Pyoderma gangrenosum of the “sinus mammarum” in ulcerative colitis

The first part of this article deals with the report of a patient suffe - ring from pyoderma gangrenosum of the “sinus mammarum” associa - ted with asymptomatic ulcerative colitis. This is followed by a revision of the present epidemiological, etiological, pathogenetic and clinical knowledges about this systemic manifestation of chronic phlogosis of the colon. The Authors have analysed the treatment for this condition and emphasized the resistance of the cutaneous ulcer encountered to conven - tional medical therapy of the underlying colonic disease which proved to be efficacious only on the latter; this led to integrate traditional treatment with the use of perilesional injections of small doses of calcic heparin as an alternative to immunosuppressive drugs or surgery. Topical antithrombotic treatment, which can be justified by the histo - logical findings of phenomena of the vasculitis in the edge of pyoderma gangrenosum, demonstrated to be crucial and represents a peculiarity in the case here reported, which is unique in the literature as far as the Authors know, since it has not been experimented by anyone else

Searching for a Stochastic Background of Gravitational Waves with LIGO

The Laser Interferometer Gravitational-wave Observatory (LIGO) has performed the fourth science run, S4, with significantly improved interferometer sensitivities with respect to previous runs. Using data acquired during this science run, we place a limit on the amplitude of a stochastic background of gravitational waves. For a frequency independent spectrum, the new limit is $\Omega_{\rm GW} < 6.5 \times 10^{-5}$. This is currently the most sensitive result in the frequency range 51-150 Hz, with a factor of 13 improvement over the previous LIGO result. We discuss complementarity of the new result with other constraints on a stochastic background of gravitational waves, and we investigate implications of the new result for different models of this background.Comment: 37 pages, 16 figure

Role of FDG PET in the management of childhood lymphomas – case proven or is the jury still out?

Positron emission tomography (PET) is a novel non invasive functional imaging modality that is increasingly used for the primary staging of lymphomas and assessment of therapeutic response. This review evaluates the published reports of its use in childhood lymphomas, particularly in the primary staging, response assessment and monitoring after completion of treatment. Specific attention is focused on the clinical circumstances in which FDG PET is most likely to have an impact on management and some indications for its use in childhood lymphomas are suggested

L’impiego di un’originale pinza nella chirurgia per via anteriore dell’ernia inguinale primitiva

Gli Autori propongono l’impiego di un’originale pinza a punta smussa da dissezione e passafettuccia negli interventi di ernioplastica inguinale protesica tension-free con ‘mini-inguinotomia’. In acciaio inossidabile e della lunghezza di 16 cm, lo strumento è costituito da due branche con impugnatura a occhiello, chiusura a cremagliera e articolazione pressoché identiche a quelle dei comuni ferri chirurgici; è lievemente curvo nella sua parte distale, laddove presenta un’ampia punta smussa e un altrettanto largo morso da presa del tutto originali. Il singolare ferro chirurgico dà all’operatore la possibilità di effettuare in modo agevole e delicato l’isolamento, per via smussa e in prossimità del tubercolo pubico, del funicolo spermatico dalla parete posteriore del canale inguinale, andando a sostituirsi al dito indice ripiegato a uncino che, utilizzato con gesti ‘sgraziati’, ‘grossolani’ e causa di trazioni nelle ampie incisioni, non può essere adoperato nelle ‘mini-incisioni’ per il limitato spazio disponibile nel focolaio operatorio. In successione di tempo la nuova pinza consente di provvedere in modo più semplice e rapido del tradizionale impiego di un grosso passafili alla sospensione su fettuccia di gomma degli elementi funicolari inguainati dalla fascia cremasterica. Nel complesso la pinza a punta smussa da dissezione e passafettuccia, il cui prototipo è dagli Autori routinariamente utilizzato negli interventi di ernioplastica inguinale protesica con accesso mini-inguinotomico, consente l’esecuzione di gesti chirurgici facili, prudenti, eleganti, precisi, efficaci e soprattutto sicuri

Addome acuto da perforazione di metastasi digiunale di carcinoma polmonare operato

Lung cancer metastases of small bowel are rare (1,1%), often with few or not symptoms. This aspecific onset and the difficult physical-instrumental approach to small bowel, led often to diagnosis at autopsy. This is not true for intestinal metastases that cause complications (haemorrhage, obstruction, perforation); in this cases emergency surgery leds to the diagnosis. Case report. We describe a case of a male 56 years old patient with acute abdomen due to perforation (X-ray and CT). He refers, about 6 months before, an upper right lobectomy for lung cancer, followed by adjuvant chemo-radiotherapy, because the presence of brain and bone metastases. During the emergency surgery we found out a perforation of the Treitz tract, treated with intestinal resection and immediate end-to-end anastomosis with manual suture. Histological examination shows the perforation of the intestinal wall tract with lung cancer metastases. Conclusions. Our case shows that any acute abdomen in patient with lung cancer can be considered as expression of intestinal metastases. Negative prognosis of this complication imposes to surgeons only a local treatmen

Rottura splenica “occulta” in paziente con mononucleosi infettiva

La rottura di milza può essere secondaria a traumi addominali (di solito chiusi) ovvero verificarsi spontaneamente su un organo sano o sede di alterazioni morfologiche secondarie a vari processi patologici. Tra le varie patologie responsabili di rottura occulta, le malattie infettive sono di gran lunga le più frequenti e tra queste un posto preminente ha la mononucleosi infettiva, che si complica con rottura splenica nello 0.5% dei casi, con una mortalità del 30%. Caso clinico. P.M., donna di 16 anni, è ricoverata in urgenza per addome acuto con anemizzazione ingravescente e incipiente instabilità emodinamica, cui si associa un quadro clinico suggestivo di mononucleosi infettiva, successivamente confermata sierologicamente e istologicamente. Confortati dal riscontro strumentale di grossa falda iperdensa pericapsulare splenica in continuità con spandimento peritoneale gravitario pelvico, abbiamo optato per una laparotomia esplorativa. Discussione. La rottura splenica nella mononucleosi si presenta invariabilmente con dolore in ipocondrio sinistro, raramente presente nelle forme non complicate; la sua insorgenza, pertanto, sia in paziente con recente diagnosi certa di mononucleosi sia in paziente con esclusivi reperti clinico-laboratoristici suggestivi di infezione acuta da virus di Epstein-Barr (EBV), obbliga all’esame ultrasonografico e/o alla TC di approfondimento, soprattutto nei casi in cui il dolore si associa a irradiazione alla spalla omolaterale (segno di Kehr), a segni di irritazione peritoneale e a instabilità emodinamica. Il trattamento della complicanza in esame è generalmente rappresentato dalla splenectomia in urgenza

I tumori stromali gastrointestinali (GIST). Esperienza personale su tre casi a localizzazione nel tenue mesenteriale trattati in urgenza

ummary: Gastrointestinal stromal tumors (GISTs). Personal experience on three cases of the tumors of the small intestine complicated and emergency surgically treated. M. Licursi, A. Bonsignore, F. Fiumara, M. Soliera, G. Grillone, G. Faro, G Pirrone, L.G. Angiò Introduction. GISTs, a new nosological entity recently described, represent a peculiar model of solid tumor: the identification of the molecular mechanism responsible for the oncogenesis led to the development of a new drug (imatinib) active on the specific molecular target, represented by the product of the mutated proto-oncogene c-kit which is a tirosyne kinasi receptor that becomes constitutively active by mutation. Surgical resection, nevertheless, is still the primary treatment and it has to be as complete as possible. These two treatments can be integrated. GISTs are not uniformly kit-positive, and they can be alternatively due to mutations of the PDGFRA gene or, in patients with neurofibromatosis type 1 (NF-1), to generally isolated mutations of the NF-1 gene. Patients and methods. We describe 3 cases of kit-positive GISTs of the small intestine (SISTs), complicated and emergency surgically treated: case 1 - 53 years, female, with small bowel obstruction and concomitant acute intestinal bleeding; case 2 - 71 years, male, with NF-1 and acute intestinal bleeding; case 3 - 47 years, male, with perforation of the Treitz tract. The first two cases have been treated with intestinal resection and immediate mechanical anastomosis; the third one with resection of the pedunculated tumor at its base, where is situated the perforation too. Conclusions. SISTs (20-30%), with little or no symptoms in the initial phases, show notable diagnostic difficulties. Their aspecific and late clinical presentation - typical of this site and of the pathology that we are talking about - and the difficult physical-instrumental approach to small bowel limit the possibility of an accurate diagnosis and expose the patient to potentially fatal acute complications and to risks related to emergency surgery treatment that decreases the possibility of a radical resection

Gallium-68 PSMA uptake in adrenal adenoma

Gallium-68 (Ga-68) labelled prostate-specific membrane antigen (PSMA) imaging by positron emission tomography (PET) has emerged as a promising tool for staging of prostate cancer and restaging of disease in recurrence or biochemical failure after definitive treatment of prostate cancer. Ga-68 PSMA PET produces high target-to-background images of prostate cancer and its metastases which are reflective of the significant overexpression of PSMA in these cells and greatly facilitates tumour detection. However, relatively little is known about the PSMA expression of benign neoplasms and non-prostate epithelial malignancies. This is a case report of PSMA uptake in an adrenal adenoma incidentally discovered on PET performed for restaging of biochemically suspected prostate cancer recurrence. With the increasing use of PSMA PET in the management of prostate cancer - and the not infrequent occurrence of adrenal adenomas - the appearance of low- to moderate-grade PSMA uptake in adrenal adenomas should be one with which reporting clinicians are familiar