Complications after laparoscopic Roux-en-Y gastric bypass: a diagnostic challenge. Report of three cases and review of the literature

The number of Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) procedures for morbid obesity and type 2 diabetes mellitus will increase worldwide, and therefore, an increase in perioperative morbidity can be anticipated. The authors present three cases based on different complications after LRYGB to demonstrate the diagnostic challenge that clinicians face in this particular group of patients. Also, a review of the literature covering the value of different imaging in these particular cases is provided by the authors. The role of imaging in the diagnostic process is discussed.

Hyperinsulinaemic hypoglycaemia - a diagnostic challenge. A report of two atypical cases

Objectives: The authors describe 2 atypical cases of patients with hypoglycaemia, suspected for insulinoma. Methods: The 2 reports are accompanied by a concise review of the literature. Results: Patient 1 had a distal pancreatectomy performed for suspected insulinoma, and was diagnosed with a glucagonoma and beta-cell hyperplasia (nesidioblastosis). To the authors’s knowledge, co-existing glucagonoma and nesidioblastosis had not been previously reported. Patient 2 was diagnosed with a benign insulinoma and 5 years later with metastatic disease. Conclusion: The authors conclude that insulinomas are rare entities which often present a diagnostic and therapeutic challenge. In such cases, patient referral to tertiary multidisciplinary centers is recommended.

Urban Retrofit and Resilience: The challenge of Energy Efficiency and Vulnerability

Urban retrofit is becoming increasingly established as one of the most effective solutions to contain the energy consumption of the existing building stock, to reduce vulnerability to natural and man-made risk and generally improve the quality of built space. However, the planning of retrofit interventions at urban scale should take account of the actual feasibility of measures lest they remain only on paper. This contribution supplies an overview of the many issues related to the subject of urban regeneration, proposing a procedure to identify practical interventions to minimize costs and maximize benefits, in terms of energy efficiency, an increase in resilience and improvement in the quality of the building stock. This procedure was applied to a case study of a neighborhood in the city of Naples, a high-density urban area which is particularly vulnerable to volcanic and seismic risk, and to risks due to climate change.