[Therapeutic and diagnostic protocol for mild acute biliary pancreatitis: our experience and review of the literature]. / Protocollo diagnostico terapeutico della pancreatite acuta biliare lieve: nostra esperienza e revisione critica della letteratura.

Through a critical review of the literature, the authors analyze and re-assess the current diagnostic and therapeutic algorithms used in the treatment of mild acute biliary pancreatitis, reporting their experience with 27 cases observed in the Policlinico Umberto I Emergency Department (Rome) over the period from March 2003 to May 2005. All patients were treated with the same diagnostic and therapeutic protocol: once the diagnosis of acute biliary pancreatitis had been made and the severity evaluated, patients presenting clinical or ultrasonographic signs of main biliary duct stones underwent ERCP within 72 hours of onset of symptoms. All patients then underwent a standard-technique laparoscopic cholecystectomy during the same hospital stay, and whenever ERCP had not been performed preoperatively, an intraoperative cholangiography was performed at the time of surgery. No intra- or postoperative complications were observed, with a mean hospital stay of 10.6 days (range: 5-25 days).

[Treatment of esophageal perforations. Considerations on a clinical case]. / Trattamento delle perforazioni esofagee. Considerazioni su un caso clinico.

The Authors describe a rare case of esophageal perforation occurred after Transoesophageal echocardiography in 68 years old patient and review the literature relating to the causes and management of this pathology. Transoesophageal echocardiography, which is a semi-invasive investigation increasingly used in cardiology and cardiac surgery and intensive care units, is a rare though extremely dangerous cause of such complications. Perforation of the esophagus continues to present a formidable diagnostic and therapeutic challenge. The diagnosis depends on a high degree of suspicion and on the recognition of clinical features and is confirmed by contrast esophagography. The outcome after esophageal perforation depends on the location of the injury, the presence or otherwise of concomitant esophageal disease and the time elapsing between the injury and inititian of treatment. Reinforced primary repair of the perforation is the procedure most frequently employed and preferred for the surgical management of the esophageal perforation. In the case reported here, early diagnosis and prompt surgical treatment consisting in primary repair of the esophageal perforation contributed to the successful management of this serious pathology.

[Drug-induced acute pancreatitis: a personal contribution]. / Pancreatite acuta da farmaci: contributo personale.

Drugs are commonly considered a rare cause of acute pancreatitis but there are an increasing number of reports of numerous medications that seem to be involved in the pathogenesis of acute pancreatitis with different degrees of causative relationship to the disease (definite--probable--possible). The number of drugs that have been associated to date with acute pancreatitis exceeds 260. The authors report here on their personal series of four cases of drug-induced acute pancreatitis (warfarin, lysinopril/hydrochlorothiazide, lamivudine/stavudine/indinavir, valproic acid), focusing on a number of epidemiological and clinical aspects.