Simple and complicated acute appendicitis. Indications for a correct diagnosis.

BACKGROUND: In this retrospective investigation the symptoms, signs, and laboratory findings collected in 2 groups of patients with simple and complicated acute appendicitis, respectively, have been observed in order to give some indication for a correct diagnosis and surgical treatment. METHODS: A total of 103 consecutive patients affected by simple and complicated acute appendicitis submitted to surgical operation have been studied. RESULTS: Data collected show statistically significant differences between clinical presentation of simple and complicated acute appendicitis. CONCLUSIONS: The conclusion is draws in that anamnesis and clinical examination of the patients affected by acute appendicitis are the best indications for an exact diagnosis and to select patients who need an immediate operation.

[Peritonitis caused by jejunal perforation resulting from metastasis of pulmonary carcinoma]. / Peritonite da perforazione digiunale di metastasi da carcinoma polmonare.

The Authors report a case of peritonitis due to perforation of a single small bowel metastasis in a woman affected by right upper lobar lung carcinoma still with neck's lymphnodes and cerebellar metastasis. They underline the rarity of the finding and analyze its clinical, therapeutic, prognostic problems.

[A case of a urachal fistula]. / Su di un caso di fistola dell'uraco.

The authors report a case of urachal fistula diagnosed after repeated omphalitis, this disease was associated with coronal hypospadias. Diagnosis was done thanks to a fistulography; subsequently, during the operation, to evidence the fistula, this was injected with methylene blue, this expedient showed that the fistula was longer than that disclosed from fistulography. To carry out a complete extirpation of the fistula the authors were bound to make a cystotomy. The course after operation was good and the patient discharged after a few days. After 5 years the patient is in perfect health. This case allowed some anatomic, clinical and semeiotic considerations.

[Role of the total and prolonged diversion of portal blood on hepatic function in the rat]. / Ruolo della derivazione totale e protratta del sangue portale sulla funzionalita' epatica nel ratto.

In this experience the effect on hepatic parenchyma and function has been analyzed 180 days after total portacaval shunt. The portacaval shunt induces 50% mortality rate at six months. In the survived animals a significant reduction of hepatic mass has been observed. The liver still presents significant elevation of necrosis and cholestasis enzymes. The residual hepatocellular function related to hepatic mass is comparable to sham operated rats, but it is quite insufficient to maintain endogenous clearances.

A longitudinal study of pelvic inflammatory disease.

OBJECTIVE: To study the microbiology and long term prognosis of pelvic inflammatory disease (PID). DESIGN: A prospective study of women with laparoscopically confirmed PID. SETTING: Teaching hospital in central London. SUBJECTS: 23 women with PID. OUTCOME MEASURES: Microbiological investigations at the time of diagnosis and at follow up; subsequent fertility and the occurrence of pelvic pain. RESULTS: PID diagnosed by laparoscopy was regarded as moderate to severe in 15 cases. Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum or a combination of these micro-organisms were detected most frequently in the cervix, less often in the endometrium and least in the tubes, C. trachomatis being the micro-organism found most commonly in the tubes. There was serological evidence of acute chlamydial infection in 13 of 20 cases in which paired sera were available and a serological response to M. hominis in 9 of 12 cases in which it was possible to evaluate the results. On the basis of microbiological and serological results, C. trachomatis appeared to be the most important aetiological agent in 10 cases, N. gonorrhoeae in four cases, M. hominis in three cases and U. urealyticum in none; in five cases, two of these micro-organisms appeared to be of equal importance. After 1 to 3 years, 33% of the women were having difficulty conceiving and 56% continued to complain of pelvic pain. CONCLUSION: It is difficult to be certain of the infectious cause of PID in any given case. However, the evidence that N. gonorrhoeae and C. trachomatis are pathogens is very strong. M. hominis may be responsible for a few cases on its own or together with other micro-organisms.