Sporadic flat ileal adenocarcinoma: an intriguing challenge in the comprehension of a rare neoplasia and its genesis. Case report and review of literature

Small bowel adenocarcinoma is a rare tumor, with a still not well studied tumorigenesis process, usually presenting in an advanced stage. The clinical diagnosis is often difficult; surgery is the treatment of choice when feasible, while the chemotherapic approach is still not well codified. We describe the case of a 71-yr-old male patient, presenting with an acute right abdomen. At laparotomy the terminal ileum appeared chronically inflamed and thickened. An ileocecal resection with laterolateral ileocolic anastomosis was performed. The gross appearance resembled an inflammatory bowel disease, but microscopic examination revealed the extensive presence of an infiltrating ileal adenocarcinoma. Literature about small bowel adenocarcinoma has been reviewed for better understanding its pathogenesis

Predicting needlestick and sharps injuries in nursing students: Development of the SNNIP scale

© 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd. Aim: To develop an instrument to investigate knowledge and predictive factors of needlestick and sharps injuries (NSIs) in nursing students during clinical placements. Design: Instrument development and cross-sectional study for psychometric testing. Methods: A self-administered instrument including demographic data, injury epidemiology and predictive factors of NSIs was developed between October 2018–January 2019. Content validity was assessed by a panel of experts. The instrument's factor structure and discriminant validity were explored using principal components analysis. The STROBE guidelines were followed. Results: Evidence of content validity was found (S-CVI 0.75; I-CVI 0.50–1.00). A three-factor structure was shown by exploratory factor analysis. Of the 238 participants, 39% had been injured at least once, of which 67.3% in the second year. Higher perceptions of “personal exposure” (4.06, SD 3.78) were reported by third-year students. Higher scores for “perceived benefits” of preventive behaviours (13.6, SD 1.46) were reported by second-year students

A rare case of extraskeletal osteosarcoma of the esophagus: an example of difficult diagnosis

Sarcomatous lesions of the esophagus are rare. We describe a controversial case of a malignant aggressive tumor of the aesophagus, with a very poor prognosis and rapid outcome for the patient. A 74-year-old man underwent endoscopic examination for recurrent thoracic pain and dysphagia. A 8 cm mass was found in the cervical esophagus. A sarcomatous tumor with osteoid aspects was observed on the histopathological examination, without any carcinomatous component

Intramuscular myxoma of the deltoid muscle: report of a case

Intramuscular myxoma is a rare, benign lesion of mesenchymal origin, affecting the skeletal muscles. We report the case of a 75-year-old woman presenting with a mass of the right deltoid region. On the MRI examination it was interpreted as a lipomatous lesion. She underwent marginal excision. The pathological examination revealed the diagnosis of intramuscular myxoma

Acute abdomen in the elderly. A peripheral general hospital experience

Abbiamo rivisto la nostra esperienza su 291 pazienti consecutivi di età superiore ai 65 anni, operati per addome acuto dal 2003 al 2007 presso l’Ospedale “Santo Spirito” di Casale Monferrato, un ospedale periferico del Piemonte. L’età media era di 78 anni e il rapporto maschi/femmine di 149/142. Un totale di 126 pazienti (43%) aveva una o più patologie associate. Le cause più comuni di intervento urgente sono state l’occlusione (45%), la perforazione di viscere cavo (18%) e l’ernia strozzata (18%). 234 pazienti (80%) hanno avuto un decorso libero da complicanze maggiori. I rimanenti 57 (20%) hanno sviluppato almeno una complicanza maggiore (inclusa la morte). I decessi postoperatori a 30 giorni sono stati 33 (11%). Le complicanze maggiori non letali sono state 24 (8%). Le complicanze più comuni sono state quelle cardiorespiratorie. Le complicanze settiche sono state 15. I reinterventi per complicanze chirurgiche sono stati 5. L’infarto intestinale e la peritonite secondaria sono state le cause più importanti di decesso (rispettivamente 42 e 17% della mortalità). Abbiamo inoltre riportato una mortalità elevata fra i pazienti con carcinosi peritoneale (24%). La chirurgia in urgenza è stata relativamente sicura per i rimanenti gruppi di pazienti, con una mortalità complessiva del 5.3%. In conclusione riteniamo che l’addome acuto sia ancora una causa apprezzabilmente frequente di morte fra gli anziani. Sono perciò richiesti un alto livello di vigilanza ed una precoce attenzione. Tuttavia, escludendo alcune gravi condizioni, i risultati complessivi della chirurgia addominale in urgenza sono soddisfacenti nella maggior parte dei pazienti anziani. Alla luce dell’attuale vivace dibattito sul ruolo degli ospedali periferici nel Sistema di Assistenza Sanitaria, ci sentiamo di poter affermare che il trattamento dell’addome acuto nell’anziano è sicuro e fattibile in questi ospedali, e che questi giocano un ruolo determinante nel trattamento dei pazienti anziani, specialmente in emergenza