The Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colonproctologia) guidelines for the management of acute and chronic hemorrhoidal disease.

The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colon-Proctologia, SIUCP) on the diagnosis and management of hemorrhoidal disease, with the goal of guiding physicians in the choice of the best treatment option. A panel of experts was charged by the Board of the SIUCP to develop key questions on the main topics related to the management of hemorrhoidal disease and to perform an accurate and comprehensive literature search on each topic, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in multiple rounds through the Delphi approach and, for each statement, a consensus among the experts was reached.

The Italian Unitary Society of Colon-proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of anal fissure.

Introduction: The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colon-Proctologia) on the diagnosis and management of anal fissure, with the purpose to guide every physician in the choice of the best treatment option, according with the available literature.

Methods: A panel of experts was designed and charged by the Board of the SIUCP to develop key-questions on the main topics covering the management of anal fissure and to performe an accurate search on each topic in different databanks, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in different rounds through the Delphi approach and, for each statement, a consensus among the experts was reached.

Cognitive dysfunction and psychopathology: a cohort study of adults with intellectual developmental disorder.

Background: Cognitive impairment of intellectual developmental disorders (IDD) is determined by several different combinations of specific cognitive alterations. People with IDD present a rate of mental health problems that is up to 4 times higher than that of the general population. Despite this, the relationship between specific cognitive dysfunctions and co-occurring mental disorders has not been adequately studied.

Doppler-guided transanal haemorrhoidal dearterialization for haemorrhoids: results from a multicentre trial.

Aim: This multicentre study, based on the largest patient population ever published, aims to evaluate the efficacy of Doppler-guided transanal haemorrhoidal dearterialization (THD Doppler) in the treatment of symptomatic haemorrhoids and to identify the factors predicting failure for an effective mid-term outcome.

Method: Eight hundred and three patients affected by Grade II (137, 17.1%), III (548, 68.

Rendezvous technique for cholecystocholedochal lithiasis in octogenarians: is it as effective as in younger patients, or should endoscopic sphincterotomy followed by laparoscopic cholecystectomy be preferred?

Background: The treatment of cholecystocholedochal lithiasis (CCL) requires cholecystectomy and common bile duct (CBD) clearance, which can be achieved surgically or with a combination of surgery and endoscopy. The latter includes a two-stage-approach-preoperative retrograde cholangiography (ERC) and sphincterotomy (ST) followed by delayed laparoscopic cholecystectomy (LC), or vice versa-or a one-stage-approach-the rendezvous technique (RVT), where ERC, ST, and LC are performed during the same procedure. No data on the use of RVT in octogenarians have been reported in the literature so far.

[Doppler-guided transanal haemorrhoidal dearterialisation: a casuistic contribution].

The search of innovative procedures, able to associate the possibility of treating the hemorrhoidal disease with of "mini-invasiveness", is of growing interest. This paper reports the results obtained during our experience in threating the hemorrhoidal disease with Doppler-guided THD (Transanal Hemorroidal Dearterialisation), which is a technique improved in the last 4 years (February 2004 - November 2009) on a sample of 408 patients. The aim of this study is to evaluate, in a short-term follow-up period, the level of satisfaction and post-operative pain, normal working routine recovery time and the incidence of early and late post-operative complications in our patients.

Simultaneous occurrence of metastasizing carcinoid tumour of the gallbladder and chromophobe renal cell carcinoma in a young man.

Carcinoid tumour is an endocrine neoplasia described for the first time in 1888 and rarely observed in the extrahepatic bile ducts. Gallbladder carcinoid tumour was first reported by Joel in 1929. An endoluminal gallbladder lesion, with a bizarre echogenicity, and a mass in the upper pole of the left kidney were found in a 27 year-old man.

Transanal haemorrhoidal dearterialisation: nonexcisional surgery for the treatment of haemorrhoidal disease.

Background: Transanal haemorrhoidal dearterialisation (THD) is a nonexcisional surgical technique for the treatment of piles, consisting in the ligation of the distal branches of the superior rectal artery, resulting in a reduction of blood flow and decongestion of the haemorrhoidal plexus. The aim of this study was to assess the long-term efficacy of this treatment.

Methods: The procedure was carried out using a proctoscope with a Doppler probe.

[Sclerosing peritonitis. A complication of LeVeen peritoneovenous shunt].

Sclerosing peritonitis (abdominal cocoon syndrome) is a rare chronic affection of the peritoneum; its etiology is multifactorial and it affects all ages. Capsulating membranes seem to grow from a poorly cellular connective deposition in many layers on the intestinal peritoneum and are casually detected by surgery or autopsy. The placement of the peritoneovenous shunt can favour the deposition of fibrin on the visceral peritoneum, determining the formation of sclerosing membranes.

[Sertoli cell tumor. Case report].

A case of Sertoli cell tumor is described. It represents 1% of testicular neoplasms. Its clinical features, histology, histogenesis and treatment on the basis of the current literature are reported.

[Perineal recurrence of rectal cancer after abdomino-perineal resection].

An interesting case of perineal recurrence of rectal cancer after abdomino-perineal rectal amputation according to Miles is reported and it is emphasized how local recurrences after radical operations are a serious problem due to their frequency, the seriousness of the situation and scarce therapeutical possibilities available. The etiopathogenetical and clinical-therapeutical aspects were examined with respect to the problems of rectal neoplastic recurrence and it was noted that only aggressive surgical action, only in a very limited group of patients, increases survival, offering substantial advantages in terms of quality of life with respect to alternative therapies that have proved ineffective. The prevention of recurrence can only be achieved with suitable surgical and adjuvant medical treatment which together with an early diagnosis of the neoplastic recurrence are necessary to obtain best results.

[Bilateral renal oncocytoma. A clinical case and review of the literature].

Renal oncocytoma is an epithelial tumour of the kidney, originally considered benign neoplasm, but now it is thought have a limited but real malignant or metastatic potential. Usually monolateral, in 6% of cases it is bilateral in a synchronous or metachronous way. A case of bilateral renal oncocytoma in a 56-year-old woman, observed by chance during a follow-up carried out after breast cancer is described.

[Rectal endometriosis. Apropos of a clinical case].

Regarding a case of rectal endometriosis, presenting with cyclic menstrual rectal bleeding, the authors discuss the clinical and treatment aspects of such a rare pathology. History was sufficient to indicate the diagnosis which was confirmed by the histological examination of the excised rectal tract. These observations underline the diagnostic difficulty; the surgical approach is the treatment of choice when medical treatment gives no success.

[Acute obstruction of the abdominal aorta].

The acute occlusion of abdominal aorta is a rare event that may have severe clinical results. Personal experience in three cases of acute thrombosis treated in emergency surgery are presented. Aorto-iliac thromboendarterectomy, aorto-bifemoral bypass and thrombectomy with Fogarty catheter were performed.

[Cholangiojejunostomy of the duct of the 3d segment. Palliative treatment of cholestatic jaundice caused by neoplastic obstruction of the hepatic hilus].

Cholangiojejunostomy of the duct of the III segment in the palliative treatment of mechanical jaundice from neoplastic obstruction of the hepatic hilus. The neoplastic obstruction of the liver hilus has an almost total absence of forewarning clinical signs and therefore results in surgery at a late stage when the patient is not susceptible to radical treatment. It is therefore necessary to use palliative treatment in order to resolve the serious jaundice, the main cause of a quick death.

[Urachal cyst. A case report and review of the literature].

The pathology of urachal disease is rarely seen. This article refers to a case of urachal cyst in a twenty-five-year-old male. In order to discuss the pathogenic, clinical and therapeutic aspects of this rare pathology, it is necessary to carry out a complete revision of the literature.

[Peritoneal echinococcus: report of a case].

The Authors report a case of peritoneal echinococcal cyst and discuss the pathogenetic and clinical aspects as well as the diagnostic and therapeutic approaches of such a particular localization. They underline the need of a radical surgical treatment in order to definitively eliminate the parasite and the disease.

Colostomy plug devices: a possible new approach to the problem of incontinence.

The authors report their experience in the use of the Conseal (Coloplast S.p.A.