Fracture and migration in right atrium of a permanent venous central access system in a elderly patient: case report and literature review

Catheter dislocation and fracture with migration of central venous lines have been reported in the International literature. Catheter fracture with consequent migration has been observed in 0.5-3.0% and may either be consequent to catheter removal or it can occur spontane-ously. Our case report concerns the migration of a Hickman catheter connected to a venous port to the right atrium in a 61-year old patient. A literature up-to-date has been performed to assess the risk of port-a-cath positioning. The position of catheter tip is considered critical for the risk of migration, that is greater as higher the tip localization respect to the carina. The aim of our study is to underline the critical role of X-ray to visualize the exact location of the catheter tip, regard-less of the approach used for catheter positioning

Palliative surgery or metallic stent positioning for advanced gastric cancer: differences in QOL

Background and Objectives: Twenty percent of the patients affected with stage IV antropyloric stomach cancer are hospitalized with a gastric outlet obstruction syndrome (GOOS) requiring its resolution to improve the quality of life (QoL).We present our preliminary short- and mid-term results regarding the influence of endoscopic placement of self-expandable metal stent (SEMS) or open stomach-partitioning gastrojejunostomy in QoL. Materials and Methods: In this prospective randomized longitudinal cohort trial, we randomly assigned 27 patients affected with stage IV antropyloric stomach cancer into two groups: Group 1 (13 patients) who underwent SEMS positioning and Group 2 (14 patients) in whom open stomach-partitioning gastrojejunostomy was performed. The Karnofsky performance scale and QoL assessment using the EQ-5D-5L™ questionnaire was administered before treatment and thereafter at 1, 3, and 6 months. Results: At 1-month, index values showed a statistically significant deterioration of the QoL in patients of Group 2 when compared to those of Group 1 (p = 0.004; CI: 0.04 to 0.21). No differences among the groups were recorded at 3-month; whereas, at 6-month, the index values showed a statistically significant deterioration of the QoL in patients of Group 1 (p = 0.009; CI: -0.25 to -0.043). Conclusions: Early QoL of patients affected with stage IV antropyloric cancer and symptoms of GOOS is significantly better in patients treated with SEMS positioning but at 6-month the QoL significantly decrease in this group of patients. We explained the reasons of this fluctuation with the higher risk of re-hospital admission in the SEMS group

Rapporto sulle attività geofisiche, oceanografiche e di campionamento durante la crociera PANSTR12 con Nave Aretusa: Isole Eolie (Stromboli, Panarea, Salina) (2012-06-30 - 2012-07-14)

All’interno della collaborazione Coordinamento Nazionale per la Geofisica Marina (CO.NA.GEM.), che riunisce i vari Istituti e organizzazioni tecnico-scientifiche italiani, si è svolta la campagna denominata PANSTR12, realizzata con Nave Aretusa della Marina Militare Italiana (MMI). PANSTR12 ha avuto come obbiettivi principali la caratterizzazione morfologica e geofisica della porzione sommersa della Sciara del Fuoco, Isola di Stromboli e la ripetizione di rilievi multibeam e magnetometrici dell’area degli isolotti di Panarea realizzati a partire dal 2002, nell’ottica di permettere analisi e valutazioni sul percorso evolutivo dei fenomeni legati all’eruzione gassosa, anche in relazione all’assetto tettonico e geodinamico dell’arco vulcanico delle Eolie. La campagna PANSTR12 è stata realizzata attraverso una proficua collaborazione tra l’Istituto Nazionale di Geofisica e Vulcanologia (INGV), gli Istituti di Scienze Marine (ISMAR) di Bologna (ISMAR-BO) e di La Spezia (ISMAR-SP), entrambi del Consiglio Nazionale delle Ricerche (CNR), e l’Istituto Idrografico della Marina (IIM).Istituto Idrografico della Marina, Marina Militare ItalianaPublished2.6. TTC - Laboratorio di gravimetria, magnetismo ed elettromagnetismo in aree attiveope

Urgent surgery for sigmoid diverticulitis. Retrospective study of 118 patients

OBJECTIVE: Aim of our study was to identify the risk factors for operative morbility and mortality after urgent surgery for complicated sigmoid diverticulitis. A further end point was define the adequate surgical approach in these patients. METHODS: Data from 118 patients who were admitted for emergency surgery between 2000 and 2009 for non-haemorrhagic complicated diverticulitis of the sigmoid colon were retrospectively evaluated and analysed. Operative options included resection with primary anastomoses (PA), Hartmann's procedure (HP) and colostomy. All operative complications were noted and potential risk factors listed. RESULTS: One hundred eighteen patients were enrolled in this study. Surgery for peritonitis was indicated for 102 patients and for intestinal obstruction in the remainder. Overall morbidity and mortality rates were 37.3% and 9.3%, respectively. Primary resection was performed on 113 patients (95.8%). Age greater than 70 years, diffuse peritonitis, Mannheim Peritonitis Index (MPI) above 18, and symptoms lasting longer than 24 hours are considered as independent risk factors for operative morbidity and mortality. DISCUSSION: Our results confirmed that while age older than 70 years and delaying treatment (> 24h) are independent risk factors for operative morbidity and mortality, comorbidity is not. According to general guidelines, first target of surgery was to attempt a primary resection of the diseased colon (95.8% of our patients). In our series an high rate of Hartmann's procedure (HP) in Hinchey's class 2 patients was observed. This unusually high number is explained by the rate (68.4%) of pelviperitonitis diagnosed in these patients. Extended pelvic peritonitis is generally defined as a local peritonitis (class 2 Hinchey), which is not accurate. Colonic resection in these cases would not completely remove peritoneal contamination and renders the indication for PA questionable CONCLUSIONS: Emergency surgery for complicated diverticulitis is characterised by high rates of morbidity and mortali. Age greater than 70 years, symptoms lasting longer than 24 hours, MPI above 18, and diffuse peritonitis were significant predictors. Early eradication of septic focus is the main goal of surgery. Primary anastomosis is recommended only if sepsis is completely removed

Day case laparoscopic cholecystectomy: Safety and feasibility in obese patients.

Day-case laparoscopic cholecystectomy (DCLC) is not universally adopted and its use is limited to patients selected by non-standardized criteria. Since laparoscopic cholecystectomy is considered technically more difficult in obese patients, a high body mass index (BMI) is often considered an exclusion criterion for DCLC. The aim of this research is to define the feasibility and safety of day case laparoscopic cholecystectomy in obese patients.Accepted manuscript, 12 month embarg

Treatment of giant intramuscular hemangioma: A multistep approach in three patients

Background: Giant intramuscular hemangioma (GIH) is a rare, progressively enlarging benign tumor, characterized by variable presentation and usually initially diagnosed in childhood. Large volume, rapid enlargement and particular radiologic imaging create suspicion of malignancy. Radiologic investigations and needle or small excisional biopsy are not always reliable for an accurate diagnosis; therefore, histology on a large surgical specimen is often requested. The timing and modality, of treatment of these tumors is a matter of debate. Patients and Methods: Data on 3 patients with GIH of the upper trunk and neck are reported. Associated vascular anomalies were found in all patients. All 3 patients had surgery because of the effect of the growth on their function, the severe symptoms and suspicion of malignancy. Results: A one-step excision of an enormous tumor was carried out in one patient, who died from severe postoperative complications. A second patient was successfully treated by a multistep surgical and multidisciplinary approach. An uneventful removal of part of the tumor was performed on the third patient, who is currently in follow-tip for completion of treatment. Conclusion: Surgery remains the most effective mode of treatment for GIH and often results in permanent cure. The authors suggest performing the surgical removal of these tumors at first diagnosis, when their smaller size requires less demanding procedures, presents lower rates of morbidity and offers a better chance of complete excision