Mesenteric ischemia in a patient with an acute aortic dissection type A. One-step repair of the aortic and visceral lesions. Role of laparoscopy for timely diagnosis and treatment.

Organ malperfusion is a serious complication of acute aortic dissection type A. Increased awareness of this complication and the availability of better diagnostic tools may improve the survival rate for these patients. Here, we discuss the potential role of laparoscopy in the setting of an acute dissecting aneurysm complicated by mesenteric ischemia.

[Laparoscopic treatment of GISTs in our experience]. / Il trattamento laparoscopico dei GISTs: nostra esperienza.

Gastrointestinal stromal tumours are rare neoplasms originating from the connective tissue of the digestive tract and constitute most of the non-epithelial primitive digestive tumours. The origin from the interstitial cell of Cajal is appreciated because of this tumours constantly present the expression of the surface antigens CD34 and CD 117 which can be determined immunohistochemistry. In the majority of cases, GISTs are symptomatic and symptoms are most commonly related to mass effect or bleeding. Asymptomatic GISTs are often found incidentally on physical examination, radiologic imaging, endoscopy, laparotomy or laparoscopy. US endoscopy and fine needle aspiration with subsequent immunohistochemistry analysis afford the best diagnostic accuracy. In primary and localized GISTs surgery is always indicated and laparoscopic technique is feasible and is recommended as the treatment of choice for all the patients. Imatinib should be started in metastatic or recurrent disease and neoadjuvant imatinib is also experimental, although its use may be justified in unresectable or marginally resectable GIST. Sunitinib has recently been approved for patients with GIST principally those who fail imatinib therapy. Our experience is based on the study of 7 GISTs: only in 2 cases the neoplasm was found occasionally; in the other, symptoms were related to mass effect or bleeding. Laparoscopic tumour resection was then performed in all the patients. The definitive diagnosis of gastrointestinal stromal tumour, was made postoperatively by analysis of the histopathological and immunohistochemical findings. We confirmed constant high positivity for CD34 and for CD117. Even in the absence of unfavourable prognostic indicators, all patients are regularly followed-up.

Acute onset of non-Hodgkin's lymphoma with bowel perforation in a patient with over 15 years' HIV positivity. A case report.

The authors report a rare case of acute onset of ileal non-Hodgkin's lymphoma with acute abdomen due to bowel perforation. The patient, a man aged 36 years, had been HIV-positive for more than 15 years. The patient had been on continuous, differentiated pharmacological treatment for the previous 5 years, and in the last month had had repeated episodes of fever with no clear aetiopathogenesis. Physical examination yielded negative findings and abdominal and chest CT failed to reveal any obvious lesions. The patient was admitted as an emergency case with a picture of acute abdomen and was immediately operated on; ileal perforation due to multiple lymphomatous lesions in the small bowel was diagnosed. The histological diagnosis was large-cell non-Hodgkin's lymphoma type B. After the operation, the patient was treated by chemotherapy and, currently, after a 12-month follow-up, is in good general condition.