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Aim: Considering ileocolic resection as a surgical standard for the treatment of ileocecal valve Crohn's disease, we propose a limited resection of the terminal ileum and ileocecal valve with ileocecal anastomosis. Material of study: Three patiens between 20 and 37 years of age, diagnosed with Crohn's disease unresponsive to medical therapy, who have stenoses or fissures confined to the terminal ileum and ileocecal valve, seen during instrumental investigations. Results: The proposed procedure allowed us to perform a minimal resection and reconstruction of a new ileocecal valve. Once the symptoms have resolved, at endoscopic follow ups, at 6 and 12 months after surgery, there were no changes in the mucosa of the ileocecal neo-anastomosis. Discussion: Since Crohn's disease is a systemic disease with a chronic relapsing course complicated by a high rate of post-surgical relapses, it is essential to limit the extension of resections to the macroscopically involved tissues and reduce the anastomotic surfaces. The proposed surgical procedure allows to preserve the caecum and the colon with an optimal postoperative course. Conclusion: We believe that, with specific clinical and endoscopic conditions, the treatment we illustrated can be proposed to other patients as an alternative to the standard VL ileocolic resection. Key words: Crohn's Disease, Ileocaecal Valve, Ileocaecal Anastomosis.

Gastric cancer represents the fourth most common form of cancer and the second most common cause of death in the world. It is also one of the most common cancers leading to mortality in Italy. Therefore, this study aimed to determine the survival rate of patients with advanced gastric cancer and its affecting factors in our experience at AOU Federico II.

The BioEnterics Intragastric Balloon (BIB) and the Spatz Adjustable Balloon System (ABS) are in fact recommended for weight reduction as a bridge to bariatric surgery. We retrospected studied patients with body mass index (BMI) and age ranges of 37e46 and 70e80 years, respectively, who had undergone BIB from January 2010 to July 2012 and prospected studied patients who had undergone Spatz balloon from July 2012 to August 2014. The aim of this study is to compare BIB and Spatz in terms of weight loss, complications, and maintenance of weight after removal. For both procedures, the median weight loss was 20 ± 3 kg, median BMI at the end of the therapy was 32 ± 2, and no severe complication occurred.

The authors have evaluated by ultrasound the CCSVI in Meniere's Disease.

Background: Angiodysplasia of the gastrointestinal tract is an uncommon, but not rare, cause of bleeding and severe anemia in elderly. Different treatments exist for this kind of pathology. Methods: The aim of this work was to study 40 patients treated for intestinal angiodysplasia with two different kind of endoscopic treatments: argon plasma coagulation (APC) and bipolar electrocoagulation (BEC). Results: Age of patients was similar in both groups (76,2 ± 10.8 years vs 74,8 ± 8,7 years, P = 0,005). Angiodysplasia treated were located in small bowel, right colon, left colon, transverse colon and cecum. We analysed number of treatment, recurrence, hospital discharge, needs of blood transfusions before and after endoscopic treatment. Number of treatment was the same in both groups (1,2 ± 0,2 vs 1,1 ± 0,1, P < 0,001). We had more recurrence in patients treated with BEC (4/20 vs 2/20, P < 0,001). Hospital discharge was comparable in both groups (5,3 ± 3,1 days vs 5,4 ± 2,8 years, P < 0.001) Conclusions: Treatment of angiodysplasia in elderly is not easy. Different kinds of treatment could be adopted. APC and BEC are both safe and effective. The choice of a treatment should consider several factors: age, comorbidity, source of bleeding. In conclusion we think that treatment of bleeding for angiodysplasia in elder population should be a tailored treatment. © 2015 Rita Compagna et al., published by De Gruyter Open.

Gli Autori descrivono il caso di un uomo di 88 anni ricoverato d’urgenza nel loro Dipartimento, per una marcata anemizzazione, senza perdite ematiche macroscopiche, con positività alla ricerca del sangue occulto nelle feci. L’EGDS ha evidenziato una lesione ulcerativa dell’antro gastrico e della parete anteriore del bulbo duodenale, il quadro istologico e morfologico delle biopsie endoscopiche è risultato compatibile con diagnosi di Linfoma non Hodgking, B cellulare a piccole cellule o mantellare.

In this paper we wanted to establish if there is a gold standard in the surgical treatment of Pilonidal Sinus. MATERIAL AND METHODS: We conducted a retrospective study on a continuous series of 140 patients, treated for pilonidal sinus. We have divided the observed patients in two groups according the different kind of closure: GROUP A (79 pts.): treated with excision and healing by second intention; Group B (61 pts.): treated with excision and closure by first intention using a personal tension-free synthesis technique.

I tumori stromali gastrointestinali sono tumori mesenchimali che, anche essendo rari,sono i più comuni del tratto gastroenterico e si stima che negli Stati Uniti vengano colpiti circa 5000-6000 individui ogni anno, con una fascia d'età maggiormente interessata compresa tra i 50 e i 60 anni. La resezione chirurgica rappresenta il gold standard per i pazienti con un GIST resecabile e localizzato e si è rivelata a tutti gli effetti la cura più efficace anche in considerazione del fatto che esistono diversi fattor idi rischio da valutare per un'accurata prognosi di vita del paziente. Al fine di eradicare il tumore ci si può avvalere dell'uso di diverse tecniche chirurgiche in base al tratto gastrico interessato dalla lesione, dalla wedge resection che circoscrive la porzione di parete coinvolta dalla neoplasia con margine libero, fino alla gastrectomia totale o esofago gastrectomia totale ed eventualmente allargata agli organi adiacenti interessati. Nel nostro studio abbiamo preso in esame 15 casi di pazienti affetti da GIST gastrico trattati chirurgicamente (in 6 casi è stata effettuata una gastrectomia totale e nei restanti casi si è proceduto con una gastrectomia parziale), in 2 di questi pazienti c'è stata una recidiva locale e poi metastatica trattata con il farmaco chemioterapico Imatinibmesilato. Uno di questi è deceduto mentre l'altro è tuttora in vita. Questo ci ha consentito di confermare le attuali linee guida disponibili circa il trattamento dei GIST gastrici che evidenzia una netta interrelazione tra cure mediche e chirurgiche.

Negli ultimi anni, grazie allo sviluppo di nuove metodiche, l’endoscopia operativa sta avendo un ruolo sempre maggiore nella gestione delle complicanze post-chirurgiche. Sulla base della più recente letteratura scientifica disponibile vengono analizzate le principali tecniche endoscopiche per il trattamento delle deiscenze e delle stenosi anastomotiche dopo chirurgia gastrointestinale. La scelta della metodica endoscopica più appropriata si basa essenzialmente sulle caratteristiche e sulla sede della lesione da trattare, sulla disponibilità delle varie tecniche, sull’esperienza e sulle preferenze dell’operatore.

Enterocutaneous Fistula1 (ECF) is a serious complication of the surgery of the digestive tract. The management of an ECF is multidisciplinary. This condition leads the patient to a profound state of cachexia and it causes often fatal complications. Nowdays, mortality has fallen to about 20%. Therapy can be medical or surgical, but surgery become mandatory according to FRIEND criteria.

Patients undergoing surgery for varicose disease of the lower limb are generally treated with elastic compression. Nevertheless, in surgical practice, there are no mandatory indications concerning the type of compression to perform and its duration. Particular attention must be paid when it is present a concomitant chronic obstructive disease. We performed an evaluation of elastic compression tolerability on 10 patients with varicose veins (CEAP C2) and PAOD (stage IIa) and calculated, for each of them, Winsor Index, Actual Claudication Distance and recovery time without and with elastic compression. Compression therapy did not influence statistically significantly Winsor Index. Compression therapy was well-tolerated by 9 of 10 patients.

Introduction: The esophagus may be affected by several infective agents, which cause mucosa alterations of various degree, and which can determine either light symptons or critical clinical problems with a high mortality risk. These diseases very often affect patients with reduced immunocompetence. Some of the infectious agents most frequently involved in esophageal infections are Herpes virus, Candida, CMV, HIV. Infectious esophagitis from HPVs are rare in the western countries. The greater number of registered cases have been discovered in the East. Hypotesis is that HPV is a possible etiologic agent in esophageal carcinogenesis, most probaby acting synergistically with physical, chemical, and/or nutritional factors in some high-risk areas of China. Although there are specific endoscopic aspect for infectious esophagitis from different agents, it is difficult to make a differential diagnosis and therefore biopsies, cultures and brushing have a particular importance. The bioptic area is a critical point for histological diagnosis of infectious oesophagitis. Infact, in case of suspected infection from herpes virus, the biopsies must be made on the mucosa surrounding the ulcerative lesion, whereas, for the cytomegalovirus, the specimen must be obteined from the ulcerative crater. Other important procedure, in case of supposed infectiouse disease, is culture, especially with the “shell vial” technique. Epidemiological and experimental evidences suggest the possibility that HPV infection increases the cancer risk for the oral cavity, pharynx and upper aerodigestive tract. However, histologic changes, suggesting HPV infection, are occasionally found adjacent to squamous cell carcinoma or in squamous papilloma of the esophagus, but the relationship between HPV infection and benign and malignant squamous lesions of the esophagus is not yet clear. It is important to differenziate infective esophagitis from gastroesophageal reflux esophagitis in order to perform an up-to-date treatment. Clinical Case: A 25 year old woman was hospitalized in the Federico II University Dept. of General Surgery for arising of retrosternal pain, odynophagia and dysphagia, both for solids and liquids. These symptoms had begun six days before admission. Bioumoral routine tests showed no abnormalities. No pathognomonic symptoms for gastroesophageal reflux nor caustic assumption was referred. The esophago-gastro-duodenoscopy showed, in midium esophagus, a large and deep ulcerative lesion, which involved the whole lumen between 26 and 30 cm. The lesion was thickened and covered by fibrin. Several bioptic tests were performed: IgG anti-varicella-zoster virus, anti-herpes simplex virus, anti-Epstein-Barr-vca were positive. The anti-HIV 1-2 test was negative. No lymphocytic alteration was observed. The histological diagnosis was “active chronic inflammatory infiltration and fibrinoleukocyte exudate”, which is direct sign of ulcerative lesion. Cytologic changes of coilocytic type (giving evidence for HPV infection) were observed. Examination of oral cavity, pharynx and upper respiratory tract gived no evidence of lesions by HPV or other causes. The patient received therapy consisting in mucosal protectives (sucralphate) and Total Parenteral Nutrition. At EGDS, performed two weeks later, the lesion appeared completely healed. References 1. Chang F., Syrjanen S., Shen Q., et al. Evaluation of HPV, CMV, HSV and EBV in esophageal squamous cell carcinomas fom a high-incidence area of China. Anticancer Res 2000 20(5C): 3935-40. 2. Chen L., Yang L., Sun Z. et al. Detection of human papillomaviral infection on Kazakh patients with esophageal squamous cell carcinoma in Xinjiang Chinese Journal of Clinical Oncology 2009; 6 (1): 64-67 3. de Villiers E.M., Lavergne D., Chang F., et al. An interlaboratory study to determine the presence of human papillomaviruses DNA in esophageal carcinoma from China. Int J Cancer 1999; 81(2): 225-8. 4. Franceschi S., Munoz N., Bosch XF et al. Human papillomavirus and cancers of the upper aerodigestive tract: a review of epidemiological and experimental evidence. Cancer Epidemiol Biomarkers Prev 1996; 5 (7): 567-75. 5. Kamangar F., Qiao Y.L., Schiller J.T. et al. Human papillomavirus serology and the risk of esophageal and gastric cancers: Results from a cohort in a high-risk region in China. International Journal of Cancer 2006; 119 (3): 579-584