Cognitive-behavioural guided self-help for obesity: a preliminary research.

This study examined the effectiveness of the manual for obesity Perdere peso senza perdere la testa (Losing weight without losing your mind) used in form of guided self-help on 161 patients. Three levels of treatments were compared: (a) guided self-help treatment (GSH); (b) minimal guided self-help treatment (M-GSH); (c) control condition (CC). At the end of the treatment, a significant reduction in body weight was observed in GSH and M-GSH, but not in the CC. At six-month follow-up 32.7% of GSH subjects and 15.1% of M-GSH subjects were able to maintain at least a 5% weight loss. The findings show that GSH is more effective than M-GSH in determining a significant short-term reduction of body weight.

Calcific tendinitis of the rotator cuff as a cause of drooping shoulder.

We describe a case of inferior glenohumeral subluxation or drooping shoulder secondary to acute calcific tendinitis of the rotator cuff. The various etiologies of drooping shoulder and the specific causes determining glenohumeral widening in our report are discussed. The importance in recognizing this uncommon complication of a common abnormal finding and correction by aspiration is stressed.

[Primary pneumococcal peritonitis: description of a case and review of the literature]. / La peritonite primitiva da pneumococco: descrizione di un caso e revisione della letteratura.

Streptococcus pneumoniae causes lobar pneumonitis but primary peritonitis can occur in cyrrotic adults as well as in children affected by nephrosis and immunopathies. In young females peritonitis can be the consequence of infection localized at genital organs. Pneumococcal sepsis is becoming rare with the antibiotic era but resistance to penicillin is actually frequent and is becoming a problem for elderly. We report a case of a young woman affected by spontaneous primary peritonitis and pneumococcal sepsis. The prevalent symptoms were gastrointestinal: diarrhea and emesis. No infectious foci could be detected on imaging studies and during surgery.

Diagnosis of tears of the quadriceps tendon of the knee: value of sonography.

OBJECTIVE: The purpose of the study was to evaluate the role of sonography in diagnosing traumatic tears of the quadriceps tendon. More specifically, it was intended to determine the value of sonography in differentiating complete from partial tears and thus in directing therapy. Knees of asymptomatic volunteers and patients' contralateral knees were used as normal standards. SUBJECTS AND METHODS: Sonography was performed in 29 patients with injuries of the quadriceps tendon in a 3-year period. As the control, 59 normal knees were examined: both knees of 15 healthy subjects and 29 contralateral knees of the injured patients. In all cases, longitudinal and transverse sonograms were obtained. In five cases (four complete and one partial rupture), the sonographic diagnosis was confirmed surgically. Those remaining patients who had a partial tendon tear were treated conservatively. Follow-up sonograms were obtained in 10 cases (three treated with surgery and seven not) and showed integrity of the affected tendon. RESULTS: Among the 29 patients, sonograms showed a partial rupture (focal hypoechoic defect in the tendon) in eight and a complete rupture (complete disruption of the tendon fibers) in four. In the remaining 17 cases, the tendon was intact. The high sensitivity and specificity of sonography (100% or four of four in our sample) in the diagnosis of complete tears of the quadriceps tendon were confirmed by surgery. As only one partial tear was confirmed by surgery (the remaining seven were treated conservatively), the sensitivity and specificity of sonography with respect to partial tears could not be determined. CONCLUSION: Results of this study, albeit obtained from a limited sample, indicate that sonography offers a high degree of sensitivity and specificity in the evaluation of quadriceps tendon rupture. This noninvasive and easily available imaging technique should be considered in the diagnostic workup and treatment planning of patients with suspected tears of the quadriceps tendon.

Sonographic findings in examination of digital ganglia: retrospective study.

A retrospective sonographic study of soft tissue masses of the hand was undertaken. A spherical fluid-filled structure with a well-defined wall was seen in 13 patients and the cases were diagnosed as ganglia. This diagnosis had been generally suspected clinically in the presence of a firm nonpainful lump. This study indicates that ultrasound is a valuable diagnostic tool for the study of soft-tissue masses of the hand and in the differential diagnosis of other soft tissue lesions, such as pigmented villonodular synovitis or tenosynovitis.

Nucleolar organizer regions (NORs) in normal and pathological liver: a quantitative analysis.

By means of a silver staining method, Nucleolar Organizer Region-associated proteins (NORs) have been evaluated on paraffin sections of a series of 58 ultrasound-guided liver biopsy specimens. These included 12 normal livers, 12 cirrhotic livers, 12 cases of chronic hepatitis and 22 cases of hepatocellular carcinoma. A significant difference (P less than 0.001) was found between the mean AgNOR scores of the normal and pathological biopsies, and between the non-neoplastic and the carcinomatous lesions. The authors suggest that AgNOR counts, in combination with conventional histocytological criteria, may be a useful method in the diagnosis of liver diseases.

[The seriatim echographic assessment of the volume of hepatic metastases]. / Valutazione ecografica seriata del volume di metastasi epatiche.

The quantitative study of neoplastic growth patterns is the ground for a correct clinical approach to patients with malignant tumors, for both prognosis and evaluation of treatment outcome. The growth of 19 hepatic metastases in 13 patients was therefore followed; the lesions diameters were measured by means of US and their volumes were calculated. The results were plotted in semilogarithmic scale and doubling times (DT) were calculated. The DT values observed were ordered according to the origin of the tumors and to their growth rate; our values were in substantial agreement with literature data. Moreover, the differential increase in the metastases diameters along the 3 orthogonal planes was analysed and a significant rate of asymmetrical growth was shown. Changes in the echo structure of the observed metastases were evaluated and the changes in peripheral hypoechoic halo were demonstrated. The authors stress the importance of a correct volumetric study during US follow-up of patients with hepatic metastases.

Sonographic appearance of primary retroperitoneal cysts.

The sonographic findings observed in four patients with primary retroperitoneal cysts were reviewed. All lesions presented as fluid-filled masses with anechoic content and regular margins; all increased through transmission. Preoperative location of the cysts within the retroperitoneal space was possible in all cases by either real-time ultrasound (US) analysis of the different relationships of the kidneys and the cysts during respiratory movements or the anterior displacement of surrounding structures. A differential diagnosis among retroperitoneal lesions containing fluid is difficult and cannot be obtained with imaging methods alone. However, preoperative knowledge of both the retroperitoneal location of the disease process and its fluid content may help to narrow the diagnostic possibilities, thus allowing the surgeon to more accurately plan the therapeutic approach to the patient.

Ultrasound and CT findings in two cases of hemangioma of the adrenal gland.

The ultrasound and CT findings in two patients with hemangioma of the adrenal gland are presented. Ultrasound showed large masses with heterogeneous nonspecific structural pattern. Unenhanced CT demonstrated lesions with hypodense centers and thick irregular peripheries with higher density. A few small peripheral calcifications were noted in one patient. Following contrast medium injection, patchy enhancement of the peripheral zone of the tumor was seen in both cases.

[Role of echography in the diagnosis of visceral ischemic syndrome]. / Ruolo dell'ecografia nella diagnosi della sindrome ischemica viscerale.

Personal experience of the current possibilities of ultrasonography in the diagnosis of visceral ischaemic syndrome is reported.

Myelolipoma of the adrenal gland: sonographic and CT features.

The radiologic findings in 13 patients with pathologically proved adrenal myelolipomas were reviewed. All lesions involved the right adrenal gland; they ranged from 2 to 9 cm in diameter. Sonograms showed hyperechoic tumors in 11 cases (five homogeneous, six heterogeneous). Two myelolipomas composed primarily of myeloid tissue were hypoechoic. A propagation speed artifact was seen in seven lesions, all of which were composed primarily of fat and larger than 4 cm. CT identified fat-density tissues in all lesions. Contrast-enhanced CT showed positive attenuation values in the two predominantly myeloid tumors. CT appears to be sensitive for the diagnosis of adrenal myelolipomas. However, precontrast images are required to avoid errors.

[Ultrasonic diagnosis of gastrointestinal perforation]. / Diagnosi ecografica di perforazione gastro-intestinale.

Three cases of gastrointestinal perforation diagnosed by ultrasonography (US) are described. In these patients US showed the presence of gas in peritoneum, anteriorly to the liver. Gas is easily identified by US for its unique aspects. More difficult may be the diagnosis of its site, external to the gastrointestinal tract. Differential diagnosis, limits and possible pitfalls are briefly discussed.

The sonographic appearances of gastric lymphoma.

The sonographic images obtained from 17 patients with gastric lymphoma were reviewed. In 15/17 cases the tumor presented as an abdominal mass, either with a "target-like" pattern or with a solid, homogeneous structure; in the remaining two cases only thickening of portions of the gastric wall was seen. Two features that may help to differentiate lymphoma from other gastric diseases were observed in patients of this series. In eight cases thickened mucosal folds could be identified within the gastric mass, outlined by strong luminal echoes arranged like the spokes of a wheel. A hypoechoic appearance of hte infiltrated gastric wall was seen in 13/17 cases; it was less echogenic than the adjacent liver parenchyma and, often, it was almost echo-free. Sonography is often used as the first imaging method in cases of patients with abdominal complaints and clinically unsuspected tumors of the stomach may be visualized first by it. In such cases, identification of these features within a gastric mass may allow sonography to suggest the lymphomatous nature of the disease.

[Renal changes in acute leukemia in children at onset. Incidence and prognostic value]. / Alterazioni renali nella leucemia acuta del bambino all'esordio. Incidenza e valore prognostico.

Microscopic leukemia infiltration of kidneys is a common autoptic finding in children for ALL before starting specific treatment. However, a palpable renal enlargement is uncommon. The authors have performed an intravenous pyelogram (IVP) in 139 pediatric cases of acute leukemia, 117 of whom ALL, the remaining 22 ANLL. ALL patients were divided in 3 groups; Group 1 was made of 18 children treated with IGG-74 protocol, independently by any prognostic factor; Group 2 included 46 patients presenting one or more negative factors; Group 3 was of 53 cases with no unfavourable factor. Abnormal IVP was found in 4/18 (22,2%) Group 1, 9/46 (19,5%) Group 2, 2/53 (3,8%) Group 3 ALL patients. The most common anomaly was a bilateral renal enlargement with normal or slightly compromised renal function. Only 3 out of 117 ALL children had palpable renal masses. All 15 children acquired CR within one month from starting therapy together with normalization of IVP. Six out of 15 of these cases died, one is alive with disease, 8 are alive in CR. Except for two cases, all presented other negative prognostic factor associated with abnormal IVP. One of 22 ANLL children had an abnormal IVP: only one kidney was involved with the unique mechanism of intraparenchimal hemorrhage and hydronephrosis due to the filling of renal pelvis and ureter by multiple coarse cloths. In conclusions, major renal alterations are present in about 10% of ALL children, rarely in ANLL. This finding is commonly associated with unfavorable prognostic factors.