Contrast-enhanced sonography in blunt scrotal trauma().

The scope of this study was to determine whether contrast-enhanced ultrasonography (CEUS), compared with basic US, can increase diagnostic confidence and provide relevant information on blunt scrotal trauma. Over a period of 75 months we examined 40 patients seen consecutively for blunt scrotal trauma using high-resolution US, color-power Doppler, low mechanical index CEUS, and power Doppler after IV administration of contrast medium (SonoVue(®)). In the 24 cases that were positive, concordance between basal US and CEUS findings was grade 0 (absent) in 4 cases, grade 1 (low) in 3, grade 2 (moderate) in 8, and grade 3 (high) in 9. The relevance of the additional information provided by CEUS was classified as follows: high in 4/40 (10%), moderate 7/40 (17,5%), low 13/40 (32,5%), none in 14/40 (35%). Our findings demonstrate that CEUS is appreciably more sensitive in detecting damage caused by blunt scrotal trauma, particularly small lesions. It is also useful for differential diagnosis and marginalization of corpuscular fluid collections, fractures, and above all ruptures, which require immediate surgery. In our series 2 out of 3 (67%) patients with testicular rupture were diagnosed only by CEUS. We feel that the use of CEUS can significantly improve diagnostic confidence in cases of closed scrotal trauma although these conclusions need to be confirmed in larger case series.

Influence of replacing corn silage with barley silage in the diets of buffalo cows on milk yield and quality.

A 150-day trial was carried out on 40 Italian Mediterranean buffalo cows that, immediately after calving, were equally divided into two homogeneous groups (M and O) based on the number of calving events and previous milk yield. The animals were fed (16 kg dry matter (DM)/head) two isoenergy/isoprotein diets (NEl: 6.39 MJ/kg DM; 15.4 CP% DM), composed of corn (diet M) or barley silage (diet O) concentrate, alfalfa hay, and a vitamin-mineral supplement. The fermentation characteristics of both silage diets were evaluated by an in vitro gas production technique, and their nutritional values were calculated as follows: NEl (MJ/kg DM) = 0.54 + 0.0959 GP + 0.0038 CP + 0.0001733 CP(2), where GP is the gas production after 24 h of incubation (ml/200 mg DM) and CP is the protein content of silage (g/kg DM). The nutritional values of the silages were slightly different (4.16 vs. 4.14 MJ/kg DM for M and O, respectively) likely due to the high content of hemicellulose in the O diet (22.0 vs. 16.9%). Average milk yield did not differ between the groups; instead, milk fat (8.39 vs. 9.06%; P < 0.01) and protein (4.41 vs. 4.60%; P < 0.01) levels were significantly higher in the O group. The results elicit great interest in southern Italy where corn cultivation is adversely affected by the high cost of irrigation.

Endoscopic treatment of sessile rectal adenomas: comparison of Nd:YAG laser therapy and injection-assisted piecemeal polypectomy.

This prospective study was carried out in order to compare endoscopic laser therapy with injection-assisted piecemeal polypectomy for treatment of sessile rectal adenomas. We randomized 94 patients with rectal sessile adenomas to either of the two treatments. The adenomas were classified according to size as extensive or intermediate. Of the patients with extensive adenomas, a complete ablation was achieved in 63.6% with laser versus 33.3% with piecemeal snaring (p < .01). For the intermediate adenomas, the rates of permanent ablation were 81.2% with laser versus 86.6% with piecemeal snaring polypectomy (difference not statistically significant). The complication rates were acceptable in both the laser and piecemeal snaring groups. (One case of perforation and one case of stenosis were observed in the laser group, both probably related to prior electroresection.) Our study suggests that the specific indication for laser therapy should be extensive lesions; with intermediate adenomas, laser therapy and injection-assisted piecemeal polypectomy are equally efficacious for achieving complete ablation. However, the duration of initial treatment differs: 6.3 weeks for laser therapy versus 2.4 weeks for piecemeal polypectomy; moreover, about 70% of the intermediate adenomas were eradicated with a single session of piecemeal polypectomy.

[Comparison of Nd-Yag laser and strip biopsy in the treatment of extensive adenomas of the rectum]. / Confronto tra Nd-YAG laser e strip biopsy nel trattamento degli adenomi estesi del retto.

This prospective study was carried out in order to compare endoscopic laser therapy and strip biopsy for treatment of large sessile rectal adenomas. Between January 1990 and December 1991, 94 consecutive patients, referred to our Endoscopy Service because of extensive rectal adenoma have been allocated to laser therapy or strip biopsy. The effectiveness of the two techniques was statistically the same from many points of view: complete ablation (76.7% vs 71.4%), recurrence (35.4% vs 30.6%) need for surgical intervention (12% vs 16.6%) and complication rates. However, from our experience, the treatment period was significantly shorter for patients affected by an intermediate sized adenoma and treated with strip biopsy. In both groups, instead, complete, permanent ablation was difficult to obtain in the cases of extensive lesions and in particular if they were localized lower than 5 cm from the anus.

[Personal experience in the treatment of esophago-cardial stenosis with the Nd-YAG laser]. / Esperienza personale nel trattamento con Nd-YAG laser delle stenosi esofago-cardiali.

The authors analyze the results of treatment, by Nd-YAG laser. of benign and malignant esophageal and cardial stenoses. Particularly the personal technique, immediate and late complications and association with complementary techniques such as dilatation or intratumoral injection of polidocanol are evaluated.

[Endoscopic endoprosthesis in the palliative treatment of carcinoma of the pancreas]. / Le endoprotesi endoscopiche nel trattamento palliativo del carcinoma del pancreas.

Perendoscopic treatment of cancer of the pancreas may be carried out through bilionasal drainage or bilioduodenal drainage. These techniques are indicated for preventing choledochic stenosis due to cancer of the head of the pancreas and should be considered as palliative techniques in inoperable patients. The present paper particularly examines the role of biliary endoprosthesis, with special attention to the results obtainable in terms of improvement to the quality of life in patients with inoperable gallbladder-obstructing cancers.

[The results of bile culture after selective sampling of the main biliary tract via endoscopic catheterization. The relation of the microbes isolated, the anatomicopathologic picture and the possibility of septic complications following endoscopic cholangiopancreatography (ERCP)]. / Risultati della bilicoltura dopo prelievo selettivo dalla via biliare principale (V.B.P.) per mezzo di cateterismo perendoscopico. Rapporti fra i germi isolati, quadro anatomopatologico e possibilità di complicanze settiche dopo colangiopancreatografia endoscopica (E.R.C.P.).

Selective sampling from the main bile way using endoscopic catheterization was used in the attempt to establish parameters capable of identifying patients at risk of septic complications following endoscopic cholangiopancreatography. The results obtained evidenced a significant relationship between neoplastic type obstructions of the main bile way, age of patient and positive bile culture with increased risk of septic complications. The advisability of using local and/or systemic antibiotic prophylaxis in elderly patients with suspected neoplastic obstruction of the bile way and thus candidates for endoscopic cholangiopancreatography is considered.