Metastatic pancreatic cancer in late pregnancy: a case report and review of the literature.

The occurrence of pancreatic carcinoma in a young patient is rare and even more so in pregnancy. In this case report, we discuss the presentation and management of pancreatic adenocarcinoma, with lung and liver metastases, diagnosed in a woman in her third trimester of pregnancy (28 weeks). Ultrasound and magnetic resonance imaging scans were carried out and pancreatic mass biopsy during endoscopic retrograde cholangiopancreatography was performed. Severe preeclampsia and fetal growth restriction occurred. A female infant was delivered by cesarean section at 30 weeks of gestation for worsening of maternal clinical conditions and hepatic and pancreatic tests. The patient died 50 days after delivery. Although pancreatic cancer is a very rare event in pregnancy, it should be suspected when epigastric abdominal pain and laboratory parameters suggestive of biliary tract obstruction occur in pregnancy to ensure, at the least, a better pregnancy outcome.

[Conservative approach to IV grade renal trauma]. / Approccio conservativo al trauma renale di IV grado.

A case of grade IV renal trauma is reported and the literature reviewed. A 29-year-old man was admitted in an emergency setting for a grade IV renal and splenic trauma as a result of a motorcycle accident. Since the patient was haemodynamically stable and the retroperitoneal haematoma was neither expanding nor pulsating, a conservative approach was adopted and the renal trauma was managed with interventional radiology. The case shows that major renal traumas can be usefully managed by non-operative treatment, necessarily consisting in a mutidisciplinary approach.

[Classification and management of gynecologic acute abdomen at a secondary level hospital emergency department]. / Inquadramento e gestione dell'addome acuto di origine ginecologica in un Dipartimento di Emergenza ed Accettazione di II livello. Analisi di 103 casi.

This study retrospectively evaluates the preoperative work-up and the classification and operative treatment of acute abdomen caused by gynaecological disorders in emergency admissions to our department. All female patients admitted in the emergency setting and operated on for gynaecological acute abdomen in our emergency department over the period from 1997 to 2002 were included in the study. A total of 103 patients were identified (54 undergoing emergency operations, 9 operated on within 72 hours, and 40 managed conservatively with medical therapy. The 54 emergency operations performed were 24 ovarian resections, 17 salpingectomies, 5 oophorectomies, 4 exploratory laparotomies, 2 uterine polypectomies and 2 hysterectomies. The non-specific presentation of the disease and an inadequate preoperative work-up in these patients often led to a generic diagnosis at admission. This approach tends to increase the number of operations performed on an emergency basis, whereas a wait-and-see type of management should be adopted. A proper use of surgery is mandatory especially in those patients in whom preservation of reproductive capability has a major impact on outcome.

[Multidisciplinary approach to the patient with multiple trauma: a case report]. / Approccio multispecialistico al paziente politraumatizzato: un caso clinico.

A multidisciplinary approach to severe polytraumatized patient is very important for a rapid, uncomplicated recovery. Specialized centres with special beds, monitoring equipment, and a multidisciplinary team are required. The authors report a case of a 26-year-old man admitted to their department in an emergency setting for a crush injury (occupational trauma) of the lumbar, gluteal and perineal areas, complicated with septic shock and gas gangrene of the injured areas. A multidisciplinary approach to the patient, consisting in surgical and plastic surgical therapy, hyperbaric oxygen therapy and the use of a special antidecubitus fluidized bed allowed complete recovery within 7 months without any motor or sphincter disorders.