[A case of perforated small bowel adenocarcinoma as first symptom of Crohn's disease]. / Adenocarcinoma perforato del piccolo intestino come prima evidente manifestazione del morbo di Crohn: case report.

A case of perforated small bowel adenocarcinoma presenting as first symptom of Crohn's disease is reported in a 53 years old male patient with abdominal pain and alteration of bowel habits. Endoscopic bioptical sampling demonstrated a Crohn's disease in active stage. The patient underwent medical therapy with resolution of the complained symptomatology; 20 days after discharge the patients is rehospitalized for acute abdomen. A narrowing perforated neoplasia in terminal ileum was discovered at laparotomy. Diffuse peritonitis and metastatic peritoneal implantations were also revealed. An ileocolic resection is performed with ileo-transverse colon anastomosis. The patient dies 4 months later for advanced disease.

[Primary HIV-1 infection in Zurich: 2002-2004]. / Die akute HIV-1-Infektion in Zürich: 2002-2004.

Acute HIV-infection mostly presents with unspecifc symptoms. Thus the acute retroviral syndrome is often not readily recognized. Here we present an interim analysis of a prospective study from 62 patients with documented acute HIV infection acquired between January 2002-August 2004 in the greater Zurich area. 61.5% of patients were infected by homosexual contacts, mostly with HIV-1 subtype B, 34% acquired infection by heterosexual contacts, often with non-B-virus subtypes. Transmission occurred in all sexually active age groups (18-72 years). Clinical symptoms presented as follows: fever (77%), pharyngitis (56%), fatigue (52%), gastrointestinal symptoms (45%), rash (39%). On first physician contact, an ARS was only suspected in 27% of the cases. Patients primarily called on their family doctors (37.5%), went to see larger walk in clinics or emergency rooms (37.5%), and 16% were hospitalised. In 16% of patients other sexually transmitted diseases were diagnosed contemporaneously. Drug resistant virus (single class resistance) was transmitted in only one patient.

[Surgical laparoscopic therapy of small bowel tumors: review of the literature and report of two cases]. / Terapia chirurgica laparoscopica dei tumori del tenue: revisione della letteratura e report di due casi.

The Authors, after a short review of small bowel tumors, point out that recently a laparoscopic approach for these tumors has been suggested and some cases have been reported. The Authors present two cases of patients operated for small bowel tumor using a laparoscopic technique: the first case for a stromal tumor (GIST), the second case for an adenocarcinoma in advanced stage with multilobar lung metastases. The first patient is alive and disease free after one year, the second died after six months for tumor progression. The Authors believe that laparoscopic technique can be employed with satisfying results also in the treatment of small bowel tumors with moderate trauma and invasiveness.

[Clinical study on laparoscopic approach to cholelithiasis in the elderly]. / Studio clinico sull'approccio laparoscopico alla colelitiasi nei pazienti geriatrici.

The Authors report 66 cases of patients aged 75 years or older who underwent laparoscopic cholecystectomy: 28 cases presented a clinical picture of acute cholecystitis, 3 cases had associated common bile duct stones. A high percentage of patients had cardiovascular disease: 29 patients presented with cardiopaties, of these 9 cases had a history of myocardial infarction, 31 patients had artheriosclerotic hypertension, associated, in 7 patients with signs of brain ischemia. Five patients were suffering from Parkinson's disease, 7 were carriers of diabetes, 2 had liver cirrosis. Three patients were converted due to extensive presence of adhesions from previous surgery. Morbidity and mortality rates were respectively 12% and 1.5%. The Authors think that laparoscopic technique widens indications and reduces risks of cholecystectomy also in elderly patients.

[Use of prosthetic materials in incisional hernias: our clinical experience]. / Utilizzo dei materiali protesici nei laparoceli: la nostra esperienza clinica.

Incisional hernias are fairly frequent complications of surgery. Such complications are presented by variable percentages ranging from 1% to 8% for non complicated laparotomies and from 10% to 15% in case of infection. The therapeutic possibilities are abdomino-plastic with direct suture and the use of prosthesis. The percentage of recurrency varies from 30% to 50% and from 0% to 19% respectively. From May 2000 to September 2003, the Authors operated 64 patients. In 30 cases they opted for a direct suture approach, in 34 cases a prosthesis was used. Of the 34 patients, 18 were treated using polypropylene mesh placed below the rectus muscles and above the peritoneum (Rives technique); 10 with PTFEe (Polytetrafluoroethylene expanded) prosthesis placed in intraperitoneal site and 6 were treated with SIS prosthesis (Small Intestine Submucosa), 3 placed using the Rives technique and 3 in intraperitoneal site. Nine patients had associated operations. The use of prosthesis in the management of incisional hernias has brought a considerable reduction in the percentages of recurrency, especially in cases of associated pathologies. The availability of SIS in the market has permitted the use of this prosthesis even in case of contaminated and/or infected fields. In a follow-up ranging from 3 years to 3 months (mean 18 months) the Authors observed 2 cases of recurrence in the group of direct suture. Despite the advantages offered by the use of prosthesis, we can affirm that there is no "universal" prosthesis. Their selection should be evaluated on the bases of the site and the dimensions of the incisional hernia, the possibility of infection, the surgical technique and the site of prosthetic placement in the abdominal wall.

[Acute torsion of the greater omentum]. / Torsione acuta del grande omento.

Primary torsion of the greater omentum is an uncommon cause of acute abdomen and frequently it is misunderstood. In fact, from the analysis of the literature the authors can evict that the preoperative diagnosis is generally wrong. The authors write about the subject and they describe four cases come to their observation and all mistaken for acute appendicitis.

[Totally implantable systems for long-term chemotherapeutic treatment]. / Sistemi totalmente impiantabili per trattamento chemioterapico a lungo termine.

The authors report their own experience with completely implantable systems for the long-term chemotherapeutic treatment, compared with a review of modern literature. The experience even if low demonstrates a good methodology in reducing the number of complications associated with the use of percutaneous catheters.

[Role of microsurgery in chronic distal obstructive arteriopathies]. / Ruolo della microchirurgia nelle arteriopatie croniche ostruttive distali.

The Authors analyze the role of microsurgery in the treatment of chronic obstructive arteriopathies. In accordance with their results, they stress the usefulness of the microtechniques in the rescue of ischaemic limbs due to distal occlusion, and how these procedures are less dangerous than amputation, even though results are not long lasting.

[Venous grafts in reimplantation of the thumb]. / Innesti venosi nel reimpianto del pollice.

The Authors analyze their experience of 25 thumb reimplantations and revascularizations within 5 years. The importance of the first finger in the functional hand economy as well as the ratio between reimplantation take rate and degree of functional recovery with regard to the type of trauma, technique used, and possible and incidental complications are underlined. The venous autologous grafts are of great importance in this microsurgical area and they are more and more applied. In most cases, indeed, intimal lesions are more extended than their macroscopic appearance and the tract of damaged vessels is always wider than assessed. The graft interposition solves the problem with the further advantage to preserve the maximal bone length and to avoid especially contaminated areas. The results achieved confirm these statements and the Authors conclude for the absolute need of venous grafts in thumb reimplantations, especially after amputation from avulsion or crush traumas, even though a greater skill is necessary in using this technique.

[Latissimus dorsi flap in reconstructive surgery of the lower limbs]. / Il lembo libero di gran dorsale nella chirurgia ricostruttiva degli arti inferiori.

The free latissimus dorsi flap has been used to repair 10 complex losses of substance of the lower extremity. The results have shown the great reconstructive potentialities of the microvascular transfer of this muscle, considered by the authors the most versatile of the myocutaneous flaps. Among the advantages there are the extended surface, its thickness, its pedicle with adequate length and diameter as well as the absence of functional involvement, especially by preserving the upper branch of the thoracodorsal nerve. The indications, however, are limited due to a significant rate of complications which prevent its extended use.