Enhanced recovery pathways in colorectal surgery: a consensus paper by the Associazione Chirurghi Ospedalieri Italiani (ACOI) and the PeriOperative Italian Society (POIS).

Enhanced Recovery After Surgery (ERAS) pathway is a multi-disciplinary, patient-centered protocol relying on the implementation of the best evidence-based perioperative practice. In the field of colorectal surgery, the application of ERAS programs is associated with up to 50% reduction of morbidity rates and up to 2.5 days reduction of postoperative hospital stay. However, widespread adoption of ERAS pathways is still yet to come, mainly because of the lack of proper information and communication. Purpose of this paper is to support the diffusion of ERAS pathways through a critical review of the existing evidence by members of the two national societies dealing with ERAS pathways in Italy, the PeriOperative Italian Society (POIS) and the Associazione Italiana Chirurghi Ospedalieri (ACOI), showing the results of a consensus development conference held at Matera, Italy, during the national ACOI Congress on June 10, 2019.

Evaporation of ionic liquids at atmospheric pressure: study by ion mobility spectrometry.

A conventional ion mobility spectrometry (IMS) was used to study atmospheric pressure evaporation of seven pure imidazolium and pyrrolidinium ionic liquids (ILs) with [Tf(2)N], [PF(6)], [BF(4)] and [fap] anions. The positive drift time spectra of the as-received samples measured at 220°C exhibited close similarity; the peak at reduced mobility K(0)=1.99 cm(2)V(-1)s(-1) was a dominant spectral pattern of imidazolium-based ILs. With an assumption that ILs vapor consists mainly of neutral ion pairs, which generate the parent cations in the reactant section of the detector, and using the reference data on the electrical mobility of ILs cations and clusters, this peak was attributed to the parent cation [emim]. Despite visible change in color of the majority of ILs after the heating at 220°C for 5h, essential distinctions between spectra of the as-received and heated samples were not observed. In negative mode, pronounced peaks were registered only for ILs with [fap] anion.

Cholecystoenteric fistula (CF) is not a contraindication for laparoscopic surgery.

BACKGROUND: Cholecystoenteric fistula (CF) is a rare complication of cholelithiasis. The aim of this study was to evaluate the safety and risk of complications when the laparoscopic approach is applied in patients with CF. METHODS: A questionnaire was mailed to all surgeons with experience of >100 cholecystectomies working in Naples, Italy, and the neighboring area. RESULTS: Between February 1990 and May 1999, 34 patients presented with cholecystoenteric fistula (0.2% of >15,000 laparoscopic cholecystectomies performed in the same period). These patients were allocated into two groups: the LT group (those who underwent laparotomic conversion after the diagnosis of CF), which consisted of 20 patients, four men and 16 women, with a mean age of 66.5 +/- 9.3 years (range, 46-85) and the LS group (laparoscopically treated patients), which consisted of 14 patients, three men and 11 women, with a mean age of 65.6 +/- 8.8 years (range, 51-74). They types of CF observed were as follows: in the former group of patients, cholecystoduodenal fistulas (n = 11, 55%), cholecystocolic fistulas (n = 5, 25%), cholecystojejunal fistulas (n = 3, 15%), and cholecystogastric fistulas (n = 1, 5%); in the latter group, cholecystoduodenal fistulas (n = 8, 5.1%), and cholecystocolic fistulas (n = 4, 28.6) and cholecystojejunal fistulas (n = 2, 14.3%). Stapler closure of CF was done in four LT patients and three LS patients with cholecystoduodenal fistula; it was also done in three LT patients and three LS patients with cholecystocolic fistula. Hand-sutured fistulectomy was performed in six LT patients and three LS patients with cholecystoduodenal fistula, in two LT patients with cholecystocolic fistula, and in all patients with cholecystojejunal or cholecystogastric fistula. There were no deaths or intraoperative complications in either group. One patient in the LT group developed a bronchopneumonia postoperatively. Postoperative hospital stay was significantly longer in LT patients-17 +/- 4 vs 3+/-1 days (p < 0.001). CONCLUSION: Cholecystoenteric fistula is an occasional intraoperative finding during laparoscopic cholecystectomy. The results of this study, which are based on the collective experiences of 19 surgeons, illustrate the growing success of the laparoscopic approach to this condition, including a decreasing rate of conversion to open surgery over the last 3 years.

[Repair of splenic lesions with video-laparoscopy]. / Riparazione di lesioni spleniche in videolaparoscopia.

Conservative therapy of spleen injuries (non-operative treatment, partial splenectomy, autotransplantation, etc.) makes it possible to avoid the risk related to post-splenectomy hyposplenism. The videolaparoscopic approach makes the performance of such treatment possible achieving a clear reduction in surgical stress. The authors report two multiple injured patients showing spleen lesions, treated conservatively through videocoelioscopic procedure. Both patients (a 42-year-old woman and a 26-year-old man) presented hemorrhagic shock in hemodynamic compensation and hemoperitoneum. Abdominal ultrasonographic scanning proved the presence of spleen injuries. Both patients underwent a conservative surgical videolaparoscopic treatment using fibrin glue and omentoplasty. The resolution of the hemorrhagic shock and the restoration of the spleen lesions were achieved in both cases. The authors have already used the videocoelioparoscopic approach both in elective (biliary lithiasis, inguinal hernia, appendicitis, etc.) and in emergency surgery (acute cholecistitis, perforated ulcer, intestinal obstruction, etc.). They note the effectiveness of the method, also in the field of the mini-invasive conservative treatment of parenchymatous organ lesions (mainly in the case of spleen injuries, when the splenic function has to be preserved). So, it's possible to add the advantages of a conservative treatment to those of the minimal invasivity, provided by the videolaparoscopic procedure.

A comparative study of the hemodynamic effects of single intravenous doses of 3-hydrazino-6-[N,N-bis-(2-hydroxyethyl)-amino]-pyridazine-dihydrochloride and hydralazine.

The new pyridazine derivative 3-hydrazino-6-[N,N-bis(2-hydroxyethyl)-amino]-pyridazine-dihydrochloride (DL 150 IT) was administered to five hypertensive patients at the dose of 50 mug/kg by i.v. bolus injection. A parallel group of five patiens received 250 mug/kg of hydralazine. Hemodynamic measurements were obtained before treatment, and then after 30--60 and 80-120 min. Cardiac output was evaluated by radiocardiography and myocardial perfusion by clearance of 86Rb. The antihypertensive effect of DL 150 IT was most pronounced 2 h after the injection, whereas by this time the increased heart rate and cardiac output tended to revert to the baseline values. On the contrary, the magnitude of these effects did not change during the observation period after hydralazine treatment. Both drugs increased myocardial perfusion. The new compound appears at least five times more potent than hydralazine and, possibly, has a longer duration of action.