[Synchronous gastric and oesophageal cancer: a case report]. / Neoplasia sincrona dello stomaco e dell'esofago: caso clinico.

We describe the case of a male patient, aged 50, affected by an undifferentiated cancer of the gastric stump of a Billroth II gastric resection associated with a well-differentiated squamous-cell cancer of the oesophagus. The patient was submitted to gastrectomy and removal of the oesophagus together with reconstruction trough colon interposition. The association of the two synchronous neoplasms of the stomach and oesophagus is a very uncommon event, as the evidence in the medical literature demonstrates. Nevertheless, for the purposes of achieving in the right surgical planning, it is important to take this possibility into consideration in the preoperative management of oesophageal cancer, through the study of the organs which could be used to reconstruct the transit (stomach, colon). The association with a gastric neoplasm implies the use of the other organs (colon, ileum). However, for a number of selected cases of association with early gastric cancer, Japanese authors have suggested using the stomach in place of the oesophagus.

[Blunt liver trauma: therapeutic options]. / I traumi chiusi del fegato: opzioni terapeutiche.

Therapeutic options for management of blunt hepatic trauma include both non-operative and operative management, until liver transplantation. The presence of associated intraabdominal lesions increases mobility and mortality. A total of 58 patients with blunt hepatic injury, observed at the 2nd Surgical Unit of the "Santa Chiara Hospital" of Trento over a four-year period (1999-2003), were analyzed. Thirty-eight patients (65.5%) were treated conservatively with a 94.7% success rate. Twenty (34.5%) patients were surgically treated. Suture hepatorraphy was the most common procedure performed. The overall morbidity in surgical patients was 25%, with 20% of liver related complications. Four patients (20%) died with a liver related mortality of 10%. Advantages of non-operative management included a reduced need for transfusion (1.1 vs. 4.3 U), with 81.5% of patients not requiring transfusion, a reduced stay in the ICU and a reduced rate of morbidity and mortality (2.6% vs. 20%). Hemodynamic instability and the presence of an associated lesion in blunt hepatic trauma patients require emergency laparotomy. The widespread application of non-operative management has reduced the rate of morbidity and mortality related to unnecessary surgical approaches.