The use of x-ray CT and MRI in the study of sacroiliac joints in patients with Behcet disease and acute anterior uveitis

Objective: It's controversial if Behcet Disease (BD) must be included in the group of seronegative spondyloarthropathy (SpA). Our aim was to establish the prevalence of sacroiliitis (SI) in patients with BD using X-Ray, CT and MRI, in comparison with patients with Acute Anterior Uveitis (AAU), that is known to belong to the subgroups of SpA. Methods: We considered, in the period from 04/2006 to 04/2009, 21 consecutive patients with BD, positive for HLA B51 and 28 consecutive patients with AAU, positive for HLA B27. These patients were previously selected by our Rheumatological Ward. Altogether we evaluated 98 sacroiliac joints (SIJ); each side of any patient was graded separately. Results: X-ray of the pelvis showed advanced SI (grade 4) in 14% of the cases in patients with AAU; in BD group only 7% CT showed advanced SI in 14% within AAU patients versus 6-12% of advanced SI (right to left) within BD patients. MR showed 14% of advanced SI (bilateral) within AAU versus 6-11% of advanced SI (right to left) in BD patients. Conclusions: This study supports the trend to not consider BD within the SpA, being the prevalence of SI in BD patients not very different from general population and anyway lower than that observed in patients with AAU. On the other side the prevalence of SI in AAU patients is higher than in BD patients and very similar to the one observed in patients with seronegative arthritis, and anyway high enough to consider joint involvement as an important feature of the disease

The impact of experience on recurrence rates after biopsy punch excision for pilonidal disease

Aim We present the outcomes and the recurrences of 848 patients with pilonidal disease (PD) treated by biopsy punch excision (BPE) and we weigh our results against progressively obtained operative experience. BPE is a modified 'merged' version of both the Bascom 'pit picking' procedure and the Gips procedure. It employs biopsy punches of different calibre, depending on whether treatment is in the natal cleft (calibre as small as possible) or lateral (larger calibre punches or even small incision). Sometimes this procedure is referred to as the Bascom-Gips procedure. Methods In all, 848 consecutive patients with PD were treated from January 2011 until December 2016 (sex 622 [73.4%] men and 226 [26.6%] women; median age 26.2 years, mean age 24.6 +/- 28.99 [range 14-55] years, men 25.1 years, women 24.8 years). Of these 848 patients, 287 were operated in 2011-2012, 301 in 2013-2014 and 260 in 2015-2016. The recurrence rates were recorded 12, 24 and 60 months after surgery both cumulatively and by examining the outcomes of the three biennia individually (years of treatment 2011-2012 or group A, 2013-2014 or group B, 2015-2016 or group C). Results The mean operating time was 34 +/- 24.45 min. Postoperative complications included early (n = 22 or 2.6%) and delayed (>24 h; n = 26 or 3.1%) postoperative bleeding. Postoperative fluid collections (<2 weeks) occurred in 83/848 patients (9.8%) and included haematoma (n = 25) and seroma (n = 58). Full recovery was obtained after a mean of 21 +/- 12.72 days and work/school/university activities were resumed after a mean of 4 +/- 12.02 days. Twelve-, 24- and 60-month follow-ups were possible in 725 (85.5%), 682 (80.4%) and 595 (70.2%) patients out of 848. An overall significant (chi(2) = 16.87, P = 0.0002) difference was found in the recurrence rates: 59 recurrences/725 patients (or 8.1%) after 1 year, 89 recurrences/682 patients (or 13.0%) after 2 years and 98 recurrences/595 (or 16.4%) after 5 years. However, when subgrouping patients in three 24-month subsets, the recurrence rates showed a steady and progressive decrease in the three biennia 2011-2012 (group A), 2013-2014 (group B) and 2015-2016 (group C) at 12-, 48- and 60-month follow-ups. Recurrences after 12 months were 29/225 (12.9%), 19/285 (6.7%) and 11/215 (5.1%) (chi(2) = 8.53, P = 0.014) in groups A, B and C respectively; after 24 months, 36/226 (15.9%), 31/242 (12.8%) and 22/214 (10.2%) (chi(2) = 2.38, P = 0.30 N.S.) in groups A, B and C respectively; after 60 months, 38/194 (19.5%), 36/215 (16.7%) and 24/186 (12.9%) (chi(2) = 2.23, P = 0.32) in groups A, B and C respectively. Conclusions BPE is an effective, disease-targeted, minimally invasive and inexpensive way to treat PD. Its results are influenced by the experience of the team involved, especially regarding early recurrences/failure of surgery. At least 5-year follow-ups are needed to ascertain the outcome of surgery for PD

Pancreas divisum. Correlation between anatomical abnormalities and bile precipitation in the gallbladder in seven patients

Pancreas divisum is a genetic defect associated with recurrent acute pancreatitis due to insufficient drainage of the accessory pancreatic duct. Seven young patients diagnosed with pancreatic divisum and thickening of the gallbladder bile as shown on magnetic resonance cholangio-pancreatography without pancreatic ductal changes underwent laparoscopic cholecystectomy. During the mean follow-up of 32 months no episode of pancreatitis was reported. There is an association between PD and higher concentration of bile in the gallbladder. Cholecystectomy can be considered curative in patients with PD in the absence of indications for major surgery

The prevalence of resistant arterial hypertension and secondary causes in a cohort of hypertensive patients: a single center experience

The prevalence of resistant hypertension (RHT) still remains unknown. Aim of the study was to investigate in a large cohort of hypertensive patients the prevalence of RHT, and to identify in these patients the secondary forms of arterial hypertension (SH). We enrolled a series of 3685 consecutive hypertensive patients. All patients underwent complete physical examination, laboratory tests, screening for SH. Ambulatory blood pressure monitoring (ABPM) was performed to exclude white-coat hypertension. Further, we investigated for any obstructive sleep apnea syndrome (OSA). Only 232 (5.8%) hypertensive patients fulfilled criteria for RHT. 91 (39%) had a SH; 56 (61%) hypertensive patients had a primary aldosteronism, 22 (24%) had OSA, 7 (7.7%) had a hypercortisolism, and 5 (5.5%) had a renovascular hypertension (RVH). Only one patient had adrenal pheochromocytoma. An accurate definition and investigation into RHT is needed. We recommend ABPM to all patients at diagnosis. Finally, all patients must be screened for SH, such as adrenal hypertension, OSA and RVH, especially those who are apparently resistant to polypharmacological treatment

De novo secondary adenocarcinoma in the colon used as urinary diversion not in contact with the fecal stream. Systematic review and meta-analysis

L'articolo descrive la correlazione tra infiammazione e formazione di adenocarcinoma nel colon trasposto chirurgicamente e non in contatto con le feci

[Ultrasonography and biliary calculi: a retrospective study on the diagnostic reliability].

The Authors evaluated diagnostic reliability of echotomography in biliary tract lithiasis, reviewing a series of 130 patients (out of 171) who were surgically treated; 30 had proved to be affected with biliary main tract stones. A high rate of false negatives was documented as related to the diagnosis of lithiasis of the main biliary duct

Monitoraggio con BIS dello stato di coscienza durante induzione dell’anestesia generale. Quale miorilassante?

I valori di BIS-index suggeriscono che l’uso di un oppioide come il fentanyl sembra consigliabile quando si usino le associazioni Cisatracurio/Propofol o Veruconio/Propofol. Potrebbe essere impiegata in questi casi un’infusione continua (TCI) al fine di evitare il rischio di awareness durante la manovra di intubazione oro-tracheale