Salcuni Pf

Elective palliative resection of incurable stage IV colorectal cancer: Who really benefits from it?

PurposeDespite the encouraging results of chemotherapy in patients affected by incurable colorectal cancer (CRC), surgical resection of a primitive tumor is still a common approach worldwide. The identification of prognostic factors related to short survival (<6 months) may allow excluding from resective surgery those who may not benefit from it.MethodsA retrospective analysis was performed of 15 variables in a population of 71 patients undergoing nonemergency palliative primary resections of incurable CRC, including patients’ demographics and clinical/histopathological characteristics of the tumor.ResultsNo variables were related to perioperative mortality (8.5% overall). A multivariate analysis revealed that older age (≥80 years) and metastasis to more than 25% of the lymph nodes were associated with survival (4 and 6 months, respectively). Mucoid adenocarcinoma therefore tends to be associated with the prognosis (P = 0.070).ConclusionsAn elderly age tends to be a contraindication to an elective primary tumor resection in patients affected by incurable CRC. Massive lymph node involvement and mucoid adenocarcinoma should also be considered before planning major colonic surgery.

Endovascular Stent Grafting of a Posterior Tibial Artery Pseudoaneurysm Secondary to Penetrating Trauma: Case Report and Review of the Literature

Endovascular treatment of posttraumatic pseudoaneurysms has become a viable less-invasive option when compared with open repair. In this study, we present a case of a posttraumatic pseudoaneurysm of the posterior tibial artery in a 34-year-old man treated with endovascular stent grafting. An extensive review of the literature has been performed.

Superior Mesenteric Artery Aneurysm Caused by Aortic Valve Endocarditis: The Case Report and Review of the Literature.

Infectious aneurysms of the superior mesenteric artery are a rare but life-threatening condition due to the risk of visceral ischemia, sepsis, or hemorrhage. In this study, we report the case of a superior mesenteric artery aneurysm (SMAA) secondary to a bioprosthetic valve endocarditis, successfully managed with aneurysm resection and saphenous vein interposition graft. We performed an extensive PubMed-based rewiew of the literature of the last 10 years on SMAA, which include the detection of 38 articles quoting 41 SMAAs. The case histories were divided in 2 groups: 18 cases belonged to nonmycotic group A and 23 cases were included in mycotic group B. In group A, 44.4% of patients were treated surgically, whereas in group B, 90.5%. The 2 study groups significantly differed (P = .01) in terms of surgical treatment. The surgical approach still remains the first choice of treatment in mycotic aneurysm.

Infection after Penetrating Superficial Femoral Artery Trauma Caused byfalling on Metal Fence

day’s stay in hospital the onset of fever and leukocytosis required the performance of a CTA (Computed Tomographic Angiography) (Figure 3), which showed the presence of an abscess in the surgical site. After a surgical drainage of the abscess, advanced silver medication was used to treat thigh wound; in the meantime the infection was treated with systemic antibiotics according to antibiogram. Bacterial culture test was positive for Pseudomonas areuginosa susceptible to Ceftazimide and Levofloxacin, so the elderly patient underwent intravenous antibiotics (6 g daily dose of Ceftazimide and 750 mg daily dose of Levofloxacin) for 19 days. During infection’s monitoring procedure, however, culture specimen revealed that thigh wound was positive for Escherichia Coli, Corynebacterium Jeikeium and Enterococcus faecium, susceptible to tigecycline and teicoplanin; he was thus given further intravenous antibiotics (1 g daily dose of Tigecycline and 850 mg daily dose of Teicoplanin) for 17 days. On his 46 th day’s