Stemming the Leak: A Novel Treatment for Gastro-Bronchial Fistula.

Laparoscopic sleeve gastrectomy (LSG) is a commonly used procedure in bariatric patients that often has excellent results. Despite its advantages, LSG is burdened by specific intraoperative and postoperative early and late complications. One of the life-threatening complications is gastric fistula, usually treated with a multidisciplinary surgical-endoscopic approach. In case of failure of the latter, alternative nonoperative techniques such as the use of autologous stem cells truly represents an innovative possibility, with only few cases described in literature. Here, we report the case of a 25-year-old man with post-LSG broncho-gastric fistula treated with application of autologous stem cells after the failure of the conventional surgical/endoscopic approach.

Non operative management of blunt splenic trauma: a prospective evaluation of a standardized treatment protocol.

PURPOSE: The advantages of the conservative approach for major spleen injuries are still debated. This study was designed to evaluate the safety and effectiveness of NOM in the treatment of minor (grade I-II according with the American Association for the Surgery of Trauma; AAST) and severe (AAST grade III-V) blunt splenic trauma, following a standardized treatment protocol. METHODS: All the hemodynamically stable patients with computer tomography (CT) diagnosis of blunt splenic trauma underwent NOM, which included strict clinical and laboratory observation, 48-72 h contrast-enhanced ultrasonography (CEUS) follow-up and splenic angioembolization, performed both in patients with admission CT evidence of vascular injuries and in patients with falling hematocrit during observation. RESULTS: 87 patients [32 (36.7 %) women and 55 (63.2 %) men, median age 34 (range 14-68)] were included. Of these, 28 patients (32.1 %) had grade I, 22 patients (25.2 %) grade II, 20 patients (22.9 %) grade III, 11 patients (12.6 %) grade IV and 6 patients (6.8 %) grade V injuries. The overall success rate of NOM was 95.4 % (82/87). There was no significant difference in the success rate between the patients with different splenic injuries grade. Of 24 patients that had undergone angioembolization, 22 (91.6 %) showed high splenic injury grade. The success rate of embolization was 91.6 % (22/24). No major complications were observed. The minor complications (2 pleural effusions, 1 pancreatic fistula and 2 splenic abscesses) were successfully treated by EAUS or CT guided drainage. CONCLUSIONS: The non operative management of blunt splenic trauma, according to our protocol, represents a safe and effective treatment for both minor and severe injuries, achieving an overall success rate of 95 %. The angiographic study could be indicated both in patients with CT evidence of vascular injuries and in patients with high-grade splenic injuries, regardless of CT findings.

[Hemorrhagic aneurysm of the celiac trunk. Diagnosis by ultrasound, CT and angiography]. / Gli aneurismi emorragici del tronco celiaco. Diagnosi con US, TC e angiografia.

The authors report their experience in the study of bleeding aneurysms of the celiac arteries. Eleven patients were examined with US, CT, and angiography (8 hepatic artery aneurysms and 3 splenic artery aneurysms). Clinical findings included digestive bleeding, upper abdominal pain, palpable pulsating masses, and jaundice. Patient history included blunt abdominal trauma, penetrating trauma due to gunshot, acute pancreatitis, recent hepatic biopsy. In all cases US showed an abdominal mass ranging in size from 2 to 10 cm. US findings included cyst-like lesions (8 cases), a lobulated solid-like lesion, and complex lesions (2 cases). Continuity of the lesion with adjacent arterial vessels was noted in 5/11 cases, and pulsing activity in 3/11 cases. US patterns, although not specific, play an important role in the diagnosis when associated to other elements such as arterial continuity, mass pulsatility, patient history, and gastrointestinal bleeding. They suggest the need for more specific imaging exams, i.e. CT and angiography, and help avoid dangerous diagnostic biopsies. CT was performed to confirm US findings in 5 cases, and detected either hypodense cystic masses, or inhomogeneous masses with arterial enhancement after bolus injection of cm. CT was used to better demonstrate the lumen, patency of the vessel, the walls of the vessel, and the parietal thrombotic component. The typical arterial enhancement was the decisive finding for the diagnosis, even though a total continuity with arterial vessels was never observed. Angiography was the method of choice for the preoperative demonstration of hepatic artery aneurysms (10 cases) and for occlusive treatment with Gianturco coils (3 cases).

[Echographic study of the inferior vena cava in abdominal neoplastic pathology. Comparison with the inferior cavography]. / Studio ecografico della vena cava inferiore nella patologia neoplastica addominale. Confronto con la cavografia inferiore.

The authors evaluated the reliability of echography in the involvement of the inferior vena cava in the abdominal tumors. 137 patients were studied with echography and 125 with inferior cavography too. All the diagnosis were confirmed with arteriography and/or CT and/or surgical findings. The reliability of the echographic method was significant, and particularly in case of emboli and tumor invasion.

[Echographic diagnosis of neuroblastoma in children]. / La diagnosi ecografica del neuroblastoma infantile.

Ultrasounds have a high diagnostic value mainly in the structural assessment of the neoplasia. They are also very useful for the evaluation of the spread. In this paper the authors analyze the criteria for a differentiated diagnosis of Wilms' tumour.

[Comparative study of echotomography and percutaneous transhepatic cholangiography in the diagnosis of obstructive jaundice]. / Confronto fra ecotomografia e colangiografia percutanea transepatica nella diagnosi dell'ittero ostruttivo.

The authors compare the results of sonography (US) and percutaneous transhepatic cholangiography (PTC) in the study of 48 patients with obstructive jaundice. The results obtained were correlated to various diagnostic levels and to the different causes of obstruction. The analysis of the results led the authors to believe that, in most cases, the association of both techniques is absolutely necessary in order to define the whole diagnostic picture.

[Radiological diagnosis of tumours of brain stem (author's transl)]. / Diagnosi radiologica dei tumori del tronco cerebrale.

Cerebral pneumography, positive ventriculography and vertebral angiography were employed in the examination of 154 of tumour of brain stem at Departments of Neuroradiology in the city of Naples between 1962 and 1974. The findings in various sites are described and discussed and several examples are presented.