Pancreatic trauma is a diagnostic and therapeutic challenge for the trauma surgeon. The integrity of the main pancreatic duct is the most important determinant of outcome after injury to the pancreas and, in Wirsung's duct rupture, early surgery may improve it.
Hepato-pancreatico-biliary (HPB) surgery includes major hepatic resection and pancreatic surgery, both procedures are complex and have a potentially high complication rate. The presence of centers of excellence with a high patients volume has lowered the complication and increased the resection rate. Increased life expectancy and improved general health status have increased the number of elderly patients eligible for major surgery. Since old patients have more co-morbidities and decreased life expectancy, the benefit of these procedures need to be critically evaluated in this group. Analysis of the literature related to this argument demonstrated that pancreatoduodenectomy can be performed safely in selected elderly patients (70 years of age or older), with morbidity and mortality rates comparable those observed in younger patients. This aspect was also confirmed by cost analysis studies that reported similar data in both groups. Similar findings are also reported for major hepatic resection in elderly patients with either hepatocellular carcinoma (HCC), Klatskin tumor or gallbladder carcinoma. More studies are needed regarding the subgroup of very elderly patients (80 years or older). Nevertheless, those elderly patients who will benefit from surgery must be adequatelly selected.
HighlightsTuberculosis is a health public problem, which has increased over the last 20 years.The diagnosis of extrapulmonary tuberculosis can be challenging, and in particular clinical manifestations of gastrointestinal tuberculosis are unspecific and can mimic other pathologies.Medical therapy is the treatment of choice and surgery is not required if it is diagnosed at an early stage, anyway diagnosis of abdominal tuberculosis still remains a challenge for both internists and surgeons.Before starting a therapy with adalimumab, every patient should be tested for latent tuberculosis infection.
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