[Retractile mesenteritis: case report]. / Mesenterite retrattile: presentazione di un caso.

The Authors report a case al retractile mesenteritis. The disease is a chronic inflammation of the mesentery with the developement of fibrosis. The mesenteritis is a benign disease and sometimes it is related to urogenital neoplasm. The CT fìndings of mesenteritis are non specific and often is necessary a laparotomic or laparoscopic biopsy. The therapy in uncomplicated cases is steroid treatment.

[Role of spiral computerized tomography in the staging of pancreatic carcinoma]. / Ruolo della Tomografia Computerizzata spirale nella stadiazione del carcinoma pancreatico.

INTRODUCTION: Few pancreatic carcinomas (5-22%) are resectable at the time of diagnosis because this lesion is seldom diagnosed in an early stage. Unresectability is mainly due to the presence of metastases to the liver, peritoneum and lymph nodes and to tumor spread especially to the portal mesenteric trunk where it can invade, compress, reduce, or occlude the vessels. We investigated the diagnostic yield of multiplanar and 3D spiral CT in the assessment of pancreatic carcinoma resectability. MATERIAL AND METHODS: Twenty-seven patients with histologically confirmed pancreatic head cancer were submitted to spiral CT and color Doppler US in the Surgical Clinic I of the Bologna University. The examination results were correlated with the intraoperative findings of careful inspection and palpation and of US studies of the pancreatic mass and adjacent structures. The tumors were classified in relation to some CT parameters: tumor size (T), infiltration of the stomach (S) and/or duodenum, lymph nodes (N) or distant (M) metastases, involvement of vascular structures (V), particularly of portal or superior mesenteric vein, or superior mesenteric artery. Five grades of vascular involvement were considered. The results of these techniques were correlated with intraoperative findings from careful inspection and palpation and with US studies of the pancreatic mass and adjacent structures. RESULTS: Spiral CT revealed vascular involvement in 19 of 27 cases (70.4%): involvement of portal and superior mesenteric vein was found in 14 (73.6%), superior mesenteric vein was involved in 2 (10.6%), the portal vein in one (2%) and, finally the portal, superior mesenteric vein and superior mesenteric artery in 2 cases (10.6%). The spiral CT results were confirmed intraoperatively in 26 of 27 cases (96.3%); spiral CT did not reveal hepatic metastasis only in one case. Spiral CT with multiplanar reconstructions had very high specificity and sensitivity (100%) in the assessment of vascular involvement, while color Doppler US had the same specificity but lower sensitivity (84.2%). Spiral CT was less sensitive (80%) in the detection of liver metastases. CONCLUSIONS: We believe that spiral CT is currently the best technique for pancreatic carcinoma staging, providing useful information for correct surgical planning.

[The role of the radiological hemithorax examination in closed trauma of the chest]. / Ruolo dell'esame radiologico dell'emicostato nei traumi chiusi del torace.

January, 1992, to September, 1994, a hundred and seventy-eight blunt chest trauma patients were examined with plain chest films and detailed rib studies. The patients were subdivided into three groups according to: a) the presence/absence of rib fractures correlated with clinical data; b) the depiction of rib fractures and/or thoracic complications; c) treatment customization in the presence/absence of rib fractures. In our series of patients the clinical data and the presence of rib fractures were poorly correlated. The detection rates of minor and major complications were also investigated on plain chest films and detailed rib studies. Plain chest films most frequently depicted the complications requiring conservative or surgical management and gave the indication for further imaging investigations. The detailed rib studies of the involved hemithorax yielded no further information useful to therapy except in few cases: and should therefore be limited to the cases exhibiting complications on chest films, which may benefit from surgical fixation. The accurate study of rib fractures is paramount in the cases where legal action may be undertaken.

[Incidence of dilatation of residual cystic duct in liver transplantation. Our experience with 152 cases]. / Incidenza della dilatazione del dotto cistico residuo nel trapianto del fegato. Nostra esperienza su 152 casi.

In our series of patients, we studied the incidence of residual cystic duct mucocele, which is still considered a rare complication in orthotopic liver transplantation (OLT). 152 OLTs were performed in 138 patients in the II Surgery Dept. of Bologna University, May 1986 to June 1994; a termino-terminal choledocho-choledochal anastomosis was performed in 145 of them. A choledocho-jejunal anastomosis was performed in other 7 patients. In 3 patients we observed an anechoic ovoidal structure localized just before the portal vein, near the main bile duct (MBD). Then, we monitored the evolution of this finding by ultrasonography (US), Doppler US, CT and CT-cholangiography. Integrated imaging, clinical and surgical data, led to the diagnosis of non-obstructive mucocele of residual cystic duct in OLT. To date, this complication has not led, on our series, to the necessity of new surgical procedures for cholestasis by MBD compression, which is in disagreement with literature data. In our series, the incidence of residual cystic duct mucocele is 2%, which is a higher value than those reported in the literature, suggesting that this condition be investigated carefully as a non-rare complication in OLT.