[Interstitial laser treatment of small hepatocarcinoma on cirrhosis without anesthesia: feasibility study]. / Laserterapia interstiziale del piccolo epatocarcinoma su cirrosi senza alcuna anestesia: studio di fattibilità.

OBJECTIVE: We evaluated if interstitial laser photocoagulation (ILP) under ultrasound (US) guidance of intraparenchymal small HCC (<2 cm) in cirrhosis can be safely and effectively performed without any anesthesia. PATIENTS AND METHODS: Twelve cirrhotic patients with 14 nodules of HCC (diameter 1.2-2.0 cm; mean: 1.7) underwent ILP. All procedures were performed without local or general anesthesia. Necrosis of the nodules was evaluated with triphasic contrast-enhanced CT. RESULTS: Post-treatment CT showed complete necrosis in all cases. Pain occurred in 5 patients during the treatment was treated with iv pain-killer and only in 1 case the procedure was stopped before the scheduled time. No major complication occurred. CONCLUSIONS: ILP under US guidance is feasible without any anesthesia in patients with small intraparenchymal HCC.

Dihydropyrimidine dehydrogenase deficiency and acute neurological presentation.

Dihydropyrimidine dehydrogenase (DPD) deficiency has been linked to 5-fluorouracil toxicity, but patients may present a wide clinical spectrum. We describe a 1-year-old Tunisian girl with a dramatic onset of neurological symptoms suggesting the possible triggering role of environmental factors.

Rett syndrome: photographic evidence of rapid regression.

Rett Syndrome is known to occur in females, around the second year, with loss of hand use, onset of stereotypes and acquired microcephaly. Such regression is often very rapid, but this has never been documented. In one of our patients, photographs taken at different times clearly demonstrate the rapid progression of first symptoms. Moreover, in the present case, the occurrence of a febrile illness, which preceded the onset of the neurological picture, support the hypothesis that environmental factors may trigger the onset of Rett Syndrome in genetically predisposed subjects.

[Simple cysts of the liver]. / Le cisti semplici del fegato.

OBJECTIVE: To evaluate the treatment of symptomatic benign non-parasitic cysts of the liver by percutaneous drainage and sclerotherapy with alcohol or surgery. DESIGN: Descriptive, prospective. SETTING: The study was conducted at the University Hospital of Catania (Italy), which serves as a general community hospital. SUMMARY BACKGROUND DATA: Solitary biliary cysts are among the most frequent cystic lesions of the liver and have a prevalence of 1 to 2 percent. They are almost always asymptomatic and do not require treatment. Ultrasonography shows a regular, round or oval, entirely liquid and trans-sonic image sufficient to make the diagnosis. Complications are exceptional. PATIENTS: Eight out of 40 patients who presented with symptomatic benign non-parasitic cysts of the liver during the period 1987-1994 and in whom percutaneous drainage was not contraindicated. INTERVENT: Drainage sclerotherapy with absolute alcohol was carried out, after which suction was applied until oozing stopped. RESULTS: Eight patients were treated, all women, 49-61 years old. In 7 patients, the cyst did not recur during the follow-up period which ranged from 8 to 60 months. Only one patient needed another percutaneous drainage. No complications of the drainage were encountered. CONCLUSION: Percutaneous drainage followed by alcohol sclerotherapy and suction is the treatment of choice in patients with symptomatic benign non-parasitic cysts of the liver. Surgical treatment should be reserved for patients who fail to respond to repeated percutaneous drainage and cases in which the location of the cyst makes it technically difficult to use a percutaneous route.

[Efficacy and tolerance of azithromycin in respiratory tract infections in children]. / Efficacia e tollerabilità dell'azitromicina nelle infezioni respiratorie del bambino.

This study was carried out to determine the clinical efficacy and the clinical safety of azithromycin in a group of children with acute respiratory tract infections. The study involved 82 children treated with a single daily 10 mg/kg dose of azithromycin for three consecutive days. 7 days later, the overall clinical response was 100% (cure and improvement): bacteriological cure was achieved in 97.5% of the patients treated. Recurrences were never observed. Side effects not requiring interruption of therapy were observed in 3 patients (3.6%). The side effects were gastrointestinal disturbances. In conclusion azithromycin showed a remarkably clinical efficacy for treatment of acute respiratory infections in children. Tolerability and therapeutic compliance were excellent.

[Surgery and blood transfusion]. / Chirurgia ed emotrasfusioni.

Advances in surgery and the extension of the surgical indications have amplified the problems due to hemorrhage, main side effect, and its treatment, which in the past consisted primarily in whole blood transfusion. Such practice, however, involves the surgeon in a series of problems due to shortage of blood donors, religious beliefs and most of all the risks related to the transfusion practice itself. Apart from early and late reactions, the risk of transmission of infective diseases, post-transfusional immunodepression and legal problems must be pointed out. Recently, to solve these problems, the indications to blood transfusion have been restricted to severe hypovolemic shock and severe untreatable hypoxia; the separate use of blood components has been privileged; and autologous blood transfusion techniques like pre-deposit for donation, normovolemic preoperative hemodilution and intraoperative autologous transfusions have been used. It's mandatory that the surgeon keeps in date with the Transfusional Medicine progresses working in strict collaboration with the Transfusional Services to best protect the good health of the patients he has in care.