[Diaphragmatic rupture with intrathoracic hepatic dislocation. Two case report]. / Rottura diaframmatrica con erniazione intratoracica del fegato. Presentazione di due casi clinici.

The authors show two cases of diaphragmatic rupture by blunt trauma with intra thoracic liver dislocation due to an accident on the street. The preoperative diagnosis has been based on the CT scan. The laparotomy, central for a patient and sub costal bilateral for the other one, gave the chance to repair the diaphragmatic defect directly and to deal with the associated lesions existing in both the casualties. No prosthetic material has been used and the reconstruction of the diaphragmatic defect has been conducted through a interrupted suture with non absorbable material. According to our experience the reparation of the diaphragmatic defect has always been conducted through a laparotomic approach and without using any prosthetic material. We repute that in these cases the laparotomic approach is the best one, which permits not only the reparation of the diaphragmatic defect but also the correct management of the related lesions which could be present. Usually we use a interrupted suture with non absorbable material for minor lesions and a continuous one, double layered if possible, for the major ones.

[Jejunal perforation from metastatic choriocarcinoma. Case report and review of the literature]. / Perforazione digiunale da coriocarcinoma metastatico. Caso clinico e revisione della letteratura.

Choriocarcinoma is a rare malignant genital tract tumor, arising in the uterus or in the testis. Primary or metastatic choriocarcinomas of the gastrointestinal tract are infrequent. We report a case of a testis choriocarcinoma presenting as jejunal metastasis with perforation. Histology revealed the origin of this metastatic tumor, allowing us to recognize the primary neoplasm of the testis. A review of literature with PubMed since 1964 and of the references of the papers retrieved was performed. Since 1933 only 30 cases of jejunal choriocarcinomas have been described in literature. In 13 cases jejunal choriocarcinoma presented gastrointestinal hemorrhage, in 4 intestinal intussusception and in 1 case upper abdominal pain and vomiting. Only 5 cases of jejunal perforation have been described. The case presented is the first in literature of jejunal perforation from a metastatic choriocarcinoma of the testis.

[Eosinophilic colitis: an unusual cause of acute abdomen. Case report and review of literature]. / Colite eosinofila: una causa rara di addome acuto. Presentazione di un caso e revisione della letteratura.

The Authors report a case of acute abdomen caused by a colic stenosis due to eosinophilic gastroenteritis. It is a not frequent disease, often clinically unclear: in the medical literature the Authors have found only 346 cases in publications concerning the period January 1990 - December 2005. The clinical presentation is very changeable, related to the involved site of alimentary tract and to the level of eosinophilic infiltration of the wall. There are no diagnosis criteria universally acknowledged and the most efficient procedure is thought being the intestinal biopsy which enables showing the infiltration of the digestive wall. The cure is above all medical with administration of corticosteroid: surgery surely has a less important role, reserved to the cases with acute onset.

One-trocar appendectomy.

BACKGROUND: Laparoscopic appendectomy is a feasible and a safe alternative to open appendectomy. Several laparoscopic procedures have been described that use one or more trocars. We report our experience with the treatment of acute appendicitis using a laparoscopy-assisted technique by means of only one transumbilical trocar. METHODS: From February 1996 to February 1999 we performed 65 laparoscopic appendectomies. In the procedures, a 10-mm operative telescope was used, with a 450-mm atraumatic grasper introduced through the operative channel. After the intraabdominal laparoscopic dissection, the appendix was exteriorized through the umbilical trocar. The appendectomy was performed outside the abdomen as in the open procedure. The procedure was completed using only one trocar in 55 patients (84.6%). Regarding the other 10 cases (15.3%), in 5 we used more than one trocar and in 5 conversion to open surgery was needed. RESULTS: The average operating time in our series was 25 min and the median time to discharge was 2 days. There were six (11%) postoperative complications (three serous umbilical secretion and three umbilical hematomas). CONCLUSIONS: Our results suggest that this technique, which combines the advantages of both the open and the laparoscopic procedures, is a valid alternative for the treatment of acute appendicitis. However, this procedure cannot always be completed using only one trocar, as happened in 10 cases in our series.

[Surgical therapy of varicocele. Technical note on the inguinal approach]. / La terapia chirurgica del varicocele. Note di tecnica sull'approccio per via inguinale.

BACKGROUND: There are several therapeutic proposals for idiopathic varicocele treatment, but all of them present a certain number of relapses. The technique proposed consists, through an inguinal approach, in a systematic ligation and section of all veins potentially responsible of a venous reflux. METHODS: During a period from 1990-1995 a total of 73 patients were surgically treated for idiopathic varicocele with this technique. All patients underwent preoperative spermiogram, hormonal assay and Doppler velocimetry. Through an inguinal approach, under selective spinal anaesthesia, a ligature and section of the internal spermatic vein at the internal inguinal ring is performed, followed by searching, ligature and section, of other veins responsible of venous reflux (external spermatic vein, anastomosis with sapheno-femoral veins, arteriovenous micro-anastomosis, pubic veins). The patient is discharged within twenty-four hours. RESULTS: An external dilated spermatic vein was discovered in 30.1%, pubic veins in 49.3%, anastomosis with safeno-femoral veins in 10.9% and arteriovenous micro-anastomosis in 43.8%. There were no mortality or serious postoperative morbidity; only in five cases there were complications consistent in two orchitis and three hydrocele. No relapse at follow-up (12-36 months), performed with palpation and a Doppler study, was found, while there was a spermiogram improvement in 61.6% of cases. CONCLUSIONS: This surgical approach is a safe and radical treatment without any relapse, of all types of varicocele.

[Silibinin and acute poisoning with Amanita phalloides]. / Silibinina e intossicazione acuta da Amanita phalloides.

The aim of the present study was to show the therapeutic effect of silibinin dihemisuccinate in a case of intoxication by mushrooms of Amanita gender. We report a clinical case of a 4-person family intoxicated by ingestion of mushrooms Amanita phalloides and admitted to the center for poisoning treatment of the Hospital "A. Cardarelli" in Naples. Although all were treated with standard therapy, there was a worsening of the clinical picture till the third day, when it was decided to add silibinin dihemisuccinate by the intravenous route to the therapy. After the beginning of silibinin administration the patients showed a favourable course with a rapid resolution of the clinical picture, although the prognosis appeared severe on the basis of hematochemical examination results. On day 9 silibinin dihemisuccinate was replaced with silibinin betacyclodextrine per os. All patients were discharged on day 10-13. After two months all hematological parameters are in the normal range also a hepatobiliopancreatic echography does not show any morphological alteration. As in the case of polytherapies and because of the lack of comparative studies, it seems difficult to establish which therapeutic component had the major role in the resolution of the clinical picture. However, on the basis of our experience, and of the literature data, we think that silibinin may play a significant role in protecting hepatic tissue not yet injured. However we believe that other studies are necessary to confirm our hypothesis.