Giorgio Carlo Ginesu

Spontaneous regression of hepatocellular carcinoma: report of a case.

The widespread use of ultrasound in screening programmes for chronic liver disease has led to early diagnosis of hepatocellular carcinoma (HCC), and to the observation of some cases of tumour spontaneous regression. This is a rare event whose underlying mechanism is still unclear. We present here a case of spontaneous regression of HCC in a 71-year-old woman with chronic hepatitis and discuss possible aetiologies. None of the causative mechanisms proposed for spontaneous regression of HCC is completely satisfactory, so further studies are necessary to improve understanding of this unusual biological event. Therefore, we stress the importance of accumulating all such cases in the literature, because the clarification of aetio-pathogenic mechanisms may lead to the development of new treatment strategies for HCC.

Melatonin and Vitamin D Interfere with the Adipogenic Fate of Adipose-Derived Stem Cells

Adipose-derived stem cells (ADSCs) represent one of the cellular populations resident in adipose tissue. They can be recruited under certain stimuli and committed to become preadipocytes, and then mature adipocytes. Controlling stem cell differentiation towards the adipogenic phenotype could have a great impact on future drug development aimed at counteracting fat depots. Stem cell commitment can be influenced by different molecules, such as melatonin, which we have previously shown to be an osteogenic inducer. Here, we aimed at evaluating the effects elicited by melatonin, even in the presence of vitamin D, on ADSC adipogenesis assessed in a specific medium. The transcription of specific adipogenesis orchestrating genes, such as aP2, peroxisome proliferator-activated receptor γ (PPAR-γ), and that of adipocyte-specific genes, including lipoprotein lipase (LPL) and acyl-CoA thioesterase 2 (ACOT2), was significantly inhibited in cells that had been treated in the presence of melatonin and vitamin D, alone or in combination. Protein content and lipid accumulation confirmed a reduction in adipogenesis in ADSCs that had been grown in adipogenic conditions, but in the presence of melatonin and/or vitamin D. Our findings indicate the role of melatonin and vitamin D in deciding stem cell fate, and disclose novel therapeutic approaches against fat depots.

A Rare Variant of Gallstone Ileus: Bouveret’s Syndrome

IntroductionBouveret’s syndrome (gastric outlet obstruction due to impaction of a stone) is a rare variant of gallstone ileus. A recently observed case led us to review the literature, with the aim to discuss the recent advances in the management of this rare syndrome.DiscussionA 69-year-old woman was admitted with symptoms of high intestinal obstruction. Computed tomography scan of the abdomen showed a large gallstone impacted in the duodenum. One-stage surgery, consisting in enterolithotomy, cholecystectomy, and fistula repair, was carried out. Although several surgical and nonoperative procedures have been used, the optimal treatment of Bouveret’s syndrome remains controversial. Surgery still maintains a prominent position, even though nonoperative procedures have an increasing role especially in high risk patients with important comorbidities. The decision should be taken on an individual basis, after evaluating patient’s general condition and age, stone size, comorbidities influencing the operative risk, and expertise of surgical and endoscopic teams. One-stage surgery may offer definitive management in selected patients.

Conservative approach to Hepatic Portal Venous Gas: A case report

Highlights • Hepatic Portal Venous Gas (HPVG) is a rare condition often associated with a significant underlying pathologies.• The mechanism underlying the passage of the gas from the intestine into the mesenteric, then portal, venous system is not fully understood.• The high mortality rate made HPVG a cause of mandatory explorative laparotomy throughout the last fifty years of the twentieth century.• The frequent presence of benign conditions underlying this condition has diverted the common therapeutic approach to more cautious options.

Primary Torsion of the Greater Omentum: A Difficult Diagnosis

Torsion of the greater omentum is an uncommon cause of acute abdomen and it is extremely difficult to identify preoperatively. Clinical features are aspecific and diagnosis is usually obtained at emergency operation. We report a case of primary omental torsion and discuss the diagnostic and therapeutic aspects of this pathology.

Bronchial mucoepidermoid carcinoma: A case report

Highlights • Bronchial localization of Mucoepidermoid carcinoma (MEC) is rare (0.1%–0.2% of all lung tumors).• Knowledge of the molecular features is essential for appropriate clinical management and improved outcomes.• Only a few studies have been performed in the field of the genetic molecular alterations of MECs.• EGFR mutations seems to be of primary importance in patients in whom a targeted therapy is under consideration.• The lack of EGFR sensitizing mutations does not preclude the use of TKIs, which may be extremely useful in patients non responsive to other therapies.

Cost and morbidity analysis of chest port insertion in adults: Outpatient clinic versus operating room placement

Background Totally implantable venous access devices (TIVADs) represent a convenient way for the administration of medications or nutrients. Traditionally, chest ports have been positioned by surgeons in the operating room, however there has been a transition over the years to port insertion by interventional radiologists in the radiology suite. The optimal method for chest port placement is still under debate. Materials and methods Data on all adult patients undergoing isolated chest port placement at our institution in a 12-year period were retrospectively reviewed. The aim of this cohort study was to compare cost and morbidity for chest port insertion in two different settings: outpatient clinic and operating room. Results Between 2003 and 2015 a total of 527 chest ports were placed in adult patients. Of them, 262 procedures were performed in the operating room and 265 procedures were undertaken in the outpatient clinic. Patient characteristics were similar and there was no significant difference in early (<30 days, p = 0.54) and late complications (30–120 days, p = 0.53). The average charge for placement of a chest port was 1270 Euros in the operating room versus 620 Euros in the outpatient clinic. Conclusion Our results suggest that chest ports can be safely placed in most patients under local anesthesia in the office setting without fluoroscopy or ultrasound guidance. Future randomized controlled studies may evaluate if surgeons or interventional radiologists should routinely perform these procedures in a dedicated office setting and reserve more sophisticated facilities only for patients at high risk of technical failure.

Nonfunctional paraganglioma of the head of the pancreas: A rare case report

Highlights • Pancreatic localization of paraganglioma is extremely rare (only 31 similar cases have been described in the scientific literature).• Differential diagnosis with meningiomas, schwannomas, and various metastatic carcinomas may be challenging to assess preoperatively.• Same management adopted for Pancreatic Neuroendocrine Tumors (NET) may be rational.

Thoracoscopic treatment of a broncho-esophageal fistula: A case report

Highlights • Broncho-Esophageal Fistula (BEF) in adults is rare.• If left untreated, BEF may lead to fatal complications despite its benign nature.• The most frequent approach is thoracotomy.• Video Assisted Thoracoscopic Surgery (VATS) may be a minimally invasive approach.

Dyspnoea, thoracic pain and fever in a young caucasian female: A case report

Highlights • The diagnostic approach to patients with mediastinal pathology is not always simple.• Mediastinal masses should always be considered to be potentially malignant.• Surgical biopsy could be the only way to correctly diagnose mediastinal mass.