Which Surgical Strategy in Sepsis from Retro Peritoneal Colic Perforation

In the last decade, attention has been paid to severe abdominal infections which, due to their severity and difficulty in treatment, cause death in 30-60% of cases

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

Carcinoma ‘meta-metacrono’ del colon: descrizione di un caso clinico

Gli Autori presentano un raro caso di carcinoma ‘meta-metacro - no’ del colon in un uomo di 70 anni ricoverato con la diagnosi di adenocarcinoma del colon trasverso. Dai rilievi anamnestici, ampiamente documentati da cartelle cli - niche, si ricavava che il paziente era già stato operato due volte per carcinoma del colon, localizzato nel colon sinistro 7 anni prima e nel cieco due anni prima. Una colonscopia effettuata sedici mesi prima non aveva evidenziato alcuna lesione nel tratto di colon residuo. È possibile che piccolissime lesioni ancora allo stadio di adenomi non siano state identificate all’esame endoscopico e/o si sia realizzata una sequenza adenoma-carcinoma eccezionalmente rapida. Sulle basi di questa esperienza gli Autori raccomandano nei pazienti con carcinoma metacrono controlli endoscopici molto ravvi - cinati o l’esecuzione preventiva di una colectomia subtotale

Spontaneous rupture of an umbilical hernia in a cirrhotic patient with ascites. A case report and review of the literature

The authors, report a case of spontaneous rupture of an umbilical hernia in a cirrhotic patient with ascites and perform a literature review. Their results and the published data suggest that it is preferable to perform elective surgery after stabilization of the ascites and the patient's general condition in order to prevent complications and mortality. KEY WORDS: Ascites, Hernioplasty, Spontaneous hernia rupture

Risonanza magnetica e radiologia tradizionale nelle localizzazioni vertebrali dell’artropatia ocronotica alcaptonurica

studiare le alterazioni della colonna vertebrale nell’alcaptonuria (ocronosi) sia con esame radiologico convenzionale sia con Risonanza Magnetica (RM), mettendo a confronto i risultati delle due tecniche. Pazienti e metodi: sono stati sottoposti allo studio cinque pazienti (4 maschi, 1 femmina, età media 51 anni). Per lo studio con esame radiologico convenzionale sono state utilizzate proiezioni antero-posteriori e latero-laterali e le immagini sono state valutate facendo riferimento ad uno score radiografico che esamina le alterazioni a livello dello spazio articolare e la presenza di calcificazioni. Per quanto riguarda l’esame RM sono state utilizzate scansioni coronali, assiali e sagittali e sequenze spin echo T1-e T2-pesate. Risultati: entrambe le metodiche hanno messo in evidenza, nei casi con diagnosi nota, le alterazioni tipiche dell’ocronosi: riduzione d’ampiezza degli spazi articolari, fino all’anchilosi ossea, calcificazioni dei dischi, osteofitosi, anche a ponte, protrusioni discali multiple e sclerosi reattiva delle superfici articolari, evidenti soprattutto a livello dorso-lombare. La RM è risultata tuttavia più accurata nell’individuare le alterazioni e nel mettere in evidenza lesioni non palesi all’indagine radiografica, quali l’ispessimento dei legamenti longitudinali anteriori. Nel caso di nuova diagnosi, l’RM si dimostra fondamentale per la sua capacità di rilevare alterazioni tipiche dell’artropatia che alla radiologia tradizionale sembrano minime. Conclusioni: le peculiarità dell’artropatia ocronotica sono tali per cui le tecniche d’immagine, in particolare la RM, sono indispensabili nella diagnosi differenziale con altre malattie articolari

Management of patients with rectus sheath hematoma: Personal experience

Rectus sheath hematoma (RSH) is a rare clinical entity. It can be mistaken for other intra-abdominal disorders, which can result in diagnostic and therapeutic difficulties. This study was undertaken to analyze the clinical presentation, diagnostic modalities, and management of patients affected with RSH. Methods: Between January 2008 and June 2011, eight patients (5 men and 3 women with a mean age of 53 years) with RSH were evaluated according to demographic characteristics, clinical and radiological findings, and methods of treatment. Results: Six patients developed RSH after anticoagulant therapy; one after local trauma, and one after laparoscopic intervention. Six patients were treated nonsurgically; one patient underwent embolization of the inferior epigastric artery and one underwent ligation of the bleeding vessel. The average hospital stay was 6 days. There were no mortality or thromboembolic complications. Conclusion: RSH is a rare nonneoplastic entity that is usually associated with abdominal trauma and/or anticoagulant therapy. The gold standard for diagnosis is computed tomography, and ultrasonography can be used in follow-up. The treatment of choice is nonsurgical therapy because RSH is a self-limited condition. Surgical intervention should be reserved for cases with hemodynamic instability

Role of Emerging Environmental Risk Factors in Thyroid Cancer: A Brief Review

Environmental factors are recognized as risk factors of thyroid cancer in humans. Exposure to radiation, both from nuclear weapon or fallout or medical radiation, and to some organic and inorganic chemical toxicants represent a worldwide public health issue for their proven carcinogenicity. Halogenated compounds, such as organochlorines and pesticides, are able to disrupt thyroid function. Polychlorinated biphenyls and their metabolites and polybrominated diethyl ethers bind to thyroid, transport proteins, replace thyroxin, and disrupt thyroid function as phthalates and bisphenolates do, highly mimicking thyroid hormones. A better knowledge of environmental risks represents a very important tool for cancer prevention through true risks prevention and management. This approach is very important because of the epigenetic origin’s theory of cancer. Therefore, the aim of this review was study the association between environmental agents and thyroid cancer promotion

Management of patients with rectus sheath hematoma: Personal experience

Rectus sheath hematoma (RSH) is a rare clinical entity. It can be mistaken for other intra-abdominal disorders, which can result in diagnostic and therapeutic difficulties. This study was undertaken to analyze the clinical presentation, diagnostic modalities, and management of patients affected with RSH. Methods: Between January 2008 and June 2011, eight patients (5 men and 3 women with a mean age of 53 years) with RSH were evaluated according to demographic characteristics, clinical and radiological findings, and methods of treatment. Results: Six patients developed RSH after anticoagulant therapy; one after local trauma, and one after laparoscopic intervention. Six patients were treated nonsurgically; one patient underwent embolization of the inferior epigastric artery and one underwent ligation of the bleeding vessel. The average hospital stay was 6 days. There were no mortality or thromboembolic complications. Conclusion: RSH is a rare nonneoplastic entity that is usually associated with abdominal trauma and/or anticoagulant therapy. The gold standard for diagnosis is computed tomography, and ultrasonography can be used in follow-up. The treatment of choice is nonsurgical therapy because RSH is a self-limited condition. Surgical intervention should be reserved for cases with hemodynamic instability

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago /

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann’s procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann’s procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment’s choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception