Right post-traumatic diaphragmatic hernia with liver and intestinal dislocation.

Right diaphragmatic hernia is an uncommon injury following abdominal trauma. A case of delayed right post-traumatic diaphragmatic hernia is presented. The patient referred us with wheezing and cough since 1 month. A chest-abdominal computed tomography scan demonstrated a large diaphragmatic defect with liver and intestinal dislocation. The patient underwent surgical intervention with diaphragmatic repair. No complications were observed during admission and follow-up is actually negative for recurrence.

Lung transplantation with grafts from elderly donors: a single-center experience.

INTRODUCTION: Use of extended criteria donors is one of the strategies to face the scarcity of donors for lung transplantation. METHODS: Between November 2002 and May 2009, we performed 52 LTs in 50 recipients, 10 of whom (group A) received lungs from donors aged 55 years or older (median, 58.5; range, 56-66 years) for comparison with 28 patients (group B) transplanted with lungs from donors younger than 55 years (median, 25.5; range, 15-54 years). We excluded 9 children and 3 recipients of combined liver plus lung transplantations from the study. RESULTS: Recipient age, gender, and indications for transplantation did not differ significantly between the 2 groups. Neither were there significant differences in PaO2/FiO2 ratios before lung retrieval, or length of the ischemic time The first PaO2/FiO2 on arrival to the intensive care unit (ICU) and the median length of ICU stay were similar. All patients, except 2 who died in the operating theatre, were extubated between 3 and 216 hours after the transplantation. Hospital mortality was similar in both groups: 3 patients in group A and 2 in group B (P = .1). The median portions of the predicted 1-second forced expiratory volume (FEV1) at 6 months after transplantation did not differ in the 2 groups: 62.4% in group A versus 70% in group B (P = .85). CONCLUSION: Lung grafts from donors older than 55 years can be effectively used for transplantation, thus increasing the total organ pool.

[Pelvic masses in young women: a case of giant uterine fibroleiomyomatosis]. / Le masse pelviche nelle giovani adulte: un caso particolare di fibroleiomiomatosi uterina gigante.

The authors reported a particular case of giant uterine fibroleiomyomatosis in young women and describe some clinical feature and differential diagnoses.

[Use of Tachosil in splenectomy in patients with clotting and blood composition disorders]. / Impiego di Tachosil nella splenectomia in pazienti con disordini della coagulazione e della crasi ematica.

UNLABELLED: Splenectomy in patients suffering from onco-haematological conditions presents clotting-related problems which make correct haemostasis more difficult. Using operative haemostasis during splenectomy for onco-haematological conditions as a starting point, the authors report their personal clinical experience of the use of Tachosil, comparing it with other similar products and drawing some personal CONCLUSIONS: To complete their reflexions on clotting problems during splenectomy in the course of onco-haematological diseases, the comparison with its use in oncological pathologies in other parenchymas, such as the kidney and liver, which also present operative haemostatic difficulties of a technical nature, is pointed out and the soundness of the results indicated. The cases of 3 patients suffering from severe clotting disturbances and treated with splenectomy and 1 patient suffering from clear cell renal carcinoma and subjected to nephrectomy in which Tachosil was used as an aid to haemostasis are reported. In the light of these cases, it can be stated that, albeit with the persistence of difficulties related to the changed clotting capacities resulting from the basic disease, the use of Tachosil has proved effective as an aid in haemostasis and suggests the validity of its use in elective and emergency splenectomy, in these types of patient.

[A surgical emergency: iatrogenic lesion of the spleen. Case report and review of the literature]. / Un'emergenza chirurgica: la lesione iatrogena della milza. Caso clinico e review della letteratura.

The spleen is an organ often injured during surgical procedures. Iatrogenic lesions belong frequently to a low grade and can be treated with a conservative therapy. The surgeon may avoid the splenectomy by using new haemostatic agents as the patch of fibrinogen and thrombin in fixed combination.