Diagnosis and Treatment of Biliary Fistulas in the Laparoscopic Era.

Biliary fistulas are rare complications of gallstone. They can affect either the biliary or the gastrointestinal tract and are usually classified as primary or secondary. The primary fistulas are related to the biliary lithiasis, while the secondary ones are related to surgical complications. Laparoscopic surgery is a therapeutic option for the treatment of primary biliary fistulas. However, it could be the first responsible for the development of secondary biliary fistulas. An accurate preoperative diagnosis together with an experienced surgeon on the hepatobiliary surgery is necessary to deal with biliary fistulas. Cholecystectomy with a choledocoplasty is the most frequent treatment of primary fistulas, whereas the bile duct drainage or the endoscopic stenting is the best choice in case of minor iatrogenic bile duct injuries. Roux-en-Y hepaticojejunostomy is the extreme therapeutic option for both conditions. The sepsis, the level of the bile duct damage, and the involvement of the gastrointestinal tract increase the complexity of the operation and affect early and late results.

[Copper and copper alloys. Technology updates]. / Rame e leghe di rame. Aggiornamenti tecnologici.

The correlations between copper and copper alloys and human health have been the subject of some recent and extensive scientific researches. The voluntary risks evaluation, which anticipated the EU REACH Directive application, has shown that copper is a "safe" product for human health and for environment. In addition, it could be of great help thanks to its antibacterial properties. Copper tube can contribute in a relevant way to the prevention of water systems pollution by Legionella. Also the spreading of nosocomial infections is significantly contrasted by the use of copper and copper alloys for the production of articles intended for being frequently touched by people. The Environmental Protection Agency of the United States has in fact "registered" as antibacterial over 350 of copper alloys.

Erectile dysfunction after prostate three-dimensional conformal radiation therapy. Correlation with the dose to the penile bulb.

PURPOSE: Erectile dysfunction is associated with all the common treatment options for prostate cancer. The aim of this research was to evaluate the relationship between erectile function and radiation dose to the penile bulb (PB) and other proximal penile structures in men receiving conformal radiotherapy (CRT) without hormonal therapy (HT) for prostate cancer, whose sexual function was known before treatment. PATIENTS AND METHODS: The study included 19 patients treated with 3D-CRT for localized prostate cancer at our department, who were self-reported to be potent before treatment, had not received HT, and had complete follow-up data available. Our evaluation was based on the International Index of Erectile Function (IIEF-5). Dose-volume histograms (DVHs) were used to evaluate the dose to the PB. Statistical analysis was performed with an unconditional logistic regression model. RESULTS: All patients reported change in potency after radiation. Eight patients (42%) remained potent but showed a decrease of 1 or 2 levels of potency, as defined by the IIEF-5 questionnaire (reduced potency group), while 11 patients (58%) reported a change of higher levels and revealed a severe erectile dysfunction after 2 years (impotence group). Multivariate analysis of morphological and dosimetric variables yielded significance for the mean dose (p = 0.05 with an odds ratio of 1.14 and 95% CI 1-1.30). Patients receiving a mean dose of less than 50 Gy to the PB appear to have a much greater likelihood of maintaining potency. CONCLUSION: Our data suggest a possible existence of a dose-volume correlation between the dose applied to the PB and radiation-induced impotence.

Vacuum-assisted closure therapy in reconstructive surgery.

In 1997, supported by experimental work, Argenta published a clinical report describing a variety of complicated wounds whose treatment responded successfully to negative pressure dressings using a vacuum-assisted closure system (VAC) (Kinetic Concepts Inc., San Antonio, TX). This system has been successfully used in the fields of orthopaedics and traumatology, general surgery, plastic and reconstructive surgery and gynaecology/obstetrics for a large variety of complicated wounds located in several regions, particularly in the torso and extremities. To the best of our knowledge, the use of the VAC therapy in treating free flaps surgical wounds has not been discussed in the literature. Since 2009 at the Novara Major Hospital, we have been using the VAC therapy in selected cases for difficult and complicated wounds of the maxillofacial region. The purpose of this study is to describe and discuss three cases undergoing VAC therapy followed by loco-regional flaps in the management of exposed bone after fibular free flap. The advantages and disadvantages of VAC therapy in treating complicated wounds have been reported by several studies; compared with conventional wet-to-dry dressings, this system eliminates interstitial oedema, exudates and debrides while increasing blood perfusion leading to a more rapid promotion of wound healing with less bacterial loading. Although surgical debridement, wet-to-dry dressing changes and antibiotic treatment are the mainstay in managing maxillofacial wounds, VAC therapy can be used to obtain primary closure or to prepare the wound bed until definitive reconstruction is carried out. In our opinion, the VAC technique is an innovative therapy, and at our institution represents the standard of care for the majority of complicated wounds.

El estudio de la resiliencia y la calidad de vida en distintas transiciones ecológicas humanas / The study of resilience and quality of Life in the different human ecological transitions

El presente trabajo tiene por objetivo presentar los avances investigativos obtenidos al estudiar diversas problemáticas referidas a las áreas de salud, educación y justicia, desde el marco de la Resiliencia y la Calidad de Vida. El eje de análisis en estas áreas comprende el estudio de aquellos factores de riesgo y de protección que interactúan otorgando características específicas a cada una de las transiciones ecológicas estudiadas. Se analizan la discapacidad motora, el proceso de morir cuando la enfermedad ya no responde a las medidas curativas, la internación del recién nacido en la Unidad de Cuidados Intensivos Neonatológicos, la transición por la que atraviesan los jóvenes al pasar del nivel primario al secundario, y la privación de libertad. Por transiciones ecológicas se entiende los cambios en la posición de una persona dentro del ambiente ecológico en el que está inmersa, como consecuencia de un cambio de rol, de entorno, o de ambos a la vez (Bronfenbrenner, 1987). El desafío será entonces, desde el enfoque señalado, valorar en cada situación, la eficacia y funcionalidad de los recursos y factores presentes, así como también, aquellos que pueden ser promovidos a través de estrategias que revaloricen el Potencial Resiliente y la Calidad de Vida de cada persona frente a la adversidad.

El estudio de la resiliencia y la calidad de vida en distintas transiciones ecológicas humanas / The study of resilience and quality of Life in the different human ecological transitions

El presente trabajo tiene por objetivo presentar los avances investigativos obtenidos al estudiar diversas problemáticas referidas a las áreas de salud, educación y justicia, desde el marco de la Resiliencia y la Calidad de Vida. El eje de análisis en estas áreas comprende el estudio de aquellos factores de riesgo y de protección que interactúan otorgando características específicas a cada una de las transiciones ecológicas estudiadas. Se analizan la discapacidad motora, el proceso de morir cuando la enfermedad ya no responde a las medidas curativas, la internación del recién nacido en la Unidad de Cuidados Intensivos Neonatológicos, la transición por la que atraviesan los jóvenes al pasar del nivel primario al secundario, y la privación de libertad. Por transiciones ecológicas se entiende los cambios en la posición de una persona dentro del ambiente ecológico en el que está inmersa, como consecuencia de un cambio de rol, de entorno, o de ambos a la vez (Bronfenbrenner, 1987). El desafío será entonces, desde el enfoque señalado, valorar en cada situación, la eficacia y funcionalidad de los recursos y factores presentes, así como también, aquellos que pueden ser promovidos a través de estrategias que revaloricen el Potencial Resiliente y la Calidad de Vida de cada persona frente a la adversidad.(AU)

Riboregulators in plant development.

npcRNA (non-protein-coding RNAs) are an emerging class of regulators, so-called riboregulators, and include a large diversity of small RNAs [miRNAs (microRNAs)/siRNAs (small interfering RNAs)] that are involved in various developmental processes in plants and animals. In addition, several other npcRNAs encompassing various transcript sizes (up to several kilobases) have been identified using different genomic approaches. Much less is known about the mechanism of action of these other classes of riboregulators also present in the cell. The organogenesis of nitrogen-fixing nodules in legume plants is initiated in specific root cortical cells that express the npcRNA MtENOD40 (Medicago truncatula early nodulin 40). We have identified a novel RBP (RNA-binding protein), MtRBP1 (M. truncatula RBP 1), which interacts with the MtENOD40 RNA, and is exported into the cytoplasm during legume nodule development in the region expressing MtENOD40. A direct involvement of the MtENOD40 RNA in the relocalization of this RBP into cytoplasmic granules could be demonstrated, revealing a new RNA function in the cell. To extend these results, we searched for npcRNAs in the model plant Arabidopsis thaliana whose genome is completely known. We have identified 86 novel npcRNAs from which 27 corresponded to antisense RNAs of known coding regions. Using a dedicated 'macroarray' containing these npcRNAs and a collection of RBPs, we characterized their regulation in different tissues and plants subjected to environmental stresses. Most of the npcRNAs showed high variations in gene expression in contrast with the RBP genes. Recent large-scale analysis of the sRNA component of the transcriptome revealed an enormous diversity of siRNAs/miRNAs in the Arabidopsis genome. Bioinformatic analysis revealed that 34 large npcRNAs are precursors of siRNAs/miRNAs. npcRNAs, which are a sensitive component of the transcriptome, may reveal novel riboregulatory mechanisms involved in post-transcriptional control of differentiation or environmental responses.

Estudio prospectivo y comparativo para evaluar el impacto de la intervención farmacéutica en la promoción de la terapia secuencial con fluoroquinolonas / No disponible

Objetivo: Evaluar el impacto de una intervención farmacéutica en la aplicación de la terapia secuencial (TS) con fluoroquinolonas.Métodos: Estudio prospectivo comparativo de intervención farmacéutica en dos fases: fase observacional y fase de intervención para la promoción de la TS.Resultados: Se estudiaron 250 pacientes con terapia intravenosa con fluoroquinolonas (113 levofloxacino y 137 ciprofloxacino),siendo 76 y 70, respectivamente, candidatos a un programa de intervención farmacéutica para la promoción de la TS. La intervención farmacéutica mostró, para ambos medicamentos,una disminución de la duración del tratamiento intravenoso y aumento de la duración del tratamiento vía oral, así como una disminuciónde los costes de la medicación, todo ello de forma estadísticamente significativa.Discusión: La promoción de la TS es una oportunidad para expandir el papel clínico del farmacéutico hospitalario y optimizar el tratamiento con fluoroquinolonas, consiguiendo disminuir la terapia intravenosa y constituyendo una alternativa más coste efectiva.(AU)

Objective: To assess the impact of pharmaceutical intervention on the use of sequential therapy (ST) with fluoroquinolones.Methods: A prospective comparative study of pharmaceutical intervention in two stages: observational stage and interventionstage for ST promotion.Results: In all, 250 patients receiving intravenous therapy with fluoroquinolones (113 with levofloxacin and 137 with ciprofloxacin) were studied, with 76 and 70 patients, respectively,being eligible for a pharmaceutical intervention program to promoteST. Pharmaceutical intervention showed a decreased duration of intravenous therapy and increased duration of oral therapy for both drugs, as well as decreased medication-related costs, all in a statistically significant manner.Discussion: ST promotion provides an opportunity to expand the role of hospital pharmacists and to optimize fluoroquinolone-based therapy, which results in decreased intravenous treatments and provides a more cost-effective option (AU)

Estudio prospectivo y aleatorizado de intercambio terapéutico de sulfonilureas en pacientes con diabetes mellitus tipo 2 / No disponible

Objetivo: Valoración clínica de la efectividad del intercambio terapéutico de glibenclamida a gliclazida en el medio hospitalario.Métodos: Estudio abierto, prospectivo y aleatorizado de dos grupos de pacientes: grupo referencia (pacientes que continúan durante el ingreso con el tratamiento ambulatorio de glibenclamida) y grupo intercambio (pacientes a los que se les sustituye glibenclamida por gliclazida según el protocolo de intercambio aprobado en el hospital).La variable de eficacia utilizada fue la glucemia de los 3 días y de los 6 días post-intervención. Se consideró como paciente clínicamente controlado aquel con niveles de glucemia < 200 mg/dL,y como diferencia clínicamente importante niveles de glucemia menor o mayor a 30 mg/dL.Resultados: Se aleatorizaron 116 pacientes. La glucemia del día previo a la intervención en el grupo referencia fue de 177,9mg/dL ± 63,4 vs 171,3 mg/dL ± 52,1 (p = 0,92) en el grupo intercambio. La media de glucemia de los 3 días siguientes a la intervención fue de 156,1 mg/dL ± 47,5 y 177,7 mg/dL ± 36,0(p = 0,14) en el grupo referencia y en el grupo intercambio; y la media de los 6 días fue 142,1 mg/dL ± 36,0 y 172,8 mg/dL ±28,2 respectivamente (p = 0,01). En el grupo referencia el análisis global de las glucemias muestra un mejor control respecto a los datos basales, lo que no se observa en el grupo intercambio, en el que los valores de glucemia se mantienen estables, siendo similares a los basales. En ningún caso, los valores de glucemia mediade 3 y de 6 días superaron los 200 mg/dL, lo que puede considerarse aceptable en un contexto hospitalario. Conclusiones: El intercambio puede realizarse de forma segura en los pacientes, sin que suponga un deterioro clínico en ningún caso, pero sin observarse el mejor control logrado en el grupo referencia (AU)

Objetivo: To clinically assess effectiveness of therapeutic interchange from glibenclamide to gliclazide in the hospital setting.Methods: An open-label prospective, randomized study with two groups of patients: a reference group (patients stillreceiving their previous outpatient regimen of glibenclamide)and an interchange group (patients with gliclazide substituted for glibenclamide according to a hospital-approved interchange protocol).The efficacy end point used was blood glucose at 3 and 6 dayspost-intervention. A patient with blood glucose < 200 mg/L was considered clinically controlled, and blood glucose changes < or >30 mg/dL were considered significant.Results: One hundred and sixteen patients were randomized.Blood glucose on the day before the intervention was 177.9mg/dL ± 63.4 in the reference group versus 171.3 mg/dL ±52.1 in the interchange group (p = 0.92). Mean blood glucoseduring the first 3 days post-intervention was 156.1 mg/dL ± 47.5and 177.7 mg/dL ± 36.0 (p = 0.14) in the reference and interchange groups, respectively; and mean values for the first 6 dayspost-intervention were 142.1 mg/dL ± 36.0 and 172.8 mg/dL ±28.2, respectively (p = 0.01). The overall analysis of blood glucose levels showed a better control in the reference group versus baseline values, which was not seen in the interchange group,where blood glucose remained stable and similar to baseline. In nocase were 3-day and 6-day blood glucose mean levels above 200mg/dL, which may be considered acceptable within the hospitalsetting. Conclusions: Therapeutic interchange may be safely performed with no clinical impairment, but better controls were achieved in the reference group (AU)

Public awareness of risk factors and screening for colorectal cancer in Europe.

Colorectal cancer (CRC) is the commonest site for malignancy in Europe. The Commissioner for Health wishes to promote screening for colorectal, breast and cervical cancer in Europe. The aim of this study was to assess public knowledge of CRC in Europe and likely take up of free screening. To this end 20710 members of the public from 21 European countries were interviewed by means of a regular survey amongst consumers (Omnibus survey) using 13 stem questions. Forty-eight per cent thought the population were at equal risk of CRC, only 57% were aware of age and 54% of family history as risk factors. Although 70% were aware of dietary factors, only 30% knew that lack of exercise might be a risk factor. Only 51% had knowledge of CRC screening but 75% were 'very', or 'quite interested, in taking up faecal occult blood (FOB) screening if offered free. Barriers to screening were lack of awareness of risk (31%), youth (22%) and an un-anaesthetic test (19%). There was a big cultural difference in willingness of the public to discuss bowel symptoms: there was a major barrier in Finland (91%), Britain (84%), Luxembourg (82%), Poland (81%) and Portugal (80%); less of a barrier in Spain (49%), Italy (44%) and Iceland (39%). In conclusion, the challenge of achieving high compliance for CRC screening must be a major objective amongst EU member states and non-aligned countries of Europe in the next decade, because it is known that the non-compliant group are those at greatest risk of death from CRC. This study has shown that awareness of CRC is low in Europe and that an educational programme will be essential to achieve high compliance for CRC screening as a means of reducing deaths from bowel cancer.

Nodule initiation involves the creation of a new symplasmic field in specific root cells of medicago species.

The organogenesis of nitrogen-fixing nodules in legume plants is initiated in specific root cortical cells and regulated by long-distance signaling and carbon allocation. Here, we explore cell-to-cell communication processes that occur during nodule initiation in Medicago species and their functional relevance using a combination of fluorescent tracers, electron microscopy, and transgenic plants. Nodule initiation induced symplasmic continuity between the phloem and nodule initials. Macromolecules such as green fluorescent protein could traffic across short or long distances from the phloem into these primordial cells. The created symplasmic field was regulated throughout nodule development. Furthermore, Medicago truncatula transgenic plants expressing a viral movement protein showed increased nodulation. Hence, the establishment of this symplasmic field may be a critical element for the control of nodule organogenesis.

Deep brain stimulation for the treatment of Parkinson's disease: the experience of the Neurosurgical Department in Monza.

deep brain stimulation is a widely accepted surgical therapy for the symptomatic treatment of advanced parkinson's disease; high frequency chronic stimulation of the subthalamic nucleus proved its efficacy to control the major motor symptoms. In the neurosurgical department of Monza we treated 72 parkinsonian patients (November 1998-January 2003). One year follow-up results are: decrease of tremor 90%, hypertonous 56%, bradykinesia 70%, voice impairment amelioration 30%, mean total daily L-dopa intake reduced 58%. Freezing and balance did not ameliorate, some voice impairment and psychic derangement have been observed. Major surgical complications were: haemorrage (1 case - transient hemiparesis), infections (2 cases), pulmonary embolisation (1 case). To optimise the surgical results, careful clinical and instrumental selection of the patients are mandatory before surgery.