[Multimodal treatment complications of post-cholecystectomy intrahepatic lithiasis. Case report]. / Complicanze del trattamento multimodale della calcolosi intraepatica nel colecistectomizzato. Case report.

The Authors presents a case of post-cholecystectomy intrahepatic lithiasis. They focalized their attention to the complications of multimodal treatment.

[Liposarcoma of the leg]. / Liposarcoma dell'arto inferiore.

The Authors report an interesting case of liposarcoma of the leg and review the international Literature. Moreover, a particular analysis of different aspects such as anatomy, clinic, diagnosis and treatment has been carried out.

[Spontaneous rupture of duodenum: case report and review]. / Rottura spontanea del duodeno: presentazione di un caso clinico e revisione della letteratura.

Although rare, injuries of the duodenum increased in frequency during the past ten years. Careful attention must be paid to them, especially in blunt trauma of the abdomen and lower thoracic regions. Often they occur along with lesions of other related structures in polytraumatized patients. X-rays are the most important mean used in diagnosis. Early diagnosis and surgical treatment are conditio sine qua non for successful results. Complete intraoperative inspection of the duodenum, careful suture of the perforation and a correct placement of drainage are essential for the prevention of postoperative complications. If the duodenal wall had lost its vitality, a gastrojejunal or duodenojejunal anastomosis or gastrostomy are performed; the duodenum is decompressed and drainage of the peritoneal cavity is established. In cases of associated injury of the pancreas or choledochus, the drainage of the extrahepatic bile duct is recommended. The Authors report a case of spontaneous rupture of duodenum in which all of the above mentioned procedures were used; they stress that only suspicion of a duodenum's rupture indicates an immediate laparotomy.

[Magnetic resonance and traditional radiology in the spine localizations of alkaptonuric ochronotic arthropathy]. / Risonanza magnetica e radiologia tradizionale nelle localizzazioni vertebrali dell'artropatia ocronotica alcaptonurica.

AIM: To study the spine alterations in alcaptonuria with traditional radiology and magnetic resonance (MR), comparing the results of the two techniques. PATIENTS AND METHODS: Five patients (4 males, 1 female, mean age 51 years) underwent the examinations. For the study with X-rays we performed anteroposterior and lateral scan and the images have been studied making reference to a radiographic score; it examines the alterations of the joint space and the presence of calcifications. MR scan, oriented in the three spatial planes, were performed using spin echo T1-weighted and spin echo T2-weighted sequences. RESULTS: Both MR and X-rays pointed out, in the cases with known diagnosis, the typical alterations of the ochronosis: narrowing of the articular spaces, even osseous ankylosis, calcifications of the discs, osteophytosis, multiple disc protrusions and reactive sclerosis of the articular surfaces, evident above all to dorso-lumbar tract; nevertheless MR has been more accurate than X-rays for individualizing the lesions and recognizing alterations, such as the thickness of the anterior longitudinal ligament. In the case of new diagnosis, the MR is fundamental to recognize typical signs of the ochronotic arthropathy not well detected by X-rays. CONCLUSIONS: Imaging techniques, first of all the MR, are essential in the differential diagnosis of ochronosis vertebral lesions with other articular diseases.

Parotid gland cancer: a case report of a primitive adenocarcinoma arising from a multirecurrent pleomorphic adenoma.

Parotid tumours represent a wide group of tumours which are mostly localized in the major salivary glands. We report a case of a 69-year old female with a parotid tumour history who was referred to us with a prominent lump and swelling localized in the right parotid area. In the period between 1985-2002, she was operated 5 times elsewhere for a recurrent pleomorphic adenoma of the right parotid (mixed tumour until 1991), which was histologically confirmed. Sixteen years after the primitive tumour, she underwent mastectomy and axillary dissection for a ductal carcinoma. Routine follow-up has been conducted on both malignancies. Pleomorphic adenoma is the most frequent tumour of the parotid. The potential risk of a malignant transformation can increase over the years with an incidence of 1% to 7%. Management of these recurrences is complex and controversial because of the different treatment options advocated such as radical resection with possible facial nerve sacrifice, or postoperative radiotherapy in non radical cases.

[Collateral effects of intraoperative hyperthermic chemotherapy in peritoneal carcinomatosis]. / Effetti collaterali della ipertermochemioterapia intraoperatoria nel trattamento della carcinosi peritoneale.

The association between chemotherapy and hypertermia produces a synergic effect. In this study the Authors present their experience, by the analysis of the results. From 1993 to 2000, 17 patients have been treated with surgery associated with hypertermic chemotherapy for peritoneal carcinomatosis. For the management of these patients a constant cooperation among surgeon, cardiologist and anaesthetist is very important.

The role of Echo Colour/Power Doppler and magnetic resonance in expansive parotid lesions.

The purpose of this research was to evaluate the role of Echo Colour/Power Doppler and Magnetic Resonance Imaging (MRI) in the diagnosis of expansive parotid lesions, and to establish criteria for differential diagnosis between benign and malignant forms. Forty nine patients (23 males and 26 females), aging from 30 to 85 years, with an expansive pathology of parotid gland were enrolled in our study from February 1999 through August 2004. Each patient was carefully assessed employing both ultrasonography integrated with Color/Power Doppler and MRI. Eventually, all patients received echo-guided needle-biopsy and surgical excision of the parotid lesion. Preliminary ultrasound assessed site, size, echoic appearance and margins of the lesion. In order to assess blood supply by means of Colour/Power Doppler, we divided the patients in four groups. Our MRI diagnostic criteria included site, size, intensity of signal, behaviour of the lesion after i.v. contrast, relationship with facial nerve and retromandibular vein, detection of margins and proximity to adjacent structures. On the basis of our results, the Authors concluded that both Echo Colour/Power Doppler and MRI play a very important role in the diagnosis and surgical planning of parotid gland lesions.

Acute abdomen in a 15-year-old patient with Peutz-Jeghers syndrome. Surgical approach.

The natural history of Peutz-Jeghers syndrome (PJS) is characterized by gastrointestinal complications (occlusion, invagination or bleeding), often the first clinical manifestation in young patients. Surgical treatment consists of treating the complication, exploring the bowel and cleaning out all polyps to prevent further emergency operations at brief intervals. For this purpose both the laparotomic and laparoscopic approaches have been proposed, especially in young patients. A 15-year-old girl was admitted for investigation of colicky abdominal pains. When she was 5 years old, PJS was diagnosed. On admission to our department, the patient underwent emergency esophagogastroduodenoscopy and colonoscopy, both negative. At 24 hours after admission peritonitis developed. Given her clinical history, we rejected the laparoscopic approach proposed at admission and decided for an open laparotomy. Laparotomy disclosed a long jejunoileal invagination that caused irreversible ischemic damage of the bowel. We resected about 130 cm of the ileum and did an end-to-end ileo-ileal anastomosis. Meticulous palpation and transillumination of the residual bowel identified no other polyps. In young patients with acute abdomen and with proven or suspected PJS instead of laparoscopy, open laparotomy is a unique occasion to explore the residual bowel thoroughly, manually and, if possible, endoscopically.