Focal active colitis as a predictor of inflammatory bowel disease: results from a single-center experience.

The term focal active colitis (FAC) is conventionally used to describe the presence of isolated cryptitis, characterized by an inflammatory infiltrate consisting of intraepithelial neutrophils and/or neutrophils invading the lumen of the criptae, with no other microscopic alteration of the colonic mucosa and, in particular, without the presence of signs of chronic inflammation. To date, only four studies, including one conducted in a pediatric population, have been performed to evaluate the clinical significance of this disease. The aim of this retrospective study on prospectively-collected data is to evaluate the clinical implications of the focal active colitis, since there still remains a marked uncertainty regarding this topic and about how often such a diagnosis will presage a diagnosis of inflammatory bowel disease (IBD). Clinical, endoscopic, and pathological data were retrospectively reviewed from 30 patients with focal active colitis, who had no other diagnostic findings on colorectal biopsy and no history of chronic inflammatory bowel disease. The histological findings were correlated with clinical diagnoses. Thirty patients (11 males, 19 females; age 24-80 years, median 56 years) (0.5%) out of 5,600 undergoing colonoscopy between January 2012 and December 2016 presented a definitive diagnosis of FAC. Follow-up ranged from 6 to 60 months (median 24 months). At endoscopy, 19 patients (63%) had mild and non-specific changes, such as mild mucosal erythema, while 11 (37%) had normal findings. Eight patients were documented as having irritable bowel syndrome, while nine cases could be attributed to the effects of drugs, five presented FAC as incidental finding, one a diagnosis of infectious colitis, and seven a diagnosis of IBD (4 with Crohn’s disease). FAC was confirmed to be a more significant predictor of IBD than the previous literature would indicate, even if larger prospective studies, targeted to study this relationship, are needed to understand more clearly its clinical significance.

[Our trend in conservative surgery in differentiated carcinoma of the thyroid]. / Nostro orientamento sugli interventi conservativi nel carcinoma differenziato della tiroide.

AIM OF THE STUDY: Report as contribution to the controversy between supporters of total thyroidectomy versus "less than total" thyroidectomy. MATERIALS AND METHODS: 42 patient operated on over six years; 35 treated with total thyroidectomy, 7 with lobohystmectomy. RESULTS: In the patients who underwent total thyroidectomy we observed recurrent nerve lesions in 5.7%, hypoparathyroidism in 14.3% and 1 lymph nodal relapse (it was a cancer stay III); in patients who underwent lobohystmectomy, we observed 1 temporary recurrent nerve palsy (14.2%) and 1 lymph nodal relapse (14.2%). DISCUSSION: The choice between total thyroidectomy and lobohystermectomy depends upon different goals: reduction in risk of relapse in total thyroidectomy, to minimize complications in lobohystmectomy. In our series the risk of lymph nodal relapse seems to depend more on biological characters of the tumour than surgical tech of lymphadenectomy; however, this occurrence does not change prognosis. CONCLUSIONS: In our experience, potential multifocality of the disease, low risk of hyatrogenic lesions and easy postoperatory management make total thyroidectomy the our preferred technique. Informed consensus is mandatory in order to involve the patients to the best choice.

[Non-toxic multinodular goitre: which surgery?]. / Il gozzo multinodulare non tossico: quale chirurgia?

AIM OF THE STUDY: Evaluation of total thyroidectomy, subtotal thyroidectomy and lobectomy in the management of multinodular non-toxic goitre. MATERIALS AND METHODS: 225 patients: 101 total thyroidectomies, 64 sub-total thyroidectomies, 29 lobo-hystmectomies. Hemorrages, recurrent nerve palsies, post-operatory hypocalcemias, clinical and ultrasonographic relapses, undesired effects of ormonal therapy and hypothyroidism after partial resection (considered risk factor for recurrence) have been pointed out. RESULTS: All three procedures showed a low incidence of recurrent nerve palsy; lobectomy didn't show post-operatory hypocalcemia, that appeared respectively in 26.6% and 23% after sub-total and total thyroidectomy. Recurrence's percentage in patients followed-up, was 18.2% after lobectomy and 12.2% after sub-total thyroidectomy, but in that group we observed 46.9% of hypothyroidism (vs. 9.1% after lobectomy) and 8.6% of undesired effects of therapy. Reoperations showed inferior laringeal palsy and post-operatory hypocalcemia significantly more elevated. DISCUSSION: Compared to lobectomy, total thyroidectomy showed higher risk of hypoparathyroidism; compared to subtotal thyroidectomy, it showed on all occasions less incidence of complications. Endocrinological follow-up is easier after total thyroidectomy. CONCLUSIONS: According to our results, we deem the indications for lobectomy have to be limited to the patients having solitary nodule, undoubtedly benign, without familiarity or other environmental risk factor of goitre.

Type of estrogen receptor determines response to antiestrogen therapy.

Failure of tamoxifen treatment for unresectable hepatocellular carcinomas (HCCs) might be caused by variant estrogen receptors (ERs) in some of these tumors. We therefore planned a study in which antihormonal therapy was done with 80 mg/day tamoxifen or 160 mg/day megestrol according to the presence of wild-type or exon 5-deleted variant ER transcripts. Growth rate (evaluated by MRI) of HCCs characterized by variant ER transcripts was 4 times more rapid than that of HCCs with wild-type ERs. Tumor volume in all patients with wild-type ERs was halved after 9 months of tamoxifen treatment, whereas megestrol in patients with variant ERs only slowed down tumor growth. Choosing antihormonal treatment according to the presence of wild-type or variant ERs in the tumor definitely improves the response rate to tamoxifen; in patients with tumors bearing variant ERs, megestrol causes only a temporary inhibition of tumor growth.

[Radiologic evaluation of an adverse evolution in total hip prosthesis]. / Valutazione radiologica dell'evoluzione sfavorevole della protesi totale d'anca.

The retrospective study of 50 operated cases of cemented total hip replacement and a review of the literature enabled the authors to define the radiological features of the above-mentioned condition. These features include one or more of the following signs: calcar reabsorption, lacunar erosions, modified relationships between the prosthesis components, sepsis and loosening, periarticular calcifications, dislocation and fracture of prosthesis components. Careful evaluation of these radiological features is extremely important for both an early diagnosis of failed total hip replacement and the choice of an adequate surgical treatment.

[Fibrinolytic therapy in acute myocardial infarction. Coronarographic evaluation of short-term results]. / La terapia fibrinolitica nell'infarto miocardico acuto. Valutazione coronarografica dei risultati a breve termine.

The authors report their experience in fibrinolytic therapy with Urokinase in acute myocardial infarction. There were 3 groups of treatment: 100 patients with intracoronary fibrinolytic therapy; 77 patients with peripheral venous fibrinolytic administration; 31 patients with conventional therapy. The 3 groups underwent, between 21 and 28 days after the acute event, a coronarographic examination to evaluate the persistence of patency of the vessels involved in the myocardial infarction. The short term results show that the fibrinolytic therapy (with the limitations due to the hemorrhagic complications associated with the use of Urokinase), especially via intracoronary, is significantly more useful and reliable than conventional therapy, which appears unsatisfactory. Therapeutic failures are probably due to diffuse atherosclerosis of the vessel and/or to the old age of the thrombus.

[Computerized tomography and scintigraphy in the evaluation of osteoid osteoma]. / Tomografia computerizzata e scintigrafia nella valutazione dell'osteoma osteoide.

The authors report their experience of bone scintigraphy and computed tomography in 19 patients, with suspected osteoid osteomas, who underwent surgery. Basing on surgical findings, the role of these techniques in diagnosis, surgical planning and follow-up of osteoid osteoma is stressed and the results are compared with those of conventional radiography.

Arteriographic and tomodensitometric pictures in three cases of popliteal artery entrapment.

CT could be an effective diagnostic modality of "popliteal artery entrapment". The authors present three cases of this pathology, studied with CT and arteriography.

[Idiopathic pachydermoperiostitis. Description of a case]. / Pachidermoperiostite idiopatica. Descrizione di un caso.

A case of pachydermoperiostosis (idiopathic hypertrophic osteoarthropathy) is presented. This chronic and usually self-limited condition must be differentiated from other diseases, such as acromegaly, the osteoarthropaties complicating disorders of the connective tissue and osteoarthropaties in paraneoplastic syndromes.

[Pierre-Marie's osteoarthropathy: scintigraphic diagnosis during staging of lung cancer]. / Osteoartropatia di Pierre Marie: diagnosi scintigrafica in corso di staging del carcinoma polmonare.

In the last years, total bone scan has gained an important place in the staging of the neoplasms of the lung. Out of 271 patients with lung cancer who underwent a bone scan in the period october 1979-october 1980. 10 showed an increased fixation of the isotope with a linear pattern along the diaphysis of the limbs. These findings, clinically silent, suggested the diagnosis of hypertrophic osteoarthropathy, which has been subsequently confirmed radiologically. The different pathogenetic theories and the evolution of the scintigraphic picture after therapy of the primary disease are briefly discussed.

[Nelson's syndrome. A case report (author's transl)]. / La sindrome di Nelson. Contributo casistico.

Two cases of Nelson syndrome with typical clinical and laboratory features are presented. Both had radiological evidence of pituitary tumor; in one case it was evident on the plain film while in the other one it was better appreciated by means of tomography. It is important in the post-surgery follow-up of patients who underwent bilateral adrenectomy for Cushing's disease a periodical evaluation of skin pigmentation, visual field width and sellar morphology for the early detection of a pituitary adenoma.

[Transhepatic percutaneous cholangiography with the Chiba needle in diagnosis of cholestasis]. / La colangiografia percutanea transepatica con ago di Chiba nella diagnostica delle colestasi.

A technique originally described by Okuda has been employed to study 78 patients suffering from cholestatic syndrome. Visualization of the biliary system was obtained in 70 (89.7%). Of these, 65 presented dilatation of the bile ways whereas in 5, the biliary tree was normal. The 8 cases in which no visualization was obtained were later examined with other techniques and 6 proved to be suffering from intrahepatic cholestasis. In patients with extrahepatic obstruction, the biliary system was visualized in 97%, while in intrahepatic cholestasis, the percentage was 45.5%. The main indication for PTC is the speed at which intrahepatic cholestasis can be distinguished from the extrahepatic type; in the second event, it always pinpoints the site of the impediment, though less frequently the nature of the lesion and its extent. No complications requiring emergency laparotomy were ever encountered. Percutaneous transhepatic cholangiography with Chiba needle is a simple, reliable inexpensive method which gives excellent results in the study of patients with cholestatic syndrome.

[Thoracic outlet syndromes. Arteriographic aspects]. / Sindromi dello stretto superiore del torace. Quadri arteriografici.

Chest outlet syndromes are characterized by pain symptomatology caused by (congenital or acquired reasons) compression of the vasculo-nervous bundle. After a brief mention of the anatomy of the question, the indications and angiographic technique are reported, special reference being made to certain positions and dynamic tests which increase symptomatology and highlight arteriographic findings. These are clearly identifiable in the pictures and offer documentary evidence of the cervical rib syndrome, scalenus syndrome, small pectoral syndrome, the hyperabduction syndrome and the costoclavicular syndrome. Differential diagnosis should consider a number of painful syndromes of the upper extremity of purely neurological interest (involvement of the brachial plexus). Vascular diseases such as arteriosclerosis, Takayasu's disease, etc., osteo-myo-articular and ORL sector diseases should also be taken into account. Arteriography is able to identify with precision the causes of the clinical syndrome and to guide surgical exploration of the supraclavicular fossa with excellent chances of success.