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Thanks to its good long-term results, surgery is the method of choice to treat subcutaneous ruptures of the Achilles tendon. Reconstructed tendons present typical morphological and functional US patterns which depend partly on the kind of surgical reconstruction and partly on the time passed since surgery. The authors report the results of the clinical and US follow-up of a series of 62 surgical patients treated in 7 years for the subcutaneous rupture of the Achilles tendon. The patients were 55 men and 7 women, whose mean age was 36 years (range: 25-65 years). The left-hand side was affected in 38 patients and the right-hand side in 24 patients. All patients were operated on using an end-to-end suture and reinforcement plastic surgery pulling down a gastrocnemius tendon flap. To homogenize the results, all the US exams were performed by the same operator, in the presence of the orthopedic specialist and under the same conditions: both the involved and the contralateral Achilles tendons were studied, longitudinal and transverse scans were performed with the foot in max. plantar and dorsal flexion and, whenever possible, dynamic scans were also performed making the sural triceps contract against resistance. The following parameters were studied clinically: pain (which was absent in 39 patients, occasional in 11, after stress in 9 and on walking in 3 patients), skin scar trophism (which was eutrophic in 53.23% of patients, keloid in 27.42% and hypertrophic in 19.35% of patients), ankle joint excursion (plantar flexion was impaired in 32.3% and dorsal flexion in 36% of patients), walking on tiptoe (in all, 22.6% of patients complained of difficulties walking on tiptoe) and, finally, work activity resumption (which all patients achieved). US depicted the surgical tendons as much bigger than the contralateral ones (3-4 times on the average), which increase in volume lasted throughout the follow-up. In 75% of patients the echo structure of the surgical tendons was inhomogeneous, with scattered hypoechoic and hyperechoic areas. In the extant 25% of patients, nearly all of them followed-up for over 6 years, US depicted a clear-cut hyperechoic area whose size and echo structure were similar to the healthy tendons'. Our results strongly suggest that tenorrhaphy and flap plastic surgery be used to repair subcutaneous ruptures of the Achilles tendon. US proved to be the most reliable and feasible method also in the follow-up. The US images of the patients submitted to surgery more than 6 years earlier revealed fibrillate reorganization patterns and tendon restructuring. These processes involve both ends of the sutured tendon and not the reinforcement flap, which further confirms the exclusively mechanical, and not biological, function of the latter.

The choice between conservative and radical operation in case of femoral neck fractures is very important because it is the determining factor for a successful therapy. In case of epiphysial necrosis, an endoprosthesis as well as an osteosynthesis will be carried out. Selective arteriography of the medial circumflex artery represents the most reliable study to establish, immediately after the fracture, the possible presence of a post-traumatic ischemic necrosis. Angiography, as a reliable diagnostic tool, has to be carried out in the most selective way and needs the image subtraction technique. The authors report their preliminary results on the reliability of angiography in the femoral epiphyseal ischemic necrosis diagnosed by comparing the results of angiography with the Wood light test carried out on the surgically removed femoral head.

The authors report their experience in 40 patients with intestinal Crohn's disease, who underwent both abdominal ultrasound scanning and double-contrast small bowel enema. The various echographic patterns are described, found in the different phases during the evolution of Crohn's disease, underlying the importance of ultrasound in evaluating the real degree of bowel wall thickening and the exo-enteral space, only indirectly appreciated with X-ray examination.

In 75 patients ultrasound (US) demonstrated fatty infiltration of the liver with diffuse increased echogenicity except for a solitary hypoechogenic area located in the quadrate lobe. The liver was also followed-up with US, computed tomography (CT), radionuclide scintigraphy, and fine needle biopsy: a skip area unaffected by steatosis was thus demonstrated. This study and further information found in literature allowed the authors to identify the particular US features which lead to a correct interpretation of these findings, which might otherwise be incorrectly diagnosed as suggestive of substitutive lesions (primary or secondary). These features are: 1) the location of skip areas, usually in the IV segment, in close relationship to a portal vessel; 2) their morphology, triangular, or inverted-V shaped; 3) the absence of mass effects upon the hepatic border and/or upon the adjacent vessels; 4) the presence of fatty liver infiltration; 5) the coexistence of a biohumoral pattern significant for diffuse hepatopathy; 6) the lack of change in US patterns during the follow-up.

The authors describe the sonographic (US) patterns of hyperplastic cholecystoses observed from January 1983 to April 1987 - 39 cases of focal extension and 12 of segmental extension--and confirm the higher sensibility of US versus oral cholecystography. Sonography (SG) allows a straight visualization of the gallbladder wall and its lesions, both in case of limited thickening of the wall (focal cholecystosis) and in case of more extensive thickening (segmental cholecystosis). To cholecystographic findings of focal lesions, SG gives additional information, adding a fundamental diagnostic element: the lack of acoustic shadowing distal to the nodular masses. Nonetheless, SG does not allow a discrimination between focal cholesterolosis and adenomyomatosis, except for particular cases, such as multiple nodular masses, and coexistence with the "comet tail" pattern--the latter due to parietal deposits of cholesterol. Furthermore, the differential diagnosis of focal cholecystoses includes some neoplasms of the gallbladder, and gallstones stuck to the wall, with no acoustic shadowing. In segmental cholecystoses, the direct evaluation of the entity and extension of the wall thickening remains a fundamental diagnostic element, even though such a morphologic detail is often integrated by the functional relieve of hypercontractility of the gallbladder wall after a fatty meal (both oral cholecystography and SG demonstrate it).