[Gastrointestinal opportunistic infections and human immunodeficiency virus (HIV). Case report]. / Infezioni opprtuniste gastrointestinali e HIV. Caso clinico.

There have been millions of people found to have AIDS. Death rates from AIDS have declined 15% to 20% in the past 5 years. However, nearly 75000 people will die with AIDS in this year. Patients with AIDS are also at risk for developing both Aids-defining cancers, such as Kaposi's sarcoma and non-Hodgkin lymphoma, and non-Aids-defining cancers and opportunistic infections. In patients with advanced Aids, the Cytomegalovirus is a frequent cause of chorioretinitis, pneumonitis, chronic perineal ulcerations and oesophagitis. It has been involved in endocrine, bone marrow, central nervous system and kidney abnormalities. CMV infection of the small bowel accounts for only 4.3% of all cytomegalovirus infection of the GI tract (large bowel 47%, duodenum 21,7%, stomach 17,4%); isolated cases of small bowel perforation due to CMV have been reported in AIDS patients, and all but one patient died. The Authors report a rare case of an HIV-positive young man with gastroenteric Cytomegalovirus infection responsible for generalized peritonitis from multiple perforations.

Appendicitis and abscess in an adult patient with intestinal nonrotation: Case report.

The aim of the article is showing a particular case of midgut nonrotation. It is a congenital defect of the bowel development, during which fails the rotation of 270° around the vascular pedicle. This anomaly causes a different intestinal arrangement: the small bowel is located in the right side of abdominal cavity while the large bowel is situated in the left side. We present a case of acute appendicitis and abscess treated successfully with urgent surgical intervention in a patient completely asymptomatic for nonrotation. Nonrotation may lead to acute symptoms, vague abdominal pain or may remain asymptomatic throughout all life and be discovered only accidentally. Radiological exams and laparoscopy can help to make a correct diagnosis. A conservative treatment could be preferred in asymptomatic patients and Ladd's surgical procedure should be performed in selected cases.

[Endoscopic treatment combined with adrenaline injection and coagulation with argon plasma in gastroduodenal peptic ulcer bleeding]. / Trattamento endoscopico combinato iniezione di adrenalina e coagulazione con Plasma di Argon (APC) del sanguinamento da ulcera peptica gastro-duodenale.

Although endoscopic injection therapy is an effective method for bleeding peptic ulcers, it is associated with significant re-bleeding rate; whether the addition of thermal method improves the outcome is still unclear. Our previous experience showed that Argon Plasma Coagulation (APC) alone is not sufficient in stopping spurting haemorrhage, and potentially dangerous for large non bleeding visible vessels (NBVV). Our hypothesis was that combination of adrenaline injection (AI) and thermal therapy could be more efficient than thermal therapy alone for permanent haemostasis of active bleeding peptic ulcers, and particularly appropriate for NBVV treatment. From October 1998 to February 2000 we examined two hundred patients with upper gastrointestinal bleeding. Fifty-three patients with major peptic ulcer haemorrhages received combined injection therapy with adrenaline 1:10.000 and Argon plasma coagulation; there were 34 male and 19 female with a mean age of 63.2 +/- 1.2 years (range 22-93). The bleeding site was duodenal in 30 patients, gastric in 17 patients, anastomotic in 5 patients and esophageal in 1 patient. Endoscopic findings were the following: active bleeding in 23 patients (6 spurting, 17 oozing), non bleeding visible vessels in 12 patients and fresh adherent clots in 18 patients. Initial haemostasis was achieved in 52/53 patients (98.1%). Re-bleeding was observed in 5/52 cases (9.6%). Surgery was necessary in 3/53 patients (5.6%). Mortality was 7.5% (4 cases). No major complications resulted from this treatment. Primary adrenaline injection provided initial bleeding arrest, facilitating the following application of APC, because of a more precise definition of the active bleeding site. Rates of initial hemostasis were significantly higher with combined therapy (injection + APC) compared to APC treatment alone. We believe that Adrenaline and APC combined therapy is an effective and safe method for treatment of non-variceal gastrointestinal bleeding.

[Unusual case of kidney rupture]. / Un raro caso di rottura di rene.

The Authors report a case of renal rupture in a patient 36 years with acute abdominal pain and progressive anaemia. The history of the patient shows no past signs and symptoms of either renal pathology or traumatic event. Radiological examinations demonstrates dislocation of the kidney through presence of large retroperitoneal formation interpretable as haematoma. Progressing bloodless, they proceeded to embolization of renal artery and successive nephrectomy. Only histological examination of the removed kidney demonstrates the presence of a renal clear cells adenocarcinoma.

[Peritoneal papillary serous carcinoma: clinical report]. / Il carcinoma papillare sieroso del peritoneo: caso clinico.

Peritoneal papillary serous carcinoma (PPSC) is a rare tumour that involves the surface of the peritoneum, with prevalence in female patients and can originate from a single or multicentric focus is here described. A primary peritoneal serous carcinoma is here described. The patient has been treated with paclitaxel 175 mg/m2 and carboplatinum AUC 6.

Treatment of permagna incisional hernia with skin necrosis and abscess: case report.

Ventral incisional hernia rate is decreasing due to the introduction of new clinical and surgery method. As a result, the complex incisional hernias, are less often described and rarely treated. We describe our experience in emergency case. We present the case of permagna incisional hernia with skin necrosis, subcutaneous abscess and bowel perforation which cause a long-lasting bedding. The successful management includes an emergency surgery applying hernia reduction, bowel resection and abdominal wall reconstruction through a biological mesh and positioning of VAC System. There is not a gold standard treatment that obtained an unanimous consensus, however we recommend the following procedure in that, in our patient, it shows no recurrences, infections and other post-operative complications.