Risk factors for postoperative pancreatic fistula following non-traumatic, pancreatic surgery. Retrospective observational study.

Pancreatic surgery e pancreatic fistula (POPF) is a potentially fatal sequela with substantial morbidity and mortality. POPF incidence and risk factors vary. This study aimed to evaluate the incidence and risk factors of patients with pancreatic fistula (PF) from patients undergoing various pancreatic surgeries for different pancreatic diseases. MATERIAL AND METHODS: A retrospective observational study was conducted in the surgical unit of our university hospitals from July 2014 to July 2019. Three hundred forty-seven patients were admitted with a clinical diagnosis of pancreatic fistula following both open and laparoscopic approaches for pancreatic benign and malignant tumors. RESULTS: The most prevalent age was >60 years (67%), with a male predominance (83%). The most common diagnosis before surgery was pancreatic head adenocarcinoma (32%), followed by duodenal neoplasm (19%) and true epithelial pancreatic cystic neoplasms (18%), ampullary neoplasms (15%), bile duct neoplasms (12%), neuroendocrine neoplasms (2%), and chronic pancreatitis (2%). The most prevalent site of the pancreatic tumor was the head (87%), while accompanied Jaundice (47%) and epigastric discomfort (37%) were the commonest presentations before surgery. Pancreatic duct diameter greater than 3 mm was present in 208 patients (60%), tumor size greater than 3 cm in 63%, hard pancreatic texture in 67%, and preoperative ERCP with a stent in 37% of cases. Tumor in the tail of the pancreas was found in 5% (17 patients) of cases. The commonest operations performed were open pylorus-preserving pancreaticoduodenectomy, open pancreaticoduodenectomy without pylorus-preserving, and open distal pancreatectomy with splenic preservation. Postoperative pancreatic fistula occurred in 8% of cases (27), with ISPGF grade A (biochemical leak) occurring in 17 patients (17/27) and clinically significant POPF occurring in 10 patients (10/27). POPF occurred in 13 patients after distal pancreatectomy, 11 patients after pancreaticoduodenectomy, two cases followed central pancreatectomy, and one. Grade B after pancreaticoduodenectomy and two after distal pancreatectomy. Grade C POPF occurred in four patients after pancreaticoduodenectomy but not after distal pancreatectomy. Age >55 (p=0.00), male (p=0.03), presence of symptom (p=0.0008), location at Head of the pancreas (p=0.0004), elevated CA19-9 (p=0.0004), jaundice (p=0.0001) and pancreatic texture (p=0.00**). CONCLUSION: Pancreatic fistula occurred in 27 patients (8%), a comparatively low incidence. POPF was linked to age, Jaundice, gender, pancreatic head cancer, symptoms, high CA 19-9, jaundice, and a soft pancreas. POPF incidence was higher after distal pancreatectomy, whereas POPF severity was higher after pancreaticoduodenectomy KEY WORDS: Pancreaticoduodenectomy, Pancreatic Fistula, Pancreatic Resection, Postoperative Complications.

Post-stroke aphasia at the time of COVID-19 pandemic: a telerehabilitation perspective.

We report on our remote speech therapy experience in post-stroke aphasia. The aim was to test the feasibility and utility of telerehabilitation to support future randomized controlled trials. Post-stroke aphasia is a common and disabling speech disorder, which significantly affects patients' and caregivers' health and quality of life. Due to COVID-19 pandemic, most of the conventional speech therapy approaches had to stop or "switch" into telerehabilitation procedures to ensure the safety of patients and operators but, concomitantly, the best rehabilitation level possible. Here, we planned a 5-month telespeech therapy programme, twice per week, of a patient with non-fluent aphasia following an intracerebral haemorrhage. Overall, treatment adherence based on the operator's assessments was high, and incomplete adherence for technical problems occurred very rarely. In line with the patient's feedback, acceptability was also positive, since he was constantly motivated during the sessions and the exercises performed autonomously, as confirmed by the speech therapist and caregiver, respectively. Moreover, despite the sequelae from the cerebrovascular event, evident in some writing tests due to the motor deficits in his right arm and the disadvantages typical of all telepractices, more relevant results were achieved during the telerehabilitation period compared to those of the "face-to-face" therapy before the COVID-19 outbreak. The telespeech therapy performed can be considered successful and the patient was able to return to work. Concluding, we support it as a feasible approach offering patients and their families the opportunity to continue the speech and language rehabilitation pathway, even at the time of pandemic.

Implementation of Sample Pooling Procedure Using a Rapid SARS-CoV-2 Diagnostic Real-Time PCR Test Performed Prior to Hospital Admission of People with Intellectual Disabilities.

Reliability, accuracy, and timeliness of diagnostic testing for SARS-CoV-2 infection have allowed adequate public health management of the disease, thus notably helping the timely mapping of viral spread within the community. Furthermore, the most vulnerable populations, such as people with intellectual disability and dementia, represent a high-risk group across multiple dimensions, including a higher prevalence of pre-existing conditions, lower health maintenance, and a propensity for rapid community spread. This led to an urgent need for reliable in-house rapid testing to be performed prior to hospital admission. In the present study, we describe a pooling procedure in which oropharyngeal and nasopharyngeal swabs for SARS-CoV-2 detection (performed prior to hospital admission using rapid RT-PCR assay) are pooled together at the time of sample collection. Sample pooling (groups of 2-4 samples per tube) allowed us to significantly reduce response times, consumables, and personnel costs while maintaining the same test sensitivity.

Functional results of surgical treatment of low-ultralow rectal cancer.

INTRODUCTION: The improvement of surgical procedures and oncological outcomes in the treatment of low-ultralow rectal cancer, made important the evaluation of functional results. The aim of this study is to evaluate the functional results after open and laparoscopic approach. PATIENTS AND METHODS: From our global experience, over the period 2000/2018, within the patients surgically treated for rectal cancer, we have gathered and studied 37 patients with low-ultralow site of lesion, submitted to sphincterpreserving surgery, subdivided based on the approach: 20 open, 17 laparoscopic, of which 8 robotic . For each type of procedure, as low and ultralow anterior resection, intersphinteric resection, abdominoperineal resection, were investigated functional outcomes, as bowel continence, urinary functions, male and female sexual functions, based on the following tests: Wexner Incontinence Score, International Prostatic Symptom Score, International Index of Erectile Function- 5, Female Sexual Function Index. The controls were performed before surgery and 3-6-12 months postoperatively. Statistical analisis: X2-test, impaired and paired t-test two tailed, Bonferroni post-hoctest. RESULTS: The immediate surgical results and pathological features of the tumor are reported and evaluated. The evaluation of fecal continence in all patients submitted to rectal resection and primary anastomosis showed function compromission without differences statistically significant between the laparo and open approach. In the comparison between specific surgical procedures, the damage of continence function were more severe after intersphinteric resection mached with low-ultralow rectal resection. The rehabilitation therapies continued for several months after surgery showed clear improvement. The urinary continence, in male and female patients, did not show statistically significant alterations in the pre and postoperative comparison in relation to the approach and the type of resective intervention. The sexual function in male patients has had impairment after all type of surgical resection but the damage was more severe after intersphinteric resection. The female sexual function had not significant changes between pre and postoperative evaluation. CONCLUSION: Bowel continence damage, urinary and sexual dysfunctions after surgical treatment for low-ultralow rectal cancer are frequent and form the low anterior resection syndrome. The severity of the syndrome is connected with the site of anastomosis. The rehabilitation therapies can play an important role in achieving the appreciable improvements of the functional alterations. KEY WORDS: Laparoscopic surgery, Rectal cancer.

The Ligation of Intersphincteric Fistula Tract Technique: A Preliminary Experience.

PURPOSE: Surgery is the only treatment for anal fistula. Many surgical techniques have been described. The aim of this study was to communicate the authors' preliminary experience in the use of a recently proposed, simplified technique. METHODS: This was a prospective study of 28 patients admitted from January 13, 2016 through July 20, 2017. Patients were managed with the ligation of intersphincteric fistula tract (LIFT) technique and results were observed and documented, including recurrence rate, incontinence rate, and other postoperative complications. RESULTS: A total of 28 patients were studied. The mean operation time was 31 minutes (range, 23-44 minutes), and there were no intra- and postoperative complications. The overall complete healing rate was 85.7%, and the recurrence rate was 14.2%. Follow-up was conducted at 1, 3, and 6 months. CONCLUSION: Many surgical techniques have been described for the treatment of anal fistula. The correct choice of surgical technique out of available procedures is the most important factor for proper treatment and reducing the risk of recurrence or incontinence. In the authors' experience, the LIFT technique is simple and easy to learn, and is a good choice for the treatment of simple anal fistula; however, a tailored surgery remains the gold standard for this condition.

Cervical Esophagotomy for Foreign Body Extraction: A Case Report and Extensive Literature Review of the Last 20 Years.

BACKGROUND Voluntary and involuntary ingestion of foreign bodies is a common condition; in most cases they pass through the digestive tract, but sometimes they stop, creating emergency situations for the patient. We report a case of meat bolus with cartilaginous component impacted in the cervical esophagus, with a brief literature review. CASE REPORT A 64-year-old man came to our attention for retention in the cervical esophagus of a piece of meat accidentally swallowed during lunch. After a few attempts of endoscopic removal carried out previously in other hospitals, the patient has been treated by us with a cervical esophagotomy and removal of the foreign body, without any complications. We checked the database of PubMed, Scopus, and the Cochrane Library from January 2007 to January 2017 in order to verify the presence of randomized controlled trials, clinical trials, retrospective studies, and case series regarding the use of the cervical esophagotomy for the extraction of foreign bodies impacted in the esophagus. CONCLUSIONS The crucial point is to differentiate the cases that must be immediately treated from those requiring simple observation. Endoscopic treatment is definitely the first therapeutic option, but in case of failure of this approach, in our opinion, cervical esophagotomy could be a safe, easy, viable, durable approach for the extraction of foreign bodies impacted in the cervical esophagus. Our review does not have the purpose of providing definitive conclusions but is intended to represent a starting point for subsequent studies.

One stage surgery for synchronous liver metastasis from a neuroendocrine tumor of the colon. A case report.

INTRODUCTION: Neuroendocrine tumors (NETs) are a heterogeneous group of tumors. NET of colon represent less than 1% of colonic tumors. Synchronous liver metastases, present in 75-80%, are considered significant adverse prognostic indicators. Liver is the second commonest site for metastasis in patients with colorectal neuroendocrine tumors. Available treatment options include surgical resection, chemotherapy, biotherapy. Surgery is the gold standard for curative therapy and it is strictly related to the localization, the grade of tumor, and the stage of disease. CASE REPORT: We present a 64-year-old man with clinical carcinoid syndrome. Colonoscopy revealed ileocecal valve vegetating mass with negative biopsy. CT scans of thorax and abdomen showed a voluminous lesion (10 cm of diameter) of right liver. CEA, CA 19.9 and aFP were all normal. Only urinary 5HIAASerum 5-hydroxyindoleactic acid and blood Chromogranin A were positive. Surgical strategy was to treat the primary tumor and the liver synchronous metastasis in one stage surgery. DISCUSSION: Management of NETs liver metastases is challenging and requires aggressive therapy. Currently, there are many therapeutic options for metastatic NETs. Although complete surgical resection remains the optimal therapy and aggressive surgical resection increases the 5-year survival of NETs with solitary liver metastasis to 100%. In this case, clinical status with doubt of carcinoid syndrome was essential for diagnosis and for subsequent surgical strategy with one stage surgery. CONCLUSION: Resection of the primary tumor, liver metastases, and local mesenteric lymph node metastases is thought to strictly promote long-term survival and quality of life. Typically, a multidisciplinary approach is a cornerstone for decision making while dealing with this aggressive disease. KEY WORDS: Carcinoid syndrome, Liver surgery, NETs, Neuroendocrine tumor, One stage surgery, Synchronous liver metastasis.

T-tube biliary drainage during reconstruction after pancreaticoduodenectomy. A single-center experience.

AIM: The purpose of this study is to communicate our experience about the results and effectiveness in the use of the Ttube biliary drainage during pancreaticoduodenectomy. MATERIAL OF STUDY: In accordance whit Whipple we perform the gastric antrum resection during pancreaticoduodenectomy. We have treated 42 patients with pancreaticoduodenectomy, 25 males and 17 females with a mean age of 62 years (range: 53-79 years), and in each of them we have placed a biliary T-tube. RESULTS: Pancreatic fistula was the most common complication and occurred in 10 patients (23.81%), all of these were low-flow fistula (<200 ml) and required only medical treatment. DISCUSSION: Resection of the pancreas is considered a major operative procedure. Pancreatic fistula is the most common complication after pancreaticoduodenectomy, and it was also the most frequent complication observed by us. In pancreaticoduodenectomy T-tube allows lesser risks of complications due to pancreatic fistula and it makes its faster healing. In all cases the treatment was not invasive. CONCLUSIONS: T-tube biliary drainage can make a positive contribution concerning all the complications that can occur after pancreaticoduodenectomy, especially against the pancreatic fistula. KEY WORDS: Pancreaticoduodenectomy, Pancreatic fistula, Pancreas head cancer, Pancreatic Tumors, T-tube drainage.

Hemoperitoneum due to breaking uterine adenosarcoma located in the omentum. Report of a case.

AIM: We report an unusual case of broken adenosarcoma located in the omentum that has procured a clinical situation of acute abdomen in a patient. CASE REPORT: A 79 year-old woman went to the emergency room for growing abdominal pain and then transferred to our department. In previous years the patient had removed endo-cervical and endometrial fibro-glandular polyps and subsequently to a total laparoscopic hysterectomy with bilateral oophorectomy was performed for another endometrial fibroglandular polyp; other vaginal recurrences were then removed. We performed a computed tomography thanks to which we made a diagnosis of moderate hemoperitoneum. RESULTS: The patient underwent to a laparotomy. After abdominal blood removal was evidenced the presence of a damaged big cystic formation starting from the epiploon, containing blood and necrotic debris treated with omentectomy. The subsequent histopathological examination revealed that this tumor was an adenosarcoma. DISCUSSION: Rarely adenosarcoma can grow in extrauterine locations. The simptoms are related to the localization. Even during an emergency surgery it is important to respect the criteria of oncological radicality. You must avoid the tumor dissemination in order to reduce late recurrences, and to achieve a better final histologic diagnosis should avoid intraoperative extemporaneous histological examination. CONCLUSIONS: This case is an example of how many diagnostic pitfalls you can hide in emergency surgery, but in conclusion it remains a doubt about our experience: it is not possible to know if this tumor was a primary extra-uterine neoplasm or a recurrence of fibro-glandular polyps removed years before already in malignant transformation? KEY WORDS: Acute Abdomen, Adenosarcoma, Hemoperitoneum, Omentum.

Are there differences between the right and left laparoscopic adrenalectomy? Our experience.

AIM: The purpose of this study was to determine if there are different outcomes between the right and left laparoscopic adrenalectomy according to our experience. MATERIAL OF STUDY: From September 2010 to September 2015 forty-two LA were performed. Variables compared include age, body mass index (BMI), ASA score, operative time, estimated blood loss, conversions, gland size, tumor size, postoperative ambulation, postoperative hospitalization, perioperative and postoperative complications. RESULTS: Substantially there are no difference in postoperative results between right and left LA. DISCUSSION: We report difference in the operative time because left procedure is more complex. The difference in the blood loss due to two intraoperative bleeding in right side, can be considered a given accidental. CONCLUSIONS: It's important an adequate learning curve to improve intraoperative and therefore postoperative Outcomes. KEY WORDS: Functioning neoplasms, Laparoscopic adrenalectomy, Laparoscopic transperitoneal adrenalectomy, Minimally invasive surgery, Non-Functioning neoplasm.

A recurrent epidermoid cyst of the spleen: report of a case and literature review.

BACKGROUND: Splenic cysts are rare disease. Epidermoid cysts of the spleen belong to the primary nonparasitic splenic cysts group. They are an unusual event in surgical practice. Usually, epidermoid cysts occur in children and young female. Most often, they are asymptomatic, but they may present with abdominal discomfort. CASE PRESENTATION: We are reporting a rare case of a 23-year-old female came to our attention with history of intermittent pain and previously undergone two times to laparoscopic decapsulation of the cyst in others institutions. During hospitalization, serum and intracystic levels of tumor marker CA19-9 increased. Enhanced CT of the abdomen showed recurrent large cyst in the upper pole of the spleen with satellite nodules. Laparotomic total splenectomy was performed. Histopathological and immunoreactive examinations were executed, and they revealed stratified squamous epithelium on the inner surface of cystic wall, which was positive for EMA, CEA, and CA19-9. The diagnosis of epidermoid cyst was confirmed. CONCLUSIONS: Recently, the surgical approach is changing towards conservative treatments in order to save the spleen in young patients for immunological reasons. Sometimes, this target is not achievable. In such circumstances, like recurrent large cyst, anomalous anatomical relationship to the surrounding tissues, total splenectomy is safe and necessary.

Haemostasis in Thyroid Surgery: Collagen-Fibrinogen-Thrombin Patch versus Cellulose Gauze-Our Experience.

Purpose. Postoperative hemorrhage is fortunately uncommon but potentially life-threatening complication of thyroid surgery that increases the postoperative morbidity and the hospital stay. In this study we compare the efficacy of collagen patch coated with human fibrinogen and human thrombin (CFTP) (group C) and oxidized regenerated cellulose gauze (group B) versus traditional hemostatic procedures (group A) in thyroid surgery. Methods. From January 2011 to December 2013, 226 were eligible for our prospective, nonrandomized, comparative study. Patients requiring a video-assisted thyroidectomy without drain, "near total," or hemithyroidectomy were excluded. Other exclusion criteria were a diagnosis of malignancy, substernal goiter, disorders of hemostasis or coagulation, and Graves or hyperfunctioning thyroid diseases. Outcomes included duration of operation, drainage volume, and postoperative complications. Results. Our results show a significant reduction in drainage volume in group C in comparison with the other two groups. In group C there was no bleeding but the limited numbers do not make this result significant. There were no differences in terms of other complications, except for the incidence of seroma in group B. Conclusion. The use of CFTP reduces the drainage volume, potentially the bleeding complications, and the hospital stay. These findings confirm the efficacy of CFTP, encouraging its use in thyroid surgery.

A Rare Case of Functioning Adrenocortical Oncocytoma Presenting as Cushing Syndrome.

Functioning adrenocortical oncocytoma is very rare neoplasm. It is usually nonfunctional and benign and incidentally detected. Generally, these tumors originate in the kidneys, thyroid, parathyroid, and salivary or pituitary glands; they have also been reported in other sites including choroid plexus, respiratory tract, and larynx. Histologically, they are characterized by cells with eosinophilic granular cytoplasm and numerous packed mitochondria. We reported a case of a 44-year-old female who presented with Cushing syndrome for hypersecretion of cortisol due to adrenocortical oncocytoma. Magnetic resonance of abdomen revealed a right adrenal mass. Laparoscopic adrenalectomy was performed and the tumor was pathologically confirmed as benign adrenocortical oncocytoma. After surgical treatment, Cushing's syndrome resolved.

Spleen assessment after laparoscopic transperitoneal left adrenalectomy: preliminary results.

BACKGROUND: Several laparoscopic approaches to the adrenal gland have been described. We prefer the lateral transabdominal approach. The aim of this study is to evaluate prospectively the presence of any anatomical and dynamic changes in the spleen after laparoscopic transperitoneal left adrenalectomy (LTLA), which can cause an increased risk of early and late complications. METHODS: We have evaluated 21 patients before and 6 months after surgery in order to verify the possible presence of a wandering spleen. A clinical and instrumental follow-up [ultrasound (US), magnetic resonance (MR)] were performed. During US protocol, in supine, right lateral, and orthostatic position, the longitudinal and anteroposterior diameter of the spleen and the resistive index within 3 cm of the origin of the splenic artery in three different measurements averaged were measured. MR protocol evaluated, in supine and right lateral position, the splenic volume and its distances from the diaphragm dome and the lateral margin of the costal arch. RESULTS: p Values calculated for each parameter were not statistically significant. Our results confirm the absence of any anatomical and dynamic changes in the spleen after LTLA. CONCLUSIONS: The most common complications after laparoscopic adrenalectomy are well known and widely described. Our experience does not exclude the occurrence of a wandering spleen, but allows us to state that a rightful mobilization of the pancreaticosplenic block can avoid this event, and in agreement with other authors, the presence of a wandering spleen remains an isolated complication.

Laparoscopic antegrade cholecystectomy: a standard procedure?

Retrograde approach ("fundus first") is often used in open surgery, while in laparoscopic cholecystectomy (LC) is less frequent. LC, with antegrade access, is done by putting in traction the infundibulum and going up to the fundus before to clip the cystic. Our study analyzes a number of surgical procedures performed by experienced surgeons in laparoscopy. From 2002 to 2015, 1740 laparoscopic cholecystectomies were performed at our Institution. The operative procedure performed since 2002 consists of the incision of the visceral peritoneum from the infundibulum away from Calot's triangle along the gallbladder bed up to the fundus. Then it continues from the fundus up to the infundibulum. RESULTS: There were no bile duct injuries. Average operative time was 40 min. 22 conversions to an open procedure (1.3%) occurred, in cases of acute cholecystitis and cirrhotic patient. Postoperative stay was mean 2 days with no delayed sequelae on follow up. CONCLUSIONS: gallbladder antegrade dissection for laparoscopic cholecystectomy can reduce the time of surgery and is an easier technique to perform. Therefore, it can be proposed as the standard procedure and not only be used for difficult cholecystectomies.

Voluminous omental inflammatory myofibroblastic tumor in an elderly man: a case report and literature review.

Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm of intermediate biologic potential, with uncertain etiology. This tumor occurs primarily in the lung, but the tumor may affect any organ system. A 75-year-old male was evaluated for voluminous palpable high abdominal mass with continuous and moderately abdominal pain, associated with abdominal distension for the last two months. Abdominal computed tomography showed a large (32 × 29 × 15 cm) heterogeneously enhanced mass with well-defined margins. At surgery, the mass originated from the greater omentum was completely excised. Histologically the tumor was a mesenchymal neoplasm in smooth muscle differentiation and was characterized by spindle-cell proliferation with lymphocytes, plasma cells, and rare eosinophils. Immunohistochemically, the tumor cells were positive for vimentin and smooth muscle actin and negative for anaplastic lymphoma kinase. Complete surgical resection of IMTs remains the mainstay of treatment associated with a low rate of recurrence. Final diagnosis should be based on histopathological and immunohistochemical findings. Appropriate awareness should be exercised by surgeons to abdominal IMTs in combination with constitutional symptoms, abnormal hematologic findings, and radiological definition, to avoid misdiagnosed.

Defining a therapeutic program for recurrent acute pancreatitis patients with unknown etiology.

AIM: To define a therapeutic program for mild-moderate acute pancreatitis (AP), often recurrent, which at the end of the diagnostic process remains of undefined etiology. MATERIAL AND METHODS: In the period 2011-2012, we observed 64 cases of AP: 52 mild-moderate, 12 severe; biliary 39, biliary in alcoholic chronic pancreatitis 5, unexplained recurrent 20. The clinical and instrumental evaluation of the 20 cases of unexplained AP showed 6 patients with biliary sludge, 4 microlithiasis, 4 sphincter of Oddi dysfunction, and 6 cases that remained undefined. RESULTS: Among 20 patients with recurrent, unexplained AP at initial etiological assessment, we performed 10 video laparo cholecystectomies (VLCs), 2 open cholecystectomies and 4 endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomies (ERCP/ES) in patients who had undergone previous cholecystectomy; 4 patients refused surgery. Among these 20 patients, 6 had AP that remained unexplained after second-level imaging investigations. For these patients, 4 VLCs and 2 ERCP/ES were performed. Follow-up after six months was negative for further recurrence. CONCLUSION: The recurrence of unexplained acute pancreatitis could be treated with empirical cholecystectomy and/or ERCP/ES in cases of previous cholecystectomy.

Laparoscopic cholecystectomy: evaluation of liver function tests.

AIM: The changes in liver function tests (LFTs) after laparoscopic cholecystectomy (LC) have been described in the literature. The aims of this study are to value the increases of the LFTs and its clinical appearance after LC. Furthermore we studied the correlation of the changes of LFTs with the operative time and the role of elevated BMI. MATERIAL OF STUDY: In the period October 2012 - May 2013, 81 patients undergone to elective LC were analyzed by examining bilirubin, AST, ALT, ALP, GGT at the admission, 1 and 3 days after surgery. Correlations of the length of intervention and BMI with changes of LFTs are evaluated. During surgery, the intrabdominal pressure has been 12 mmHg in all patients. The Student t test, PCC (Pearson's correlation coefficient) OR (odds ratio) were performed to determine statistical significance. RESULTS: The level of (serum) AST, ALT increased significantly during 24-48 hours after LC (p < 0,0001). The increase of (total and direct) bilirubin has not the statistical significance. On the contrary ALP, GGT was significantly decreased (p < 0,001). Three days after surgery LFTs returned to normal level in the patients with previous normal level of tests. The length of intervention doesn't show correlations with changes of LFTs (PCC 0.2). the BMI >28 led increased risk of changes of LFTs (OR 2.44). CONCLUSIONS: The changes of LFTs are transient and clinically silent in patients with a normal liver function. Nevertheless must be evaluated preoperative BMI and liver dysfunction.

Common bile duct lithiasis: therapeutic approach.

INTRODUCTION: Treatment of cholecysto-choledocholithiasis has been revisited from the standpoint of either endoscopic or laparoscopic mini invasive approach. A standard diagnostic-therapeutic procedure has not been unanimously defined. PATIENTS AND METHODS: Since 1997 to 2011 we have treated 924 patients: 555 gallbladder lithiasis, 276 acute biliary pancreatitis and 93 choledocholithiasis (without pancreatitis). We have compared, by the review of the literature, our results of two stage endoscopic stones removal followed by laparoscopic cholecystectomy versus one stage laparo-endoscopic rendezvous technique/VLC and laparoscopic approach alone. RESULTS: In our experience endoscopic removal of stones have been performed in 82 patients (88.17%); 11 patients (11.82%),not eligible for endoscopic approach, have been submitted to laparotomic therapy. In sum preoperative ERCP/ES with CBD cleaning followed by VLC, not with standing the valid results of laparoscopic approach alone remains the strategy more frequently applied in clinical practice, because the good results. CONCLUSIONS: The results of the treatment of CBD lithiasis of sequential laparo-endoscopic approach (two or one stage) and of laparoscopic approach alone are roughly overlappable. Therefore the first has remained the treatment of reference and comparison in all the clinical evaluation of different procedure.

Multiple skeletal muscle metastases from colon carcinoma preceded by paraneoplastic dermatomyositis.

Skeletal muscle metastases are very rare events in colorectal carcinoma. By contrast, dermatomyositis is an idiopathic inflammatory myopathy with characteristic cutaneous manifestations and a well-recognized association with several human malignancies and, among others, colorectal cancer. Here, we report the case of a 71-year-old woman with paraneoplastic dermatomyositis followed by the development of a metastatic colon cancer. Interestingly, this patient developed multiple skeletal metastases which were preceded by the worsening of systemic symptoms of dermatomyositis. This observation suggests that, while muscle tissue is usually resistant to the development of tumor metastases, the inflammatory and immune response which characterizes and boosts paraneoplastic myopathy may represent a favorable soil for tumor cell invasion and metastasization to skeletal muscles.