[Spontaneous pneumoperitoneum: a case secondary to thoracic trauma]. / Pneumoperitoneo spontaneo: presentazione di un caso secondario a trauma toracico.

Spontaneous pneumoperitoneum is the radiographic manifestation of free air in the peritoneal cavity without visceral perforations and peritoneal signs, and it occurs in about 10% of the cases of pneumoperitoneum. The etiology can be postoperative, thoracic, abdominal, gynecologic, idiopathic; it generally introduces a benign evolution and does not require surgical treatment but just a conservative approach. The authors describe here a case of spontaneous pneumoperitoneum secondary to thoracic trauma. This case is interesting for the occurrence of pneumoperitoneum without clinical peritoneal signs such as fever and leucocytosis, after closed thoracic trauma in absence of pneumothoracic and pneumomediastinum. Correct clinical approach has allowed a conservative treatment avoiding an useless laparotomy.

[Ectopic thyroid: report of a case]. / Tiroide ectopica: a proposito di un caso clinico.

The development of thyroid tissue can occur in any moment of the migration of the thyroid along the thyroglossal duct from the tongue, resulting in lingual (at tongue base), sublingual (below the tongue), prelaryngeal (in front of the larynx), and substernal (in the mediastinum) ectopy. Thyroglossal duct cyst is the most common type of clinical abnormality related to thyroid ectopy. Surgical removal of such ectopic tissue is justified since some Authors describe thyroid cancer arising from aberrant thyroid tissue. The Authors report a case of thyroid ectopy in a patient who underwent 20 years before a left thyroid resection with isthmectomy; during the operation the surgeon described a hypertrophic pyramidal lobe which was left in situ and the patients did not receive any hormone suppressing therapy.

[Rubber band ligation of hemorrhoids. 5-year follow-up]. / Legatura elastica delle emorroidi. Follow-up a cinque anni.

The Authors quickly reviewing the various surgical ambulatorial methods of hemorrhoids, considered the rubber band ligation, technique. The purpose of this study is that to define the real advantages of the before said technique through the analysis of the cases operated. From December 1992 through 1997 100 patient with hemorrhoids were observed. Of these, 37 have been submitted to rubber band ligation, for a total of 135 bindings. In 26 cases (86%) the Authors observed disappearance of the bleeding and the local troubles. In eight patients complete reduction of the mucous prolapse was obtained. Two patient have continued to complain even if with small intensity, the subjective symptoms, that induced the Authors recommend surgical therapy. The last two patients have been submitted with success to hemorrhoidectomy and reduction of the concomitant prolapse. The advantages of the rubber band ligation are indisputable: it offers the possibility of a definitive, ambulatorial with least risk solution to without necessity of hospitalisation and anesthesia, repeatable in the time and with an overall percentage of complications (0.4%) inferior to that of the surgical hemorrhoidectomy.

[Diagnosis and treatment of epigastric hernia. Analysis of our experience]. / Diagnosi e terapia delle ernie epigastriche. Analisi della nostra esperienza.

BACKGROUND: Epigastric hernias are 0.35-1.5% of abdominal hernias and 8% of midline ones. They are often of small dimensions (15-25 mm) but voluminous epigastric hernias (5-10 cm) may occur. In these cases the sac may contain epiploic appendages or viscera (ileum loops, stomach). 20% of epigastric hernias are multiple: for this reason we must consider the integrity of the whole linea alba. Ultrasound scan, showing a 100% sensibility towards this pathology, is extremely effective to achieve this aim. METHODS: We have reviewed our experience since 1989 analysing the clinical, diagnostical and therapeutical aspects and pointing out the not too distinct symptomatology of epigastric hernias, including those complicated by incarceration. We always carry out surgical correction of epigastric hernias in general anaesthesia and open the peritoneal sac in order to loosen possible adhesions. We have employed a properitoneal MESH (polypropylene) only in voluminous hernias. RESULTS: In a two years follow-up in 79% of patients, no recurrences have been observed. CONCLUSIONS: The surgical correction of epigastric hernias does not always need a prosthesis, but it may be a simple direct reconstruction as long as the suture is carried out in the correct direction depending on the dimensions of the hernial porta. On the other hand, recurring epigastric hernias and voluminous hernias, multiple or isolated, can be corrected with a polypropylene MESH placed in the properitoneal area.

[An expert clinical diagnosis system for the support of the primary consultation]. / Sistema experto de diagnóstico clínico para el apoyo de la primera consulta.

In Brazil, as in other Latin American countries, there was a sharp increase in the number of medical schools in the past 20 years. The result was a steep increase in the number of physicians. These professionals are in many cases, however, poorly trained. As a consequence, public, as well as private health services, are exposed to professionals of great diversity of qualification. Few effective solutions have been proposed for this health services management problem. This paper presents a potential solution. It exposes preliminary results of field tests of an Expert System based on the first author's (Rozenbojm) three decades of experiences as a clinician, and medical residency advisor. The system was developed using ESE IBM Expert Systems language and a mainframe hardware. It was designed to support diagnosis based only in anamnesis and physical examination data, without lab or X ray support. Its original purpose was to increase the primary care physician's diagnostic and therapeutic accuracy. An initial test with specialist panels (endocrinology, cardiology, nephrology, G.O., gastroenterology, pediatrics and pneumology) revealed spell out a diagnostic and therapeutic concordance rate over 95 percent (based on real everyday practice cases brought by the specialists). A second test was performed in a private Health Care Network, at primary care level. In this case, concordance rate was over 83 percent in diagnostic aspects and 95 percent in the clinical orientation aspects. This expert system may be very useful for Health Services providing, first encounter standardization, medical graduate basic education and cost containment. The next proposed steps includes transcription of the software for personal computer utilization and an evaluation of its economic impacts.

Technetium-99m DADS complexes as renal function and imaging agents: II. Biological comparison with iodine-131 hippuran.

To find a 99mTc agent with a high renal extraction efficiency similar to [131]hippuran, 21 analogs of DADS were labeled and evaluated. Preliminary screening by serial gamma camera imaging in rabbits showed that most analogs had a higher liver uptake and/or slower renal clearance, than hippuran. Three agents (P-DADS, AP-DADS, and CAP-DADS), exhibiting a relatively rapid blood clearance and lower liver uptake in the rabbit, were studied in greater detail in comparison with hippuran and CO2-DADS-A, the best analog to date. In the rat, the plasma clearance of the four DADS analogs was slower than that of hippuran. In rats with tubular damage induced by cisplatin, the difference in renal retention at 1 hr compared to controls was much greater with hippuran than with the DADS compounds. In the dog, there was marked hepatic retention of the four DADS compounds. In volunteers, serial posterior images obtained with these [99mTc]DADS complexes showed significant hepatic as well as renal activity. The 1-hr plasma clearance and urinary excretion were much lower than with simultaneously injected hippuran. Although these 99mTc agents are satisfactory for imaging the kidneys, they closely mimic the biodistribution of hippuran only in the rabbit, and not in the rat, dog, or man.

N,N'-bis(S-benzoylmercaptoacetamido) ethylenediamine and propylenediamine ligands as renal function imaging agents. I. Alternate synthetic methods.

A new method was developed to synthesize tetradentate ligands containing the N,N'-bis(S- benzoylmercaptoacetyl ) ethylenediamine and propylenediamine moieties (DADS compounds). Methods are also represented with which to synthesize some of the positional isomers of the above compounds. These isomers represent a new class of compounds. A total of 21 different compounds were prepared. These will be used in an effort to establish a relationship between structure and renal imaging properties.

New diphosphonate compounds for skeletal imaging: comparison with methylene diphosphonate.

Three-hour biodistribution of Tc-99m complexes of six diphosphonates was compared in rabbits with tibial lesions to determine which was best for detection of focal bone lesions. Sr-85 was used as a standard. N,N-dimethylaminomethylene diphosphonate (DMAD) was the only agent with a higher lesion/normal bone ratio than methylene diphosphonate (MDP), attributable to lower concentration in normal bone. Hydroxymethane diphosphonate (HDP) and 2,3-dicarboxypropane-1, 1-diphosphonate (DPD) demonstrated higher concentration than MDP in normal bone without improving lesion contrast. They also exhibited much higher uptake in the liver and kidney, as well as muscle and red marrow in the case of DPD. None was superior to MDP as an all-purpose skeletal agent, though others may be better for specific applications.