Simultaneous Bilateral Laparoscopic Adrenalectomy Is Safe for Synchronous Large Adrenal Tumors

Laparoscopy is now considered the gold standard for treating benign monolateral adrenal lesions. We present the case of a patient affected by Cushing's syndrome due to large bilateral adrenal adenomas (7.5cm) who underwent simultaneous laparoscopic bilateral adrenalectomy. An anterior, lateral transperitoneal approach was used. Operative time was 200 minutes, and blood loss was 200mL. No intraoperative complications were encountered. The postoperative course was uneventful, and the patient was discharged after 3 days. Laparoscopic bilateral adrenalectomy is a safe, effective procedure when performed by experienced hands and may be an alternative treatment for large adrenal lesions

An unusual case of bowel obstruction in emergency surgery: The heterotopic mesenteric ossification

The heterotopic mesenteric ossification, also known as myositis ossificans, is a rare form of heterotopic ossification, a metaplastic phenomenon where new bone is formed in the mesenteric base, generally after abdominal trauma (surgical or other). The pathophysiology of heterotopic mesenteric ossification is unknown; clinical presentation is not specific, with vague abdominal symptoms, uncertain radiological findings, and often regular laboratory exams. No consensus exists on the best possible approach, although it might well be both medical and surgical. We reviewed the clinical history of a 28-year-old man with a recent motor vehicle accident who was admitted to our surgical unit with symptoms consistent with a small bowel obstruction; after surgery, a diagnosis of myositis ossificans was surprisingly made

Minimally-invasive multidisciplinary treatment of deep endometriosis: 103 cases

Background: Endometriosis is a multifactorial disease which can cause severe pelvic pain that can impact everyday life. In addition, the complex of pain, inflammation, altered pelvic anatomy, adhesions, disrupted ovarian reserve/function, and compromised endometrial receptivity is a common cause of infertility. The treatment of this disease should be individualized according to the clinical situation and to the level of impairment. This study aims to define the role of surgery in the treatment of deep endometriosis with intestinal localization, particularly whether surgery is capable or not to improve painful symptoms, disease recurrence, and fertility. Methods: In this retrospective clinical single-arm study, from March 2017 to March 2022, we included all patients who underwent to surgical intervention involving bowel resection for deep endometriosis. To analyze the effects of surgery in improving symptoms a standardized questionnaire, based on the verbal rating scale (VRS) [0–4], was given pre-operatively on the first gynecological visit and post-operatively at least 6 months from intervention. In addition, each patient seeking a pregnancy before surgery was contacted at the end of the follow-up to find out whether she had a full-term pregnancy or not. Results: A total of 103 patients undergoing surgery for deep endometriosis involving the intestinal tract were included in the present study. The indication for surgery was given based on the severity of the symptoms, the desire for pregnancy, or a combination of the two. The 28.9% of the patients became completely asymptomatic after intervention and reported a clear decrease in the intensity of the painful symptomatology. The average pre-operative VRS score was 1.37, in the post-operative period, the average VRS score was 0.4, a difference that was statistically significant. About fertility, we observed a 20% increase after surgery. Conclusions: Deep endometriosis is an aggressive form of endometriosis which has a great impact in patients’ quality of life. Medical therapy control symptoms without a real resolution of them. This study emphasizes as surgical minimally invasive treatment represents the gold standard for the cure of deep endometriosis with excellent results on infertility and symptoms improvement

Development and Multicenter Validation of a Novel Immune-Inflammation-Based Nomogram to Predict Survival in Western Resectable Gastric and Gastroesophageal Junction Adenocarcinoma (GEA): The NOMOGAST

Background. More than 50% of operable GEA relapse after curative-intent resection. We aimed at externally validating a nomogram to enable a more accurate estimate of individualized risk in resected GEA. Methods. Medical records of a training cohort (TC) and a validation cohort (VC) of patients undergoing radical surgery for c/uT2-T4 and/or node-positive GEA were retrieved, and potentially interesting variables were collected. Cox proportional hazards in univariate and multivariate regressions were used to assess the effects of the prognostic factors on OS. A graphical nomogram was constructed using R software’s package Regression Modeling Strategies (ver. 5.0-1). The performance of the prognostic model was evaluated and validated. Results. The TC and VC consisted of 185 and 151 patients. ECOG:PS > 0 (p < 0.001), angioinvasion (p < 0.001), log (Neutrophil/Lymphocyte ratio) (p < 0.001), and nodal status (p = 0.016) were independent prognostic values in the TC. They were used for the construction of a nomogram estimating 3- and 5-year OS. The discriminatory ability of the model was evaluated with the c-Harrell index. A 3-tier scoring system was developed through a linear predictor grouped by 25 and 75 percentiles, strengthening the model’s good discrimination (p < 0.001). A calibration plot demonstrated a concordance between the predicted and actual survival in the TC and VC. A decision curve analysis was plotted that depicted the nomogram’s clinical utility. Conclusions. We externally validated a prognostic nomogram to predict OS in a joint independent cohort of resectable GEA; the NOMOGAST could represent a valuable tool in assisting decision-making. This tool incorporates readily available and inexpensive patient and disease characteristics as well as immune-inflammatory determinants. It is accurate, generalizable, and clinically effectivex

COVID-19-associated vasculitis and thrombotic complications: from pathological findings to multidisciplinary discussion

Neutrophilic arterial vasculitis in COVID-19 represents a novel finding and could be responsible for thrombotic complications

Short-term and long term morbidity in robotic pancreatic surgery: a systematic review

BACKGROUND: Pancreatic cancer is one of the most aggressive and lethal tumours in Western society. Pancreatic surgery can be considered a challenge for open and laparoscopic surgeons, even if the accuracy of gland dissection, due to the close relationship between pancreas, the portal vein, and mesenteric vessels, besides the reconstructive phase (in pancreaticoduodenectomy), lead to significant difficulties for laparoscopic technique. Minimally invasive pancreatic surgery changed utterly with the development of robotic surgery. However, this review aims to make more clarity on the influence of robotic surgery on long-term morbidity. METHODS: A systematic literature search was performed in PubMed, Cochrane Library, and Scopus to identify and analyze studies published from November 2011 to September 2020 concerning robotic pancreatic surgery. The following terms were used to perform the search: “long term morbidity robotic pancreatic surgery”. RESULTS: Eighteen articles included in the study were published between November 2011 and September 2020. The review included 2041 patients who underwent robotic pancreatic surgery, mainly for a malignant tumour. The two most common robotic surgical procedures adopted were the robotic distal pancreatectomy (RDP) and the robotic pancreaticoduodenectomy (RPD). In two studies, patients were divided into groups; on the one hand, those who underwent a robotic pancreaticoduodenectomy (RPD), on the other hand, those who underwent robotic distal pancreatectomy (RDP). The remaining items included surgical approach such as robotic middle pancreatectomy (RMP), robotic distal pancreatectomy and splenectomy, robotic-assisted laparoscopic pancreatic dissection (RALPD), robotic enucleation of pancreatic neuroendocrine tumours. CONCLUSIONS: Comparison between robotic surgery and open surgery lead to evidence of different advantages of the robotic approach. A multidisciplinary team and a surgical centre at high volume are essential for better postoperative morbidity and mortality

Covid-19 and hepatic injury: A systematic review

After observing patients with pneumonia of unknown cause in Wuhan (China), a novel Coronavirus was identified as 2019 novel coronavirus (COVID-19). Gastrointestinal symptoms are common in COVID-19 and can be present in up to 26% of patients in some populations; the most common is diarrhoea, followed by nausea and/or vomiting and abdominal pain. A few studies recently described liver impairment as a common manifestation of the virus; therefore, a correlation between the severity of the disease and liver injury is being sought up

Oxford Manuale di Medicina Clinica

Traduzione della nona edizione del manuale tascabile di Medicina Clinic