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The authors face the problem of accuracy, specificity and sensitivity of double-contrast arthrography in meniscal injury of the knee. They report the results obtained in a clinical-statistic and retrospective investigation on 206 patients. The final diagnoses were obtained by arthrotomy (105 cases) by arthroscopy (70 cases) and clinically with a follow-up of 6 months (31 patients). Diagnostic accuracy (94,5%), sensibility (92%), specificity (98,7%) and predictive values on positives (99%) and negatives (87,5%), confirm double-contrast arthrography as a highly accurate examination. A specific diagnosis can be made only when the diagnostic modalities are correctly applied and the arthrographers are qualified.

The authors report a case of shunt-nephritis due to bacteremia from Stafilococcus albus. Kidney biopsy, comprehensive of IF study allowed to assess the diagnosis of a disease from immunocomplexes. The Authors stress the importance of a close follow-up of patients who carry liquoral shunt for an early recognition of symptoms of glomerulopathy.

Personal experience of the intra-operative use of oesophageal manometry in cases of hiatus hernia is presented. Using this system the pressure in the air cushion surrounding the L.E.S. can be adjusted to avoid any complications due to overtight or overlax surgery. Various types of post-operative tests confirm the value of the technique.

The diagnosis of a popliteal cyst is usually made on the basis of a history of discomfort and pain in the medial portion of the popliteal region, together with the finding of a palpable mass in the popliteal fossa. The clinical diagnosis can be confirmed by knee arthrography, if the cyst communicates with the knee joint; in recent years, however, noninvasive US has also become an important diagnostic aid to the radiologist. The S. Anna Hospital (Ferrara) experience is here reported in the diagnosis of symptomatic popliteal cysts, with no valve mechanism at the connection with the joint cavity. Arthrography was performed on 438 patients with popliteal cysts to determine their extent and size in relation to the symptoms and to the presence of underlying knee pathology; only 76 patients from this group were then submitted to surgery. The authors confirm that popliteal cyst is a frequent occasional finding during knee arthrography which almost completely lacks any clinical relevance in most cases. Moreover, taking arthrographic findings as a starting point, the authors describe the different anatomotopographic patterns of popliteal cysts.

1. The expected number of patients with Cooley anemia in Naples, as predicted from heterozygote frequencies, is about 300 which is more than that found from hospital statistics. 2. Considering the presence of at least two beta-thalassemic alleles and the coexistence of a significant incidence of the Lepore gene in the population of the area surrounding Naples (the maximum incidence is thought to be in the neighboring province of Caserta), there are at least 6 different genotypes (3 true homozygotes and 3 genetic compounds) that can give rise to clinically important thalassemia syndromes, ranging from thalassemia intermedia to classic Cooley anemia. 3. Since an alpha-thalassemic gene is also present at polymorphic frequency in this population, this gene may coexist by random assortment in subjects who also have a beta-thalassemia syndrome, thus accounting for part of the variability of globin gene expression. 4. It is remarkable that 2 brothers homozygous for Hb Lepore present differences in the non-alpha/alpha ratio. The clinical differences could be explained by the gamma/alpha mRNA ratio close to 1 in one of them.

The authors performed a statistical study on a series of 1000 patients examined with double-contrast fluoroscopically-guided knee arthrography. Arthrographic diagnoses were compared with the arthrotomic (500 patients), arthroscopic (350 patients) or clinical diagnoses of 150 patients with a follow-up of 6 months. In this series of patients with a history of "recurrent meniscal injury", arthrographic diagnoses were confirmed in a high percentage of cases, with 96.9% accuracy, 96.7% sensitivity for tears, and 98.6% specificity. On the basis of these results the authors suggest double-contrast arthrography as an examination of considerable value in the diagnosis of meniscal lesions, while in their opinion arthroscopy should be limited to questionable cases, to complex lesions with involvement of multiple articular structure and to the alterations clearly treatable by arthroscopy.