[Responsibility and development in medical imaging]. / Responsabilité et évolution de l'imagerie médicale.

The recent evolution in medical law, permitting a responsibility without objective fault, underlines obligations in radiology. The radiologist is a doctor, specialist, doing an act of radiodiagnosis of which he is responsible, so much in his decision that in his realisation. This concept is important because of the diversity of technical meanings, and the surgical consequences, realised by the radiologist. The medical fault must be examined by the radiologist, by degrees, according to the different responsibilities. Then, we describe a logical realisation of the radiodiagnosis act. At last, we explored the condition of the complain and jurisdictional followings.

[Rupture of an aneurysm of the internal iliac artery into the primary iliac vein]. / Rupture d'un anévrysme de l'artère hypogastrique dans la veine iliaque primitive.

Authors present a case of spontaneous rupture of internal iliac artery in common iliac venous, and propose a review of cases reported in literature. Abreast of modern imagery and especially computed tomography is able to give a precise diagnosis, but angiography is the Most accurate procedure for detecting arteriovenous fistula and cannot be excluded out of diagnostic approach.

[Bilateral adrenal hemorrhage induced by stress. Radiological diagnosis. Apropos of a case]. / Hémorragie surrénalienne bilatérale par stress. Diagnostic radiologique. A propos d'une observation.

Bilateral hemorrhage of the adrenal gland is a rare disease in adults. Although stress is often said to be the cause, it is rarely observed. The non specific clinical manifestations, and the absence of adrenal insufficiency demonstrate the importance of radiology. The diagnosis is made by ultrasonography and CT scan, which reveals an oval adrenal mass of high density that subsequently decreases in both size and density.

[Mortality in 709 patients with acute myocardial infarct treated in the intensive care unit]. / Die Letalität auf der Intensivbehandlungsstation bei 709 Patienten mit akutem Myokardinfarkt.

To control the quality of our care and to define the potential for lifesaving early intervention in patients with acute myocardial infarction, we analyzed the course of 709 patients (66.4 +/- 10.8 yrs) admitted to the coronary care unit for acute myocardial infarction over a period of 36 months. 77 patients (70.2 +/- 9.3 yrs) died in the coronary care unit, and thus early mortality was 10.9%. Only 8% died from disturbances of cardiac rhythm and 19% from rupture of a ventricle. 73% died in cardiogenic shock, of whom 21 were below 70 years old and represent a potential group for early intervention. In 13 patients of this subgroup possibilities of better management in the pre-hospital phase were found retrospectively. In 5/77 patients the optimal treatment was not achieved during clinical course. Cardiogenic shock is the major cause of death in the early phase of acute myocardial infarction. A further substantial reduction of mortality will be achieved only by reaching more risk patients in the pre-infarction phase and by shortening the pre-hospital phase.

[Role of total parenteral nutrition (TPN) in the treatment of pseudomembranous colitis in surgical patients. Our experience]. / Ruolo della NPT nel trattamento della colite pseudomembranosa nel paziente chirurgico. Nostra esperienza.

The authors describe their experience using TPN (total parenteral nutrition) associated with specific drugs in the treatment of antibiotic-associated pseudomembranous colitis in surgical patients. They discuss the benefits and the possible complications of the above mentioned treatment. Three different cases observed during a three year period are reported; one of these is carefully analysed in order to better explain the methods and procedures used during TPN.

[Lung-term results in patients operated for benign diseases of the common bile ducts]. / Risultati a lungo termine in pazienti operati per affezioni benigne della via biliare principale.

The remote results obtained in the treatment of the benign diseases of the main biliary duct were appraised on a specimen of 47 people operated on at the Surgical Department of the Turin University between 1960 and 1970, subjected to a checking visit at a distance from operation ranging from 12 up to 22 years. The investigation confirmed the impression that in biliary surgery some eventual failures can reach the clinical evidence after many years from operation, and allowed to demonstrate percentages of satisfactory, unsatisfactory and bad results as high as 80,8%, 8,5% and 10,6%, respectively.

[Early ergometry following acute myocardial infarction?]. / Früh-Ergometrie nach akutem Myokardinfarkt?

One hundred and twenty patients underwent a symptom limited submaximal exercise test (SSET) 8-40 days after acute myocardial infarction. No complications occurred during the exercise test. Sixty-two patients (52%) showed a normal SSET. ST-segment depression (greater than or equal to 1 mm) was detected in 21 (17.5%). Dyspnea, fatigue, inadequate blood pressure response and angina pectoris without changes in ST-segments were the end-point in 33 patients (27.5%). Furthermore, significant premature ventricular contractions occurred in four cases (3%) and limited the SSET. An SSET soon after myocardial infarction can be performed without risk. High specificity of ST-segment depression in lead V5 was confirmed by the coronary angiographic findings. Apart from ST-segment depression there were other, more frequent nonspecific end-points of SSET which require further examination regarding their prognostic value.

[Clinical studies on peripheral arteriosclerotic lesions in the Piedmont region]. / Ricerche cliniche sulle lesioni arteriosclerotiche periferiche nella Regione Piemonte.

The assistance of the Piedmont Region calculation centre was obtained in the evaluation and detailed examination of data on all patients admitted to hospitals in the Region for peripheral atherosclerotic arteriopathy during a three-year period. Age, sex, site of lesion, occupation, geographical distribution, and type of treatment employed were all analysed statistically. A difference between age categories in relation to sex was noted for incidence and site of lesions, while occupation was not correlated to the clinical progress of the disease. Regional incidence (for all Piedmont local health units) was both above and below the general average in some areas. It also appeared that the greatest incidence lay along the Alps.

[Clinico-epidemiological study of patients with phlebolymphatic diseases admitted to the hospitals of the Piedmont region 1976-1979. I. Analysis of all phlebolymphatic diseases]. / Studio clinico-epidemiologico sui pazienti affetti da patologie flebolinfatiche ricoverati negli Ospedali della Regione Piemonte nel periodo 1976-1979. Parte I. Analisi delle flebolinfopatie in toto.

In conjunction with the University Calculation Centre and the Piedmont Region, a computerised study was made of all patients (31,514 cases) admitted to Piedmont hospitals for phlebopathy and peripheral lymphopathy, including pulmonary embolism, in the period 1976-79. An account is given of the method used, the material, and the statistical technique. An 18.9% prevalence of women was noted. Occupation, age category, type of pathology, and treatment adopted were assessed for phlebopathies in toto and for each type. The data for each public health unit, divided by age category, were correlated with the general cases for the Region and those for each unit. In this way, it was possible to determine the incidence of phlebopathies in each unit and over the Region as a whole in relation to age. A map of the Region showing areas of higher, lower, and not significantly different from the regional mean hospitalisation (i.e. phlebopathy) was prepared. The significance of the different incidences in the several units is discussed in relation to their populations, geographical location, raye of migration, and types of occupational activity.

[Clinico-epidemiological study of patients with phlebolymphatic diseases admitted to the hospitals of the Piedmont region 1976-1979. II. Analysis of lymphatic diseases and pulmonary embolism]. / Studio clinico-epidemiologico sui pazienti affetti da patologie flebolinfatiche ricoverati negli Ospedali della Regione Piemonte nel periodo 1976-1979. Parte II. Analisi delle linfopatie e delle embolie polmonari.

The second part of this research project looks at two very different pathologies. Pulmonary embolisms are usually emergency admissions, while lymphopathies, and this may well be an incorrect term, usually receive outpatient treatment and are only hospitalised in cases of serious incapacitation. Whereas lymphopathies were so few as to prevent any conclusions being drawn, regional admissions of pulmonary embolism occur every 28 hours and 44 minutes i.e. about 1 case per day. No particular relation between the distribution of pulmonary embolism and geographical area, level of industrialisation or migration was discovered. On the contrary there are few areas with higher figures than the expected regional average and these may be attributed to better medical organisation. Finally it should be emphasised that while cases of pulmonary embolism increase with age, the rise is less substantial than might have been expected.

[Clinico-epidemiologic study of patients with phlebolymphatic diseases admitted to the hospitals of the Piedmont region 1976-1979. III. Analysis of varicose disease]. / Studio clinico-epidemiologico sui pazienti affetti da patologie flebolinfatiche ricoverati negli Ospedali della Regione Piemonte nel periodo 1976-1979. Parte III. Analisi della malattia varicosa.

With the aid of the University and Piedmont Region Computer Centre all cases of varicose admitted to Piedmontese hospitals between 1976 and 1979 were examined. One admission every 1 hour 35 minutes is the regional average. In terms of age there is a numerical prevalence (8526 cases) of the under forty-fives, while in percentage terms, admissions appear to increase in proportion to age. Admissions in age groups to all the individual clinics were correlated with a view to the evaluation of any variations from the regional average, without incidentally confirming these figures. Detailed statistical analysis was employed to correlate the study.

[Clinico-epidemiological study of patients with phlebolymphatic diseases admitted to the hospitals of the Piedmont region 1976-1979. IV. Analysis of thrombophlebitis]. / Studio clinico-epidemiologico sui pazienti affetti da patologie flebolinfatiche ricoverati negli Ospedali della Regione Piemonte nel periodo 1976-1979. Parte IV. Analisi delle tromboflebiti.

In the 1976-79 period, 8040 cases of thrombophlebitis, equivalent to 0.17% of the population, were admitted to Piedmontese hospitals, an average of 1 admission every 4 hours and 3 minutes. The present study revealed a numerical and percentage increase with increasing age. The figures per age group from each individual clinic revealed two large areas in the East and South West of the Region where phlebitis cases were numerically lower than the regional average. In other areas figures were higher than estimated, while still others produced statistically insignificant figures. An interpretation of these results is attempted.

[Peripartum cardiomyopathy]. / Peripartuale Kardiomyopathie.

Peripartum cardiomyopathy is a rare disease of unknown etiology. Its onset is rarely in the last trimester of pregnancy but more often during the first 5 months after delivery. A hemodynamically well documented case from Switzerland with a follow-up period of 6 1/2 years is reported.

[Initial immunologic evaluations in breast and thyroid cancer]. / Prime valutazioni immunologiche nel carcinoma dell mammella e della tiroide.

In evaluating pre- and post-operative immunological status of 15 patients with malignant breast and thyroid tumors and of 9 patients with benign breast and thyroid lesions, rosette E test, CEA, cortisol, immunocomplexes and determination of circulating leukocytes, B lymphocytes and immunoglobulins was employed. The obtained data were not significative to show a lack of immune response in tumor bearing patients. Among the reexamined parameters, CEA was the only one that apparently correlated with prognosis; its serum levels, being at a high rate in a high percentage of malignancies, tended to fall down after surgical treatment.