Chronic anisakidosis presenting with intestinal intussusception.

OBJECTIVE: Anisakidosis is a parasitic infection caused by the ingestion of row or uncooked fish, containing larval nematodes from the Anisakidae family. Intestinal anisakidosis represents about 4% of all cases, the majority being localized in the small bowel, with rare colonic involvement. Here we present an infrequent case of chronic anisakidosis, presenting with intestinal intussusception. CASE REPORT: A 52 years old woman, chronically treated with immunosuppressants, presented to our Institution with acute abdominal pain and vomiting, due to colocolic intussusception. Colonoscopy successfully reduced the intussusception and revealed the presence of a voluminous colonic submucosal mass, near the hepatic flexure. Therefore, the patient underwent laparoscopic right hemicolectomy. The diagnosis of anisakidosis was made when the histological examination of the surgical specimen revealed the infestation of the intestinal wall by a nematode of the Anisakidae family, with an intense erosive-inflammatory adjacent reaction.

A laparoscopic approach to left diaphragmatic rupture after blunt trauma.

Diaphragmatic rupture after blunt trauma is rare, but indicates a powerful external impact. Associated lesions are often life-threatening and require a rapid diagnosis and management. We report a case of a 24-year-old man, admitted to the emergency department after a serious car accident. He complained of a left sided thoraco-abdominal pain with breathing difficulties. Chest X-ray showed a left diaphragmatic elevation. Computed tomography demonstrated a left haemo-pneumothorax, herniation of the stomach in the chest and a haemoperitonium. Laparoscopically, herniated organs were re-integrated in the abdominal cavity ; the diaphragmatic tear was repaired by both direct suture and synthetic prosthesis. Closure of a small bowel perforation found during the laparoscopic exploration was also performed. We consider this therapeutic modality to be an excellent approach in the management of acute left side diaphragmatic rupture in haemodynamically stable patients. Firstly, it permits an inspection of the thoracic cavity through the diaphragmatic tear and secondly, an easy repair of damaged structures in the abdominal cavity.

Major hepatectomy in patients with synchronous colorectal liver metastases: whether or not a contraindication to simultaneous colorectal and liver resection?

OBJECTIVE: Synchronous hepatic lesions account for 15-25% of newly diagnosed colorectal cancer and its optimal timing to surgery is not completely defined, but simultaneous colorectal and liver resection is recently gaining acceptance, at least in patients with a right colonic primary and liver metastases that need a minor hepatectomy to be fully resected. METHOD: From September 2002 to December 2004, 16 patients underwent simultaneous resection as treatment of synchronous colorectal liver resection; in 10 patients (62.5%) a major hepatectomy was performed. RESULTS: The mean duration of intervention was 322.5 +/- 59.5 min, operative mortality and morbidity rates was 0% and 25% respectively; the hospitalization was 14.4 (range 8-60) days on average. Mean follow-up was 14 months and actuarial survival was 76.5% at 1 year and 63.5% at 2 years. CONCLUSION: We concluded that simultaneous colonic and liver resection should be undertaken in selected patients with synchronous colorectal liver resection regardless of the extent of hepatectomy; major liver resection, in fact, seems capable of providing better oncological results, allowing resection of liver micrometastases that, in almost one-third of the patients, are located in the same liver lobe of macroscopic lesions, without increased morbidity rates.

[Surgical therapy of Crohn's disease: observations on 63 patients]. / La terapia chirurgica della malattia di Crohn. Considerazioni su una casistica di 63 osservazioni.

AIM: The purpose of our retrospective study is to evaluate the correct indications for the surgical therapy of Crohn's disease. METHODS: Our case series consists of 63 patients admitted to our Surgery Department from January 1, 1973 to December 2002 with a diagnosis of Crohn's disease. Of the 56 operated patients, 43 patients were followed-up. For an objective evaluation of the Crohn's disease activity, the Crohn's Disease Activity Index (CDAI) was used. Surgical treatment has been carried out in 56 cases: in 29 cases of intestinal occlusion a minimal gut resection was performed; in the 26 cases of perforation a suture of the perforation was preferred, with a drainage of the peritoneal cavity and a toilette of abscess when it was present, and in 1 case an ileocolic resection was performed. RESULTS: Only 1 case showed a CDAI score >150 (153.63). This shows that in all the other cases the surgical and medical treatment has led to a satisfactory control of the disease. A relapse has been observed in 17 patients after an average period of 5 years without showing signs of disease. CONCLUSION: It is suggested that Crohn's disease therapy should be mainly of a medical nature and surgical treatment should be reserved for complicated cases.

[Stable copper complexes derived from nitrogen sugars]. / Complexes cuivriques stables de dérivés de sucres azotés.

This paper describes the synthesis of six new well-defined, stable cupric complexes of the general formula Cu(Ligand)2 in which the organic ligand is a nitrogen-bearing sugar derivative. Some of these compounds showed a border-line cytotoxic activity.