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This paper shows our experience concerning the study of Streptococcus bovis infectious endocarditis (EI): 47 patients, with no prior history of IV drug abuse (NTD), who suffered EI caused by Streptococcus bovis were excerpted from a case record of 1053 cases with diagnosis of EI defined in accordance with Duke's Hospital criteria. For each patient we considered age, sex, complications, echocardiographic findings, antibiotic therapy, eventual heart-surgery and final outcome of the disease. We then compared the parameters of our patients, with the ones of 216 NTD patients suffering non Streptococcus bovis EI, selected according to age correspondence and concomitant onset of the disease. The characteristics of Streptococcus bovis EI are analogous to the ones of EIs caused by other micro-organisms in NTD patients, except for a non statistically significant trend of higher frequency in old age and in males. Concerning possible predisposing conditions, we considered the association extensively described in the literature between Streptococcus bovis EI and gastroenteric pathology (above all colon neoplasms): this association was not frequently observed in our study because appropriate instrumental investigations of the digestive tract were carried out only in a minority of patients.

This paper describes a case of epithelioid leiomyosarcoma of the rectum in a patient admitted for constipation and rectal bleeding. After an initial biopsy diagnosis of leiomyoma, a local excision was performed, showing the malignant nature of the tumour. Consequently, the patient underwent an abdomino-perineal amputation, adjuvant radiation (50 Gy) and a 24-month follow-up, which revealed no signs of local or distant recurrence. Sarcomas of the rectum are rare and therefore poorly documented neoplasms. They belong to the wider group of gastrointestinal stromal tumours, which are classified in 4 histological types: (i) smooth muscle, (ii) neural, (iii) mixed and (iv) undifferentiated. Since they grow within the intestinal wall, the symptoms are usually few or late, leading to delays in diagnosis. The diagnostic and staging protocol of stromal tumours of the rectum includes CT and MRI. The treatment is primarily surgical, where possible, and should guarantee complete clearance of the tumour, which often requires an aggressive approach. Non-curative resection, high tumour grade and size10 cm, are considered unfavourable prognostic factors. Further trials are needed to establish the exact role of adjuvant therapy. Though it prolongs the disease-free interval, there is no clear evidence that it influences the overall survival.

Occlusion of the superior vena cava is a rare but serious complication of transvenous endocardial pacing. We describe 1 case of superior vena cava obstruction associated with permanent transvenous DDD pacemaker, following local infection. Thrombolytic therapy was initially effective, resulting in relief of signs of obstruction. However systemic infection occurred 3 months later. The patient was subsequently submitted to surgical removal of the infected pacemaker apparatus. Several therapeutical options described in previous papers are reviewed: anticoagulants, thrombolytics, percutaneous dilatation, surgical removal of the catheter. In conclusion, when a chronic process induced by local infection is present, surgical treatment is the best therapeutical approach.

Adjuvant chemotherapy is one of the latest and more promising modality of cancer treatment within the multidisciplinary approach to neoplasms. This paper illustrates the biological rationale as well as preliminary evaluation of its effectiveness for bladder carcinoma.