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Analisi dei risultati della terapia chirurgica dell'acalasia esofagea con tecnica di Heller-Dor laparoscopica in pazienti anziani con e senza dilatazione pneumatica pregressa

Lymphadenopathy is fairly widespread among the population and recognize multiple causes, often benign and self-limiting. We report on case about one young women with Kikuchi-Fujimoto disease or histiiocytic necrotizing lymphadenitis. This is a rare self-limiting lymphadenopathy which is usually diagnosed in young women. It is a self-limiting condition, usually resolving within 2-3 months, a low recurrence rate of 3% to 4% has been reported, of unknown origin, that does not require any specific management.

The common hepatic artery aneurysms (HAA) are uncommon atherosclerotic lesions and often they are clinically silent. Their diagnosis is often difficult prior to rupture, due to nonspecific clinical presentation. We report a case of a giant aneurysm of the common hepatic artery causing obstructive jaundice through compression of the biliary tract. The presence of the lesion was confirmed with the use of spiral computed tomographic angiography. Hepatic artery aneurysm is a lesion that should be considered in cases of unexplained obstructive jaundice.

Incisional hernia is a frequent complication of abdominal surgery with an incidence reported in the literature of 2–20%. The condition is associated with local and systemic, potentially severe risks. The incidence of incisional-hernia recurrence is even higher, between 8 and 55%, depending on the initial type of repair technique. Thus, incisional hernia should be regarded as a serious and disabling clinical condition, with a poorly understood aetiology and dangerous complications, especially incarceration with resulting obstruction or necrosis of the bowel and omentum. Other aspects of incisional hernia must also be mentioned, such as total loss of the abdominal contents due to postural, respiratory, and dynamic deficiencies that impair overall physical activity and the daily quality of life.

To evaluate retrospectively the outcome of the curative open and laparoscopic surgical approach to the diverticular disease according to timed steps based on the pathologic stage.From 1989 83 out of 242 outpatients underwent surgery in emergency or after medical failure and at least two acute attacks requiring hospital admittance, or complicated diverticulitis. Modified Hinchey classification staged the disease. Clinic and instrumental criteria, surgical procedures, early and late complications were statistically evaluated (Students t-test and exact Fischer test, p0.05) in comparison with the different steps of therapeutic strategy.Twenty nine patients were classified as Hinchey 0, 26 as I, 14 as II, 11 as III, 3 as IV. Clinical characteristics of the lap and open groups overlapped, with higher rate of earlier age in first and advanced stages in the second group. 16 patients (19.3%) underwent surgery at the first attack in emergency or in delayed emergency (5 TC-guided drainages). 30 open and 53 lap procedures were done: 21 two-stage: 18 primary resections + ileostomy and 3 Hartmann; 61 single stage: 49 sigmoidectomy, 12 left colectomy. 4 conversions (7.5%), 12 early (14.5%) and 10 late (12.1%) complications were observed.Complications rate was higher in the open group including more advanced stages. Elective surgery performed following conservative therapy, 4 weeks from the first acute attack in younger people (age55yrs.) and after two attacks in elder (age55yrs.) showed a significant lower complications' incidence (p0.05) compared to the 8 weeks delayed operations.Surgery of diverticulitis must follow standardized criteria. The laparoscopic approach could be performed in more severe stages, provided that conditions of delayed emergency were achieved.