Search

Objectives: The aim of this study was to compare mortality of dilated cardiomyopathy (DCM) patients with the mortality in the background Italian population, taking into account demographic characteristics and clinical stratification of long-term outcome, ie, "reverse remodelling" within the first 2 years of follow-up., Background: DCM is a myocardial disease, characterized by left and/or right ventricular dilation and dysfunction and poor outcome. Evidence-based treatment with ACE inhibitors, beta-blockers and, in the last decade, implantable cardioverter defibrillators have been demonstrated to improve significantly heart failure symptoms and prognosis. At present, DCM patients are unlikely to be accepted for life insurance., Methods: A cohort of 577 DCM patients consecutively enrolled from 1988 to 2004 in the Heart Muscle Disease Registry of Trieste, Italy, was matched by sex, age and registry data entry with the mortality data of the Italian population. Relative survival has been estimated by means of Kaplan-Meier technique, and mortality ratios (MR) with corresponding 95% confidence intervals have been computed., Results: DCM patients who showed a significant reverse remodelling within the first 2 years of treatment showed comparable survival with respect to the control population, and therefore could be taken into consideration for life insurance coverage, at least for a short or medium-term of years., Conclusions: The data illustrate that survival probability strongly depend on the individual treatment and evolution of the disease and could be easily measured within the first 2 years of follow-up. If this information is collected at the time of evaluation of an applicant for life cover, the insurance company could possibly improve its risk stratification.

We report the case of a patient with von Recklinghausen's disease, who was admitted with a diagnosis of acute abdomen due to small bowel neurofibromatosis. The patient was submitted to an abdominal CT scan that showed a homogeneous round lesion, with a regular margin, probably belonging to the small bowel and with the appearance of a benign lesion that probably caused an intestinal intussusception. The patient was submitted to a surgical procedure that mainly consisted in multiple small bowel resections. The histopathological examination confirmed the benign nature of the lesions. About one third of patients affected by von Recklinghausen's disease present involvement of the bowel, but only 5% of them are symptomatic. The intestinal tumours are usually neurofibromas and are mainly localized in the jejunum. However, there have also been reports of stromal, nervous and endocrine tumours and even other tumours not belonging to these categories, including adenocarcinoma. The overall incidence of intestinal malignancy in patients with von Reckilnghausen's disease is about 10%. The surgical operation, as well as the histopathological and immunochemical examination of the intestinal lesions are of crucial importance for the treatment of the complications of intestinal neurofibromatosis and for the treatment and diagnosis of malignancy.

We examine the indications and the operative options for proceeding to emergency surgery in patients with inflammatory bowel disease. Emergency surgery is absolutely mandatory in case of generalized peritonitis due to bowel perforation. Other life-treating complications are acute disease not responding to medical treatment, toxic megacolon, bowel obstruction and massive hemorrhage. Early medical treatment of these conditions often prevents most severe clinical expressions and improves the prognosis. However surgery should be performed immediately if there is no improvement within 5 days of medical management in case of acute colitis, within 24-48 hours in case of toxic megacolon, within 48-72 hours in patients with intestinal obstruction or severe bleeding, or if the patient deteriorates during this period. In such circumstances, subtotal colectomy with ileostomy and mucous fistula of distal sigmoid colon is the best procedure. That is because it is relatively easy to perform and consents a simpler restorative operation than other procedures preserving the rectum. Moreover it leads to lower morbidity and mortality than the total proctocolectomy that should be reserved to patients with severe rectal disease or sphincter lesion. The most important factors influencing outcome of complicated or severe inflammatory bowel disease are the choice of the appropriate timing for surgery and the procedure performed.

The proliferative activity was evaluated in colorectal biopsies of 39 healthy subjects living in two distinct geographical areas, Trieste in northern and Florence in central Italy. Subjects living in Trieste had a significantly higher mitotic activity compared with subjects living in Florence (mitoses/cells counted x 100 were 0.17 +/- 0.04 in Trieste and 0.089 +/- 0.02 in Florence). The results of a dietary questionnaire also showed that subjects in Trieste consumed significantly fewer starches, fibers, nitrites, and proteins. However, no correlation was evident between the consumption of these nutrients and intestinal proliferation.

The injuries incident to enemas may vary from oedema of the mucosa to gangrene of the large bowel. The burn of the rectum is very rare, and in mild cases it has an identical course to that of the caustic oesophagitis. The place of corticosteroids, administered by intravenous route or topically, in the therapy of te burn of the rectum is unproven. Healing of the lesion occurs by fibrosis and may result in structure formation, which usually need a treatment only when obstructive symptoms develops.

The authors show a case of paralysis of right femoral nerve, subsequent to extrinsic compression due to traumatic hematoma of ileo-psoas muscle. What emerges from the revitwing of the international literature, as well as from the personal experience is both a complete nosographic framing and the necessity for an early surgical intervention.

The Authors, although not working in an emergency ward, have performed 30 fiberoptic sigmoidoscopies (FFS) in emergencies on patients hospitalized in their Institutes. The indications for the investigation were: acute bowel obstruction (22 cases); severe post-operative diarrhea (5 cases); massive rectal bleeding (8 cases). In all the patients, FFS, performed immediately, allowed diagnosis of both the type and the site of tht lesion. The Authors believe that fiberoptic sigmoidoscopy, in trained hands, in emergencies can be a valid and safe tool for a quick and sure diagnosis. In particular, as far as acute intestinal obstruction is concerned, FFS can prove useful for the defferential diagnosis between mechanical and dynamic ileus; it is also clearly indicated in order to establish, during the pre-operative phase, the neoplastic or not-neoplastic character of the lesions. FFS should, therefore, be performed every time the clinical data and the direct radiography of the abdomen suggest a left colon obstruction.

Conservative treatment of Recurring Acute Pancreatitis (R.A.P.) is characterised by a fairly high disease and death rate due to the numerous relapses involving pancreatic lesions of ever increasing severity. 42 patients with R.A.P., subjected to biliary tract surgery at Trieste University Institute of General Surgical Clinic, were re-examined (average follow-up of three years) in order to assess the effectiveness of the treatment given. The follow-up results confirm the need for prompt surgical operation aimed at correcting the biliary pathology and at obtaining complete "restitutio ad integrum" from the pancreatic anatomo-functional standpoint when such therapy has been correctly applied.

The Authors present a medium-term (2 years) followup of 8 out of 10 patients treated by pancreatojejunostomy. Good results were obtained in 100% of these cases, with a possibility of later failures if the patient continues to drink. The mere clinical assessment of such patients affords a sufficiently faithful reflection of the results of derivation procedures.