[Idiopathic ischaemic infarction of the stomach. Case report]. / Infarto ischemico idiopatico dello stomaco: case report.

Idiopathic ischaemic infarction of the stomach is an extremely rare condition since only 2 other cases have been published in the Literature so far. The Authors report a case of such entity on a 75 year old male patient, admitted from the accident and emergency department because of a upper digestive tract haemorrhage with clinical signs of hypovolemic shock. The patient subsequently underwent an upper gastro-intestinal endoscopy that suspected an ulcerated gastric neoplasm. The patient therefore underwent a total gastrectomy and was discharged home on p.o. day X. The pathology report showed an Ischaemic infarction of gastric mucosal tissue with pomphoid Oedema of submucosal layer. Ulcerative superficial necrosis with venous haemorragic swarm and focal acute pseudomembranous inflammation. Not neoplastic features. Etiopathogenetic, pathophisiologic ipoteses and clinical implication of Idiopathic ischaemic infarction of the stomach are discussed.

[Strangulated pelvic internal hernia: early postoperative complication of sacral colpopexy with prosthesis]. / Ernia interna pelvica strozzata quale complicanza postoperatoria precoce di colposacropessi con protesi.

The Authors report a case of internal strangulated hernia in a patient operated of colposacropexy for vaginal prolapse following total hysterectomy. The diagnosis was formularized by abdominal TC consenting the surgical treatment by bowel loop resection completed by pelvic floor reconstruction.

[Inguinal hernioplasty: Shouldice vs. tension-free techniques. A personal experience]. / L'ernioplastica inguinale: metodiche a confronto (Shouldice vs. tecniche "tension-free"). La nostra esperienza.

The Authors report their experience with the use of Shouldice technique and tension-free procedures (Lichtenstein, Trabucco). They evaluate long time results with both procedures making a comparasion of Shouldice versus tension-free. The results evaluation underlines the best performance of tension-free procedures with elimination of recurrence. The Authors achieve that the tension-free techniques are now the gold standard for surgical treatment of groin hernia.

[Primary non-Hodgkin's lymphoma of the colon: a rare but possible location. Therapeutic approach. Description of a clinical case and review of the literature]. / Linfoma non-Hodgkin primitivo del colon: una rara, ma possibile localizzazione. Iter terapeutico. Descrizione di un caso clinico e revisione della letteratura.

On the basis of a case of large cell, highly malignant, non-Hodgkin's lymphoma of the colon, the authors describe the special features of this rare location; the general aspects of this rare pathology of the colon are then considered. The clinical case relates to a large cell, highly malignant, non-Hodgkin's colic lymphoma located in the caecum at two thirds proximally of the ascending colon of which it occupies half the lumen. The patient had come to our observation for a quite aspecific symptomatology characterised by digestive disturbances and a tendency to stipsis. In disaccord with certain literature reports, surgical treatment was considered by the authors the key to the therapeutic approach. Surgical exeresis should be as radical as possible to permit complementary therapies (chemotherapy and radio-therapy) to act with most effectiveness and thus offer the patient a better life.

[Acute bleeding in gastrointestinal stromal tumor: case report]. / Enterorragia acuta da tumore stromale gastrointestinale (GIST). Contributo clinico.

A.A. refer a case report on a patient observed in emergency condition for acute bleeding from digiunal bowel by a GIST. Starting from clinical case, describe a brief profile of clinical, histogenetic, diagnostic and prognostic characteristics of the GIST also delineated by recent reports from literature; agree with other A.A. about treatment procedure represented always by resection of affected intestinal tract and never by enucleation for inconstant and unforeseeable biologic comportment by this tumours.

[Gastrointestinal stromal tumors]. / I tumori stromali gastrointestinali.

The Authors report two cases of GIST and underline cytogenetic, clinic and prognostic aspects of this disease; they describe as well new histo-cyto-genetic data that identify as origin tissue interstitial cells of Cajal, by immunohistochemical and genetic tests. They also consider new diagnostic and therapeutic options based on surgical treatment. Finally controversial prognostic problems are discussed.

Inducible nitric oxide synthase knockout mice exhibit resistance to the multiple organ failure induced by zymosan.

In the present study, by comparing the responses in wild-type mice (+/+) and mice lacking (-/-) the inducible (or type 2) nitric oxide synthase (iNOS), we investigated the role played by iNOS in the development of non-septic shock. A severe inflammatory response characterized by peritoneal exudation, high peritoneal levels of nitrate/nitrite, and leukocyte infiltration into peritoneal exudate was induced by zymosan administration in iNOS +/+ mice. This inflammatory process coincided with the damage of lung, liver, and small intestine, as assessed by histological examination. Lung, small intestine, and liver myeloperoxidase (MPO) activity, indicative of neutrophil infiltration and lipid peroxidation, were significantly increased in zymosan-treated iNOS +/+ mice. Peritoneal administration of zymosan in the iNOS +/+ mice induced also a significant increase in the plasma levels of nitrite/nitrate and in the levels of peroxynitrite at 18 h after zymosan challenge. Immunohistochemical examination demonstrated a marked increase in the immunoreactivity to nitrotyrosine and to poly ADP-ribose synthetase (PARS) in the lung, liver, and intestine of zymosan-treated iNOS +/+ mice. The intensity and degree of nitrotyrosine and PARS were markedly reduced in tissue section from zymosan-iNOS -/- mice. Zymosan-treated iNOS -/- mice showed a significantly decreased mortality and inhibition of the development of peritonitis. In addition, iNOS -/- mice showed a significant protection on the development of organ failure since tissue injury and MPO were reduced in lung, small intestine, and liver. Furthermore, a significant reduction of suppression of mitochondrial respiration, DNA strand breakage, and reduction of cellular levels of NAD+ was observed in ex vivo macrophages harvested from the peritoneal cavity of iNOS -/- mice subjected to zymosan-induced non-septic shock. In vivo treatment with aminoguanidine (300 mg/kg 1 and 6 h after zymosan administration) significantly prevents the inflammatory process. Taken together, our results clearly demonstrate that iNOS plays an important role in zymosan-induced non-septic shock.

[Posterior approach in the treatment of sacrococcygeal chordoma: a rare, locally infiltrating, destructive and recurrent tumor. A case report and review of the literature]. / L'approccio posteriore nel trattamento del cordoma sacrococcigeo: tumore raro, localmente infiltrante, distruttivo e recidivante. Descrizione di un caso e revisione della letteratura.

Based on personal observation of a case of recurrent chordoma in the sacrococcygeal region four years after the first excision with subtotal resection of the coccyx using a posterior approach, the authors describe the unique characteristics of this rare neoplasm and underline the simplicity of this method of treatment. The surgical technique used to treat the recurrent form also used a posterior approach, with complete resection of the neoplasm including the scar of the previous operation and the last remaining segment of the coccyx. No intra- or postoperative complications were reported. The authors examine the clinical and histological aspects of this neoplasm, concluding that the correct form of treatment must aim both to protect the adjacent anatomic structures and to achieve radical exeresis, as well as achieving a simpler surgical approach unhampered by complications. The authors believe that this approach is simpler than the abdominal-dorsal approach, although this is necessary in the event of intra-abdominal infiltrations.

Tempol, a membrane-permeable radical scavenger, reduces dinitrobenzene sulfonic acid-induced colitis.

Inflammatory bowel disease is characterized by oxidative and nitrosative stress, leukocyte infiltration, and up-regulation of intercellular adhesion molecule 1 (ICAM-1) expression in the colon. The aim of the present study was to examine the effects of tempol, a membrane-permeable radical scavenger, in rats subjected to experimental colitis. Colitis was induced in rats by intracolonic instillation of dinitrobenzene sulfonic acid. Rats experienced bloody diarrhea and significant loss of body weight. At 4 days after the administration of dinitrobenzene sulfonic acid, the colon injury comprised of large areas of mucosal necrosis. Neutrophil infiltration (measured as increase in myeloperoxidase activity in the mucosa) was associated with up-regulation of ICAM-1 and expression of P-selectin and high levels of malondialdehyde (an indicator of lipid peroxidation). Immunohistochemistry for nitrotyrosine and poly (ADP-ribose) synthetase showed an intense staining in the inflamed colon. Treatment of rats with tempol (15 mg/kg daily i.p.) significantly reduced the appearance of diarrhea and the loss in body weight. This was associated with a remarkable amelioration of the disruption of the colonic architecture as well as a significant reduction in the degree of both neutrophil infiltration and lipid peroxidation in the inflamed colon. Tempol also reduced the appearance of nitrotyrosine and poly (ADP-ribose) synthetase immunoreactivity in the colon as well as the up-regulation of ICAM-1 and P-selectin. The results of this study suggest that membrane-permeable radical scavengers, such as tempol, exert beneficial effects in experimental colitis and may, hence, be useful in the treatment of inflammatory bowel disease.

[Spigelian hernia: clinical, diagnostic and therapeutical aspects]. / L'ernia di Spigelio: aspetti clinici, diagnostici e terapeutici.

The Authors describing a case of Spigelian hernia observed point out clinical, diagnostic and therapeutic considerations about this rare pathology of abdominal wall. They specify the anatomic characteristics of the region and underline as any diagnostic difficulties are by passed by use of USG and TC imaging for formulation of correct preoperative diagnosis. They confirm as surgical treatment by a correct access isn't different by a normal hernioplasty and guarantee the long term surgical outcome.

[Evaluation of the treatment with disodium cromoglycate in the ulcerative rectocolitis. Our experience]. / Valutazione del trattamento con disodiocromoglicato orale nella rettocolite ulcerosa. Nostra esperienza.

BACKGROUND AND AIMS: This study highlights the possibility of treating recidivating ulcerative rectocolitis with oral disodium cromoglycate based on the assay of plasma IgE. METHODS: The study was performed from January 1995 to December 1997 in 28 patients suffering from recidivating ulcerative rectocolitis whose main symptom was hematic diarrhoea. Total plasma IgE were assayed in all patients and oral disodium cromoglycate treatment was commenced at a dose of 1.500 mg pro/die with follow-up at 2, 6, 12 and 24 months to evaluate general and endoscopic clinical conditions. RESULTS: Patients with a high titre of total IgE showed a full remission of symptoms and no recidivation. CONCLUSIONS: The authors conclude by emphasising the importance of immunological factors in the pathogenesis of the disease and underline the stabilising effect of oral disodium cromoglycate on mast cells.