Asymptomatic pneumoperitoneum or pneumatosis cystoides intestinalis? Easy to make a mistake.

Pneumoperitoneum refers to the presence of intraperitoneal free gas outside the viscera. A perforation of a hollow viscus is the main cause and usually indicates a surgical emergency. However, some case of pneumoperitoneum can be completely asymptomatic and secondary to benign conditions that do not require any surgical intervention. In this situation a misleading diagnosis of pneumoperitoneum may occur. The authors are going to present a case of a 79-year-old man with an asymptomatic pneumoperitoneum incidentally detected by CT-scan and subsequently revealed to be pneumatosis cystoides intestinalis (PCI) at diagnostic laparoscopy. PCI is a rare condition characterized by the presence of gas-filled cyst in the submucosa/subserosa of the bowel wall that can easily mimic pneumoperitoneum on radiological imaging. A thorough examination of radiological findings is crucial in preventing unnecessary surgical procedures that may expose patients to potential associated morbidities.

Tracheal glomus tumor successfully resected with rigid bronchoscopy: a case report.

Glomus tumor of the trachea is a rare disease. A glomus tumor of the trachea in a 70-year-old man is described. The tumor was successfully excised with rigid bronchoscopy. Twenty-four months after treatment there remains no evidence of endobronchial regrowth at bronchoscopy or imaging studies. Histologic features and treatment are discussed.

The da Vinci robot in right adrenalectomy: considerations on technique.

The da Vinci Robotic System (Intuitive Surgical, Mountain View, CA) became available at the General Surgery Department of Camposampiero Hospital in May 2001. From May 2001 to October 2002, 139 robotic operations were performed, one of which was a right adrenalectomy for a right adrenal mass. The progressive growth of the mass was the indication for surgical excision. Surgical adrenalectomy was successfully completed with da Vinci Robotic System using 5 ports (3 for the robotic system, 2 as service trocars). The wrist-like movements of the instrument's tip easily enabled the detachment of the right hepatic lobe from the gland and vessel isolation, while the 3-dimensional vision facilitated dissection of the veins from the vena cava.

[Nurses in specialistic surgery: centrality of a role]. / L infermiere "dedicato" alla chirurgia specialistica: centralità di un ruolo.

According international trend patients over 70 submitted surgery in our Thoracic Surgery Unit are increasing. Therefore these patients are at higher risk of complications in the post-operative period owing to advanced age and comorbidities; most important among them BPCO and cardiovascular diseases. In our study most frequent and best evaluable complication was pneumonia. However postoperative pneumonia percentage decreased since 2000, when a nurse dedicated for thoracic patients only was instituted. Since then in our unit assistance model consisted of two thoracic surgeons supported by a nurse in charge to General Surgery Paramedic Unit. Innovation did not request adjunctive costs and contributed to a significant increase in professional level of nursing standard.

Autoimmune-like pancreatitis in thymoma with myasthenia gravis.

A patient with thymoma and myasthenia gravis admitted for surgery presented increased serum levels of pancreatic amylase and lipase. Suspecting a thymoma-related autoimmune disorder, autoantibody serum titers were determined: increased autoantibody titers to acetylcholine receptors, thyroglobulin, thyroperoxidase and pancreatic insulin were detected. After thymectomy the serum levels of pancreatic enzymes decreased rapidly. Myasthenia gravis symptoms also improved. To the best of our knowledge no similar cases have been reported in the literature.