Acute thrombosis of abdominal aorta and hypercoagulable disorders.

Acute abdominal aortic occlusion (AAAO) is a rare, life threatening condition, which usually occurs in elderly patients, causing challenging management issues. In patients who have no cardiac or vascular disease this catastrophic event is very rare and is due to hypercoagulable disorders. This study reviews the literature on AAAO in hypercoagulable states in the light of our experience on a case of an acute thrombosis of nonaneurysmal, nonatherosclerotic abdominal aorta in a female patient with protein S deficiency and Sjögren's syndrome and her younger brother, which was found to have atherosclerotic involvement of distal aorta and elevation in homocysteine levels. Because of a misleading clinical presentation, the diagnosis was delayed and conservative treatment failed. Both were successfully treated with emergency aorto-bifemoral grafting. Other cases of arterial thrombosis and hypercoagulable disorders were found in first-degree relatives. Our experience and the review of the literature suggest that the interaction between host and environment factors can lead to acute thrombosis of the non-pathologic abdominal aorta; not only classic hypercoagulability disorders, but also immunologic, metabolic, toxicological cofactors can be involved. Delay in diagnosis is frequent and may not influence the prognosis, but does not allow conservative therapy. Prognosis depends mainly on pathologic cofactors that require detection and appropriate treatment in order to prevent complications and recurrences.

A mini-invasive technique for axillary lymphadenectomy in early breast cancer: a study of 15 patients.

Axillary lymphadenectomy is the major cause of morbidity reported in breast surgery, but remains the gold standard in breast cancer staging procedures. The aim of this study was to evaluate if endoscopic lymphadenectomy, preceded by fat suction, could reduce morbidity and hospitalization, giving better aesthetic results, while conserving the same oncologic radicality as the traditional open technique. We studied 15 cases of breast cancer with tumour diameter < or = 25 mm, N0. The subjects underwent endoscopic lymphadenectomy. We removed an average of 15.5 node/patient, the volume of lymphorrea was 580 ml, the drainage was kept up for 5 days, the mean length of hospitalization was 6 days. One seroma (4.6%) was found. No shoulder restriction has been reported and aesthetic results were excellent. The follow-up will demonstrate if this technique can reduce the incidence of lymphoedema.

[Enteral feeding in the treatment of severe anorexia nervosa]. / La nutrizione enterale nel trattamento della grave anoressia nervosa.

A programme of integrated enteral nutrition treatment is proposed for severe cases of anorexia nervosa. Such treatment seems better to satisfy patients' requirements and is closer to normal physiological nutrition. Treatment techniques are described and the results discussed, while the advantages of this therapy over all other methods used until now are underlined.