Occult coeliac disease and iron-deficiency anaemia

Coeliac disease can cause selective malabsorption and, therefore, a poorly specific clinical pattern. In the two cases of iron-deficiency anaemia described, targeted diagnostic procedures enabled to find an effective therapy. The identification of patients affected by coeliac disease in a subclinical phase may reduce the risk of autoimmune and lymphoproliferative diseases.

[Primary extranodal non-Hodgkin's lymphoma of the head and neck]

Primitive extranodal head and neck non-Hodgkin's lymphoma represents 10% of total non-Hodgkin's Lymphomas and 5% of total head and neck malignant tumors, preferably 55-65 years old males. The aim of this study was to review the literature and to compare the available data with our cases, particularly referring to the results of therapy. We studied 7 cases of primitive extranodal head and neck non-Hodgkin's lymphoma (5 male and 2 females, mean age 58 years) observed between 1989 and 1994. All patients were treated with polychemotherapy, 2 of them with combined therapy. After a mean follow-up of 44 months, 6 patients (85.7%) still are in complete remission. Primary extranodal head and neck non-Hodgkin's lymphomas present peculiar clinical features compared to other lymphomas. The best treatment is the polychemotherapy (including anthracycline) associated (combined) with radiotherapy. A minimal follow-up of 5 years is required, also considering nodal and extranodal relapses not adjacent to the beginning site.

Ultrasonography and plain film versus intravenous urography in ureteric colic

Urography (IVU) is considered the best first investigation in patients with suspected ureteric colic, but recently ultrasonography (US), combined with a plain film of the abdomen (KUB), has been suggested as an alternative. We have undertaken a prospective study to see if this approach can be used in an Emergency Department by radiologists with different amounts of ultrasound experience. Some 180 patients with suspected ureteric colic presenting to the Emergency Department over an 8-month period were studied. They had a plain abdominal film (KUB) and US examination of the kidneys, ureters and bladder following hydration. Some 120 patients subsequently underwent IVU at a mean interval of 3.5 days after the ultrasound examination. Of these, 15 patients passed a stone before their IVU. Of the remaining 105 patients, 44 had an IVU positive for stone and 61 had a negative IVU. Fifty of the 60 patients who did not have an IVU had clinical follow-up and 31 had ultrasound. Our findings in this prospective study suggest that in the hydrated patient the combination of KUB plus US is a sensitive but not very specific screening test (sensitivity 95%, specificity 67%). Because of the high negative predictive value of KUB plus US (95%), urography is not likely to be helpful when KUB plus US are negative. Urography is indicated only if KUB plus US findings are equivocal or if intervention is necessary. If we had used KUB plus US alone as the first test in our patients, urography would have been unnecessary in approximately 60%. Twenty per cent of our patients passed a stone in the first 48 h.

Isolated intraperitoneal bladder rupture in patients with alcohol intoxication and minor abdominal trauma

Rupture of the urinary bladder secondary to abdominal trauma is uncommon and is usually associated with visceral or bone injuries; less than 10% of all cases occur without associated injuries. We present two cases of bladder rupture in intoxicated patients after minor abdominal trauma and without evidence of associated injuries. Given the absence of any symptoms in either case, we did not initially suspect bladder rupture. One of the two patients also presented with an intravesical herniation of the rectosigmoidal junction.