Double esophageal perforation by ingested foreign body: Endoscopic and surgical approach. A case report.

INTRODUCTION: Esophageal perforation in adults is most frequently caused by ingested foreign bodies. They can migrate through the esophageal wall, damaging the nearby organs such as the aorta or the trachea, with fatal outcome. After the diagnosis, the viable treatments for extracting the foreign body and repairing the perforation are several. The appropriate treatment, may be endoscopic, surgical or combined, depending on the level of the perforation, on the co-morbidities of the patient and on the available resources. PRESENTATION OF CASE: This paper describes a case of a 68 years old patient with a double EP caused by a meat-bone that perforated the thoracic esophageal wall, approaching the aorta on the left side and the azygos vein on the right side. DISCUSSION: Because of the double transfixion and the position near the aorta and the azygos, it was not possible to remove safely the bone during the endoscopy. The management required a combined endoscopic and surgical approach. This way it was possible to detect easily the location of the perforation, to remove safely the foreign body, to repair the perforation both from the outside and from the inside, and to place the nasogastric tube under direct vision. CONCLUSION: Even when the type of esophageal perforation requires surgical treatment, the simultaneous use of endoscopy proved to be an advantage in order to extract the foreign body safely, to perform a double repair of the perforation and to place the nasogastric tube under direct vision.

In vitro productive infection of non polarised cervical and rectal biopsies by syncytium-inducing and non syncytium inducing primary HIV-1 isolates.

An in vitro model was used to study the transmission of HIV-1 primary isolates with different biological phenotype to cervical and rectal non polarised bioptic fragments. The method described allowed the productive infection of both cervical and rectal tissues and the virus produced could be propagated onto peripheral blood mononuclear cell cultures. Syncytium-inducing and non-syncytium inducing viral isolates were equally able to produce infection and replication.

Gastrointestinal infection due to Anisakis simplex in southern Italy.

The authors present four cases of infection due to Anisakis in an area where people are prone to infectious diseases transmitted by raw fish, but in which the presence of this parasite has never been reported. Three of four cases were discovered accidently during surgical procedures for co-existing abdominal pathologies. Raw fish was apparently not involved in all patients. Characteristics of the patients are discussed.

Is endoscopic injection hemostasis of bleeding gastrointestinal ulcers obsolete in 1995?

Bleeding non-neoplastic lesions of the upper gastrointestinal tract, not due to portal hypertension, are a frequent cause of emergency admission. In the present paper we report our retrospective experience in hemostatic injection treatment of these lesions. From May 1990 to May 1994, 164 patients were admitted to our institution for a bleeding gastrointestinal lesion. In 124 cases an ulcer classified according Forrest's criteria was detected. Four patients underwent immediate surgery. The second group of 86 patients (FIIa/FIIb/FIII) were treated conservatively. The third group of 34 patients (FIa/FIb/FIIa) underwent perilesional injection of adrenaline 1:10,000 and polidocanol 1% saline solution during endoscopic examination; 29% (25 pts) of the second group re-bled during the first 72 h vs 8.8% (3 pts) of the third group. The postoperative morbidity in the rebleeding patients was higher in the second group: 38.4% vs 0%. The importance of immediate, inexpensive, and simple hemostatic treatment extended to Forrest IIa lesions is emphasized.

[Cholelithiasis in advanced age]. / La colelitiasi in età avanzata.

Fifty seven patients over 65 affected with cholelithiasis underwent surgical procedures at II Patologia Chirurgica-University of Bari-Italy, from July 1987 to December 1988. Different risk factors were considered. The results, which reported a low incidence of morbidity and mortality, suggest the importance to adopt early surgery. Though 73.2% of patients had associated pathologies and 28.6% had two or more risk factors, only 5.3% of them had complications not strictly related to surgery.

[Total pericystectomy in the treatment of hepatic echinococcosis]. / La pericistectomia totale nel trattamento dell'echinococcosi epatica.

Fourteen patients, affected with hepatic echinococcosis, who underwent total pericystectomy at II Patologia Chirurgica, University of Bari-Italy, were retrospectively evaluated. The period considered was July 1987-December 1988. Immediate (low morbidity and no mortality) and late (no recurrences) results showed that total pericystectomy is the treatment of choice in hepatic hydatidosis.