Ultrasound transmission gel as a bolus device for skin irradiation of irregular surfaces: technical note.

PURPOSE: This paper describes an uncommon radiation treatment of the external ear, with ultrasound (US) transmission gel used as bolus device to compensate for the irregularity of the target surface. MATERIALS AND METHODS: Postoperative radiotherapy for cutaneous carcinoma was performed with a single high-energy electron beam directed over the ear auricle. Due to the irregular surface of the target, a "missing tissue" compensator was employed. Daily, after patient positioning, the concha was filled and flattened with US gel, and a dose of 54 Gy in 27 fractions was delivered. RESULTS: Water equivalence of the gel was verified by comparing the gel's computed tomography (CT) number [Hounsfield units (HU)] and density with the corresponding values for water and another commercial bolus device. Whereas ultrasound gel and water had comparable values (HU: 0; density 1 g/cm(3) for both), the corresponding values for the commercial device were slightly higher (HU: 80; density 1.02 g/cm(3)). CONCLUSIONS: Ultrasound gel proved to be an easy, fast and cheap compensating tool. Its water equivalence allows it to be used as an alternative to water, though easier to position and with lower risk of displacement. Thus, it is recommendable as a practical tool for most irregular sites. Further investigations are warranted to validate this solution in more complex irradiation techniques.

Clinical utility of the serum CA 19-9 test for diagnosing pancreatic carcinoma in symptomatic patients: a prospective study.

The diagnostic accuracy of the serum CA 19-9 determination was prospectively evaluated in patients selected for the presence of signs or symptoms highly suggestive for pancreatic cancer. Of 110 patients included in the study, 54 had a final diagnosis of pancreatic adenocarcinoma (49% prevalence). CA 19-9 values were higher than 40 U/ml in 45 patients with pancreatic carcinoma and in 18 of the 56 patients with other final diagnosis (sensitivity, 0.83; specificity, 0.68; positive predictive value [PPV], 0.71; negative predictive value [NPV], 0.81). The serum CA 19-9 determination was not capable of shortening the diagnostic workup of patients with strong clinical suspicion of pancreatic cancer since adequate imaging of the pancreas was required to confirm or exclude the diagnosis. However, values above 120 U/ml were strongly suggestive for pancreatic carcinoma in the overall population (PPV, 0.85) and they were diagnostic (PPV, 1.0) in the anicteric portion. Combined with pancreatic imaging, the CA 19-9 was an excellent confirmatory test; a normal value in a patient with negative imaging ruled out pancreatic carcinoma as the cause of symptoms (NPV, 1.0), whereas a pathological result in the presence of positive or equivocal pancreatic radiology was highly suggestive for the presence of the disease (PPV, 0.93).

[Mucocele of the appendix]. / Il mucocele dell'appendice.

Reference is made to two cases of mucocele of the appendix in a brief discussion of this form, its frequency, and the difficulties associated with its preoperative diagnosis. Mention is also made of the problems arising in the differentiation of benign and malignant mucoceles. Some conclusions are drawn with regard to treatment.

[Hypertrophic pyloric stenosis in the adult. Presentation of 4 cases]. / La stenosi ipertrofica del piloro nell'adulto. Presentazione di 4 casi

4 cases of hypertrophic stenosis of the pylorus, an infrequent benign disease often associated with gastro-duodenal lesions and characterized by narrowing and lengthening of the channel owing to hypertrophy-hyperplasia of the circular muscular fibres, are reported. Aetiopathogenesis, diagnosis and therapy, namely always gastric resection, are discussed.

[Angiosarcoma of the breast. Apropos of a case]. / L'angiosarcoma della mammella. A proposito di un case.

A case of angiosarcoma of the breast is described. This is an unusual, malignant, vascular tumour observed in young, fertile women. Its aetiopathogenesis, histological picture and pathological anatomy are described, and reference is made to the deceptively benign nature it often displays initially, its diagnosis, and its clinical picture. Emphasis is also placed on the limited possibilities of treatment, and its dependence on the earliest possible diagnosis for a certain degree of validity.

[Fibromas of the spermatic cord]. / I fibromi del funicolo spermatico.

The authors review the literature and report on a case of fibromatosis and a case of fibrolipoma of the spermatic cord, stressing the rarity and the therapeutic problems they may pose.

[Primary torsion of the greater omentum]. / La torsione primitiva del grande omento.

Omental torsion means a partial or total rotation of omentum around its main axis, which is called primary or secondary, depending upon the presence or absence of another associated abdominal lesion. Due to the objective rareness and absence of a typical symptomatology, the diagnosis often is neither made, nor considered preoperatively. The Authors present three cases that they the opportunity to observe. They point out that, in case of laparotomy for acute painful symptomatology of the lower abdominal quadrants, one should not forget the inspection of greater omentum.

[An unusual case of a stomal complication]. / Su un caso singolare di complicanza stomale.

The Authors present a case, never reported till now, of stomal complication, and, after shortly reviewing the different colostomic complications, emphasize its rareness and hypothesize its pathogenesis.

[A case of compression of the common peroneal nerve due to an intraneural mucoid pseudocyst]. / A proposito di un caso di compressione del nervo sciatico popliteo esterno da parte di una pseudocisti mucoide intraneurale.

The Authors report a case of paralysis due to compression of the external common peroneal nerve by a mucoid pseudocyst. They emphasize the rareness of such lesion, as well as the importance of a prompt diagnosis and a conservative surgical treatment.

[Cystic mucinous neoplasms of the pancreas]. / Neoplasie cistiche mucinose del pancreas.

The Authors report on three cases of Mucinous Cystic Neoplasms of the pancreas. These tumours are rare and the diagnosis is based on echography and CT scanning. After a radical excision the prognosis is good although these tumours are "all" potentially malignant.

[High-insertion choledochus]. / Il coledoco ad impianto alto.

A case of high-insertion choledochus is reported. The Authors, after a reviewing of the existing literature thereabout, describe the clinical and radiographic pictures whereby such lesion can appear. They emphasize the presence of this malformation requires particular attentions and changes in the surgical approach.

[Angiomyolipoma of the kidney]. / L'angiomiolipoma del rene.

Kidney angiomyolipoma, although it is a benign tumour, may originate serious complications, which can endanger the patient's life. After a reviewing of the literature, the Authors show a case they had the opportunity to observe, in which it was necessary to perform the emergency nephrectomy. In the last years the modern diagnostical techniques allowed to precociously diagnose angiomyolipoma in preclinical stage, what suggests new therapeutical strategic.

[Obturator hernia]. / L'ernia otturatoria.

Obturator hernia, which is a rare cause of intestinal occlusion, generally presents non-specific signs and symptoms. Radiology may be sometimes useful for the diagnosis. Four cases of obturator hernia are described, and the possible surgical access routes are illustrated, emphasizing the use of prosthetic mesh.

[Our experience in the treatment of intrathoracic and intraspinal hourglass neurogenic neoplasms]. / Nostra esperienza nel trattamento delle neoplasie neurogene a clessidra, intratoraciche ed intraspinali.

The authors describe their experience in the treatment of dumbbell neurogenic tumours, intrathoracic and intraspinal, with particular reference to clinical presentation, diagnostic for imaging, anatomo-pathological classification and surgical treatment, comparing their clinical cases (9) with the international literature, accurately reviewed. The authors think that the best surgical treatment is the combined approach, in only one stage, of thoracic surgeon and neurosurgeon by hemilaminectomy and extended costotrasversectomy, reserving hemilaminectomy and thoracotomy only for the tumours with big dimension of intrathoracic portion.

[Splenic arteriovenous fistula (a clinical case)]. / Fistola artero-venosa splenica (un caso clinico).

A splenic arteriovenous fistula is a situation often presenting with signs of portal hypertension and with a characteristic murmur. Though rare, the possibility of a splenic arteriovenous fistula must be borne in mind in differential diagnosis, since it can be corrected surgically by resolving the portal hypertension.