Impact of cardiovascular/diabetic comorbidity on conversion rate during laparoscopic cholecystectomy for acute cholecystitis: a multi-center study on early versus very delayed approach.

BACKGROUND: The impact of diabetes and cardiovascular comorbidity on laparoscopic cholecystectomy has been long debated, evaluating them as risk factors for conversion to an open procedure especially in patients with acute cholecystitis: an "early" procedure, as suggested by 2013 Tokyo guidelines, has been compared to a "very delayed" one in patients under anticoagulant/antiplatelet therapy or treated for diabetes and referred by medical wards to surgery after the acute period. METHODS: We selected 240 patients operated for acute cholecystitis by laparoscopy over the last 4 years at St. Orsola University Hospital-Bologna and Umberto I University Hospital-Rome, comparing 98 diabetic/cardiovascular patients versus 142 subjects as control group: the selection was based on operative timing, "early" (73 patients treated within 3 days) and "very delayed" (167 patients operated after 6 weeks). RESULTS: In the "early" subgroup there was no difference comparing diabetic/cardiovascular patients (31 pts) versus control group (42 pts) while in the "very delayed" subgroup among diabetic/cardiovascular patients (67 pts) there was significantly male predominance, ASA III/IV prevalence and less positive imaging findings versus control group (100 pts). In both subgroups, the conversion rate was significantly higher for diabetic/cardiovascular patients ("early"=25.8% and "very delayed"=8.95%) compared to control groups ("early"=4.76% and "very delayed"=1%), showing a trend (p=0.058) towards an increased conversion rate in the early approach among diabetic/cardiovascular group. CONCLUSIONS: Our study showed a significantly increased conversion rate to an open cholecystectomy for diabetic/cardiovascular patients affected by cholecystitis, especially within 3 days by the acute episode.

Neck hibernoma: case report and literature review.

The case history of a 23 year old man with a large hibernoma of the cervical region is reported. Th tumour showed all the clinical and pathologic characteristic of these rare benign neoplasms. A review of the most recent literature supports the Authors' conclusion that local excision is curative.

Successfully managed genital necrotizing fasciitis with multiple debilitating diseases. A case report.

Genital necrotizing fasciitis is a rapidly progressive bacterial infection of soft tissues with a reported average mortality of about 36%; associated debilitating diseases increase the mortality rate. The Authors report a case of successful management, due to an aggressive medical and surgical therapy, despite the presence of multiple debilitating diseases and an advanced necrosis.

[The chance finding of gallbladder carcinoma during cholecystectomy for long-term symptomatic lithiasis. A clinical case]. / Riscontro occasionale di carcinoma colecistico durante colecistectomia per litiasi sintomatica di lunga durata. Caso clinico.

The case of a patient who underwent conventional cholecystectomy for gallbladder adenocarcinoma is reported. Gallbladder carcinoma is rare, but since laparoscopic cholecystectomy has quickly emerged as a popular alternative to open cholecystectomy an increasing number of gallbladder carcinomas are discovered. Most of the time it is detected as an incidental tumor, the patient being with no or few symptoms and often the lesion too far advanced for any type of curative surgery. The most important questions related to the therapy are focused and a partial review of the literature is made.

Surgical management of thrombosed popliteal artery aneurysm: two case reports.

Popliteal artery aneurysm is not a rare event and is the most common type of peripheral arterial aneurysm. The Authors report on their experience with two cases. One patient had a giant popliteal aneurysm and was treated with a dacron patch, while the other had a smaller one and was treated with an inverse saphenous vein bypass. The Authors stress the importance of a thorough study of the patients in order to rule out aneurysmal disease in other sites. They conclude that early surgical intervention is the only effective therapeutic tool to avoid serious complications.

[Postectomy for phimosis: 5-year-experience]. / La postectomia per fimosi: esperienza di cinque anni.

Phimosis, i.e. congenital or acquired preputial stenosis, is one of the most frequent problems encountered in surgery departments. Circumcision remains the most frequently adopted surgical treatment, but, since this operation entails the sacrifice of the prepuce and frenulum, the penis loses its natural protection. The Authors describe five years of experience with postectomy, a technique which spares both the prepuce and frenulum while repairing the preputial phimosis, defining its benefits compared with circumcision.

RT-PCR analysis of immune-modulating factors in PBMCs from patients with cancer: reduced IL-2 and increased IL-2-receptor (p55) expression characterize gastroenteric neoplasms.

BACKGROUND: To determine the potential contribution of cytokines associated with lymphocyte activation to the pathogenesis of immune impairment in gastroenteric cancer, we examined the expression of cytokine mRNA in peripheral blood mononuclear cells (PBMCs) and tumor-draining lymph nodes (LNs). MATERIAL AND METHODS: Using a reverse transcriptase-polymerase chain reaction (RT-PCR) technique, mRNA transcripts for interleukin (IL)-4, IL-2, IL-5, IL-6, IL-1 beta, IFN gamma, IL-10 and IL-2-receptor(IL-2R)(p55) were detected in PBMCs from 16 patients with gastroenteric cancer, undergoing surgical resection, and from 13 healthy donors. RESULTS: Patients expressed a different pattern of cytokines. Significantly increased IL-2R(p55) and reduced IL-2 mRNA expression were found in patients (p = 0.034, p = 0.043). IL-10 expression was significantly correlated to IL-2R(p55) expression in both groups (p = 0.011, p = 0.009). In LNs, the results reflected those from PBMCs of the same patient. CONCLUSIONS: Gastroenteric cancer showed a suppressive pattern of cytokine expression, suggesting an impairment of T cell activation that can be evidenced from the specific pattern of PBMC cytokine expression.

Disregulation in TH1 and TH2 subsets of CD4+ T cells in peripheral blood of colorectal cancer patients and involvement in cancer establishment and progression.

Recent theories have established that, during an ongoing immune response, the lymphokines produced by TH1 and TH2 subsets of CD4+ T cells are critical to the effectiveness of that response. In vivo and in vitro studies have demonstrated that the type of environmental cytokines plays a determinant role in directing the development of naive T cells into TH1 or TH2 effector cells. Disregulated expansion of one or other subset may contribute to the development of certain diseases. To establish whether a similar situation might exist in the cells of the peripheral blood (PBMC) of colorectal cancer patients, we have performed immunological studies on a group of patients and a group of healthy subjects. We examined the interleukin-2 (IL-2), interferon gamma (IFNgamma), IL-4, IL-6 and tumour necrosis factor alpha levels in serum; the production of IL-4 and IL-2, with and without activating agents, by PBMC, tumour-draining lymph node lymphocytes and tumour cells; and the proliferative response of PBMC to IL-2, IL-4 and anti-CD3 monoclonal antibody (anti-CD3), which were variously combined. The data of the present study lead us to hypothesize that, because of suppressive effects probably due to environmental IL-4, in the peripheral blood of patients there seems to be a disregulation in the functionality of TH1 and TH2 subsets of CD4+ T cells, with an expansion in TH2 and a malfunction in TH1 cells. Moreover it seems that this disregulation increases with as the disease progresses through the stages, suggesting that it can be directly implicated in the mechanisms that allow the tumour to locate and progress in the host.

[Traumatic diaphragmatic hernia]. / Ernie diaframmatiche traumatiche.

The authors analyse a series of 10 patients urgently treated for traumatic disruption of the diaphragm. Main aetiopathogenetic, pathophysiological, diagnostic and surgical aspects of the condition are discussed.

[Primary tumors of the small intestine]. / I tumori primitivi del piccolo intestino.

Thirteen cases of primary small bowel malignancies treated in the last 11 years are reviewed. Remarkable diagnostic and therapeutic problems are related to these rare tumors that are often followed by poor results.

Duodenal stenosis from retroperitoneal fibrosis secondary to traumatic retroperitoneal hematoma: a case report.

A case is presented of retroperitoneal fibrosis secondary to post-traumatic retroperitoneal hematoma, resulting in duodenal obstruction six years after the traumatic event. The fibrotic encasement of the duodenum and the head of pancreas made it necessary to perform an "en bloc" resection, with excellent results both immediately and after three years of follow-up.

Lipoma of the omentum in a child.

A solitary giant lipoma of the omentum and gastrocolic ligament in an 8-year-old boy is reported. The patient had a large abdominal mass and signs of partial intestinal obstruction. Radiographs showed the characteristic radiolucency of a fatty mass, excluding a mesenteric cyst.