INTRODUCTION:Adrenal cysts are usually asymptomatic; they are usually identified occasionally during ultrasound or C.T. scans (incidentaloma). Among adrenal cysts the most common types are epithelial cysts and pseudocysts. Intracystic haemorrhage is one of the possible complications of adrenal pseudocysts.CASE REPORT:We report a case of a young woman with right superior abdominal pain, fever and acute anemia. A C.T. scan showed a 10 cm. mass between the liver and the right kidney. To be sure of the nature of this mass also M.R., urography and C.T.-guided biopsy were carried out. This latter only let us make the final diagnosis of hemorrhagic adrenal pseudocyst. Thereafter, a laparotomic right adrenalectomy was performed, with full recovery of the patient.DISCUSSION:Adrenal cysts may cause differential diagnostic problems with masses of contiguous organs like kidney, liver and gallbladder. For this reason, ultrasound and C.T. scans may not be sufficient and must be completed by M.R., urography and/or C.T.-guided biopsy. Intracystic hamorrhage, spontaneous or post-traumatic, may cause to the patient acute anemia which, as soon as the diagnosis is confirmed, indicates surgery. The operation usually is a laparotomic adrenalectomy, since the laparoscopic approach is not sufficient to control large masses with active bleeding inside.

Despite advances in diagnosis, surgical treatment, antimicrobial therapy and intensive care support, severe secondary peritonitis remains a potentially fatal affliction. The purpose of this study is to present our experience of postoperative mortality in 255 patients with secondary acute peritonitis between 1998 to 2002. The Mannhein Peritonitis Index score (MPI) was calculated for each patient to predict the peritonitis related in-hospital death. Both literature reviews and our results show a strong correlation between some etiopathogenetic elements (age, origin of sepsis, organ failure, ...) and prognosis. Our patients were classified in three groups according to MPI, one with a score less than 21, another with a score between 21 and 29 and the third one with a score greater than 29. There was no mortality in the first group and there was significantly less mortality in the second group than the third one (P<0.001). While prognosis is influenced by many factors, the intervention time was the same, greater than 24 hours, for all the patients regardless of MPI score. This study suggests that intervention time may be considered the main determinant of mortality in patients with peritonitis. This observation is especially relevant since intervention time is a modifiable prognostic factor whilst many other factors are not.

Aim of this study was to compare, taking into consideration data from the literature, the various diagnostic examinations and therapeutic modalities nowadays available to manage patients affected by pancreatic pseudocysts. Personal experience regarding three patients with post-necrotic pancreatic pseudocysts is reported; these patients complained of epigastric pain with nausea and tenderness in the upper abdominal quadrants. Diagnosis was made by CT. In one case a progressive decrease of the pseudocyst was observed; the second patient was treated by a pseudocyst-jejunostomy; the last patient initially underwent a trans-gastric percutaneous drainage for infection of the pseudocyst and afterwards an open pseudocyst-gastrostomy. All patients were cured, even if the second patient during the postoperative course developed a pleuric effusion, which was treated by thoracentesis. Pancreatic pseudocysts in 20% of cases resolve spontaneously, as observed in one of our patients. In other cases, a surgical operation is needed, now feasible through an endoscopic, percutaneous, laparotomic or laparoscopic approach. The endoscopic and percutaneous approach are indicated only in selected cases, so that the "gold standard" treatment is still the laparotomic one, especially by a pseudocyst-jejunostomy, which also in our experience has given the best result. Very promising also, according to the latest data from the literature, seems the laparoscopic approach, by which a wide communication between the stomach and the pseudocyst is obtained.

A valid program of follow-up has always been a crucial point in the overall therapy of the colon-cancer. In this retrospective study, the authors have used as specimen 74 patients put under observation between the years 1987 and 1992. The patient have been followed throughout the diagnostic period with various methods. It has been the will of the authors, who have presented their protocol of reference, to put under comparison the various controlling methods in order to visualize their reliability, specificity and the indication of each one of them. The CEA is the most sensible haemanalysis for lifting the doubt of recidivation. As for the TAC and ultrasound it has been reserved the job of formulating a correct diagnosis; the results of both diagnostics through imagery have been more or less the same. However, the ultrasound examination have shown more false positives than the TAC. The research of the blood occult in the stool is a rapid and economic detection in the case of intramural recidivations, even if we cannot disregard the share of false positives. A high specificity for the study of intramural recidivations has been offered by the endoscopic scan particularly when associated by a brushing and biopsy.

HistopathologyVolume 28, Issue 4 p. 369-371 Localized primary amyloidosis of axillary lymph nodes S. Lanzafame, S. Lanzafame Institute of Pathological Anatomy, University of Catania,, Search for more papers by this authorG. Magro, G. Magro Institute of Pathological Anatomy, University of Catania,, Search for more papers by this authorN. Buffone, N. Buffone Department of Emergency Surgery, University of Catania, ItalySearch for more papers by this authorC. Emmanuele, C. Emmanuele Institute of Pathological Anatomy, University of Catania,, Search for more papers by this authorE. Cirino, E. Cirino Department of Emergency Surgery, University of Catania, ItalySearch for more papers by this author S. Lanzafame, S. Lanzafame Institute of Pathological Anatomy, University of Catania,, Search for more papers by this authorG. Magro, G. Magro Institute of Pathological Anatomy, University of Catania,, Search for more papers by this authorN. Buffone, N. Buffone Department of Emergency Surgery, University of Catania, ItalySearch for more papers by this authorC. Emmanuele, C. Emmanuele Institute of Pathological Anatomy, University of Catania,, Search for more papers by this authorE. Cirino, E. Cirino Department of Emergency Surgery, University of Catania, ItalySearch for more papers by this author First published: April 1996 https://doi.org/10.1046/j.1365-2559.1996.d01-445.xCitations: 6 Professor S. Lanzafame Istituto di Anatomia Patologica, Università di Catania, Via Biblioteca 4, 95124 Catania, Italy. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume28, Issue4April 1996Pages 369-371 RelatedInformation

The observation of a case of intestinal intussusception caused by lipoma of the colon prompted the authors to review the literature on the subject and to examine the main characteristics of lipoma of the colon which represent the most frequent benign neoplasia of the large intestine after adenomatous polyps. Lipomas of the colon are localised in 90% of cases at the submucous level, are usually solitary, of varying size and may be sessile or pedunculated. They are almost always asymptomatic; only when they are of a reasonable size do they become manifest following alterations of the alveus, rectorrhagia, abdominal pain or the occupation of the colic lumen by the mass, or intestinal intussusception caused by the progression of the pedunculated lipoma. This difficult diagnosis may be aided by colonscopy with biopsy and dual contrast opaque enema. The prognosis of the disease depends on the presence or absence of complications and, in the case of the former, on early diagnosis and treatment. Lipoma of the colon of less than 2 cm may be electively removed endoscopically, those greater than 2 cm by laparotomy or laparoscopy. In emergency cases, it is advisable to perform a more or less extensive resection of the colon depending on the size of the tumour. In the case reported by the authors, an intussusception manouevre was first performed followed by left segmentary colectomy.

Two cases of rectal carcinoid tumors are reported. In the first case the endoscopic diagnosis was intramural rectal neoformation. At histology, rectal carcinoid tumor with infiltration of the muscularis mucosae was diagnosed. Abdominoperineal resection was performed. The patient is still living 3 years following surgery. In the second case, the endoscopic diagnosis was non-adenomatous polyp. Endoscopic polypectomy was performed. At histology, rectal carcinoid tumor was diagnosed. The patient is still living 2 years following surgery.

The sexual activity was studied in 28 males and 18 females, one year after abdominoperineal resection for low rectal carcinoma, using a questionnaire. Sexual desire, potentia coeundi and ejaculation, capacity for orgasm and sexual satisfaction in the male, and sexual desire, possibility of vaginal coitus, dyspareunia, orgasm capacity and sexual satisfaction in the female were analyzed. Among the female patients (18 cases), sexual desire was judged to be decreased in 77.77% (15 cases) and decreased capacity for orgasm occurred in 5.5% (1 case). Loss of sexual satisfaction and dyspareunia were present in 44.4% (8 cases) and 33.6% (6 cases) respectively. Among the male patients (28 cases), sexual desire decreased in 75% (21 cases), incomplete erection but sufficient for copulation occurred in 17.85% (5 cases), such as retrograde ejaculation in 10.71% (3 cases) and no ejaculation in 7.14% (2 cases) and impotentia coeundi in 25% (7 cases). In couples that reported a satisfying sexual activity, the first coitus occurred 6 months after surgery (range: 4 to 15 months). In no case was there separation of the couple after surgery.

A case of ampicillin-associated colitis is described. The authors stress the importance of emergency colonoscopy for the correct diagnosis and treatment of severe diarrhea and hemorrhage occurring during treatment with antibiotics.

The authors review several existing classifications of traumatic events affecting the peripheral blood vessels; after discussing the symptoms of such events and diagnostic guidelines, they outline therapeutic approaches and emphasize above all the need for prompt surgery with the least possible delay after the injury. They review of cases of their own observation, and conclude by highlighting the basic concepts of modern surgery in this field of pathology.

In the light of three cases of their own observation, of children with mesenteric cysts causing complete or incomplete intestinal obstruction, the authors review the existing literature on the subject, discuss the etiology, clinical aspects, and therapeutic methods for the correction of such pathology, and conclude by calling attention to mesenteric cysts as possible causes of intestinal transit disorders in the pediatric age group.

In consideration of the well-known difficulties associated with the precise diagnosis of hemoperitoneum, the authors offer their personal experience in support of laparoscopy as a diagnostic aid in such dramatic events. They review 23 cases of emergency laparoscopy performed in the First Institute of Clinical Surgery of the University of Catania between January 1978 and January 1979. Recalling that the procedure was applied to patients as young as 3 and as old as 80, they confirm the opinion expressed from other quarters, namely that laparoscopy is an essentially harmless and rapid procedure conducive to very accurate diagnosis in view of appropriate planning of therapeutic treatment.