Isolated and complete traumatic rupture of the pancreas: A case report and a review of the literature.

INTRODUCTION: Pancreatic trauma without injuries to other organs is uncommon, as reported in the reviewed literature. Diagnosis of pancreatic trauma might be difficult, due to unspecific signs and symptoms. The integrity of the main pancreatic duct is the crucial point in the management and outcome of patients with pancreatic trauma. PRESENTATION OF CASE: The authors report a case of delayed diagnosis after a complete traumatic rupture of the main pancreatic duct, successfully managed by surgical treatment. The authors performed a laparotomy with complete removal of necrotic pancreatic tissue at the site of rupture. The proximal pancreatic stump was hand-sewn with detached stitches and a disposable catheter was positioned into Wirsung's duct, a diversion of the distal stump with a Roux-en-y pancreato-jejunal anastomosis was performed. The postoperative course was uneventful. DISCUSSION: Traumatic injuries of the pancreas occur after blunt abdominal traumas or penetrating wounds with a ratio of 3:1. Isolated traumatic injuries of the pancreas are uncommon; and they are usually associated with injuries to other organs. Surgical solutions for the treatment of pancreas lesions vary and it is well known that a surgical procedure performed after a delayed diagnosis is associated with high mortality and morbidity, especially in pancreatic duct rupture. CONCLUSION: Pancreatic trauma is a diagnostic and therapeutic challenge for the trauma surgeon. The integrity of the main pancreatic duct is the most important determinant of outcome after injury to the pancreas and, in Wirsung's duct rupture, early surgery may improve it.

The gluten-free diet: a nutritional risk factor for adolescents with celiac disease?

BACKGROUND: The gluten-free diet is the standard therapy for patients affected by celiac disease, although compliance with the diet is not optimal in adolescents or adults. Moreover, the gluten-free diet may induce nutritional imbalances. METHODS: Alimentary habits and diet composition were examined in 47 adolescents with celiac disease and 47 healthy aged-matched control subjects. All subjects compiled a 3-day alimentary record that allowed determination of their energy intakes: the macronutrient composition of their diets; and their iron, calcium, and fiber intakes. To evaluate compliance with the gluten-free diet, immunoglobulin A antigliadin and antiendomysium antibodies were assessed in all with celiac disease. RESULTS: The analysis of the records and the results of antibody levels showed that 25 subjects strictly followed dietetic prescriptions (group 1A), whereas 22 patients consumed gluten-containing food (group 1B). Those with celiac disease and control subjects (group 2) consumed a normocaloric diet. Lipid and protein consumption was high, however, and the consumption of carbohydrates low. Moreover, dietary levels of calcium, fiber, and especially in girls, iron, were low. These nutritional imbalances were significantly more evident in group 1A than in group 1B, as a consequence of poor alimentary choices. Moreover, in group 1A overweight and obesity were more frequent (72%) than in group 1B (51%) and in the control subjects (47%). CONCLUSIONS: In people with celiac disease, adherence to a strict gluten-free diet worsens the already nutritionally unbalanced diet of adolescents, increasing elevated protein and lipid consumption. In the follow-up of patients with celiac disease, considerable effort has yet to be made to improve compliance with a gluten-free diet, and especially to control the nutritional balance of the diet in compliant patients.

Speech lateralisation in callosal agenesis assessed by the dichotic fused words test.

Child patients with left-hemisphere damage (n = 2), with total callosal agenesis (n = 2), and with partial callosal agenesis or hypotrophy (n = 3) were submitted to dichotic verbal stimulation by the Fused Words Test. The controls were nine normal children, right-, left-, and mixed-handed. As expected, the left-injured patients presented a massive advantage of the ear contralateral to the intact hemisphere. Among the controls the right-handers showed a significant right-ear prevalence, whereas left-and mixed-handers exhibited rather inconsistent earasymmetries. The major finding of this study is the striking difference in perceptual asymmetry between partial and total acallosals. Based on the notion that the dichotic verbal asymmetry is an effect of the underlying functional asymmetry for language, these findings are interpreted as an indication that development of the unilateral speech control is influenced by the presence, during ontogenesis, of callosal connections.

[Incidentally discovered masses: diagnostic and therapeutic features]. / Gli incidentalomi: aspetti diagnostici e terapeutici.

The term "incidentaloma", which was first used to indicate a mass discovered by chance at an adrenal level, is currently used to indicate any lesion identified accidentally, namely in the absence of specific symptomatology, during echographic or tomographic examination. The authors report their experience of just over one year and, through a review of the literature, draw attention to the fact that these incidentalomas raise unresolved problems both from a diagnostic and therapeutic point of view. They hope that routine abdominal echography will be extended at least to a selected hospital population given that these lesions, diagnosed by chance, may be malignant or even if benign may have a potential evolution. Obviously surgery in these cases would lead to a marked prognostic improvement.

[The rational use of drains in surgery]. / Uso razionale dei drenaggi in chirurgia.

The authors report their clinical experience in 100 cases in which various kinds of drainage were used. They outline the best present techniques, when it is wished to apply this free drainage in the abdominal cavity, at the end of the operation.

[Double hydatid cyst of the liver, one of them with a fistula and causing stenosis of the pyloric canal associated with calculous cholecystitis]. / Cisti di echinococco duplice del fegato, una fistolizzata e provocante stenosi del canale pilorico ed associazione di colecistite calcolosa.

A case of double hydatid cyst of the liver (one fistulised into the pyloric canal where it had caused stenosis) and its association with calculous cholecystitis is reported. The therapy chosen to treat this rare phenomenon had a very satisfactory outcome in view of the complexity of the case given the need to perform several operations in contemporary (enucleation of the cyst, gastric resection and cholecystectomy) and the age of the patient.

[Diverticulitis of the right colon. Description of our experience]. / Diverticolite del colon destro. Descrizione delle nostre esperienze.

Two cases of diverticultis of the right colon are described which received surgical treatment. These lesions often simulate acute appendicitis and thus represent a intraoperative surprise Differential diagnosis using a neoblastic mass is often impossible. The paper stresses the importance of surgical treatment which in general terms is the same as the treatment of the diverticular mass of the left colon. In cases where it is difficult to decide between a phlogostic and neoblastic pathology, it is advised that a right hemicolectomy should be performed in line with criteria for oncological requirements.

[Approach methods to the central venous system]. / Modalità di aggressione del sistema venoso centrale (S.V.C.).

Personal experience in the aggression of the CNS for various purposes is considered. It is thought that the internal trans-jugular route is the easiest approach and procedures the fewest complications with appropriate techniques.

[Treatment of acute cholecystitis and its complications]. / Terapia della colecistite acuta e delle sue complicazioni.

Forty cases of acute cholecystitis and its complications have been reviewed. Examination of the literature and a study of the personal series leads to a discussion on the need or otherwise for early surgery, particularly in those patients in whom a more unfavourable course for the clinical picture can be objectively presumed.

[Possibilities in biological diagnosis and therapy of neoplastic pathology of the oral cavity]. / Possibilità della diagnosi e della terapia biologica nella patologia neoplastica del cavo orale.

After a brief summary of the role played by immunity in preventing the development of malignant neoplasms, the AA. in a speedy sequence treat of tumoral markers and their possibilities in diagnostic use. Then AA. make a precis of trials of different types of immunotherapy and as well of researches object of future therapeutic use.

[Treatment of septic complications in diverticular disease of the colon]. / Trattamento delle complicanze settiche della malattia diverticolare del colon.

Eight years' experience in the treatment of the septic complications of diverticular disease of the colon is examined and 44 cases treated in the period 1980-1988 are considered. The Hartman procedure gave good results in the majority of cases; other procedures such as drainage with colostomy, or anastomosis resection during a single intervention are reserved for particular cases. In addition, on examining the case histories and the current literature it seems that it is correct to treat DD (diverticular disease) surgically whenever the typical manifestations of the overt disease appear; waiting often represents nothing more than a postponement of the surgical treatment until an emergency arises.

[Value of axillary lymphadenectomy in malignant tumors of the breast. Apropos of 135 controlled cases]. / Valore della linfoadenectomia ascellare nel tumore maligno di mammella. A proposito di 135 casi controllati.

Personal experience in the treatment of breast cancer is reported along with the results of 135 cases in which long-term follow-up was carried out. The results are in line with what has been observed in the recent literature. Study of therapeutically removed axillary lymph nodes proved to be the main factor on which to base prognostic judgment and programmes of multidisciplinary treatment, if applicable. Further elements derive from hormonal receptors and, in future, from the study of cell kinetics with tritiated thymidine.

[Bilaminar technic in the treatment of gingival recessions]. / Tecniche bilaminari nel trattamento delle recessioni gengivali.

Bilaminar procedures represent an evolution in the treatment of marginal tissue recessions. A connective tissue graft removed from the palate and over which a pedicle flap is sutured, is used in these procedures. The advantages of these new procedures are: 1) sure predictability of graft survival to which a double-blood supply is guaranteed; 2) primary intention healing at the donor site, with minimum post-operative discomfort; 3) excellent esthetic results consisting of better color blending between graft and adjacent tissues and absence of keloid- like scars, very common after free gingival grafts.

[Nimesulide: multicenter clinical study for evaluation of its therapeutic effect in odontostomatology]. / Nimesulide: studio clinico multicentrico per la valutazione dell'attività terapeutica in odontostomatologia.

A Polycentric Study was carried out so as to assess the anti-inflammatory effectiveness and pain-killing activity of Nimesulide in Odontostomatological practice, in 78 patients suffering from alveolo-gingival and parodontal abscesses, consequences of tooth extraction, suppurated radicular cysts, dysodontiasis, osteitis, periodontitis, periostitis. The results obtained confirm the anti-inflammatory and analgesic effect as well as the good tolerability of this drug.

[Clinical and immunological aspects of Lichen ruber planus]. / Brevi considerazioni su alcuni aspetti clinici ed immunologici del Linchen ruber planus.

Clinical and histopathologic features of lesions in lichen r. planus are characteristic of inflammatory reaction: this it is possible some pondering on immunologic performance related to uncertain etiology of the disease.