4 underwent successful heart transplantation). Clinical, hemodynamic and morphometric data of the 2 groups were compared. Only lower systemic vascular resistance (Group A 2,836 +/- 637 versus Group B 3,637 +/- 1113; p = 0.025) and higher prevalence of alcohol intake > 80 g/day (Group A 85% versus Group B 40%; p = 0.03) were significantly associated with improvement. Discriminant analysis utilizing these 2 variables along with cardiac index, mitral regurgitation, pulmonary resistance and cardiothoracic ratio reached a discriminant power of 72% (p = 0.0014). The above results suggest that, in our series, relatively simple data provide the most accurate assessment of prognosis. Yet, prediction of favourable versus unfavourable outcome remains uncertain, since an incorrect prognosis will be made in 28% of cases. Morphometric analysis of endomyocardial bioptic specimens does not provide significant prognostic information. The identification of a high alcohol intake has a clinical relevance, since abstention from alcoholic beverages is significantly associated with a favourable outcome in our patients.

[Echographic features of urachal cysts]. / Aspetti ecografici delle cisti uracali.

The authors discuss the anatomical, clinical, and US patterns of 5 cases of urachal cysts observed in pediatric patients (average age: 9.2 months) over the last 4 years. All cases had surgical confirmation. Linear and convex probes with 3.75, 5, and 7.5 MHz frequency were employed. Most of the observed lesions were oval in shape, their size ranging 3-6 cm; they were found in ventral-epivesical regions and had no mobility. Liquid echotexture with hyperechoic deposits on the lower layers was observed in 2 cases, and inhomogeneous solid or complex mass-like echotexture in 3 cases (suppurated cysts). Differential diagnosis includes mesenteric cyst, simple and teratomatous ovarian cyst, bladder diverticulum and hydrometrocolpos. Echotomography exhibited high accuracy in detecting this kind of lesion and allowed guidance of percutaneous drainage for the preoperative treatment of infected cysts. Both cystography and CT appeared to be useless.

[Renovascular hypertension in childhood]. / Ipertensione reno-vascolare in età pediatrica.

One to two per cent of children and up to 11% of adolescent have arterial hypertension. In most cases children and adolescent are not recognized to be hypertensive because physicians do not routinely measure blood pressure. Often the diagnosis is recognized only when the pediatric patients develop a complication: seizure, stroke, heart failure or paraplegia. Renovascular hypertension in children and adolescents is more common than all of the other causes combined, except for coarctation of the aorta. The diagnosis is not so easy and includes the usual history, physical examination (signs and symptoms of coarctation of the isthmic or abdominal aorta or of an abdominal mass or of one of the adrenal causes of hypertension), laboratory studies, abdominal ultrasound study and chest x-ray. Sometime a CAT can be usefull. The next steps are the early and rapid-sequence IVP, renal angiography and peripheral and renal renin activity. The management of renovascular hypertension in children and adolescent includes a conservative approach (percutaneous transluminal renal angioplasty or renal embolization), rarely used in pediatric age, and the surgical treatment. This latter includes all the surgical procedures of renal revascularization and, in unilateral renal parenchymal diseases, the nephrectomy or a partial nephrectomy. The postoperative results are very good in a high percentage of cases. In bilateral cases, the revascularization surgical procedures improve or normalize also the impaired renal function.

[Diagnostic aspects of aneurysm of the splenic artery (description of a case)]. / Aspetti diagnostici dell'aneurisma dell'arteria splenica (descrizione di un caso).

A case of splenic artery aneurysm with ultrasonic examination discovered is reported and analyzed. The aneurysm pas asymptomatic and founded as incidental finding during standard x-ray. Arteriography was required to confirm the diagnosis and indicate the correct surgical treatment.

[Primary carcinoma of the gallbladder: ultrasonic features (remarks on 8 cases)]. / Il carcinoma primitivo della colecisti: aspetti ecotomografici (considerazioni su otto casi).

The authors illustrate the ultrasound features of gallbladder carcinoma after reviewing literature and basing upon their own experience. The diagnosis of this neoplasia is formulated more frequently today by introduction of scanning means, but it remains very difficult on initial phase because of its precocious lymphatic and hilar infiltration.

[Epidemiology and monitoring of closed abdominal injuries]. / Epidemiologia e monitoraggio dei traumi addominali chiusi.

The authors review the epidemiological and aetiopathogenetic characteristics of abdominal blunt injuries (118 cases) monitored in a homogeneous manner. The relatively young age of the patients, the diagnostic difficulties encountered and the frequent presence of associated lesions call for the rigorous application of a predetermined clinico-diagnostic protocol.

[Ductal adenoma of the breast: correlations between clinico-radiologic and histo-pathologic aspects (considerations on a case)]. / L'adenoma duttale della mammella: correlazioni tra aspetti clinico-radiologici ed isto-patologici (considerazioni su di un caso).

The authors report on a case of ductal adenoma of the breast, pointing out that routine clinico-instrumental diagnostic signs, though suggesting a picture of malignancy, may actually relate to this rare benign form of tumor. In the presence of cases of this type, we therefore advise a cautions approach to surgery, in that oncological radicality is subordinate to confirmation in the form of a traditional histological preparation, as freezer examinations are unable to provide wholly reliable responses.