Large Meckel's Diverticulum Enterolith. A case of small bowel obstruction.

The Meckel's diverticulum is usually asymptomatic but in sometimes it presents severe complications, such as bleeding or perforation. The presence of enterolith inside a Meckel diverticulum is rare. In this report, we present a case of a 56- years- old man, with an abdominal pain and small bowel obstruction for a enterolith. Preoperative radiologic studies in Emergency Room (ER) didn't reveal this stone, but realeved a small bowel obstruction. Initially, we tried a conservative management, however after about 48 hours, due to worsening symptoms, the patient undergoes an exploratory laparotomy and a intestinal resection. Key words: Enteriith, Meckel's diverticulum, Small bowel obstruction.

Total Severity Score (TSS) comparison in vaccinated and unvaccinated patients during the fourth wave (December 2021 - January 2022) of COVID-19 in Italy.

OBJECTIVE: This study aims at comparing the severity score assessed using high-resolution computed tomography (HRCT) in vaccinated and unvaccinated COVID-19 patients. PATIENTS AND METHODS: From the first of December 2021 to first of February 2022, we conducted a single-center retrospective analysis on COVID-19 patients who accessed ED services. The hospital in question is a level II facility with a catchment area of around 200,000 people. According to the Italian recommendations, patients were divided into four groups based on the CT score of Micheal Chung. The sum of acute inflammatory lung lesions involving each lobe was scored as 1 (0-25%), 2 (26-50%), 3 (51-75%) or 4 (76-100%) on a visual quantitative assessment of CT. The total severity score (TSS) was determined by summing the five lobe scores. RESULTS: The study included 134 patients divided into two groups: 67 vaccinated and 67 unvaccinated people. 53 people had incomplete (single dose/double dose) immunization, while 14 people completed the vaccination cycle. It was discovered that the mean CT severity score was lower in fully vaccinated patients compared to partially vaccinated or unvaccinated patients. The mean CT score was significantly lower in fully vaccinated patients aged 60 compared to older patients. The mean CT score was higher in unvaccinated patients compared to fully vaccinated patients. CONCLUSIONS: Individuals who received three doses of COVID-19 vaccination had lower CT severity scores than patients who received only one dose of vaccine or no vaccines at all.

Left ventricular systolic and diastolic function measurements using an ambulatory radionuclide monitor: effects of different time averaging on accuracy.

The accuracy of an ambulatory radionuclide detector (VEST) for left ventricular systolic (ejection fraction, EF) and diastolic (peak filling rate, PFR) measurements was assessed at different time averaging of the nuclear and electrocardiographic data. Fifty-one patients, in a total of 67 studies, underwent equilibrium radionuclide angiography (RNA) immediately before a VEST study. VEST data were analyzed using single-beat analysis and different time averaging of 5, 10, 15, 30 and 60 sec. Agreement between VEST and RNA in estimating EF and PFR was evaluated by computing limits of agreement (LA). These were computed as 1.96 times the s.d. of the mean differences between the two methods, expressed in the same unit as EF and PFR. Differences between the two methods were plotted against their mean, allowing investigation of any possible relationship between measurement error and the true value (whose best estimate is the mean between the two methods). The entire statistical analysis was repeated at each different time averaging. LAs for EF measurement by VEST were -10.4:8.8 (single-beat analysis), -11.2:9.9 (5-sec averaging), -5.4:4.8 (10-sec averaging), -4.9:4.5 (15-sec averaging), -6.2:5.6 (30-sec averaging), -6.9:4.5 (60-sec averaging). Results indicate good agreement between VEST and RNA in measuring EF, at least for time averaging > or = 10 sec. LAs for PFR ranged from -0.6:0.6 (single beat) to -1.0:0.6 (60-sec averaging), which was considered a clinically acceptable agreement between VEST and RNA. No relationship between measurement error and true value was found either for EF and PFR.

Morphine stimulates nitric oxide release from invertebrate microglia.

Morphine stimulates nitric oxide (NO) release in human endothelial cells. To determine whether this mechanism also occurs in invertebrates, the mussel Mytilus edulis was studied. Exposure of excised ganglia to morphine for 24 h resulted in a significant dose-dependent decrease in microglial egress that was naloxone sensitive. In coincubating the excised ganglia with morphine and the nitric oxide synthase inhibitor, N omega-nitro-L-arginine methyl ester (L-NAME), an increase in microglial egress was observed, suggesting that morphine may stimulate microglia to release NO. Morphine exposure to these cells in vitro resulted in NO release (39.4 +/- 4.9 nM), a phenomenon found to be naloxone sensitive (10(-6) M; NO level = 5.9 +/- 2.6 nM) and L-NAME sensitive (10(-4) M; NO level = 2.8 +/- 1.8 nM). Opioid peptides did not stimulate NO release, indicating that the process was mediated by the opiate alkaloid selective mu 3 receptor. Coincubation of microglia with L-arginine or the superoxide scavenger, superoxide dismutase, resulted in significantly higher NO levels observed following morphine stimulation. Taken together, the data demonstrate that morphine can stimulate NO release in cells obtained from an invertebrate that represents an animal 500 million years divergent in evolution from man, underscoring the significance of this process and further substantiating the critical importance of morphine as a naturally occurring signal molecule.

Computed tomography and second-look surgery in ovarian cancer patients. Correlation, actual role and limitations of CT scan.

Computed tomography (CT scan) was performed on 58 clinically disease-free ovarian cancer patients. The scans were correlated with the results obtained at a subsequent second-look laparotomy. The sensitivity was 0.47, the specificity 0.87, diagnostic accuracy 0.63, positive predictive value 0.84 and negative 0.53. Undetected microscopic disease was classified as a false-negative result. Sensitivity was poor for omental, mesenteric and peritoneal implants and for bowel infiltration, good for lymphnodal involvement and abdominal mass and decisively good for intrahepatic and plenic metastases of ovarian cancer. Due to a still high false-negative rate a normal CT scan does not provide sufficiently accurate diagnostic information to replace a second-look laparotomy. But on the other hand, due to a high specificity, the usefulness of CT can be limited to approximately 27% of patients, with true-positive findings, who might have been saved surgical reexploration. Adjunct studies such as immunoscintigraphy with radiolabelled monoclonal antibodies and measurement of tumor markers further increase its diagnostic accuracy.

Evaluation of myocardial perfusion and function by technetium-99m methoxy isobutyl isonitrile before and after percutaneous transluminal coronary angioplasty. Preliminary results.

Myocardial perfusion and function were evaluated with Tc-99m MIBI myocardial scintigraphy before and after percutaneous angioplasty in six patients. In addition to conventional stress-rest images (3 projections: 45 degrees left anterior oblique, anterior, and left lateral), gated images were obtained at rest and during stress before and after angioplasty. Improvement in myocardial perfusion after angioplasty was demonstrated in all patients. The increase from rest to stress of radionuclide fractional shortening (an index of global left ventricular function computed on gated images) was greater after angioplasty than before (9% +/- 7% versus--0.5% +/- 8%, respectively, p < 0.05). Systolic wall thickening (an index of regional left ventricular function) showed a significantly greater rest-to-stress increase after angioplasty than before it in the regions supplied by treated vessels. Thus, Tc-99m MIBI myocardial scintigraphy is capable of evaluating myocardial perfusion and function.

[Myocardial scintigraphy with technetium 99m methoxyisobutylisonitrile. A comparison with coronary arteriography in patients with suspected ischemic cardiopathy]. / La scintigrafia miocardica con tecnezio 99m metossi-isobutil-isonitrile. Confronto con l'arteriografia coronarica nei pazienti con sospetta cardiopatia ischemica.

Technetium-99m methoxy-isobutyl-isonitrile (MIBI) myocardial scintigraphy has been proposed as an alternative to Thallium 201 myocardial imaging in the evaluation of patients with coronary artery diseases. We studied 39 patients (37 men, mean age 56 +/- 9 years) with suspected coronary artery disease. All patients underwent 99mTc MIBI myocardial scintigraphy after stress and at rest. Coronary arteriography, performed within 1 month, showed significant (greater than or equal to 50%) stenosis of at least 1 epicardial coronary artery in 36 subjects. 99mTc MIBI myocardial scintigraphy exhibited 94% sensitivity (34/36 patients) and 100% specificity (3/3 subjects with normal coronary arteries). Sensitivity for individual vessel stenosis was 81% (96% for the left anterior descending artery, 65% for the circumflex artery and 79% for the right artery). Our data show that 99mTc MIBI myocardial scintigraphy is capable of evaluating patients with coronary artery diseases.

[Left ventricular systolic and diastolic asynchronism in patients with ischemic cardiopathy: its effects on ventricular filling]. / Asincronia sistolica e diastolica del ventricolo sinistro nei pazienti con cardiopatia ischemica: influenze sul riempimento ventricolare.

To assess whether left ventricular asynchrony would influence filling in coronary artery disease, 27 patients with coronary artery disease and 39 normal subjects were studied by rest radionuclide angiography. Lower ejection fraction and peak filling rate were found in the coronary artery disease group (56% +/- 17% versus 65% +/- 6%, p less than 0.05; 1.8 +/- 0.7 versus 2.9 +/- 1.4 end-diastolic volumes/s, p less than 0.05). Moreover, the patients with coronary artery disease had a prolonged isovolumic relaxation period (114 +/- 86 ms versus 70 +/- 43 ms, p less than 0.05). Two indices of left ventricular asynchrony were evaluated: the coefficient of variation of regional time to end-systole, and the coefficient of variation of regional time to peak filling rate. The coefficient of variation of regional time to peak filling rate was higher in the coronary artery disease group (10.1% +/- 10%) than in the normal subjects (6.2% +/- 3.7%, p less than 0.05). Both these parameters were inversely related to global peak filling rate in the coronary artery disease group. These findings suggest that in patients with coronary artery disease left ventricular systolic and diastolic asynchrony plays a role in determining left ventricular diastolic properties.

Microglia in invertebrate ganglia.

The results of this study lend strong support to the concept of the existence in insects and molluscs of a distinctive class of neuroglial cells comparable to vertebrate microglia. The evidence presented is as valid as that used in reference to the separate status of vertebrate microglia--i.e., the demonstration of a close structural and functional relationship of these cells with cells of the immune system. As in vertebrates, the excision of ganglia from three invertebrate species (the molluscs Planorbarius corneus and Mytilus edulis and the insect Leucophaea maderae) and their maintenance in incubation media led to an exodus of small cells and their accumulation in the culture dish. During this process, they underwent conformational changes from stellate to rounded, and then to more or less ameboid, comparable to those indicative of the process of activation in the animals' immunocytes. Functional characteristics which these translocated microglia-like cells share with immunocytes are motility, phagocytotic activity, and adherence to the culture dish. Furthermore, the two cells have certain biochemical features in common--e.g., the presence of certain cytokines and (at least in Planorbarius) that of corticotropin. An additional phenomenon of particular interest for the classification of microglial elements is their response to morphine. At 10(-6) M, this drug decreases not only the number of cells emerging from the excised ganglia but also the degree of their transformation to the "active" ameboid form. This dose-dependent and naloxone-sensitive effect of morphine on microglial cells parallels that on activated immunocytes of the same species. Corresponding results demonstrating an inhibitory effect of morphine on mobilized microglial cells of the frog Rana pipiens indicate that this relationship between the two cell types under consideration also exists in vertebrates. Binding and displacement experiments with membrane homogenates of microglial cells as well as immunocytes of Mytilus have shown that the effects of morphine on both cell types are mediated by the same special opiate receptor (mu 3).

[Scintigraphy with gallium-67 citrate in patients with AIDS: pathologic extrapulmonary uptake]. / Scintigrafia con 67Gallio-citrato in pazienti con AIDS: captazione patologica extrapolmonare.

67Gallium citrate can accumulate in different inflammatory and neoplastic lesions. The mechanisms of 67Gallium uptake in abnormal tissue are still partially unknown and the tracer is considered a nonspecific indicator of disease. In AIDS patients, 67Gallium citrate is used in the diagnosis and characterization of opportunistic pulmonary infections and especially of Pneumocystis carinii pneumonia. From June 1989 through December 1992 in our Department 140 67Gallium scans were performed on 103 AIDS patients, referred for evaluation of pulmonary symptoms. All studies were carried out 72 hours after i.v. administration of 185 MBq 67Gallium citrate, with anterior and posterior views of head, chest and abdomen. The images were evaluated with conventional diagnostic criteria and site, number and intensity of abnormal foci of extrapulmonary uptake were recorded. Abnormal extrapulmonary uptake was found in 17 patients (12%): gastric (3, two of which also exhibited abnormal intestinal uptake), esophageal (1) hepatic (1), intestinal (2) renal (4), nodal (3), ocular (1), cutaneous (1), sinusal (1) localizations. In all cases clinical, endoscopic, bioptic or microbiological demonstration of the possible cause of 67Gallium uptake was obtained. An intriguing finding in our series was the lower incidence of gastric uptake (two patients with miliary tuberculosis and one patient with gastric candidiasis) than in the literature. This finding could be explained by clinical and epidemiologic differences between different patient populations. However, the scan interval after tracer administration should be also taken into account, since in our study scans were always performed at 72 hours, while in other series the interval ranged 24-48 hours. The relatively high incidence of abnormal extrapulmonary uptake confirms the opportunity of whole body exploration after 67Gallium administration in the patients with such multisystemic disease as AIDS, even when the patients are referred mainly for respiratory problems.