Intestinal obstruction by giant Meckel's diverticulum. Case report

Most cases of Meckel’s diverticulum (MD) are asymptomatic and discovered by chance. Management of MD is controversial. The authors describe an exceptional case of intestinal obstruction caused by a giant MD in a patient who had previously undergone appendectomy. A review of the contradictory literature on this subject leads to the conclusion that careful consideration of clinical and morphological data (patient's age, ASA score, the surgical procedure to be performed, morphology and position of the MD, any fibrotic bands) is required before deciding whether or not to resect an asymptomatic MD.

Dynamic self-regulating prosthesis in inguinal hernia repair

Inguinal hernia repair is one of the most common surgical procedure performed in Western countries and it consumes a lot of healthcare resources. Several types of different mesh are now disposable and tension-free techniques represent the “golden standard”. In our study, fifty male patients were operated on for inguinal hernia and a PAD (i.e., dynamic self-regulating prosthesis) used for the repair of the inguinal defect: this technique demonstrated to be safe, effective and easy to perform.

A rare case of giant papillary adenoma of the breast

The authors present a case of giant papillary adenoma of the breast and discuss their therapeutic strategy. The patient subsequently returned due to a local recurrence, which was treated with oncoplastic surgery, with satisfactory aesthetic results. The authors conclude by stressing the considerable rarity of this disease and the need for effective cooperation between surgeons and pathologists.

Laparoscopic treatment of mucinous adenocarcinoma of jejunum associated with celiac disease. Case report

Mucinous adenocarcinoma of the small bowel is very rare, and only few cases have been described in the literature. Association of this tumor with celiac disease has never been published. The authors report a unique case of jejunal mucinous adenocarcinoma in which a concomitant celiac disease has been histologically recognized. The difficult diagnosis, the role of laparoscopic surgery and the relationship between small bowel tumors and celiac disease are discussed. A 49-year-old man presented with recurrent melena, nausea, vomiting and anemia. A stenosis of the jejunum was documented by means of CT scan and video capsule enteroscopy. A laparoscopy was scheduled. A tumor, found in the first jejunal loop, was removed by laparoscopic surgery. Histopathology revealed a rare mucinous adenocarcinoma associated with epithelial changes secondary to celiac disease. Although small bowel tumors are rare entity, in patients with celiac disease complaining of symptoms related to altered intestinal transit or occult bleeding, an appropriate work-up should be planned for diagnosis. Mucinous type intestinal adenocarcinoma, even if never published before, could be observed. Laparoscopic surgery is often essential for the diagnosis and treatment.

Polyp of the cecum. Laparoscopic-assisted polypectomy

The Authors discuss on a laparoscopic-assisted approach for excision of a sessile villous adenomatous polyp of the cecum, unresectable by endoscopy. Because of the large implant of the polyp, endoscopic polypectomy was considered at high risk and a surgical laparoscopic procedure was scheduled for removal of the lesion. After right colon mobilization, an intraoperative endoscopy confirmed the location of th polyp in the posterior wall of the cecum, closed to the ileo-cecal valve. A small 10 cm laparotomy, through which the cecum was pulled out the abdominal cavity, was performed. Then, a minimal colotomy along the intestinal taenia was carried out to allow a safe and complete excision of the polyp. This laparoscopic approach differs from the other laparoscopic-assisted methods reported in the Literature since it provides at the same time the postoperative advantages associated with minimal access surgery and a safe oncological removal of the polyp with low risks of complications. .

Role of emergency thoracic ultrasonography in spontaneous pneumomediastinum. Two case report

Early identification of spontaneous pneumomediastinum in an Emergency Department is possible with thoracic ultrasound. We report two cases of spontaneous pneumomediastinum, diagnosed in a 26-year old man with chronic asthma and a 19-year old athlete, and discuss the role of thoracic US alongside conventional X-ray and thoracic CT in emergency medicine. The patients were transferred to an Emergency Department, where conservative treatment produced a good outcome. The greater sensitivity and specificity of thoracic US over conventional supine X-ray in the detection of occult pneumothorax is ever more appreciated. However, training in the diagnosis of pneumomediastinum is required.

Surgical treatment of papillary thyroid carcinoma without lymph nodal involvement

Background. In the treatment of differentiated thyroid cancer (DTC), in absence of enlarged lymph nodes, the role of routine central lymph node dissection (RCLD) remains controversial. The aim of this study is to analyze data resulting from total thyroidectomy (TT) not combined with RCLD in the treatment of DTC. Methods. We retrospectively evaluated the clinical records of 80 patients treated between January 1996 and December 2003 with TT without RCLND, in absence of suspected enlarged lymph nodes at preoperative ultrasonography and intraoperatively during neck exploration. In this series, 75 patients (93.7%) underwent radioiodine (RAI) ablation, followed by Thyroid Stimulating Hormone (TSH) suppression therapy. In case of locoregional lymph nodal recurrence, a central (VI) and ipsilateral (III-IV) selective lymph node dissection was performed. Results. Incidence of permanent hypoparathyroidism (iPTH < 10 pg/ml) and unilateral temporary vocal fold paralysis were respectively 2.55% and 2.55%. Locoregional recurrence, with positive cervical lymph nodes, after a 10.3 ± 4.7 years mean follow-up was observed in 3 patients (3.75%). They were submitted to a central (VI) and ipsilateral (III-IV) selective neck dissection without significant complications. Conclusions. In our series, TT not combined with RCLD was associated to a low locoregional recurrence rate, even if the lack of a control group treated with RCLD does not allow any generalized assumption. RCLD may be indicated in high risk patients, in whom lymph nodal recurrence is more frequent. More prospective randomized studies are needed to better define the role of RCLD and postoperative radioiodine ablation.

Long-term outcomes following “presumed” total parathyroidectomy for secondary hyperparathyroidism of chronic kidney disease

Aim. The most efficacious surgical treatment for renal hyperparathyroidism is still subject of research. Considering its low incidence rate of long-term relapse, “presumed” total parathyroidectomy without autotrasplantation (TP) may be indicated for secondary hyperparathyroidism (2HPT) in patients with chronic kidney disease (CKD), not eligible for kidney transplantation. The aim of this study was to analyse the TP long-term results in 2HPT haemodialysis (HD) patients. Method. Between January 2004 and October 2009, 25 2HPT HD patients, not eligible for kidney transplantation, underwent TP of at least four parathyroid glands. Clinical status and intact parathyroid hormone (iPTH) serum levels were assessed intraoperatively and during a 36-month follow-up. Results. TP improved the typical clinical symptoms and a significant reduction of iPTH serum levels was achieved in each patient. Aparathyroidism was never observed; in case of severe postoperative hypocalcemia, hypocalcemic seizures were never reported and the long-term recurrence rate was 8%. Only one patient received a kidney transplantation. Postoperative cardiovascular events (hypertension, peripheral artery disease, arrhythmia, coronary or cerebrovascular disease) were observed in 32% of cases and mortality rate was 16%. Conclusions. Considering its low long-term relapse rate and the absence of postoperative aparathyroidism, TP may still be considered the treatment of choice in patients with aggressive forms of 2HPT or of advanced dialytic vintage, with no access to renal transplantation. In case of postoperative hypoparathyroidism, hypocalcaemia can be effectively managed by medical treatment.

Primary neuroendocrine lung tumor presenting with acute ileal obstruction. Case report

The authors describe a clinical case of a patient with neuroendocrine carcinoma of the lung diagnosed after the onset of an intestinal obstruction from an ileal metastasis. A review of literature reveals that the incidence of symptomatic gastro-intestinal metastases from lung cancer has been estimated to be about 2-3% and is exceedingly rare that the intestinal symptoms may be the initial presentation of cancer of the lung. The authors emphasize the difficulty of preoperative diagnosis of gastro-intestinal metastases which is made, almost always, too late because of the lack of specific symptoms. In our case, on account of the computed tomography, we leaned towards the diagnosis of lymphoma because of the double mediastinal and abdominal localization. Furthermore, this diagnosis was supported by the fact that the pulmonary lesion did not have clear radiological features of a lung cancer. The prognosis is poor because once intestinal metastases occur, other metastatic sites, which would make surgery only a palliative measure, are already present. The review of the literature shows that the average survival rate of these patients is 136 days. In our case the patient survived 277 days.

Laparoscopic-endoscopic rendez-vous resection of iuxta-cardial gastric GIST

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and they often require a surgical removal. Gastrointestinal stromal tumors can originate from any part of the gastrointestinal tract but gastric location is the most common. In the past the risk of rupture of pseudocapsula and peritoneal dissemination have discouraged surgeons from making a minimally invasive surgical treatment. Recently laparoscopic wedge resection has been proposed. Performance of this mini-invasive technique is however difficult in some gastric location of gastrointestinal stromal tumors, such as iuxta-cardial region. The Authors report and discuss a new technique they used to remove a gastrointestinal stromal tumor located just below the cardia, using a rendez-vous endoscopic and laparoscopic technique.

Smart Cities @ DIITET

La presentazione oltre a illustrare le attività progettuali del Dipartimento di Ingegneria, ICT e Tecnologie per l'Energia e i Trasporti (DIITET) del Consiglio Nazionale delle Ricerche (CNR) nell'ambito delle Smart Cities, spiega che cos'è una città intelligente/sostenibile, i livelli su cui opera, perchè è importante. Si evidenziano tre esempi progettuali concreti testati anche con i cittadini su tre città italiante: Siracusa, Pisa e Bologna.

Il vulcanismo esplosivo : l'isola Ferdinandea: eruzione del 1831 nel mar di Sicilia

Il contenuto di questo volume non vuole rappresentare un testo didattico per lo studio in generale della vulcanologia in quanto in esso si tratta unicamente quell’a-spetto della disciplina che riguarda il vulcanismo esplosivo. In tal senso l’autore ritiene che questo testo possa essere utile per gli studenti di Scienze Geologiche che, vivendo nelle aree vulcaniche italiane di età quaternaria ed anche attive, possano, da laureati, svolgere attività professionali mirate alla individuazione e definizione di Pericolosità, Vulnerabilità e Rischio Vulcanico. Trattare gli argomenti che seguono non è stato facile e forse si poteva, in alcuni casi, renderli più semplici, ma talvolta la semplicità non sempre è sinonimo di precisione; inoltre, per descrivere certi aspetti non quantitativi si è costretti ad utilizzare un linguaggio quanto più possibile “ad hoc”. L’autore ha svolto la propria attività di ricerca in aree vulcaniche, sia in Italia che all’estero. Le ricerche in Italia sono state da sempre concentrate nelle aree di vulcanismo attivo in cui l’attività del vulcanologo è finalizzata fondamentalmente alla definizione della Pericolosità Vulcanica supporto indispensabile per la definizione dell’aree a Rischio Vulcanico, intendendo per Rischio il prodotto della Pericolosità per il Danno in termini, questo, di numero di vite umane ovvero di valore monetario dei beni a rischio nell’area vulcanica attiva. Le ricerche svolte dall’autore in Africa Orientale (Etiopia e Somalia) e nello Yemen hanno contribuito ad assimilare i concetti di vulcanologia regionale, rappresentata dall’ampia diffusione del vulcanismo di plateau, variabile per spessore dai 1500 ai 3000 metri, fra i quali si inseriscono, nella depressione dell’Afar, catene vulcaniche inquadrabili, dal punto di vista geodinamico, come “oceaniche” alcune delle quali attive e che si sviluppano per decine/centinaia di chilometri. Nelle aree vulcaniche italiane le difficoltà che sorgono durante il rilevamento risiedono nella scarsa continuità di affioramenti, talvolta incompleti per la descrizione delle variazioni di facies piroclastiche, non disgiunta dalla fitta vegetazione ovvero ur banizzazione specialmente nelle aree di vulcanismo attivo. Il rilevamento vulcanologico richiede competenze e l’adozione di scale adatte a poter cartografare le variazioni di facies piroclastiche che, a differenza dalle assise sedimentarie, in un’area vulcanica possono essere diffuse arealmente soltanto per alcune centinaia di metri. I metodi di studio delle rocce piroclastiche sono del tutto simili a quelli che si usano per le rocce clastiche, cioè dall’analisi delle strutture e delle tessiture alla litologica fino a quella meccanica; su questi clasti inoltre le determinazioni della densità, della mineralogia e della geochimica (Elementi in tracce e Terre Rare), ottenute sulla frazione vetrosa, rappresentano parametri talvolta identificativi di un’area vulcanica sorgente. Non esistono testi nei quali venga descritto come si debba operare nelle aree vulcaniche per le quali l’unica certezza unificante è rappresentata dall’evidenza che, nelle sequenze stratigrafiche, il termine al top rappresenta quello più relativamente recente mentre quello alla base indica il termine relativo più vecchio. Quanto viene riportato in questo testo nasce dall’esperienza che è stata acquisita nel tempo attraverso una costante azione di rilevamento che rappresenta l’uni- ca sorgente di informazione che un vulcanologo deve ricavare attraverso un attento esame dei depositi vulcanici (dalla litologia alla mineralogia, alla tessitura, etc.) la cui distribuzione, talvolta, può assumere un carattere interegionale in Italia nell’ambito dell’Olocene. Soltanto l’esperienza acquisita con il rilevamento produce, in un’area di vulcanismo attivo, risultati positivi per la definizione della Pericolosità, sapendo però che le aree vulcaniche italiane presentano caratteristiche ampiamente differenti e di conseguenza il modo di operare non può essere sempre lo stesso. Un esempio? Immaginate di eseguire un rilevamento vulcanico prima al Somma-Vesuvio e poi nei Campi Flegrei: sono mondi completamente differenti. L’autore desidera ribadire che questo testo si basa sulla esperienza acquisita sia come geologo sia come docente di Vulcanologia; pertanto il libro potrà forse risultare più o meno bilanciato, in forza dell’argomento trattato, in quanto durante l’attività di ricerca l’autore, come tutti, ha affrontato alcuni argomenti più di altri. Questo approccio può essere considerato valido per chiunque voglia scrivere un libro in maniera autonoma e originale, non limitandosi, come molte volte avviene, a tradurre in italiano un libro su tematiche analoghe diffuso, ad esempio, nel mondo anglosassone.Diversamente, si sarebbe potuto concepire un libro come un collage di capitoli scritti da vari autori, che magari avevano esperienza più specifica nei singoli argomenti, ma in tal senso si sarebbe snaturato lo spirito con cui si è impostato il progetto. L’autore, infine, ha fatto ricorso al contributo di altri autorevoli colleghi solo per temi importantissimi, ma in qualche modo complementari rispetto al corpus costitutivo del Vulcanismo Esplosivo.

Comunicazione urbana nelle città storiche del Sol Levante: l'esperienza di Kyoto tra tradizione e innovazione

The book collects the Papers (from Europe, Asia and Latin America) presented at the Workshop organized by the ICOMOS International Committee in Historic Towns and Villages (CIVVIH) and by ICOMOS Italy in Palazzo Coppini (branch of Fondazione Romualdo del Bianco) in Florence (March 3-4, 2016) and focus on the comparison of different propositions of digital urban signage to realize a good quality of the “visit experience” in the historical towns, not only as urban marketing, but of a authenticity genuine culture. The urban culture founded on the identity and authenticity of every historical towns and their multilayered history must be the objective of an tourism of culture for the inhabitants and the visitors. The book focused its interest on the outstanding existing urban assets in Europe, Asia and Latin America, and heritage not sufficiently promoted.