Massive pulmonary embolism as a rare complication of a stab in the inguinal region in a HIV-positive patient: a case report

Venous thromboembolism (VTE) is a severe preventable disease; HIV-infection represents a prothrombotic condition, because of specific factors due to the virus itself, the host response and the antiretroviral therapy. Our aim is to raise awareness of thromboembolic risk when dealing with HIV-positive patients presenting to the Emergency Department for treatment of injuries, even though small

Gastro-intestinal symptoms as clinical manifestation of peritoneal and retroperitoneal spread of an invasive lobular breast cancer: report of a case and review of the literature

BACKGROUND: Distant spread from breast cancer is commonly found in bones, lungs, liver and central nervous system. Metastatic involvement of peritoneum and retroperitoneum is unusual and unexpected. CASE PRESENTATION: We report the case of a 67 year-old-woman who presented with gastrointestinal symptoms which revealed to be the clinical manifestations of peritoneal and retroperitoneal metastatic spread of an invasive lobular breast cancer diagnosed 15 years before. CONCLUSION: To the best of our knowledge, the case presented is the third one reported in literature showing a wide peritoneal and extraperitoneal diffusion of an invasive lobular breast cancer. The long and complex diagnostic work up which led us to the diagnosis is illustrated, with particular emphasis on the multidisciplinary approach, which is mandatory to obtain such a result in these cases. Awareness of such a condition by clinicians is mandatory in order to make an early diagnosis and start a prompt and correct therapeutic approach

ESTIMATION OF REAL PER CAPITA CONSUMPTION OF MEAT IN ITALY

Food consumption refers to the amount of food available for human consumption. The knowledge of food consumption is crucial to set production and food supply policies, to compare eating habits with other countries, to assess the nutritional status of a population and to study the relationship between diet and health. In the last years all these aspects have taken an increasingly important interest because epidemiological studies have indicated a possible association between high consumption of meat and an risk of several forms of cancer as well as metabolic and cardiovascular diseases. Unfortunately meat consumption is often estimated by methods that are inappropriate for this use because they do not represent the actual amount of meat consumed or, better, eaten by the consumers. The actual food consumption may be lower than the quantity shown as food availability depending on the magnitude of wastage and losses of food during the slaughtering, in the household, e.g. during storage, in preparation and cooking, as plate-waste or quantities fed to domestic animals and pets, thrown or given away The consumption estimated by FAO and by statistical offices of the various countries through the national food balance sheets does not indicate the amount of meat, ie the weight of the skeletal muscles of animals with included or adherent tissues, but the amount of the weighted carcass at the slaughterhouse, including bones, tendons, connective tissues and fat. This paper discusses a method of estimating the real per capita consumption of meat in Italy with accuracy comparable to that of individual consumption, developed by the Study Commission of Animal Science and Production Association (ASPA). This action responds to the need of producing statistical indicator related to health food, as recommended by many international organizations (FAO, Eurostat)

Rippled mesh: a CT sign of abdominal wall ePTFE prosthesis infection

Background. Infection of polytetrafluoroethylene (ePTFE) prostheses for abdominal incisional hernia is a rare but serious complication that often makes meshes removal necessary. Instead serous collections (seromas) without signs of infection don?t require surgical removal. Differential diagnosis between infected and non-infected fluid collections is difficult and sometimes impossible before surgical exploration. Methods. We describe a new sign observed in two patients who underwent abdominal computed tomography for evaluation of a fluid collection without clear signs of prosthesis infection, complicating abdominal wall repair for incisional hernia in which an ePTFE mesh was used. In both patients an alteration of the mesh profile was demonstrated on imaging, and in both patients prostheses resulted infected at surgical exploration and at microbiological examination after removal. The sign we observed is not evident in computed tomography images performed in cases of seromas. Conclusions. We discuss the possible mechanism of this finding and propose that this sign may be due to a ?rejection? of the infected prosthesis from the surrounding neo-formed fibrous and inflammatory tissue

The new retained foreign body! Case report and review of the literature on retained foreign bodies in laparoscopic bariatric surgery

The advent of laparoscopic surgery has created a set of peculiar morbidities. As the laparoscopic devices, also the type of retained foreign bodies has changed. We present a case of unusual, apparently isolated and recurrent lung abscess, pleural effusion and poorly evident subphrenic abscess after laparoscopic gastric bypass, due to a retained Endo-Catch bag. A 27-year-old obese female underwent an uneventful laparoscopic Roux-en-Y gastric bypass. After surgery she developed a left basal lung abscess, that resolved in two weeks with heavy antibiotic therapy, while radiological abdominal imaging was apparently normal. Patient was discharged on p.o. day 30. After two months, she presented with fever and dyspnoea and no gastrointestinal complaints. Chest and abdominal computer tomography showed a left recurrent abscess with effusion but this time a 3 cm subphrenic mass with metallic clips inside was demonstrated on CT scan. Patient was treated with an explorative laparoscopy that identified an Endo-Catch bag with the jejunal blind loop inside. Postoperative left lung abscess can be a warning of a suphrenic surgical complication. Laparoscopic surgery requires even more attention to retained foreign bodies due to the reduced visibility of the surgical field. The recommendation to enforce recording of laparoscopic maneuvers is mandatory

Stapled Hemorrhoidopexy and Milligan Morgan hemorrhoidectomy in the cure of fourth-degree hemorrhoids. Long-term evaluation and clinical results

PURPOSE: The long-term results after stapled hemorrhoidopexy compared with Milligan-Morgan procedure are discussed. METHODS: The clinical data of 100 patients treated by Milligan-Morgan procedure or stapled hemorrhoidopexy for fourth-degree hemorrhoids have been reviewed. All patients were visited and submitted to a questionnaire to evaluate resumption of symptoms, functional results, and recurrence rate. RESULTS: The mean follow-up was 54 months for stapled hemorrhoidopexy and 92 months for the Milligan-Morgan procedure. Postoperative pain and return to normal activity were worse in the Milligan-Morgan procedure (Visual Analog Scale 8.56 vs. 5.46, P<0.001; and 2.4 vs. 2 weeks, P value=0.018). Eight percent of patients who had stapled hemorrhoidopexy complained of spontaneous pain or pain during defecation vs. 0 percent of patients who underwent the Milligan-Morgan procedure. We noted that there was bleeding in 14 percent of stapled hemorrhoidopexy vs. 0 percent of Milligan-Morgan procedure (P<0.006), tenesmus in 32 percent of stapled hemorrhoidopexy vs. 0 percent of Milligan-Morgan procedure (P∈<∈0. 001), and pruritus in 4 percent of stapled hemorrhoidopexy vs. 0 percent of Milligan-Morgan procedure. Minor leakage was similar in the two groups. Flatus impaired control was less frequent in Milligan-Morgan. The relative risk of recurrence for stapled hemorrhoidopexy compared with Milligan-Morgan procedure was 1.18 (95 percent confidence interval 1< relative risk < 1.4). No statistical difference was noted in patients' satisfaction after the procedures. CONCLUSIONS: Long follow-up seems to indicate more favorable results in Milligan-Morgan procedure in terms of resumption of symptoms and risk of recurrence. © 2007 The American Society of Colon and Rectal Surgeons

Isoflavone intake in four different European countries : The VENUS approach

The aim of this study was to identify the level of isoflavone intake (total isoflavones, daidzein and genistein) in four European countries: Ireland, Italy, The Netherlands and the UK. For this purpose national food composition databases of isoflavone content were created in a comparable way, using the Vegetal Estrogens in Nutrition and the Skeleton (VENUS) analytical database as a common basis, and appropriate food consumption data were selected. The isoflavone intake in Ireland, Italy, The Netherlands and the UK is on average less than 1 mg/d. Small groups of consumers of soya foods could be identified in Ireland, The Netherlands and the UK. The estimated intake levels are low compared with those found in typical Asian diets (∼20-100 mg/d) and also low compared with levels where physiological effects are expected (60-100 mg/d). The results (including a subgroup analysis of soya product consumers) showed that such levels are difficult to achieve with the European diets studied here. Chemicals/CAS: daidzein, 486-66-8; genistein, 446-72-0; isoflavone, 574-12-9; daidzein, 486-66-8; Genistein, 446-72-0; Isoflavone

Peptic ulcer in gastric heterotopia of the gallbladder without evidence of Helicobacter pylori infection

Peptic Ulcer in Gastric Heterotopia of the Gallbladder Without Evidence of Helicobacter pylori Infectio

Laparoscopic approach to recurrent incisional hernia repair. A 3-year experience

Background: Incisional hernias are one of the most frequent complications of open abdominal surgery. The incidence of relapses after a conventional repair procedure is higher in recurrent than in primary cases (30%-50% vs. 11%-20%). The laparoscopic approach can prevent the complications associated with the conventional approach when dealing with recurrent incisional hernias. The aim of this study was to evaluate the efficacy of laparoscopic treatment in such cases. Materials and Methods: We prospectively analyzed data from 41 consecutive patients with recurrent incisional hernias, who submitted to a laparoscopic repair procedure with an expanded polytetrafluoroethylene Dual Mesh (Gore-Tex® Dual Mesh® Plus Biomaterial; W.L. Gore 8 Associates) from December 2001 to December 2004. All of the patients underwent clinical follow-up at 1, 6, and 12 months and then yearly. An ultrasound scan of the abdominal wall was performed at 6 and 12 months after the procedure. The parameters considered for the analysis were: mesh size, operating time, hospital stay, postoperative complications, and recurrences. Results: The defects were usually localized along midline laparotomies. The mean mesh size was 400 cm2, the mean operating time was 68 minutes, and the mean length of hospital stay was 2.7 days. Complications were encountered in 17% of patients. The mean follow-up was 38 months (range, 18-54). Recurrence was reported in 1 case only (2.4%), which occurred within the first 6 months after the operation. Conclusions: The laparoscopic repair of recurrent incisional hernia seems to be an effective alternative to the conventional approach, as it can give lower recurrence and complication rates

Measurement of the photoproduction phases of the ρ\rho, ω\omega, and ϕ\phi mesons

We measured 30 000 wide-angle electron-positron pairs from the reaction γ+p→p+e++e− in the invariant-mass region 500≤m≤1060 MeV. The photoproduction amplitudes of the ρ, ω and ϕ mesons were measured to deviate from being pure imaginary by 37.5°−3.1°+2.8°, 29.6°−12.9°+15.5°, 3.4°−4.2°+5.3°,respectively