Absence of gene mutations in a case of concomitant presence of carcinoid of the ampulla of vater pheochromocytoma and Von Recklinghausen disease.

The rare association between Von Recklin-ghausen's disease (VRD) and tumours other than in central nervous system is well recognized. However, the concomitance of VRD, a carcinoid of the ampulla of Vater, and a pheochromocytoma has been described very rarely in literature. Furthermore, the possible role of the genes usually involved in multiple endocrine neoplasia (MEN) syndromes, in this association, is unclear. We report the case of a patient affected by VRD and extra-adrenal pheochromocytoma, operated on in the past for a carcinoid of the ampulla of Vater. To determine if genes involved in MEN syndromes might play a role in this particular triad, we investigated the presence of somatic or germline mutations in the RET proto-oncogene and menin gene by non isotopic polymerase chain reaction single stranded conformation polymorphism (PCR-SSCP) and heteroduplex gel electro-phoresis. The results demonstrated that no somatic or germline mutations in the MEN-1 and MEN-2 genes were involved in the pathogenesis of these tumours.

Malignant colonic obstruction managed by endoscopic stent decompression followed by laparoscopic resections.

BACKGROUND: Acute left-side colonic obstruction is a surgical emergency whose management is controversial. Recently metallic expandable stents have been used to relieve obstruction either to palliate the condition or to prepare for an elective surgical resection. METHODS: We propose a new minimally invasive therapeutic strategy for the management of malignant colonic obstructions: emergency endoscopic stenting followed by elective laparoscopic one-stage resection. The first four cases are presented. RESULTS: The stents were positioned successfully in all cases, and all the patients had an immediate restoration of bowel functions. After a period that varied from 4 to 5 days, they underwent a one-stage laparoscopic resection and were discharged 5 to 7 days after the operation. There were no postoperative complications. CONCLUSIONS: Malignant colonic obstruction can be managed by a sequential minimally invasive endolaparoscopic approach with an excellent postoperative outcome, good patient comfort, and a short hospital stay without the need for diverting stomas. A study involving a larger number of patients is needed to determine whether this approach is superior to traditional open surgery in terms of morbidity, mortality, quality of life, and recurrences.

[Ultrasound in trauma (FAST)]. / Ecotomografia nel trauma (FAST).

During last 20 years ultrasonography has been widely used in Europe to investigate abdominal trauma. In United States it has not been considered a reliable test especially because of its lack of sensitivity in diagnosing parenchymal injuries. Recently American surgeons reconsidered ultrasonography in trauma and codified its use into FAST (Focused Assessment for the Sonographic examination of the Trauma patients). The goal is to detect hemoperitoneum and pericardial effusion. Advantages are remarkable: ultrasound is cost-effective, fast, non-invasive, can be performed by surgeons even on unstable patients. FAST is now included in ATLS framework for examination of thoraco-abdominal trauma.