Annali italiani di chirurgia
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Case Reports
[Successful endoscopic treatment of spontaneous esophageal perforation in the elderly].
To discuss the diagnostic and therapeutic aspects of spontaneous esophageal perforation. It is considered a surgical emergency with high rate of mortality. Its diagnosis can be difficult since the presentation is often nonspecific and can be confused with others disorders. Many strategies have been advocated for its management. Prompt diagnosis and early treatment are required to decrease the poor prognosis of this condition. A conservative therapy may be effective in selected cases. ⋯ The key to improve the prognosis of this life-threatening emergency is the immediate and correct diagnosis and the most appropriate selection of the primary employed procedure.
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Laparoscopic cholecystectomy is no more an elective procedure. The question is when to perform laparoscopic cholecystectomy in the face of acute cholecystitis. The last decade (1995-2004) 297 patients had a laparoscopic cholecystectomy for acute cholecystitis. ⋯ The success of the operation depends on the degree of the inflammatory changes in the gallbladder and the expertise of the operator both in emergency and laparoscopic surgery. Timing of the operation is crucial to executing a successful procedure. The operation is easier, faster and safer when performed in first 4-5 days of the onset of symptoms.
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Malignant Pleural Mesothelioma is a rare tumour that arise from the mesothelial cells of the pleura and in recent time the incidence of this disease is rising. Because of the implications for management and therapy, it is important to assess the accurate staging. 18F-fluorodeoxiglucose Positron Emission Tomography (18F-FDG PET) is become a useful tool in the diagnosis of many neoplasms, such as Malignant Pleural Mesothelioma. In particular it has been shown to be useful in the evaluation of the extent of pleural disease, in the establishment of lymph node involvement, in the evaluation of tumour invasion into the lung and thoracic wall, in the diagnosis of extrathoracic metastases, in the assessment of the response to treatment, and in planning radiotherapy. Developments in system technology, like improvements in hybrid system (integrated Positron Emission Tomography/Computed Tomography) and the discovery of new radiopharmaceuticals, promise to make PET much more useful and versatile in the future.
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Rectus sheath haematoma is a well-documented clinical entity. The accumulation of blood within the rectus sheath produces a painful swelling that can mimic an intraperitoneal mass, with features of an acute abdomen. ⋯ Two cases of this entity are reported. The correct diagnosis was established by appropriate assessment of the clinical, laboratory and imaging findings.