[Intestinal occlusion caused by internal hernia of the retrocaecal recess. Description of a case]. / Occlusione intestinale da ernia interna del recesso retrocecale. Descrizione di un caso.

The authors describe an acute intestinal occlusion due to a rare case of strangulated intra-abdominal hernia of the retrocaecal peritoneal recess. They underline the rarity of this pathology which is often treated in emergency without any possibility of preoperative diagnosis. Therefore, in order to carry out surgical therapy with good results, a correct knowledge of the anatomical features of these hernias is necessary.

[Mini-invasive surgical approach for obstructive sleep apnea syndrome (OSAS). A case report]. / Approccio chirurgico combinato mini-invasivo per il trattamento della sindrome delle apnee ostruttive del sonno (OSAS). Descrizione di un caso clinico.

It is well known that the obstructive sleep apnea syndrome (OSAS) is caused by the collapse of the pharyngeal walls and subsequent reduction in the diameter of all viscera. It is possible to increase the antero-posterior diameter by shifting the genioglosso muscle forward and suspending it; on the other hand the latero-lateral diameter can be achieved by sectioning the hyoid bone along the midline and through lateral fixation of the resulting stumps to the mandibula. This paper presents a clinical case of OSAS which underwent surgery using a procedure combining suspension of the genioglosso muscle and sectioning and suspension of the hyoid performed using a REPOSEa kit.

Effect of repetition of Semont's manoeuvre on benign paroxysmal positional vertigo of posterior semicircular canal.

If Semont's liberating manoeuvre does not lead to relief of symptoms in benign paroxysmal positional vertigo of posterior semicircular canal after the first session, it can be repeated once again, in refractory cases, whilst symptomatic patients after second manoeuvre require rehabilitation therapy Repeating Semont's manoeuvre several times has proven to progressively increase the percentage of cured patients or it may convert posterior semicircular canal forms to typical incomplete or lateral semicircular canal forms, hence requiring other manoeuvres to achieve vertigo resolution. Aim of study was to assess the effect of liberating manoeuvres repeated up to 4 times and to establish possible passages from one canal to the other during manoeuvres as well as percentage of cases refractory to this therapy, who would then need rehabilitation. Benign paroxysmal positional vertigo was diagnosed in 448 cases of whom 344 (76.8%) of the posterior semicircular canal, 20 (0.45%) the incomplete form of the posterior semicircular canal, 20 (0.45%) subjective positional vertigo and 74 of the lateral semicircular canal (4.2%). Right side was affected in 58.4% of cases, left in 34.5%, and bilateral in 7.1%. All 344 patients underwent Semont's liberating manoeuvre (1st manoeuvre) with first control after 48 hours: if symptoms (typical, atypical nystagmus or paroxysmal vertigo evoked by Dix-Hallpike's manoeuvre) persisted, Semont's liberating manoeuvre was repeated (2nd manoeuvre). In presence of lateral semicircular canal benign paroxysmal positional vertigo conversion, Lempert's manoeuvre was performed instead. Second control was performed after 48 hours and in cases of persistent typical, atypical or lateral semicircular canal nystagmus 3rd manoeuvre was performed. After further 48 hours, third control was carried out: symptomatic patients with typical forms were submitted to 4th manoeuvre, while typical incomplete forms or forms of the lateral semicircular canal underwent Lempert's manoeuvre. In conclusion, symptoms disappeared after 1st manoeuvre in 61.6% of cases; further manoeuvres, carried out in view of possible changes in semeiology of vertigo, increased the percentage of cured patients to 82.5% after the 2nd, 90.7% after 3rd and 94.1% after the 4th. Repeated positioning manoeuvres in benign paroxysmal positional vertigo led to a progressive increase in percentage of cured vertigo, at the same time, allowing detection of those cases converted to multicanal pathology, hence offering the possibility to proceed with appropriate liberating manoeuvres.

[Combined genioglossus advancement (ACMG): inferior sagittal mandibular osteotomy with genioglossus advancement and stabilization with suture in patients with OSAS. Preliminary clinical results]. / Avanzamento combinato del muscolo genioglosso (ACMG): osteotomia infero-sagittale mandibolare con avanzamento muscolo genioglosso e sua stabilizzazione con sutura in pazienti con OSAS. Risultati clinici preliminari.

Surgical treatment of obstructive sleep apnea syndrome (OSAS) centres on the identification of the level of obstruction of the upper airway and the choice of the most suitable procedure to correct it. Shaping of the retrolingual hypopharyngeal space is among the most difficult to achieve because it stems from an alteration of the soft tissue of the tongue, from the hypopharynx, and is correlated to the contraction pattern of the genioglossus and the pharyngeal constrictors. We propose a surgical technique of combined genioglossus advancement (CGA) in cases of anteroposterior collapse of the retrolingual airway. Four patients affected by OSAS (RDI average = 22 events/hour), evaluated as type III obstruction in the Fujita classification, presenting the indications for surgical management of retrolingual hypopharingeal obstruction, underwent treatment. They were studied by means of a guided medical history, fiberopy endoscopy evaluation and Muller maneuver, cephalometry, endocrine tests, pneumological examinations and polysomnography. The technique proposed consists in the advancement of the genioglossus muscle by means of a bone screw on the mandibular symphysis, according to the method described by Powell, associated with the stabilization of the base of the tongue with a suspension suture, following the technique originally described by the Author and DeRowe, but without using the Repose kit. This technique makes it possible to access the retrolingual site of obstruction more effectively, more economically and with no increase in morbidity when compared with the individual techniques. In all of the patients, the only complaints regarded dysaesthesia in the area of the lower lip innerved by the mental nerve for 2-5 weeks and moderate odynophagia for 2-3 weeks; there were no haemorrhages or infections. Deglutition of fluids and solids was resumed on the 3rd post-operative day. Polysomnography after 6 months documented three positive results and one partial result, on the basis of Sher's criteria. In conclusion, the CGA technique calls for advancement of the genioglossus insertion tubercle and stabilization of the tongue to be carried out at the same time, without using the Repose kit. The CGA technique is minimally invasive and does not involve cutaneous incisions, making it a therapeutic strategy which may be inserted in a multilevel protocol excluding transcutaneous access. It is therefore proposed for type III or type IIb cases in the Fujita classification.

Pseudo-Kaposi sarcoma with arteriovenous malformation.

Pseudo-Kaposi sarcoma with vascular malformation (Stewart-Bluefarb syndrome) is an uncommon and important entity characterized by congenital arteriovenous malformation and skin lesions that may resemble Kaposi sarcoma. This is usually seen in the lower limb of young people. We report a case of this syndrome in a 17-year-old boy who had skin lesions on the right leg and foot.

Traumatic abdominal aortic pseudoaneurysm treated with balloon-expandable bifurcated endoprosthesis.

A 22-year-old man came to our institution with upper gastrointestinal bleeding and massive intra-abdominal hemorrhage. His history included an abdominal gunshot, with aortic and multiple intestinal perforations, 9 months before. At the time of the original injury, he was treated elsewhere by primary closure of the aortic laceration and multiple intestinal resections. An aortic pseudoaneurysm was revealed by means of an angiogram of the descending aorta. Conventional surgical procedures were deemed not feasible because of previous abdominal operations, so a balloon-expandable bifurcated endoprosthesis was constructed and inserted into the terminal aorta through the femoral approach, with resolution of the abdominal aortic pseudoaneurysm.