Isolated jejunal perforation after blunt trauma. Report of three cases.

Small bowel perforation occurs in 3% to 5% of cases of blunt abdominal trauma. The initial clinical exam can be unremarkable because signs of hollow viscus injury (HVI) may take time to develop. Conventional radiograms are often unable to diagnosis of this subset of trauma. Three cases of jejunal perforation after a blunt abdominal trauma are described. One of these showed at laparotomy small sero muscular diastasis of the jejunum and multiple ecchymosis of the small bowel without peritonitis. The detection of this subset of trauma patients has improved markedly with CT, which has led to a decrease in the number of negative laparotomies performed. In our report CT imaging showed a increased thickness of bowel loop wall in left ipocondrium in the first and second case. In our small experience this sign suggest us a jejunal contusion in which an isolated perforating is always possible.

[Duplex US evaluation of mesenteric vessels in acute abdomen. Prospective study on 325 patients]. / La valutazione ecocolor-Doppler degli assi vascolari mesenterici nell'addome acuto. Studio prospettico su 325 pazienti.

BACKGROUND: Acute Mesenteric Insufficiency (AMI) is a surgical emergency with a difficult methodological approach. Its high mortality is mainly due to delay in the correct diagnosis. In turn this is due to the lack of specificity of the clinical presentation and of the laboratory data and abdominal radiographic findings, especially in the early-middle phase. PURPOSE: To evaluate the positive predictive value (PPV) and negative predictive value (NPV) of Duplex Ultrasound (DU) of mesenteric vessels in the diagnosis of acute mesenteric ischaemia. PATIENTS AND METHODS: 325 patients were prospective analyzed with Duplex US (Aloka ssd 1700); 120 with acute abdomen (group A); 120 healthy subjects without abdomen preparation (group B); 85 healthy subjects with abdomen preparation (group C). We considered the B mode visualization, the vessel extension and diameter, the colour signal capture (enhancement), the velocitograms with systolic peak velocity and medium diastolic velocity. RESULTS: In 32 patients with high suspect of AMI we founded 21 really negative results, 3 wrong positive results, 5 really positive results, 3 false negative results. The PPV and NPV were respectively 0.62 and 0.87. CONCLUSIONS: The Duplex Us is more useful rather exclude than confirm AMI.

[Retroperitoneal sarcomas: our experience]. / Tumori dei tessuti molli a localizzazione retroperitoneale: la nostra esperienza clinica.

BACKGROUND: Retroperitoneal soft tissues sarcomas (STS) are relatively uncommon and constitute a difficult management problem. Although surgical resection is often difficult or impossible, current chemotherapy is not effective and radiation is limited by toxicity to adjacent structures. Thus, complete surgical resection remains the most effective modality for selected primary and recurrent disease. PATIENTS AND METHODS: Fifteen patients with retroperitoneal STS were admitted and treated between January 1990 and January 2003, and prospectively followed. Nine patients underwent complete surgical resection of 8 malignant and 1 benign tumor. Two patients underwent incomplete surgical resection of 1 malignant and 1 benign tumor. Patient, tumor, and treatment variables were analyzed for disease-specific and disease-free survival. RESULTS: The patients with unresectable disease, incomplete resection, and high-grade tumors presented significantly reduced survival time. In this study, stage at presentation, high histologic grade, unresectable primary tumor, and positive gross margin are strongly associated with the tumor mortality rate. CONCLUSIONS: Patients approached with curative intent should undergo aggressive attempts at complete surgical resection. Incomplete resection should be undertaken only for symptoms relief. Because death often occurs as a result of local progression in retroperitoneal liposarcomas, it is possible that incomplete resection may be beneficial in this histologic type. Complete surgical resection is the most effective modality for the treatment of retroperitoneal sarcomas.

[Spigelian hernia. Diagnosis and surgical treatment]. / Ernia di Spigelio: diagnostica e trattamento.

Spigelian hernia (SH) is a rare partial abdominal wall defect; its manifestation is rare. Seven cases were observed--4 females and 3 males with mean age of 56.5 years (range 38-65)--in 857 patients operated for hernia (0.8%) between 1995 and 2003. Ultrasound examination avoid the diagnosis and marked the fascial defect, measuring diameter and sac contents. In all cases a surgical approach with an epicritic incision has be done and the fascia defect closed with properitoneal and subfascial polypropylene mesh (Prolene Hernia System, PHS). All patients underwent to follow-up demonstrating no recurrences or complications like mesh suppuration or dislocation.

[Color Doppler ultrasound in acute mesenteric ischemia: 2 case reports]. / Il rilievo ecocolordoppler nell'ischemia mesenterica acuta: descrizione di due casi clinici.

Acute mesenteric insufficiency is a surgical emergency with a difficult methodological approach. Its high mortality is mainly due to delay in the correct diagnosis. In turn this is due to the lack of specificity, especially in the early-middle phase of the clinical presentation, and of the laboratory data and abdominal radiographic findings. Echo-doppler ultrasound promises to be more accurate than conventional ultrasound in the diagnosis of visceral ischemia and may help to identify those patients who may require angiography. Two women presenting atrial fibrillation, abdominal pain, leukocytosis, hyperamylasemia were accepted in October 2000 ad March 2001. US colordoppler was performed 12 hours after admittance demonstrating a "stop" of enhancement of the superior mesenteric artery in one case and absence of enhancement in the other.

[Papillary microcarcinoma of the thyroid. Clinical implications and therapeutic strategy]. / Il microcarcinoma papillare della tiroide. Implicazioni cliniche e strategia terapeutica.

The Authors examine their experience about clinical implications and therapeutic strategies on Papillary MicroCarcinoma (PMC) of the thyroid gland. Clinical charts of 412 patients, who underwent thyroid surgery, were analyzed. The Authors stress "incidental diagnosis", benign associated lesions and frequency of population presentation; they conclude that the total thyroidectomy is the procedure of choice with oncology validity.

[Defect of the broad ligament as a cause of internal hernia]. / Un difetto del legamento largo dell'utero causa di ernia interna.

Herniation of small bowel trough a defect of the broad ligament is an extremely rare event, more over in women never had surgical operations. Pathogenetic hypothesis are considered. Differential diagnosis may be difficult. The Authors report a recent observation of such small bowel herniation trough the left mesosalpynx.

[Therapeutic strategies in differentiated cancer of the thyroid: total thyroidectomy]. / Strategie terapeutiche nel cancro differenziato della tiroide: la tiroidectomia totale di principio.

Differentiated thyroid cancer is peculiar for its prognosis often excellent. The Authors report their experience about 78 patients affected with differentiated thyroid carcinoma, operated between 1976-1999 at the Institute of Surgical Pathology and Surgical Clinic of Cagliari University. 70 (89.7%) patients underwent total thyroidectomy, 6 (7.5%) subtotal thyroidectomy and 2 (2.5%) thyroid lobectomy. In 11 patients total thyroidectomy was performed in two times within 60 days after initial lobectomy. Tumor was found in 2 (18%) of 11 of the reoperations. Lymphadenectomy was performed only in presence of cervical lymph nodal metastases. Following 70 total thyroidectomy the incidence of recurrent nerve palsy was 4.2% and permanent hypoparathyroidism 11.4%. 79% patients received adjuvant postoperative radioiodine therapy to ablate residual functioning tissue or distant suspected metastases. After a mean follow up period of 5.8 years, recurrences developed in 10.2%. Any local recurrences, 5 (6.4%) cervical nodal recurrences, 3 (3.8%) distant metastases were encountered. Two (2.5%) of the three patients with recurrence distant metastases died from thyroid carcinoma. The Authors identify total thyroidectomy as the minimal procedure. Surgical management of the cervical nodes is recommended only in the presence of metastatic lymph-nodes. Post surgical ablation with I131 of microscopic remnants optimize detection and treatment of the recurrence and distant metastases.