Sleep quality can influence the outcome of patients with multiple sclerosis.

OBJECTIVE: Sleep plays a role in some oligodendrocyte processes, including myelination. This study aimed to analyze the possible correlations between sleep quality and Multiple Sclerosis (MS) course. METHODS: Forty patients with Relapsing-Remitting MS were admitted. Based on the score obtained by the Pittsburgh Sleep Quality Index (PSQI), they were divided into good sleepers (<5) and bad sleepers (≥5). A set of data was collected retrospectively for each patient to investigate whether PSQI scores correlated with EDSS score changes, the number and the duration of each relapse and the cumulative day-number of MS reactivations over a three-year period. RESULTS: In a multivariate model, a PSQI score ≥5 independently and significantly correlated with an increase in number and duration of relapses (p = 0.000) and number of days of MS activity (p = 0.000) during the three-year retrospective observation period. CONCLUSIONS: The results of this study show that the course of MS may be influenced by sleep quality. Assessment of sleep quality could be used to obtain reliable prognostic information in patients with relapsing-remitting MS. Further investigations are necessary to evaluate whether the correction of sleep disorders may be effective in improving the prognosis of MS patients.

Subfascial endoscopic perforator surgery (SEPS) in chronic venous insufficiency. A 14 years experience.

INTRODUCTION: Subfascial Endoscopic Perforator Surgery (SEPS) enables the direct visualization and section of perforating veins. Morbidity and duration of hospitalization are both less than with conventional open surgery (Linton's or Felder's techniques). PATIENTS AND METHODS: A total of 322 legs from 285 patients with a mean age of 56 years (range 23-90) were treated at our Department from May 1996 to January 2010. In 309 cases, an endoscope (ETM Endoskopische Technik GmbH, Berlin, Germany) was introduced through a transverse incision approximately 1.5 cm in length and 10 cm from the tibial tuberosity, as with Linton's technique. A spacemaker balloon dissector for SEPS, involving a second incision 6 cm from the first, was used in only 13 cases. RESULTS: The procedure used in each case was decided on the basis of preoperative evaluation. SEPS and stripping were performed in 238 limbs (73.91%), SEPS and short stripping in 7 limbs (2.17%), SEPS and crossectomy in 51 limbs (15.84%), and SEPS alone in 26 limbs (8.07%). 103 patients presented a total of 158 trophic ulcers; the healing time was between 1 and 3 months, with a healing rate of 82.91% after 1 month and 98.73% after 3 months. CONCLUSION: Subfascial ligature of perforating veins is superior to sclerotherapy and minimally invasive suprafascial treatment for the treatment of CVI. It is easy to execute, minimally invasive and has few complications.

['Incidentaloma' in inguinal hernia surgery]. / 'Incidentaloma' nella chirurgia dell'ernia inguinale.

Adult Granulosa-Cell Tumor (GCT) is an uncommon ovarian malignancy. The clinical course is characterized by slow growth with late recurrence. A variety of clinical and pathologic parameters have previously been evaluated for prognosis with inconclusive results. The aim of this study was to report a case of a granulosa-cell tumor of the ovary that recurred 25 years after first surgery. The clinical course and histopathology of the case were reviewed and a literature search for other reported cases was performed.

[Sigma's stenosis. Clinical, diagnostic and therapeutical problems]. / Le stenosi del sigma. Problematiche cliniche, di diagnostica e terapeutiche.

Sigma's stenosis represent a frequent pathology, but its very difficult to have a pre-operatory diagnosis about the nature of these stenosis, not withstanding the introduction of more sophisticated instruments of diagnosis. In this work we present 9 cases of sigma stenosis; some of these with a common etiology and other very interesting for their rare and unusual origins. The patients were underwent to a different timing of diagnosis and therapy based on clinical history and diagnostic hypotheses; our experiences demonstrate that the clinical intuition is really useful for a correct diagnosis in the patients with a sigma's stenosis and consequently, in order to plan the correct therapy.

Breast cancer takes up 99mTc bombesin. A preliminary report.

BACKGROUND: Several tumors including lung, prostate, ovarian, colon, and exocrine pancreatic cancer show receptors for the amphibian neurotransmitter and growth factor bombesin (BN) and its mammalian counterparts gastrin-releasing peptide and neuromedin B. Also breast cancer has been reported to show such receptors: the presence of BN receptors in primary breast cancer has been demonstrated on cultured cells and by autoradiography on breast tissue samples. Authors who have studied BN receptors in breast cancer do not agree on their frequency in primary cancer, but indicate that 100% of metastatic breast cancers show such receptors. METHODS: We examined three primary breast cancer patients with 99mTc BN and 99mTc sestamibi one week before surgery. One of them showed axillary node invasion. The same acquisition technique was used for breast and chest imaging with both radiopharmaceuticals, whereas total body images were acquired only with 99mTc BN. Also the administered radioactivity was different: 20 mCi of 99mTc sestamibi and 5-8 mCi of 99mTc BN. Dynamic images were acquired for 20 mins after iv injection with the patient in ventral decubitus and the gamma camera positioned in a lateral view, as is generally done in Khakhali's prone scintimammography. Anterior chest images were acquired for 30 mins. Prone scintimammography was performed one hour after administration of both tracers. ROIs were drawn on tumors and surrounding breast with the same technique in order to calculate the tumor to breast ratio (T/B). In addition, total body scan was performed one hour and three hours after 99mTc BN administration. All three patients underwent breast conserving surgery with lymphadenectomy. Postoperative pathologic assessment showed the following T and N stages in the three patients: T1bN0, T1c-N0, and T1cN1. RESULTS: All three cancers were imaged with both tracers. The T/B of 99mTc BN was always higher than that of 99mTc sestamibi. Chest uptake was always much higher with 99mTc sestamibi than with 99mTc BN. Comparison between 99mTc BN and 99mTc sestamibi images gave other intriguing results: in the N1 patient both tracers clearly imaged the invaded node, but on the 99mTc BM image the primary tumor was larger than on the 99mTc sestamibi image and the node was smaller. It is known that 99mTc BN is not taken up by vessels and inflammatory tissue. The time activity curves of the two tracers were significantly different in all patients, with an increase in 99mTc BN uptake in the first three to five minutes, followed by a less sharp uprise of the curve, quite similar to a plateau. CONCLUSIONS: Our first impression is that 99mTc BN is a useful breast cancer seeking agent and very promising for lymph node staging.

[Breast carcinoma with neuroendocrine differentiation. Clinical case and review of the literature]. / Il carcinoma mammario con differenziazione neuroendocrina. Osservazione clinica e revisione della letteratura.

Female breast carcinoma with neuroendocrine differentiation is a lesion which can enhance of conventional therapy added with tamoxifene-octreotide association. The Authors report a case completely responsive after two years therapy, which grading was: pT4, N1biii, Mx, G2 staging III.

An evaluation of the brachial plexus block at the humeral canal using a neurostimulator (1417 patients): the efficacy, safety, and predictive criteria of failure.

UNLABELLED: To evaluate the efficacy and safety of the multiple peripheral nerve block technique at the humeral canal (humeral block) with the use of a neurostimulator, we prospectively studied 1417 patients undergoing upper limb surgery with a brachial plexus block at the humeral canal (1468 blocks). The success rate (defined as sensory block [in all nerve distributions] and/or the absence of another anesthetic technique required to allow surgery) was 95%. The threshold of minimal stimulation used to locate each nerve before injecting the anesthetic solution was the unique predictive factor for identified failure. For the median nerve, the threshold was 0.8 mA with a relative risk of failure (RRf: relative risk evaluated by series of Taylor with a 95% confidence interval) = 1.49 (P = 0.04), for the radial nerve the threshold was 0.6 mA (RRf 1.3, P = 0.02), and 0.7 mA for the ulnar nerve (RRf 1.36, P = 0.04). For any equal or higher stimulation level, the risk of failure of the humeral block increased. For the musculocutaneous nerve, we did not observe a significant stimulation threshold for the risk of failure; although beyond 0.7 mA, the RRf was always more than 1.3. Adverse events occurred in 7% of all cases and were usually minor (nausea/vomiting, anxiety, local pain). Our study provides supplementary information on the efficacy and safety of this technique. Stimulation thresholds are clinically identified for the first time as the main factor linked to the failure of a technique using a neurostimulator. We conclude that the humeral block is a reliable peripheral block allowing good success rates results with minor complications, which can be used as an alternative to the axillary block. IMPLICATIONS: We prospectively evaluated the feasibility and the factors causing failure of a peripheral nerve block technique (humeral block) using neurostimulation in a large number of patients. The importance of the level of stimulation for the success of the block was evaluated for the first time.

[Role of total thyroidectomy in benign multinodular benign goiter]. / Il ruolo della tiroidectomia totale nella tireopatia nodulare plurifocale benigna.

The Authors report a review of the Literature and their personal series to evaluate the role of total thyroidectomy in the surgical management of non-toxic multinodular goiter. On the basis of the data obtained, the Authors consider total thyroidectomy the therapy of choice for this pathology.

[Ambulatory surgery of varices: our experience]. / La chirurgia ambulatoriale delle varici: nostra esperienza.

The Authors, on the basis of their experience with 196 patients aged from 18 to 45, affected by relapsing varicose veins, stress the advantages of the outpatient treatment according to Muller's technique. For these lesions excellent aesthetic and functional results, easy surgical technique, low incidence of complications, prompt resumption to work were registered.

[Gardner syndrome: diagnostic, clinical and genetic questions in the light of 2 case reports]. / Sindrome di Gardner: problematiche diagnostiche, cliniche e genetiche alla luce di due casi clinici.

The authors on the base of two cases of Gardner's syndrome recently observed, proceed to a wide review of literature on this subject so as to stress the peculiar aspects of this syndrome, so complex and uncommon. The greatest emphasis is given to the role of genetics as regarding to diagnosis and screening programs, as well as to the more recent acquisitions about diagnosis, therapy and follow up of risk lesions, such as colorectal and duodenal adenomas, as well as of intrabdominal desmoid tumours, which, although not histologically malignant, may often influence prognosis negatively, because of their remarkable local invasiveness and tendency to recurrence.

[Subtotal colectomy with ceco-rectal anastomosis]. / La colectomia subtotale con ciecorettoanastomosi.

A case of subtotal colectomy cecoproctostomy for multiple lesions of the colon is introduced. This procedure has advantages over ileoproctostomy because it spares the terminal ileum, ileocecal junction and cecum. Due to the high incidence of bowel movements after the ileoproctostomy operation, the authors recommend cecoproctostomy as a valid choice in a selectioned group of patients with multiple or extended lesions that spares cecum and rectum.

[A case of ileocecocolic intussusception from cecal carcinoma]. / Un particolare caso di invaginazione ileo-cieco-colica da carcinoma del cieco.

The authors present a case of ileocecocolic intussusception by carcinoma of the caecum. They stress the most peculiar aspects of this condition: rare etiology; complete invagination of caecum appendix and ileum; typical clinical presentation characterized by variable dimensions of the mass and symptoms not ascribing to occlusion, no lesions at endoscopy; evidence of a typical "target mass" visualized at T.C.

[Tietze's syndrome: importance of differential diagnosis and role of CT]. / Sindrome di Tietze: importanza della diagnostica differenziale e ruolo della TC.

A case of Tietze's syndrome is reported. A 55-year-old woman had experienced left anterior chest pain and tender swelling of the left second costosternal junction for one month. CT showed a focal enlargement of the left second costal cartilage with partial calcification. Six months later a complete recovery was registered and a second CT scan was negative. These clinical and CT findings are consistent with Tietze's syndrome.

[Ovarian endometriosis involving the intestine with "ab ++estrinseco" stenosis of the sigmoid]. / Endometriosi ovarica a sviluppo intestinale con stenosi "Ab estrinseco" del sigma.

The Authors report a case of ovarian endometriosis causing an "Ab extrinseco" sigmoid stenosis. The histogenesis as well as different possibilities of treatment, i.e. medical and surgical, are discussed.

[The colorectal adenoma-carcinoma sequence: the limits between polypectomy and intestinal resection]. / Sequenza adenoma-carcinoma rettocolico: limiti tra polipectomia e resezione intestinale.

According to a clinic case, the authors pointed out the role of histological diagnosis in the therapeutic approach of large intestinal adenomas. In order to identify those lesions which can metastasize, having exceeded the muscularis mucosae and having invaded the submucosa, rigorous histological standards must be performed. Intestinal resection versus polypectomy is determined only according to the involvement or not of the muscularis mucosae.

[Bilateral carcinoma of the breast: treatment and prevention, Review of the literature]. / Il carcinoma bilaterale della mammella: trattamento e profilassi. Revisione della letteratura.

Authors analyze 256 patients admitted in III Clinica Chirurgica of University of Rome "La Sapienza" for breast cancer, from 1982 to 1992; 16 of them had later developed another neoplasm in the opposite breast. After a retrospective study of the clinical history of all patients they came to the conclusion that bilateral neoplasm frequency is similar to that reported in world literature (1-18%) (23, 9, 2). Moreover, are analyzed the primary risk factors for a bilateral carcinoma, and they consider the utility of the prophylactic surgical treatment of the opposite breast.

[Pathology and clinical course of pancreatic pseudocyst]. / Patologia e clinica delle pseudocisti pancreatiche.

According to the literature and the personal experience of the authors there seem to exist many controversies on the treatment of pancreatic pseudocysts, partly due to the lack of definitions and to the fact that prognosis is different based upon the pathophysiology of the lesions. We report 4 cases of pancreatic pseudocysts successfully treated with a multidisciplinary approach, stressing the role of pharmacology and of artificial nutrition and endoscopy on the outcome of these lesions.