Cryptogenetic intestinal angiodysplasia and elderly aortic stenosis: Heyde's syndrome? A case report.

Gastrointestinal haemorrhage is extremely frequent, but in some cases the aetiology may remain unknown. Haemorrhage from the small bowel especially can create important diagnostic problems. We report the case of a patient admitted to hospital with intestinal bleeding in an ileal site in association with aortic stenosis. Enteric angiodysplasia is a frequent pathology in the surgery of the gastrointestinal tract. Recognizing bleeding lesions in the small intestine can be really difficult. Concerning the case reported here, the most probable diagnostic hypothesis is Heyde's syndrome, which is characterised by valvular aortic stenosis together with gastrointestinal bleeding due to cryptogenetic angiodysplasias. The choice to be made in the therapeutic management of angiodysplasia is still a debatable issue and should be suited to the patient's clinical state and the site and extent of the bleeding. In the literature the link between aortic valvular stenosis and intestinal angiodysplasia is unclear. The physiopathological relationship between the two entities is still mysterious.

[Intestinal carcinoid tumours: personal experience and a review of the literature]. / I carcinoidi intestinali: esperienza personale e revisione della letteratura.

The observation of a number of cases of intestinal carcinoid tumours prompted the authors to review the literature in order to define the principal biological and anatomopathological aspects and the current therapeutic choices. The diagnosis is often obtained on the basis of anatomopathological examination. The kind of surgical treatment is still a matter of controversy: minimal or extended resection? A number of criteria may orient the surgeon towards major surgery, such as tumour size, node involvement, infiltration of the serous membrane, and liver metastases.

[Incarcerated inguinal hernia in elderly: personal tension-free hernioplastic technique]. / Tecnica operatoria di ernioplastica protesica tension-free nelle ernie inguinali intasate nei pazienti anziani.

AIMS OF THE STUDY: With the increasing of the middle age, more and more elderly patients with incarcerated inguinal hernia have to be surgically treated with lower operatory time and lower anesthesiological stress. The Authors present a personal tension-free hernioplastic technique. MATERIALS AND METHODS: Thirthy-seven male patients (range 80-92 years) recovered for incarcerated inguinal hernia (Gilbert II tipe) without vascular injury, underwent to tension-free hernioplastic technique without inguinal canal opening, in local anaesthesia. RESULTS: The average operative time was 33 minutes (range 25-42 min). Follow-up at 10 days, 3 months and 5 years shows a correct position of the plug, no recurrence, no alterations of normal testicular vascolarization in absence of paresthesia or chronic pain. The post-operative pain was absent or trascurable whitout the use of any antalgical therapy.

[Difficulties in diagnosing and treating GIST: report and analysis of a case]. / Difficoltà diagnostiche e terapeutiche nei GIST: nostre considerazioni su un caso clinico.

Gastrointestinal stromal tumours account for fewer than 1% of malignant tumours of the digestive system. Analysing a case referred to us for observation, we review the literature with regard to diagnostic and therapeutic difficulties. A 68-year-old patient was referred to our institute with a diagnosis of "retroperitoneal haematoma". Computerised tomography showed a solid mass with a liquid component, occupying almost the whole of the abdominal cavity. An ultrasonography-guided biopsy examination suggested the presence of a sarcoma. Exploratory laparotomy and the histological examination, which was positive for CD117, CD34 and the smooth muscle marker caldesmon, allowed a diagnosis of gastrointestinal stromal tumour to be made. Thus, no thoroughly reliable and accurate diagnosis of gastrointestinal tumour can be made without surgical exploration and consequent histological and immunohistochemical examinations that still represent the only method capable of confirming or ruling out a diagnosis of gastrointestinal stromal tumour. Such tumours are rare and aggressive and their prognosis is closely related to tumour size and the mitotic index per high power field. Radical resection affords the only possibility of long-term survival.