Sterile carbon particle suspension vs India ink for endoscopic tattooing of colonic lesions: a randomized controlled trial.

BACKGROUND: Different markers have been used preoperatively to mark colonic lesions, especially India ink. In recent years, another kind of marker has been developed: sterile carbon particle suspension (SCPS). No comparison between these two markers has yet been made. The aim of the present study was to compare the pyrogenic, inflammatory and intraperitoneal effect of these two markers. METHODS: From September 2015 to December 2018, adult patients who were candidates for elective laparoscopic colon resection were randomized to the SCPS or conventional India ink injection group using computer-based randomization. The primary endpoint of the study was the presence of intraoperative adhesions related to the endoscopic tattoo. Secondary endpoints were differences in white blood cell, C-reactive protein, and fibrinogen levels as well as, abdominal pain and body temperature at baseline (before endoscopic tattooing) and 6 and 24 h after colonoscopy. Finally, the visibility of the tattoo during the minimally invasive intervention was assessed. RESULTS: Ninety-four patients were included in the study, 47 for each arm. There were 45/94 females (47.9%) and 49/94 males (52.1%), with a median age of 67.85 ± 9.22 years. No differences were found between groups in WBC, fibrinogen levels, body temperature or VAS scores, but we documented significantly higher CRP values at 6 and 24 h after endoscopic tattooing with India ink injection. There were significantly fewer adhesions in the SCPS Endoscopic Marker group. All the endoscopic tattoos were clearly visible. CONCLUSIONS: SCPS is an effective method for tattooing colonic lesions and has a better safety profile than traditional India ink in terms of post-procedure inflammatory response and intraoperative bowel adhesions. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov (ID: NCT03637933).

Robotic versus laparoscopic approach to treat symptomatic achalasia: systematic review with meta-analysis.

Minimally invasive Heller myotomy is considered the gold standard surgical approach for symptomatic achalasia because it is a safe and effective procedure. Over the last years, several studies comparing the laparoscopic and robotic approach for Heller myotomy have been published. Although the robotic approach appears to have some advantages over standard laparoscopy, data on this topic are still controversial and no definite conclusions have been drawn. This metanalysis has been designed to systematically evaluate and compare the effectiveness and safety of the robot-assisted Heller myotomy as compared to the standard laparoscopic approach. According to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, a systematic search on both laparoscopic and robotic Heller myotomy was performed in all the major electronic databases (PubMed, Web of Science, Scopus, EMBASE), using the following search string: (achalasia OR Dor) AND robotic. Six articles were included in the final analysis. A metaregression analysis was performed to assess the possible effects of demographic variables (age, gender, body mass indes (BMI)) and previous abdominal surgery or endoscopic intervention on the analyzed outcomes. No statistical difference was observed in operative times (mean difference (MD) = 20.79, P = 0.19, 95% confidence interval (CI) -10.05,51,62), estimated blood loss (MD = -17.10, P = 0.13, 95% CI -40.48,5.08), conversion rate to open surgery (risk difference (RD) = -0.01, P = 0.33, 95% CI -0.05,0.02), length of hospital stay (MD = -0.73, P = 0.15, 95% CI -1.71,0.25) and long-term recurrence (odds ratio (OR) = 0.59, P = 0.45, 95% CI 0.15,2.33). On the contrary, the robotic approach was found to be associated with a significantly significant lower rate of intraoperative esophageal perforations (OR = 0.13, P < 0.001, 95% CI 0.04, 0.45). Our results suggest that the robotic approach is safer than the laparoscopic Heller myotomy, encouraging the use of robot-assisted surgery. However, our analysis is limited because of the exiguous number of comparative studies and because most of the included studies were statistically underpowered, given the small sample size. Moreover, a high degree of heterogeneity was observed in most of published studies. Taking in consideration the additional costs of robot-assisted procedures, larger Randomized Controlled Trials (RCTs) are advocated to confirm the safety and effectiveness of the robotic approach, and its advantages over standard laparoscopic surgery. In conclusion, well-designed prospective trials and RCTs with homogeneous parameters are needed to draw definitive conclusions about the best surgical approach to pursue in treating symptomatic achalasia.

Molecular detection and phylogenetic analysis of hepatitis E virus strains circulating in wild boars in south-central Italy.

Hepatitis E virus (HEV) is a zoonotic pathogen with a worldwide distribution, and infects several mammalian species, including pigs and wild boars, which are recognized as its natural reservoirs. The virus causes a usually self-limiting liver disease with a mortality rate generally below 1%, although mortality rates of 15%-25% have been recorded in pregnant woman. Chronic infections can also occur. The prevalence of HEV has been extensively studied in wild boars and pigs in northern Italy, where intensive pig herds are predominantly located. In contrast, few data have been collected in south-central Italy, where small pig herds are surrounded by large regional parks populated with heterogeneous wild fauna. In this study, 291 liver samples from wild boars caught in south-central Italy were analysed with the molecular detection of viral RNA. Our results confirm the circulation of HEV in these animals, with a mean prevalence of 13.7% (40 of 291). A nucleotide sequence analysis showed that the HEV strains were highly conserved within the same geographic areas. The wild boar HEV strains belonged to the HEV-3c subtype, which is frequently described in wild boars, and to an uncommon undefined subtype (HEV-3j-like).The viral prevalence detected is concerning because it could represent a potential risk to hunters, meat workers and consumers of wild boar liver and derivative products. The hypothesized inter-species transmission of HEV to pigs and the possibility that the virus maintains its virulence in the environment and the meat chain also present potential risks to human health, and warrant further investigations in the near future.

Fingerprint on trigger: A real case.

The results obtained by employing a usual technique for latent prints development on firearms are presented. A fingermark on a trigger was enhanced and this print was used to identify the person who handled the firearm. Indeed, it is not usual to find a useful fingermark in that position and, more in general, on firearms because of many different factors described in the following sections. The uniqueness of the results reported in this paper allow to consider the present casework as very interesting for the forensic community.

NIR luminescence for the inspection of thermal paper: a novel tool for fingermarks detection.

The near infrared (NIR) spectral region could offer advantages over the visible region in the detection of latent fingermarks due to the enhanced contrast between the background and the print. In this present paper, this spectral range of the electromagnetic spectrum was explored in order to study the possibility to make feasible the inspection of forensic evidences when the substrate is represented by the thermal paper, which is one of the most extensively used porous surfaces for printing receipts. We successfully applied the method to thermal paper treated with several kinds of amino acid sensitive reagents. We demonstrated that, even if the treatments could cause a dark stain over the latent fingermarks, by exploiting the luminescence of thermal paper in the NIR window we were able to create a contrast otherwise impossible in the visible region.

Prokinetic effect of a standardized yarrow (Achillea millefolium) extract and its constituent choline: studies in the mouse and human stomach.

BACKGROUND: Functional dyspepsia (FD) is a highly prevalent gastrointestinal disorder characterized by alterations in gastric motility. Yarrow (Achillea millefolium L., Fam Asteraceae) preparations are traditional remedies used to treat dyspeptic complaints. Herein, we investigated the effect of a standardized dry water extract obtained from A. millefolium flowering tops (AME) on gastric motility. METHODS: The effect of AME on motility was evaluated on the resting tone of the isolated gastric antrum and on gastric emptying in vivo (phenol red meal method) both in control mice and in the model of cancer chemotherapy (cisplatin)-induced gastric abnormalities. KEY RESULTS: The AME contracted mouse and human gastric strips and this action was unaffected by hexamethonium and tetrodotoxin, but strongly reduced by atropine. Among various chemical ingredients in yarrow, choline, but not the flavonoids rutin and apigenin, mimicked the action of AME. Furthermore, AME deprived of choline did not exert a contractile effect. In vivo, AME stimulated gastric emptying both in control and in cisplatin-treated mice, being more active in pathological states. CONCLUSIONS & INFERENCES: It is concluded that (i) AME exerts a direct spasmogenic effect on gastric antrum; (ii) choline is the chemical ingredient responsible of such effect; (iii) the prokinetic effect of AME observed in vivo could provide the pharmacological basis underlying its traditional use in the treatment of dyspepsia.

Proinflammatory stimuli activates human-derived enteroglial cells and induces autocrine nitric oxide production.

BACKGROUND: Enteric glial cells (EGCs) have been recently indicated as key regulators of intestinal inflammation in animals. Whether or not this is true and how these cells participate to inflammatory responses in humans is unknown. METHODS: We isolated primary EGCs from human small bowel and then, we purified and characterized those using specific glial markers, such as S100B and glial fibrillary acidic protein (GFAP). To mimic an inflammatory scenario, we exposed EGCs to exogenous stimuli, such as lipopolysaccharide and interferon-gamma (LPS and IFN-γ), alone or in combination, to evaluate glial activation [measuring GFAP, S100B level together with c-fos, major histocompatibility complex (MHC) class II, inducible nitric oxide (iNOS) proteins expression and nitric oxide (NO) production] and proliferation, respectively. KEY RESULTS: We showed that, when challenged with a combination of LPS and IFN-γ, EGCs are significantly activated, as indicated by their positivity to c-fos and MHC class II. Similarly, pro-inflammatory stimuli significantly increase the cell proliferation rate, the expression of both S100B and GFAP, and the NO production consequent to the induction of EGCs-derived iNOS protein, with the last being dependent on S100B-RAGE (receptor for advanced glycation endproducts) interaction. CONCLUSIONS & INFERENCES: Our data provide the first evidence that human EGCs directly respond to pro-inflammatory stimuli by changing their expression profile and by proliferating. The finding that stimulated EGCs are able to produce NO points to a role of this cell population in the scenario of intestinal inflammation.

Cytological evidence for population-specific sex chromosome heteromorphism in Palaearctic green toads (Amphibia, Anura).

A chromosome study was carried out on a number of European and Central Asiatic diploid green toad populations by means of standard and various other chromosome banding and staining methods (Ag-NOR-, Q-, CMA3-, late replicating [LR] banding pattern, C-and sequential C-banding + CMA3 + DAPI). This study revealed the remarkable karyological uniformity of specimens from all populations, with the only exception being specimens from a Moldavian population, where one chromosome pair was heteromorphic. Though similar in shape, size and with an identical heterochromatin distribution,the difference in the heteromorphic pair was due to a large inverted segment on its long arms. This heteromorphism was restricted to females, suggesting a female heterogametic sex chromosome system of ZZ/ZW type at a very early step of differentiation.

[Surgical treatment and prognostic factors in colorectal cancer]. / Trattamento chirurgico e fattori prognostici nel cancro colo-rettale.

AIM: The aim of this study was to make a contribution to improve the care of patients with colorectal cancer by optimizing times and methods of the follow-up; particular attention is given to factors which may be important for the prognosis and for the quality of life in the immediate postoperative period. METHODS: The study includes all the patients with colorectal cancer who underwent laparotomic surgical treatment from 1996 to 2003. The total number of patients was 226 with an average age of 65 years; male to female ratio was 1.57:1. According to the stage of tumor, an adjuvant radiotherapeutic and/or chemiotherapeutic treatment was associated to surgery. RESULTS: On the basis of the preoperative staging and tumor localization, our patients underwent: 3 total colectomies, 57 right hemicolectomies, 137 left hemicolectomies, 6 Hartmann resections, 19 Miles resections, 4 transverse resections. CONCLUSION: The results obtained show that the 5-year overall survival is particularly influenced by the stage and the factors which directly or indirectly affect the primary tumor; thus the prognostic factors which should be considered for the survival and in the follow-up of these patients are: stage, grading and nodal involvement of the tumor.

Karyology of the Antarctic scallop Adamussium colbecki, with some comments on the karyological evolution of pectinids.

Karyotype, location of the nucleolar organiser region (NOR) and heterochromatin presence and composition were studied in the Antarctic scallop Adamussium colbecki Smith, 1902. The karyotype exhibits 2n = 38 chromosomes with 11 pairs of metacentrics, 5 of submetacentrics, one subtelocentric and two telocentrics. Ag-NOR, CMA(3), DA/MM and NOR-FISH evidenced paracentromeric NORs on the short arm of 2nd pair chromosomes. Digestion with three restriction endonucleases followed by sequential staining with Giemsa, CMA(3) and DAPI evidenced on all chromosomes centromeric heterochromatin positive for both DAPI and CMA(3). In situ hybridisation analysis showed the presence of an AT-rich satellite DNA in the centromeric heterochromatin of several chromosomes. A mosaicism was detected in the germinal cell lines of one specimen, as in six of the 20 plates examined the set had 37 chromosomes with a missing pair of telocentrics and an unpaired metacentric. Comparison of the chromosome sets of all the pectinids studied to date and comparison with a phyletic tree obtained from molecular mitochondrial genes studies yielded good agreement between karyotype morphology and taxonomic classification.

[Ultrasound-guided endoscopic drainage, without radiological examination, in patients with neoplastic biliary obstruction. Preliminary results]. / Sulla possibilità di drenaggio endoscopico, sotto guida ecografica, senza controllo radiologico, in pazienti con stenosi neoplastiche della via biliare principale. Risultati preliminari.

AIM: Endoscopic stent insertion has become the preferred method for palliation of malignant biliary obstruction. Currently, endoscopic stent placement involves the use of contrast media and radiological equipment to achieve direct opacification of the biliary duct systems, and to determine the location and the extension of biliary obstruction. This report proposes a new combination of ultrasonography and biliary endoscopy, with endoscopic stent placement entirely performed under US-guidance. METHODS: US-guided stent placement was carried out in 8 patients. A guide-wire and a guiding-catheter were endoscopically introduced and identified, by US, the common bile duct across the stricture. Hydromer-coated polyurethane angled stents (10F) were finally inserted over the guide-wire/guiding-catheter by a pusher tube system. RESULTS: Successful stent insertion was achieved in all patients. There were no complications. Successful drainage, with substantial reduction in bilirubin level, was achieved in all patients (14.2+/-9.5 vs 4.2+/-2.9 mg/dl at 1 week). CONCLUSION: Endoscopic stent placement performed under US-guidance, is safe and effective. Further studies in a larger series, including more proximal strictures are suggested.

Hidradenitis plantar idiopatica recurrente / Hidradenitis idiopathic palmoplantar recurrent

La hidrade4nitis palmoplantar recurrente idiopática (HPPRI) es una entidad benigna y autolimitada que se presenta en niños y jóvenes sanos. Se caracteriza por pápulas y nódulos erityematosos, dolorosos, localizados en plantas y excepcionalmente en palmas. Presentamos los tres primeros pacientes pediátricos de nuestro medio con hallazgos clínico patplógico de hidradenitis palmoplantar recurrente idiopática. (AU)

Hidradenitis plantar idiopatica recurrente / Hidradenitis idiopathic palmoplantar recurrent

La hidrade4nitis palmoplantar recurrente idiopática (HPPRI) es una entidad benigna y autolimitada que se presenta en niños y jóvenes sanos. Se caracteriza por pápulas y nódulos erityematosos, dolorosos, localizados en plantas y excepcionalmente en palmas. Presentamos los tres primeros pacientes pediátricos de nuestro medio con hallazgos clínico patplógico de hidradenitis palmoplantar recurrente idiopática.

Cytological and molecular analysis in the rare discoglossid species, Alytes muletensis (Sanchiz & Adrover 1977) and its bearing on archaeobatrachian phylogeny.

Cytogenetic and molecular data on Alytes muletensis (Amphibia: Discoglossidae) are compared with other representatives of archaeobatrachian frogs: Bombina variegata pachypus, Pelobates cultripes, Pelodytes punctatus, Xenopus laevis, and Discoglossus. A. muletensis has the karyotype typical for the genus Alytes, 38 elements with either one or two arms, some of which can be considered as 'microchromosomes'. The NORs are located on the telomeres of the tenth chromosome pair which agrees with the state in A. obstetricians but differs from A. cisternasii reflecting phylogenetic affinities. C-banding and staining with DAPI and chromomycin A3 revealed important blocks of telomeric CMA-positive heterochromatin on the smaller chromosomes of Alytes, similar to the state found in Discoglossus. Phylogenetic analysis of 750 bp of fragments of the mitochondrial 16S and 12S rRNA genes corroborated that Discoglossus and Alytes are sister taxa which together probably form the sister group of the Bombinatorinae. Centromeric heterochromatin in Alytes may be responsible for the retention of a plesiomorphic asymmetric karyotype which independently has evolved into a symmetric karyotype through centric fusions in Bombina and Discoglossus. The HindIII satellite DNA family was present in all archaeobatrachians studied but absent in hyloid and ranoid neobatrachians.

Role of surgery in thymic disorders.

Thymomas are relatively slow-growing neoplasms that should be considered malignant tumours. When treated in the early stages, however, they have an excellent prognosis for long-term survival. Surgery, radiation therapy and chemotherapy all play a role in the management of these neoplasms. Surgery is the treatment of choice in thymoma patients and has become an increasingly accepted procedure in the treatment of myasthenia gravis (MG) since 1936, when thymectomy was performed for this disease for the first time. Improvement in myasthenic symptoms is nearly always observed following thymectomy, but the rates of complete remission vary from 7% to 63%. We have studied the potential preoperative factors predicting the evolution of MG.

[Aneurysms of the splanchnic arteries]. / Aneurismi delle arterie splancniche.

Although visceral aneurysms usually have an asymptomatic course, ruptures associated with high mortality do occur. When an asymptomatic lesion is found, the physician must decide whether it should be treated surgically and which surgical technique should be used. Because this type of aneurysm is relatively rare, the answer to these questions have not been determined previously. The outcome in 16 patients treated by surgical or embolization procedures was evaluated. A group of 16 patients with visceral aneurysms were observed in our institution between 1987 and 1993. Localization of aneurysms was on the splenic artery in 8 cases, renal artery in 4 cases, hepatic artery in 3 patients and superior mesenteric artery in one patient. Hypertension was related to renal aneurysms and angina abdominis to the patient with superior mesenteric artery aneurysm. Of the 16 patients, 8 (6 splenic and 2 hepatic aneurysms) were asymptomatic, 3 (2 splenic and 1 hepatic) were treated as an emergency because they presented with shock. In the splenic group (8 cases), 2 patients underwent embolization procedures with Gianturco's coils, and 6 surgical procedures; in the hepatic group 1 embolization and 1 surgical procedure were performed; and finally in the renal and mesenteric group surgical reconstruction was performed during aortic prosthetic surgery. Because of well documented natural history of progressive enlargement and eventual rupture, the aneurysms of visceral arteries should be corrected surgically when the diagnosis is confirmed by vascular imaging (ultrasounds, CT, RM, angiography). Ruptures are treated with emergency operations, when possible. In high-risk patients, non operative management by selective embolization (in case of splenic and hepatic aneurysms) may be suitable alternative.

Poroqueratosis lineal tratada con etretinato / Lineal porokeratosis treated with etretinate

Se presenta un paciente de 16 años de edad,con lesionesclínicas e histopatológicas características de poroqueratosis lineal.Se realiza tratamiento con etretinato con remisión total de las lesiones(AU)

Poroqueratosis lineal tratada con etretinato / Lineal porokeratosis treated with etretinate

Se presenta un paciente de 16 años de edad,con lesionesclínicas e histopatológicas características de poroqueratosis lineal.Se realiza tratamiento con etretinato con remisión total de las lesiones

The early effects of intravenous L-propionyl carnitine on ulcerative trophic lesions of the lower limbs in arteriopathic patients: a controlled randomized study.

Large numbers of patients with severe peripheral arteriopathic disorders (Stage IV) present a characteristic clinical history of pain and ulcerative trophic lesions requiring either major or minor amputation. Recent studies have shown that L-propionyl-carnitine (LPC) can possibly moderate the tissue damage induced by ischaemia in peripheral arteriopathic disorders. In the present study 12 patients with severe obstructive chronic arteriopathy were treated either with 2 g of LPC (plus heparin and buflomedil) by slow infusion b.i.d, or by placebo plus heparin and buflomedil. In the LPC-treated patients, one lesion was completely healed (17%); two showed a > 50% decrease in the surface of the ulcerative lesion (34%) and three a reduction in such surface < 50% (50%). Control patients showed a reduction < 50% of the ulcerative lesions in two cases (34%), unaltered limits of the ulcer margin in three cases (50%) and worsening of such a lesion in one case. In addition, the LPC-treated patients showed a progressive reduction in the evening pain symptom as monitored by the fewer requested doses of the analgesic compound ketoprofen (77 vs 125 requests for administration in treated and control patients, respectively). The long-term effect of LPC treatment evaluated after three months showed that in treated patients only one minor (digital) amputation was performed, whereas in the control group two patients underwent minor (digital and foot) and one major (above knee) amputations. In conclusion, the results of the present preliminary study suggest that LPC administration can improve the healing of ulcerative lesions, can reduce the need for analgesic medication and can lessen the incidence of amputation.