[Giant adrenal myelolipoma: a case report and review of the literature]. / Mielolipoma gigante del surrene: case report e review della letteratura.

Adrenal myelolipoma is a rare nonfunctioning tumor consisting histologically of an admixture of adipose tissue and extramedullary hemopoietic elements within the adrenal glands. Most of these lesions are 5 small and asymptomatic, but there are also giant ones, associated with endocrine disorders. These tumors are mostly detected incidentally by imaging. The increasing number of incidentally discovered adrenal myelolipomas arise the question of appropriate treatment modalities. The authors report a case of giant myelolipoma associated with lithiasic cholecystitis and discuss different imaging and terapeutic aspects.

[Chromoendoscopy in the diagnosis of precancerous lesions of the esophagus. Our experience]. / La cromoendoscopia nella diagnostica delle lesioni precancerose dell'esofago. Nostra esperienza.

The elements of an unfavourable prognosis for oesophageal cancer are frequent metastasis, high incidence of local recurrence and mainly the difficulty of an early diagnosis. Alcohol, tobacco and precancerous lesions are the most important risk factors of these tumours. According to literature, the authors suggest the method of chromoendoscopy, with vital staining by lugol or blue toluidine for endoscopic; guidance to biopsy in the aimed screening of patients, whose habits--alcohol, smoking--should cause, in time, the rising of lesions with neoplastic potentiality. Endoscopy with bioptic test is the best diagnostic investigation. In fact sensibility and specificity of these investigations increase using this method with vital staining.

[Post-traumatic diaphragmatic hernia with late diagnosis. Report of a clinical case]. / Ernia diaframmatica post-traumatica a diagnosi tardiva. Descrizione di un caso clinico.

Starting from the observation of a case of late diagnosed left-side hernia after traumatic rupture of diaphragma, the authors consider the increasing incidence of this pathology during the years. The increased frequency of thoraco-abdominal traumas and the more sophisticated diagnostic tools, permit an earlier diagnosis nowadays. In our patient the diagnosis was made late on the basis of the standard x-ray of the thorax. The CT scan of the thorax and of the abdomen gave more informations. Left thoracotomy enabled a wide exposure of the herniated viscera; the breakthrough of the diaphragm was repaired by means of interrupted suture and it was necessary to apply two prostheses of synthetic material.

Preoperative plasma levels of prothrombin fragment 1 + 2 correlate with the risk of venous thrombosis after elective hip replacement.

Better preoperative identification of those patients at high risk of developing a deep vein thrombosis (DVT) after hip surgery could reduce the incidence of this postoperative complication, which still occurs despite prophylaxis. One hundred fifty-nine patients undergoing elective total hip replacement and given anticoagulant prophylaxis, were investigated, looking for the presence of a hypercoagulable state, that represents one element of Virchow's triad predisposing to DVT. Plasma levels of three markers of coagulation activation, namely prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin III complexes (TAT) and D-dimer were measured using ELISA procedures and were correlated with the results of the postoperative phlebography. A high correlation (p < 0.001) between the preoperative plasma levels of F1 + 2 and the risk of postoperative venous thromboembolism was detected. The performance of TAT and D-dimer levels in predicting DVT was lower. These findings support the hypothesis that preoperative measurement of coagulation activation markers might be useful in predicting DVT following a total hip replacement.

Ceramic-ceramic in total hip arthroplasty. An analysis of 7-13 year survival rate.

After 7-13 years, the long-term results of primary replacement of the hip joint by total cemented arthroplasty, with a head and acetabulum in high-density alumina, and a stem in chrome-cobalt alloy in a series of 38 patients were analyzed. The age of the patients ranged from 36 to 76 years (mean 55 years). The patients were monitored annually, by both clinical-radiographic follow-up and by an interview over the telephone (pain, independence walking, degree of hip flexion). The presence of a correlation between loosening of the implant and several clinical parameters (age, sex, diagnosis) and radiographic parameters (orientation, height and lateralization of the acetabular cup, rotation center of the implant, position of the femoral stem) were searched for. Data concerning 35 of the 43 prostheses implanted were gathered. The data were analyzed by the survival curve with an actuarial method, log-rank test and chi square test. The differences were considered significant for p < 0.05. There were no clinical or radiographic signs of loosening of the femoral prosthetic component. Instead, the acetabular cup was loosened in 7 cases. An implant was removed because of infective complications 6 months after surgery. The cumulative percentage of survival of the implant after 13 years was 81.2%. There was no statistically significant correlation between loosening of the implant and the parameters considered. Despite the favorable mechanical features of bioceramics, the acetabular component proved to be the weak point of the implant. The authors believe that only the introduction of new concepts of acetabular fixation could contribute to a significant increase in the survival rate for ceramic-ceramic.