BACKGROUND: The early diagnosis of Human Hydatidosis through immunologic methods has been one of the most important activities displayed by the Programme of Struggle (fight) in endemic areas of Argentina, to improve the prediction of the Hydatid patient. It is of great interest to define exactly the advantages and limitations of the DD5 and Elisa techniques in the diagnosis of hydatidosis in inhabited areas with no clinic symptoms of the disease. METHODS: For this, the sensibility, the specification and predictive value of both methods has been evaluated, studying serologically 499 inhabitants from a rural community in the Province of Río Negro. The inhabitants with reactive serology to EIE and/or DD5 are studied by means of images using US, RX and TC. A controlled group is selected according to its un-reactive serology. The cases compatible with Hydatidosis are directed to surgery. RESULTS: The DD5 technique is shown as 100% specific but with a sensibility of only 31%; on the other hand, EIE at a cutting level of 8 DE presents a specification of 97% with a sensibility of 63%. CONCLUSIONS: It is important to underline the value of the US as the first image prognosis, while the TC, in the present experience, did not show a great number of positive images, allowing only to confirm the US findings.

Echinococcosis↗

PubMedDate not supplied

[Thrombocytosis and neonatal subcutaneous adiponecrosis].

The authors report three newborns with subcutaneous fat necrosis, that appeared between the 4th and 21st day of life. The infants, full term of normal weight, presented severe perinatal hypoxia and needed primary resuscitation. Severity and duration of perinatal hypoxia were not related with the time of cutaneous lesion onset. Serum calcium levels were in the higher values of the neonatal normal range. Vitamin D levels were within the normal range and only one patient showed a transient elevation of PTH, suggesting a poor relevance of both these factors in determining serum calcium increase. All patients showed a marked increase of platelets number, before the onset of clinical manifestations. Thrombocytosis could play an important role in the pathogenesis of adipose tissue necrosis, causing lower blood perfusion with relative hypoxia and hypothermia.

Fat Necrosis↗

PubMedDate not supplied

[Massive hemorrhage caused by colonic diverticulosis].

Massive hemorrhage from diverticular disease of the colon is a very difficult problem in abdominal emergency surgery. The pathogenesis of bleeding colonic diverticulosis is strictly correlated to the angioarchitecture of the colonic diverticular wall. Here the vasa recta penetrate the colonic wall from the serosa to the submucosa through connective tissue septa. Injurious factors arising from the colonic or diverticular lumen can produce an eccentric damage to the luminal side with intimal thickening, segmental weakening of the artery and its rupture with massive bleeding. Conventional barium enema is not able to show the source of the hemorrhage in the majority of the bleeding patients; colonoscopy, as primary emergency procedure, has significant positive findings in 41.5%-83.7% of patients. Radionuclide bleeding scans have a sensitivity rate of 86%-94%. Emergency arteriography localizes the bleeding source in higher rates ranging from 58% to 86% and is successful after intraarterial infusion of vasopressin or embolization in 47%-92% of patients. Surgical treatment for continued bleeding from diverticular disease is controversy. Segmental resection should be performed on patients with localized bleeding sources (positive arteriogram). Laparotomy, anterograde irrigation and intraoperative colonoscopy are indicated in patients with multiple bleeding sites and negative arteriography. Because the right colon is the most common site of bleeding in same cases is necessary to perform a subtotal colectomy with ileorectal anastomosis. Blind resections particularly in the elderly patients present high rebleeding rate (> 60%) and high mortality (30%) with sepsis accounting for the majority of deaths.

Aged↗

PubMedDate not supplied

[Adrenal myelolipoma (author's transl)].

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Adrenal Gland Neoplasms↗

PubMedDate not supplied

[Splenic lymphangiomas associated with polycystic liver and kidneys (author's transl)].

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Cysts↗

PubMedDate not supplied

Multiple primary malignant tumors in patients with hepatocellular carcinoma. A review of 29 patients.

BACKGROUND: The study of patients with hepatocellular carcinoma (HCC) and multiple primary malignant tumors (MPMTs) is interesting from an etiopathogenetic as well as from a clinical point of view. There are few studies dealing with this topic. METHODS: Smoking habits, alcohol intake, HBsAg status, alpha-feto-protein serum concentration, presence of liver cirrhosis, type of associated cancers, treatment, and survival were evaluated in 29 patients (25 men and 4 women; median age 73 years) with histologically confirmed HCC and MPMTs. All patients were examined between January 1980 and February 1995 at the General Hospital of Monfalcone, in northeastern Italy. In the same period there were 143 patients with HCC. RESULTS: Tumors associated with HCC were located in: prostate (9 cases), colon-rectum (5), bladder (3), lung (3), stomach (2), gallbladder (2), and brain, breast, oesophagus, pancreas, thyroid, larynx, pleura, small intestine, kidney (1 each). In 25 patients there was a single, and in 4 patients two associated malignancies. A diagnosis in vita of the associated malignancy was made in 15 cases. Cirrhosis was present in 90% of patients and HBsAg was positive in 15%. Mean survival time from diagnosis was 5.5 weeks (0-150) in patients with MPMTs and 6.8 weeks (0-221) in patients with HCC only. The cause of death was HCC in 18 patients, the associated tumor in 8, and non-neoplastic diseases in 2. Treatment of the associated tumors was performed in 8 cases. CONCLUSIONS: In this study the prevalence of MPMTs in patients with HCC is high (20.3%) in accordance with other autopsy series. Mean survival time in patients with MPMTs was similar to that in patients with HCC only. From a clinical point of view, attention must be paid to the diagnosis of hepatic lesions in patients affected with cirrhosis and extrahepatic cancer.

Aged↗

PubMedDate not supplied

[A case of traditional appendectomy changed to laparoscopic surgery].

The utility of appendectomy performed with laparoscopic procedure is at the present accepted by many surgeons, especially when there is uncertain diagnosis of appendicitis or when an ectopic position is suspected. The authors describe the case report of a 17 years old woman with a diagnosis of subacute appendicitis, in which the unsuccessful finding of the appendix made necessary conversion of traditional laparotomy approach to laparoscopic technique. This choice avoided the execution of an enlargement of laparotomy access, and allowed an easy finding of appendix. Aesthetic results at a distance are very satisfying.

Adolescent↗

PubMedDate not supplied

[Non-Hodgkin's lymphoma with perianal localization in patients with acquired immunodeficiency syndrome: a case report].

Non-Hodgkin lymphoma (NHL) in a human immunodeficiency virus (HIV)-infected person is an AIDS-defining condition. The clinical presentation of this neoplasm is characterized by frequent involvement of extranodal sites, and it is primarily of intermediate or high grade B-cell origin, with poor prognosis for aggressive nature of the malignancy with and early recurrence. Perianal localization of the NHL imposes a differential diagnosis with anorectal suppurative disease including abscesses, fissures or fistulae. The modern techniques of imaging (TC scan and MNR) and fine needle biopsy are very useful for diagnostic accuracy. Surgical therapy is frequently useful only for obstructive complications on urinary or gastro-intestinal tract, and the medical treatment with chemotherapeutic drugs remains the best therapeutic choice, even if the same chemotherapy can make prognosis worse for the additional immunosuppressive effects of drugs with possible onset of opportunistic infections. The authors describe a case of NHL in HIV-infected man showing how the simile-abscess findings of the neoplasm in the perianal localization can determine a delay in the final diagnosis, obtained with fine-needle biopsy and histological and immunocytochemical examination, treated with temporary percutaneous nephrostomy and standard chemotherapy regimen.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

[Familial adenomatous polyposis. Problems encountered with rectum preservation in surgical treatment and life expectancy].

Familial adenomatous polyposis is a genetically inherited disease with very high risk of colorectal cancer and with a large expression of multiple extracolonic malignancies. In recent years two surgical options are available for the treatment of FAP: total colectomy with ileorectal anastomosis and restorative proctocolectomy with ileoanal reservoir. The preservation of the rectum offers good quality of life and good functional results, but needs an accurate surveillance of the rectal stump and screening for the development of cancer. Restorative proctocolectomy is reserved for patients with large or confluent polyps of the rectum, for older patients and for those who had already had an ileorectal anastomosis and who develops subsequently large adenomas at increased risk for rectal cancer. Prophylactic procedures of surveillance, screening and surgery have reduced in patients at risk the incidence of colorectal cancer. But recently an increased number of malignant extracolonic tumors (gastric cancer, duodenal and periampullary cancer, small intestinal cancer, adrenal and thyroid cancer) and abdominal desmoid tumors, that causes a significant mortality, has been documented. The knowledge of the extracolonic features of FAP suggests a careful follow-up of the patients and the prevention and treatment of upper gastrointestinal cancers and desmoid disease.

Adenomatous Polyposis Coli↗