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Background: The association between aortic valve stenosis (AVS) and myocardial perfusion abnormalities has been incompletely characterized. We sought to assess the predictors of myocardial ischemia in patients with mild-to-moderate AVS, and its relationship with long-term prognosis., Methods: Eighty-nine patients with mild-to-moderate AVS (peak velocity between 2.6 and 4.0 m/second and aortic valve area > .6 cm 2 /m 2 ), preserved left ventricular (LV) function, and either normal coronary arteries (28 patients) or non-obstructive coronary artery disease (<50% stenosis; 61 patients) were individuated. Myocardial perfusion imaging was performed using a cadmium-zinc-telluride camera, and the summed difference score (SDS) was computed. The presence of either LV hypertrophy (LVH) (LV mass index [LVMI] > 115 g/m 2 [males] or 95 g/m 2 [females]) or concentric LV remodeling (relative wall thickness: >.42) was determined at two-dimensional echocardiography., Results: Forty (45%) and 49 (55%) patients had mild and moderate AVS, respectively. Fifty (56%), 17 (19%), and 22 (25%) patients had normal LV geometry, concentric LV remodeling, and LVH, respectively. An interaction between LV remodeling and inducible ischemia was revealed with progressively higher values of SDS in patients with normal LV geometry (3 ± 3), concentric remodeling (4 ± 2), and LVH (7 ± 2) (P < .001). Accordingly, a moderate correlation existed between LVMI and SDS values (R: .67; P < .001). After a median follow-up of 84 ± 47 months, 27 adverse events were recorded, including 19 AV replacements and 8 deaths. On multivariable analysis, the presence of LVH (hazard ratio [HR]: 6.46; 95% confidence interval [CI]: 2.09-20.00; P = .001) and a higher SDS (HR: 1.41; 95% CI: 1.15-1.75; P = .001) were the two independent predictors of AE., Conclusions: In patients with mild-to-moderate AVS, myocardial ischemia correlates with the severity of adverse LV remodeling. Patients with LVH and ischemia are at increased risk of AE., (Copyright © 2024 American Society of Nuclear Cardiology. Published by Elsevier Inc. All rights reserved.)

Background: Sigmoid gallstone ileus is a rare complication of cholelithiasis, accounting for 1-4% of all cases of large-bowel obstruction. This is a highly morbid, and often fatal, condition due to its challenging diagnosis and late presentation., Case Presentation: We report a case of a 90-year-old woman admitted to Emergency Department with abdominal pain and large-bowel obstruction due to a 6 cm gallstone lodged in a diverticulum of the proximal sigmoid colon as a consequence of a cholecysto-colonic fistula. Colonoscopy was deferred due to gallstone size carrying a high possibility of failure. The patient underwent urgent laparotomy with gallstone removal via colotomy. The cholecystocolonic fistula was left untreated. The post-operative course was uneventful; the patient was discharged on 6th post-operative day., Conclusion: A multidisciplinary discussion between endoscopists and surgeons is often needed to choose the best therapeutic option, especially in high-risk patients., (© 2024. The Author(s).)

Background: The duodenal «diverticulization» is a surgical technique described by Berne and colleagues in 1968 for the treatment of combined duodenal pancreatic injuries. It consisted of closure of the duodenal injury by suture and tube duodenostomy, gastric antrectomy with end-to-side isoperistaltic Billroth II gastrojejunostomy, and abdominal drainage. As evidenced from the literature in few reports, this technique has also been adopted for lateral duodenal lacerations in non traumatic conditions. Most biliary disease may be responsible for duodenal injury., Case Presentation: Herein, we describe the application of this emergency technique for the treatment of a wide lateral duodenal laceration discovered intra-operatively during laparoscopic cholecystectomy for acute cholecystitis. A comprehensive critical review of the different surgical methods proposed for duodenal protection in case of severe duodenal lesions has been performed and discussed., Conclusion: Duodenal injuries represent a challenging condition, especially for surgeons with limited experience in this field. The key-message of this report is to consider emergency surgical techniques in difficult unexpected intra-operative situations which may occur during routine surgical practice., Key Words: Duodenal diverticulization, Duodenal fistula, Laparoscopic cholecystectomy, Surgical repair.

Purpose: To compare the outputs of a novel all-purpose SPECT camera equipped with CZT detectors (Discovery NM/CT 670) with the state-of-the-art represented by a dedicated CZT (Alcyone, Discovery 530c) cardiac camera in patients submitted to myocardial perfusion imaging (MPI)., Methods: We included 19 patients that underwent sequential low-dose 99m Tc-tetrofosmin (148-185 MBq during stress and 296-370 MBq at rest) MPI with Alcyone and Discovery 670 cameras. Quantitative (% tracer's uptake) and semi-quantitative analyses of perfusion data were performed for each scan. Moreover, major left ventricular (LV) functional and structural parameters were derived from each camera and compared., Results: The two cameras showed excellent correlation for segmental myocardial % uptake at stress (R = 0.90; P < 0.001) and at rest (R = 0.88; P < 0.001) with narrow Bland-Altman limits of agreement. The level of diagnostic agreement of Discovery 670 and Alcyone cameras regarding perfusion analysis was excellent (Cohen's κ 0.85). Similarly, the two cameras showed excellent correlation in the evaluation of LV ejection fraction (R = 0.95), peak filling rate (R = 0.97), and mass (R = 0.98)., Conclusions: Our preliminary results suggest that MPI with an all-purpose Discovery 670 CZT-SPECT camera is feasible, comparing well with the current state-of-the-art technology., (© 2019. American Society of Nuclear Cardiology.)

Background: Cadmium-zinc-telluride (CZT) SPECT allows the estimation of left ventricle myocardial volume (LVMV). We tested the clinical relevance of rest-stress LVMV changes (Δ LVMV) in detecting coronary artery disease (CAD, coronary stenosis > 70%), using CZT-SPECT., Methods: We prospectively enrolled 512 consecutive patients with known or suspected CAD (mean age: 70.3 ± 9.2 years, 72% male) for stress-rest myocardial perfusion imaging (MPI, single-day stress-rest protocol). We quantified summed stress scores (SSS), summed rest scores, and summed difference scores, together with LVMV and ejection fraction (EF) after stress and at rest. All patients underwent coronary angiography within 30 days., Results: Two hundred seventy-two patients had CAD at coronary angiography. ΔLVMV ≤ 5 mL, corresponding to 6% of change from rest LVMV, was the best predictor of CAD (AUC = 0.831, 79% sensitivity, 82% specificity), irrespective of the stress protocol (dipyridamole or exercise stress) and independently of MPI-SSS, LV EF, and clinical history (P = 0.004). Integrated discrimination improvement (IDI) and net reclassification improvement (NRI) were significant for the addition of ΔLVMV ≤ 5 mL (IDI = 6.1%, P < 0.0001; NRI = 29.7%, P = 0.02) to MPI-SSS, whereas the other parameters were not., Conclusions: The evaluation of ΔLVMV using CZT-SPECT can improve the diagnostic accuracy in predicting the presence of CAD when added to conventional MPI., (© 2019. American Society of Nuclear Cardiology.)

Background: Pulmonary arterial hypertension (PAH) is characterized by the right ventricle (RV) remodeling and pulmonary endothelial dysfunction. We studied cardiac perfusion and innervation in PAH with a cadmium-zinc-telluride (CZT) scanner and lung uptake impairment of 123 I-metaiodobenzylguanidine ( 123 I-MIBG)., Methods: In 13 patients with newly diagnosed PAH and 11 dilated cardiomyopathies (DCM, for comparative purposes), we assessed early and delayed 123 I-MIBG uptake ratios of lung-to-mediastinum (L/M) and heart-to-mediastinum (H/M) on anterior planar images. A quantitative myocardial innervation with 123 I-MIBG and perfusion with 99m Tc-tetrofosmin using CZT-SPECT was performed. All patients underwent right heart catheterization., Results: Early and delayed L/M ratios in PAH were lower than DCM (1.47 ± 0.14 vs 1.98 ± 0.11 and 1.40 ± 0.13 vs 1.83 ± 0.09; P < .001), while early and delayed H/M were impaired but not different (1.73 ± 0.20 vs 1.65 ± 0.18 and 1.73 ± 0.27 vs 1.58 ± 0.19). RV perfusion and early innervation were significantly higher in PAH compared to DCM (68.4 ± 13.4 vs 28.6 ± 4.1 and 58.8 ± 9.3 vs 27 ± 2.2; P < .001); delayed RV innervation was not evaluable. RV/LV perfusion and innervation ratios were significantly related (R = 0.74; P < .0001) and had a significant correlation with clinical, hemodynamic, and morpho-functional parameters, including L/M ratios., Conclusion: Cardio-pulmonary scintigraphy through a perfusion and innervation study is feasible and may identify pulmonary vascular and RV remodeling, as in PAH.

Background: To evaluate the hospital stay, morbidity, and patients' compliance for short stay inguinal hernia repair., Methods: Retrospective analysis of 669 patients (594 men and 75 women) who underwent short stay inguinal hernia repair (706 inguinal and 45 femoral repairs) at the Institute of General Surgery, University of Ferrara. Mean age was 60.7 years (range, 18-84 years). The anesthesia was: loco-regional in 495 patients (74%) and general or epidural in 174 (26%)., Results: Mean hospital stay was 1.2 days. Postoperative complications were: three scrotal hematomas, two ischemic orchitis, three prosthetic infections, one local anesthetic intolerance, and three high fever. Eighty-five percent of patients were satisfied of the surgical procedure in short hospital stay. Mean follow-up was 36 months., Conclusions: Short hospital stay in inguinal hernia repair is safe, effective, and widely accepted by patients.

Objective: Evaluation of long saphenous vein sparing surgical procedures alternative to high ligation and distal stab avulsion, in terms of effectiveness and suitability for eventual by-pass surgery., Experimental Design: Prospective evaluation of 125 operations for primary varicose veins, 52 external valve-plasties of the sapheno-femoral junction (EV-SFJ) (42 performed using the hand sewing technique and 10 using the Veno-cuff device), mean follow-up 45 months, and 73 hemodynamic correction of varicose veins (French acronyms: CHIVA), mean follow-up 30 months., Setting: Department of General Surgery, University of Ferrara. Institutional practice, one-day surgery., Patients: Patients were selected using clinical, Doppler cw, and duplex scanning evaluations. Patients with early varices due to sapheno-femoral reflux with duplex scanning evidence of mobile valve leaflets underwent EV-SFJ. The other patients were operated on using the hemodynamic correction technique. Both groups underwent preoperative ambulatory venous pressure (AVP) and light reflection rheography-refilling time (LRR-RT) measurements., Interventions: EV-SFJ restores valve function correcting vein wall dilitation by applying an external prosthesis. CHIVA consists of selected ligatures of the superficial veins that allow superficial blood aspiration in the deep veins through the perforators., Measures: The outcome was evaluated with clinical and ultrasonographic examinations, AVP and LRR-RT measurements., Results: Long saphenous vein patency registered after EV-SFJ and CHIVA was 94.2% and 90.4%, respectively. Both treatments preserve the drainage function in the saphenous system. Varicose veins recurrence percentage rate was 9.6% and 10.9%, respectively., Conclusions: Following the proposed selection criteria, these two alternative procedures seem to be more effective in varices treatment than high ligation and have the advantage of preserving saphenous veins suitable for eventual by-pass surgery.

The AA. considered 58 pregnant women affected by asymptomatic bacteriuria of pregnancy and 20 pregnant women with sterile urine during the first trimester of pregnancy as control group. Despite a constant treatment suggested by antibiogram the incidence of infective relapses was high but no patients were affected by important infections as acute haemorrhagic cystitis and acute pyelonephritis. In control group only 15% of patients had an asymptomatic urinary infection. These patients received the same treatment of the first group. In AA. opinion, a constant and careful screening of asymptomatic urinary infections is necessary in all pregnant women to prevent acute pyelonephritis.

Primary surgical treatment in cervical carcinoma offers an unrepeatable chance to assess the biologic characteristics of the neoplasia by surgical staging and pathologic examination of the surgical specimen. The detection of factors of risk for locoregional diffusion, clinical staging being equal, can guide a subsequent target radio-treatment by identifying a group of patients at higher risk for relapses. The analysis of 155 cases of cervical carcinoma treated with radical primary surgery and pelvic lymphadenectomy at the Gynecologic Institute of Padua University has stressed the statistically significant correlation (P less than 0.05) existing between lymphatic diffusion and presence of neoplastic cells in capillaro-like spaces, degree of neoplastic cervical infiltration and parametrial diffusion. According to the Authors the presence of these features is a reliable basis to select patients eligible for post-surgery radiotreatment.

85 high risk pregnant women were evaluated by RIA of total estriol, unconjugated estriol and HPL by ultrasonic measurement of foetal BPD and by NST and Fischer's score. In all, 277 evaluations were made. The Authors found a good correlation between results of the cardiotocographic tests and levels of HPL and measurements of foetal BPD. A low correlation was noticed between the levels of total and unconjugated estriol and the characteristics of cardiotocography. The evaluation of the cardiotocographic tests, according to Lee and Coll., resulted better than according to Fischer's score. The contemporary qualitative and quantitative evaluation of the cardiotocograms seems to reduce significantly the false-positive results and to half the false-negative results of the other tests for foeto-placental function. Result were analysed.

In order to verify the endogenous steroid influences on the myometrium, we compared the receptor status in 18 specimens of uterine leiomyomata and 31 specimens of pregnant myometrium. 17-beta-Estradiol and Progesterone receptors were assayed in the cytosol and nuclear extracts. In the uterine leiomyomata we observed the following mean values: PgR/c 279 fmol/mg, PgR/n 89 fmol/mg, ER/c 52.5 fmol/mg, ER/n 12.3 fmol/mg. In the pregnant myometrium we observed the following mean values: PgR/c 5.86 fmol/mg, PgR/n 166 fmol/mg, ER/c 0.76 fmol/mg, ER/n 1.65. It was concluded that direct correlation between estrogen power and progesterone receptor replenishment in the nucleus exists.

The administration of betamethasone to the mother in order to accelerate maturation of foetal lungs induces significant modifications in the foeto-placental hormonal secretion. Both the total estriol and unconjugated estriol present a sharp fall in the days immediately following the administration and a rise 10-12 days later, depending on a rebound effect. The HPL levels do not variate except for a progressive and constant rising due probably to better cardiocirculatory maternal condition with, consequently, a higher utero-placental blood-flow. All these phenomena increase when the administration of betamethasone to the mother is repeated more then once. The AA. believe that the sharp fall of the estriol doesn't represent a danger for the foetus being only an effect of maternal and fetal adrenal depression. Consequently the AA. suggest to drive the management during and after the administration of betamethasone to the mother on the basis of other foeto-placental functional tests, as cardiotocography. The results were analysed.