Glomus tumours of the hand

Based on 8 cases of glomus tumour of the hand, observed over the last 3 years, the authors review the clinical features and pathological anatomy of this rare condition. They propose nuclear magnetic resonance as a preoperative instrumental study as an alternative to angiography because it is non-invasive, free from risk and is clinically very effective.

[Primary hyperparathyroidism and peptic ulcer]

The prevalence of peptic ulcer disease was retrospectively analysed in 35 patients affected by primary hyperparathyroidism consecutively observed from 1977 through 1987. Eight of the examined patients (22.8%) had peptic ulcer (7 duodenal and 1 gastric ulcer), that in five cases (14%) represented the first clinical manifestation of the endocrine disease. A Zollinger-Ellison syndrome was demonstrated in three cases (8.5% of the total series, 37% of the patients with ulcer). There was no difference in calcium, gastrin and parathormone serum level between patients with and without ulcer, excluding patients with Zollinger-Ellison syndrome. These data confirm the high prevalence of peptic ulcer disease in hyperparathyroidism, but the mechanism causing this association remains to be elucidated.

Hyperthyroidism associated with primary cirrhosis. Two case reports

Only a single case of Graves' disease has been reported so far in Primary Biliary Cirrhosis (PBC), whereas hypothyroidism is a rather common association. We report two cases of hyperthyroidism associated with PBC. A common pathogenic mechanism involving HLA II class antigens is suggested.

First web-space reconstruction by Caroli's technique in congenital hand deformities with severe thumb ray adduction

A personal technique is described for reconstruction of the first web-space in congenital hand deformities with severe adduction of the thumb. The technique is based on the use of two local rotation flaps, one designed on the thenar area and the other on the radial half of the back of the hand. Seven patients were treated with such a technique and followed up for an average of 32 months. Excellent results were obtained in five cases.

[Melorheostosis linear scleroderma with osteopoikilosis. Description of a clinical case]

A case of melorheostosis with osteopoikilosis and linear scleroderma is reported. The authors emphasize the rarity of the disease, the complexity of the therapeutic approach to the patient.

[Variability in immunologic aspects of Whipple's disease. Is a unitary interpretation possible?]

A case of Whipple's disease with histological and ultrastructural studies, characterized by unusual bacteriological and immunologic findings, is reported. Alpha hemolytic Streptococcus and Candida tropicalis were isolated from the culture of the intestinal biopsy specimens. The immunological function study showed a global defect both of humoral and cellular immunity. On the basis of the literature review, the Authors debate a unitary interpretation of the various immunological dysfunctions reported in this disease.

Transfer in emergencies of the left ring finger to the right thumb. Case report

The authors report a case of serious crushing of both hands treated in emergency situation with transfer of the left ring finger, which could not be replanted, to the right thumb, as well as revascularization of the four fingers of the right hand.

[Mallory-Weiss syndrome. Personal experience and review of the literature]

The Mallory-Weiss syndrome is a more common cause of upper gastrointestinal bleeding than that previously recognised. Personal experience is reported of twelve cases of Mallory-Weiss tear, constituting 6.4% of all cases of upper gastrointestinal tract hemorrhage observed in the three year period from 1984 to 1986. History of alcoholism was present in 50% and hiatus hernia was associated in 41% of all the cases. Ten patients (84%) were managed nonoperatively, two patients underwent operation. None of the twelve patients in this series died. The literature of the last few years, is reviewed with particular reference to progress in the treatment of the syndrome.

Proposition for a new continuous suturing technique for microvascular anastomosis: a comparative study

The authors describe a suturing technique for end-to-end anastomosis in small vessels, which involves the use of continuous suturing without resorting to rotation of the approximator. The method is described in detail.

Variability of reduced glutathione levels in Massese ewes and its effect on daily milk production

The variability of the erythrocyte concentration of the tripeptide glutathione was studied in four flocks of Massese sheep. A relationship was found between glutathione level and stage of lactation in which the second month showed the lowest content. Genotype at transferrin and haemoglobin loci was associated with glutathione levels. Homozygotes at the transferrin locus yielded higher levels, while the D allele at the same locus was associated with lower concentrations. Animals with haemoglobin AA showed higher contents of glutathione. Also, a negative correlation was found between daily milk production and glutathione level.

The Italian Heart Transplant Project: organization of a multicenter program

The Italian Heart Transplant Project is a national program coordinated by the Health Ministry and involves eight cardiac surgery centers, two coordination centers for organ procurement, and one national registry. An intercenter network for the solution of logistic problems regarding organ procurement and assignment has been built up. Preintervention and clinical follow-up data are recorded in each center and in a national registry by the implementation of a computerized data base. This is realized by employing low cost and diffuse software and hardware. The complex goal of common data collection and standardization is also being pursued for collateral areas such as cardiac pathology and immunologic surveillance. Data collection is useful for clinical monitoring and also for costs and/or requirements analysis.

[Diagnostic reliability of clinical and instrumental data in identifying the presence of coronary disease in women with chest pain]

The present study was performed to assess the reliability of clinical symptom, rest and exercise electrocardiogram, exercise Thallium myocardial scintigraphy, as well as rest and exercise radionuclide angiocardiography, in order to detect significant coronary artery disease in 85 female patients with chest pain, who underwent coronary angiography. Of these, 54 underwent Thallium myocardial scintigraphy, 53 rest and exercise radionuclide angiocardiography. We have evaluated sensibility, specificity and positive and negative predictive value for each single variable or every possible combination. Within the population examined, Thallium myocardial scintigraphy reaches the highest sensibility (92%), specificity (92.5%), positive predictive (81%) and negative predictive value (97%). In comparison with all other clinical or instrumental parameters, taken either single or in combination. By subdividing the sample in two groups, of 20 and 65 patients respectively on the basis of the clinical symptom angina or thoracoalgy, with different predominance of coronaropathy (60 and 15%), Thallium myocardial scintigraphy is confirmed to be the most reliable diagnostic test (within the angina group sensibility 86%, specificity 100%, positive predictive value 100%, negative predictive value 83%, within the thoracoalgy group sensibility 100%, specificity 91%, positive predictive value 70%, negative predictive value 100%). However, within the thoracoalgy group, a negative maximal exercise test and a normal rest radionuclide angiocardiography detect patients with low probability of coronaropathy (negative predictive value respectively 100% and 93%). Within the angina group only Thallium myocardial scintigraphy significantly increases the predictive value of the angina symptom itself with respect to the presence of coronaropathy (positive predictive value of angina symptom alone 60%, of angina symptom plus Thallium myocardial scintigraphy 100%).

[Prognostic setting and bloodless hemodynamic evaluation of acute myocardial infarct with equilibrium radioisotopic ventriculography]

Forty-four consecutive patients with acute myocardial infarction were studied with equilibrium radionuclide angiography (RNA) within 24 hours from the onset of symptoms, three days after admission and three days before hospital discharge (14 +/- 3 days). To assess the prognostic value of RNA derived parameters we assessed: the ejection fraction (EF), the left ventricular end-systolic volume index (ESVI), the left ventricular end-diastolic volume index (EDVI), the cardiac index (CI), the stroke volume index (SVI) and the peak systolic pressure/end-systolic volume index ratio (PSP/ESVI); we also determined Peel's prognostic index (PI) on admission and measured systolic arterial pressure (SAP), diastolic arterial pressure (DAP) and cardiac frequency (CF) as the same time as the radioisotopic parameters were taken. Thirty-nine patients were discharged without signs of ventricular failure with and without medical treatment (group A), 5 died during hospitalization (group B). Using EF alone, we obtained a very clear distinction between the two groups (Group A 43 +/- 12%; Group B 22 +/- 3%; p less than 0.005). Stepwise, multivariate analysis showed that, by linking PSP/ESVI to EF, we can even obtain a function that correlate better with hospital survival (F = 0.09832 X EF - 0.32035 X PSP/ESVI - 3.12981; p less than 0.002). There was good exponential correlation between EF and PSP/ESVI (r = 0.781) and this would seem to confirm that PSP/ESVI is a more sensitive contractility index for patients with a not very depressed EF.