Two Cases of Spontaneous Isolated Dissection of Superior Mesenteric Artery in One Night: Report of a (Noninvasive) Double Challenge.

BACKGROUND Spontaneous isolated dissection of the superior mesenteric artery (SID-SMA) is a rare but potentially fatal condition. Although many cases of SID-SMA have been reported in the literature in recent years because of the increased use of contrast-enhanced computed tomography (CT) scanning, optimal management has not yet been firmly established. CASE REPORT We report 2 cases of SID-SMA that were managed with stenting and angioplasty via transfemoral access. In case 1 a 54-year-old man presented with diffuse abdominal pain without Blumberg sign. Laboratory data were unremarkable. Abdominal CT scanning revealed SID-SMA and initial bowel ischemia. The angiogram revealed a dissected true lumen of SMA with a narrowing of the ileo-colic artery managed, respectively, with self-expandable stent placement and angioplasty. In case 2, a 45-year-old man presented with severe abdominal cramping and pain of 3 days' duration. Physical examination revealed abdominal tenderness with positive Blumberg sign. Laboratory tests showed leukocytosis and increased lactate dehydrogenase. Abdominal CT scan revealed SID-SMA and initial bowel ischemia. After an SMA angiogram, 2 self-expandable stents were placed and an angioplasty was performed. Although a postprocedural angiogram showed good patency of the SMA in both patients, the first patient had a recurrence of abdominal pain after 5 days with a new narrowing tract of the SMA and more inferiorly a dissection with aneurysm of a false lumen, detected on CT scan, treated respectively with stenting and coils. CT follow-up showed successful morphological results in both patients. CONCLUSIONS In our experience, endovascular treatment of SID-SMA is safe and effective, including in cases of recurrence and postprocedural evolution.

Open mini-incision vs laparoscopic appendectomy A retrospective single Centre study.

INTRODUCTION: Laparoscopy appendectomy (LA) is the most widely used method for the treatment of acute appendicitis (AA). The interest has shifted towards the mini-incision open method (MOA). MATERIALS AND METHODS: A retrospective study was conducted considering all patients who underwent surgery due to suspected appendicitis from December 2014 to January 2019. The final analysis included 234 patients. The following data were collected: patient age, sex, surgery duration, hospitalization time, wound infections, and mortality. RESULTS: The average time of surgery was 69.89 minutes in the LA group and 62.17 minutes in the MOA group, while the average time of postoperative hospitalization was respectively 5.579 days and 5.143 days. Wound infections occurred in 2 patients in the LA group and in 3 patients in the MOA group. CONCLUSION: Laparoscopic appendectomy has a similar operating time, hospitalization time and wound infections as Mini-incision open appendectomy. Therefore,both techniques are to be considered valid. KEY WORDS: Appendicitis, Laparoscopic appendectomy, Appendectomy, Instrumentation, Open approach.

Epigastrium: unusual site of incisional hernia from a 5 mm trocar.

The observation of an unusual case of incisional hernia, found in the epigastric zone at the site of a 5 mm trocar incision for a cholecystectomy, has caused us to describe it and to review the literature. C.A. is a male aged 59 and He came to our attention in 2014, complaining about the presence, for about three months, a swelling in the epigastric area, without occlusive symptoms. An objective examination showed an epigastric mass at the scar of the insertion site of a 5mm trocar during the cholecystectomy operation. The patient was hospitalized and underwent traditional surgery: incision at the scar; isolation of the extruded fatty tissue, which had no sac, identified as part of the round ligament, herniated through the residual incision of the previous operation. Based on experience acquired it is useful to make careful sutures of 5 mm incisions repairing peritoneal laceration. KEY WORDS: Epigastrium, General surgery, Incisional hernia, Laparoscopy, Trocar.

The thyroid disease in the elderly: Our experience.

INTRODUCTION: The number of elderly people in Italy is growing, so it is important to study the presentation of diseases in these subjects. MATERIALS AND METHODS: We selected 1362 patients who underwent thyroidectomy for different thyroid diseases from January 2008 to December 2014. The patients weredivided into two groups, according to the age. The patients aged 65 years and over were included in the group A, and the patients under the age of 65 years were included in the group B. DISCUSSION: Thyroid diseases in the elderly often present with atypical symptoms which are very similar to symptoms of the aging process. In elderly hypothyroidism occurs frequently sub-clinically and hyperthyroidism is often presented with cardiovascular symptoms. In our study we evaluated the differences in incidence of thyroid diseases in the elderly and in the younger groups of patients. CONCLUSION: The data analyzed in this study showed that in the elderly we have a reduced secretion and metabolization of thyroid hormones. The symptomatology in the elderly is nonspecific and can create a delay in the correct diagnosis.

Synchronous ileal neuroendocrine tumor: diagnosis and treatment. A case report and review of the literature.

INTRODUCTION: The majority of neuroendocrine tumors (NET) are located in the gastrointestinal tract (67.5%) and in the bronchopulmonary (25.3%). CASE REPORT: CA, female, 42 years old, profuse diarrhea about two months, cramping for increased peristalsis, vomiting and weight loss. The patient, diagnosed with ileal neuroendocrine tumor, by colonoscopy with biopsy of lesion, therefore came in our unit to be subjected to surgical therapy. Plasma assay Chromogranin A was performed: 160 ng / ml (nv: 15-100 ng / ml). The patient underwent surgery of right hemicolectomy. DISCUSSION: Neuroendocrine tumors although are rare diseases, have an increasing impact, probably by virtue of improved diagnostic methods. In case of profuse diarrhea should be suspected a neuroendocrine tumor. Certainly the diagnosis of certainty is given by histological examination (biopsy or resected nodule). CONCLUSION: After surgical excision is necessary to perform the follow-up of chromogranin A, and, if not executed, perform nuclear medicine examinations such as Octreoscan and PET. KEY-WORDS: Chromogranin A, Neuroendocrine tumor, Octreoscan.

Thyroidectomy: Natural drainage or negative drainage? Experience with randomized single-center study.

AIM: The aim is to investigate, in relation to the volume of blood drained, which type drainage to use after thyroidectomy natural drainage or negative drainage. MATERIAL OF STUDY: 141 patients who underwent total thyroidectomy for multinodular thyroid disease between 22 November 2012 and 7 November 2013 were included in the present study. For the 141 patients a randomized method was used with closed circuit natural drainage (59 cases) or negative drainage (82 cases). The evaluation of the drained volume was performed 24, 48 and 72 hours following surgery. RESULTS: The amount of blood drained during the first 24 hours of the postoperative period averaged 78.59 ml in patients with a negative drain and 54.24 ml in those under natural drainage. After 48 hours, the total volume in the first group was 117.98 ml, while in the second group it was 85.18 ml. In cases where the observation was prolonged up to 72 hours, the average volume was 217 ml in the 10 cases of negative drainage and 117.5 ml in the 4 cases of natural drainage. CONCLUSION: The difference in blood volume observed between the two groups of patients with natural drainage and negative drainage, leads us to conclude that the best drainage in thyroidectomy is the natural one, diverging from the older concept of the use of negative drainage in superficial cavities.