Gastroduodenal major haemorrhages in critical patients: an original surgical technique.

AIM: Upper gastrointestinal bleeding represents today a serious pathology with two important problems: mortality and correct management. Our study is a review of recent and past licterature about causes, diagnosis and treatment of upper gastrointestinal bleeding. PERSONAL EXPERIENCE: The Authors describe an original surgical technique in treating patients with gastroduodenal haemorrhages and critical circulatory-coagulative conditions. Any surgical resective procedure could be absolutely inacceptable for the rates in morbility and mortality in these absolutely instable patients. We approached the problem with a control damage surgery by endoluminal packing of the stomach or the duodenum.

[Emergency colonic surgery: analysis of risk factors predicting morbidity and mortality]. / Chirurgia del colon in urgenza: analisi dei fattori di rischio di morbilità e mortalità.

The aim of the present study was to identify risk factors for morbidity and mortality in patients submitted to emergency colonic surgery. Between 1997 and 2008 157 patients, 106 of whom affected by colon cancer (67.5%) and 51 by benign disease (32.5%), were treated. The risk factors for morbidity and mortality were evaluated by univariate and multivariate analysis considering clinical and demographic data. The overall 30-day morbidity and mortality rates were 19.1% (30 patients) and 12.7% (20 patients), respectively. Among patients affected by cancer the mortality rate was 15% (16 patients) and the morbidity rate 23.6% (25 patients), while among the patients with benign disease the mortality rate was 7.8% (4 patients) and the morbidity rate 9.8% (5 patients). No postoperative surgical complications were noted. The strongest risk factors for early death were postoperative medical complications such as cardiopulmonary, renal, thrombo-embolic and infectious complications. The results of the univariate analysis showed that advanced age, neoplastic disease, advanced stage of cancer and associated medical disease prior to surgery play a role as risk factors for morbidity and mortality. In the multivariate analysis only the presence of associated medical disease proved to be a significant independent predictor of outcome. Emergency surgery for both neoplastic and benign colonic disease is still associated with an increased risk of death. Although restorative colectomy should be regarded as the first choice procedure in the emergency setting, Hartmann's procedure is still widely used in high-risk patients.

[Cervico-mediastinal teratoma. A case report and review of the liberature]. / Sindrome dispnoizzante acuta da teratoma cervico-mediastinico. Descrizione di un caso e revisione della letteratura.

Cervical teratomas are very rare tumors. Actually, most of the times they appear as a cervical extension of a mediastinal teratoma due or to intracystic haemorrhage and/or a higher content of pancreatic tissue. Progressive growth and compression on adjacent organs, as the tracheo-bronchial tract in our case, can be the arising symptoms that determine hospital admission of the patient. Histologically, they are classified as mature, benign in 95% of cases, immature and malignant tranformation. Complete surgical removal is the elective treatment. We report a rare case with significant respiratory symptoms due to extrinsic compression and a review of the literature.