Arterial anomalies of the middle ear associated with stapes ankylosis.

An aberrant internal carotid artery in a young woman complaining of pulsatile tinnitus and conductive hearing loss was diagnosed pre-operatively by CT scan and angiographic findings. An exploratory tympanotomy was performed in order to evaluate the cause of the severe conductive hearing loss. It was possible to detect a large persistent stapedial artery associated with a stapedial fixation of unknown cause. Despite these vascular anomalies a stapedotomy was performed successfully.

[Abdominal scintigraphy with leukocytes marked with indium-111 in Crohn disease: clinical importance and prognostic usefulness]. / Scintigrafia addominale con leucociti marcati con indio-111 nella malattia di Crohn: rilevanza clinica ed utilità prognostica.

The exact role of 111In leukocyte scanning in the assessment of clinical activity of Crohn's disease (CD) is still a matter of controversy. In our center we studied 22 patients with CD (8 with active disease) with standard 111In labelled mixed leukocyte scans. We determined the extent of the lesion measured as lesion-occupied cells on scanned area and the degree of inflammatory activity assessed as count ratio between the involved region and the iliac crest. Particularly in delayed scans, these scintigraphic parameters showed good correlation with clinical and laboratory indices of disease activity. In our series, only 6 patients had completely negative scans. They were in clinical and laboratory remission, and 5 of them had undergone surgery for CD during the previous year, with no radiological and/or endoscopic findings of recurrence. Among the other 8 patients in clinical remission, 5 had positive early scans, while the rest showed persistent delayed images. Moreover both early and delayed leukocyte scans were positive in 8 cases in which disease was undoubtedly active. A 1-year follow-up was available for 14 patients in clinical remission when 111In-scan was performed. During this period, 3 patients, all of whom had had early and delayed positive 111In-scan, suffered from clinical relapse; no clinical relapses were documented in patients with only 4th hour positive scans. In conclusion, in our series, 111In-scan was also frequently positive in patients in clinical remission; in this patient subset persistent images on delayed scans might suggest the risk of clinical relapse.

[The fibrinolytic treatment with urokinase of acute arterial thrombosis]. / Tratamiento fibrinolítico con Urokinasa de la trombosis arterial aguda.

We present our experiences on 86 patients with acute arterial thrombosis of the legs, undergoing a fibrinolytic treatment with urokinase. Results from the treatment are analyzed according to: the administration way (systemic, locoregional, intrathrombotic), the level of thrombosis (upper or lower legs), the associated morbidity and mortality.

Unusual case of colonic sub-obstruction by giant pseudopolyposis in Crohn's colitis.

Giant pseudopolyposis of the colon is a very rare local complication of ulcerative and Crohn's colitis. 10 cases have been reported in the literature available to us. All the patients were surgically treated for clinical symptoms of obstruction or radiological stimulation of carcinoma. In this paper we present a peculiar case diagnosed by colonoscopy and biopsy which regressed after eight months of medical treatment.

[The role of radiology in assessing patients with pathological obesity submitted to modified Mason's vertical gastroplasty. A study of 322 cases]. / Ruolo della radiologia nella valutazione dei pazienti affetti da obesità patologica sottoposti a gastroplastica verticale secondo Mason modificata. Studio di 322 casi.

PURPOSE: Mason's vertical banded gastroplasty (VBG) is one the most popular surgical techniques for the treatment of morbid obesity because it is effective and easy to perform and presents a low incidence of long-term complications. We report our personal results in 322 Mason's VBG patients who were followed-up radiologically. MATERIAL AND METHODS: 322 patients submitted to modified Mason's VBG underwent radiological follow-up, preferably with single contrast, to assess the shape and volume of the pouch and the presence of postoperative complications. The patients were 272 women and 50 men whose average weight was 124 kg (range: 78 to 218 kg). The women's average age was 37 years (range: 17 to 69) and the men's 36 (range: 19 to 64). We performed a double contrast examination, adapting the dosage of effervescent powders to the gastric pouch capacity, only in particular cases where a more detailed study of pouch surface was required. The examinations were performed at 1 month and 12 months postoperatively to evaluate the pouch shape and volume, in order to correlate surgical results with weight loss. Premature or unscheduled examinations were necessary only in some cases due to suspected complications or unsatisfactory weight loss. First we perform right anterior oblique projections with the patient standing, with a direct preliminary study of the epigastric region to locate the two metal clips. The patient is given barium in small swallows because large amounts might obscure the pouch by filling the fundus of the excluded stomach. Then we take left anterior oblique views to depict the neopylorus and the staple lines, and left posterior oblique projections in lateral and supine recumbency. RESULTS: We observed early postoperative complications such as pseudopylorus edema (8 patients) and intragastric hemorrhage (1 patient), and late complications such as pseudopylorus adherence to the gallbladder bed (1 patient), pseudodiverticular extroversion (1 patient), and axial enlargement (4 patients) of the pouch. The only two cases of staple-line dehiscence were both identified radiographically. In 305 patients with satisfactory weight loss no complications were observed with a pouch size of 45-70 mL (at 1 month) and 58-70 mL (at 12 months). DISCUSSION AND CONCLUSIONS: Upper gastrointestinal radiological studies permit to detect both early and late postoperative complications in Mason's VBG patients. They also provide data on the neostomach and permit to correlate the pouch volume with weight loss.

Postoperative course of inflammatory abdominal aortic aneurysms.

Of 779 patients undergoing repair of abdominal aortic aneurysms over a 7-year period (1984-1990), 40 (5.1%) had gross features of inflammatory abdominal aortic aneurysms (IAAAs). Twenty IAAAs were assessed by CT scan preoperatively and postoperatively to evaluate the outcome of the inflammatory layer of the aneurysm in 19 cases. Complete postoperative regression was observed in nine cases (47.3%), partial regression in four (21%), and stable lesions in six (31.7%). No roentgenographic progression was found. The comparison between the roentgenologic outcome and preoperative clinical features (age, sex, erythrocyte sedimentation rate, and abdominal lumbar pain), pathologic findings, and follow-up time revealed a significant correlation (p < 0.05) between the postoperative outcome and the histologic findings in the wall (cell density and cell/fibrosis ratio). Complete regression of inflammation was observed when high cell density (16 +/- 0.7 cells/2116 microns 2) and a cell/fibrosis ratio > 1 were found. On the contrary, little or no regression of inflammation occurred when a low cell density (3.4 +/- 0.3 cells/2116 microns 2) and a cell/fibrosis ratio < 1 were found. Although it is generally thought that inflammation in IAAAs regresses after surgical repair, in our study, 31.7% of the postoperative CT scans showed no change. Histologically, the variability of morphologic aspects seemed to correlate with the relative proportions of cellular infiltrate and interstitial fibrosis in the aneurysmal wall. These proportions determine the postoperative course of the inflammation layer and, most likely, the response of the latter to steroid therapy as well.

Retrograde spread of 5-aminosalicylic acid enemas in patients with active ulcerative colitis.

In an attempt to know the exact retrograde spread of high-dosage 5-aminosalicylic acid enemas, we have studied eight patients with active left-sided colitis, by adding a small amount of barium sulfate to the enemas and by checking the spread radiologically after 15 minutes, 1 hour, and 6 hours. Four grams of 5-aminosalicylic acid in 100-ml enemas and 4 gm in 200-ml enemas were used. The same experiment was repeated in a subsequent attack, with enemas labeled with technetium-99m and checked by scintiscans in five of these patients. We always have observed a volume-dependent spread of enemas but, interestingly, in the patients studied with technetium-99m there was always a wider spread than that which was detected with barium enemas. In all five patients, 100-ml enemas reached the splenic flexure. In two patients with total colitis, a progression of 100-ml technetium-99m enemas was performed in the transverse colon, but the maximum opacity remained in the left side. We can conclude that 4 gm of 5-aminosalicylic acid in 100-ml enemas can be suitable for treating patients with left-sided colitis, and will represent a valid addition for patients with more extensive colitis.