Late Epiphrenic-Retroperitoneal Fistula of an Esophageal Diverticulum Ten Years after Surgical Excision: Report of the First Case

Background: Esophageal fistula is a rare complication of an epiphrenic diverticulum and represents a difficult diagnostic challenge. In the majority of cases in the English literature, the fistula is secondary to the spontaneous perforation of the epiphrenic diverticulum and in only one case an esophagobronchial fistula occurs after resection of an epiphrenic diverticulum. No case of esophageal fistula communicating with the retroperitoneum tissues was found. Case Report: We present a case of 84 years old male admitted in 2017 in our Hospital for the appearance of epigastralgia and cough with traces of blood to sputum, asthenia and night sweats. Ten years before he underwent to a hiatal hernia plastic sec. Nissen and subsequently was reoperated for exeresis of diverticulum of the distal third of the esophagus by thoracotomy. In August 2008, because of esophageal substenosis an operation of posterior gastropexy sec. Hill with the demolition of the previous hiatoplasty was performed. In 2017, a computerized tomography shows a voluminous abscess in the right paravertebral region with development along the muscular plane of the ipsilateral psoas and a fistular path of about 4 cm between the posterior wall of the esophagus and the retroperitoneal collection of the abdomen. Conclusions: Esophageal fistula represents a complex problem of epiphrenic diverticulum and rarely a hidden complication of surgery. Surgery is the treatment of choice in suitable patients

A case of pulmonary dirofilariasis in Ferrara, Italy

The pulmonary filariasis is a rare entity and it is caused by a dog worm (Dirofilaria) that is transmitted to humans by mosquitoes. The filarial nematode enters the subcutaneous tissue, travels to the right ventricle, dies and then embolizes the pulmonary vessels causing a small pulmonary infarction. Usually it is casually identified by chest radiography, done for other reasons, in asymptomatic patients; the coin-lesion shape is generally presumed to be neoplastic. We reported a case of human pulmonary filariasis in a man who shown multiple lung coin-lesions shaped presumed to be neoplastic. The patient underwent surgery with double-wedge resection of the right lung and he was discharged on the fifth post-operative day. The Dirofilariasis incidence is increasing in the canine population, making human pulmonary dirofilariasis likely to occur. The differential diagnosis of a solitary pulmonary nodule includes primary lung cancer, metastatic cancer, infectious disease, septic embolism, Wegner's granulomatosis, pulmonary echinococcosis and reumatoid nodules. No single preoperative laboratory test has been a diagnostic value. Human pulmonary dirofilariasis should be considered in the differential diagnosis of solitary or multiple subpleural, non calcified pulmonary nodules in the clinical and appropriated epidemiological setting, since more cases of this infectious disease are likely to be found with greater awareness of this condition

Agent-Based Business Process Management with Eclipse

This paper describes WOLF (WOrkflow LiFe cycle management environment), an open-source development environment that leverages the full power of Eclipse to provide users with an industrial-strength business process modelling tool that has already proven its functionality in real-world projects. WOLF provides users with a graphical view of the advanced abstractions related to agent-based BPM (Business Process Management) like agents, workflows, events and messages. The core advantage of such abstractions is their high-level expressiveness that turns agent-based BPM into a solid technology that can be easily understood and mastered by both technical personnel and domain experts. The main feature of WOLF is the support for the graphical definition of workflows by means of a dedicated Eclipse editor; besides that, WOLF also helps developers in setting up Eclipse projects for realizing and managing agent-based business processes

Thymic Epithelial Tumors: Prognostic Significance and Relationship between Histology and the New TNM Staging System

Background This study aims to describe the relationship between the new tumor nodes metastasis (TNM) staging and World Health Organization (WHO) classification and to identify how these two variables relate to each other and whether they possess a prognostic value in predicting survival and recurrence of disease. Methods Medical records of 54 patients who underwent surgery for thymic epithelial tumors between 1996 and 2015 were reviewed. The histologic type of neoplasm was classified according to the criteria of WHO and staging was evaluated using the new TNM classification system. Results A significant correlation between the TNM stages and the histological classification was found (p < 0.001). Complete resection is related to both TNM stage and histological grading (p < 0.001). Evaluation of the 5- A nd 10-year survival curves shows how these are significantly correlated only at the stage (p = 0.03 and = 0.04, respectively). The risk of death at 5 and 10 years for stages III to IV is six and three times higher than in stages I to II, respectively. Regarding the disease-free survival, there is significant correlation with both staging and histology (p = 0.001 and = 0.02, respectively). Conclusions There is a significant correlation between the new TNM staging and the histological grade WHO. The ability to implement a complete resection, the overall and disease-free survival is closely related to the thymoma stage. Furthermore, both histotype and stage correlate with disease-free survival. In fact, the least aggressive stages, both WHO and TNM, have a free time out of disease superior to advanced stages

Primary Pulmonary Epithelioid Hemangioendothelioma: A Rare Cause of PET-Negative Pulmonary Nodules

We report here a case of primary pulmonary epithelioid hemangioendothelioma diagnosed in a 67-year-old Caucasian man, presenting with exertion dyspnoea, dry cough, and multiple bilateral pulmonary nodules revealed by computed tomography. At the 18F-fluorodeoxyglucose positron emission tomography, these nodules were negative. The histopathological diagnosis was made on a pulmonary wedge resection (performed during video-thoracoscopic surgery)