Monoclonal gammopathy after visceral leishmaniasis: just a coincidence?

The authors describe a case of monoclonal gammopathy occurring about six months after a visceral leishmaniasis. A literature survey suggests that strong antigenic stimulation caused by visceral leishmaniasis can induce monoclonal gammopathy in a predisposed subject.

[Cardiac manifestations during viral acute hepatitis]. / Manifestazioni cardiache in corso di epatite acuta virale.

The authors describe a retrospective study conducted on 46 patients with acute viral hepatitis, searching for cardiac disorders. These disorders appeared in about 43% of cases, only with benign evolution. The most frequent alterations are electrocardiographic disorders, followed by conduction blocks, axis deviations and arrhythmias. Acute pericarditis was also described, associated with HCV infection. The viral agents most frequently involved are HBV and HCV, followed by cytomegalovirus, and Epstein-Barr virus. In conclusion, the incidence of cardiac manifestations during viral acute hepatitis is rather high, but with benign evolution.

[Hydrothorax in absence of ascites: an unusual complication of hepatic cirrhosis with portal hypertension]. / Idrotorace in assenza di ascite: una complicanza inusuale della cirrosi epatica con ipertensione portale.

AIM: Authors, describing a clinical case of hepatic hydrothorax in absence of ascites, analyse the disease physiopathology and their therapeutic options. PATIENTS AND METHODS: Case report of a mixed aethiology (HCV and alcohol) hepatic cirrhosis, with pleural effusion, without ascites. CONCLUSIONS: Hepatic hydrothorax without ascites is an uncommon complication of cirrhosis with portal hypertension. Treatment could be pharmacological, with diuretics administration, or operating. A simple and cheap method is thoracentesis. If hydrothorax relapses, most effective method is transjugular intrahepatic portosystemic shunt.

[Choledochal cysts. Clinico-radiological considerations and surgical technical notes]. / La cisti del coledoco. Considerazioni clinico-radiologiche e note di tecnica operatoria.

A successfully operated case of neonatal common bile duct cyst is described. Cystoduodenostomy was employed. Whether or not this condition is attributable to obstruction dysembryogenesis or aganglia is discussed. Assessment of the anatomopathological features leads to the establishment of three clinical types: cyst properly so called, hernia and diverticulum. True choledochus cyst has three main symptoms: mass, icterus and pain. The other two forms constitute only 5% of the reported cases. They have no distinct signs and the few cases described have been encountered during surgery or necropsy. Diagnosis is complicated by cholostatic cirrhosis and portal hypertension. Treatment is necessarily surgical: excission of the cyst, reconstruction of the main duct by direct anastomosis of the hepatic duct to the duodenum or a jejunal loop prepared according to Roux; anastomosis by means of cystoduodenostomy.

[Substernal goiter: a diagnostic and therapeutic problem. (Report of 39 surgically treated cases)]. / Gozzo immerso: un problema diagnostico e terapeutico. (Osservazioni su 39 operati).

Substernal goiter is a rare pathology and its definition varied from author to author. We considered substernal the goiter that has the larger diameter below the thoracic inlet, in accord to definition of Valdoni (1957). The authors examined retrospectively 40 cases of endothoracic goiter, that represent 6.1% of patients operated on thyroid. Surgical access was in 35 cases a cervical collar incision; in 2 patients was necessary to associate a median superior sternotomy and in another patient a lateral thoracotomy. In 3 patients the access was a median sternotomy and in the last patient a posterolaterally thoracotomy. The authors carried out 12 total thyroidectomy (30.7%), 15 subtotal thyroidectomy (38.6%), 10 total lobectomy (25.6%), 2 subtotal lobectomy (5.1%). No mortality was observed. The morbility was represented by 5 monolateral temporary palsy of recurrent laringeal nerve, 6 transitory hypocalcemia, 1 tetanic syndrome, 1 transitory arrhythmy. The follow-up was managed on 35 patients (89.7%). We observed 1 definitive hypoparathyroidism, 1 paralysis of recurrent laringeal nerve, 1 mediastinic relapse. One patient was operated on total thyroidectomy 14 years after the first surgery for a differentiated carcinoma. In conclusion the treatment of substernal goiter is surgical. Debating point is the entity of exeresis. We think that the first choice operation is thyroidectomy, done through a cervical collar incision. Occasionally sternotomy or thoractomy are necessary.

[Case of cleft palate]. / Considerazioni su un caso di palatoschisi.

The present paper briefly outlines the pathogenesis of cleft palate and proposes a classification system for cleft palate since both are considered essential for the understanding and assessment of its sequelae. The Authors describe one case of cleft palate. Cleft palate patients present functional and aesthetic alterations in the maxillomandibular area that often require prosthetic correction. Given the features of these malformations therapy and rehabilitation should be programmed as soon as possible after birth and the plastic surgeon should be informed of the factors that cause the malformations and influence the growth of such patients.