Malignant small-bowel neoplasms: spectrum of disease on MR imaging.

Malignant neoplasms of the small bowel are among the rarest types of cancer, accounting for only 2% of all gastrointestinal neoplasms. Owing both to the intrinsic difficulty of common radiographic and endoscopic methods in visualising the entire small bowel and the lack of typical physical findings, a delay in diagnosis is common. Recently, magnetic resonance (MR) imaging has become a widely accepted imaging modality in the study of suspected small-bowel neoplasms due to its ability to depict, without exposure to ionising radiation and with excellent soft-tissue contrast, intraluminal disorders in conjunction with mural, extraparietal and regional abnormalities. The aim of this pictorial review is to illustrate the MR appearance of malignant small-bowel neoplasms.

Two dosage interferon-alpha 2b maintenance therapy in patients affected by low-risk multiple myeloma in plateau phase: a randomized trial.

BACKGROUND AND OBJECTIVE: The role of interferon (IFN) in the remission phase of multiple myeloma (MM) is still an open question, particularly for its scheduling and the subset of patients who could benefit from this approach. The present randomized multicenter study was designed to compare two schedules of IFN maintenance therapy in order to assess the difference in effectiveness and tolerance. DESIGN AND METHODS: This prospective randomized multicenter study was attempted to assess the best schedule of IFN administration in the maintenance treatment of MM in plateau phase with regard to progression free survival (PFS) and toxicity. The second aim was defining the difference between the two schedules in overall survival (OS) and identifying the critical dose of IFN therapy needed to prolong plateau phase and survival. We enrolled 52 patients affected with low-risk MM (i.e. with serum beta 2-microglobulin < 6.0 mg/L and serum albumin > 3.0 g/dL); 27 patients (group A) were randomly assigned to receive IFN alpha-2b 3 megaunits (MU) subcutaneously three times a week and 25 patients (group B) 3 MU/day until disease progression. RESULTS: Median progression free survival (PFS) was 11.9 months in group A and 38.3 months in group B (p = 0.0038). Median survival was 63.2 months in group A and 61.9 months in group B (p = 0.489). However, those patients who were given an IFN dose > or = 30 MU/month experienced a significantly longer PFS and survival than the other patients. Seventeen patients (32.7%) discontinued therapy and sixteen patients (30.8%) reduced IFN alpha-2b dose because of severe side effects without having a significant difference between the two schedules. INTERPRETATION AND CONCLUSIONS: Our results show that patients treated with IFN alpha 3 MU/day had a significantly longer remission duration than patients treated with IFN alpha 3 MU three times weekly. Moreover, an IFN dose is probably critical for obtaining a longer survival in patients affected with low-risk MM. Since the patients' discomfort during a IFN maintenance therapy was frequently experienced the quality of their lives should be carefully taken into account.

[Placental chorioangioma. Two cases and review of the literature]. / Chorio-angiome placentaire. A propos de 2 cas et revue de la littérature.

Two cases of placental chorioangiomas were discovered, one echographically after in utero death at mid-term pregnancy and the second during the neonatal period associated with acute hydramniosis and a single umbilical artery. At 8 months, the new-born was in good health after persistent cholestasis at birth. A review of the literature of the macroscopic, histologic, echographic characteristics and the foetal-maternal complications of chorioangiomas revealed few cases of in utero death, especially so early in term.

Further considerations on the changing face of pneumonia in Marche Region (central Adriatic coast of Italy).

The present paper provides a more detailed review of some themes already discussed in previous papers concerning the changing face of pneumonia in an area of the central Adriatic coast of Italy, including an ex novo examination of the correlations between radiological findings and serological groups not previously reported. The discussion concentrates particularly on some questions raised by the research, such as the apparent rarity of pneumococcus, the elevated number of seronegatives appearing as atypical pneumonia, the high percentage of "bacterial-type" cases occurring among the viral-like, and the therapeutic problem.

Effects of selective reduction in triplet gestation: a comparative study of 80 cases managed with or without this procedure.

OBJECTIVE: To evaluate the effect of selective termination in triplet pregnancies. DESIGN: Comparative, prospective, nonrandomized study. SETTING: All 80 pregnancies were managed in a single tertiary center by the same obstetrical team. PATIENTS: Eighty women with triplet pregnancies were divided into two groups: group I consisted of 48 women who wished to continue their pregnancies without reduction; in group II were 32 women who choose reduction generally to obtain twins. INTERVENTIONS: Selective terminations were performed after an average term of 9.6 weeks of gestation by transcervical or transabdominal approaches. MAIN OUTCOME MEASUREMENTS: The rate of miscarriage and prematurity, fetal growth, perinatal morbidity and mortality, and maternal complications in the two groups. RESULTS: Prematurity was lower in reduced pregnancies (95.5% in triplets versus 53.5%), especially between 24 to 32 weeks' gestation where prematurity was reduced by half. Birth weight was > 450 g higher in the reduced group. The perinatal mortality rate was lower for reduced pregnancies, but this difference was not statistically significant. Five life-threatening maternal complications occurred in triplets, with none in the reduced group. CONCLUSIONS: Selective terminations are effective in decreasing the rate of prematurity, improving fetal growth, and avoiding maternal complications. The procedure thus could be used in triplet gestations. The ultimate decision should be taken by the couple who must be well informed of the risks of the procedure before deciding.

Multifetal pregnancy reduction: a consecutive series of 61 cases.

OBJECTIVE: The effect of selective fetocide on the course of 61 multiple pregnancies. DESIGN: An observational study. SETTING: A tertiary centre. SUBJECTS: 61 women whose pregnancies included 37 triplets, 18 quadruplets, 5 quintuplets and 1 hepatuplet; 97% followed IVF or the induction of ovulation. The aim of the procedure in most cases was to obtain twins. INTERVENTIONS: Selective reduction was performed before 13 weeks gestation under general anaesthesia, using either a transcervical (n = 26) or transabdominal approach (n = 35). Fifty-four twins, 4 singletons and 3 triplets were obtained after the procedure. MAIN OUTCOME MEASURE: Preterm labour rate. RESULTS: The rate of unplanned fetal loss was 13% and was related to the number of suppressed embryos (P < 0.05). The preterm labour rate was 56.6%, the mean gestation at delivery was 35.6 weeks. Seven deliveries were before 32 weeks and led to all neonatal deaths. A comparison with published data suggested that fetal reduction reduced the rate of preterm labour in high multiple pregnancies; in 24 twin pregnancies obtained after reduction of triplets there was probably a gain of 2 weeks gestation. Severe growth retardation occurred in 13%. The perinatal mortality rate was 10.8%. CONCLUSIONS: Selective termination reduces but does not prevent early preterm labour. The procedure is of value in pregnancies with more than 3 fetuses and should be considered carefully for triplet pregnancies.

Favourable outcome in 33 triplet pregnancies managed between 1985-1990.

In this paper, we describe the outcome of 33 triplet pregnancies referred to us between 1985 and 1990. They were managed as follows: management at home as soon as the diagnosis was made, then hospitalization at 28 weeks' gestation. Progesterone and beta-mimetics were administered daily, a cesarean section was always performed. One late abortion occurred at 21 weeks. The rate of prematurity was 90.6%, mean gestational age at delivery was 34.1 +/- 3 weeks, and 62.5% of deliveries occurred between 34 and 37 weeks. Ninety-four fetuses were delivered alive. Mean birth weight was 1880 +/- 410 g. Fetal growth retardation rate was 61.8%, including 28 infants under the third centile and 31 under the 10th centile. Perinatal death rate was 4.16% including 2 in utero deaths and 2 neonate deaths. All infants are healthy except for one child with severe mental retardation. These results show that triplet pregnancies can be safely managed, and that selective first-trimester reduction in triplet pregnancies does not appear to be necessary.

[Techniques, results and indications of embryonic reductions in multiple pregnancies. Review of the literature]. / Techniques, résultats et indications des réductions embryonnaires au cours des grossesses multiples. Revue de la littérature.

The authors report, after a review of the literature, the evolution of ideas concerning first-trimester terminations in multiple pregnancies. Different techniques are performed including transabdominal approach or transvaginal approach at the mean gestational age of 9 or 11 weeks of amenorrhea. Analysis of obstetrical results obtained after these procedures (rates of early or late abortions, preterm labor or in utero growth retardation) shows a high rate of abortions and demonstrate also that reductions are unable to prevent premature births. Indications are discussed: concerning pregnancies of high order (four or more), most part of authors agree with the procedure and also when a triplet pregnancy occurs on a scarred or malformed uterus. Concerning triplet pregnancies, the procedure remains considered by some teams as an unethical approach of theses gestations, specially when considering the recent advances in perinatal medicine. In all cases, a clear and complete information about the risks of these procedures should be given to couples faced with multiple pregnancies.

Obstetrical results after embryonic reductions performed on 34 multiple pregnancies.

Thirty-four women with multiple pregnancies (three or more fetuses) underwent embryonic reduction in order to reduce abortions, premature births or fetal growth-retardation by obtention of twins. Four early abortions occurred. Thirty pregnancies reached term and out of 60 fetuses, 58 infants were born alive. Fetal death in utero of one twin occurred in two pregnancies. The mean term until delivery was 36 +/- 2.8 weeks gestation and the prematurity rate was 51.7%. Of 55 neonates, 25 were underweight within the 10th percentile and 10 out of 55 neonates were underweight below the 3rd percentile. There were three deaths in the early neonatal period. The rate of perinatal mortality was 8.3%. Fifty-four children are currently healthy and one child has a mild axial hypotonia. A reduction in prematurity was observed with a gain of 2 weeks on reported data concerning triplet pregnancies. The rate of low-birth-weight infants was high, 63.5% being underweight at birth.

[The new aspect of pneumonia in an area of the Middle Adriatic]. / Il nuovo volto delle polmoniti in un'area del medio Adriatico.

The present work reports the findings of a ten-year, research, the aim of which is to outline current views of pneumonia in a zone of the Middle Adriatic (USL 17-Regione Marche). The study confirmed, in its entirety, a lesser aggressiveness and loss of the "seasonal feature" of today's pneumonias. The high incidence of Atypical Pneumonia (AP) due to viral-like microorganisms (mycoplasma, chlamydia, coxiella, legionella) and an even higher one of unknown etiology is reported. After having analysed the most likely reasons for such a change and its various implications, the authors conclude that this type of research should be extended in order to trace a map of the more common infectious agents in single geographical zones, as an indispensable premise for a more concrete etiological diagnosis and for a more rational choice of the antibiotic.

[A small epidemic focus of pulmonitis caused by Legionella]. / Su un piccolo focolaio epidemico di polmonite da legionella.

A mini-epidemic consisting of 5 cases of Legionnaire's disease treated during september 1983 is reported. These patients shared many of the symptoms distinguishing the most common form of this disease in its severe or very severe form and some characteristic features of this case series are emphasised. It was impossible to trace the source of the outbreak, in spite of the fact that the mini-epidemic took place in an open situation. It is underlined that diagnosis is mainly clinical. The Legionella pneumophila bacteria should always be considered as one of the causal agents of bronchopneumonia, particularly when the following conditions are fulfilled: a) the disease takes the form of a confined, out-of-season, mini-epidemic; b) it is accompanied by multisystemic symptomatology and/or much greater involvement of general conditions that is usually to be expected in normal cases of bronchopneumonia. Since the disease is often fatal, erythromycin or rifampicin treatment should be started upon the slightest suspicion of contagion.

[Psychosomatic disorders considered from an internist viewpoint. II. Problems of drug therapy]. / I disturbi psicosomatici considerati dal versante internistico. Nota II. Problemi di farmacoterapia.

Following a previous communication concerning some of the principal diagnostic and differential diagnostic questions regarding psychosomatic pathology, with the present note the authors wish to review the most common therapeutic problems related to these disorders. The text has been subdivided into two parts. In the first part it has been adjusted the approach to the pharmacological treatment of these disorders, following principally the authors' experience, and, in the second, have been analyzed some of the most common prejudices that have taken shape around this therapeutic praxis and that have contributed so much to handicap the diffusion of antidepressants in general practice. The authors conclude providing some clues both to those who, encouraged by the reading of this paper, should feel persuaded to deal with psychosomatic disorders from the general practitioners' point of view and to those who, for any reason, should not feel to tackle this task.

[Psychosomatic disorders considered from an internist viewpoint. I. Nosographic aspects and diagnostic problems]. / I disturbi psicosomatici considerati dal versante internistico. Nota I. Aspetti nosografici e problemi diagnostici.

After a brief introduction regarding the nosography of psychosomatic disorders and the main reasons that have little by little discouraged non-psychiatric physicians to deal with this type of pathology, considering its high incidence among all the areas of general practice, the Authors go on discussing the diagnostic problems and pointing out the most important aspects concerned with these. The Authors conclude by warning not to over-value the effects obtained with an antidepressant especially when it is set up only on the basis of the ex-juvantibus principle. The Authors also invite their colleagues general practitioners to take greater care in the fight for prevention and treatment of these disorders, side by side with the psychiatrist.

[Role and importance of antidepressants in general medicine. Bibliographic review and case contribution]. / Ruolo ed importanza degli antidepressivi in medicina generale. Riferimenti bibliografici e contributo casistico.

Starting from the consideration that communications relating to antidepressant drugs are chiefly reported by psychiatrists and that such reports deal with cases that we don't find in general practice, or at least marginally, the authors go on considering again their material consisting of 944 patients treated with antidepressants alone or associated with tranquilizers and/or with neuroplegic sedatives, hoping to gather usefull informations for a better definition of the role of these drugs in this large nosographic area. The authors could, therefore, by that way: confirm the high incidence of psychosomatic disorders among all the professional areas concerned with general practice; confirm the clear prevalence of the less symptomatic forms; verify in a high percentage of cases the coexistence of an organic disorder in way of progress or in outcome; confirm the double role of these drugs, diagnostic (ex-juvantibus) and therapeutical; suggest a third role of nosographic nature.

[Irritable colon and psychosomatic disease]. / Colon irritabile e psicosomatosi.

The authors, after having considered the close likeness between the collateral clinical picture described by others in regard to the irritable colon syndrome and the outstanding one pointed out by them in many cases of psychosomatic disorders, have analyzed again a large number of personal cases diagnosed as "psychosomatic" in order to find possible relations between these two unwholesome conditions. At the end of their examination, after having ascertained that the "Irritable colon" has not to be considered an isolated disease but a syndrome caused by many factors, hinged on a predisposing condition likely of constitutional nature, the authors remark how it may nest in the folds of a psychosomatic disorder and sometimes be its outbreaking feature. The authors by this way, don't want to conclude identifying the I.C. with a psychosomatic disorder and suggest that in such cases one may take this syndrome as the main manifestation of a condition marked by an impairment of the digestive tract motility inside a psychosomatic disorder with a somatic expression of this apparatus.

[Secretory lymphomas]. / I linfomi secernenti.

After a short introduction regarding the concept of "secreting" lymphoma and the most recent theories about the dynamics of normal and pathologic lymphocytes, resulting from the actual immunologic advancements and designed in order do give an explanation of some of the problems concerned with these diseases, such as "classification", "transmutation" of one type of lymphoma into another and the lymphoma/leukemia question, the authors go on describing few personal cases taken as examples. Finally, upon having pointed out that following now a day's whole population screening there is an always more increasing number of asymptomatic "secreting" lymphomas, casually diagnosed, the authors call the general practitioners' attention on the most common clinical and laboratory features that should lead to suspect a lymphoma of this type.