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The aim of the study was to investigate major vascular injury during laparoscopic cholecystectomy, which is a rare but potentially lethal complication if not recognized and treated swiftly, usually secondary to placement of the Veress needle or trocar. We report on our experience with a 35-year-old woman presenting an aortic laceration of the anterior wall and a puncture wound penetrating the anterior wall of the inferior vena cava. Repair of the injuries was done using a 5-0 Prolene suture mounted on pledgets. In addition, it was necessary to suture three mesenteric vascular injuries in the posterior peritoneum with Vicryl 2-0. The estimated blood loss was 1300 cc. The patient did well and was discharged on postoperative day 13. The distal abdominal aorta, inferior vena cava and large pelvic vessels are particularly prone to injury during laparoscopic cholecystectomy. In most cases, the vascular defect can be closed by direct suturing. Rarely is it necessary to reconstruct the injured vessel with an alloplastic prosthetic patch or a prosthetic implant.

Carotid surgery must be preventive; therefore cerebral protection procedures have been the centre of interest for a decade. Nowadays local cervical block anaesthesia seems to have changed the terms of the problem allowing achieve the aim of "no risk surgery". Therefore we considered our 16 year experience (352 carotids operated on 290 patients). Since 1990 we employed cervical block anaesthesia. In order to ratify as much as possible the two groups of comparison, considering that we adopted some exclusion criteria, we compared the results of the first hundred carotids that underwent surgery with general anaesthesia and the first hundred operated using cervical block anaesthesia. Since we adopted cervical block anaesthesia there was no need of intra-operative monitoring systems because we considered exclusively the patients' clinical answer to preclamping. The use of shunt decreased from 9% to 3%. Surgery performed in cervical block anaesthesia gives a positive impression. This is due to the fact that there is not only a significant reduction of the morbidity rate, especially from a neurologic point of view, but also a reduction of the post-operation hospital stay. Furthermore there is also a better organization of the surgical phases. Direct monitoring of the cerebral function allows a precise analysis of the peri-operatory neurological events. In conclusion our study suggests that cervical block anaesthesia allows clinical benefits for the patient as far as safety is concerned being also more convenient under the economic point of view.

The Authors present a case of inflammatory pseudotumour (IPT) of the urinary bladder occurring in a 57-year-old female patient, who was referred to our department with haematuria, stranguria and hypogastric pain. Ultrasonographic, radiological and endoscopic examinations showed a sessile, ulcerated, easily bleeding bladder formation; urinary cytology revealed no atypical transitional cells. Abdomino-pelvic computed tomography analysis showed thickening of the bladder walls and infiltration of the perivesical fat. Histopathologically, the formation was indicated as an inflammatory pseudotumour (IPT) of the bladder. The patient underwent TURB (transurethral resection of the bladder) and was discharged clinically healed on postoperative day 4. A one-year follow up revealed no evidence of recurrence. On the basis of their experience and a thorough review of the literature review, the Authors discuss the clinico-pathological features of IPT of the bladder and the possible factors involved in the malignant transformation of IPT. In conclusion, the benign nature of the lesion is stressed.