Amyand's hernia with acute phlegmonous appendicitis: case report.

Any inguinal hernia containing the vermiform appendix is called Amyand's hernia. Amyand hernias are very rare and even rarer is the association of Amyand hernia with acute appendicitis. Due to the rarity of this entity, it constitutes a challenging case in terms of diagnosis and treatment. The surgical management is not yet standardized and there are no clear guidelines. There are some controversies regarding whether to perform an appendectomy if appendix appears normal or whether mesh can be used for the hernia repair if appendectomy is performed. We describe a case of Amyand hernia in a 90-year old man with acute appendicitis and we review current literature regarding surgical strategy.

[Isolated agenesis of the gallbladder: case report]. / Agenesia della colecisti: caso clinico.

The gallbladder agenesis is a rare congenital abnormality which is frequently mistaken with cholecystolithiasis, regardless of the imaging modality used. The diagnosis is confirmed at laparoscopic surgery with intraoperative sonography and intraoperative cholangiography and postoperative MRI-cholangiography. Intraoperative cholangiography may be risky because the absence of normal anatomical structures and the impossibility of pulling on the gallbladder to dissect the triangle of Calot represents an increased risk of iatrogenic injury to biliary or portal structures. Therefore postoperative MRI-cholangiography seems to be a more suitable approach to confirm the diagnosis.

[Duodenal villous adenoma: a case report]. / Adenoma villoso del duodeno: un caso clinico.

Small bowel tumours are rare neoplasms representing just 1% of all the gastrointestal tract lesions. Adenomas are the benign forms which, developing in the duodenum, tend to localize in periampullary region, with high incidence of malignant degeneration. The authors report a case of a fifty-five-years old woman with a periampullary villous adenoma.

[Synchronous multiple gastric adenocarcinoma: a clinical case]. / Adenocarcinomi gastrici multipli sincroni: un caso clinico.

The Authors present a case of synchronous double gastric carcinoma in a 75-year-old man. Synchronous multiple gastric carcinoma (SMGC) constitutes 4% to 10% of all gastric cancers. It exhibits several clinicopathological characteristics that differ from those of solitary cancers: SMGC occurs in older people (men more than women); early carcinoma is observed more frequently in SMGC than in solitary cancers; the rate of intestinal type lesions is higher in multiple than in single gastric carcinoma. With regard to the pathogenesis of multiple gastric cancer, the theory proposing a multicentric or independent origin rather than the local or distant spread of one cancer (multifocality) has been favored.

[Cystadenocarcinoma in situ of the urachus: a clinical case]. / Cistoadenocarcinoma in situ dell'uraco: caso clinico.

Urachal carcinoma is a rare neoplasm which represents 0.01% cancers in adults. If this neoplasm is unusual, the development of cystadenocarcinoma on a urachal cyst is still more rare. The surgical treatment of choice is en-bloc excision of umbilicus and median umbilical ligament with partial cystectomy. As the urachal cystadenocarcinoma of Authors' patient was in situ and without bladder-invasion, they performed a more conservative treatment without partial cystectomy. They believe that this treatment may be indicated in association with a close follow-up after surgery.

Spontaneous rectus sheath haematoma in HCV mixed cryoglobulinemia requiring emergency treatment (case report).

Hepatitis C virus-related mixed cryoglobulinemia is a vasculitis, associated with a number of systemic manifestations and diseases. The Authors present a patient with mixed cryoglobulinemia, who developed acute abdominal pain and severe anemia, caused by spontaneous haematoma of rectus abdominis sheath. Prompt diagnosis of this unusual complication of cryoglobulinemia vasculitis may allow conservative treatment and avoid surgery, which is more expensive and invasive. To the best of Author's knowledge, spontaneous rectus sheath haematoma in a patient with cryoglobulinemia has not been previously reported.

Basic fibroblast growth factor and myointimal hyperplasia after experimental polytetrafluoroethylene arterial grafting.

OBJECTIVE: To assess the role of polyclonal antibodies to basic fibroblast growth factor (bFGF) in inhibiting myointimal hyperplasia after insertion of polytetrafluoroethylene (PTFE) grafts in rats. DESIGN: Experimental study. SETTING: University laboratory, Italy. ANIMALS: 24 inbred Lewis rats. INTERVENTIONS: A segment of PTFE I cm long was interposed in the abdominal aorta. The animals were randomised in two groups, n = 12 in each. The first were given polyclonal antibodies to bFGF at the time of operation, and for the first two postoperative days; and the second were given non-specific IgG at the same time periods. MAIN OUTCOME AND MEASURES: Two animals died during the immediate postoperative period of anaesthetic complications. 12 animals (6 in each group) were killed 7 days postoperatively (24 hours after injection of 5-bromo-deoxyuridine BrdU) to assess smooth muscle cell proliferation. The remaining 10 animals (5 in each group) were killed after 1 month to assess the degree of anastomotic myointimal hyperplasia. RESULTS: Antibodies to bFGF resulted in less smooth muscle cell proliferation at the anastomoses as well as anastomotic myointimal hyperplasia. Smooth muscle cell proliferation was reduced to about half in animals treated with anti-bFGF antibodies. Neointimal thickness was reduced in treated animals. CONCLUSIONS: We conclude that after PTFE arterial grafting there is increased production of bFGF at the anastomotic regions that leads to smooth muscle cell proliferation and formation of myointimal hyperplasia. Agents that reduce the production of bFGF may also reduce the development of myointimal hyperplasia after PTFE arterial grafting.

Suppression of smooth muscle cell proliferation after experimental PTFE arterial grafting: a role for polyclonal anti-basic fibroblast growth factor (bFGF) antibody.

OBJECTIVES: To determine the role of polyclonal anti-basic Fibroblast Growth Factor (bFGF) antibody in inhibiting the proliferation of smooth muscle cells after experimental polytetrafluorethilene (PTFE) arterial grafting. MATERIALS: In 14 male inbred Lewis rats (weight 250 mg) a 1 cm long segment of PTFE was interposed at the level of abdominal aorta. Animals were randomised to receive polyclonal anti-bFGF antibody (group A: n = seven animals) or aspecific immunoglobulin (group B: n = seven animals). Anti-bFGF antibody or aspecific immunoglublin were given intraperitoneally at the end of operation, and for the first 2 postoperative days. Animals were sacrificed 7 days after surgery, 24 h after intraperitoneal injection of BromodeoxyUridin (BrdU) to label proliferating smooth muscle cells. RESULTS: One animal in each group died in the immediate postoperative period due to anaesthetic problems. All grafts were patent at the time of sacrifice. BrdU labelling index was statistically higher in the control group B animals at the level of the anastomotic regions (proximal anastomosis: group B 7.9% vs. group A 4.1%. Distal anastomosis: group B 5.1% vs. group A 2.6% p = 0.009) and at the level of PTFE graft (group B 3.8% vs. group A 2.6% p = 0.002), while there was no statistical difference between the control thoracic aorta of the two groups. MAIN CONCLUSIONS: bFGF plays a major role in the proliferation of smooth muscle cells at the level of the anastomoses after arterial PTFE grafting. Agents able to block the action of bFGF may be useful in inhibiting the formation of myointimal hyperplasia.

Poliarterite nodosa na infancia. Descricao de caso. / Polyarteritis nodosa in childhood. Report of a case

Relata-se poliarterite nodosa na infancia associada a endocardite infecciosa descrita em seus aspectos clinicos laboratoriais e histopatologicos.Discutem-se as dificuldades de diagnostico, etiopatogenia, assim como o envolvimento neurologico central e a resposta a terapeutica instituida.com dois modelos e resistencia, sensive