Non operative management of blunt splenic trauma: a prospective evaluation of a standardized treatment protocol.

PURPOSE: The advantages of the conservative approach for major spleen injuries are still debated. This study was designed to evaluate the safety and effectiveness of NOM in the treatment of minor (grade I-II according with the American Association for the Surgery of Trauma; AAST) and severe (AAST grade III-V) blunt splenic trauma, following a standardized treatment protocol. METHODS: All the hemodynamically stable patients with computer tomography (CT) diagnosis of blunt splenic trauma underwent NOM, which included strict clinical and laboratory observation, 48-72 h contrast-enhanced ultrasonography (CEUS) follow-up and splenic angioembolization, performed both in patients with admission CT evidence of vascular injuries and in patients with falling hematocrit during observation. RESULTS: 87 patients [32 (36.7 %) women and 55 (63.2 %) men, median age 34 (range 14-68)] were included. Of these, 28 patients (32.1 %) had grade I, 22 patients (25.2 %) grade II, 20 patients (22.9 %) grade III, 11 patients (12.6 %) grade IV and 6 patients (6.8 %) grade V injuries. The overall success rate of NOM was 95.4 % (82/87). There was no significant difference in the success rate between the patients with different splenic injuries grade. Of 24 patients that had undergone angioembolization, 22 (91.6 %) showed high splenic injury grade. The success rate of embolization was 91.6 % (22/24). No major complications were observed. The minor complications (2 pleural effusions, 1 pancreatic fistula and 2 splenic abscesses) were successfully treated by EAUS or CT guided drainage. CONCLUSIONS: The non operative management of blunt splenic trauma, according to our protocol, represents a safe and effective treatment for both minor and severe injuries, achieving an overall success rate of 95 %. The angiographic study could be indicated both in patients with CT evidence of vascular injuries and in patients with high-grade splenic injuries, regardless of CT findings.

Management of corrosive injuries of the upper gastrointestinal tract. Our experience in 58 patients.

BACKGROUND: The ingestion of caustic substances is one of the most difficult conditions to be treated in Emergency Department. PATIENTS AND METHODS: The medical records of patients with caustic ingestion and hospitalized from 2003 to 2008 at the Division of General Emergency Surgery with Polyspecialistic Observation of AORN "A. Cardarelli "in Naples, have been revalued. RESULTS: From 2003 to 2008, 58 patients with caustic ingestion were admitted to our Division. Ten of these patients (17.24%) underwent surgery. Six patients underwent oesophageal and gastric resection with cervical esophagostomy and alimentary digiunostomy in emergency; two underwent exploratory laparotomy, two had gastroenteroanastomosis for antropyloric stenosis. One patient underwent new operation for a complication. In total, three reconstructions of oesophagus with colon were performed . Of the six patients undergoing esofagogastrectomy, two died in the first postoperative day, but four have passed the acute phase. CONCLUSIONS: There is no universally accepted diagnostic and therapeutic procedure for the management of these patients, who are often left - as it appears in literature - to the personal experience of the surgeon who is dealing with this situation.

[Diaphragmatic rupture with intrathoracic hepatic dislocation. Two case report]. / Rottura diaframmatrica con erniazione intratoracica del fegato. Presentazione di due casi clinici.

The authors show two cases of diaphragmatic rupture by blunt trauma with intra thoracic liver dislocation due to an accident on the street. The preoperative diagnosis has been based on the CT scan. The laparotomy, central for a patient and sub costal bilateral for the other one, gave the chance to repair the diaphragmatic defect directly and to deal with the associated lesions existing in both the casualties. No prosthetic material has been used and the reconstruction of the diaphragmatic defect has been conducted through a interrupted suture with non absorbable material. According to our experience the reparation of the diaphragmatic defect has always been conducted through a laparotomic approach and without using any prosthetic material. We repute that in these cases the laparotomic approach is the best one, which permits not only the reparation of the diaphragmatic defect but also the correct management of the related lesions which could be present. Usually we use a interrupted suture with non absorbable material for minor lesions and a continuous one, double layered if possible, for the major ones.

[Jejunal perforation from metastatic choriocarcinoma. Case report and review of the literature]. / Perforazione digiunale da coriocarcinoma metastatico. Caso clinico e revisione della letteratura.

Choriocarcinoma is a rare malignant genital tract tumor, arising in the uterus or in the testis. Primary or metastatic choriocarcinomas of the gastrointestinal tract are infrequent. We report a case of a testis choriocarcinoma presenting as jejunal metastasis with perforation. Histology revealed the origin of this metastatic tumor, allowing us to recognize the primary neoplasm of the testis. A review of literature with PubMed since 1964 and of the references of the papers retrieved was performed. Since 1933 only 30 cases of jejunal choriocarcinomas have been described in literature. In 13 cases jejunal choriocarcinoma presented gastrointestinal hemorrhage, in 4 intestinal intussusception and in 1 case upper abdominal pain and vomiting. Only 5 cases of jejunal perforation have been described. The case presented is the first in literature of jejunal perforation from a metastatic choriocarcinoma of the testis.

[Eosinophilic colitis: an unusual cause of acute abdomen. Case report and review of literature]. / Colite eosinofila: una causa rara di addome acuto. Presentazione di un caso e revisione della letteratura.

The Authors report a case of acute abdomen caused by a colic stenosis due to eosinophilic gastroenteritis. It is a not frequent disease, often clinically unclear: in the medical literature the Authors have found only 346 cases in publications concerning the period January 1990 - December 2005. The clinical presentation is very changeable, related to the involved site of alimentary tract and to the level of eosinophilic infiltration of the wall. There are no diagnosis criteria universally acknowledged and the most efficient procedure is thought being the intestinal biopsy which enables showing the infiltration of the digestive wall. The cure is above all medical with administration of corticosteroid: surgery surely has a less important role, reserved to the cases with acute onset.

[The timing in differential diagnosis of cystic tumors of the pancreas: clinical report of three cases of cystadenocarcinoma]. / Il "timing" nella diagnosi differenziale dei tumori cistici del pancreas: contributo clinico su tre casi di cistoadenocarcinoma.

The Authors analyze their own twelve-years experience about the Cystic Tumors of the Pancreas, considering the data existing in the literature. In particular, after a description of anatomo-pathological and clinical characteristics, they set out the problems in the differential diagnosis between the Cystadenocarcinomas and the other benign cystic lesions of the Pancreas. The solution of this problem is often reached only during the operation with multiple biopsies. Moreover they pay attention to the therapeutic choices, determined by the symptomatology of the patients and the localization and the histological kind of the lesions.

[A case of anaplastic thyroid carcinoma]. / Un caso di carcinoma anaplastico della tiroide.

The Authors report a case of anaplastic thyroid carcinoma surviving more than 20 months from the time of diagnosis and still living. The patient underwent surgery (total thyroidectomy), chemotherapy (cisplatin and doxorubicin according to Schlumberger), and radiotherapy (5000 Gy).