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Overall, lymphomas of the gastrointestinal tract are rare, although they are the most frequent extranodal location. The incidence of primary colic lymphoma, above all in the non-Hodgkin variant, is clearly higher in the HIV positive population, especially in subjects with AIDS. The authors present the case of a 51-year-old patient with AIDS undergoing antiviral therapy; he was suffering from abdominal pain and presented a palpable mass in the right iliac fossa; diagnosis was caecal non-Hodgkin lymphoma (NHL); radical right hemicolectomy was carried out with definitive histological diagnosis of Burkitt-type small cell NHL. The NHL of the colon represents no more than 1.2% of all malignant cancers of this part of the intestinal tract. Nevertheless such cases are comparatively frequent in patients with HIV virus, especially in the active phase and clinically proven to be due to immunodeficient syndrome. Of cardinal importance is the differential diagnosis between primary and secondary forms because of the different treatment and prognosis. Frequently such forms are observed in patients with AIDS, at advanced stages and with differentiated and hence more aggressive histotypes, also because they are present in organisms weakened by the underlying disease and by immunodeficiency. Primary NHLs of the colon are relatively frequent and aggressive in patients with AIDS; early diagnosis and treatment are therefore of fundamental importance to improve the oncological outcome for these patients.

Retroperitoneal great vessel injuries are a rare but dramatic complication of any minimally invasive procedure. We report a case of laceration of the anterior aspect of the inferior vena cava following insertion of the Verress needle during a laparoscopic cholecystectomy. A 32-year-old man was operated on for acute cholecystitis. During the insertion of the Verress needle, a laceration of the anterior aspect of the inferior vena cava occurred. Immediate conversion and suture of the vessel were performed. The patient did well and was discharged after 24 days because of postoperative pancreatitis, managed with medical therapy. Major vascular injuries during laparoscopic procedures are rare but catastrophic complications which may endanger the patient's life. Over 75% of these lesions occur during insertion of the Verress needle or the Hasson trocar. Prompt diagnosis and immediate conversion are mandatory for correct management of these injuries so as to minimise morbidity and mortality.

Purpose: Magnetic resonance diffusion-weighted imaging (MR-DWI) is useful to assess proton motion by the computation of an apparent diffusion coefficient (ADC). This property could be used to assess renal damage, with special regard to unilateral dysfunction. The aim of this study was to estimate the correlation between ADC and the stage of chronic renal failure (CRF) using a spin-echo echo-planar imaging (SE-EPI) sequence with the sensitivity encoding (SENSE) technique., Materials and Methods: Fourteen patients (nine men and five women, mean age 49 years, range 22-66 years) underwent an MR examination on a 1.5-T system. Seven patients had a history of hypertension or CRF, one had Takayasu disease and one had nephrovascular hypertension. Five subjects without known kidney disease were used as controls. The glomerular filtration rate (GFR) assessed by Cockcroft-Gault's equation was used as a functional marker. The imaging protocol consisted of T1- and T2-weighted sequences followed by a SE-EPI acquisition with a diffusion gradient of 600 s/mm(2) and SENSE factor 2 and pixel-by-pixel ADC map reconstruction. In five patients, the SE-EPI-DWI sequence was repeated after i.v. administration of 1 mg of furosemide., Results: ADC was of 2.44+/-0.24 x 10(-3) mm(2)/s in patients with normal GFR and of 2.05+/-0.33 x 10(-3) mm(2)/s (p<0.05) in subjects with altered GFR; a significant difference was found between stage III and IV (p<0.01), whereas no differences were found between stage I and II (p=0.27) and between stage II and III (p=0.39). A good correlation was found between GFR and ADC (r=0.79; p<0.01), with no significant change after furosemide administration (p=0.7)., Conclusions: DWI is a feasible MR technique for assessing renal damage. Further studies with scintigraphic correlation are needed to confirm these results and to establish reference values for this imaging technique.

Purpose: The purpose of this study was to test the reproducibility of the three-dimensional (3D) Advanced Lung Analysis software (3D-ALA, GE Healthcare) in the estimation of pulmonary nodule volume., Materials and Methods: We retrospectively reviewed the unenhanced multislice CT scans (Lightspeed Pro 16 GE) of 77 patients with a solitary pulmonary nodule (n=71) or metastatic pulmonary disease (n=6). A total of 103 pulmonary nodules (19 well-circumscribed, 45 juxtavascular and 39 juxtapleural) were analysed grouped into five classes based on diameter: <5 mm, 10 nodules (9.7%); >or=5 to <10 mm, 25 nodules (24.2%); >or=10 mm to <15 mm, 41 nodules (39.8%); >or=5 to <18 mm, 14 nodules (13.6% ); >or=8 to <30 mm, 13 nodules (12.62%). The following acquisition parameters were used: slice thickness 0.625 mm, reconstruction interval 0.4 mm, pitch 0.562:1, 140 kV, 300 mAs, field of view 13 cm, bone kernel. For each of the 103 nodules three, 3D volume measurements were obtained by the 3D-ALA software. The reproducibility of nodule segmentation was evaluated according to a visual score (1=optimal, >or=95%; 2=fair, 90-95%; 3=poor, 0.05)., Conclusions: Three-dimensional volume measurement with ALARiassunto 1 software is reproducible for all nodules as regards dimension and site. ALA-1 software provided a good and reproducible volume measurement in well-circumscribed and most juxtavascular nodules. Volumetric evaluation and reproducibility of volume estimation in juxtapleural pulmonary nodules, particularly those adjacent to diaphragmatic pleura, is inadequate, and software improvement is needed.

This study aims at measuring association between environmental exposure to PAHs and internal or biologically effective dose biomarkers among 212 individuals living at different distance from the industrial area of Taranto, Italy. Environmental PAH exposure was determined by area monitoring. PAH levels was measured by HPLC UV/FL. Urinary 1-hydroxypyrene levels were measured by HPLC/Fluorescence. The levels of DNA adducts were determined by 32P. post-labelling. A questionnaire was administered to gather personal data, residence, occupational history, alcohol, tobacco smoke, and diet, to control for other sources of exposure to PAH. Blood and urinary samples, drawn from the subjects studied were collected and analysed. A multivariate regression model was used to investigate the influence of several confounding factors. Housing was placed within 1 km from smokestacks in Taranto and Statte, whereas they were more far away in Locorotondo and in Alberobello. The prevalence of current smokers was 31.6%.

Background: Aim of this study is to verify whether tonus neurophysiological and communicative-relational aspects in hypotonic subjects can be recovered by psychomotor therapy., Methods: This case series includes two randomized groups of children with central hypotonia observed at the Department of Child Neuropsychiatry of the Gaslini Institute of Genova from February 1992 to December 1996. The 1st group includes 6 subjects treated in a local rehabilitation service only by kinesitherapy. The 2nd group includes 6 children undergoing psychomotor treatment in our Department, where all the 12 cases underwent periodical controls., Results: Tonus physiological aspects equally improved in the two groups, whereas the improvement of the communication aspect was more marked in the second., Conclusions: The conclusion is drawn that psychomotor therapy seems more appropriate for a global recovery of the hypotonic child.

Background: Rehabilitation techniques have always attached great importance to the recovery of hand functions in the different forms of child cerebral palsy. The human hand has complex structure and functions, and it can be defined as "instrument-hand", "expression-hand", "relation-hand" and "constant challenge to rehabilitation programmes. Among the most common techniques used today, neuromuscular facilitation allows the recovery only of the instrumental function, and cortical facilitation allows only the awareness of the motor learning. The psychomotor approach is aimed at a global recovery of the gesture, i.e. at the restoration of the movement neurophysiologic, relational and interactive aspects. Aim of this paper is to evaluate the possibility of restoring the hand communicative function in children with paresis., Methods: Ten patients (6 males and 4 females; age range 20 months-8 years) with hemiparesis not associated with other disorders undergoing psychomotor therapy were compared with 10 controls (5 males and 5 females) undergoing traditional therapy (generally following Bobath)., Results: The communicative function of the hemiparetic hand was restored in 8 patients compared to 2 patients in the control group., Conclusions: Even though our series includes few cases and it is not possible to draw any definitive conclusion, it is reasonable to hypothesize that the psychomotor approach is a therapeutic model able to restore the hand complex functions.

The authors in this study, after a short survey of the most important therapeutic techniques for cancer pain, report their results in the treatment of 18 patients suffering from incurable disease. It was impossible to dismiss them from hospital care on account of a painful symptomatology not controllable by oral morphine or owing to excessive collateral morphinic consequences. The analgetic technique employed was continuous intrathecal infusion of morphine, clonidine, droperidol and, in 10 cases, bupivacaine. Drug delivery systems, totally internalized, except infusion pump, were always utilized. Adequate pain relief was obtained, within - 5 days, in all the patients. Family membres, in the same period, learnt the infusion circuit action. At this point the patients were dismissed and treated with home care. The average time of assistance was 140 days, and very moderate variations in posology were necessary. Hospital reentrance, really little numerous, happened only when no member of palliative care service was present. Reasons were no bodily pain, but the total suffering of cancer disease. No complication nor collateral consequences were never found.

In this study we took into consideration the neuroendocrine alterations caused by surgical stress, studying the cortisol and prolactin's course in plasma, during the period between preanesthesia and the morning after operation. Our research was particularly interested in identifying the influence of anxiety, pain and drugs. At this purpose, twenty-four patients (ASA 1-2) submitted to abdominal surgery, were subdivided in to two groups of twelve members each. In the first (group G) a general inhalising anesthesia with analgesic component was performed; in the second (group B) a selective peridural anesthesia associated with slight general anesthesia, the so-called blended anesthesia. The interpretation of the results showed an action particularly on prolactin, and of pain on cortisol. Thus, a proper use of anesthetic drugs, even if some of them have sure stimulating properties, is useful to reduce the hormonal response. Therefore as good is the control of anxiety and pain, so good is the hormonal metabolic reaction to surgical stress. If the measures to reduce anxiety are limited to a suitable preanesthesia (possibly combined with psychological preparation), on pain, on the contrary, it is possible to act with suitable technology, first of all by locoregional anesthesia. It is, however, important to underline that the best therapy of pain is its prevention.

The author reports a patient, treated with tranylcipromine as antidepressant (a MAO inhibitor), who underwent an operation for abdominal aortic aneurysm. The antidepressant was stopped five days only, for neurological problems. The anesthesia was a combination among general anesthesia (Diprivan and Tracrium), epidural anaesthesia (lidocaine and clonidine) and electro-acupuncture. The cardio-circulatory, ventilatory and metabolic parameters were very stable both in the perioperative and in the postoperative period.