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Severe or major burns induce a pathophysiological, immune, and inflammatory response that can persist for a long time and affect morbidity and mortality. Severe burns are followed by a "hypermetabolic response", an inflammatory process that can be extensive and become uncontrolled, leading to a generalized catabolic state and delayed healing. Catabolism causes the upregulation of inflammatory cells and innate immune markers in various organs, which may lead to multiorgan failure and death. Burns activate immune cells and cytokine production regulated by damage-associated molecular patterns (DAMPs). Trauma has similar injury-related immune responses, whereby DAMPs are massively released in musculoskeletal injuries and elicit widespread systemic inflammation. Hemorrhagic shock is the main cause of death in trauma. It is hypovolemic, and the consequence of volume loss and the speed of blood loss manifest immediately after injury. In burns, the shock becomes evident within the first 24 h and is hypovolemic-distributive due to the severely compromised regulation of tissue perfusion and oxygen delivery caused by capillary leakage, whereby fluids shift from the intravascular to the interstitial space. In this review, we compare the pathophysiological responses to burns and trauma including their associated clinical patterns.

Aim: The purpose of this study is to analyze a rare and under-reported complication of abdominal liposuction and the role of laparoscopy., Clinical Case: We report a case of bowel perforation after 7 days of abdominal liposuction and bilateral mastopexy. The patient presented clinical and radiological findings of bowel obstructive syndrome and bilateral peripheral pulmonary embolism. An emergency diagnostic laparoscopy was performed and confirmed the diagnosis of bowel perforation., Discussion: Bowel perforation is a known but under-reported comSOD Romaplication of abdominal liposuction, and it is characterized by a difficult diagnosis. The clinical presentation is characterized by a difficult diagnosis and severe complications. Bowel obstructive syndrome was constant, as our case and also peritonitis was never frank. This is an important point because it is one of the reasons for diagnostic delay. The development of laparoscopic surgery has changed the way to manage such conditions, where the diagnosis was doubt. In particular, when an acute abdomen occurs, laparoscopy may have three different roles: to confirm or not the diagnosis, to facilitate and guide a subsequent laparotomy or, finally, to entirely treat the disease., Conclusion: The bowel perforation is a dramatic and underestimated complication of abdominal liposuction. Diagnosis is complex. A clinical and radiological investigation should be quickly performed. In doubtful cases, an emergency laparoscopy can confirm the diagnosis and guide a possible subsequent laparotomy.

Myiasis is a parasitic infestation of vertebrate animal tissues due to maggots of two-winged flies (Diptera) that feed on living or necrotic tissue. Dermatobia hominis occurs widely in tropical parts of Latin America; it is the most common cause of furuncular myiasis in this region. The continuous increase in international travel has increased the possibility of observing this pathology outside endemic countries, especially in travelers returning from the tropics. If clinicians are aware of the possibility of the disease and its treatment options, this dermatosis can be easily managed. However, diagnostic delay is very common because the disease is often misdiagnosed as a bacterial skin infection. Here, we report 2 cases of furuncular myiasis caused by D. hominis in travelers returning to Italy from Latin America. Surgical and noninvasive treatment approaches are also described.

A 79-year-old man, with history of recent laparoscopic cholecystectomy, came to our attention for persistent hiccup, dysphonia, and dysphagia. Noninvasive imaging studies showed a nodular lesion in the right hepatic lobe with transdiaphragmatic infiltration and increased tracer uptake on positron emission tomography. Suspecting a malignant lesion and given the difficulty of performing a percutaneous transthoracic biopsy, the patient underwent surgery. Histological analysis of surgical specimen showed biliary gallstones surrounded by exudative inflammation, resulting from gallbladder rupture and gallstones spillage as a complication of the previous surgical intervention. This case highlights the importance of considering such rare complication after laparoscopic cholecystectomy.

Background: Ovarian cancer usually spreads intra-abdominally. Supradiaphragmatic metastases are rare, and axillary lymph node metastases are exceptional. Here, we present the first case of ovarian carcinoma detected at screening mammogram as intramammary lymph node metastases., Case Report: A 44-year-old obese woman underwent core biopsy of a suspicious mammographic finding histologically consistent with lymph node metastases from breast cancer. Serum tumor markers, including CA 125, were normal, and clinical staging was negative. The patient underwent quadrantectomy and axillary dissection that revealed four involved lymph nodes but no primary breast carcinoma. Accurate re-evaluation of the histological specimens suggested the possible ovarian origin of the tumor. An [(18)F]-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography revealed a 33-mm solid mass with intense metabolic FDG uptake in the right groin and a small simple ovarian cyst with normal FDG uptake. The ovarian cyst was removed laparotomically and was malignant on frozen section. Surgical staging revealed a well-differentiated serous ovarian carcinoma microscopically involving the omentum and massively infiltrating the groin node. After chemotherapy, the patient developed metastases in the contralateral axilla that was removed surgically. The patient is alive with no evidence of disease 20 months after surgical removal of the primary tumor., Conclusions: Surgeons should be aware that ovarian cancer may rarely metastasize to intramammary and axillary nodes, mimicking a primary breast carcinoma.

Between March 1986 and September 1988, 38 patients underwent extended aortic resection (aortic valve, ascending aorta, and arch) for acute type-A aortic dissection with aortic valve insufficiency; deep hypothermia and circulatory arrest were used. All patients were operated on within 17 hours of the onset of symptoms. In the first 24 patients, operation was performed by the "inclusion technique." In the last 14 patients, the "excision technique" was used: the ascending aorta and arch was excised, and the aorta was transected at the beginning of the descending thoracic tract. Excision and transection were considered essential to prevent back flow from the false lumen, which is the main source of bleeding, and to allow all anastomoses to be constructed beyond the limits of dissection. The only anastomosis to the dissected aorta was at the distal end of the graft. One of the 14 patients died (7.1%). One patient was reopened for bleeding: blood was issuing from the attachment of the carotid trunks, and the defect was repaired by interposing a bifurcated Dacron graft between the arch graft and the carotid arteries. Extended aortic excision meets the principle of either eliminating as far as possible the diseased aorta or controlling intraoperative and postoperative bleeding. An operation of great magnitude can be considered a life-saving procedure when compared with the high risk of acute type-A aortic dissection.

Fifty-four patients with acute type A aortic dissection were surgically treated with extended aortic resection. The age of the patients ranged from 22 to 75 years, and all of them were in very critical condition. In 50 patients, the resection extended from the aortic valve (included in 33) to the beginning of the descending thoracic aorta and in 4, from the valve (included in 3) to the aortic bifurcation. Deep hypothermia and circulatory arrest were employed during the aortic arch resection; inclusion of the graft at the end of procedure was done in 44 patients; in the others, the diseased aortic wall was excised. Early mortality was 20 +/- 6% (11/54). Nine deaths were due to persistence of the distal dissection. Acute type A aortic dissection with aortic valve insufficiency should be treated as an emergency with extended aortic resection. As far as control of bleeding and closure of distal dissection are concerned, the best results have been achieved when the diseased aortic wall has been completely excised.

Simultaneous total aortic replacement, including the arch and extending to bifurcation, has been performed in six cases at our institution. The cases presented were (1) acute dissection, including the intimal tear in the arch (one case); (2) chronic Type-I dissection, with both visceral and inferior limb ischemia (three cases); and (3) multiple aneurysms (two cases). The broad outline of the surgical technique employed consists of inducing general hypothermia with extracorporeal circulation. At core temperature of 20 degrees C, circulation is stopped and the aortic arch is replaced. Afterward, cerebral perfusion and total body perfusion are resumed at low flow, keeping body temperature between 20 and 24 degrees C. The intercostal orifices are attached to the side of the aortic graft, and the spinal cord is reperfused. Finally, during a period of hypothermic abdominal ischemia, the abdominal aorta is replaced, and subsequently, rewarming is started. This result is achieved by instituting extracorporeal circulation with two arterial return cannulae (in the ascending aorta and in a femoral artery), making it possible to continue the perfusion of both the upper and lower body during the stages of aortic occlusion. Two patients died from bleeding 3 to 6 hours after operation, and medullary injury was not ascertained; one patient died after 1 month without neurologic disturbances; three patients are alive and in good functional condition 6 to 27 months after operation. We believe that total simultaneous aortic replacement is feasible with the hypothermic technique.

Inhibitory non-adrenergic non-cholinergic efferent nerves are activated in the stomach of the rabbit by electrical vagal stimulation (1). Aim of the present research is to ascertain, in the rabbit stomach, by means of quinacrine fluorescence technique (6) the presence of quinacrine-positive cells and nerve fibers which are thought to be non-adrenergic non-cholinergic inhibitory nerves of gastric motility. A population of neurons showing a high affinity for quinacrine was revealed by fluorescence microscopy in the myenteric plexus of the rabbit stomach.