Clinical strategies for the management of intestinal obstruction and pseudo-obstruction. A Delphi Consensus study of SICUT (Società Italiana di Chirurgia d'Urgenza e del Trauma).

Background: Intestinal obstructions/pseudo-obstruction of the small/large bowel are frequent conditions but their management could be challenging. Moreover, a general agreement in this field is currently lacking, thus SICUT Society designed a consensus study aimed to define their optimal workout.

Methods: The Delphi methodology was used to reach consensus among 47 Italian surgical experts in two study rounds.

Toxic megacolon in ulcerative rectocolitis. Current trends in clinical evaluation, diagnosis and treatment.

Toxic megacolon is a clinical condition associated to high risk of colonic perforation, that significantly increases--even triplicates--the megacolon-related mortality when causing diffuse peritonitis. Abdominal and pelvic helical CT scan proved to be a fundamental diagnostic tool, in defining the colic dilatation and perforation. Conservative treatment is initially indicated in the event of toxic megacolon arising at the onset of a severe or toxic colitis.

[Correlations between splenectomy and allergic symptoms. Preliminary results of a study concerning IL-4 and IgE serum level].

The Authors, studying the condition of immunodepression observed in patients who underwent splenectomy for traumatic lesion, noticed that a significant part of them complained of allergic symptoms. These seemed to appear only in subjects whose Th2 lymphocytes functionality was preserved--as witnessed by normal or increased IL-4 serum level--showing an increased level of IgE too, thus confirming the role of Th2 lymphocytes in stimulating IgE synthesis. On the contrary splenectomized patients with functional harm of the Th2 lymphocytes--proved by low IL-4 serum level--did not show increase of haematic IgE level nor allergic manifestations.

Postsplenectomy type-1 hypersensitivity response: a correlation between IL-4 and IgE serum levels.

Authors demonstrated the presence of allergic manifestations in splenectomized patients following traumatic rupture of this organ. In particular, allergic diathesis, as supported by serum IgE increase, was exclusively found in patients with preserved T helper (h)-2 lymphocyte function. Th-2 function was monitored by measuring serum levels of interleukin (IL)-4, a cytokine involved in IgE synthesis.

[Conservative treatment of the splenic traumas].

Authors hope for a growing diffusion of conservative treatments for lien's lesions, to avoid the asplenia syndrome, and the unfavourable implications derive from, above all immunodepression that increases septic risk. They report their experience about conservative choices for spleens traumatic injures and emphasize the absolute need of select the appropriate patients for those procedure, that must require: haemodynamics stability; not geriatric age; type I and II, according to Buntain's classifications, ien's lesions, and attentive selection of the patients carriers of type III lesions; absence of preceding spleens injures, opportunity of monitor patients, in immediate postoperative, in intensive care units. Authors suggest that one of the essential condition for the correct selection and achievement of conservative treatments of traumatic lien's injures, is the team work of the surgeon, of the anesthesiologist, of the radiologist.

Management of retrosternal goiters: experience of a surgical unit.

The aim of this study was to retrospectively analyze 5 years' experience of cervico-mediastinal goiters (CMG) management. Twenty-five patients with cervico-mediastinal goiters underwent surgery between January 1998 and December 2002. The group consisted of 16 females and 9 males (mean age, 48.

Risk factors of morbidity in thyroid surgery: analysis of the last 5 years of experience in a general surgery unit.

The aim of this retrospective study is to analyze the risk factors of morbidity in thyroid surgery. From January 1997 to December 2001, 343 patients (69 males and 280 females, mean age 46.1) who underwent surgery under general anesthesia for thyroid disease were analyzed.

Postsplenectomy immunodepression and its implications: an underestimated problem.

The most important sequelae of splenectomy is immunity depression. This study, conducted in three phases, was aimed at confirming this clinical condition. Data from our phase 1 study clearly show that patients undergoing splenectomy for trauma are in a critical condition because of a latent immunodeficiency shown by skin tests (ST) and in vitro evaluation of the aspecific immune activity.

Diffuse neuroendocrine tumor of the small bowel: an exceptional case with long survival and literature review.

Malignant tumors of the small intestine are uncommon. Carcinoid tumors represent 20% of all malignancies occurring in this segment. We report the case of a 53-year-old female who was treated surgically for intestinal obstruction secondary to carcinoid tumors diffuse to the small intestine.