Search

Abstract: Background/Aim: Factors involved in hepatitis C virus (HCV) recurrence versus acute cellular rejection are not fully understood. The aim of the present study was to investigate whether patients with recurrence after liver transplantation (OLT) showed similar CD4+/CD25+ cell frequency and function as those who became chronically infected. Patients and Methods: After written informed consent, we enrolled 20 patients (group A) who underwent OLT with HCV recurrence within 6 months. HCV-RNA and hypertransaminasemia were used to assess the reactivation of viral hepatitis. CD4+/CD25+ T cells were enumerated using a flow cytometry assay, gated on CD3 cells, stained for FoxP3. After immunomagnetic sorting (Dynal, Oslo, NW), Treg suppressor activity was measured, as the ability to inhibit proliferation of autologous CD4+/CD25− T cells (anti-CD3/CD28 stimulation—1:2, 1:20 ratio). Eight patients with acute hepatitis C who evolved to a chronic infection after 6 months (group B) were used as positive controls, while 10 healthy individuals were negative controls (group C). Results: We did not observe any difference in CD4+/CD25+ frequency or function among group A compared with group B (CD4+/CD25+ = 14% ± 2% versus CD4+/CD25+ = 16% ± 3%), although both groups were significantly increased with respect to group A (CD4+/CD25+ = 6% ± 3%; Mann-Whitney U test, P < .01). Conclusion: Patients developing HCV recurrence after OLT have the same immunoregulatory network as patients with acute hepatitis C evolving to persistent infection, likely suggesting that CD4+/CD25+ numbers may be a marker to predict recurrence of HCV after OLT. [Copyright &y& Elsevier]

The authors describe a case of giant appendiceal mucocele, secondary to a mucinous neoplasm of the appendix, diagnosed during laparotomy for acute abdomen. By a review of the literature they stress the rarity of this lesion, the particular onset in their case as acute complication of appendiceal neoplasm with rupture of the intestinal wall, the difficulties of diagnosis and management in emergency.

Hydatid disease is endemic in some areas of the world. It is located mostly in the liver. The cysts rupture is possible after a trauma, or spontaneously by the increase of intracystic pressure. Rupture of the hydatid cyst requires urgent surgical intervention. We report our experience in treatment of traumatic rupture of hepatic hydatid cyst.

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver, being the fifth most frequent cancer worldwide. It usually occurs in the setting of chronic liver disease and has a poor prognosis if untreated. Following the diagnosis, this disease requires multidisciplinary management. Orthotopic liver transplantation is theoretically the best treatment for early, unresectable HCC. However, the major practical obstacle is the extreme shortage of organs, which makes this a practical option only in selected patients. In this report we describe new advancements in diagnosis, classification, and treatment that have emerged in the field of HCC in recent years.

The Authors report the clinical course of M.L., a 22 years old man. He came to our observation after a road accident, in third care. In the former hospital admissions hemodynamic stabilization, surgical haemostasis of multiple hepatic lacerations with hemoperitoneum and right leg amputation were performed. He arrived to our department in a critical condition owing to mild respiratory insufficiency due to many rib fractures with sero-haematic spillage into the pleural cavity, in dialytic treatment for acute renal insufficiency consequent to right renal artery damage, soft tissues necrosis of the amputation stump with sepsis and persistent fever until 40 degrees C. The treatment and care of this patient required a team-work with the collaboration of many specialists, namely surgeons, nephrologists, anaesthetists, interventionist radiologists and hyperbaric oxygen therapy experts. Thanks to such collaboration we achieved an excellent quoad vitam result. The aim of this paper is to confirm and emphasize the central role of a Trauma Team, fed in a Trauma Center and in a Trauma System, in the management of complex traumas.

The Authors report the clinical case of polytraumatized patient who has colic abdominal pain and Murphy sign after 68 days from damaging event. This symptomatology is consequent to Acute Acalculous Cholecystitis (ACC) associated with hemobilia. This work may be different because hemobilia in polytraumatized patient, like causal factor of acute cholecystitis, is an isolated case in literature. The Authors discuss on ACC risk factors, diagnosis and therapy.

Despite the decrease in incidence observed during the last decades, gastric adenocarcinoma remains the fourth most common cancer in the world and the second leading cause of cancer-related death. Radical surgical resection is the best treatment option, though the role of extended and super-extended lymphadenectomy remains debatable. This review examines the different issues related to the surgical treatment of early and advanced gastric adenocarcinoma as well as the most recent strategies for the treatment and prevention of peritoneal carcinomatosis.

Aim of the Study: Oncological patients are particularly prone to the onset of septic complications such as abdominal abscesses. The aim of our study was to analyze clinical and microbiological data in a population of oncological patients, submitted to percutaneous ultrasound-guided drainage (PUD) for postoperative abdominal abscesses., Patients and Methods: Data from 24 patients operated on for neoplastic pathologies and treated with PUD for abdominal abscesses during the postoperative period were reviewed. In all cases cultural examination with antibiogram was performed., Results: In 5 out of 24 patients (20.8%), the abdominal abscesses appeared after the discharge, with a mean hospital stay of 34.2 +/- 24.9 days. In six out of 24 patients (25%) there were multiple abscesses localizations. The cultural examination was positive in 23 patients and negative only in one patient. Abscesses localized only in the upper abdominal regions had a significant prevalence of monomicrobial cultural examinations (57.1%) with respect to the results for abscesses placed in the lower abdominal regions, that were polymicrobial in 88.8% of cases (p = 0.027). An antibiogram demonstrated a stronger activity of beta-lactamines, chinolones, and glycopeptides with respect to aminogycosides, cephalosporins, and metronidazole., Conclusions: In oncological patients, the planning of the empiric antibiotic therapy should be based on the anatomotopographic localization of the abdominal abscess and on the typology of the operation performed giving preference to beta-lactamines, chinolones and glycopeptides.

Desmoid tumor is a monoclonal, fibroblastic proliferation arising in musculoaponeurotic structures. This connective tissue hyperplasia infiltrates locally, recurs frequently after resection but does not metastasize. Abdominal desmoid occurs sporadically, in association with some familial syndromes and often represents a clinical dilemma for surgeons. The enigmatic biology and anatomical location of abdominal desmoids make treatment recommendations difficult. This distinct pathological entity is reviewed with a specific focus on aetiology and management.

Liposarcomas represent the single most common type of soft tissue sarcoma. Its abdominal localization is rare, occurring in only 5% of cases. A 55 year old male was found to have a case of primary giant liposarcoma of the mesenterium with a maximum diameter of 40 cm and weight of 9 kg. Computed tomography revealed the presence of a large mass presenting a dishomogeneous density with an adipose component, probably of mesenteric origin. A xifopubic laparotomy confirmed the presence of a pedunculated growth originating from the mesentery. The mass was removed and the histopathological report noted a well differentiated sclerosing liposarcoma with the peritoneal liquid positive for malignant cells. Surgery currently represents the only possibly curative therapy for this type of tumour but close long-term follow up and accurate evaluation of the clinicopathologic parameters are needed.

Subtotal gastrectomy is considered the preferred treatment for gastric cancer with antral location. The aim of this study was to assess the incidence of early postoperative complications and late functional results in patients who underwent subtotal gastrectomy with Billroth II reconstruction for primary gastric adenocarcinoma. The results of 310 patients were analyzed with regard to postoperative complications and death rates. Functional results as they relate to the gastric resection were evaluated in 195 disease-free patients. Of the 310 patients, 77 developed postoperative general and surgical complications (24.8%) and 13 consequently died (in-hospital mortality: 4.2%). Although infrequent (6 cases, 1.9%), anastomotic leak was the most serious complication (4 cases died during the postoperative phase). Considering functional results, weight loss continued for the first trimester after surgery, after which it stabilized. Loss of appetite was rarely observed; early after the operation the majority of patients were consuming a normal diet and regularly consumed less than five meals per day (83.6%). Dumping syndrome was uncommon and usually resolved within one year (12.3% at three months, 9.5% after one year, 5.2% after two years). On the other hand, postprandial abdominal fullness was frequently observed (43.1% at three months, 36.1% after one year, 21.3% after three years, and 16.5% after five years). Billroth II reconstruction after subtotal gastrectomy is associated with a limited risk of anastomotic complications. Anastomotic leak, although infrequent, is a life-threatening complaint and requires prompt recognition and aggressive surgical treatment. The incidence of late complications was low and the majority of patients recovered from them within one year after surgery, although the occurrence of postprandial abdominal fullness was not completely irrelevant.

Objective: The prognosis of gastroesophageal junction adenocarcinoma is unquestionably related to the extent of nodal involvement; nonetheless, few studies deal with the pattern of lymph node spread and specifically analyze the prognostic value of the site of metastasis. The present study was aimed at evaluating these key aspects in advanced gastroesophageal junction adenocarcinoma., Methods: Of 219 patients consecutively operated on for gastroesophageal junction adenocarcinoma at the Department of General Surgery and Surgical Oncology, University of Siena, and at the Department of General Surgery, University of Verona, 143 pT2-4 tumors not submitted to prior chemoradiation were analyzed according to the Japanese Gastric Cancer Association pN staging system., Results: The majority of patients were given diagnoses of nodal metastases (77.6%). The mean number (P = .076) and the percentage of patients with pN+ disease (P = .022) progressively increased from Siewert type I to type III tumors. Abdominal nodes were involved in all but 1 of the patients with pN+ disease; conversely, nodal metastases into the chest were 46.2% for type I, 29.5% for type II, and 9.3% for type III tumors. Survival analysis showed virtually no chance of recovery for patients with more than 6 metastatic nodes or lymph nodes located beyond the first tier., Conclusions: In advanced gastroesophageal junction adenocarcinoma, the high frequency of nodal metastases and the related unfavorable long-term outcome achieved by means of surgical intervention alone are indicative of the need for aggressive multimodal treatment along with surgical intervention to improve long-term results.

Presacral ganglioneuromas are so rare benign tumors that only 17 cases have been reported in the literature. They are abdominal masses growing slowly and differential diagnoses have to be considered. Surgical resection is important for definitive diagnosis because it represents the only therapeutic choice. Because of the benign nature of ganglioneuroma, adjuvant chemo- or radiotherapy is not indicated but regular follow-up is necessary for an early diagnosis of potential local recurrence. We report a case of a 64-year-old man with a presacral ganglioneuroma.

Abdominal abscesses arising postoperatively constitute a serious problem, particularly in the field of oncological surgery. The aim of our study was to interpret clinical and microbiological data relating to a population of oncological patients, undergoing ultrasound-guided drainage for postoperative abdominal abscesses, so as to be able to better plan empiric antibiotic therapy. We therefore retrospectively analysed the data of 24 patients operated on for neoplastic pathologies and treated with ultrasound-guided percutaneous drainage for abdominal abscesses during the postoperative period. Microbiological and clinical data showed that abscesses located in the lower abdominal regions almost always present a polymicrobial growth, though abscesses in the upper regions are more frequent. Moreover, the antibiotic assay results prompted us to consider the use of beta-lactamines, quinolones and glycopeptides more favourably, in view of their greater efficacy against the microbes tested. Thus, the planning of empiric antibiotic therapy should be based above all on the anatomical-topographic location of the abdominal abscess and on the type of operation performed, with thorough assessment of the use of the above-mentioned antibiotics.

Small bowel metastases from renal cell carcinoma (RCC) are very rare. Clinical presentation includes obstruction, bleeding, intussusception and rarely perforation. We report a case of a 48-year-old female presenting a jejunal intussusception due to intestinal metastasis from RCC. To our knowledge, there are only a few such cases reported in the literature (seven cases). However, if considered in the total summary of reported cases with small bowel metastases from RCC, intussusception is a probable cause.

Mucocele of the appendix is a rare lesion, characterized by distension of the lumen due to accumulation of mucoid substance. This disease is often asymptomatic and pre-operative diagnosis is rare. If untreated, one type of mucocele may rupture producing a potentially fatal entity known as pseudomyxoma peritonei. The type of surgical treatment is related to the dimensions and to histology of the mucocele. Appendectomy is used for simple mucocele or for cystadenoma. Right hemi-colectomy is recommended for cystadenocarcinoma. In this paper, we report a case of a 51-year-old woman with a mobile, painless mass in the right lower quadrant of abdomen caused by a giant appendiceal mucocele. Imaging showed a large, tubular, cystic structure extending below from the inferior wall of the cecum. Surgery revealed a giant retro-cecal appendix measuring 17 cm in length and 4 cm in diameter. The final pathologic diagnosis was mucocele caused by mucinous cystadenoma.

We describe a case of duodenal, third portion, segmental resection for gastrointestinal stromal tumor. A 76-year-old man was referred for gastrointestinal bleeding, dyspnea and asthenia. Esophagogastroduodenoscopy showed a duodenal bleeding fistula. Computerized tomography demonstrated a retroperitoneal mass that compressed and displaced forward the third duodenal tract. Segmental resection of the third portion of the duodenum with a subtotal gastrectomy was performed. The patient was reconstructed with a termino-terminal duodenal anastomosis of the second and the fourth tract and with a Roux-en-Y gastrojejunum anastomosis. There were no postoperative complications. This duodenectomy procedure could be useful as a less extensive resection for duodenal gastrointestinal stromal tumor located in the third portion of the duodenum when the tumor is well capsulated, when the surrounding structures are not infiltrated and when there are no vascular difficulties. The technique reduces the morbidity and mortality correlated with duodenocefalopancreasectomy and improves postsurgical quality of life without worsening the risk of recurrence.

Background: The immune system includes all the innate or acquired mechanisms, that the organism uses for protecting itself from the aggression of external pathogens or neoplasia. About the control of the tumor growth, the immune mechanisms implicated are quite a lot: the cytotoxicity against the tumor cells by cytotoxic T lymphocyte, macrophages, NK cells; simil-NK cells (ADCC). Tumors have generally antigenic marked potential, for which numerous antigens have been identified, but none of these has revealed a correlated specificity to the neoplasia. Only a glycoprotein at elevated molecular weight, the CA125, presents an elevated specificity and sensibility. The objective of this study was to examine immunological variations in the peripheral blood of patients with ovarian carcinoma before and after radical surgical treatment., Methods: In the Institute of Obstetrics and Gynaecology of Second University of Studies of Naples the immunological variations in 8 women (mean age: 59.5; range: 49-70 years) suffering from ovarian cancer, have been evaluated before and after radical surgical treatment (when the stage of the tumor made possible the surgery) and compared to 8 normal volunteers of comparable age (control group), in the period January 1994-June 1998. The patients were followed in average for two years and subjected to a immunological screening with blood drawings effected at the hospitalisation and later 1, 6, 12, 18, 24 months from surgical treatment. The immune evaluation were effected with: proliferation tests on the monocytes of the peripheral blood, evaluation of the production of Interleukin 1 and 2 with the leukocyte phenotyping, evaluation of NK cells activity. The patients were followed in average for two years., Results: The radical surgery decidedly improves the immune response. The ability to produce IL-1 by the lymphocytes of the patients object of our study, appeared constantly falling (with reduction of about 50%) before the surgery and it meaningfully increases in the post-surgery period. The surgery doesn't modify the lymphocytes T helper and T inducer. The surgery delays the diminution of the NK cells in a little meaningful way. The periodic dosage of the CA125 does not give the same results: in the 60% a progressive increase was realised and in the 40% it remained constant., Conclusions: The surgery constantly improved the physical state of the patient, determining an increase of the immune response toward the neoplasia, and therefore achieving a meaningful increase of survival.

Background: This study was performed to evaluate, in women suffering from Systemic Lupus Erythematosus (SLE), the relationship between the assumption of oral contraceptives and the evolution of the disease., Methods: In the Institute of Obstetrics and Gynaecology in collaboration with the Institute of Dermosyphilopathical Clinic of Second University of Studies of Naples, 20 women in fertile age suffering from SLE with specific cutaneous manifestations were studied for the year 1999. All the patients requested to take, at contraceptive purpose, low-dosage estroprogestagens. The contraceptives we prescribed have, as active substance, the gestodene at the dose of 0.075 mg and the etinilestrdiol at the dose of 0.02 mg per day. Patients' group in object was compared for a year with a similar control group of women suffering from SLE not subjected to any pharmacological therapy., Results: Only 5 patients out 20 have had to suspend therapy after 4 or 5 months, because a relapse of the illness was experienced while the others 15 patients did not lament a relapse of the illness. In the control group a more or less similar percentage of patients, during the months of the observation, spontaneously had episodes of relapse of the illness., Conclusions: The results of our brief study have shown that the administration of hormonal contraceptives in reality doesn't constantly produce immediate and remarkable exacerbations of the illness in women suffering from SLE. In our opinion the contraception with the latest estroprogestagens can comfortably be effected under strict medical control, probably because the medicines at low dosage are quickly metabolized and in the majority of the cases they don't have capacity to influence the course of such chronic connectivitis.

Background: The need for the early detection of ovarian cancer continues to be one of the most important issue in women's health care. The ovarian neoplasia characteristically have a scarce symptomatology for which it tries to create a sensitive and specific screening test so that the diagnosis could precociously be made and, consequently, improve the prognosis with a timely therapy. Our purpose was to assess the performance of transvaginal color Doppler ultrasonography in ovarian cancer screening., Methods: In the Institute of Obstetrics and Gynaecology of Second University of Studies of Naples, in the period between January 1997 and December 1998, 60 women, divided into two groups (the 1st group included 30 women in fertile age with standard uterine dimensions, the 2nd group included 30 menopausal women), were submitted to transvaginal color Doppler ultrasonography. Color Doppler ultrasonography was performed with an ESAOTE ANSALDO AU5 HARMONIC ultrasound machine provided with a 6.5 MHz real-time sector electronic array endovaginal probe with a 5 MHz pulsed Doppler system and equipped with the color velocity imaging system for the color blood flow codification. The score used in the evaluation of the ovary are us follows: volume of the adnexa (from 1 to 5); presence of papillas and septa (from 1 to 5); wall thickness (from 1 to 5). An high score (> 12) corresponds to probability of presence of neoplasia. For the flow modifications the following parameters were considered: RI (Index of resistance); PI (Pulse Index); Vmax (Maximum Speed). CD was considered as suspicious when flow was detected and the lowest RI found was < or = 0.45, PI < or = 0.58 Vmax < or = 60., Results: Sonographic morphology evaluation and CD were suspicious in 11 cases and 9 of these were positive on histopathological analysis (true positive = 15%, false positive = 5%). All the women that had morphologically normal ovaries observed on ultrasound examination and were not suspicious on CD analysis, were also negative on histopathological analysis (true negative = 80%)., Conclusions: The color Doppler ultrasonography revealed a decidedly valid method of screening of the first level, being non-invasive examination, painless, therefore well accepted by the patients, even if in some women, especially if in fertile age, the physiological modifications calls for repeated investigations and compare its parameters.