Search

Highlights • The incidence of periprosthetic hip infections his just below 2%, and the Enterobacteriaceae are fairly rare, being the cause of infection in 3–6% of cases. • A 76 year old woman with multiple comorbidities underwent surgical implantation of endoprosthesis of the left hip. • Multidisciplinary diagnosis of a rare periprosthetic infection., Introduction The Enterobacter cloacae is a microorganism found in the intestinal flora of the majority of animals, including humans. Primary infections caused by E. cloacae are rare in immunocompetent patients, but are very common in hospital settings in newborns and immunocompromised patients, and can be aggravated by the insurgence of antibiotic resistance. The incidence of periprosthetic hip infections is just below 2%. Case presentation A 76 year old woman with multiple comorbidities underwent surgical implantation of intermediary total hip prosthesis of the left hip, in a different health facility, in February 2014, after the basicervical fracture of the upper femur extremity due to trauma. After an episode of dislocation of the prosthetic implant, in September 2014, she underwent a surgical operation to implant the acetabular component. A month later not in our facility, following a re-hospitalization for the dislocation of the arthroprosthesis, an infection from E. cloacae complex was discovered. After 2 years of chronic infection she came to our attention; the clinical picture featured coxalgia and secreting fistula in the surgical wound. Following a specific antibiotic therapy, carried out intravenously over the course of a month, we decided to intervene removing the left hip arthroprosthesis and placing an antibiotic spacer following the direction deduced from the antibiogram study of August 2016. Conclusion The patient was hospitalized in our facility and 2 months later she underwent another operation to remove the antibiotic spacer and to place a new total hip arthroprosthesis. Multiple swabs showed the complete healing from the infection, which was confirmed a couple of months later.

Purpose of investigation to assess the radiological findings of women undergoing hysterosalpingography (HSG) as initial infertility investigation protocol. Materials and methods A retrospective study on infertile women who underwent HSG at Institute of Radiology of Sassari University, Italy. Results The present case series included 2,845 HSG, performed from January 1997 to March 2014. The age of the patients ranged from 20 to 48 years. The negative exams (tubal patency) were 2,039 out of 2,845 (71.67%). Conclusion A technique of diagnostic imaging for the evaluation of infertility should be non-invasive, not expensive, rapid, of simple execution, and also be able to provide information on tubal patency and pelvic diseases. For these reasons, HSG today remains a useful diagnostic investigation tool in the diagnostic work-up of infertile patients.

Lumbar interbody fusion is a valid technique for the treatment of disc diseases. We report a series of 37 patients who underwent posterior lumbar interbody fusion with titanium cylindric screwing-expansion cages. Clinical outcomes and radiological results were evaluated 3 years after surgery. After surgery, the majority of patients returned to their normal activities. Follow-up plain roentgenograms showed no loss of disc height and no signs of implant looseness. Computed tomography (CT) showed the presence of mineralized autologous bone grafts inside the interbody cages. Expandable interbody cages allow the restoration of disc space height, giving support to the anterior column, opening the neuroforaminal area and providing increased stability. The interpretation of fusion on the basis of roentgenograms is difficult; CT offers more information than radiography about the fusion process, but a bony arthrodesis cannot be demonstrated with certainty.

The aim of this case report was to evaluate the usefulness of combined biliary and duodenal stenting in the palliation of pancreatic cancer. We report a series of 4 consecutive patients (2 men and 2 women, mean age 58.5 years, range 38-77 years) who underwent combined biliary and duodenal stenting in our department between March 2000 and April 2001. All patients had cancer of the head of the pancreas causing stricture of the common bile duct and second portion of the duodenum. Biliary and duodenal stents were successfully positioned, with relief of symptoms in all cases. No early complications were observed, except for a transient increase in serum lipase and amylase in one case. Mean follow-up was 7.5 months (range 5-14 months). One patient presenting recurrence of vomiting after 4 months because of tumour overgrowth at the distal edge of the prosthesis was successfully treated by insertion of a partially overlapping second coaxial stent. Combined biliary and duodenal stenting for the palliation of pancreatic cancer was performed safely and successfully. Stents allowed effective re-canalization of the biliary tract and duodenum, relieving both jaundice and vomiting. This procedure should be considered as an alternative to palliative surgery, especially in critically ill patients.

Purpose: To assess the usefulness of stereotactic vacuum-assisted core breast biopsy (VCBB) performed using a stereotactic add-on device and film-screen technology with the patient in an upright seated position. Material and Methods: We reviewed a series of 129 women with non-palpable mammographic abnormalities who required stereotactic VCBB from December 1999 to November 2000. Twenty-seven (20.9%) cases were excluded due to difficulties in keeping the correct position during the procedure, while the other 102 (79.1%) underwent successful VCBB. Patients with lesions consisting of either atypical ductal hyperplasia or lobular carcinoma in situ were considered for excisional biopsy. Patients with either ductal carcinoma in situ or infiltrating breast cancer were referred for definitive surgery. The results of stereotactic VCBB were correlated to the subsequent surgical histology. Results: Stereotactic VCBB was interrupted because of bleeding in 1 case and vasovagal reaction in 5 cases. Two haematom...

Objectives To assess the diagnostic accuracy of ultrasound-guided mammotome vacuum biopsy in impalpable breast lesions. Methods Seventy-three patients who presented with impalpable breast lesions that were suspicious for malignancy at mammography and/or sonography were included in the study. In the first instance the women underwent ultrasound-guided fine-needle aspiration cytology, then, 3 days later, histological biopsy with an ultrasound-guided mammotome device. The patients with both cytological and histological diagnoses of malignancy underwent surgery; those with a negative (for malignancy) cytological diagnosis, but with a histological diagnosis of atypical hyperplasia or sclerosing adenosis, underwent surgical biopsy. Results The diagnostic accuracy of fine-needle aspiration cytology was 67.2%; the sensitivity was 86.7%, the specificity was 48.4%, the negative predictive value was 78.9% and the positive predictive value was 61.9%. In comparison, the diagnostic accuracy of histological sampling by mammotome vacuum biopsy was 97.3%; the sensitivity was 94.7%, the specificity was 100%, the negative predictive value was 94.6% and the positive predictive value was 100%. Thus there was a statistically significant difference in diagnostic accuracy between fine-needle aspiration cytology and mammotome vacuum biopsy (67.2% vs. 97.3%; χ2 test, P < 0.001). The 2.7% (2/73) failure rate of mammotome biopsy was likely to be due to an error in the positioning of the needle. The subsequent surgical biopsy proved that two cases, negative for malignancy by mammotome biopsy, were in fact malignant. Conclusions Our data confirm the value of sonography for the diagnosis of breast carcinoma in the preclinical phase and the efficacy of ultrasound sampling using a mammotome device to confirm the diagnosis in impalpable breast lesions. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology

Primary malignant tumors of the breast are the most frequently occurring neoplasms in women whereas breast metastases are rare. We report the first case, in literature, of metastasis within the breast resulting from a previous cecum carcinoma. We discuss the case and review the literature.

A wide range of surgical procedures are performed for either benign and malignant esophageal lesions, that may be classified as demolitive or conservative interventions. The former is characterized by resection and replacement of the esophagus with another organ, whereas conservative surgery is obtained preserving esophageal function without resection. Knowledge of surgical techniques and major complications is extremely important for a correctly performed radiographic study and a proper interpretation of the imaging findings. Functional evaluation of the operated alimentary tract and early detection of postoperative complications are essential for a successful recovery of esophageal surgery patients. We provide a brief overview of the main esophageal surgical procedures, reporting our experience on postoperative imaging of 104 patients submitted to surgery for either benign or malignant esophageal disease during a 6-year period.

The authors illustrate the technique for small-bowel imaging using enteroclysis with multidetector-row computed tomography (MDCT), underscoring the important role played by CT in the assessment of the small bowel thanks to the advent of first the spiral and later the multidetector technique. The paper makes a detailed comparison of the various methods that have been used in CT study of the small bowel and proposes a standardised technique to achieve correct distension of bowel loops and adequate evaluation of bowel wall vascularity, making reference to the well-consolidated experiences of the various Italian research groups. The paper accurately describes the different procedures required for CT assessment of the small bowel, from nasojejunal intubation to the selection of the most appropriate acquisition phases for assessment of bowel wall vascularity.