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Since gastroduodenal FTRD system is commercially available, several data have been reported in Literature concerning duodenal full-thickness resections, whereas few cases of gastric full-thickness resections has been described. In this case series We report three patients treated with this innovative tool for resecting lesions of the gastric wall. The indications ranged notably a neuroendocrine tumor in a difficult to treat environment in the first case, a recurrent adenocarcinoma in a poorly surgical candidate patient in the second case and a pre-pyloric lesion for the third patient. click here In the third patient, a complete pyloric stenosis due to the clip deployment occurred. Clinical success rate was 100%. Even if current Literature is still poor of articles dealing with gastric full-thickness resection device based on over-the-scope-clip system. Our case series show how this novel tool might be take into consideration for whenever both surgery and standard endoscopic resection techniques are poorly feasible.AIM Enhanced recovery after surgery programs aims to standardize care, improving colorectal surgery outcomes. Older patients are a challenge population for these programs. The aim of this manuscript is to explore the effect of application Enhanced recovery after surgery protocol among older patients and high-risk patients undergone colorectal surgery for cancer. METHOD Since January 2005, until September 2016, 1189 consecutive patients underwent elective Colorectal Surgery and treated according to our Enhanced recovery after surgery protocol. Patients are divided in three groups according to age Group1 under 69 y-o (control group), Group2 70 to 79 y-o and Group3 over 80 y-o. Primary end point was Time to Readiness to Discharge. RESULTS Median Time to Readiness to Discharge was 4 days (3-30) in Group 1, 5 (3-47) in Group 2 and 5 (3-19) in Group 3. Length of stay in Group 1 had a median length of 6 days (3-58), in Group 2 of 8 days (3-70) and in Group 3 of 8 days (3-53). CONCLUSIONS Once more Enhanced recovery after surgery program has showed its efficacy in colorectal surgery field. Moreover, our experience has underlined the need to concentrate efforts mainly on older and high-risk patients.We retrospectively collected data of 100 consecutives elective Longo's procedures for third- and fourth-degree simptomatic haemorroids, classified ASA grade I and II. All patients stayed overnight, because discharge was scheduled the day after the operation. 98 were discharged the day after the operation. Two patients were not discharged the day after because mild and severe bleeding respectively occurred during the first night after the operation which settled conservatively. All the patients were discharged on oral NSAID and stool softeners. None required rehospitalisation. Our retrospective study, pointing out that, in general patients did not require active intervention on the first postoperative night, represents an encouragement to introduce day-case stapled procedure for haemorroids.AIM To determine if recruitment of a hip fracture nurse specialist has a reduction in length of stay for hip fracture patients. METHOD Primary data was extracted from the National Hip Fracture Database (NHFD). The length of stay of hip fracture patients from 2011-2014 was compared to the period 2014-17, following appointment of a hip fracture nurse specialist in 2014. link2 RESULTS The average length of stay in the first group (2011-2014) was 19.94 days and in the second group (2014-2017) was 16.52 days. There was a reduction of 3.42 days (17.15%) and was statistically significant. There was also a reduction in the time to surgery (1.38 days versus 1.15 days) and the crude 30-day mortality (10% versus 6.06%) both of which were statistically significant. The two groups were well-matched with regards to age, female male ratio and severity of co-morbidities (based on American Society of Anaesthesiologists physical status classification system). CONCLUSION The introduction of a dedicated hip fracture nurse specialist has a positive outcome on hip fracture patients by reducing length of stay, time to surgery and the crude 30-day mortality.BACKGROUND Undifferentiated pleomorphic sarcoma (UPS) of the breast is an extremely rare, but aggressive subtype of sarcoma that can develop in radiotherapy (RT)-treated breast cancer patients. Due to the low incidence, there are many uncertainties regarding the adequate management of these tumors. We present a rare case of radiation-induced UPS in a 63-year-old woman who had undergone breast conserving therapy for invasive ductal carcinoma of the left breast, six years prior to presentation. CASE PRESENTATION A 63-year-old woman presented with a rapidly growing left breast mass. She had been diagnosed with invasive ductal carcinoma of the left breast for which she underwent a left upper outer quadrantectomy and ipsilateral axillary dissection followed by RT, six years previously. During her routine oncologic follow-up, the mammography revealed a dense, nodular opacity with microcalcifications. link3 The breast ultrasound (US) confirmed the presence of the nodule. US-guided fine needle aspiration biopsy was performed and the diagnosis of UPS was made, the reason for which the patient underwent wide local excision of the left breast. CONCLUSION The diagnosis of RT-induced UPS is challenging and often missed due to the low incidence, long latency period, unspecific imaging findings, and difficulties in clinical and histological detection of these lesions. These tumors should be considered in differential diagnoses of rapidly-growing breast masses in previously RT-treated breast cancer patients, as they can mimic the local recurrence of the primary tumor. Since the prevalence of breast-conserving surgery followed by RT has been increasing, the careful monitoring of at risk patients is of utmost importance, as UPSs are highly aggressive tumors associated with very poor outcomes.WDLPS are very rare retroperioneal tumors that can reach huge size before becoming symptomatic. The aim of this article is show the diagnostic management and the surgical approach to giant WDLPS. A standard treatment has yet to be established because the pre-operative diagnosis is very difficult. We present a case of a 69-year-old male patient with progressive increase of abdominal girth, weight loss and light abdominal pain and with an abdominal mass of over 15 kg that displaced the right kidney. A complete tumor resection and right nephrectomy were performed. Histology revealed a well-differentieated liposarcoma. CT scan is the most common imaging technique and laparotomic open radical resection represent the most common surgical approach.Hemoperitoneum due to ruptured retroperitoneal varices is an extremely rare condition and a poor prognostic sign with a catastrophic and life-threatening situation. Early recognition affords appropriate management and urgent surgical intervention in order to favor the survival rate. In this case report we accurately describe the complex clinical course of a 56-year old woman with retroperitoneal varices, who few months earlier had a chest trauma with multiple left lower rib fractures and 10 years earlier she underwent to ovarian hyperstimulation for an ovulation induction. She was taken to the emergency room for a fainting episode with signs of a clear hemodinamic shock without a present history of trauma. The intricacy of this case was mostly due to the choice of the correct management, where the damage control resuscitation turned out to have an important role.Splenic artery aneurysm (SAA) is the most common aneurysm of visceral vessels. Usually the rupture occurs into the free peritoneal cavity and causes massive bleeding, much less frequently the rupture happens into the lumen of the gastrointestinal tract. We describe the case of a 39-year-old male patient with a spontaneous rupture of a splenic artery aneurysm and an acute massive peritoneal bleeding. The case described confirms the rupture of SAA is always a dramatic event and an emergency laparotomy is a life-saving procedure.Liposarcoma is a malignant soft tissue sarcoma usually located in the thigh or the posterior peritoneum in an adult. However, the occurrence of liposarcoma, and indeed a coexistance with scrotal myxofibrosarcoma, is rare. We present an interesting case of a 56-year old male who presented with an inguinal hernia. During the operation a massive fibro-elastic mass located within the left scrotum was noticed which deposited the testicle upward by displacing it into a sack rather than the penis. The mass did not come into contact with the spermatic cord but alongside it the existence of the blood vessels of the mass was found. The histopathological examination revealed a well differentiated liposarcoma along with dedifferentiated low grade myxofibrosarcoma.BACKGROUND The objective of this retrospective study is to evaluate how neck pain is influenced by post-operative cervical alignment in patients operated for cervical spinal trauma. PATIENTS AND METHODS From January 2013 to June 2017, at our department we operated 34 patients with cervical spinal trauma, 22 males and 12 females. Age, sex, level and type of fractures, surgical approach, fixation levels (cervical or cervico-dorsal), preoperative and postoperative CT scan, cervical (C2-C7) Cobb angle (lordotic > +10°, straight 0 /+10°, kyphotic less then 0°) at X-rays on sitting position 3 months after surgery, postoperative self-reported neck stiffness scale, preoperative and follow-up ASIA score, pre and postoperative VAS value were evaluated for each patient. Statistical analysis was performed according to the Mann-Whitney and T-test. RESULTS In this series, 22 patients were operated by anterior approach, 7 patients by posterior approach and 5 by combined approach. Postoperative chronic cervical pain was not correlated with cervical sagittal alignment after surgery, fracture type, surgical approach, fixation level and postoperative ASIA score but is correlated with the presence of neck stiffness (P=0,001). Patients treated with posterior approach (P=0,022) and fracture type C (P=0,026) had higher significantly neck stiffness compared to patients who underwent anterior approach for type B fractures. CONCLUSIONS The presence of abnormal cervical lordosis after surgery for cervical spinal trauma does not correlate with neck pain. Patients treated with posterior fixation had higher neck stiffness and related chronic pain.Accreditation for colorectal (CR) cancer surgery has become a major issue in Italy. This study aimed to analyze the early results of a newly structured program for the treatment of CR cancer in a rural district hospital. Between 2017 and 2018, a total of 214 consecutive patients underwent a CR procedure for malignancy. There were 113 men and 101 women of a mean age of 74 years. Primary CR adenocarcinoma was diagnosed in 210 patients (98%). The incidence of stage I, II, III, and IV disease was 26%, 31%, 24%, and 19% respectively. Hospital volume increased tenfold compared to previous years. Anatomical resection was performed in 204 patients. Right-sided resection and resection of the transverse colon or left angle were performed in 76 (37%) and 14 (7%) patients, respectively. A restorative left sided CR resection was performed in 80 patients (39%), whereas Hartmann procedure and Miles abdominal-perineal resection were performed in 27 (13%) and 6 (3%) patients, respectively. Total colectomy with ileorectal anastomosis was performed in one patient, and two more patients underwent atypical resection.