[Normal anatomy and pathologic features of the supraspinatus muscle: comparison between ultrasonography and surgery. Analysis of the potential sources of diagnostic errors]

The supraspinatus muscle performs about 60% of the elevation-abduction motion of the arm; therefore, it has a prominent functional role among the extrarotational muscles of the shoulder and is the most injured in subacromial space conditions. Seventy-four patients, aged 21-64 years, were examined to compare ultrasonography (US) results with surgical findings in supraspinatus conditions and to analyze the possible pitfalls in US diagnosis. All the patients underwent conventional X-ray, US and then surgery or arthroscopy. The following criteria were considered: morphology, thickness, echotexture, the convexity of the superior border of supraspinatus tendon, the relationships with the subacromial bursa and the tendon of the biceps long head, the regularity of the bone cortex of the humeral head. US showed: chronic degenerative tendinopathy in 10 patients; perforating focal injuries in 21 patients; deep focal injuries in 10 patients; intramural focal injuries in 6 patients; superficial focal injuries in 8 patients; complete tendon tear with detachment in 19 cases. 62/74 US diagnoses were surgically confirmed, with a specificity of 83.7%. In our experience, US provided very useful information about the pattern, size and site of the injuries and was very helpful in the surgical planning.

[Intraportal air secondary to gastric dilatation. A clinical case]

The authors report a case of hepatic portal venous gas (HPVG) secondary to massive gastric dilatation in a diabetic patient following blunt trauma. Both flat plate of the abdomen and ultrasound of the liver were necessary to reach the correct diagnosis. They review the pertinent literature and stress the importance of an accurate nosologic assessment of this uncommon entity in order to avoid undue mishaps.

[Crural hernia after inguinal hernia repair. A technical note]

A case of femoral hernia following repair of an inguinal hernia with the Shouldice method is presented. The authors discuss the pathogenesis, suggest the use of ultrasound for a precise preoperative diagnosis, and propose the "plug" technique of Lichtenstein as the method of choice for the repair. This method offers a minimally invasive approach, without disturbing the previous inguinal repair and it is very simple to perform.

[Calculosis of the cystic duct]

The authors report on three cases of cystic duct syndrome, a fairly uncommon complication of cholelithiasis, consisting in migration of a large gallstone from the gallbladder to the common bile duct, resulting in the formation of a common cavity between cystic, hepatic and common bile ducts. They review the pathogenesis of this entity, as well as the diagnostic modalities best suited to a precise diagnosis. They stress that surgical therapy must be chosen on a case by case basis, trying to restore a functional extrahepatic biliary tree.

[Surgical treatment of toxic megacolon]

After an introduction on the various aetiological factors involved in toxic megacolon, its onset, medical treatment and indications to surgery, the paper describes personal experience with seven cases. The report highlights the importance of medical treatment which is recommended as the appropriate initial therapeutic approach. Then after a review of evolving surgical techniques, it is suggested , again on the basis of personal experience, that the surgical approach should be neither excessively aggressive (total proctocolectomy with permanent ileostomy) nor excessively conservative (multistoma decompression). According to this report, the operation of choice is currently subtotal colectomy plus ileostomy and sigmoidostomy which combine modest morbidity and mortality with the possibility of future reconstruction.

[Echographic study of the shoulder. Clinico-echographic correlations]

US is indicated in the study of the impingement syndrome. A series of 152 shoulders was examined in a clinical-US study carried out following a standard protocol including a physical examination first and then a US examination. The study was aimed at investigating the agreement between clinical and US findings and at assessing the diagnostic reliability of US. 57% of the shoulders were positive to clinics (1 test at least) and were then divided in 4 groups. Positivity rate was high (85-87% for at least 3 or 4 tests). US findings included several different patterns. Our results demonstrate that a correct clinical-diagnostic protocol increases reliability, besides reducing the use of more complex and expensive imaging modalities--e.g., CT and MR.

[Heterotopic splenic autotransplantation: a therapeutic option in splenic trauma]

The Authors report two cases of splenectomy for trauma, followed by heterotopic autotransplantation of splenic tissue in omental pockets. A follow-up nuclear scan and ultrasonography showed function and growth of the splenic implants. The pertinent surgical literature is reviewed.