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Tuberculosis or TB (tubercle bacillus) remains a major public health problem in developing countries. Over the last decades extrapulmonary locations of the disease have become more frequent due to the increased prevalence of acquired immune deficiency syndrome and the increase number of organ transplants. The urogenital localization represents about 27% of all extra-pulmonary localizations of TB and may be due either to a disseminated infection or to a primitive genitourinary localization. The majority of patients, has pyuria, sometimes with hematuria. The diagnosis of urinary tuberculosis is based on the finding of pyuria in the absence of infection by common bacteria. The initial medical treatment includes isoniazide, rifampicin, pyrazinamide, ethambutol and streptomycin. This disease should be suspected in patients with unexplained urinary tract infections, especially if immunocompromised and/or coming from endemic areas.

The treatment of the acute diverticulitis is still a stimulating and complex problem sustained by several anatomopathological and clinical factors and the possibility of different therapeutic options, being the operative mortality among 5% and 45%. With the modern technologies it is possible to follow the evolution of the illness so to perform more appropriate therapeutic plan. From 1997 to 2007 we have observed 278 patients with acute diverticulitis. In 219 (78,7%) patients the inflammatory and sub-occlusive condition has been faced with medical therapy, with resolution of the disease in 170 (61%) cases. In 49 (17,6%) patients we have gotten the resolution of the inflammatory disease, but not of the sub-occlusion and therefore we liked to submit them to surgical treatment in election. In 1 case we have found a colovesical fistula. A total of 59 (21,2%) patients with signs of acute abdomen have been submitted to surgery in urgency, within the 24 hours from the hospitalization. We have performed a primary resection with anastomosis and without stoma in all the patients, except in 3 cases in which we have done the Hartmann procedure for the cheap general conditions. We have not recorded intra and postoperative mortality and only in 3 cases we have had a leakage, that has not needed a surgical treatment. In 9 cases we observed infection of the wound, treated with antibiotic therapy. In our experience, performing a surgical procedure, without derivative stoma and manual anastomosis, it seems to be the fittest and less expensive procedure, also in situation of emergency-urgency, without increase of mortality and morbidity.

From 1985 to 2004, 229 patients (171 M, 58 F) aged from 16 to 35 years, affected by pilonidal sinus were treated by complete excision of the sinus and primary closure. Primary healing was achieved in 208 patients (91%) in an average time of 11.9 days. Secondary healing was achieved in 21 patients (9%) in 16-19 days. The mean postoperative hospital stay was 1.9 days and the average time off work 16 days. Recurrent pilonidal sinus was observed in 10 patients with a mean follow-up of 18 months (range: 12-24). On the basis of their experience, the authors conclude that complete excision of the pilonidal sinus with primary closure yields good results in terms of healing, morbidity, early return to work and recurrence rate and can be considered the treatment of choice for pilonidal sinus.

Diverticular disease is very frequent in Western countries; in 5% of the cases it is the cause of serious bleeding, haemodynamic instability and death. The authors report a case of 74 years old patient with severe lower gastrointestinal bleeding. She was in antiplatelet treatment with acetylsalicylic acid (100 mg/die) and clopidogrel (75 mg/die) for preventing the restenosis of medicated stents positioned to treat an acute coronary syndrome. At the same time the patient was under treatment for primary hypercholesterolemia with rosuvastatin (20 mg/die). The severe haemorrhage demanded haemodynamic stabilization, achieved by colloid infusion and blood transfusions. The bleeding continued; selective arteriography showed it's origin from the areas of the sigmoid and superior hemorrhoidal arteries. During the procedure, embolization of the inferior mesenteric artery using spiral type BALT was performed, with consequent bleeding interruption. Fifteen days after the embolization, a rectosigmoid colonoscopy showed a sigmoid diverticular disease. The treatment with acetylsalicylic acid and clopidogrel has surely contributed to the severity of the hemorrhage. Recent experimental and clinical evidence suggests a possible antiplatelet effect of the statins.

The management of traumatic retroperitoneal haematomas is still a much debated question. Although the diagnosis has become easier using CT with contrast medium, the therapeutic decisions are still difficult because of the great variability of the lesions, which may be simple but very often complicated. Our study is based on 1086 treated patients, 29.5% of the 3682 critical abdominal polytrauma seen in 35 years. Mortality has been 12.9% with a medium ISS (Injury Severity Score) of 23.4. 71.4% of the cases were closed traumas, 28,6% were open traumas. The most common single lesions have been pelvic (43%), followed by the renal traumas (39%). Regarding the associated lesions, the thoracic traumas cause an increment of the ISS score up to 26.2% and of mortality up to 14.6%. The maxillofacial traumas associated with traumatic retroperitoneal haematomas represent 11%, mainly associated with motorcycle accidents, which have increased in the last years from 2,4% in the 70s to 32% these days. Our approach to these patients has been basically conservative. Following the indications obtained by the CT, we widely used interventional angiography, especially for renal lesions and, after pelvic stabilization, for pelvic haematomas. We have chosen surgery considering the kind of traumas (open or closed), the location of the haematoma and especially, the clinical course of the patient's hemodynamic condition.

Authors report their initial experience in surgical treatment of thyroid diseases in an area with high percentage of thyroid tumors. Since January 2006, we examinated 428 patients. By clinical features, hormonal profile, imaging and US-guided FNAB, we selected 134 of them for surgery; 93 patients underwent thyroidectomy in January-November 2006. The Authors analyse therapeutic choises and surgical techniques, stressing the high percentage of thyroid neoplasms.

There have been millions of people found to have AIDS. Death rates from AIDS have declined 15% to 20% in the past 5 years. However, nearly 75000 people will die with AIDS in this year. Patients with AIDS are also at risk for developing both Aids-defining cancers, such as Kaposi's sarcoma and non-Hodgkin lymphoma, and non-Aids-defining cancers and opportunistic infections. In patients with advanced Aids, the Cytomegalovirus is a frequent cause of chorioretinitis, pneumonitis, chronic perineal ulcerations and oesophagitis. It has been involved in endocrine, bone marrow, central nervous system and kidney abnormalities. CMV infection of the small bowel accounts for only 4.3% of all cytomegalovirus infection of the GI tract (large bowel 47%, duodenum 21,7%, stomach 17,4%); isolated cases of small bowel perforation due to CMV have been reported in AIDS patients, and all but one patient died. The Authors report a rare case of an HIV-positive young man with gastroenteric Cytomegalovirus infection responsible for generalized peritonitis from multiple perforations.

The abdominal compartment syndrome (ACS) is defined a situation of high degrade abdominal hypertension (IAH) with clinicals signs of multiorganic dysfunction. It's observed like in the intensive care, in particular surgycals and postraumatics, there is ever a bigger frequence of complications presented by criticals patients. The various trials remark a changeable incidence, but the common factor is characterized by a particular severity of scores. All the possibles mechanicals, haemorragicals, infiammatories, and postraumatics causes act, but don't enable the stability among abdominal content, abdominal compliance and parietal tension. The initial triad of effects is constitued by the elevation of diaphragm and the visceral and vascular compression; after this triad provoke a pathophysiologic system that, through various levels, bring to a respiratory, renal and cardiocirculatory dysfunction and to a parietal, hepatic and intestinal ischemia with consequent bacterical translation: sepsis and MOF. The Burch's classification (1996) report four levels of gravity by the slight (< 15 mmHg) to the heavyest (> 35 mmHg): the firsts two levels are of intensivistic competence and for the detention are used conservatives metodics and pharmacological approach; instead in the lasts two levels it's necessary to foresee a surgycal treatment of laparotomy, washing and drainage with following temporary paret's closure. The mortality is now very elevated (29-62%) especially when it's already established a multiorganical dysfunction; therefore it's necessary forward its appearance through the monitorization of abdominal pression (IAP) with the measurement of vescical pression in alls criticals patients at the aim to treat immediately the firsts signs of IAH.

The femoral hernia can be defined as infrequent, and predominantly found in females, with the highest incidence between 30 and 40 years of age. It shows a high tendency to strangulation, also up to 40% of cases, due to the presence of the Gimbernat ligament, which with its tense fibrous margins, aids strangling known as "raised crest". The diagnosis may not be easy, overall in the clinical presence of acute abdomen in elderly patients, disabled people or people who are uncooperative during physical examination. Therefore, it should be sought with an adequate bilateral exploration of the region in all occlused patients and especially with the use of radiological images of the small intestine. The solution currently practiced is prosthetic, proposed by Lichtenstein, and variously modified by Gilbert, Rutkow, Bendavid, and other which uses a prolene plug in the shape of a cigar, umbrella, or basket, according to the size and characteristics of the parietal defect. In emergency conditions, the technique doesn?t change; but if there is stercorary contamination, it is advisable to use direct repair according to the old method of Bassini. In the last 10 years, we have treated 37 femoral hernias in emergency, using direct repair in only 2 cases. In 3 cases we used PTFE; in the other 32 cases prolene was always used; 20 patients were operated under local anesthetic, 12 under general anesthetic and 5 under peridural anesthetic. Satisfactory results were achieved, with average hospital recovery time of 1.4 days, with an early recovery between 3 and 5 days, with only 2 relapses.

Bezoars are masses of indigestible material which form in the stomach. Their genesis depends on the kind of food ingested, on the presence of anomalies of the small bowel and on psychiatric disturbs. Phytobezoar rarely causes bowel obstruction and its most frequent location is the ileocecal valve. The risk increases in those patients who have undergone gastric surgery or present a reduced masticatory ability. Moreover, the genesis can be also caused by endocrine disorders.

Colorectal cancers have an extremely negative prognosis in the elderly, with a high percentage of clinical presentations requiring emergency surgery and high perioperative mortality rates. The clinical manifestations of this type of cancer set in a cutely in 20% of cases due to the sudden onset of one of the basic complications. The authors report on their experience with 79 patients undergoing emergency surgery for colorectal cancer. The choice of operation was made on the basis of the patient's general condition, as estimated by his or her ASA score, and the presence of associated diseases.

The Authors describe a rare case of esophageal perforation occurred after Transoesophageal echocardiography in 68 years old patient and review the literature relating to the causes and management of this pathology. Transoesophageal echocardiography, which is a semi-invasive investigation increasingly used in cardiology and cardiac surgery and intensive care units, is a rare though extremely dangerous cause of such complications. Perforation of the esophagus continues to present a formidable diagnostic and therapeutic challenge. The diagnosis depends on a high degree of suspicion and on the recognition of clinical features and is confirmed by contrast esophagography. The outcome after esophageal perforation depends on the location of the injury, the presence or otherwise of concomitant esophageal disease and the time elapsing between the injury and inititian of treatment. Reinforced primary repair of the perforation is the procedure most frequently employed and preferred for the surgical management of the esophageal perforation. In the case reported here, early diagnosis and prompt surgical treatment consisting in primary repair of the esophageal perforation contributed to the successful management of this serious pathology.

Radiosurgical cervical excision has been performed in 59 patients affected by CIN of various stages. This non-traumatic method uses 3.8 MHz radio waves to cut and/or coagulate without postoperative pain and tissue destruction. The radiosurgical excision has been performed in local anesthesia by a loop electrode or microneedle according to the seat of the lesion. The therapy was "effective" in 98% of cases (58/59) whereas the "incomplete excision" of CIN was observed in 6.7% (4/59). Complications (postoperative and late bleeding) occurred in 3.2% of the patients (2/59). Therefore, the Radiosurgical Excision Procedure (REP) can be considered an easy technique in ambulatory surgery; this method is effective in the treatment of CIN with either therapeutic and economic advantages and guarantee the functional and anatomic integrity of the cervix.

The authors report in a retrospective study their experience in the treatment of anal fistulas suggesting the total exercises of the fistula with primary closure of external and internal anal sphincters and rectal mucosa. In our department of surgery between 1987 and 1993, 36 patients (22 males and 14 females) with anal fistulas (17 intersphincteric, 15 trans-sphincteric and suprasphincteric) were treated with this technique. Postoperative in-hospital stay ranged between 2 and 5 days (mean 3.1) and surgical healing needed 12-15 days. A dehiscence of distal tract was observed in 3 cases (8.2%). in these cases secondary closure of the wound needed 24-28 days. All the patients controlled at follow-up (it lasted at least 1 year) did not show rectal incontinence for gas or stools. The authors conclude that total exeresis with primary closure is a safe procedure indicated in the treatment of anal fistula not associated to inflammatory bowel disease in consideration of earlier healing and minor costs.

The authors describe their technique providing total excision of the rectum and its muscular wall with an anastomosis between the colon and the anal canal at the level of the pectinate line for cancer of the low rectum. Of 20 patients, 17 had good functional results, two required later abdominoperineal resection for local recurrence, and one died of diffuse metastatic spread.