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Visceral artery aneurysm account for up to 5-10% of overall artery aneurysm. Celiac artery aneurysm are reported in 4% of these patients. The most common etiologic findings are atherosclerosis and tunica media infective degeneration. The radiological imaging led to more accurate morphological and anatomical definitions of this pathology and improved elective and urgent surgical treatment of selected patients. The Authors report a case of celiac artery aneurysm.

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Traumatic injuries of the liver and hepatic pedicle secondary to blunt abdominal trauma are unusual and often associated with injuries of other abdominal and/or thoracic organs. These lead the patient to an emergency operation for hemorrhagic shock. The diagnosis of trauma severity and hepatic pedicle involvement is made intraoperatively. Often only one anatomical structure of the hepatic pedicle is involved, whereas involvement of two or all three anatomical structures is rare and associated with a bad prognosis. The management of these injuries still remain one of the most challenging scenario in trauma surgery. The overall experience is not significant. Clear treatment guidelines or management algorithms have not yet been established, in part due to the complexity, severity and variability of these injuries and to the lack of large series with these rare events. Three cases of associated liver and hepatic pedicle injuries treated in our unit are reported.

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The authors report a prospective series of patients with-long term vascular access for chronic hemodialysis fashioned with a transposed brachio-basilic fistula. Over a three-year period (1998-2000), 14 patients underwent creation of the arteriovenous fistula. Demographic and clinical data were registered and a length of follow up more than 12 months was in all cases obtained. Of the 14 fistulas performed, 7 were successfully used for dialysis without complication. In seven patients late revision of fistulas was performed. The primary and secondary patency actuarial rates at two years were 50% and 75% respectively. The results of this series highlight as the basilic vein fistula provides reliable vascular access for chronic hemodialysis therapy. The low cost and the low morbidity rates suggest the brachial artery-transposed basilic vein fistulas as a valuable part of vascular access history of patients with chronic renal failure.

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Clinical findings and surgical treatment of a 68 years old man with carcinoid tumor of Meckel's diverticulum are reported. Carcinoids in Meckel's diverticula are rare tumors, commonly discovered incidentally during surgical procedures for different indications. Symptoms are frequently expression of a metastatic disease. Specific diagnostic and therapeutic tools are discussed.

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Neurofibromatosis is an autosomal dominant trait with variable expressivity clinically defined by the coexistence of multiple cafè au lait spots, subcutaneous neurofibromas and Lisch nodules. Hemorrhage from intestinal neurofibromas or related tumors may be life-threatening because often inaccessible and therefore difficult to locate. The Authors report a case of gastrointestinal hemorrhage in a 68 year old patient with neurofibromatosis who had an episode of melena from duodenal ulcer endoscopically detected 5 years earlier. Endoscopy failed to discover the site of bleeding; this was successfully demonstrated by angiography: superior mesenteric arteriography disclosed 32 hypervascular masses supplied by a digiunal branch and by the oleo-colic artery. Because of continuing hemorrhage the patient was submitted to surgery. The exploration demonstrated ulcerated neurofibromatous neoplasms at the level of the digiunum and terminal ileum, with a Meckel's diverticulum and gallbladder stones. Intestinal resection, right emicolectomy, Meckel's diverticulum resection and colecystectomy were performed. Review of the literature demonstrates angiography is the most reliable imaging modality for detecting such tumors.

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The authors propose an alternative which has been proved valid in four cases of peritoneovenous shunt with an occluded Le Veen valve for venous thrombosis implanted in cirrhotic patients with refractory ascites. After having explored the various possibilities using the vessels adjacent to the superior cava branch, the authors resolved the problem of reimplanting the valve by using an access route through the saphenous vein and inferior vena cava. Using this technique it was possible to reactivate the shunt with a marked improvement in the recurrent ascitic state and above all shunt functionality, and consequently in the clinical conditions and quality of life of these patients.

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Muscular localization of echinococcosis is considered unusual. The authors report a case of such uncommon hydatid localization. Pathogenetic hypotheses are discussed.

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The authors report a case of macroamylasaemia and discuss diagnostic implications especially in surgical emergencies. In fact, laboratory findings of hyperamylasaemia may lead to erroneus diagnosis or even to useless surgical operations.

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