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Introduction: FA.S. T (Focused Assessment with Sonography for Trauma) is an ultrasound investigation that can discover presence of peritoneal fluid. The availability of an investigation that can be used directly at the patient bed optimizes the Emergency Room Service. The learning curve is short and all doctors working in Emergency Room can use it., Aim of the Study: End point of the study was to evaluate the applicability of fast to our hospital, to study it's efficacy when compared to other investigations and to produce a flow chart for patients with abdominal trauma., Material and Methods: From July 2002 we evaluate 400 consecutive patients with medium - high grade abdominal trauma. After ATLS we investigate the patient with FAST Ultrasound. Patients with indication to immediate laparotomy (ATLS Flow Chart) where evaluated only with FAST and send to the operating theatre. All others patients follows the normal abdomial trauma flow chart as in use in our Emergency Room., Results: We performed 2 immediate laparotomy (0.5%) and 8 (2%) after the results of investigations. In group of immediately laparotomy FAST ultrasound confirmed the presence of haemoperitoneum (Sensibility and Specificity of 100%). In the other group (not immediately laparotomy) in 6 over 8 cases FAST Ultrasiound was in accord with other conventional radiological investigations (Sensibility 75%, Specificity 100%). In 2 over 8 patients only TC permitted to evidence intrabdominal damage not seen by FAST (MesoColon Haemathom and Gastric Rupture)., Conclusions: FAST ultrasound resulted an effective and reliable investigation to evidence abdominal fluid when compared with other radiological investigations. We hope this tipe of investigation will be adopted in all Emergency Room.

Acute appendicitis is a frequent abdominal pathology, more frequent in the childhood. The pathophysiology of acute appendicitis is obstruction of the appendix lumen and distension due to continued mucosal secretion. The second step is a rapid multiplication of resident bacteria, excretion of toxine and wall inflammation. Causes of this processes are different: in most of cases there is an hyperplasia of intrinsic lymphoid tissue (60%) or hard stool. Another cause may be foreign body. But is there a relationship between abdominal trauma and appendicitis?

Pneumocystis carinii is a common cause of interstitial pneumonitis in AIDS patients: it affects 85% of patients with cell-mediated immunodeficiencies. Extrapulmonary infection is much more infrequent and it is observed only in these patients who receive aerosolized pentamidine prophylaxis because of minimal systemic distribution of the drug. No case of extrapulmonary disease was observed in patients receiving systemic prophylaxis for Pneumocystis carinii with cotrimoxazole. The pathogenesis of extrapulmonary infection is not clear: it is probably connected with hematogenous or lymphatic dissemination from the lung. In a small number of case is due to reactivation of extrapulmonary foci or to a new infection. The management of disseminated infection of Pneumocystis carinii is medical: only recently a combination of medical and surgical approach was proposed for a patient with extrapulmonary infection. We report a case of 29 years old patient with AIDS with a demonstrated pulmonary and splenic localisation of pneumocystis carinii submitted to surgical splenectomy. The surgical decision was taken for several reasons: no response to medical therapy, the relative good general condition of the patient despite the immunological status, the presence of thrombocytopenia and abdominal pain in the left upper quadrant, and the risk of rupture of spleen. The post-operative course was eventful. We support splenectomy for splenic infection of Pneumocystis carinii in very small selected cases and only with palliative intent.

This paper evaluates the cellular immune system of 16 cadaver kidney transplant recipients more than three years after transplantation. The number and percent of active E rosette forming cells, of E rosette forming cells and of IgG and IgM bearing lymphocytes were determined; the blastogenic response of peripheral blood lymphocytes to PHA and PWM was studied in homologous and autologous serum. Significant alterations of the tests performed were found in patients who had undergone kidney transplant, suggesting a pathogenetic role of chronic immunosuppressive therapy but not excluding other possible factors.