Acute respiratory distress following fine needle aspiration of thyroid nodule: case report and review of the literature.

BACKGROUND: Fine needle aspiration (FNA) is a widely used practice to assess thyroid lesions, with a low morbidity rate. Although neck hematomas following this procedure are quite common, only three cases of massive hemorrhage causing acute airways obstruction have been previously described. CASE REPORT: We report the case of a 74 years old female with acute respiratory distress following ultrasound-guided FNA for a right paraisthmic thyroid nodule. The patient was admitted to the Emergency Room (ER) 6 hours after the procedure with a large neck hematoma compressing the cervical trachea and requiring surgical decompression. Patient underwent endotracheal intubation followed by isthmectomy and evacuation of the hematoma. Extubation was made 24 hours later in the Intensive Care Unit and the patient was discharged after 48 hours uneventfully. CONCLUSIONS: Acute thyroid hemorrhage following FNA is very rare but still possible. Prompt intervention is mandatory for patients with rapidly evolving symptoms.

[Burkitt's lymphoma of the caecum in a patient with AIDS: clinical case and review of the literature]. / Linfoma di Burkitt del cieco in paziente con AIDS conclamato: caso clinico e revisione della letteratura.

Overall, lymphomas of the gastrointestinal tract are rare, although they are the most frequent extranodal location. The incidence of primary colic lymphoma, above all in the non-Hodgkin variant, is clearly higher in the HIV positive population, especially in subjects with AIDS. The authors present the case of a 51-year-old patient with AIDS undergoing antiviral therapy; he was suffering from abdominal pain and presented a palpable mass in the right iliac fossa; diagnosis was caecal non-Hodgkin lymphoma (NHL); radical right hemicolectomy was carried out with definitive histological diagnosis of Burkitt-type small cell NHL. The NHL of the colon represents no more than 1.2% of all malignant cancers of this part of the intestinal tract. Nevertheless such cases are comparatively frequent in patients with HIV virus, especially in the active phase and clinically proven to be due to immunodeficient syndrome. Of cardinal importance is the differential diagnosis between primary and secondary forms because of the different treatment and prognosis. Frequently such forms are observed in patients with AIDS, at advanced stages and with differentiated and hence more aggressive histotypes, also because they are present in organisms weakened by the underlying disease and by immunodeficiency. Primary NHLs of the colon are relatively frequent and aggressive in patients with AIDS; early diagnosis and treatment are therefore of fundamental importance to improve the oncological outcome for these patients.

[Validity of ano-rectal manometry in the diagnosis of cathartic colon as a cause of chronic pseudo-obstruction of the colon. Considerations on a case]. / Validità della manometria ano rettale nella diagnosi di colon catartico causa di pseudo ostruzione cronica del colon. Considerazioni su di un caso.

Cathartic colon is a rare pathology which hits old people and is radiologically characterized by dolichocolon and megarectum. It is nearly sure that the unusual length of the whole colon might be the first source of the cathartic disease. Rectal ampulla dilatation (megarectum) is due to the extended use of laxatives which induce changes in smooth muscle and in the myenteric nervous plexus. The anatomo-pathological changes of the rectum have been proved so far by histological examination of local and deep biopsy; now, in our opinion, they can be shown by manometry. The authors emphasize the possibility that cathartic colon might give episodes of diarrhoea and also recurrent bowel obstructions limited to the colon and so-called "chronic pseudo-obstruction" of the colon. They describe a case of this rare pathology admitted and treated in their ward. Gastric and esophageal motility in the patient was normal as was the motility of the upper rectum. Therefore they think that changes resulted from extended use of cathartics. In both cases patients show low manometric pressure, disordered peristalsis and in particular lack of internal anal sphincter relaxation in response to high balloon distension. As the occlusive status developed in an old patient (the patient was 81 years old), the authors think that the functional disorders were absent at birth. Cathartic colon is, in the authors experience, a cause of chronic pseudo-obstruction of the colon. Rectal manometry makes it possible to avoid surgical treatment. The therapy of pseudo-occlusion, if correctly diagnosed, consists in endoscopic intubation and decompression of the colon.(ABSTRACT TRUNCATED AT 250 WORDS)

[Synchronous and metachronous carcinoma of the large intestine]. / Carcinomi sincroni e metacroni del grosso intestino.

The Authors report their experience about 20 cases of multiple large bowel adenocarcinomas, 9 of them synchronous and 11 metachronous. After developing a brief reexamination of epidemiology and etiopathogenesis, they explain their diagnostic and therapeutic considerations. The necessity of a real complete and exact radiological and endoscopical preoperative study, being also early, is at last emphasized, as well as an accurate postoperative follow-up.

[Rupture of the pancreas after closed injury of the abdomen (presentation of a case, clinical and therapeutic notes)]. / Rottura del pancreas in seguito a trauma chiuso dell'addome (presentazione di un caso, note cliniche e terapeutiche).

The authors observed a case of a complete breaking of pancreas between head and body associated to a serious lesion of the liver, favourably treated in emergency by means of a subtotal splenopancreatectomy and a suture of the hepatic lacerations, and that gave them the occasion to think over the serious risks linked with an insufficient evaluation of a pancreatic lesion and its most appropriate surgical treatment. In details, personal experience and the examination of Literature showed that in the laparotomy it is absolutely necessary to examine all the gland carefully and methodically in order to recognize and evaluate accurately the pancreatic lesion, which is often concealed by the massive manifestations caused by the concomitant lesions of other intra-abdominal viscera. Besides, among the suggested surgical techniques, the subtotal splenopancreatectomy proved to be the safest, bringing no consequences from the functional point of view, even when extended to more than 80% of the glandular tissue.

[Submucosal lipomas of the colon (considerations apropos of 3 clinical cases)]. / I lipomi sottomucosi del colon (considerazioni a proposito di tre casi clinici).

Submucous colonic lipoma is relatively rare and can be the cause of important diagnostic and consequently therapeutic problems. The AA. reexamine the anatomo pathological and clinical features and the diagnostic and therapeutic problems, and refer 3 cases observed one of which was localized in the ileo-cecal valve. The AA. remark that radiological and endoscopic investigations and laparotomy features also can simulate a malignant tumor and address to the surgical technics of the oncologic surgery.

[2 cases of annular pancreas]. / Su due casi di pancreas anulare.

The AA. happening to observe two cases of annular pancreas, took the opportunity to study its etiopathogenetic, anatomo-clinical, diagnostic and therapeutic features. In particular, even considering the validity of the recently proposed duodeno-plastic modelling approach, they affirm a more valid technic, the latero-lateral duodeno-duodeno anastomosis surmounting the annular pancreas when one is not dealing with pre-stenotic duodenal dilations of elevated degree.

[External duodeno-pancreatic fistulas. Proposal of an associated treatment: aspiration with a nutripump and infusion of lactic acid]. / Le fistole duodeno-pancreatiche esterne. Proposta di trattamento associato: aspirazione con nutripompa ed infusione di acido lattico.

A technique is proposed for a conservative treatment of the duodenal-pancreatic fistula. The use of a two-way peristaltic pump; with normal flux for the enteric route and inverted flux for aspiration with terminal in external fistula allowing for in the meantime a constant infusion of lactic acid.

[Critical evaluation of the protracted use of somatostatin in the conservative treatment of complex pancreatico-duodenal fistulas]. / Valutazione critica dell'impiego protratto della somatostatina nella terapia conservativa delle fistole complesse pancreatico-duodenali.

The authors refer to their experience in dealing with prolonged intravenous infusion of Somatostatin in treating two cases of complicated duodenal-pancreatic fistula. The results confirm the therapeutic efficiency in accelerating the healing process without any side effects of the drug.

[Short-term effects of cimetidine in patients with bleeding duodenal ulcer. Presentation of cases]. / Effetto a breve termine della cimetidina in pazienti affetti da ulcera duodenale sanguinante. Presentazione della casistica.

The authors here present a work dealing pith two groups of subjects, both groups having the diagnose of bleeding duodenal ulcer; one group using therapy antacid alone, the other using cimetidine and antacid. This last is more affected in controlling bleeding then just using antacids alone. Moreover the use of cimetidine reduces the period of bleeding, increases the number of subject who stop bleeding and reduces the amount of blood transfused in these subjects. We are also convenced that the use of cimetidine even prolong in time, does not protect these subjects from having other relapse. Therefore propose the Billroth II and from own experience this is a good therapy to prevent other bleeding.

[Passage from the thigh to the retroperitoneum through the obturator foramen of an enormous recurrent lipoma]. / Estrinsecazione dalla coscia al retroperitoneo, attraverso il foro otturatorio, di un enorme lipoma recidivante.

The authors refer to an enormous lipoma relapsing from the thigh and the retro-peritoneum space which they have observed. Underlying the rarity of the case, they reveal their reasons whereby one must consider the origin of this lipoma the medial region of the thigh, and the foramen obturatorium the passage-way of the same lipoma from the thigh to the retroperitoneum. Furthermore considering the frequent impossibility of complete removal of these extremely developed lipomas rendering a reserved quod vitam prognosis.

[Wilkie's syndrome: etiopathogenetic, clinical and therapeutic aspects of some cases we have seen]. / La sindrome di Wilchie: considerazioni eziopathogenetiche, cliniche e terapeutiche su alcuni casi giunti alla nostra osservazione.

The Authors hold that for the onset of the clinical manifestations of the Wilchie's syndrome the contemporary appearance of 2 causes is necessary: the first is an anatomical variance of the organs comprising that particular anatomical location and the second being a pathological alteration taking place in one or more of these set organs. Moreover they suggest appropriate surgical procedure art at removing both causes that produced the disease.

[A rare clinical manifestation of intestinal carcinoid conditioning mesenteric vascular insufficiency (author's transl)]. / Una rara manifestazione clinica del carcinoide intestinale condizionante insufficienza vascolare mesenterica.

The Authors after having paid considerable attention on the contemporary existence of numerous carcinoid tumours of the intestine and of other abdominal organs, as well as on the frequent multicentricity exhibited by the very same at the level of the last tract of the ileum, explain this by considering the recent research performed on the APUD cells and on the cells of the diffuse endocrine system (DES) of the intestine. They present a carcinoid case, where it is understood that the product of secretion of the same, still not completely identified in its structure and mode of action, produces an arterial vascular alteration even at considerable distance from the tumour, hence bringing about an intestinal ischemic symptomatology which they hypothesize is the case for all the cells of the intestinal diffuse endocrine system, a type of self-regulatory feed-back hormonal system.

[Schwannoma of the rectum. Clinico-therapeutic study]. / Lo schwannoma del retto. Contributo clinico-terapeutico.

On the basis of a case of rectal Schwannoma and a review of the literature on this rare condition, stress is laid on the clinical features, diagnostic difficulties and indicated surgical therapy approaches. The need for radical operation, because of the tendency of the form to recur locally and because of the real possibility of malignant degeneration in this event, is stressed. Emphasis is also laid on the problem of making a certainly benign diagnosis even histologically.