[Deferred elective colonic resection in complicated acute diverticulitis].

Twenty-three patients with acute diverticulitis complicated by pericolic or paracolic abscesses (Hinchey stage I-II) after a first phase of medical treatment were treated with deferred elective resection of the descending colon and sigmoid plus colorectal anastomosis performed on average 30 days after the onset of the acute episode. The pathologist's investigation of the surgical specimens demonstrated persistence of severe inflammatory lesions despite the apparently satisfactory clinical outcome. These data explain the frequent recurrences and indicate surgical treatment as being the only therapy capable of definitively resolving the condition.

[Aneurysms of the superior mesenteric artery].

Splanchnic arteries aneurysmatic pathology is rare, even if, in the last decades it has been noticed an increase of its incidence, owing to the worldwide use of the recent diagnostic tools as echography, TC, MR and angiography. Among visceral aneurysms those of the superior mesenteric artery (SMA) range the 5.5-8%.

[Splenic traumas: indications and limitations of conservative treatment].

According to the experience of the authors, comparison between two consecutive periods (1980-1994 and 1995-2000) has shown a substantial increase in splenic traumas simply treated by observation and monitoring. Their number in fact has risen significantly from 5 to 32. This has allowed a rise in the overall percentage of spleen conservation, which has increased from 16.

Platelet kinetic study in patients with idiopathic thrombocytopenic purpura (ITP) refractory or relapsing after corticosteroid treatment.

Background: A platelet kinetic study (PKS) is not indicated in the evaluation of adult patients with idiopathic thrombocytopenic purpura (ITP) at presentation. However, in ITP patients refractory to or relapsing after corticosteroid therapy, its appropriateness is considered uncertain.

Methods: We prospectively performed a PKS with (111)In oxine-labeled autologous platelets in 93 consecutive adult ITP patients failing steroid treatment.

[Lipohyperplasia of the ileocecal valve: unusual cause of severe digestive surgery].

The lipohyperplasia of the ileocaecal valve is a condition of rare clinical observation mainly characterized by an abnormal accumulation of adipose tissue along the submucosal layer of the ileocaecal valve. This pathology presents an unspecific symptomatology that can make difficult the differential diagnosis with a local neoplastic process. Sometimes this pathology can be the cause of gastrointestinal bleeding of unknown origin.

[Acute postoperative mediastinitis: retrospective analysis of various treatment methods].

Infective acute mediastinitis is a postoperative complication reported in 0.5-1% of patients undergoing open chest operations. The treatment of choice for this life-threatening complication is still a matter of debate.

[Acute pancreatitis: resultos of a diagnostic-therapeutic protocol in 80 consecutive cases].

The treatment of acute pancreatitis cannot be standardized in the absence of a prompt diagnosis and of an accurate severity and prognostic score. This study, based on 80 consecutively observed patients, compared the aetiological, clinical, diagnostic (laboratory and imaging) and prognostic data used to select the most appropriate therapy for each patient. The results confirm that the Ranson score shows a satisfactory prognostic relationship between the number of positive parameters and the severity of the disease.

[Necrotizing soft tissue infections as the only clinical manifestation of retroperitoneal colonic perforation].

Necrotizing infections are rapidly progressive potentially lethal bacterial diseases of the soft tissues. In based on the widely varying levels of soft tissues affected and the variety of the microflora, two types of necrotizing soft tissue infections need to be delineated: pure Chlostridial myonecrosis and other necrotizing soft tissue infections (NSTI). From an etiopathogenetic point of view NSTI can be secondary to perianal or urogenital abscesses, traumatic lesions, wound infections, trophic or decubitus ulcers, oral cavity abscesses; only in a limited number of cases their origin can be idiopathic.

[Vascular trauma of the lower limbs].

Background: This study was conducted to evaluate the results of treatment of vascular trauma of the lower extremities and those factors associated with limb loss.

Design: a retrospective evaluation of a series with lower extremities vascular trauma.

Setting: University Hospital.

[Gastroduodenal artery pseudoaneurysm ruptured at the pancreatic head].

The presence of splancnic aneurysms associated with pancreatitis represents an uncommon evidence (10%) but extremely formidable for the high mortality related to the elevate risk of rupture (50%). A case of a broken gastroduodenal artery pseudoaneurysm plugged in the pancreatic head in a patient with chronic pancreatitis surgically treated is reported. The Authors believe that in presence or in suspicious of peripancreatic pseudoaneurysm bleeding, showed by abdominal echography or CT scan, is mandatory the execution of splancnic and peripancreatic vessels angiography to determine the correct localization of the aneurysm, essential to determining the best surgical treatment.

Shock and dyspnea after cardiopulmonary resuscitation: a case of iatrogenic gastric rupture.

Rupture of the stomach is a rarely reported complication of cardiopulmonary resuscitation. The number of cases reported in the literature since 1970 does not exceed 30. We present a recent case of a young woman submitted to cardiopulmonary resuscitation in whom a gastric rupture gave rise to massive pneumoperitoneum with haemodynamic shock and respiratory failure.

[Vascular trauma of the upper extremities].

The aim of this study was to evaluate short- and long-term results of the treatment of upper extremities vascular trauma considering aetiology of the lesions, percentage of limb salvage and residual functional disability. The Authors retrospectively evaluated 17 patients accounting for 21 vascular lesions of the upper extremities (16 arterial and 5 venous injuries). Age, sex, modality of trauma, site of the vascular lesions and of the associated injuries, diagnostic procedures at the admission, ischemic time, arterial and venous repair performed were analyzed.

Solitary metachronous splenic metastases: an evaluation of surgical treatment.

Splenic metastases occurring after primary tumor removal and apparently solitary have been documented only recently in Literature. They are, most of the times, clinically asymptomatic and their presence is casually determined by ultrasonographic follow-up in subjects otherwise in good conditions. The belief that splenic metastases occur only in disseminated cancer is today no longer accepted.

Life-threatening digestive haemorrhage from duodenal recurrence of gastric cancer.

Invasion of the duodenum by gastric carcinoma is not uncommon. The duodenal invasion by transpiloric infiltration through the submucosal layer or lymphatic spread frequently being microscopic and in minimal number of cases involving the mucosa, is generally asymptomatic and detected only in postmortem examinations. We report a case of life-threatening gastrointestinal bleeding from cancer recurrence at duodenal stump after subtotal gastrectomy for gastric carcinoma.

[Splenectomy in immune thrombocytopenia and other hematological diseases].

The Authors report a retrospective study of 74 splenectomies performed for hematologic diseases. The role of splenectomy has changed over recent years with increased indications for immune thrombocytopenic purpura (ITP). The aim of this study was to assess indications to surgery in relation to clinical presentation with typical hemorrhagic features or severe thrombocytopenia only; interval between onset of symptoms and splenectomy; failure of medical management and complications from steroid administration; scintigraphic studies predictive of response to splenectomy and preoperative treatment in patients with severe thrombocytopenia were also studied.

[Primary malignant tumor of the 4th duodenal segment at the angle of Treitz. Report of a case].

A case of 34-years old woman with adenocarcinoma of the IVth duodenal segment extended to the angle of Treitz, treated with duodenojejunal segmentary resection, is described. Clinical features and diagnostic strategies are reported. Personal observation compared with Literature confirms the difficulty of an early diagnosis.

[Benign non-parasitic cysts of the spleen].

The present retrospective study is related to 7 cases of non-parasitic splenic cysts, 5 post-traumatic and 2 true epidermoid. Symptoms of displacement and pressure on adjacent viscera or physical examination showing an enlarged spleen have caused the beginning of diagnostic investigation in some patients, in others the cyst has been incidentally discovered. The young age and the positive history for prior trauma suggest for pseudocyst but they didn't give us absolute value.

[Hilar localization of splenic cyst does not always exclude the possibility of resective treatment].

Non parasitic cysts of the spleen require surgical treatment because of their progressive growth and in order to prevent the potential severe complications associated with such cysts. Since it is now well known that total splenectomy, especially in young patients, has potential for short- and long-term complications, much emphasis has been placed on splenic salvage, suggesting partial splenectomy as procedure of choice for splenic cysts. However various Authors suggest that many but not all splenic cysts can be treated with partial splenectomy.

[Splanchnic aneurysms: 10 treated cases and review of the literature].

The splanchnic aneurysms, which are complicated by rupture in 25% of cases with a mortality of 25-70%, are usually a surprise during diagnostic tests for other abdominal pathologies or emergency laparotomies. 10 cases treated (8 in elective and 2 in emergency surgery) are presented here: the aneurysm was in celiac trunk (1 patient), common hepatic artery (1 pt.), hepatic artery (2 pts.

[Hepatic injuries: diagnostic and therapeutic features].

Sixty-four consecutive patients with hepatic trauma were examined. Five (7.8%) patients were managed nonoperatively and 59 (92.

Superior mesenteric artery emboli during renal PTA: successful surgical treatment after fibrinolysis failure.

The paper presents a rare case of iatrogenic embolization of the superior mesenteric artery which required an emergency operation after an unsuccessful fibrinolytic treatment. An old woman, who had undergone renal percutaneous angioplasty (r-PTA), presented sudden but transient abdominal pain. Angiographic control of the angioplasty showed the goal of r-PTA but also an embolic occlusion of the main trunk of the superior mesenteric artery that did not respond to a selective fibrinolytic treatment.

Unusual localizations of hydatid disease: a 18 year experience.

The Authors report their experience with rare localizations of hydatid cysts during a period of 18 years. In 8 patients (14%) other organs than liver or lungs were involved: in particular one case of hydatid cyst of the spleen, one of the pancreatic area and one of the soft tissue of the back presented as primary locations. In 5 patients the disease of the liver was associated to hydatid cysts in other sites: 3 multiple peritoneal localizations, one in the abdominal rectus muscle and one of the gallbladder.

[The complications of pulmonary resection surgery: the experience of 200 consecutive cases].

Postoperative complications observed in 200 patients after pulmonary resection (66 pneumonectomies--30%, 106 lobectomies--53% and 28 wedge resections--17%) are presented. Surgical operations were carried out in 86% of cases for cancer, in 16% for benign lesions. Major complications were: lobar atelectasis, bronchopneumonia, pulmonary embolism, respiratory insufficiency, bronchial fistula, ventricular tachyarrhythmia, altogether they concerned 21% of the cases.

[Intra- and postoperative changes in blood viscosity].

Blood and plasma viscosity has been controlled in a group of patients undergone to aorto-iliac reconstruction and in a group of control after thyroidectomy, cholecystectomy, and hernioplasty. The hemodilution induced by intraoperative infusion in the vascular reconstruction produced an important decrease of hematic and plasmatic viscosity which lasted for several days after the operation. Removing the hemodilution effect by a mathematical correction of the viscosity measured values to a standard haematocrit, it has demonstrated as surgical operation, apart from its entity, promoted an increase of the viscosity which persisted long in the postoperative course.

[Staging of lung cancer by computerized tomography: evaluation based on surgical experience].

One hundred seventy patients with M0 bronchogenic carcinoma were preoperatively evaluated by CT staging whose results were correlated with surgical findings. A number of over and understaging were observed in assessing mediastinal nodes involvement, chest wall invasion, mediastinal pleura and vessels invasion as well as pulmonary vessels involvement. In conclusion, the Authors believe that no patient surgical indication should be excluded on the basis of CT evidence of intrathoracic invasion, in the light of the demonstrated potential for false-positive diagnoses.