Photodynamic therapy for the treatment of complex anal fistula.

BACKGROUND: Photodynamic therapy (PDT) is a new procedure for the treatment of anal fistula. This preliminary study was designed to investigate the safety and effectiveness of this new technique in the treatment of anal fistula. METHODS: Ten patients were treated with PDT. Intralesional 5-aminolevulinic acid (ALA) 2% was directly injected into the fistula. The internal and external orifices were closed. After an incubation period of 2 h, the fistula was irradiated using an optical fibre connected to a red laser (MULTIDIODE 630 PDT, INTERmedic, Spain) operating at 1 W/cm for 3 min (180 Joules). Patient demographics, operation notes and complications were recorded. RESULTS: There were no complications. The average length of patient follow-up was 14.9 months (range 12-20 months). We could observe primary healing in eight patients (80%). Two patients (20%) showed persistence of suppuration after the operation. No patient reported incontinence postoperatively. CONCLUSIONS: PDT is a potential sphincter-saving procedure that is safe, simple and minimally invasive and has a high success rate.

[Surfactant replacement therapy with a minimally invasive technique: Experience in a tertiary hospital]. / Terapia con surfactante con técnica mínimamente invasiva: experiencia en un hospital terciario.

INTRODUCTION: Surfactant delivered using a minimally invasive technique, known as MIST (Minimally Invasive Surfactant Therapy) is a method which allows surfactant to be administered to a patient connected to non-invasive respiratory support. This is an increasingly used therapy in Neonatal Units that reduces the intubation rate and the pathology associated with intubation and allows the surfactant to be administered to the patients who clinically need it. PATIENTS AND METHODS: In years 2013 and 2014 in the Hospital General Universitario de Elche surfactant was delivered using this method to 19 patients, five of whom were 28 or less weeks of gestation age at birth. A comparison is made with a historical cohort consisting of 28 patients with Respiratory Distress Syndrome treated initially with non-invasive respiratory support. RESULTS: No incidents were recorded that caused the interruption of the administration. A reduction in the fraction of inspired oxygen was observed in all cases after surfactant administration. Fewer intubations in the first 72 hours of life were found in the treatment group compared to the control group (42% vs. 54%). DISCUSSION: The experience recorded in the Hospital General Universitario de Elche shows that the administration of surfactant using a MIST technique is a reproducible method of treatment, which allows the surfactant distribution during spontaneous breathing with non invasive respiratory support.

Tumores extramucosos de colon: diagnóstico diferencial / Extramucosal colon tumors: differential diagnosis

Los tumores estromales o mesenquimáticos derivan de la pared extramucosa del tubo digestivo y constituyen un grupo raro de tumores originados del tejido conectivo. Presentamos dos casos clínicos, en lo que la sospecha diagnóstica inicial era GIST pero tras intervención quirúrgica y resultado anatomo-patológico se evidenció la existencia de tumor fibroso solitario y lipoma, descartando por tanto la existencia de GIST. Es fundamental, por tanto, llevar a cabo un diagnóstico diferencial de estos tumores extramucosos ya que el tratamiento y el seguimiento dependeran de la entidad

Mesenchymal or stromal tumors derived from extramucosal gut wall and are a rare group of tumors caused connective tissue. We present two cases in which the initial diagnostic suspicion was but after GIST surgery and anatomy-pathological result was evidence of solitary fibrous tumor and lipoma, thus ruling out the existence of GIST. It is essential therefore to carry out a differential diagnosis of these tumors extramucosal as treatment and monitoring depend on the entity

Perforación vaginal iatrogénica tras colonoscopia virtual / Latrogenic vaginal perforation after computed tomographic colonography

La colonoscopia virtual o colonografía por tomografía computarizada (TC) es una alternativa potencial a la colonoscopia convencional para la detección de pólipos y cáncer colorrectal. Presentamos un caso inusual de perforación iatrogénica vaginal durante una colonoscopia virtual. El paciente fue tratado con medidas conservadoras sin complicaciones. El presente caso es el primero en la literatura de perforación vaginal iatrogénica debido a la introducción del catéter de Foley a través de la vagina durante la realización de una colonografía por TC. La perforación vaginal es una complicación rara, fácilmente evitable con una correcta exploración clínica

Computed tomographic colonography is a potential alternative to conventional colonoscopy for the detection of colorectal polyps and cancers. We present an unusual case of iatrogenic vaginal perforation during a computed tomographic colonography. The patient was managed with conservative treatment without complications. The present case is the first in the literature of iatrogenic vaginal perforation due to the introduction of the Foley's catheter through vagina during the accomplishment of a computed tomographic colonography. Vaginal perforation is a rare complication, easily avoidable with a correct clinical exploration

Sacral nerve stimulation in the treatment of severe faecal incontinence: long-term clinical, manometric and quality of life results.

BACKGROUND: Faecal incontinence (FI) is a complex and multifactorial health problem. Treatment has to be individualised, analysing the aetiology and gravity in every case. Sacral nerve stimulation (SNS) has been shown to effectively improve treatment of FI. METHODS: Fifty patients with severe FI treated with SNS between March 2002 and December 2010 were analysed. Preoperative assessment included physical examination, anorectal manometry and anal endosonography. Anal continence was evaluated using the Wexner continence grading system. Quality of life was evaluated using the Fecal Incontinence Quality of life Scale (FIQLS). Follow-up appointments were scheduled at 1, 6 and 12 months and annually thereafter. Wexner score, FIQLS and the ability to defer defecation were assessed at each visit. RESULTS: Fifty patients underwent a permanent implant. The overall mean follow-up period was 55.52 ± 31.84 months. After 6 months, SNS significantly improved FI and positively impacted quality of life, as evidence by significant improvements in all 4 scales of the FIQLS. Anorectal manometry showed a trend towards an increase in maximum resting pressure and maximum pressure. After the first assessment at 6 months, Wexner score and FIQLS remained stable. Ability to defer defecation was also maintained. During follow-up, 3 patients (6 %) experienced implant site pain and episodes of extremity pain and paresthesias that were refractory to medical management and required device explantation. The implant site infection rate was 2 %. CONCLUSIONS: Analysis of our long-term results confirms the safety and effectiveness of SNS in the management of patients with FI.

Applicability, safety and efficiency of outpatient treatment in uncomplicated diverticulitis.

BACKGROUND: In most cases of diverticulitis, inflammation is mild, and the only treatment required is a clear liquid diet and antibiotics. Until recently, patients were given this treatment as inpatients with the consequent expenditure of resources. The aim of this study was to assess the safety and efficacy of an outpatient treatment protocol with oral antibiotics in selected patients with uncomplicated acute diverticulitis in comparison with inpatient intravenous treatment. METHODS: We conducted a prospective non-randomized study between January 2007 and December 2009. We included all patients diagnosed with uncomplicated acute diverticulitis, at the Emergency Department of the University General Hospital of Elche. We compared the efficacy, safety and costs of hospital treatment with intravenous antibiotics and outpatient treatment with oral antibiotics. Seventy-six patients were included in the study. Forty-four of them underwent intravenous treatment with Metronidazole 500 mg/8 h + Ciprofloxacin 400 mg/12 h (hospital treatment group) and 32 took oral antibiotics Metronidazole 500 mg/8 h and Ciprofloxacin 500 mg/12 h (outpatient group). RESULTS: Outpatient treatment is viable in almost 95 % of those patients suffering from uncomplicated acute diverticulitis. Treatment was effective in resolving inflammation, and there were no complications in the majority of cases (94 %). Only 2 patients (6 %) required admission after outpatient treatment. The results further reflect complications and relapse rates similar to those of patients admitted to hospital and treated with intravenous antibiotics. There are no significant statistical differences (p = 0.86) between inpatients and outpatients. It is possible to save approximately 1,600 € per patient with outpatient treatment (p < 0.05). CONCLUSIONS: Outpatient treatment has demonstrated a safety and efficiency similar to inpatient treatment, producing an important reduction in expenses and medical resources.

Plantar fascia evaluation with a dedicated magnetic resonance scanner in weight-bearing position: our experience in patients with plantar fasciitis and in healthy volunteers.

PURPOSE: This study assessed the usefulness of upright weight-bearing examination of the ankle/hind foot performed with a dedicated magnetic resonance (MR) imaging scanner in the evaluation of the plantar fascia in healthy volunteers and in patients with clinical evidence of plantar fasciitis. MATERIALS AND METHODS: Between January and March 2009, 20 patients with clinical evidence of plantar fasciitis (group A) and a similar number of healthy volunteers (group B) underwent MR imaging of the ankle/hind foot in the upright weight-bearing and conventional supine position. A 0.25-Tesla MR scanner (G-Scan, Esaote SpA, Genoa, Italy) was used with a dedicated receiving coil for the ankle/hind foot. Three radiologists, blinded to patients' history and clinical findings, assessed in consensus morphological and dimensional changes and signal intensity alterations on images acquired in both positions, in different sequences and in different planes. RESULTS: In group A, MR imaging confirmed the diagnosis in 15/20 cases; in 4/15 cases, a partial tear of the plantar fascia was identified in the upright weight-bearing position alone. In the remaining 5/20 cases in group A and in all cases in group B, the plantar fascia showed no abnormal signal intensity. Because of the increased stretching of the plantar fascia, in all cases in group A and B, thickness in the proximal third was significantly reduced (p<0.0001) under upright weight-bearing compared with the supine position. CONCLUSIONS: Imaging the ankle/hind foot in the upright weight-bearing position with a dedicated MR scanner and a dedicated coil might enable the identification of partial tears of the plantar fascia, which could be overlooked in the supine position.

Role of high-resolution ultrasonography without and with real-time spatial compound imaging in evaluating the injured posterior cruciate ligament: preliminary study.

PURPOSE: This study sought to compare high-resolution ultrasonography (HRUS) without and with compound imaging in evaluating the injured posterior cruciate ligament (PCL). MATERIALS AND METHODS: Thirteen patients with a magnetic resonance imaging (MRI) diagnosis of PCL lesions (ten acute and three chronic) and 20 healthy controls underwent conventional and compound HRUS performed by the same radiologist who was blinded to the subjects' case-control status. The PCL was scanned in a longitudinal direction in all cases. HRUS images were assessed for PCL thickness by two other radiologists blinded to the number and type of PCL injury. PCLs were classified as normal or injured, and the latter as having acute or chronic injuries. Inter-method reproducibility of measuring PCL thickness was assessed on conventional and compound HRUS images. RESULTS: Complete agreement in classifying normal or injured PCL and acute or chronic PCL injuries was achieved. PCL thickness in volunteers was 4.5+/-0.7 mm on conventional images and 4.6+/-0.7 mm on compound images. On conventional and compound HRUS images, the thickness of acutely injured PCL was 9.1+/-1.5 mm and 9.2+/-1.7 mm, respectively, and that of chronically injured PCL was 7+/-0.9 mm and 7+/-0.8 mm. Inter-method reproducibility of PCL thickness measurements on conventional vs. compound HRUS images was 98.6%. CONCLUSIONS: HRUS is a reliable technique for studying the PCL and detecting PCL injuries.

High-resolution ultrasonography (HRUS) of the meniscal cyst of the knee: our experience.

PURPOSE: This study was undertaken to assess the diagnostic accuracy of high-resolution ultrasonography (HRUS) in the detection of meniscal cysts. MATERIALS AND METHODS: Over a 2-year period, 1,857 patients underwent magnetic resonance imaging (MRI) of the knee for traumatic or degenerative disorders. All patients with MRI evidence of a meniscal cyst were studied by HRUS. HRUS was also performed on an equal number of patients without MRI evidence of meniscal cyst who were used as a control group. All HRUS examinations were conducted by a radiologist blinded to the MRI findings. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of HRUS were assessed with reference to MRI. All patients underwent surgery, and the resected masses were studied by histological examination. RESULTS: MRI allowed identification of a meniscal cyst in 52 patients. HRUS enabled correct detection of the meniscal cyst in 49/52 cases. In the control group, HRUS excluded the presence of meniscal cysts in all cases. HRUS had a sensitivity, specificity, PPV and NPV of 94.23%, 100%, 100% and 94.54%, respectively, for the detection of meniscal cysts. CONCLUSIONS: HRUS is a fairly reliable technique in the detection, characterisation and differentiation of the different forms of meniscal cyst.

Is anal endosonography useful in the study of recurrent complex fistula-in-ano?

INTRODUCTION: performing anal endosonography in complex fistula-in-ano allows us to design a personalized surgical strategy in each case, thereby improving results. However, there are doubts in the literature as to its utility in recurrent complex fistulas. The aim of this study was to compare the utility of anal ultrasonography in the study of primary versus recurrent complex fistula-in-ano. PATIENTS AND METHOD: prospective study of patients diagnosed and treated for complex fistula-in-ano. Physical examination and anal ultrasonography provided data on primary track, internal opening, horseshoe extension and the presence of secondary tracks or cavities in a protocol designed specifically for the study. These assessments were subsequently contrasted with operative findings. RESULTS: we included 35 patients, 19 (54.3%) with primary complex anal fistulas and 16 (45.7%) with recurrent fistulas. According to the operative findings, fistulas were classified as high transsphincteric in 28 patients (80%), suprasphincteric in 6 (17.1%) and extrasphincteric in one patient (2.9%), with no differences between groups. Physical examination correctly classified 28 of the 35 fistulous tracks, in contrast to the 32 (91.4%) correctly described on ultrasonography (80%). We did not find any statistically significant differences between the primary and the recurrent fistula groups with regard to sensibility, positive predictive value and accuracy of the anal ultrasonography for any of the parameters studied. CONCLUSION: the accuracy of anal ultrasonography does not decrease in recurrent complex fistula-in-ano.

¿Es útil la ecografía endoanal en el estudio de la fístula anal compleja recidivada? / Is anal endosonography useful in the study of recurrent complex fistula-in-ano?

Introducción: la realización de la ecografía endoanal en la fístulacompleja permite diseñar una estrategia quirúrgica personalizadaen cada caso, mejorando los resultados. Sin embargo, existendudas en la literatura acerca de su utilidad en fístulascomplejas recidivadas. El objetivo de este estudio es comparar lautilidad de la ecografía endoanal en el estudio de fístulas perianalescomplejas primarias versus recidivadas.Pacientes y método: estudio prospectivo de pacientes diagnosticadose intervenidos de fístula anal compleja. La exploraciónfísica y ecografía endoanal recogieron los datos relativos al trayectoprincipal, orificio interno, extensión en herradura y presenciade otros trayectos o cavidades en un protocolo elaborado para elestudio. Dichos datos se contrastaron posteriormente con los hallazgosintraoperatorios.Resultados: incluimos 35 pacientes, 19 (54,3%) con fístulascomplejas primarias y 16 (45,7%) con fístulas recidivadas. Deacuerdo a los hallazgos intraoperatorios, las fístulas fueron clasificadascomo transesfinteriana alta en 28 pacientes (80%), supraesfinterianaen 6 (17,1%) y extraesfinteriana en un paciente (2,9%),sin diferencias entre ambos grupos. La exploración física clasificócorrectamente 28 de los 35 trayectos fistulosos (80%), frente a los32 (91,4%) correctamente descritos por la ecografía. No encontramosdiferencias estadísticamente significativas entre el grupo defístulas primarias y el de recidivadas en cuanto a la sensibilidad,valor predictivo positivo y fiabilidad de la ecografía endoanal paraninguno de los parámetros estudiados.Conclusión: el poder diagnóstico de la ecografía endoanal no disminuyeen el estudio de las fístulas perianales complejas recidivadas

Introduction: performing anal endosonography in complexfistula-in-ano allows us to design a personalized surgical strategy ineach case, thereby improving results. However, there are doubtsin the literature as to its utility in recurrent complex fistulas. Theaim of this study was to compare the utility of anal ultrasonographyin the study of primary versus recurrent complex fistula-inano.Patients and method: prospective study of patients diagnosedand treated for complex fistula-in-ano. Physical examinationand anal ultrasonography provided data on primary track, internalopening, horseshoe extension and the presence ofsecondary tracks or cavities in a protocol designed specifically forthe study. These assessments were subsequently contrasted withoperative findings.Results: we included 35 patients, 19 (54.3%) with primarycomplex anal fistulas and 16 (45.7%) with recurrent fistulas. Accordingto the operative findings, fistulas were classified as hightranssphincteric in 28 patients (80%), suprasphincteric in 6(17.1%) and extrasphincteric in one patient (2.9%), with no differencesbetween groups. Physical examination correctly classified28 of the 35 fistulous tracks, in contrast to the 32 (91.4%) correctlydescribed on ultrasonography (80%). We did not find anystatistically significant differences between the primary and the recurrentfistula groups with regard to sensibility, positive predictivevalue and accuracy of the anal ultrasonography for any of the parametersstudied.Conclusion: the accuracy of anal ultrasonography does notdecrease in recurrent complex fistula-in-ano

Endometriosis intestinal como causa de rectorragia y masa intestinal / Intestinal endometriosis as a cause of rectorrhagia and intestinal mass

Se presenta el caso de una mujer con anemia y rectorragias ocasionales, cuyo estudio objetivó una masa intestinal estenosante que finalmente resultó ser una endometriosis intestinal (EI). Realizamos además, una revisión de la enfermedad en la que se subraya la dificultad del diagnóstico prequirúrgico, dada la multitud de posibles cuadros clínicos que puede simular, y muchos de ellos son tributarios de cirugía. Resaltamos la importancia de la sospecha de EI en el diagnóstico diferencial ante toda paciente en edad fértil que curse con masa intestinal, y es necesario investigar en la anamnesis acerca de una posible sintomatología ginecológica concomitante. Para el correcto manejo y enfoque terapéutico de la EI diagnosticada prequirúrgicamente, es necesaria una cooperación adecuada entre los servicios de ginecología y cirugía general, teniendo en cuenta la afectación clínica de la paciente y la proximidad de la edad de ésta a la menopausia. Las opciones terapéuticas disponibles actualmente son: la administración de análogos de la hormona liberadora de gonadotropinas (GnRH) y la resección del segmento afectado por el endometrioma con adecuados márgenes de seguridad para evitar recidivas locales. Recientemente, se ha demostrado que el tratamiento neoadyuvante con análogos de GnRH facilita la cirugía en los casos programados de EI (AU)

We present the case of a woman with anemia and occasional rectorrhagia who was discovered to have an intestinal stricturing mass that was revealed to be an intestinal endometrioma. We provide a review of the literature on the topic and emphasize the difficulty of presurgical diagnosis because of the multitude of clinical presentations that this disease can simulate, many of which are suitable for surgical treatment. We stress the importance of including intestinal endometriosis (IE) in the differential diagnosis of all patients of reproductive age with intestinal masses and of inquiring about concomitant gynecological symptoms when taking a history. The appropriate management of EI diagnosed before surgery requires liaison between the departments of general surgery and gynecology, bearing in mind the patient's symptoms and age in relation to the menopause. Currently available therapeutic options are admi nistration of gonadotropin-releasing hormone (GnRH) analogues and resection of involved section of the intestine with adequate margins to avoid local recurrences. Recently, neoadjuvant treatment with GnRH analogues has been shown to facilitate elective surgery for EI (AU)

Útero gigante / Giant uterus

Presentamos el caso clínico de una mujer de43 años con aumento del perímetro abdominalde un año de evolución. El volumen del abdomenfue notorio en los últimos meses adquiriendouna consistencia dura y acompañándosede pérdida de 10kgr. de peso. Ante tal tumoraciónabdominal gigante y con sospecha de probableorigen mesentérico, sin poder definir origenni naturaleza, se decidió extirpación quirúrgicadel tumor, encontrando una gran tumoraciónabdominal dependiente de útero, tratándosede un útero gigante de 5.250 kilogramoscon un único mioma

We report on the case of a 43-year-old female;;patient who complained of progressive increase;;in abdominal perimeter during the last year,;;along with weight loss of approximately 10 kg.;;On clinical examination there was abdominal;;tenderness. CT scan revealed a great abdominal;;mass, apparently spawning from the mesenterium.;;At surgery, the tumor was found to stem;;from the uterus, and weightened 5.25 kgr. The;;histopathological report informed of myoma

Long-term results of botulinum toxin for the treatment of chronic anal fissure: prospective clinical and manometric study.

BACKGROUND: The aim of this prospective trial was to analyse the effectiveness and morbidity of chemical sphincterotomy in the treatment of chronic anal fissure after a 3-year follow-up. METHODS: One hundred consecutive patients with chronic anal fissures were treated by chemical sphincterotomy with 25 U botulinum toxin injected into the internal sphincter. Clinical and manometric results were recorded. RESULTS: No major complications were found; initial incontinence at the 2-month review (6%) spontaneously reversed at 6 months. There was a tendency of progressive recurrence over time, with an overall healing after 3 years of 47%. We found a group of patients with clinical (symptoms longer than 12 months and presence of a sentinel pile before treatment) and manometric factors (persistently elevated mean resting pressure, percentage of time with slow waves, and number of patients or percentage of time with ultra slow waves after treatment) associated with a higher recurrence of anal fissures. CONCLUSION: Since it avoids the greater risk of incontinence associated with surgical sphincterotomy, we recommend the use of botulinum toxin as the first therapeutic approach for patients with chronic anal fissure and risk factors for incontinence; despite the higher rate of recurrence associated with this treatment. In patients with factors related to recurrence, re-injection with higher doses of botulinum toxin or complementary medical-surgical treatment should be considered.

Open versus closed day-case haemorrhoidectomy: is there any difference? Results of a prospective randomised study.

BACKGROUND AND AIMS: Nowadays there is still controversy as to whether open or closed haemorrhoidectomy is the surgical treatment of choice for haemorrhoidal pathology. PATIENTS AND METHODS: We carried out a randomised prospective study in the Day Surgery Unit comparing 100 patients undergoing Milligan-Morgan haemorrhoidectomy (group A) versus 100 patients undergoing Ferguson haemorrhoidectomy (group B) for symptomatic haemorrhoids, in whom medical treatment or rubber band ligation had failed. RESULTS: Characteristics of the population were: mean age 43.5 years, with predominance of males, 123 vs. 77; 88% ASA I-II. CLINICAL PRESENTATION: 95% rectal bleeding; 87.5% third-fourth degree. The anaesthetic technique of choice was local anaesthesia plus sedation in 180 patients (90%). Length of surgery: 24 min (group A) and 30 min (group B) (p=n.s.). Resection of three haemorrhoidal cushions was done in 87.5% of cases. There were no re-operations or re-admissions after discharge. Symptomatic recurrence, stenosis and incontinence were not found during the follow-up of the first year. Postoperative pain during the first postoperative week was greater in the open haemorrhoidectomy group, but the difference was statistically significant (p<0.05) only during bowel movements. There was complete healing in 40% of the patients in group A and 90% of those in group B (p<0.05) after 1 month. After 1 year, the results and complications were similar in both groups (p=n.s.). CONCLUSIONS: Closed haemorrhoidectomy gives better results in terms of pain and healing than open haemorrhoidectomy, whereas recurrence and complications are similar after 1 year.

Hemorroidectomía milligan-morgan en cirugía sin ingreso / Milligan-morgan haemorrhoidectomy in ambulatory surgery

INTRODUCCIÓN: Actualmente persiste la controversia de la idoneidad de la hemorroidectomía en régimen de cirugía sin ingreso. MÉTODOS: Realizamos un estudio prospectivo de pacientes intervenidos en la Unidad de Cirugía Sin Ingreso por diagnóstico de hemorroides sintomáticas con fracaso a tratamiento médico ,a los que se realizó hemorroidectomía Milligan-Morgan o abierta, siendo alta el mismo día de la intervención quirúrgica. RESULTADOS: Características de la población: edad media 43,5 años (rango: 25-75); 180hombres/ 120 mujeres; 88% ASA I-II. Presentación clínica: 97% rectorragia; 90% gradoIII-IV. Técnica anestésica: anestesia local más sedación en 270 pacientes (90%) y 10% raquídea. Tiempo quirúrgico: 24 minutos. Se realizó hemorroidectomía de 3 paquetes hemorroidales en el90% de los casos. No hubo reintervenciones, 2%de los pacientes requirieron ingreso >24h, y 1,3%sufrieron readmisión tras el alta. El mayor dolor postoperatorio fue referido durante la primera semana y durante la defecación. En la revisión del 1º mes el 40% de los pacientes tenían una cicatrización completa, siendo el 100% a los seis meses. CONCLUSIONES: La hemorroidectomía abierta es factible realizarla en cirugía sin ingreso con anestesia local y sedación (AU)

INTRODUCTION: Nowadays there is still controversy with regard to the convenience of performing haemorrhoidectomy as a day case procedure. METHODS: We carried out a prospective study of open haemorrhoidectomy at the Day Surgery Unit, in patients diagnosed as having symptomatic haemorrhoids after failure of medical management. RESULTS: Characteristics of the population: average age 43.5 years (range: 25-75); 180 men/120 women; 88% ASA I-II. Clinical presentation:97% as rectal bleeding; 90% were third-fourth degree haemorroids. Anaesthetic technique: local anaesthetic plus sedation in 270 patients (90%)and 10% spinal anaesthesia. Duration of surgery:24 (..) (AU)

Pigmented villonodular synovitis of the foot: MR findings.

PURPOSE: To evaluate the MRI findings in the various forms of pigmented villonodular synovitis (PVNS) of the foot. MATERIALS AND METHODS: Seven hundred and fifty-three MR studies of the foot performed at our institute between June 1994 and April 2000 were retrospectively reviewed for the presence of PVNS. Spin echo (SE) T1W, Gradient echo (GE) T2*W, and fat suppression (Short Time Inversion Recovery: STIR) images were acquired with a 0.5 T superconductive unit (Vectra, GE Medical System, Milwaukee, WI, USA) provided with a dedicated transmitter/receiver coil. The site and type of lesions, the signal intensity patterns, and the presence of associated changes were evaluated. RESULTS: On the basis of the MR images and the above parameters, six patients (3 men, 3 women, age range: 35-48 years) with PVNS were selected. Three out of six PVNS were nodular, whereas the remaining three were diffuse. Of the three nodular forms, one was found in the sub-talar joint and the remaining two antero-medially to the talus. Instead, all of the diffuse lesions were located on the metatarsus. Perilesional oedema was seen in all cases, although more obvious in the nodular forms, whereas bone involvement (osteochondral erosion) was observed only in the diffuse metatarsal PVNS. Intra-articular bloody effusion was never observed. The MRI findings were confirmed by surgery in all cases. DISCUSSION: The high contrast resolution and multiplanar capabilities of MRI allow the complete evaluation of the structures of the foot affected by PVNS, and of the extent of soft tissue (bursae, synovial or nervous structures), bone and articular involvement. Although not specific, the presence of haemosiderin results in characteristic MR findings, due to the shortening of both T1 and T2 relaxation times. GET2* images are particularly well suited to this PURPOSE: Furthermore, in our experience, FIR images added better depiction of associated swelling. CONCLUSIONS: According to our results, MRI is now the most reliable technique for identifying and classifying PVNS, and allows correct treatment planning and effective monitoring.