Trend in predictive factors of choledocholithiasis: the key to the management of pediatric patients with suspected gallstones. / Tendencia en los factores predictivos de coledocolitiasis: la clave para el manejo de pacientes pediátricos con sospecha de cálculos en la vía biliar.

OBJECTIVES: To reduce the overuse of magnetic resonance cholangiopancreatography and the rates of non-therapeutic endoscopic retrograde cholangiopancreatography in pediatric patients suspected of choledocholithiasis. MATERIALS AND METHODS: Retrospective study of patients suspected of choledocholithiasis between January 2010 and June 2023. Patients with cholangitis or two or more of the following predictive factors of choledocholithiasis in initial laboratory tests and ultrasound were categorized as high-risk group: total bilirubin level ≥ 2 mg/dl, common bile duct > 6 millimeters on ultrasound; and detection of choledocholithiasis by ultrasound. Patients were recategorized according to the results of the second set of laboratory and ultrasound analysis. Confirmatory modalities (magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, and/or intraoperative cholangiography) were used to evaluate the presence of choledocholithiasis. Finally, we assessed the predictive capability of both the initial high-risk group and the group after recategorization. RESULTS: A total of 129 patients were included. After initial studies, 72 (55.8%) patients were classified into the high-risk group. After recategorization, only 29 (22.5%) patients were included in this group. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of the initial high-risk group were 89.3%, 53.5%, 34.7%, 94.7%, and 61.2%, respectively, while after recategorization, they were 82.1%, 94.1%, 79.3%, 95.0%, and 91.5%, respectively. CONCLUSIONS: Recategorization of the risk of choledocholithiasis would significantly improve the diagnostic accuracy of choledocholithiasis and help reduce the overuse of more complex and unnecessary studies/procedures.

OBJETIVOS: Disminuir la sobre indicación de la colangiorresonancia y las tasas de colangiopancreatografía retrógrada endoscópica o terapéuticas en pacientes pediátricos con sospecha de coledocolitiasis. MATERIAL Y METODOS: Estudio retrospectivo de pacientes con sospecha de coledocolitiasis entre enero de 2010 y junio de 2023. Los pacientes con colangitis o dos o más de los siguientes factores predictivos de coledocolitiasis en las pruebas de laboratorio y ecografía iniciales, se categorizaron como grupo de alto riesgo: nivel de bilirrubina total ≥ 2 mg/dl, colédoco > 6 milímetros en ecografía; y la detección de coledocolitiasis por ecografía. Los pacientes fueron recategorizados de acuerdo a los resultados del segundo conjunto de análisis de laboratorio y ecografía. Para evaluar la presencia de coledocolitiasis se utilizaron modalidades confirmatorias (colangiorresonancia, colangiopancreatografía retrógrada endoscópica y/o colangiografía intraoperatoria). Finalmente, evaluamos la capacidad predictiva tanto del grupo de alto riesgo inicial como del grupo después de la recategorización. RESULTADOS: Se incluyeron 129 pacientes. Luego de los estudios iniciales, 72 (55,8%) pacientes se clasificaron en el grupo de alto riesgo. Luego de la recategorización, solo 29 (22,5%) pacientes fueron incluidos dentro de este grupo. La sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y precisión diagnóstica del grupo de alto riesgo inicial fueron de 89,3%, 53,5%, 34,7%, 94,7% y 61,2%, mientras que luego de la recategorización fueron de 82,1%, 94,1%, 79,3%, 95,0% y 91,5%, respectivamente. CONCLUSIONES: La recategorización del riesgo de coledocolitiasis, mejoraría significativamente la precisión diagnóstica de coledocolitiasis y ayudaría a disminuir la sobre indicación de estudios/procedimientos complejos e innecesarios.

[Assessment of the modification of the clinical, endocrinal and metabolical profile of patients with PCOS syndrome treated with myo-inositol]. / Valutazione delle modificazioni del profilo clinico, endocrino e metabolico di pazienti con sindrome dell'ovaio policistico in trattamento con mio-inositolo.

AIM: Aim of the study was to evaluate the effects of 24 weeks administration of myo-inositol plus folic acid (Inofert ®) on clinical, endocrine and metabolic parameters of polycystic ovary syndrome (PCOS) patients. METHODS: Seventy women, 18 to 35 years, were enrolled; 35 patients were enrolled as study group and treated with Inofert ® (200 µg folic acid plus myo-inositol 2 g per day) for 24 weeks. The other 35 patients, similar at baseline to patients in the study group, were enrolled as control group and received no treatment. In all patients the restoration of ovulation and variations of the endocrine and metabolic profile after treatment were assessed. RESULTS: After 24 weeks, only five of 35 patients treated with Inofert® and 14 of 35 patients in the control group remained anovulatory and this difference was statistically significant. Body mass index decreased significantly in the study group, while a non-significant increasing was recorded in the control group. Moreover, non-significant reduction in circulating levels of LDL, and a statistically significant increase in the levels of HDL in the study group were observed. CONCLUSION: Treatment with Inofert® allows to restore rapidly spontaneous ovulation in amenorrheic patients with PCOS and shows a significant advantage in terms of reduction in BMI and a positive trend in terms of changes in serum lipid profile.

Gastroschisis: deferred closure with releasing incisions. A case report. / Gastrosquisis: cierre diferido con incisiones de descarga. Reporte de caso.

Primary defect closure is the surgical treatment of choice in gastroschisis. When this is not feasible, a silo is required to progressively reduce the organs and perform a deferred closure of the wall. We present the case of a newborn with gastroschisis that required the use of a silo. Once the silo had been created, the distance between borders did not allow the defect to be closed, so decision was made to conduct releasing aponeurotic incisions for mobilization purposes.Progression was uneventful, and enteral nutrition was initiated at 24 days of life. Total enteral total nutrition was achieved at 40 days of life. He received parenteral nutrition for 36 days. He was discharged at 59 days of life. Abdominal wall treatment through releasing incisions allows prostheses to be avoided and represents an alternative for these patients.

El tratamiento quirúrgico de referencia en la gastrosquisis es el cierre primario del defecto. En los casos en que esto no es posible es necesario confeccionar un silo para reducir progresivamente las vísceras y realizar así el cierre diferido de la pared. Presentamos el caso de un recién nacido con gastrosquisis, que luego de confeccionar un silo, la distancia entre los bordes no permitía cerrar el defecto, por lo que se decidió realizar incisiones de descargas aponeuróticas para movilizar los mismos. El paciente evolucionó sin complicaciones, iniciando alimentación enteral a los 24 días de vida, alcanzando el aporte enteral total a los 40 días de vida. Recibió nutrición parenteral durante 36 días. Fue dado de alta a los 59 días. El tratamiento de la pared abdominal mediante incisiones de descarga permite evitar el uso de prótesis y agrega otra alternativa para el tratamiento de estos pacientes.

Gallbladder polyps ultrasound: what the sonographer needs to know.

Gallbladder polyps are protuberances of the gallbladder wall projecting into the lumen. They are usually incidentally found during abdominal sonography or diagnosed on histopathology of a surgery specimen, with an estimated prevalence of up to 9.5% of patients. Gallbladder polyps are not mobile and do not demonstrate posterior acoustic shadowing; they may be sessile or pedunculated. Gallbladder polyps may be divided into pseudopolyps and true polyps. Pseudopolyps are benign and include cholesterolosis, cholesterinic polyps, inflammatory polyps, and localised adenomyomatosis. True gallbladder polyps can be benign or malignant. Benign polyps are most commonly adenomas, while malignant polyps are adenocarcinomas and metastases. There are also rare types of benign and malignant true gallbladder polyps, including mesenchymal tumours and lymphomas. Ultrasound is the first-choice imaging method for the diagnosis of gallbladder polyps, representing an indispensable tool for ensuring appropriate management. It enables limitation of secondary level investigations and avoidance of unnecessary cholecystectomies.

Cerebral organization for language in Down's syndrome patients.

Language lateralization was assessed with a dual task procedure in 10 male right-handed patients with Down's Syndrome and relatively preserved linguistic skills. Their performance was compared with that of two control groups, with and without mental retardation, matched with Down's Syndrome individuals for sex, handedness and I.Q. Results did not support the hypothesis that mental retardation is related to specific pattern of cerebral lateralization.

Coeliac disease and autoimmune cholangitis: a case report.

Autoimmune cholangitis can be associated with other autoimmune disorders. The case is described of a 58-ear-old female who developed severe microcytic anaemia resistant to oral iron treatment. Evaluation of the patient led to the diagnosis of coeliac disease, a rarely described association. Gluten-free diet and treatment with oral haematinics led to reversal of the anaemia.

Metastasis to the male breast from carcinoma of the urinary bladder.

We report a case of male breast metastasis from a urothelial carcinoma. Only two cases of this type of metastasis have been previously reported, and these were in the female breast. Clinical examination showed a progressive swelling of the left mammary region, with periareolar skin infiltration. Both mammography and ultrasound showed a rounded mass. Only histological examination with immunohistochemical staining permitted the correct diagnosis to be made. A particular feature of the present case is the absence of contralateral gynaecomastia, normally seen in cases of metastatic tumour to the breast from prostatic carcinoma.

Endocrine and morphological study of a case of ovarian sex-cord tumor with annular tubules in a woman with Peutz-Jeghers syndrome.

A bilateral ovarian sex-cord tumor with annular tubules (SCTAT) was incidentally discovered in an amenorrheic patient with Peutz-Jeghers syndrome during conservative surgery in which a small non-capsulated mass was removed from each ovary. Ovulation was then induced over two consecutive cycles with urinary gonadotropins; the couple did not conceive because of a male infertility factor. Hysterectomy and bilateral oophorectomy were performed to prevent recurrence and avoid the possibility of a cervical malignant adenoma. Immunohistochemistry of the SCTAT showed positivity for estradiol and testosterone similar to that of Sertoli and granulosa cell tumors; progesterone was not detected in any cellular component of the neoplasia. Electron microscopy showed that the neoplasm consisted of numerous solid cords of cells surrounded by fibrillary layers of basal lamina, as well as central hyaline bodies. Two types of cells, clear and dark, were noted; clear cells were predominant and intermixed with scattered dark cells. No crystalloids or Charchot-Bottcher filaments were detectable in the tumors.

Individual differences in cerebral organization: influence of sex and familial sinistrality in the language lateralization of strongly right-handed subjects.

Sixty right-handed subjects, divided into four groups of 15 according to sex and familial sinistrality (FS), performed a test of language lateralization. A verbal-manual dual-task paradigm was employed. Results suggest that the pattern of cerebral organization may differ among right-handers in relation to both sex and FS. However, it is not merely the separate influence of these two factors, but rather their interaction which determines the pattern. It is stressed that identification of individual predictors of language laterality may provide some information on prognosis and management of aphasic patients.

[Borderline ovarian tumors. Retrospective analysis of 20 cases]. / Tumori ovarici borderline. Analisi retrospettiva di 20 casi.

BACKGROUND: To evaluate the clinical features, the surgical management and outcome of 20 patients with stage-I borderline ovarian tumors. METHODS: Twenty cases of FIGO stage-I ovarian tumors, aged from 31 to 58 years (mean 37 years) have been reviewed. All informations of clinical stage, surgical intervention and prognosis were achieved by reviewing hospital records. Minimal requirements for conservative management were adequate staging and complete information about the therapeutic options. Factors important in the choice of the treatment were, age, wish to preserve fertility, histologic type and grade, and the stage of the tumour. RESULTS: Eleven of the 20 patients (55%) were at stage IA, 6 cases (30%) were at stage IB, 3 cases (15%) were at stage IC. Thirteen (65%) were with mucinous cystadenoma of borderline malignancy, 7 cases (35%) were of serous type. Thirteen patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH and BSO). Seven patients were treated with unilateral oophorectomy or unilateral salpingo-oophorectomy (USO). One patient underwent enucleation of ovarian tumor and biopsy of contralateral ovary. Any patient were treated with chemotherapy after operation. With a median follow up of two years, we observed no recurrence of carcinoma in women treated conservatively or in those treated more radically. CONCLUSIONS: Conservative surgery remains a therapeutic option in selected patients with borderline ovarian tumors. Prolonged intensive follow-up is required for women treated conservatively for borderline malignant ovarian tumours.

[Ovarian cysts in adolescence: epidemiologic, clinical and management assessment]. / Cisti ovariche in età adolescenziale: valutazione epidemiologica, clinica e strumentale.

BACKGROUND: To evaluate the frequency of ovarian cyst formation in the adolescents and to report on the clinical implications of these cysts. METHODS: A prospective analysis of data on 94 girls (aged 10-19) with diagnosed ovarian cysts was performed at the Gynecology Department of Aversa and Naples hospitals between 1995-2000. Operations were performed because of pains or ultrasound suspected features. The patients who were not operated on were kept under observation and had ultrasound tests monthly, receiving gestogen to facilitate resolution of the cyst and as treatment of menstrual disorders. The site, number, size and type of the cysts were examined. RESULTS: The ovarian cysts were unilateral, unilocular, and simple, with the size varying between 3 cm and 5 cm in 83 cases, more than 5 cm in 8 cases and less than 3 cm in 3 cases. Among 94 patients 6 (6.4%) were initially qualified for the operation because of the strong pains or ultrasound equivocal aspect. Hormonal treatment was given in 74 cases, whereas in 14 cases only follow up sonography was performed. Cysts resolved spontaneously in 2 months on average, or in 1 month after hormonal treatment. No malignant tumors were found in the observed group. CONCLUSIONS: Clinical observation periodically repeated ultrasound tests seems to be the most appropriate procedure employed at adolescent girls with asymptomatic ovarian cysts. Hormonal treatment shortened the duration of the cysts somewhat, even if in a not significant manner, and thus was useful mainly in the treatment of concomitant menstrual disorders.

134Cs and 85Sr in fruit plants following wet aerial deposition.

The knowledge of processes concerning the radiocontamination of fruit after a spike release can improve the understanding of exposure through ingestion of food and better assess the public dose. The fate of 134Cs and 85Sr in the above ground part of different species of fruit plants after wet deposition on leaves or on fruits was compared. Grapevines, apple trees, and pear trees grown under field conditions were contaminated with 134Cs and 85Sr either via leaves or via fruits before ripening. Spiked and non-spiked fruits and leaves were picked 50 d later, at harvest time, and their 134Cs and 85Sr contents were measured by gamma spectrometry. The residual fraction in leaves was on average 7% of the initially applied 134Cs and 8% of 85Sr, while that in fruits was 60% of 134Cs and 28% of 85Sr. Rinsing of fruits before consumption causes a loss of 24% for 134Cs and 36% for 85Sr present in fruit at harvest. Leaf-to-fruit transfer factors are considerably higher for 134Cs, 4% of the applied activity, than for 85Sr, 0.04%. Leaf-to-leaf are also higher on average for 134Cs than for 85Sr. Transfer also occurs from spiked fruits to leaves; its extent is affected more by the kind of plant than by the radionuclide. 134Cs and 85Sr are transferred to fruits and leaves of non-contaminated branches to a lesser extent than within the contaminated branches.

Pitfalls of contrast-enhanced ultrasound (CEUS) in the diagnosis of splenic sarcoidosis.

By observing the real-time behavior of focal liver lesions at three vascular phases (arterial, portal-venous, and late), contrast-enhanced ultrasound (CEUS) has been successfully applied to differentiate benign from malignant hepatic nodules. In recent years, numerous studies highlighted the usefulness of CEUS also for other applications such as abdominal trauma, renal, pancreatic, thyroid, and inflammatory bowel diseases, supporting its role even in differentiating benign from malignant splenic nodules. Therefore, the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) recently updated the guidelines for the use of ultrasound contrast agents in clinical practice, pointing out the indication to characterize splenic parenchymal inhomogeneity or suspected lesions found on conventional ultrasound (BUS). We describe the case of a patient with a history of colon cancer and finding, at BUS and CEUS, of hypoechoic lesions with a highly suggestive pattern for metastases, subsequently histologically proved to be splenic localizations of a benign and multisystemic granulomatous disease such as sarcoidosis. We therefore reviewed the current literature focusing on the role of CEUS in differentiating benign from malignant splenic lesions, emphasizing on the lack of data and numerical shortage of sarcoidosis derived-lesions in the available studies. We conclude that sarcoidosis remains a diagnosis of exclusion and new studies are needed before defining precise indications of CEUS in these patients.

Large resection and reconstruction of primary parietal thoracic sarcoma: a multidisciplinary approach on 11 patients at minimum 2-years follow-up.

BACKGROUND: Thoracic sarcomas are rare, and resection can leave behind defects that require significant reconstruction by the multidisciplinary surgical team. The aim of this study is to review the experience of our regional referral centre with primary thoracic tumor resection and thoracic reconstruction. METHODS: We have reviewed the treatment of all chest wall tumors resected at Sir Charles Gairdner Hospital in Western Australia over a 5-year period. There were 11 cases in total that involved removal of deep muscle, ribs and/or sternum. RESULTS: In the six cases that required bony resection, the surgical team utilized a Gore-Tex (e-PTFE) mesh prosthesis to allow immediate closure of the defect, whilst five other closures were achievable using primary layered closure alone. Four patients had postoperative complications, including one who required prosthesis removal. Mean length of hospital stay was 5 days. No 30-day or 6-month mortality was recorded. All patients were followed-up for a minimum of 24 months, and all patients were alive and free of disease at their most recent follow-up. CONCLUSIONS: This study concurs with previous literature indicating that thoracic tumor resection and immediate reconstruction often involving use of prosthetic mesh is a safe and effective one stage surgical procedure for a variety of chest wall defects with low postoperative morbidity.

Traumatic anterior glenohumeral instability: quantification of glenoid bone loss by spiral CT.

PURPOSE: We evaluated the role of computed tomography (CT) for quantifying glenoid bone defects in patients with anterior glenohumeral instability and assisting in planning the most appropriate type of surgery. MATERIALS AND METHODS: From January to November 2006, 93 patients were studied by spiral CT with multiplanar reconstructions (MPR) for recurrent posttraumatic anteroinferior instability, chronic multidirectional instability and recurrent glenohumeral dislocation after surgical stabilisation. RESULTS: Quantitative CT enabled us to measure bone defects of the anteroinferior glenoid in terms of area (mm(2)) or surface percentage. Glenoid osseous defects were classified as small (<15%), medium (15%-20%), and large (>20%). CONCLUSIONS: CT quantification of glenoid bone loss is very accurate as well as rapid, simple and easily reproducible. CT therefore provides an important contribution to preoperative selection of patients, assisting in directing those with <20% bone loss towards arthroscopic capsular repair.