[16-MDCT angiography coronary artery in the emergency department for patients with acute coronary syndrome (NSTEMI-UA)]. / La 16-MDCT delle arterie coronarie eseguita in urgenza nei pazienti affetti da sindrome coronarica acuta (NSTEMI-UA).

AIM: The diagnosis of acute coronary syndrome (ACS), non-ST-elevation myocardial infarction and unstable angina in the emergency department (ED) remains a challenge. The aim of our study was to investigate quality and the diagnostic accuracy of 16-MDCT coronary angiography, detecting coronary artery lesions in patients with suspected ACS presented in ED. MATERIALS AND METHODS: We studied with 16-MDCT (Sensation 16, Siemens, Forchleim, Germania) and coronary angiography 37 patients with the following inclusion criteria: chest pain compatible with myocardial ischemia, normal or no-diagnostic ECG changes and initial concentrations of serum troponin-I < or =1 ng/ml. The 16-MDCT was performed with ECG-gated technique after the intravenous administration of 90-100 ml of iodinated contrast material followed by a saline bolus. The scan parameters were: 120 kV, 650-720 mAs, 16 x 0.75mm collimation, 0.42s rotation time, 3 mm (pitch 0.25) feed/rot, B30f kernel. We evaluated for each patient: image quality and different artefacts, plaques identification and characterization. RESULTS: The evaluation of the image quality was based on a total of 453 segments, of which 415 segments (92.2%) were considered to have diagnostic image quality. MDCT correctly detected 15 patients with at least 1 stenosis >50% and correctly ruled out significant coronary artery disease in 19 patients with 1 FP and 2 FN: sensitivity 88%, specificity 95%, PPV 94%, NPV 90%. The plaques were hard in 6 cases, mixt in 16 cases and soft in 14 cases, respectively. CONCLUSIONS: Our results point-out that 16-MDCT in ED has the real ability to detect and rule out significant coronary stenoses in patients with ACS.

[Imaging of median sternotomy complications]. / Imaging delle complicanze dopo sternotomia mediana.

Median sternotomy is the surgical technique of chosen for cardiac surgery. Although the complications after median sternotomy are not so frequent, these are associated to elevated mortality. The complications can interest the presternal compartment, the sternal compartment or the retrosternal compartment. Even if the clinical diagnosis of infection is not difficult for the clinician, it is nearly impossible to establish the depth of the infection. Multislice CT, thanks to the possibility to obtain thin layers and three-dimensional multiplanar reconstructions and Volume Rendering, turns out extremely useful for being able to demonstrate the extension and the depth of the infection. Of fundamental importance it is the elaboration of the images, executed on workstation, with which multiplanar reformatted and Volume Rendering images are obtained. The CT turns out useful moreover like guide for the execution of interventional procedures such as aspiration of material for bacteriological characterization or eventual positioning of a catheter for abscess drainage. The Magnetic Resonance, thanks to its high resolution of contrast and to its multiplanarity, finds one of its elective applications in the study of the flogistic and neoplastic processes of the soft tissues. A great limit of the MR is the possible generation of artifacts due to sternal suture.

[Lumbar hernia of Grynfeltt's quadrilateral space. Apropos a case]. / Ernia lombare del quadrilatero di Grynfelt. A proposito di un caso.

The authors discuss a case of Grynfeltt's quadrilateral lumbar hernia in an 85-year-old patient. These rather rare hernias can be classified as Grynfeltt's hernias of the superior lumbar space, as Petit's inferior lumbar space and as diffused hernias concerning the whole hip. In our case this hernia was located in the superior lumbar space and it was delimited on the upper part by the 12th rib and by the serratus posterior-inferior muscle; in the lower part by the internal oblique muscle and by the lumbar quadratus muscle. Surgical treatment was effected by plastic surgery with synthetic material put in the extra-peritoneum space and fixed by serum-muscular stitches. Postoperative control effected after a month from the operation proves a good keeping of the plastic surgery reconstruction with total disappearance of the hernia.

The Trabucco technique in the treatment of inguinal hernias; A six-year experience.

BACKGROUND: The introduction of both polypropylene prosthesis and the new tension-free methods for the treatment of inguinal hernias, induced us to choose the Trabucco technique since August 1994. METHODS: Up to April 2001 983 inguinal hernia repairs were carried out in 825 patients, 948 with the Trabucco technique. RESULTS: Minor complications (hematoma, seroma, inguino-crural pain) were 42 (5.1%) with no wound infections. There were 3 relapses (0.36%), one treated in an other hospital and the other two were surgically treated because of the small dimension of the hernia and they were not troublesome for the patients, although they were strictly controlled. CONCLUSIONS: In spite of the limited follow-up period, there is satisfaction for the short-term period outcomes which showed the superiority of the Trabucco method compared with the traditional techniques both as to hospitalization and good recovery and to the early relapse.

[Latero-terminal anastomosis in colorectal surgery using a mechanical stapler. Technical note]. / L'anastomosi latero-terminale con suturatrici meccaniche in chirurgia colo-rettale. Nota tecnica.

Following a discussion of the various methods of colorectal anastomosis in cancer surgery, the Authors describe a technical variant using a mechanical stapler in a high rectal location. The rapidity of anastomosis as well as the decreased risk of dehiscence, fistula and stenosis are underlined.

[The selective use of intraoperative cholangiography in video laparoscopic cholecystectomy]. / L'utilizzo selettivo della colangiografia intraoperatoria nella colecistectomia videolaproscopica.

Intraoperative cholangiography, a diagnostic method through images introduced in to clinical use in 1932, has recently become a different technical support from that attributed by traditional surgery and it has got a different diagnostic meaning with the introduction of video surgery. The authors used it in 54 of 194 patients submitted to a CVL, always making use of the trans-cystic access, with a percentage of success of 82.6%. It was not possible in 8 patients due to the complete section of the cystic duct during the work (3 cases) and the impossibility of introducing the catheter (5 cases). There is still no common agreement about the opportunity to use IC daily: the authors think selective use is better preceded by a careful clinical laboratory instrumental preoperative study to find patients with the common duct stone. Besides, they are of the opinion that a rigorous surgical technique is fundamental to reduce the lesions of the VBP that there are not in their experience.

[Internal hernias. Description of 2 cases]. / Le ernie interne. Descrizione di due casi.

The authors describe two cases of recent observed internal-hernia, regarding in the first case the right para-duodenal dimple, and in the second a mesenteric breach. They report the clinic presentation and the diagnostic and therapeutic approach compared with the data deriving from the international literature. A complete clinical classification of the internal-hernia is illustrated showing the different clinical signs. The respective symptomatology that in the initial phases of this pathology is not too evident, shows that the internal hernia should always be held in due consideration at the moment of diagnosis because the consequent mortality due to complications such as intestinal-gangrene is rather high.

[Cancer of the gastric stump. Our experience]. / Il cancro del moncone gastrico. Nostra esperienza.

The authors discuss their experience of six cases of cancer of the gastric stump observed by them in the period from 1988 to 1992 inclusive. All the patients were operated; five total gastrectomies and a gastric re-resection were effected. In association also the spleen was removed in four patients, in one of them a hepatic metastasectomy and a distal pancreasectomy were effected. In the discussion the problems concerning the diagnostic and therapeutic implications with some references to the more likely etiopathogenetic theories were dealt with.

[A rare case of Meckel's diverticulum perforation]. / Un raro caso di perforazione del diverticolo di Meckel.

Meckel's diverticulum is a pathology not rarely found everyday clinical medicine especially when it present with one of its complications. The specific diagnosis is a bit difficult to put because of the low sensibility and specificity of symptoms of diagnostic and instrumental techniques used. The reported case shows a rare type of complication constituted by the phlogosis of Meckel's diverticulum, itself due to an extraneous thing ingested by the patient. The authors discuss the entity of the manifestations of this pathology and highlight every aspects.

[Cancer of the gallbladder]. / Il cancro della colecisti.

Carcinoma of the gallbladder is the most frequent neoplasia of the biliary tract with an incidence of 2.5-4.4 cases for every 100,000 inhabitants; it more often affects females and elderly patients (60-70 years). It is an extremely malignant tumour with an often fatal prognosis owing to both its site and the generally late diagnosis; the majority of patients in fact undergo surgery at an advanced stage of the disease when surgery is only palliative. At the Surgical Division of S. Massimo Hospital in Penne (PE) a total of 897 operations on the gallbladder and biliary tract were performed between 1988 and 1994, revealing 21 cases of carcinoma of the cholecyst (2.3%). Sixteen patients were female (male-female ratio 1:3.2) with a mean age of 67.8 years (range 58-83 years). These patients were divided into 5 stages according to the UICC-1992 classification: 80.9% of cases were stage 3-4. Diagnosis was performed intraoperatively in 2 patients, whereas in 3 cases cancer had been diagnosed by the anatomo-pathologist. A total of 3 simple cholecystectomies were performed, 4 were associated with hepatic resection and lymphadenectomy of the hilus and hepatoduodenal ligament; surgery was enlarged in 2 cases due to the involvement of adjacent organs. After exploratory laparotomy, palliative surgery was performed in the remaining 12 patients in the form of biliary and derivation. Four system were implanted for intra-arterial chemotherapy. The most frequently found histological type was adenocarcinoma (76.2%). The mean survival rate of patients who died was 7.6 months. Six of the operated patients are still alive, of whom only one with a follow-up of 4 years. In conclusion, the authors agree with those who consider carcinoma of the gallbladder generally fatal in view of the rarity of early diagnosis and the difficulties of performing radical therapy.

[The role of angiography in cryptogenic submesocolic digestive tract bleeding]. / Ruolo dell'angiografia nelle emorragie digestive sottomesocoliche criptogenetiche.

Three cases of chronic gastrointestinal bleeding are described; the Authors emphasize the important role of mesenteric arteriography in establishing site and nature of bleeding. The review of international literature shows a success rate between 41 and 73% of cases studied with this method after negativity of other diagnostic procedures.

[Laparovideocholecystectomy]. / La laparovideocolecistectomia.

The authors present the guidelines which have been followed to introduce into their own Surgical Division an alternative method to cholelithiasis treatment: laparovideocholecystectomy (l.v.c.). They point out how the directions for use of the new surgical method, in place of the traditional laparectomic technique, must be limited to non-complicated cholelithiasis cases, especially in the initial learning stages. That sets the global "morbility" of the above said l.v.c. beneath the cholecystectomy performed with traditional technique. In addition, they point out the sure economic advantages at social and contributions level arriving at the conclusion that l.v.c. is the best treatment for Gallstones.

[Laparoalloplasty by the Rives' technique for the treatment of large ventral hernias. Ten-year experience]. / Laparoalloplastica secondo Rives per il trattamento dei grandi laparoceli. Dieci anni di esperienza.

The problems of the surgery of bulky laparoceles began to find concrete solutions with the introduction of materials of synthesis that can be used to reinforce or to substitute the abdominal wall. Despite that, the ideal prosthesis has still not been found, the Dacron (Mersilene), the Polypropylene (Marlex, Prolene) and PTFE (Goretex) are today considered the best materials for the alloplasty. The authors describe their experience in matter of bulky laparocels treated with the technique of Rives. 49 patients have been operated, using Dacron in 44 cases and Polypropylene in 5. They had no mortality and no relapse, while the most frequent complication was 6 seromas, all resolved with conservative therapy. In their series 3 infections of the subcuticular occurred more of which required the removal of the prosthesis.

[Radiologic staging after surgical, chemical, and radiation treatment of non-seminomatous tumors of the testis]. / La stadiazione radiologica dopo trattamento chirurgico, chemio e radioterapico dei tumori non seminomatosi del testicolo.

The aim of this work was to evaluate the clinic usefulness of Computed Tomography (CT) and Magnetic Resonance (RM) in the staging after surgery, radiotherapy and chemotherapy of the nonseminomatous germ cells tumours of the testis. The Authors discussed the CT and MR dimensional criteria for the diagnosis of retroperitoneal metastases of the nonseminomatous germ cells tumours and delineated their CT and MR morphologic appearances in detail. The density of the residual mass on CT was classified as solid, cystic and half-cystic. The retroperitoneal hematoma and lymphocele formed as a complication respectively of orchiectomy and retroperitoneal lymphadenectomy can be misinterpreted to represent metastatic disease on post operative staging CT scans. Early recognition of this complication are crucial if unnecessary treatment is to be avoided. Finally the Authors evaluated, in patients affected from nonseminomatous germ cells tumours of the testis, the possibility to characterize with CT and MR imaging the retroperitoneal mass. The density and character of the residual mass on CT scan did not reliably predict the histology. On the basis of tumor consistency and signal intensity in T1 and T2 weighted images, MR cannot yet warrant any conclusion about the ultimate effect of chemotherapy.

[Carcinoid of the appendix. Clinical report of 3 cases and diagnostic and therapeutic considerations]. / Il carcinoide dell'appendice. Osservazione clinica di 3 casi e considerazioni diagnostiche e terapeutiche.

The Authors report three cases of carcinoid of the appendix and discuss the difficult preoperative diagnosis and the different therapeutic options available. Over the period from January 1994 to December 1999, in the Surgery Unit of Penne Hospital, 424 appendicectomies were performed in 182 males and 242 females (age: 12-86 years; mean age: 39.9 years). In three cases the histological response was positive for carcinoid of the appendix. No postoperative mortality or morbility were reported. The authors analyze the biological peculiarities and the prognostic factors associated with appendiceal carcinoid tumours, such as tumour size and the lymphatic or vascular infiltration of the mesoappendix (and the corresponding more aggressive surgical treatments) and recommend an appropriate postoperative follow-up since synchronous or metachronous bowel carcinomas are likely to occur. Pharmacological therapy has also made important progress, with the possibility of administering compounds capable of interfering with tumour development and neoplastic growth.

[Imaging of neuroendocrine tumors]. / Imaging dei tumori neuroendocrini.

Neuroendocrine tumors (NET) of the pancreas are distinguished in functional (85%) and non functional (15%) in relation to the production and release of the hormone produced. Functional tumors show early, because the neoplasm release the hormone produced when they are still small. Non functional tumors show late when the tumor grows. The localization and the evaluation of the extensive of these tumors has come fundamentally important both in correct presurgical detection and also in the diagnosis of metastases which excluded surgery. Also, as the survival of 20% of the patients with metastases is only five years, the use of non-invasive imaging techniques is very important for the evaluation of results of the various therapies (chemotherapy, interferon, somatostatin). Recent studies have shown that in patients with Zollinger-Ellison syndrome, SRS is the most sensitive non invasive method in localizing primitive tumors and metastases. The accuracy of this technique has not yet been provided in the study of tumors like insulinomas which do not have a high percentage of somatostatine receptors on their cell membranes. The sensitivity obtained in recent studies on a large number of patient and the low cost, lower than all the other imaging technique in use today, surely make SRS the first choice in the study of NET. Where SRS is negative and surgery is possible, Spiral CT or better still MRI is the best tool to check the results of chemotherapy in patients with hepatic metastases (already detected by SRS), because it is easier to compare the changes in size and morphology of metastases.

[Non-seminomatous tumors of the testis: problems of radiological staging before and after treatment]. / Tumori non seminomatosi del testicolo: problemi di stadiazione radiologica pre e post-trattamento terapeutico.

The aim of this work was to evaluate the usefulness of Computed Tomography and Magnetic Risonance in the staging of the nonseminomatous germ cells tumours of the testis. The authors discussed the role of CT and MR imaging to value the detection of retroperitoneal metastases of the nonseminomatous germ cells tumours of the testis pre and post treatment.

[Clinical use of endorectal coil MR in the study of prostatic pathology with special reference to hyperplasia and carcinoma]. / Impiego clinico della RM con bobina endorettale nello studio della patologia prostatica con particolare riferimento all'iperplasia e al carcinoma.

In this report we evaluated the usefulness of endorectal surface coil MR imaging in the study of prostatic anatomy, age-related changes, benign prostatic hyperplasia and carcinoma. At present, endorectal coil MR imaging seems to be one of the most important diagnostic steps in the study of prostatic diseases, because it is the technique that allow to gain very high resolution images.

[Can triphasic spiral CT provide data for the histologic characterization of liver masses?]. / Può la TAC spirale trifasica fornire elementi per la caratterizzazione istologica delle masse epatiche?

Spiral Computed Tomography (CT) has rapidly gained acceptance as the preferred CT technique for routine liver evaluation because it provides image acquisition at peak enhancement of the liver parenchyma during single breath hold. In this study, we evaluated a wide range of non cystic liver lesions with triphasic spiral CT technique, that allows imaging of the entire liver in arterial, portal and equilibrium phases. In particularly we focused on hemangioma, adenoma, focal nodular hyperplasia, hepatocarcinoma and metastases.

[The role of MRI in the diagnosis and evaluation of extension of the disease and condition of patients with neurofibromatosis]. / Ruolo della RM nella diagnosi, nel bilancio d'estensione e nella gestione dei pazienti affetti da neurofibromatosi.

Neurofibromatosis 1 (NF 1) and Neurofibromatosis 2 (NF 2) have been recently recognized to be distinct disorders through genetic linkages. MR imaging can be used to identify abnormalities of the head and spine in patients with these disorders. This review highlights some important but lesser known aspects of the two more common phakomatoses. The role of newer imaging technique such as contrast-enhanced MR imaging in the evaluation of these disorders also are discussed.