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The authors present a case of echinococcosis of the kidney that is interesting because of the uncommon site of localization; they illustrate their diagnostic and therapeutic approach to surgical and pharmacological management of the infection. Epidemiologically, hydatid cysts localized in the kidney occur far less often in northern Italy compared with the central-southern areas and the islands. However, echinococcosis should be suspected whenever symptoms include lumbar pain or swelling. Echography will reveal characteristic capsule and daughter cysts, while radiographic studies will often show a rim of calcification on the outline of the kidney. This information should be considered in conjunction with serologic tests (IgG-specific titers). If results to these tests are negative, abdominal computed tomography scans with contrast medium may be useful in demonstrating more details to establish diagnosis. Conservative (pericystectomy) or radical (nephrectomy) surgery is usually effective in curing the patient. Pharmacological therapy with albendazole can be a useful support in association with surgery or as an alternative single therapy in patients with other medical problems or spontaneous fistula formation that preclude surgery.

Two-hundred-and-three female patients (mean age: 58 yrs; SD: 8.2 yrs) suffering from osteoarthritis entered this late phase IV multicentre, stratified according to previous therapy (e.g. ketoprofen, naproxen, aspirin, indomethacin or indoprofen), randomized, double-blind, between within-patient trial of 2-week duration. Each patient received either diclofenac SR 100 mg/day (D), piroxicam 20 mg/day (P), or placebo (P1 by oral route. Clinical evaluation (functional class; pain assessment; osteoarthritic condition; joint motility and stiffness) was performed at entry, as well as after the first and the second week. Patient compliance and reported signs and symptoms were recorded after the first week and at the end of the trial. Patient preference, as regards previous therapy, and global evaluation (both by the physicians and the patients) were checked at the end of the trial. The clinical evaluation showed a superiority of D and P over P1. No difference was seen between the two active drugs. Placebo effect was very strong. Global evaluation was significantly in favour of D and P. Patient compliance was extremely good (greater than or equal to 95%). Diclofenac was preferred to naproxen, aspirin and indomethacin, while piroxicam and placebo were preferred only to aspirin. The tolerability of the two active drugs was good and comparable. A significantly lower number of patients complaining of unwanted effects (u.e.) was detected in the placebo group. The number of patients withdrawn for u.e. was similar in the three trial groups.