The "Black Pattern", a Simplified Ultrasound Approach to Non-Traumatic Abdominal Emergencies.

BACKGROUND: A key issue in abdominal US is the assessment of fluid, which is usually anechoic, thus appearing "black". Our approach focuses on searching for fluid in non-traumatic patients, providing a new, simplified method for point-of-care US (POCUS). OBJECTIVE: Fluid assessment is based on a three-step analysis that we can thus summarize. 1. Look for black where it should not be. This means searching for effusions or collections. 2. Check if black is too much. This means evaluating anatomical landmarks where fluid should normally be present but may be abnormally abundant. 3. Look for black that is not clearly black. This means evaluating fluid aspects, whether wholly anechoic or not (suggesting heterogeneous or corpusculated fluid). DISCUSSION: Using this simple method focused on US fluid presence and appearance should help clinicians to make a timely diagnosis. Although our simplified, systematic algorithm of POCUS may identify abnormalities; this usually entails a second-level imaging. An accurate knowledge of the physio-pathological and anatomical ultrasound bases remains essential in applying this algorithm. CONCLUSION: The black pattern approach in non -traumatic emergencies may be applied to a broad spectrum of abnormalities. It may represent a valuable aid for emergency physicians, especially if inexperienced, involved in a variety of non-traumatic scenarios. It may also be a simple and effective teaching aid for US beginners.

Role of osteopontin in breast cancer patients.

AIM AND BACKGROUND: In breast cancer, as in almost all neoplastic diseases, the prognosis is strictly related to the invasive capacity, local and distant, that characterizes the growth of all tumors. Since the mechanisms that regulate replication of the neoplastic cells, with consequent capacity to metastasize, are not completely known, identification of new markers represents the gold standard of research in the stratification of patients with such a pathology. Osteopontin, a specific phosphoglycoprotein isolated from extracellular bone matrix and actively involved in mechanisms of bone reabsorption, appears to play a key role in osteoclastogenesis at the level of the skeleton in some pathologic situations. It has been found that patients with metastatic bone lesions from breast or prostate cancer present, with respect to subjects without repetitive bone lesions, elevated serum levels of the protein, indicating that osteopontin could play an important role in the development and progression of the neoplastic disease at the bone level. METHODS AND STUDY DESIGN: The authors studied 26 patients with breast cancer, evaluating as a marker also serum osteopontin levels. RESULTS AND CONCLUSIONS: The results, although obtained on a small number of patients, showed that osteopontin evaluation in breast cancer patients can be a particularly interesting method of research in staging of the disease as well as in the prognosis, thereby attributing a role of a biotumoral marker also in the follow-up of the therapy.

Volvulus due to a giant sigmoid diverticulum: a rare cause of intestinal occlusion.

The case of a giant sigmoid diverticulum complicated by a volvulus of the bowel is reported. After an exhaustive literature review, the Authors analyse the aetiopathogenetic, physiopathological and clinical aspects of this rare condition, considering its diagnostic and therapeutic implications. The Authors describe surgical problems and therapeutic management, pointing out that without an accurate study by radiological imaging, it is very difficult to diagnose the condition, particularly when no specific symptoms have been observed.

Rare localizations of echinococcosis: personal experience.

BACKGROUND: The rare localizations of hydatidosis represent an interesting topic, especially with reference to epidemiological and diagnostic problems. Hydatid disease, common in Mediterranean countries, still remains endemic in some regions of Italy. METHODS: In the period April 1983-October 2003 73 patients with hydatid disease were observed. RESULTS: Seven patients (9.5%) presented a primary rare localization (thyroid, kidney, sacrospinal muscle, peritoneum and spleen). The main peculiarity of primary rare hydatidosis localizations concerns diffusion of the infecting embryo; the most reliable hypothesis is that liver and lung can be bypassed through precapillary anastomosis between pre- and post-parenchymal circulation. The new imaging techniques allow a correct topographic evaluation and so a radical surgical treatment. The chemotherapy, complementary to surgery, produced degenerative modifications of parasite in 75.8% of the present cases and reduction of recurrence from 23.3% to 6.7%. At follow up of 1-5 years no patients had recurrence. CONCLUSION: It is important to be aware, especially in countries where echinococcosis is endemic, that it is possible to find an echinococcosis cyst in a rare localization.

[Massive hematemesis resulting from stomach rupture caused by pseudoaneurysm of the splenic artery in a patient with chronic pancreatitis. A case report]. / Ematemesi massiva da rottura nello stomaco di pseudo-aneurisma dell'arteria splenica in paziente con pancreatite cronica. Osservazione personale.

The authors report a case of a pancreatic pseudocyst, due to alcoholic chronic pancreatitis, that was transformed into a pseudoaneurysm of the splenic artery as a result of vascular erosion and that manifested itself with massive haematemesis due to spontaneous fistulisation in the stomach. After defining the incidence of the pancreatic disease and of this unusual form of gastric bleeding, particular attention is devoted to the clinical data and to the aetiopathogenic and physiopathological mechanisms involved in the vascular glandular and periglandular damage, outlining the sources and sites of bleeding. The authors go on to discuss the rationale in using imaging techniques, which cannot ignore the haemodynamic conditions of the patient and the conviction that the execution time of a selective coeliac arteriography never represents an unacceptable delay in the management of a life-threatening ruptured pancreatic pseudoaneurysm. This conviction is due both to the therapeutic potential inherent in the method itself and to the greater safety with which the following operation can be performed, owing to the topographical guidance the procedure provides. After a review of the conditions that make the treatment difficult, the authors stress the importance of a certain measure of eclecticism and careful planning to obtain effective and safe results. Only the combined, integrated efforts of the interventional radiologist and the surgeon can ensure rapid stabilisation of the bleeding and the desired improvement in survival.