Giuseppe Scuderi

Acute gallstone cholecystitis in the elderly: treatment with emergency ultrasonographic percutaneous cholecystostomy and interval laparoscopic cholecystectomy.

BackgroundThe treatment of acute cholecystitis in the elderly is still a subject of debate, particularly with reference to the timing of surgery and the role of laparoscopy.PatientsFrom January 1994 to June 2002 we observed 27 patients aged over 70 years with acute calcolous cholecystitis. The patients were submitted to ultrasonographic percutaneous cholecystostomy within 12 h of the acute attack. For two patients (7.4%) at high operative risk, we chose a conservative treatment. Twenty-five patients (92.6%) were submitted, in 15 cases (60%) within 5 days and in 10 patients (40%) within 8 days, to a laparoscopic cholecystectomy. Statistical significance was accepted when the value of p was less than 0.05.ResultsUltrasonographic percutaneous cholecystostomy was performed successfully in all patients, without major morbidity or mortality, and complete resolution of clinical symptoms was obtained within 48 h. The conversion rate of laparoscopy was 20% (13.3% in patients submitted to surgery within 5 days and 30% in the group submitted within 8 days — p > 0.05). The postoperative morbidity rate was 24%; it was higher (40% versus 15%) in patients converted to laparotomy (p > 0.05); mortality was 4%. The period of hospitalization was 11 days in patients operated laparoscopically and 21 days in those converted to open cholecystectomy (p < 0.001).ConclusionsThe more rational treatment of acute calcolous cholecystitis in elderly patients is represented by ultrasonographic percutaneous cholecystostomy followed, within 5 days, by laparoscopic cholecystectomy using an abdominal insufflation maximum to 12 mmHg and a limited 10–15° head-up tilt.

Serum levels of interleukin 1β, interleukin 8 and tumour necrosis factor α as markers of gastric cancer

Abstract Despite the efforts made, a serum marker reliable for the screening and follow-up of patients with gastric cancer has not yet been identified. The aim of this preliminary study was to test the role of pro-inflammatory cytokines interleukin 1β, interleukin 8 and tumour necrosis factor α in patients with gastric cancer and in control groups. The statistical analysis of cytokines serum levels in the group with gastric cancer versus control groups has shown considerable differences (p<0.001) in their mean rates. The results indicate that the cytokines interleukin 1β, interleukin 8 and tumour necrosis factor α might perhaps act as diagnostic markers in patients with gastric cancer. Therefore, it is hypothesized that after more extended trials, their use in the screening and prognostic assessment of these patients could be a possibility.

Rare localizations of echinococcosis: personal experience

Background:  The rare localizations of hydatidosis represent an interesting topic, especially with reference to epidemiological and diagnostic problems. Hydatid disease, common in Mediterranean countries, still remains endemic in some regions of Italy.

Ischemic Colitis Following Colonoscopy in a Systemic Lupus Erythematosus Patient: Report of a Case

BACKGROUNDIschemic colitis is an uncommon complication in patients with systemic lupus erythematosus but may be precipitated by colonoscopy.CASE REPORTA 43-year-old female with systemic lupus erythematosus under treatment with immunosuppressive drugs and prednisone was submitted to colonoscopy because of a change in bowel habit. Apart from the presence of a small metaplastic polyp, colonoscopy showed only a few erythematosus areas in the sigma and left colon. Four hours after colonoscopy, the patient developed lower colic abdominal pain and mucous diarrhea followed by rectal bleeding from ischemic colitis. The patient was successfully treated with fluids, spasmolytic drugs, sodic heparin, antibiotics and enteral feeding.CONCLUSIONSAwareness of the risk of this potential complication, secondary to colonoscopy, in patients with connective tissue disorders may lead to a prompt diagnosis and effective treatment, with a successful outcome.

Ulcerative colitis complicated by dural sina venous thrombosis

Dear Editor: Cerebral and dural sine venous thrombosis during ulcerative colitis is uncommon and is characterized by a severe prognosis in a high rate of cases [1]. We observed a case that showed thrombophlebitis of the upper sagittal sinus associated with cortical infarction and left frontal-parietal hemorrhage during a relapse of the ulcerative rectocolitis. A 17-year-old woman had been suffering since the age of 15 years from monthly attacks of migraine

Chromophobe renal cell carcinoma in pregnancy: case report and review of the literature.

A 25-years old gravida 2, para 1001, came to our clinic in November 1998 at 10 weeks’ gestation because of a palpable mass in her left flank. Laboratory tests were normal and hematuria was not present. A sonogram, performed at admission, showed a 145¿137 mm complex mass under the spleen that prevented the study of the left kidney; annex and embryo (CRL 20 mm) were normal. Magnetic resonance imaging (T1-weighted with fat suppression) showed the presence of a 140¿180¿150 mm homogeneous mass, with clear outline, infiltrating the left kidney and displacing upward, without infiltration, the tail of pancreas (Fig. 1); no metastasis was demonstrated. The patient was transferred to the general surgical department and submitted to left radical nephrectomy with lymphadenectomy. At macroscopic examination (Fig. 2) the volume of left kidney appeared remarkably enlarged (180¿140 mm), with irregular surface, some hemorrhagic areas and solid consistency to the knife. The histological examination (Figs. 3, 4), performed on 5 micron sections included in paraffin and hematoxylin-eosin staining, demonstrated a compact architecture with poligonal cells of variable dimensions with evident cytoplasmatic mem-

Novel use of a T-tube access to perform an internal/external biliary drainage

We report a case of post-surgical temporary functional stenosis of the sphincter of Oddi and biliary leak in a patient with a previous Billroth II reconstruction who had undergone cholecystectomy, surgical choledocotomy and sphincterotomy for biliary calculi. The patient was treated by creation of an internal/external biliary drainage using the T-tube access with an unreported technique.