Life-threatening bleeding for a large cameron ulcer. A novel description of a tailored-surgical strategy: report of a case and literature overview.

Hiatal hernias (HHs) are usually divided into two main groups: sliding and para-esophageal (torsional) ones. Sometimes patients presenting HHs experience progressive anemia, whereas rarely an acute anemia with melena or hematemesis can occur. In such cases a Cameron ulcer should be suspected and a careful esophago-gastro-duodenoscopy (EGDS) with a meticulous inspection of the mucosal folds along the neck of the hernia is the best examination in order to find out the ulcer itself. In front of massive hemorrhage due to a Cameron erosion, the first aim should be the control of the bleeding itself, in order to ree1Romastablish hemodynamic stability. The Authors report the case of a 72-year-old man presenting a severe bleeding secondary to a large Cameron ulcer in a para-esophageal hiatal hernia. Firstly, a combined medical-endoscopic therapy was tried; the patient underwent transfusions of pooled red blood cells and endovenous anti-acid therapy combined with an operative endoscopic treatment; unfortunately this initial approach failed, therefore the patient was referred to surgery. The surgeons realized a minimally invasive atypical gastric resection associated with the HH repair; the post-operative course was uneventful and no other rebleeding episodes occurred. The urgency treatment of a life-threatening bleeding for Cameron ulcers remains a very challenging problem as no univocal and standardized recommendation has been described in literature since now. In this case-report the Authors make an overview of the current literature on the treatment of Cameron ulcers, describing a novel surgical technique for massive upper gastro-intestinal bleeding secondary to these lesions.

[Cardiovascular disease and professional activities]. / Malattie cardiovascolari e attività professionali.

Cardiovascular diseases occurrence in the industrial countries is very high and represents one of the major cause of invalidity and mortality. Studies show the close connection between cardiovascular diseases and other risk factors. In Italy heart diseases prevention is one of the main goals of the National Centre for Disease Prevention and Control. Coronary disease increased by 40% among shift-workers and those workers exposed to vibrations and microclimate; extra-auditory effects of noise have also proved to be relevant. Reintegration into labour market and work eligibility certificate can be a problem for patients with coronary diseases, after pathological events. A record of the cardiovascular system could be useful for a readmission to work, in particular after acute episodes. The PreSAL service on the basis of the 2009 data provided by qualified doctors did not show professional diseases but the undervalue may be due to the limited use of specific complementary tests.