Abscess formation at the ischiorectal fossa 7 months after the application of a synthetic transobturator sling for stress urinary incontinence in a type II diabetic woman.

A 50-year-old diabetic woman was referred to our unit because of high fever, foul-smelling vaginal discharge and pain in the leg, 7 months after undergoing surgery for application of a transobturator suburethral sling. Patient evaluation revealed erosion of the tape through the vaginal wall; the infection had spread to the region of the internal obturator muscle and then up to the anterior recess of the ischiorectal fossa. The patient underwent surgery for sling removal, antibiotic therapy and, finally, surgical incisions to facilitate drainage of the abscess. All these passages were necessary to obtain complete resolution of the symptoms. Infectious complications are possible after transobturator sling procedures. Patients should then be informed about the risks of erosion and infection and be warned that the appearance of pain and foul-smelling vaginal discharge may indeed be the first symptom of subsequent and much more severe infectious complications.

Minilaparotomy vs laparotomy for uterine myomectomies: a randomized controlled trial.

AIM: To evaluate the efficacy and applicability of the minilaparotomy technique in abdominal myomectomies and to compare it with traditional laparotomy. METHODS: We enrolled 99 women, suffering from symptomatic uterine myomas, to be operated for myomectomy. Through computer randomization, 55 women were assigned to the study group (minilaparotomy) and 44 women to the control group (traditional laparotomy). Women assigned to the study group were operated using a recently modified minilaparotomy technique. Statistical evaluation was performed through Mann-Whitney U test, chi2 test, Student's t-test. RESULTS: Duration of surgery, time for spontaneous recanalization and days of postoperative hospital stay were significantly lower in the study group, as well as treatment satisfaction reported by the patients (p<0.05). Moreover, each minilaparotomy operation ended by saving 620 Euro. CONCLUSIONS: Minilaparotomy seems to be a valid alternative to the removal of symptomatic uterine myomas. The objective and subjective advantages in operated patients, as well as the reduction in sanitary costs are underlined.

[Echo-color Doppler and echo-Doppler in the diagnosis of carotid body tumors]. / L'eco-color Doppler e l'eco-Doppler nella diagnosi dei chemodectomi latero-cervicali.

Echo-Doppler and Color Flow Doppler examinations, are able to combine the advantages offered by echography with those had with the Doppler exam. In the presence of tumours of the carotid body, these exams can furnish morphological data with regard to tumor size, its precise location and its rapport with contiguous organ as well as data regarding blood flow in the mass itself. The color Flow Doppler exam, in particular, can reveal the echographic aspect and the flow toward and away from the sonde all on the same image. This enables a precise diagnosis of a tumor of the carotid body to be reached even without angiography. The personal experience here reported involves ten cases observed during the last seven years.

Troponin T as a marker of ischemic myocardial injury.

A study was undertaken to evaluate the clinical relevance of serum troponin T (TnT) as a marker of ischemic myocardial injury, using a new automated enzyme immunoassay. The reference range for serum TnT was established by measuring serum TnT concentrations in blood obtained from 262 healthy subjects. The serum concentration of TnT was compared to serum creatine kinase activity, creatine kinase MB (mass and activity), myoglobin concentration, and lactate dehydrogenase activity: in 77 patients with myocardial infarction (55 received thrombolytic treatment); in 32 patients with unstable angina; in 30 patients with nonischemic heart diseases; and in 40 patients with skeletal muscle injuries. Our findings showed that: a) 99% of healthy blood donors had TnT concentrations < 0.10 micrograms/L; b) the test had a high clinical efficiency in the diagnosis of acute myocardial infarction, with a sensitivity of 1.0 and a specificity of 0.88 at a decision level of 0.20 micrograms/L; c) serum TnT had a later peak value (8-38 h), but a wider diagnostic window (> 126 h) than the traditional markers considered in the study; d) serum TnT had an excellent sensitivity in the detection of microinfarctions in patients with unstable angina pectoris; e) the release patterns of serum TnT were qualitatively different in perfused versus nonperfused patients. Peak serum TnT values and time to peak values were statistically different (p = 0.0336 and p = 0.0001) in reperfused and nonreperfused AMI patients, respectively; f) a ratio of serum TnT at 16 h to serum TnT at 32 h after chest pain > 1 provided a good indication of reperfusion in thrombolytic treatment (94% efficiency).

[Idiopathic dilatation of the atria: a syndrome? Description of a case of idiopathic biatrial dilatation, review of the literature and a proposal for a pathogenetic interpretation]. / La dilatazione idiopatica degli atri: una sindrome? Descrizione di un caso di dilatazione idiopatica biatriale, revisione della letteratura e proposta di interpretazione patogenetica.

Idiopathic severe dilatation of bilateral atrial and urethero-pelvic systems was found in a 53-year-old woman. Degeneration of muscle fibers without inflammation is a constant feature of idiopathic atrial enlargement. Degenerative process can extensively involve atrial wall (generalized dilatation) or can be localized (aneurysmal dilatation). In both types of lesion clinical features are related to atrial arrhythmias and to compression on atrio-ventricular valves and ventricles by the enlarged atria. Only the outcome of the atrial arrhythmias can help to distinguish between the two conditions: development of irreversible atrial standstill in generalized dilatation and definitive restoration of sinus rhythm, following surgery, in aneurysmal dilatation. In each atrium, a different rate of incidence of the two types of dilatation has been documented in the literature: as for the right atrium, more than 40 cases of generalized dilatation have been reported and only 4 of the aneurysmal type. On the other hand, isolated left atrial enlargement was of aneurysmal type in all 30 reported cases. Biatrial dilatation was generalized in 7 cases and due to multiple aneurysms in a single case. The Authors support the hypothesis that idiopathic atrial dilatation could be due to a degenerative process affecting the atrial components derived from primitive atria, in which the muscular layer is structured into pectinate muscles. They also suggest to distinguish, even from the etiopathogenetic point of view, between aneurysmal dilatation (localized and fortuitous lesion) and generalized dilatation (diffuse degeneration of pectinate muscles). This distinction could well related with the different outcome of atrial arrhythmia in the two types of dilatation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Double-outlet right ventricle with intact interventricular septum. Case report, review of the literature and proposed pathogenetic interpretation]. / Ventricolo destro a doppia uscita con setto interventricolare intatto. Presentazione di un caso, revisione della letteratura e proposta di interpretazione patogenetica.

Double Outlet Right Ventricle with intact ventricular septum is an extremely rare malformation. Only nine cases are recorded in the known world literature. A new case is reported, concerning a female infant six months old when first seen, and still alive after atrial septectomy. The anatomical studies in Double Outlet Right Ventricle suggest that only the Ventricular Septal Defect in the outlet septum is an integral part of the malformation and can be defined as "typical". In more than 10% of cases the Ventricular Septal Defect opens into the inlet or trabecular-muscular portions of the septum: these latter locations of the defect should therefore be considered as "associated". Double Outlet Right Ventricle with intact ventricular septum can be interpreted as the variant lacking both typical and associated Ventricular Septal Defect. From the analysis of anatomical descriptions of the ten known specimens of Double Outlet Right Ventricle with intact Ventricular septum, the Authors word out the hypothesis that ventricular septum closure could be referred to a well developed bulbo-ventricular fold (bulbo-ventricular fold synonimous of cono-ventricular flange and bulbo-atrio-ventricular ledge), as a consequence of missed or defective conal absorption. They conceive a range including on one hand the Subarterial Ventricular Septal defect (bulbo-ventricular fold poorly developed due to effective conal absorption), on the other hand the Restrictive Ventricular Septal Defect and Intact Ventricular Septum (bulbo-ventricular fold well developed due to defective conal absorption).

[Aortic insufficiency caused by valvular dysplasia in childhood. Apropos of 3 cases]. / Insufficienza aortica da displasia valvolare nella fanciullezza. A proposito di tre casi osservati.

Three patients whose aortic incompetence (A.I.) was recognized in childhood, have had an angiographic study 10, 9 and 4 years, respectively, following the first clinical diagnosis of their valvular disease. A.I. was related, in all three cases, to a dysplastic valve ("floppy valve syndrome"); in none of them was there an abnormal dilatation of ascending aorta. In our opinion, the absence of an abnormal aortic root dilatation separates our cases from those in whom aortic regurgitation is part of Marfan's syndrome, either in its full form or in the "forme fruste". From the clinical viewpoint, the presence of a normal ascending aorta could explain the mild course of these cases, as compared to the rapid progression observed in Marfan's syndrome. In the attempt to differentiate the two types of dysplastic valvular disease from an etiologic viewpoint, we suggest that the basic problem in our patients could be an alteration of the valvular connective tissue development, rather than a genetic disorder, like the one possibly responsible for Marfan's syndrome.

[AQRS left axial deviation of more than -30 degrees and incomplete right branch block in isolated ventricular septal defects]. / Deviazione assiale sinistra di AQRS oltre -30 gradi e blocco di branca destra incompleto nei difetti isolati del setto ventricolare.

Electrocardiographic findings in five out of forty-three cases of isolated Ventricular Septal Defects (VSD) demonstrated incomplete Right Bundle Branch Block (RBBB) with left AQRS deviation of more than -30 degrees. These features are said to be characteristic of VSD of the Persistent Common Atrioventricular Canal type. However, in two of our five cases a defect of the Inlet Septum was documented angiographically; in the remaining three cases a defect of the peri-Membranous septum was clearly demonstrated. Moreover hemodynamic data in our patients indicate that right ventricular diastolic overload could not account for RBBB in all of the cases. The clinical importance derived from this experience is that ECG findings of RBBB and left AQRS deviation of more than -30 degrees are not necessarily associated with, and therefore do not represent certain proof of the presence of VSD of the A-V Canal type. The association of this ECG pattern with VSD's other than the A-V Canal type, as previously observed, appears to have an anatomic explanation, which however needs further substantiation through electrophysiologic studies.

[Aortic sinus aneurysm. The angiographic diagnosis (author's transl)]. / Aneurismi dei seni di Valsalva. Diagnostica angiografica

Three cases of aortic sinus aneurysm and three cases of prolapse and regurgitation of the aortic valve associated with ventricular septal defect are discussed from an angiographic point of view. It is pointed out that aortic regurgitation into the left ventricle might be helpful for a correct diagnosis. Aortic regurgitation, in fact, is the result of an anatomically unsupported aortic valve that becomes gradually distorted by haemodynamic influences. This pathogenetic mechanism is often found in subpulmonar and infracrestal ventricular septal defect.