Spiral computerized tomography : a diagnostic aid in patients with atypical acute appendicitis.

This retrospective study aimed to estimate the value of spiral Computerized Tomography (sCT) in patients with suspected appendicitis who remained undiagnosed after 48 hours of expectant management. We assessed a cohort of 150 patients by focused unenhanced sCT. According to the clinical scenario we occasionally employed contrast media and extended the scanned area. The major radiological signs were appendiceal enlargement and inflammatory changes of periappendiceal tissue and mesenteric fat. Regarding acute appendicitis the examination was 95.8% sensitive, 97.4% specific, had a positive predictive value of 97.18%, a negative predictive value of 96.2% and an accuracy of 96.7%. It also provided alternative diagnoses in 55 patients leading correctly 31 of them to the theatre for a variety of abdominal surgical diseases. For abdominal surgical pathology in general, sCT was 97.1% sensitive, 95.7% specific, had a positive predictive value of 98% and a negative predictive value of 93.8%. The importance of good communication between the clinicians and radiologists was pointed out by the correct alternative diagnoses set by imaging in the 55 patients after modifying the sCT protocol and was highlighted by the unnecessary appendectomy of three patients with negative imaging. Our results verify the accuracy and value of unenhanced sCT in patients with a clinical picture which remains inconclusive after an initial period of expectant management.

Cystic adenomyoepithelioma of the breast.

Cystic adenomyoepithelioma of the breast is a rare tumor. We report a case of this entity in a 42-year-old woman who presented with a lump behind her left nipple. Clinical examination suggested the diagnosis of a cyst. Ultrasound showed a cyst with an intracystic mass. The lesion was biopsied and found to be a cystic adenomyoepithelioma.

Schwannoma in the inguinal canal masquerading an inguinal hernia.

Benign neoplasms originating from the neuronal sheath are usually found along the distribution of the cranial nerves and in the flexor surfaces of the upper and lower extremities. We herein present a case of a 65-year-old man with a schwannoma located in the inguinal canal, which presented as an irreducible hernia. This is the first reported case in the English literature of a schwannoma with such a presentation.

[Surgical treatment of ruptures of hydatid cysts of the liver]. / Traitement chirurgical des ruptures des kystes hydatiques du foie.

During the last 20 years (1972-1992), 421 patients underwent surgery for hydatid disease of the liver. 96 out of 421 patients had a rupture such as, intrabiliary rupture 49 patients, intrathoracic rupture 43 patients and free rupture in the peritoneal cavity 4 patients. The surgical treatment required a variety of procedures: 1) Prolonged tube drainage of the residual cavity and exploration of the common bile duct followed by either T tube drainage or sphincteroplasty or choledocho-duedonostomy if it was necessary, for intrabiliary rupture. 2) Lung resection if it was necessary, and evacuation plus drainage and the hepatic cavity followed by suture of the diaphragmatic rupture of closure of the bronchial opening if present for intrathoracic rupture. 3) Lavage and prolonged tube drainage of the hepatic cavity for free rupture in the peritoneal cavity. Five patients died in the postoperative period one from suppurative cholagitis, one from pulmonary embolism and 3 from M.O.F.

[Benign tumors of the liver]. / I tumori benigni del fegato.

Benign tumours of the liver, being rare compared to malignant forms, constitute a big diagnostic and therapeutic problem to prove their benignity and the relation between the patients' symptoms and their existence. During 1983-91, we had the chance to study ten (10) patients with benign liver tumour-six (6) women and four (4) men-with a mean age of 51 years, concerning 5 hemangiomas, one hepatic adenoma and 4 focal nodular hyperplasia. Two of the hemangiomas coexisted with metastatic liver tumours. In seven patients there was surgical confirmation of tumor existence and in the remaining two patients the diagnosis was based upon laboratory findings and imaging techniques. Four patients were asymptomatic and the tumors were identified as an incidental finding during operations concerning the liver and biliary system or under imaging techniques. The disease was confirmed by intraoperative biopsy. Surgical intervention was undertaken to one patient with hepatic adenoma appearing symptoms of acute abdomen and haemorrhagic shook and a partial hepatectomy was attempted. There was no considerations of any therapeutic intervention to the rest of the patients. The diagnostic procedures used by our team to investigate and to follow up the progress of the disease in our series were ultrasonography, CT scan, magnetic tomography and selective hepatic arteriography.

[The treatment of external biliary fistulae by means of lavage and continuous aspiration]. / Il trattamento delle fistole biliari esterne tramite lavaggio ed aspirazione continua.

In 99% of cases external biliary fistulas are caused by liver and biliary tract surgery. The paper describes a new continuous aspiration of the fistula. This method was used to treat 18 patients and full closure of the fistula was achieved in 15 out of 18 patients.

[Blood endotoxin in acute pancreatitis using limulus amebocyte lysate test (LAL test)]. / Studio sull'endotossinemia nella pancreatite acuta con l'impiego del limulus amebocyte lysate test (LAL test).

Forty-five cases of acute pancreatitis observed during the period 1986-88 were included in this study. Four of the 45 patients were operated during the acute phase and of these, two died. The remaining 41 patients were treated with conservative therapy using the application of a nasogastric tube, analgesics, and the endovenous administration of various solutions and antibiotics. The severity of each attack of pancreatitis was assessed according to Ranson and Agarwal's criteria. In severe cases (more than 3 of Ranson's criteria) the presence of endotoxin in the systemic circulation was shown using the "limulus" method, together with contemporary low levels of C3 complement factor. As is evident from the results of the study, the presence of endotoxinemia and the low level of C3 in acute pancreatitis are related to the high percentage of complications.