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Intestinal obstructions/pseudo-obstruction of the small/large bowel are frequent conditions but their management could be challenging. Moreover, a general agreement in this field is currently lacking, thus SICUT Society designed a consensus study aimed to define their optimal workout.The Delphi methodology was used to reach consensus among 47 Italian surgical experts in two study rounds. Consensus was defined as an agreement of 75.0% or greater. Four main topic areas included nosology, diagnosis, management and treatment.A bowel obstruction was defined as an obstacle to the progression of intestinal contents and fluids generally beginning with a sudden onset. The panel identified four major criteria of diagnosis including absence of flatus, presence of3.5 cm ileal levels or6 cm colon dilatation and abdominal distension. Panel also recommended a surgical admission, a multidisciplinary approach, and a gastrografin swallow for patients presenting occlusions. Criteria for immediate surgery included: presence of strangulated hernia, a10 cm cecal dilatation, signs of vascular pedicles obstructions and persistence of metabolic acidosis. Moreover, rules for non-operative management (to be conducted for maximum 72 hours) included a naso-gastric drainage placement and clinical and laboratory controls each 12 hours. Non-operative treatment should be suspended if any suspects of intra-abdominal complications, high level of lactates, leukocytosis (18.000/mm3 or Neutrophils85%) or a doubling of creatinine level comparing admission. Conversely, consensus was not reached regarding the exact timing of CT scan and the appropriateness of colonic stenting.This consensus is in line with current international strategies and guidelines, and it could be a useful tool in the safe basic daily management of these common and peculiar diseases.Delphi study, Intestinal obstruction, Large bowel obstruction, Pseudo-obstruction, Small bowel.Le ostruzioni e pseudo-ostruzioni del piccolo/ grande intestino sono condizioni frequenti, ma la loro gestione risulta spesso difficile per cui è necessario avere un adeguato e condiviso percorso gestionale. A tal proposito la Società Italiana di Chirurgia d’Urgenza e del Trauma (SICUT) ha disegnato uno studio volto a definire il management ottimale dei pazienti con occlusione intestinale.Lo studio è stato condotto utilizzando la metodologia Delphi coinvolgendo un panel di 47 chirurghi italiani con maturata esperienza clinica. Il consenso è stato definito come un accordo uguale o superiore al 75.0%. Lo studio si è focalizzato su quattro aree tematiche comprendenti la nosologia, la diagnosi, la gestione e il trattamento delle ostruzioni e delle pseudo-ostruzioni intestinali. Un occlusione intestinale è stata definita come un ostacolo alla progressione del contenuto intestinale. RISULTATI: in genere ad esordio improvviso. Il panel ha identificato quattro principali criteri di diagnosi, tra i quali l’assenza di canalizzazione ai gas, la presenza di livelli ileali3.5 cm o di una dilatazione del colon6 cm nonché di una distensione addominale. Viene inoltre consigliato il ricovero in chirurgia, un approccio multidisciplinare e un transito con Gastrografin per tutti i pazienti che presentano un’occlusione. Tra i criteri per un intervento chirurgico immediato sono inclusi: la presenza di un’ernia strozzata, una dilatazione del cieco10 cm, segni di ostruzione del peduncolo vascolare e la persistenza di acidosi metabolica. La gestione non operatoria dei pazienti (la cui durata massima dovrebbe essere di 72 ore) include il posizionamento di un sondino nasogastrico e la necessità di effettuare controlli clinici e laboratoristici ogni 12 ore. Il trattamento non operatorio deve essere sospeso in caso insorga il sospetto di complicanze intra-addominali, compaia un alto livello di lattati, una leucocitosi (18.000 / mm3 o neutrofili85%) o un raddoppiamento del livello di creatinina rispetto ai valori basali al ricovero. Al contrario il panel non ha raggiunto alcun consenso riguardo l’esatta tempistica della TAC e l’opportunità di stenting del colon come intervento palliativo in attesa di chirurgia definitiva.Le raccomandazioni stabilite sono in linea con le strategie e le linee guida internazionali, e potrebbero essere uno strumento utile per la gestione del paziente affetto da occlusione intestinale.

Malignant melanoma is characterized by metastases also to the gastrointestinal tract, especially in the small bowel. The diagnosis is often delayed because unspecific clinical presentation (frequently as chronic iron deficiency anemia, rectal bleeding or intestinal obstruction). We present a case of melanoma of unknown primary site, with clinical presentation of intestinal obstruction. A segmental resection of the ileum was performed including mesentery with lymph nodes. Histology revealed metastatic melanoma from unknown primary. PET and MRI confirmed disseminated disease without brain metastasis.

Background: Traffic accidents are major causes of disability and mortality due to the increasing number of vehicles, changes in lifestyle and high-risk behavior among the general population. Traumatic hemipelvectomy is a type of exceptional lesion representing 0.6% of all pelvic fractures, although lesions of the lower extremities are more usual than those of the upper extremities.Case presentation: The authors present an unusual case of traumatic left hemipelvectomy, and consider the medical-legal aspects resulting from an accident of a motorcycle driver, which involved a lateral collision between the subject’s motorcycle and a car.Conclusion: With traumatic hemipelvectomy in young subjects difficulties arise at any level and in all medical fields: clinically, surgical and medicolegal

Societal expectations from rural lands have traditionally been focussed on the production of food and fibre. Yet the perception of rural areas is changing and they are now seen in many instances to be capable of delivering multiple functions or non-commodity outputs including land conservation and the preservation of biodiversity, contributing to the sustainable management of renewable natural resources and enhancing the socio-economic viability of many areas (OECD, 2001). The overall multifunctionality is constrained or favoured by biophysical and socio-economic drivers. As these types of drivers vary spatially and temporally, so does the functionality of the landscape and heterogeneous patterns emerge. Associated with multiple functions at a single location are a variety of pressures which can manifest themselves as conflict between interacting land uses (Gimona and van der Horst, 2007; Willemen et al., 2010). One such conflict in rural zones is that between agricultural use and residential use.

We report a case of acute relapsing pancreatitis associated with pancreas divisum, who underwent major papilla sphincterotomy after failed minor papilla cannulation. Long-term results were satisfactory. The possible explanations of the efficacy of major papilla endoscopic resection in this particular case are discussed.

Gallbladder polypoid lesions occur in 1.3%-6.9% of cases. The preoperative diagnosis between benign, malignant and potentially malignant lesions is difficult. Therefore it is not possible any.The Authors describe three cases. The case 1 was a gallbladder diffuse adenomyomatosis; the ultrasound and the CT were of little help in defining preoperatively the nature and the gravity of the thickening. Case 2 was an adenomyomatosis of the fundus: the ultrasound examinations were not able to establish preoperatively lesion's nature, site and dimensions. In the case 3, ultrasounds showed polypoid lesions and calculi concrections not found in colecistectomy.The ultrasound is the most widely used diagnostic tool in the evaluation of gallbladder polypoid lesions; its accuracy is only 66%. CT, which has an accuracy level of 75%, must be carried out there is any possibility of malignant degeneration of the polyp. If doubts persist, a MR, 93% accuracy, is indicated. In selected cases, PET can be of further help.The preoperative diagnosis of the nature of gallbladder polypoid lesions is "difficult" and this justifies the lack of consensus on treatment. However, the adenoma-carcinoma sequence, widely discussed in literature, can justifies to the use of CT, MR, PET and surgical treatment after an ultrasound examination.

Umbilical endometriosis is a very rare disease. We report a case of spontaneous umbilical endometriosis in a 36-year old female. Endometriosis was suspected because of the presence of the typical cyclic bleeding and swelling. Abdominal CT excluded the presence of other endometriotic localizations. The umbilical mass was widely excised together with the umbilicus, fascia and peritoneum. The ensuing defect was primarily closed without using prosthetic mesh. Postoperative recovery was uneventful. Histological examination of the specimen showed the presence of endometrial glands with a stromal component, compatible with the diagnosis of endometriosis. At one-year follow-up the results of surgery were satisfactory with no sign of endometriosis recurrence and or parietal defect occurrence. We suggest that surgical excision should be wide in order to prevent local recurrence, and prosthetic materials should not be used to repair the ensuing umbilical defect.

Uterine carcinosarcoma is a highly aggressive neoplasm with tendency to early recurrence and/or metastasis. The neoplasia has both epithelial and stromal malignant components. Clinically, it is characterized by a postmenopausal metrorrhagia, associated sometimes with abdominal pain. The Authors describe a case of carcinosarcoma in a 82-year old woman with a vaginal bleeding since 10 months and an ingravescent hypochromic anemia. The RMN of the abdomen and pelvis showed a mass occupying the whole uterine lumen, without signs of pelvic diffusion. A bilateral hystero-oophorectomy was performed; the patient's critical conditions and a high anaesthesiological risk advised us not to perform a bilateral pelvic lymphadenectomy with aortic sampling. Six months after operation, a clinical follow-up with a total-body CT didn't show any sign of local recurrence and/or distant metastasis. From the analysis of this case report and from the data of the literature some important considerations can be done: a) gynecologic check up in post-menopausal women with associated risk factors (obesity and hypertension) can allow an early diagnosis also in asymptomatic patients; b) sovrapubic and transvaginal US, abdomino-pelvic CT and MRI are essential for a correct clinical staging; c) surgical excision followed by the histological examination of the specimen is mandatory to establish a correct diagnosis.

Many environmental studies require accurate simulation of waterand solute fluxes in the unsaturated zone. This paper evaluatesone- and multi-dimensional approaches for soil water flow as wellas different spreading mechanisms to model solute behavior atdifferent scales. For quantification of soil water fluxes,Richards equation has become the standard. Although currentnumerical codes show perfect water balances, the calculated soilwater fluxes in case of head boundary conditions may dependlargely on the method used for spatial averaging of the hydraulicconductivity. Atmospheric boundary conditions, especially in thecase of phreatic groundwater levels fluctuating above and below asoil surface, require sophisticated solutions to ensureconvergence. Concepts for flow in soils with macropores andunstable wetting fronts are still in development. One-dimensionalflow models are formulated to work with lumped parameters inorder to account for the soil heterogeneity and preferentialflow. They can be used at temporal and spatial scales that are ofinterest to water managers and policymakers. Multi-dimensionalflow models are hampered by data and computation requirements.Their main strength is detailed analysis of typicalmulti-dimensional flow problems, including soil heterogeneity andpreferential flow. Three physically based solute-transportconcepts have been proposed to describe solute spreading duringunsaturated flow: The stochastic-convective model (SCM), theconvection-dispersion equation (CDE), and the fractionaladvection-dispersion equation (FADE). A less physical concept isthe continuous-time random-walk process (CTRW). Of these, the SCMand the CDE are well established, and their strengths andweaknesses are identified. The FADE and the CTRW are more recent,and only a tentative strength weakness opportunity threat (SWOT)analysis can be presented at this time. We discuss the effect ofthe number of dimensions in a numerical model and the spacingbetween model nodes on solute spreading and the values of thesolute-spreading parameters. In order to meet the increasingcomplexity of environmental problems, two approaches of modelcombination are used: Model integration and model coupling. Amain drawback of model integration is the complexity of theresulting code. Model coupling requires a systematic physicaldomain and model communication analysis. The setup andmaintenance of a hydrologic framework for model coupling requiressubstantial resources, but on the other hand, contributions canbe made by many research groups.

30 citazioni su Scopus. 46 citazioni su GoogleScholar. ------ http://www.scopus.com/record/display.url?eid=2-s2.0-0347771343&origin=resultslist&sort=plf-f&src=s&sid=1BklTwBDkRxWaxt9FLi7YAz%3a70&sot=aut&sdt=a&sl=37&s=AU-ID%28%22Benassai%2c+Giacomo%22+6602920646%29&relpos=11&relpos=11&searchTerm=AU-ID(\"Benassai, Giacomo\" 6602920646) ------ An open-label prospective, randomized, parallel multicentre study was undertaken to compare the efficacy and tolerability of 1.5 g/day intravenous imipenem/cilastatin with 3 g/day intravenous meropenem in the treatment of intra-abdominal infections, A total of 287 patients mere enrolled; 201 patients, divided between the 2 treatment groups, were evaluable. Clinical outcome, bacteriological outcome, untoward microbiological effects, and clinical and laboratory adverse experiences mere evaluated, 98% of patients receiving imipenem/cilastatin therapy mere cured, with 96% showing eradication of infection, 95% of those on meropenem mere cured, with 98% showing eradication. These differences in clinical and bacteriological outcome between the 2 treatments were not statistically significant, Two patients receiving imipenem/cilastatin and 5 receiving meropenem had untoward microbiological effects. There mas a 0.7% frequency (1/139 patients) of possibly or probably drug-related clinical or laboratory adverse experiences with imipenem/cilastatin and a 2.7% frequency (4/148) with meropenem, The mean time to defervescence was significantly less for patients in the imipenem/cilastatin treatment group than for those receiving meropenem. This study shows that 1.5 g/day of imipenem/cilastatin is equivalent to 3.0 g/day meropenem in clinical and bacteriological outcome, as well as in incidence of side effects.