Steadily high IDDM incidence over 4 years in Sardinia.

OBJECTIVE: To verify whether the high incidence of insulin-dependent diabetes mellitus (IDDM) in Sardinia is an epidemic outbreak or a steady phenomenon. RESEARCH DESIGN AND METHODS: All newly diagnosed cases of IDDM with onset in patients 0-29 years of age between 1 January 1989 and 31 December 1992 among residents in Sardinia were obtained from the Sardinian IDDM Incidence Registry. The local IDDM patient association (Associazione Diabete Infantile Giovanile) served as the secondary and independent source. RESULTS: The completeness of ascertainment was 91%. The age-standardized mean annual incidence of IDDM (per 100,000) was 34.4 in the 0- to 14-year-old age-group and 26.2 in the entire 0- to 29-year-old range, respectively. Men-to-women ratios were 1.38 and 1.55, respectively. Seasonal variation in incidence was observed, with a peak in fall and winter and a nadir in summer. CONCLUSIONS: Sardinia has a very high and steady IDDM incidence rate, which is up to fivefold that of other Italian regions and Mediterranean countries and approaches the Finnish top rate in the world. Interaction between the genetic peculiarity of Sardinians and still unidentified powerful environmental agents is likely to account for the phenomenon.

Comparison of the seasonal pattern in the clinical onset of IDDM in Finland and Sardinia.

OBJECTIVE: To examine the seasonal pattern for the clinical onset of IDDM in Finland and Sardinia, two areas where the incidence of IDDM is the highest in the world, and to determine the effect of climate and temperature on the clinical onset of IDDM. RESEARCH DESIGN AND METHODS: Analysis of seasonality for the diagnosis of IDDM was based on 1,405 cases in Finland and 425 cases in Sardinia diagnosed at < or = 14 years of age from 1989 to 1992. The average annual incidence of IDDM was 36.4/100,000 in Finland and 34.4/100,000 in Sardinia. Seasonal patterns were estimated presenting the data as short Fourier series up to three harmonics together with a possible linear trend. Likelihood ratio tests and Akaike's information criterion were used to determine the number of harmonics necessary to model the seasonal pattern. Seasonal patterns in both countries were compared between sexes and between the three 5-year age-groups, each controlling for the other's effect. RESULTS: In both countries, a significant seasonal pattern during a calendar year was found for the sexes combined and for two age-groups (0-9 and 10-14 years). In Sardinia, two distinct cycles were found in the younger age-group, with a decreased incidence during May through August and an increased incidence during the autumn months. Two cycles were apparent in the older age-group, with the nadir occurring during June through September. In Finland, one cycle was found in the younger age-group, with a decreased incidence in June. In the older age-group, there were two distinct cycles, with a decreased incidence in June and in the September through December period. CONCLUSIONS: Differences between Finland and Sardinia in the seasonal pattern for the incidence of newly diagnosed IDDM cannot be explained by differences in climate, temperature, a longer warm period in Sardinia, or other climatic phenomena. The results do not provide evidence in favor of a specific viral etiology of IDDM. It may be suggested that there are triggering events at certain times, but they are likely to be unspecific. Nevertheless, why the incidence of IDDM in these two populations is equally high despite differences in climate, environment, and genetic background remains an unsolved question.

[Doppler ultrasonography in the diagnosis of diseases of the supra-aortic trunks]. / L'ultrasonografia doppler nella diagnostica delle affezioni dei tronchi sovraaortici.

Systematic examination of the upper aortic arch vessels by direct Doppler ultrasonography of the common and internal arteries is proposed, together with calculation of the flow rate, pressure-perfusion index, carotid ratio, and carotid distensibility index on a systematic basis. Obligatory compression movements to evaluate the several supplementary pathways in the case of disease are also recommended to complete the examination.

[Doppler ultrasonic arteriography with colorimetric morpho-function analysis of frequency (Echoflow). Preliminary trials]. / L'arteriografia ultrasonica ad effetto Doppler con analisi colorimetrica morfo-funzionale delle frequenze (Echoflow). Esperienza preliminare.

Doppler arteriography with chromatic frequency analysis is a new and very sound diagnostic method in cases of vascular disease. It can be carried out with apparatus such as the Echoflow (reg'd), a natural development of the Doppler technique ultrasonography. Vessels are shown in red, yellow, or blue, depending on the rate of their intraluminal flow. Surface arteries lying 5-6 cm below the skin and not hidden by bone can be studied. Preliminary results on 23 supra-aortic trunks, 21 lower extremity arterial systems, and 5 upper limb systems are described. The use of the instrument in other situations in also recommended.

[Hepatic amebiasis. Apropos of two cases]. / L'amebiasi epatica. A proposito di due casi.

The authors report 2 cases of amebic hepatic abscess, through to their observation with a little interval of time one from another and both coming from the same small town. Transmission modalities, the diagnostic approach and the therapeutic possibilities are discussed on the basis of personal experience.

[The emergency treatment of perforated colonic diverticula]. / Trattamento d'urgenza dei diverticoli perforati del colon.

The authors report their experience of the treatment of 43 cases of perforated colonic diverticula. The operations were: 12 primary resections-anastomoses; 7 resections-anastomoses with protective colostomy; 2 operations of suture and drainage; 22 Hartmann's resections. The authors believe that Hartmann's resection is the operation of first choice in cases of diffuse or stercoraceous peritonitis. This operation another the removal of the sick part of intestines without exposing the patient to the possible complications of an operation "at risk", and allows a late recanalization destitute of risk: in our experience 13 cases of 22 (59%).

[Cancer of the rectum and sigmoid. Our experience]. / Il cancro del retto-sigma. Nostra esperienza.

The paper reports the Authors' experience during the period 1989-91 and refers to 80 operated cases of rectum-sigma cancer. Given that data reported in the literature affirm that the limit of oncological safety is 1.5-2 centimetres distal from the tumour, and owing to their use of mechanical staplers, the Authors were able to use the preferred anterior section followed by low or very low colo-rectal anastomosis in 96% of cases. Miles' technique for abdomino-perineal amputation was only resorted to in 4% of cases. Tumours parameters, short- and medium-term complications and the results of a short-term follow-up are all discussed. The Authors compare their experience with that of other researchers reported in the literature.

[The "emergency" treatment of celiac trunk obliteration diagnosed during duodenocephalopancreatectomy. A case report]. / Trattamento "d'urgenza" della obliterazione del tronco celiaco diagnosticata in corso di una duodenocefalopancreatectomia. Case report.

The authors report about a case of celiac axis obliteration, noticed during an operation of pancreaticoduodenectomy for pancreatic formation. The arterial flux of sovramesocolic district took place completely through the gastroduodenal artery. To complete the operation the authors were obliged to stop the circulation of the pancreaticoduodenal artery and to rivascular the common hepatic through bypass with aorta. The authors confirm the importance of arteriography for the study of expansive lesions of the pancreas, liable to surgical treatment as well to avoid treating urgently similar cases or due to anatomic variants.

[Treatment of inguinal hernia in local anesthesia: our experience with the Shouldice surgical technique]. / Trattamento delle ernie inguinale in anestesia locale: nostra esperienza della plastica sec. Shouldice.

The authors present their personal experience in the surgical treatment of 256 cases of patients suffering from inguinal hernia, using the Shouldice technique in local anaesthesia. Minor incidence intra and postoperative complications compared with other types of anaesthesia, the possibility to converse with the patient during the operation and if necessary to invite him to cough in order to exclude the presence of other associated hernias or to assay the robustness and the resistance of the plastic, minor frequency of relapses compared with other operating techniques (1.5% in the Shouldice against 3% of the Bassini), and last but not least the possibility of early discharge from hospital and more swift resumption of work, confirm the full validity of this hernial plastic surgery.

[Malignant tumors of the pancreas and periampullary area. Our experience]. / I tumori maligni del pancreas e dell'area periampollare.

The authors analyse and evaluate the clinical records of 45 patients treated in the last 4 years for pancreatic cancer and neoplasm of the bilioduodenapancreatic area, comparing the results with data available in the literature. In the group of patients treated with resection (12 cases), postoperative morbidity and mortality were respectively 28% and 6%, and three-years survival was 22%. The authors discuss particularly about reconstruction ways after duodenopancreatectomy, showing good results after reconstruction by Y loop sec. Roux and pancreato-jejunal anastomosis.

[Cystic dilatation of the choledochus associated with stenosis of the hepatic duct bifurcation. An analysis of a clinical case]. / Dilatazione cistica del coledoco associata a stenosi della biforcazione dei dotti epatici. Analisi di un caso clinico.

The authors report a case of cystic dilatation of the choledochus associated with narrow stenosis at the confluence of the left and right hepatic ducts which was found to be inflammatory on histological examination. This pathology is becoming an increasingly more commonplace clinical finding. The case reported here is particularly interesting owing to the onset of the disease and the way in which it was treated. An attempt was made to treat the patient using a simple operation which was to the least radical possible. The authors take this opportunity of reviewing the literature on the subject.

[Access to the rectum via a posterior route and via a combined abdominal-posterior route: when and why]. / L'accesso al retto per via posteriore e per via combinata addomino-posteriore: quando e perché.

The authors report their experience of the posterior rectal access route. They used this route to operate 7 patients with rectal carcinoma during the period February 1989-October 1994; 3 patients were affected by villous adenoma, 3 by adenocarcinoma, and 1 by pelvic recidivation. Of the 3 patients suffering from adenocarcinoma, two underwent palliative treatment owing to their poor general conditions and the systemic nature of the base pathology, consisting in the exeresis of the tumour using a posterior route. The third patient was treated using a combined abdominal-posterior route; the site of the tumour and the presence of a narrow pelvis would in fact have made an "ultra low" front resection highly risky, whereas coloanal anastomosis (pull through) might have jeopardized efficacious anal continence. On the basis of their experience the authors indicate the posterior access route as a therapeutic possibility in the treatment of medium-low rectal tumours at an early or very advanced stage. The posterior approach is only justified in other forms if combined with laparotomic access. An oncologically correct operation is therefore guaranteed in full respect of sphincteric function.

[Neurilemmoma of the stomach. Presentation of a case]. / Il neurilemmoma dello stomaco. Presentazione di un caso.

The paper describes a recent case of neurilemmoma of the stomach. Following a review of the literature, the Authors focus their attention on the diagnostic difficulties and the choice of therapy. Tomography, arteriography and gastroscopy with multiple biopsies may at times be misleading depending on the development of the tumour. Most Authors agree that local resection or, when possible, enucleation are the most appropriate forms of therapy.

[Axillo-femoral bypass in the treatment of aorta prosthesis infection. A special case]. / Il by-pass axillo-femorale nel trattamento di protesi aortica infetta. Un caso particolare.

The authors report a case recently brought to their observation: T.A., a 77 year old patient, operated on in July 1990, for aortic aneurysm with axillo femoral by-pass. The patient was reoperated on the 5th day for ischaemic necrosis of the descending colon. In 1992 he was operated in another hospital for right iliac branch removal of the by-pass and performing of extra-anatomic bifemoral by-pass for right iliac branch infection of anatomic prosthesis. He was brought to our observation in March 1993, after the patient was refused in other Centres because of purulent abscess located near the aortic prosthesis and in the right iliac fossa, with a fistula to right superior anterior iliac crista. The patient was operated on in April 1993, with an explorative laparatomy to drain the abscess and to remove the aortic prosthesis. The aorta was sutured with closed bottom by means of delayed points. The postoperative course was regular and an arteriography performed three months after confirms the good running of the axillo-femoral by-pass and of the bifemoral one previously performed. The authors because of their experience and the bibliographical data underline the goodness of the axillo-femoral by-pass in serious infections of an aortic prosthesis.

[Pseudo-acute abdomen in familial Mediterranean fever. A case report]. / Pseudo addome chirurgico in corso di febbre mediterranea familiare. Osservazioni su di un caso.

The Authors report a case of familial mediterranean fever with pseudo-acute abdomen recently observed and emphasize how a careful anamnesis can avoid unnecessary surgical intervention.