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Chronic pelvic pain is a hidden issue which needs to involve many different usually uncoordinated specialists. For this reason there is a risk that treatments, in the absence of well-defined pathways, common goals, and terminology, may be poorly effective. The aim of the present paper is to summarize the evidence on anorectal pelvic pain, offering useful evidence-based practice parameters for colorectal surgeons' daily activity. Analysis of chronic anorectal and pelvic pain syndromes, the diagnostic and clinical optimal needs for evaluation, and the innumerable low evidence treatments and therapeutic options currently available suggests that a multimodal individualized management of pain may be the most promising approach. The limited availability of dedicated centers still negatively affects the applicability of these principles. [ABSTRACT FROM AUTHOR]

Antonio Pesce, Stefano Palmucci, Gaetano La Greca, Stefano Puleo Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, Catania, Italy Abstract: Iatrogenic bile duct injuries (BDIs) after laparoscopic cholecystectomy, being one of the most common performed surgical procedures, remain a substantial problem in gastrointestinal surgery with a significant impact on patient’s quality of life. The primary aim of this review was to discuss the classification of BDIs, the proposed methods to prevent biliary lesions, the associated risk factors, and the management challenges depending on the timing of recognition of the injury, its extension, the patient’s clinical condition, and the availability of experienced hepatobiliary surgeons. Early recognition of BDI is of paramount importance and limiting the diagnosis delay is crucial for an optimal postoperative outcome. The therapeutic management depends on the type and gravity of the biliary lesion, and includes endoscopic, radiologic, and surgical approaches. Keywords: bile duct injury, laparoscopic cholecystectomy, biliary anatomy, early recognition, management challenge, endoscopic treatment, surgical repair

OBJECTIVE: Pancreatic cystic tumors are relatively rare tumors and only 1% of them are malignant. They are often asymptomatic and detected as incidental findings through diagnostic imaging. Currently there are no universal guide lines for the correct clinical approach to pancreatic cystic lesions. Cross-sectional imaging demonstrates some typical morphological features that determine the preoperative diagnosis of the pancreatic cystic lesions (serous or mucinous cystadenoma, intraductal papillary mucinous neoplasms). In addition, endoscopic ultrasonography permits the collection and analysis of the fluid content. The aim of this paper is to describe our case load in the management of pancreatic cystic neoplasms and propose some criteria for choosing between surgical or conservative approaches. PATIENTS AND METHODS: 12 patients with pancreatic cystic neoplasms were retrospectively evaluated. They were studied using cross-sectional imaging modalities (computed tomography and magnetic resonance); endoscopic ultrasonography was performed in 7 patients. RESULTS: In each patient a careful evaluation of several factors (age, comorbidity, imaging features, symptoms, life expectancy) conditioned our clinical decision. Among our 12 patients, surgical resection was performed in 7 cases. DISCUSSION: The treatment of pancreatic cystic lesions is still a dilemma because even in the presence of malignant potential, pancreatic surgery remains very complicated and demolitive. Many factors need to be considered in the management of cystic pancreatic tumors. The most important include histological type, location, size, age and clinical condition of the patient. CONCLUSIONS: A correct multidisciplinary pre-operative diagnosis is mandatory. Surgery should only be performed in selected cases. [ABSTRACT FROM AUTHOR]

Desmoids are rare mesenchimal tumors that may originate also inside the abdomen or in the abdominal wall. These tumors are biologically characterized by a tendency to local growth, and only rarely are they able to develop distant metastases. Surgical excision usually is the best treatment with a chance of a cure. In the few reports on intraabdominal or abdominal wall desmoids, open surgery always was performed. The first case of successful laparoscopic resection of a symptomatic anterior wall desmoid tumor with intraabdominal growth is reported. During the procedure, it was difficult to mobilize and grasp the mass using the common laparoscopic instruments, but with the help of the "marionette trick," modified suture traction technique, the tumor could be removed easily using only three trocars. With four traction sutures minimizing the wall trauma, the trick made it possible to mobilize the mass in at least, seven directions, according to the principles of physical forces and vectors. This simple trick can be helpful for other common laparoscopic procedures, avoiding the insertion of sometimes ineffective instruments through more traumatic trocars. [ABSTRACT FROM AUTHOR]

Key words: intraperitoneal insulin; osmotic agents; peritonitis [ABSTRACT FROM PUBLISHER]

Paired filtration dialysis (two-chamber haemodiafiltration) was evaluated as a short, highly efficient renal replacement therapy in 35 uraemic subjects belonging to three different dialysis centres. The study period was 1 year. Patients were divided into two groups according to their body-weight and drinking habits. The smaller patients underwent 150-min dialysis sessions three times weekly. The larger patients underwent 3-h treatments thrice weekly. The treatment was adequate in all patients according to the KT/V criteria of adequacy. The intradialytic symptomatology was remarkably low and the treatments were well tolerated in all patients. The study confirms the reliability of aired filtration dialysis as a short dialysis technique. In some patients 150 min may be insufficient to achieve an equate dialysis efficiency and 180 min may be required for the majority of the population. [ABSTRACT FROM PUBLISHER]

The feasibility and reliability of a short dialysis technique performed with standard dialysis equipment and a modified cuprammonium rayon hollow-fibre filter has been studied. The hydraulic response of the filter and membrane to high blood flows and transmembrane pressures were tested in vitro and the maximal clearances of different solutes achievable during high-flux bicarbonate dialysis were studied in vivo. Clinical studies were undertaken to evaluate the longterm effects of the short, highly efficient dialysis therapy. Six patients were treated for more than a year with singlepass bicarbonate dialysis with a blood flow of 500 ml/min, dialysate flow of 700 ml/min, and average duration of 150 mm/session three times weekly. The treatment showed an adequate efficiency with an average KT/V greater than 1. All patients obtained an average blood urea nitrogen during the study of less than 80 mg/dl and an average protein catabolic rate of 0.9 g/kg per 24h. The treatment was well tolerated by all patients and, on echocardiography, no significant changes in myocardial function were detected after one year of therapy. The treatment is efficient, well tolerated, simple to monitor and does not require the use of synthetic membranes or machines with advanced technology. Thus the reduction of dialysis treatment time is feasible in all centres at a relatively low cost. [ABSTRACT FROM PUBLISHER]

Creatinine clearance has been evaluated under baseline conditions and after acute protein load in five normal and 29 pregnant women at different stages of pregnancy without evidence of renal disease. After a 3-h period in which creatinine clearance was measured hourly (resting GFR), a meal containing 80 g of proteins was administered and creatinine clearance was measured hourly for 4 h (test GFR). Resting GFR in normal sub jects averaged 104±22.5 ml/min per 1.73m, the wide variation being due to different dietary, protein intake (from 0.3 to 1.2 g of protein per kg body weight). In the pregnant women the resting GFR increased progressively from the first month (99.8±12.8m1/min per l.73m) to the last month of gestation (149.6±12.5 ml/min per 1.73 m) All subjects showed a significant increase of GFR after protein load although the greatest difference between the resting and the test GFR was detected in the first trimester. Inulin clearance was also measured in seven subjects after protein loading to compare creatinine and inulin clearance values. The two clearance values did not differ significantly, showing that creatinine can be safely used as a reliable marker for measuring GFR. Test GFR averaged 163.3±4.1 mI/min per 1.73 in normal subjects and l63.8±6.5 ml/min per l.73m in pregnant women without any relationship with the stage of pregnancy. The identity of test GFR both in normal subjects and in pregnant women suggests that this parameter is likely to be related to the functioning renal mass, and represents the filtration capacity of the kidney. The difference between the test GFR and the resting GFR represents the renal functional reserve. The progressive increase of the resting GFR during pregnancy suggests a progressive utilisation of the renal functional reserve under the stimuli of gestation. It is evident that only subjects with intact renal functional reserve may increase their GFR during pregnancy, under specific metabolic requirements. Acute protein load might be used, therefore, as a simple test to evaluate renal functional reserve and to predict the renal response during future pregnancies. Since the test may detect the existence of renal disease even in the early phases when the reduction of the functioning nephrons is not clinically evident, it might be utilised in some cases to prevent or predict possible pregnancies at risk. [ABSTRACT FROM PUBLISHER]