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The internal mammary veins (IMV) are suitable vessels for thoracic wall reconstruction thanks to their relatively predictable anatomy and because they are less affected by atherosclerosis, injury or scarring of previous surgery and radiotherapy. Their position near to the lateral border of the sternum allows easier access for surgeon and the possibility of placing the most vascularized part of a flap for breast reconstruction in the medial thoracic region [1]. As the complexity of reconstruction has increased, the use of the caudal portion of IMV has been reported as a convenient option for additional venous drainage. This procedure, requires retrograde blood flow that could be altered by the presence of efficient valves in the IMV. In this study, we evaluated 32 IMVs dissected from 16 fresh cadaver thoracic walls. Retrograde blood flow and the presence of valves were investigated. We observed an efficient flow in 18 IMVs, partial flow in 7 IMVs and no flow in 5 IMVs. In these last, single and/or multiple sacciform swelling and competent valves were macroscopically observed. Histomorphological analysis by Haematoxylin and Eosin and Masson-Goldner Trichrome staining confirmed their presence. In addition, some rudimental valves, not identified macroscopically, were found duringhistomorphological analysis. Taking together, these data highlight the possible presence of complete or rudimental valves in IMV. This aspect should be considered when retrograde flow of IMV as a single venous drainage was performed during surgical breast and thoracic reconstruction. [ABSTRACT FROM AUTHOR]

Boerhaave syndrome is a rare disease with a mortality rate that varies from 10 to 40%. The typical clinical presentation (vomiting, pain, subcutaneuous emphysema) is relatively infrequent. In the case of atypical clinical presentation CT scan with contrast medium administered per os is fundamental for diagnosis. Though there is no general consensus on therapeutic strategies, prognosis is dependent on time interval between onset and diagnosis. We observed four patients with Boerhaave syndrome with an atypical presentation. The time lapse between acute event and diagnosis was less than 6 hours in two cases, 24 hours in one case and 72 hours in the last. All patients presented abdominal pain at admission, preceeded by vomiting in two cases. In all cases diagnosis was carried out by CT scan. All patients were treated surgically: in one case raffia alone was performed, in two cases raffia was associated with temporal bipolar oesophageal exclusion, one case went through oesophageal resection with delayed reconstruction of digestive continuity. One patient with severe COBP died from post-surgical sepsis. One fistula after cervical recanalisation and another after raffia of the oesophageal lesion were successfully treated with endoscopy. We suggest that an aggressive surgical approach is the best treatment for this rare and often severe disease.

Introduction: Peripancreatic arterial pseudoaneurysm is a rare but potentially lethal complication of severe acute pancreatitis because it can massively bleed into the gastrointestinal tract. Since surgical treatment of such cases has a high mortality, percutaneous angiographic embolization of bleeding artery has recently been advocated as an alternative therapy. We report a case of acute pancreatitis complicated by gastrointestinal hemorrhage due to a ruptured gastroduodenal artery pseudoaneurysm, in which hemostasis was achieved by transcatheter arterial embolization., Clinical Case: A 65-year-old woman was transferred from another hospital with a diagnosis of severe acute biliary pancreatitis, and having had hematemesis. Upper GI endoscopy detected bleeding from the papilla of Vater, and CT showed hemorrhage in a pseudocyst at the pancreatic head. Angiography revealed active bleeding from an arterial pseudoaneurysm of the gastroduodenal artery: hematemesis was considered to result from rupture of the pseudoaneurysm (hemosuccus). Transcatheter arterial embolization was performed by a 2-step procedure, both through the celiac trunk, that was stenotic, and through the superior mesenteric artery, and hemostasis was achieved., Conclusions: We conclude that transcatheter arterial embolization is a minimally invasive and highly effective treatment for acute bleeding from a ruptured pseudoaneurysm secondary to acute pancreatitis.

Background and Aim: The surgical management of IPMT is based upon a preoperative suspicion of malignancy, that is difficult to obtain from the available diagnostic tools., Methods: Telomerase gene expression was investigated by means of hTERT/RT-PCR on total RNA from peripheral blood, tumour and non-tumour pancreatic samples of 2 patients with IPMT., Results: Histological diagnosis was mild-grade dysplasia in the first case and invasive carcinoma in the second. Telomerase expression was undetectable in all the samples derived from the first case. Blood and tumour samples from the second patient were positive for telomerase mRNA expression, while the pancreatic non-tumour specimen was not., Conclusions: The following suggestions are made: 1) the telomerase gene expression seems to be implicated in the malignant evolution of IMPT; 2) the malignant transformation may be limited to a single area of the gland; 3) the presence of invasive carcinoma may be preoperatively suspected by peripheral venous blood sample collection. A possible clinical employment of telomerase gene expression determination in the management of IPMT is thus hypothesized.