Correlation between oesophageal acid exposure and dyspeptic symptoms in patients with nonerosive reflux disease.

Oesophageal acidification induces dyspeptic symptoms in healthy individuals. This study aimed to evaluate the correlation between oesophageal acid exposure and dyspeptic symptoms in patients with nonerosive reflux disease. METHODS: A total of 68 patients with dominant symptoms of heartburn, negative upper gastrointestinal endoscopy and concomitant dyspeptic symptoms participated in the study. The severity of dyspepsia and reflux-related symptoms was evaluated, and 24-h gastro-oesophageal pH-monitoring study was performed in all patients at baseline and after 4 weeks of therapy with esomeprazole 40 mg. RESULTS: Oesophageal basal acid exposure was pathological in 43 patients and normal in 25 patients, with a similar prevalence and severity of individual dyspeptic symptoms in the two groups. A significant correlation between reflux and dyspepsia scores was observed in the subgroup of patients with normal, but not in those with abnormal pHmetry (r=0.4, P=0.04 and r=0.2 P=0.07, respectively). After esomeprazole, a reduction in severity of dyspepsia (>or=50% with respect to baseline) was observed, independent of improvement of reflux-associated symptoms. Improvement in dyspepsia was, however, similar in patients with normal and abnormal basal acid exposure (14/25 vs. 33/43, respectively, P=NS). CONCLUSION: Dyspeptic symptoms coexist in a subset of nonerosive reflux disease patients, but prevalence and severity of the symptoms seems to be independent of oesophageal acid exposure

Polypoid vascular malformation of the small intestine.

A 56-year-old man underwent capsule endoscopy because of obscure GI bleeding. Capsule endoscopy showed a pink and somewhat nodular polypoid lesion of the small bowel partially obstructing the intestinal lumen (A). The patient underwent an ileal resection and the operative specimen showed loss of mucosal folds and the presence of an erythematous area with a polypoid formation of 3.5 × 3 cm (B). Histologic examination revealed the presence of numerous ectatic thin-walled blood vessels and a small number of thick-walled vessels in the submucosa (C and D, arrows; H&E, orig. mag. ×4), surrounded by hypertrophic muscularis mucosae and a chronic inflammatory infiltrate that infiltrated the muscularis propria; the diagnosis of polypoid angiodysplasia was suggested. There has been no recurrence of GI bleeding 14 months after the ileal resection

Laparoscopic Cholecystectomy with a Mixed Approach in a Patient with Kartagener Syndrome: Technical Report and Review of Literature

Kartagener syndrome (KS) is a rare autosomal recessive disease. The disease is characterized by three typical symptoms: chronic sinusitis, situs viscerum inversus (SVI), and bronchiectasis. The laparoscopic cholecystectomy (LC) is the standard procedure in most cases of cholelithiasis, but in SVI patients it can be difficult, especially for right-handed surgeons. We report the case of a 24-year-old female affected by KS, presenting with a history of symptomatic cholelithiasis. Ultrasound and magnetic resonance cholangiopancreatography confirmed SVI totalis and cholelithiasis. The patient underwent a laparoscopic cholecystectomy by a right-handed surgeon performed with a mixed approach without complications. Laparoscopic cholecystectomy in SVI patients can be a safe and reliable technique especially for a left-handed surgeon. The described technique is also easy for a right-handed surgeon. However, it is considered a technically challenging procedure and often requires technical modification

Correlative imaging of cystic lymphangiomas: ultrasound, CT and MRI comparison

Cystic lymphangioma is a rare benign lesion derived from the detachment of the lymph sacs from venous drainage systems; the treatment of choice is a surgical excision and the final diagnosis is of histological type

BioEnterics Intragastric Balloon (BIB) versus Spatz Adjustable BalloonSystem (ABS): Our experience in the elderly

The BioEnterics Intragastric Balloon (BIB) and the Spatz Adjustable Balloon System (ABS) are in fact recommended for weight reduction as a bridge to bariatric surgery. We retrospected studied patients with body mass index (BMI) and age ranges of 37e46 and 70e80 years, respectively, who had undergone BIB from January 2010 to July 2012 and prospected studied patients who had undergone Spatz balloon from July 2012 to August 2014. The aim of this study is to compare BIB and Spatz in terms of weight loss, complications, and maintenance of weight after removal. For both procedures, the median weight loss was 20 ± 3 kg, median BMI at the end of the therapy was 32 ± 2, and no severe complication occurred

Emergency groin hernia repair: implications in elderly

BACKGROUND: Groin hernia is one of the most frequently encountered pathologies occurring in old age and it is often the cause of emergency procedures. In our study we evaluate the impact of emergency procedures in over 75 patients compared to younger patients. METHODS: We conducted a retrospective study about patients who underwent emergency hernioplasty between September 2007 and January 2013. Bilateral hernias and recurrences were excluded. We divided patients into two groups by age (under and over 75 years old) and then analyzed the early postoperative surgical complications. RESULTS: A total of 48 patients were enrolled, 18 were included in under 75 group and 30 in over 75. In the older group we found a higher rate of comorbidity and also a significant higher rate of postoperative complications. Two patients of over 75 group died. CONCLUSIONS: Our data suggests that a quick diagnosis and elective surgical procedures are desirable in order to avoid the complications that occur in emergency operations

Management of pheochromocytoma during pregnancy from diagnosis to laparoscopic adrenalectomy. A case report and review of literature

INTRODUCTION: Pheochromocytoma is an endocrine tumour of chromaffin cells. It can be diagnosed either sporadically or in the context of hereditary syndromes (e.g. Von Hippel Lindau, Neurofibromatosis type 1 and multiple neuroendocrine neoplasia type 2). During pregnancy, its frequency is very low (about 0,007%). This tumour causes paroxysmal hypertension in 0,1-0,6% pregnant women, because of an overproduction of catecholamines. If undiagnosed and nontreated, it's associated with high maternal and fetal mortality (40-50%). We report the case of a 30-year-old female diagnosed with pheochromocytoma during pregnancy at week 31 of gestation. In a multidisciplinary team made of surgeons, gynaecologists, anaesthetists, geneticists and endocrinologists we evaluated the case and according to literature, we choose a surgical approach after childbirth: performing a laparoscopic right adrenalectomy. DISCUSSION: In pregnancy, pheochromocytoma is a rare clinical condition. Gold standard treatment is laparoscopic adrenalectomy. However, the optimum timing of surgery is a challenge. CONCLUSION: Timely diagnosis of pheochromocytoma in pregnant women with hypertension and appropriate therapeutic management can lead to improve maternal, fetal and neonatal outcomes. The multidisciplinary team is necessary to recognize the symptoms and to adopt the right pre - and post - operative treatment. Laparoscopic adrenalectomy after delivery is safe and feasible even though the surgical procedure should be performed by an experienced surgeon. KEY WORDS: Pheochromocytoma, Pregnancy, Laparoscopic adrenalectomy and pregnancy, Management of pheochromocytoma, Laparoscopic adrenalectomy, Adrenalectomy, Pregnancy and pheochromocytoma