Pseudoaneurysm of the cystic artery after acute necrotizing pancreatitis.

A 35-year-old woman, chronic alcoholic, was admitted for an attack of acute, necrotizing pancreatitis. Antibiotics and percutaneous drainage failed to control the septic status and the pancreatic collection. Open surgery allowed a successful necrosectomy and drainage. However, a control CT scan before removal of drains showed a 1 cm diameter pseudoaneurysm of the cystic artery, not present at previous abdominal imaging. A redo laparotomy was performed followed by cholecystectomy with en bloc resection of the pseudoaneurysm and a second look of the peripancreatic area. The patient made an uneventful recovery and was discharged on postoperative day 5. Pseudoaneurysms of the cystic artery after acute necrotizing pancreatitis are very rare. Percutaneous embolization is effective in controlling the pseudoaneurysm, but requires subsequent cholecystectomy within a short delay, due to the risk of gangrene of the gallbladder requiring a further, emergency surgical treatment. Open resection of the pseudoaneurysm en bloc with cholecystectomy appears, therefore, an appropriate treatment of this rare condition. KEY WORDS: Cystic artery, Pancreatitis, Pseudoaneurysm.

Laparoscopic treatment for ventral hernia in obese patients.

AIM: Obese patients generally are not considered good candidates for wall defect repair, because of associated comorbidities, increased surgical risk, and high risk of surgical site infection and recurrence. The purpose of this retrospective study was to evaluate the results of laparoscopic incisional hernia repair in a group of patients with Body Mass Index (BMI)>35 kg/m2. MATERIAL AND METHOD: From January 2016 to October 2018, 15 obese patients, including 11 females (73.3%) with a BMI > 35 kg/m2 underwent laparoscopic repair of an incisional abdominal hernia. Median BMI was 40 (SD±5). No selection related to comorbidities was performed. As primary endpoints, main postoperative general complications and hernia recurrence were taken into account. Secondary endpoints were the incidence of seroma, hematoma, wound infection and length of hospitalization. In addition, a systematic review of the literature on open and laparoscopic repair techniques was carried out. RESULTS: All patients were treated by laparoscopy and no conversions were required. No intraoperative complications were observed, and no patients underwent early re-intervention. Mortality was zero. One patient (6.6%) presented a seroma, conservatively managed, and evaluated over time without the need of re-intervention. One patient (6.6%) suffered a recurrence a year later, also treated by laparoscopy. Average hospital stay was 2.79 days (DS±0.77). CONCLUSIONS: Despite positive data and good results, laparoscopic treatment of wall defects has yet to be standardized. The feasibility of the laparoscopy for ventral hernias in patients with BMI>35 kg/m2 should be considered. The proposed technique is standardizable and easily reproducible. In terms of complications in the short term (perforations, kidney and pulmonary failure, cardiovascular events) and in the long term (relapses, wound infections, seromas) our results justify recommendation of the minimally invasive approach for almost all patients with abdominal wall defects. KEY WORDS: Laparoscopy, Obese, Ventral hernia.

Iodine: Its Role in Thyroid Hormone Biosynthesis and Beyond.

The present review deals with the functional roles of iodine and its metabolism. The main biological function of iodine concerns its role in the biosynthesis of thyroid hormones (THs) by the thyroid gland. In addition, however, further biological roles of iodine have emerged. Precisely, due to its significant action as scavenger of reactive oxygen species (ROS), iodine is thought to represent one of the oldest antioxidants in living organisms. Moreover, iodine oxidation to hypoiodite (IO-) has been shown to possess strong bactericidal as well as antiviral and antifungal activity. Finally, and importantly, iodine has been demonstrated to exert antineoplastic effects in human cancer cell lines. Thus, iodine, through the action of different tissue-specific peroxidases, may serve different evolutionarily conserved physiological functions that, beyond TH biosynthesis, encompass antioxidant activity and defense against pathogens and cancer progression.