The treadmill test in the assessment of peripheral arterial occlusive disease.

Results of a study using the treadmill test on 32 patients with peripheral Fontaine's stage II arterial disease are described. The aim of the study was to evaluate the utility of the test in assessing useful information concerning the site of the lesion. Patients were divided in three classes depending on the arterial segment involved (iliac-femoral, femoro-popliteal, associated lesions) as resulted from the velocimetric and angiographic evaluation. Ankle pressure and WI, at rest and after stress test, PFWD and RT were evaluated. The authors conclude that data achieved with the dynamic test are related to the arterial involvement, allowing to differentiate obstructive and stenotic lesions, but do not give information concerning the site of the lesion. Nevertheless it is a valuable means of highlighting arterial lesions well compensated at rest and with normal pressure values.

[Diagnosis of thyroid nodules]. / Sulla diagnostica del nodulo tiroideo.

The basic features of the most common endocrine pathology, the thyroid nodule are analysed. After a brief assessment of the incidence of the condition the problem of clinical and instrumental diagnosis is tackled with the aim of demonstrating the value and possibility of sub-clinical diagnosis of micronodules. The present work aims to identify the fastest, most efficient and cheapest diagnostic procedure.

[Autonomous adenoma of the thyroid]. / L'adenoma autonomo della tiroide.

Toxic goitre often referred to in the literature as "autonomous" adenoma or nodule actually signifies a number of different pathologies that are characterised by autonomy and hyperfunction so that it is now thought more appropriate to call it an autonomous follicle. Clinical features and the hormone profile suggest the diagnosis which is confirmed by scintiscan with curve as well as dynamic inhibition and stimulation tests using TRH, procedures that reveal both latent hyperfunction and autonomy. The most common current therapeutic approach is surgical since this provides a complete cure while leaving the surrounding thyroid tissue undisturbed.

[Prognostic factors in gastric carcinoma]. / Fattori prognostici del carcinoma gastrico.

A personal experiment conducted on 80 gastric carcinoma patients requiring radical surgery at the Special Surgical Pathology Institute is reported. The aim of the study was to identify and assess the factors capable of influencing prognosis e.g. sex, age, TNM, type of operation, symptoms etc and to make a comparison with data from the international literature.

[Autonomous thyroid nodule: relations between clinical symptomatology and goiter endemia]. / Il nodulo autonomo tiroideo: correlazione fra sintomatologia clinica ed endemia gozzigena.

Sixty-three patients with autonomous thyroid nodule were studied, thirty-five from an endemic goiter area (EA) and twenty-eight from a non-endemic goiter area (NEA). Clinical history, physical examination, ultrasonography, thyroid hormone levels, and fine needle aspiration (FNA), were utilized to investigate whether or not iodine deficiency determined differences in the latency of progression to toxicity, the seriousness of illness and thyroid hormone levels. No significant difference was observed in the age of onset of nodularity, while the latency of progression to toxicity was significantly decreased in the EA (p less than 0.001). The ultrasonographic pattern did not show significant volume variations between the EA and NEA, but there was a slight prevalence of multinodular lesions in EA. No significant difference in serum thyroid hormone levels was found between the two areas in non toxic patients, while at the onset of hyperthyroidism higher levels of FT were observed in the EA than in the NEA. FNA showed a prevalence of colloid lesions in EA, while hyperplastic lesions prevail in the NEA. Forty-two patients underwent surgery: the extent of surgery was greater in patients from the EA. In conclusion, in iodine deficient areas earlier clinical thyrotoxicosis and a higher prevalence of hypoactive thyroid nodules were observed. Furthermore, in EA, the autonomous nodule in non toxic phase is more frequently associated with colloid lesions than hyperplastic lesions.

Carotid bifurcation stenosis: a comparative study between MR angiography and duplex scanning with respect to digital subtraction angiography.

PURPOSE: This study compared sensitivity, specificity and diagnostic accuracy of Echoduplex and Magnetic Resonance Angiography (MRA) in the evaluation of carotid bifurcation stenosis. MATERIAL AND METHODS: Twenty-five patients with clinical signs suggestive for cerebrovascular insufficiency (CVI) were studied with Duplex scan, MRA and Digital Subtraction angiography (DSA). Gold standard was the angiographic examination. RESULTS: on equal value of sensitivity (80.5%), MRA showed 96% specificity versus 81% of Duplex scan, 89.4% diagnostic accuracy versus 80.9% for Duplex scan. As for stenosis over 31%, the value of sensitivity did not change i.e., 80.5%; MRA showed 100% specificity versus 97.1% for Duplex, 91.2% diagnostic accuracy versus 89.1% respectively. These values compared by the test for categorial analysis and correspondence analysis (p < 0.05) did not indicate any statistically significant difference. DISCUSSION: on the basis of our experience and as shown by current literature [2, 12] we can state that both MR-angiography and Duplex scan fail in quantifying correctly carotid stenosis with consequent over- and underestimation [3, 4]. However, they can be considered effective diagnostic procedures in a screening program [12, 16]; they are accurate, safe and accepted by the population. CONCLUSIONS: on the basis of the cost in planning the screening of a population at risk for CVI, Duplex scanning is still to be considered the elective procedure.

Evaluation of flow in nodular tumors of the breast by Doppler and duplex scanning.

Evaluation of flow in nodular tumors of the breast may be performed by Doppler and computerized frequency analysis. In 46 nodules of the breast (22 malignant) the nodular flow velocity and frequency analysis revealed a faster flow with a significantly higher peak frequency and mean velocity. The intensity of sound which may be considered an index of the entity of flow in the nodule was larger than that observed in the normal surrounding breast tissue. In malignant nodules and generally in fast growing nodules the flow velocity and intensity was even larger. The flow intensity and velocity was also well correlated with the growth rate as reported by single patients. In elder patients a slow rate of growth even in tumors of larger size was associated with a significantly increased flow in comparison with the normal breast tissue but this increase was not particularly large when compared with fast growing nodules in younger subjects. In conclusion the evaluation of flow characteristics (mainly velocity, frequency analysis and intensity) may be a useful index of the growth rate of nodular tumors of the breast and these data may be useful to evaluate and monitor the evolution and pathophysiology of these nodules.

Evaluation of the effects of elastic compression in patients with chronic venous hypertension by laser-Doppler flowmetry.

The evaluation of the effects of elastic compression in patients with venous hypertension and perimalleolar ulceration may be performed using laser-Doppler flowmetry (LDF). This technique may reveal microcirculatory positive variations which are not evident by standard methods as Doppler, plethysmography and ambulatory venous pressure (AVP). In this study we demonstrated the good correlation between AVP values and laser-Doppler parameters, particularly the resting flow and the venous vasomotor response. Also the response of the skin of the perimalleolar region to a local increase of skin temperature was well correlated with AVP parameters. By evaluation of laser-Doppler parameters it was possible to differentiate normals from abnormals (patients with venous hypertension) and it was possible to show variations of microcirculation associated with the decrease of the areas of ulceration after 3 week elastic compression. No significant variations have been recorded by AVP before and after 3 weeks of treatment with elastic compression in 80 patients with venous ulcerations. Laser-Doppler flowmetry was useful to evaluate the positive changes produced by elastic compression.

[Carcinoma of the male breast. Our experience]. / Il carcinoma della mammella maschile. Nostra esperienza.

A case series of 5 male patients afflicted with breast carcinoma is reported. The Authors describe symptomatology, diagnostic iter, principles of surgical treatment and results. Underlined is the wider surgical demolition in male breast cancer in comparison with females, even if natural history and biological conduct are comparable. This is because in male breast carcinoma the local and remote infiltration is more rapid than female for the less development of breast gland. Finally, indications for radiochemotherapy are comparable to female breast cancer.

[A case of carcinoma arising on the duodenal stump after gastric resection]. / Su di un caso di carcinoma insorto su moncone duodenale consecutivo a gastro-resezione.

The duodenal cancers are very uncommon and the carcinomas arising on a duodenal stump following a B II gastric resection are a real rarity. The Aa. present a case of a patient with a cancer arisen on a duodenal stump 24 years after a gastric resection. The patient was operated with a Whipple D.C.P.

[Study of the possibility of an effect of biliary disease on the occurrence of chronic pancreatitis]. / Studio sulla possibilità di una influenza della patologia biliare nell'insorgenza di una pancreatite cronica.

The authors report a series of patients suffering from chronic pancreatitis and underline the high frequency of biliary pathology in these subjects. The authors remind, then a research performed, some years ago, by one of them. In such a research the performing of an anastomosis between the pancreatic duct and the biliary common duct in a series of experimental animals caused an acute pancreatitis or in the surviving animals a chronic pancreatitis. The authors believe that a biliary pathology may be responsible not only of an acute pancreatitis but also of a chronic pancreatitis.

[A rare case of thyroid carcinoma associated with salivary gland carcinoma]. / Su di un raro caso di associazione di un carcinoma della tiroide e di un carcinoma delle ghiandole salivari.

The authors examine the association of the tumors of salivary glands with other cancers. They point out that most frequently there is an association with tumours of the skin or of the breast in women and of the prostate in men. The synchronous or metachonous presence of tumours of the salivary glands and of the thyroid is quite exceptional. For this reason the authors believe interesting the case observed of a patient with a synchronous adenoid-cystic cancer of the right sub-maxyllary gland and a papillary cancer of the thyroid. They point out that in this case there was not any previous radiation of the neck regions of the patient which could represent a common risk factor for the two tumours.

[Aneurysms of the subclavian artery: clinical experience]. / Gli aneurismi dell'arteria succlavia: esperienza clinica.

The aneurysm of the subclavian artery is not common. The authors present three cases of aneurysms of the subclavian artery of which two cases already were in phase of complication for rupture. Two Patients underwent intervention of by-pass with Dacron prosthesis: between common carotid and axillary artery in one and between common carotid and distal head of the subclavian artery in the other. In a Patient with post-traumatic pseudoaneurysm of the subclavian artery was not possible to perform any intervention of direct reconstruction because of the precarious clinical conditions due to the hemorrhage for rupture and we performed only a resection of the aneurysm with binding of the subclavian artery. A Patient died two months after the operation for respiratory failure due to bronchial pneumonia; two Patients are still living, one with a moderate motor deficit of the upper limb. The rupture of the arteriosclerotic aneurysms of the subclavian artery is not frequent, but the gravity of this complication recommends the surgical treatment also in the asymptomatic cases if the clinical conditions of the Patient allow it.

Thyroid paraganglioma: report of a case and review of the literature.

A case of thyroid paraganglioma is reported. Immunohistochemically the tumor showed negativity for thyroglobulin and calcitonin and positivity for chromogranin A and S-100. Protein-positive sustentacular cells were demonstrated. The authors discuss the previous literature on these tumors.

[The effect of ionizing radiation on the onset of breast carcinoma]. / Influenza delle radiazioni ionizzanti sull'insorgenza del carcinoma della mammella.

The authors examine the influence of ionogenic radiations on the onset of breast cancer. They remark the connection between the doses of radiations and the incidence of cancer and point out that the danger increases when the women is exposed to radiations during her fertile age. They present five cases of patients suffering from breast cancer where the exposition to radiations may have been a cause of the cancer.

[The finger fracture technique in hepatic resection]. / Il metodo della digitoclasia nelle resezioni epatiche.

The main complementary techniques for "finger fracture" in liver resections are evaluated. It is retained that transparenchymal resections should be limited to segmental resections (uni-, bi- or trisegmentectomies), while in case of extensive resections (lobectomy or extensive lobectomy) an operation with extraparenchymal preparation of the hepatic pedicle and possibly of the suprahepatic vein is preferable. Lastly a casuistry of 24 hepatic resections for primary or metastatic tumours is presented.

[The surgical treatment of primary hyperparathyroidism: clinical experience]. / Il trattamento chirurgico dell'iperparatiroidismo primitivo: esperienza clinica.

The primitive hyperparathyroidism (PHPT) constitutes still cause of discussion both from the diagnostic point of view and from the therapeutic one although surgical successes are generally reported. Between the most important problems there is the increase of the HPT asymptomatic or oligosymptomatic patients with the decisional difficulties in the timing of the surgical treatment and the difficult framing of the HLP disease associated with MEA and the relating surgical failures. Besides some authors support an unilateral dissection of the neck in patients with adenoma diseases diagnosed before the intervention against the traditional address of a bilateral exploration. Our experience is based on 31 patients subjected to intervention of parathyroidectomy for primitive HPT: 26 carriers of adenomas, of which 1 double, and 5 of diffused hyperplasia. We have effected 25 simple parathyroidectomy for adenoma, 1 resection of three parathyroid glands for double adenoma, 2 subtotal parathyroidectomy (7/8) for diffused hyperplasia. 2 patients had new surgical treatment for persistent hypercalcemia, and they were respectively carriers: 1 of a second ectopic adenoma and 1 of asymmetrical hyperplasia; 2 patients finally, operated in other hospitals had a second exploration and they were affected from MLP. In 26 patients we had very good results, in 2 persistence of hypercalcemia (patients who had a second look) and 3 hypocalcemia.

[Clinical experience in tumors of the common bile duct]. / Esperienza clinica sui tumori della via biliare comune.

The authors, after a short review of the literature present 6 cases of cancer of the common bile duct. One was localized at the hepatic hilus, three in the middle of the c.b.d., two in the distal choledochus. In each case a c.b.d. resection was performed associated in one case to a minor hepatic resection, in two cases to a Whipple operation.

[Experience on the pancreatic function after an episode of acute biliary oedematous pancreatitis]. / Studio sulla possibile alterazione della funzionalità pancreatica dopo un episodio di pancreatite acuta biliare edematosa.

The authors have examinated 35 patients 4 - 5 years after a previous episode of acute oedematous biliary pancreatitis. 20 patients had been cholecystectomized while 15 had not been operated. The patients of the first group didn't show any impairment of the endocrine or exocrine pancreatic function while the patients who were not cholecystectomized in 4 cases on 15 showed an impairment of the exocrine pancreatic function valued with the elastase-1 test in the stools. In 2 patients there was also a slight impairment of the glucose metabolism. The authors suppose that the persistance of a biliary disease can affect the pancreatic function.

[Our experience with pheochromocytoma]. / La nostra esperienza in tema di feocromocitoma.

The authors report cases of pheocromocytomas operated in the period 1991-1997. 16 of these patients presented a monolateral pheocromocytoma, 1 a bilateral. A patient had a malignant evolution, one patient presented an extrasurrenal para-aortic localization. All the patients were operated by a middle longitudinal laparotomy. There was no mortality, neither significant morbility. In all the patients, who presented pre-operatory arterial hypertension, there was a regression of the symptomatology.