The authors describe a case of Crohn's disease associated with Takayasu's arteritis. The coexistence of these two diseases has been previously reported in 28 subjects. The late onset of Crohn's disease, particularly in relation to that of the arteritis, and colonic involvement were peculiar features of the present case. Aetiopathogenetic theories regarding the association are discussed after reviewing previous case reports.
In the last two decades, there has been a Copernican revolution in the decision-making for the treatment of Diverticular Disease.This article provides a report on the state-of-the-art of surgery for sigmoid diverticulitis.Acute diverticulitis is the most common reason for colonic resection after cancer; in the last decade, the indication for surgical resection has become more and more infrequent also in emergency. Currently, emergency surgery is seldom indicated, mostly for severe abdominal infective complications. Nowadays, uncomplicated diverticulitis is the most frequent presentation of diverticular disease and it is usually approached with a conservative medical treatment. Non-Operative Management may be considered also for complicated diverticulitis with abdominal abscess. At present, there is consensus among experts that the hemodynamic response to the initial fluid resuscitation should guide the emergency surgical approach to patients with severe sepsis or septic shock. In hemodynamically stable patients, a laparoscopic approach is the first choice, and surgeons with advanced laparoscopic skills report advantages in terms of lower postoperative complication rates. At the moment, the so-called Hartmann's procedure is only indicated in severe generalized peritonitis with metabolic derangement or in severely ill patients. Some authors suggested laparoscopic peritoneal lavage as a bridge to surgery or also as a definitive treatment without colonic resection in selected patients. In case of hemodynamic instability not responding to fluid resuscitation, an initial damage control surgery seems to be more attractive than a Hartmann's procedure, and it is associated with a high rate of primary anastomosis.
Structural alterations of subcutaneous small resistance arteries, as indicated by an increased media:lumen ratio, are frequently present in hypertensive and/or diabetic patients and may represent the earliest alteration observed. In addition, media:lumen ratios of small arteries have a strong prognostic significance. However, no data are available about the structure of small resistance arteries of obese patients, particularly after weight loss. We have investigated 27 patients with severe obesity. Twelve of them were normotensive, and 15 were hypertensive. All of the obese patients underwent bariatric surgery. We compared results obtained with those observed in 13 normotensive lean controls and in 13 hypertensive lean patients. All of the subjects and patients underwent a biopsy of subcutaneous fat during surgical intervention. In 8 obese patients, a second biopsy was obtained after consistent weight loss, during a surgical intervention for abdominoplasty. Subcutaneous small resistance arteries were dissected and mounted on a wire myograph, and structural parameters were measured. A concentration-response curve to acetylcholine was performed to evaluate endothelial function. Obese patients, independent from the presence of hypertension, show the presence of an increased media:lumen ratio and media cross-sectional area, together with an impaired endothelial-dependent vasodilatation. After surgical correction of obesity and consistent weight loss, a significant improvement of microvascular structure and of some oxidative stress/inflammation markers were observed. In conclusion, our data suggest that the presence of obesity is associated with structural alterations of subcutaneous small resistance arteries, mainly characterized by hypertrophic remodeling. Weight loss may improve microvascular structure.
Testicular choriocarcinoma is an infrequent non seminomatous germ cell tumor, usually presenting histologically as part of a mixed germ cell tumor, and rarely as pure form. It metastasizes early, usually along hematogenous routes, lungs being the most frequent sites of metastasis. Involvement of the gastro-intestinal tract as metastatic site is extremely uncommon and rarely described in the literature. We report the case of a 47 year-old male with gastric and pulmonary metastases from testicular mixed germ cell tumor mainly represented by choriocarcinoma as histological subtype, presenting with melena and gynecomastia as first clinical signs. Morphological and immunohistochemical analyses of biopsies taken from the endoscopically identified gastric hemorrhagic lesion and from lung nodules showed undifferentiated neoplastic epithelial cells in a necrotic and hemorrhagic background. Coexistence of gynecomastia addressed towards an hormonal-dependent tumor and prompted us to apply further morphological and immunohistochemical analyses, revealing the gonadal primary neoplasm, subsequently confirmed at surgery.
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