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To identify some dynamic or morphological patterns for the diagnosis of small bowel obstruction by hernia, adhesions or volvulus, we submitted to ultrasonography (US) 61 patients with clinical and radiographic syndromes of mechanical small bowel obstruction. The cause of obstruction was demonstrated in 58 patients-namely, with surgery in 56 patients and further instrumental examinations in 2. Three patients died before surgery. In our series, small bowel obstruction with strangulation was demonstrated at surgery in 31/56 patients. In 27/31 patients, US showed the coexistence of dilated loops with different kinetic behavior in the abdominal cavity-i.e., the simultaneous presence of akinetic loops with an intraluminal fluid-fluid level by sediment and peristaltic loops with solid particles in suspension. In 4/31 patients with strangulating small bowel obstruction. US provided no useful elements to explain the mechanism of obstruction. The US pattern of fluid-fluid levels due to intraluminal sediment in all the intestinal mass above the occluded segment was observed in 6/6 patients with uncompensated mechanical intestinal obstruction. This sign is due to the absence of intestinal muscular activity in the late stages of mechanical intestinal obstruction; its value is purely prognostic. To conclude, the US pattern of fluid-fluid levels by sediment diffused in the whole intestinal mass provides no useful elements to explain the cause of obstruction: on the contrary, the US pattern characterized by isolated intraluminal fluid-fluid levels or by the association of akinetic and peristaltic loops in the abdominal cavity appears pathognomonic of strangulating obstruction caused by volvulus, adhesion or hernia, with 87% sensitivity and 100% specificity.

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Various substances can interfere with the urinary activity of N-acetyl-beta-D-glycosaminidase (NAG), particularly certain bacteria that exert inhibitory or enhancing effects on the enzyme. Clearly, all this constitutes a limitation on the use of the technique. For these reasons, in patients suffering from interstitial and glomerular nephropathies and essential arterial hypertension a comparative study was carried out between the activity of urinary and serum NAG to establish if the latter produces more reliable results than the former. The results of urinary NAG activity confirm that there is no significant difference between healthy subjects and those with essential arterial hypertension; on the other hand, nephropathic patients present significantly higher urinary enzyme activity than healthy controls. On the other hand, evaluation of serum NAG does not seem to provide any practical aid as it does not highlight any difference between measurements carried out in healthy subjects and those carried out in hypertensive patients or those suffering from interstitial or glomerular nephropathy.

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The authors refer the results of a serological investigation about Toxoplasmosis done on 4119 patients during 1984-1986 related to a similar research executed on 2119 patients during 1976-1979. The results show a constant yearly increase of requests of Toxoplasmosis test and a progressive increase of the serologically negative cases. The authors suggest an improvement of Toxoplasmosis epidemiology.

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The Authors report a case of renal neoplasm association to polycystic kidney. The report was quite occasional, as the patient was not aware to be bearer of a renal dysembryopathy, although such a familiarity was existing formerly. The diagnosis was placed subsequently to ascertainments aiming at establishing the origin of a transient arterial hypertension, occurring recently, in absence of any other symptomatology.

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Neoplasms of male urethra are particularly interesting for the diagnostic and therapeutical problems involved, urologist surgeons may be charged to resolve. The authors effected an anatomo-pathologic, diagnostical and especially therapeutical framing, by reviewing the data reported by the literature. The indications the Authors may draw therefrom are favourable to a radical surgery, even in consideration of the extensive nature of such tumours and the poor successes, in terms of survival, got by the conservative therapy.

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Thirty-two cases of advanced bladder cancer (pT3b-pT4) undergoing radical cystectomy are compared with other similar series of patients of the same stages submitted to different treatments (radiotherapy, chemotherapy and combined treatments) reported in the literature. Survival rates at 3 and 5 years are analyzed in relation to the anatomopathological stage, cellular grading, lymph node infiltration, surgical risk and relative mortality. The results confirm that radical cystectomy is presently the most effective treatment.

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The Authors show an operation of urological surgery, unusual in relation to the rather limited indications. The operation of hemitrigonectomy, although it is framed in the chapter of the partial resections of bladder, does not get an exact identity in literature; yet, it is peculiar for both technical problems and some basic expedients sheltering surgeons from various complications. Hemitrigonectomy, performed by the Authors in six cases in the last 3 years, supplied excellent anatomic and functional results, and was burdened by no relevant complications.

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A personal surgical technique in the treatment of the tuberculous stenosis of the juxtavesical and intramural ureter, is described. 62 patients suffering from tuberculosis of the urinary tract underwent surgical treatment. 42 of these cases presented with ureteral stenosis: 14 were submitted to ureterocystoneostomy (UCNS) according to a personal technique. The results confirmed the initial hypotheses.

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