Effects of Two Types of 9-Month Adapted Physical Activity Program on Muscle Mass, Muscle Strength, and Balance in Moderate Sarcopenic Older Women.

The present study aimed to evaluate the effects of two types of 9-month adapted physical activity (APA) program, based on a muscle reinforcement training and a postural training, respectively, on muscle mass, muscle strength, and static balance in moderate sarcopenic older women. The diagnosis of sarcopenia was done in accordance with measurable variables and cut-off points suggested by the European Working Group on Sarcopenia in Older People (EWGSOP). Seventy-two participants were randomly assigned to two groups: the muscle reinforcement training group (RESISTANCE) (n=35; 69.9 ± 2.7 years) and the postural training group (POSTURAL) (n=37; 70.0±2.8 years). Body composition, muscle mass, skeletal muscle mass index (SMI), and handgrip strength (HGS) were evaluated for sarcopenia assessment, whereas Sway Path, Sway Area, Stay Time, and Spatial Distance were evaluated for static balance assessment. Sixty-six participants completed the study (RESISTANCE group: n=33; POSTURAL group: n=33). Significant increases of muscle mass, SMI, and handgrip strength values were found in the RESISTANCE group, after muscle reinforcement program. No significant differences appeared in the POSTURAL group, after postural training. Furthermore, RESISTANCE group showed significant improvements in static balance parameters, whereas no significant differences appeared in the POSTURAL group. On the whole, the results of this study suggest that the APA program based on muscle reinforcement applied on moderate sarcopenic older women was able to significantly improve muscle mass and muscle strength, and it was also more effective than the applied postural protocol in determining positive effects on static balance.

Multigram-scale synthesis of an orthogonally protected 2-acetamido-4-amino-2,4,6-trideoxy-D-galactose (AAT) building block.

Reported is the gram-scale synthesis of tert-butyldiphenylsilyl 4-(N-benzyloxycarbonyl)-amino-2-azido-2,4,6-trideoxy-ß-D-galactopyranoside, which represents an orthogonally protected 2,4-diamino-D-fucose building block, a common constituent of various zwitterionic polysaccharides. The building block has been synthesized from D-glucosamine in 19% overall yield over 14 steps, requiring 5 chromatographic purifications. The key step in the synthesis is the introduction of the C-4 amino substituent, which has been accomplished by a one-pot three step procedure, involving regioselective C-3-O-trichloroacetimidate formation, C-4-O-triflation, and intramolecular substitution. The building block can be used as an acceptor and is readily transformed into a donor glycoside.

Total mesorectal excision with radiofrequency in rectal cancer: open versus laparoscopy approach.

AIM: The aim of this study was to compare the safety, efficacy and oncologic results in the low rectal resection with total mesorectal excision with radiofrequency (Ligasure™, Covidien, Boulder, CO, USA) in laparoscopic surgery. METHODS: From July 2005 to December 2008, 227 patients underwent colorectal resection for cancer at S. Martino Hospital in Genoa. Sixty-one patients underwent curative rectal resection for mid or low rectal cancer using Ligasure™ device applied on smaller vessels and for the execution of total mesorectal excision. Forty-six patients underwent open laparotomy (OL), 15 laparoscopic surgery. There were no differences concerning demographics data and diagnosis, but only regarding staging (P=0.009). Primary goal was to evaluate major complications, operating time, hospital stay, distal margin of the tumor and number of nodes harvested in specimen. Secondary goal was to assess the average time of survival in the short period. RESULTS: The mean operative times were shorter in the OL group (188 vs. 246 min) overall. This difference was significant (P=0.004). In particular two parameters of specimens were analyzed: the total number of nodes and distal clearing from cancer, excluding abdominoperineal resection. An average number of 16.6 nodes in the OL group and 13.9 in the VL group (P=ns) were detected; mean distal clearing in the OL group was 30.7 mm and 48.1 mm in the VL group (P=ns). There were no differences concerning major complications in either group. The hospital stay in the VL group was shorter than in the OL group, but the differences were not significant. CONCLUSION: The Ligasure™ device does not reduce operating time in laparoscopy rectal cancer resection but it allows to get correct oncologic results in patients submitted to total mesorectal excision.

Gastric Abrikosoff tumor (granular cell tumor): case report.

Granular Cells Tumor (GCT), also called Abrikosoff tumor, is very uncommon lesion of neural derivation. It is characterized by the presence of granular cell; benign and malignamt counterparts are known, even if the second ones are rare. It has a slight predominance in female sex and black race; the age range is wide, with peak between fourth and sixth decades of life. Any localisation is possible, although surface lesions (head, neck, trunk, extremities) are far more common than visceral ones (esophagus, stomach, small and large bowel, larynx, bronchi, gallbladder and biliary tract). Surgical en-block excision is curative for both benign an malignant forms. Radiotherapy and chemotherapy are not effective. We report the case of a 45 year old man who had a cytologic diagnosis of fusocellular stromal tumor of the gastric fundus during examination for gastritis. He underwent a wedge resection of the gastric wall: at the histological examination neoplastic cells had a granular cytoplasm and immunoassay was positive for S100 protein, PGP 9.5 and NSE. Complete excision guarantees from recurrence and metastases: however a long term endoscopic follow-up is necessary.

Survival in surgical palliative resection of stage IV colorectal cancer: short term results in a single institution.

AIM: In this study, we analyze clinical parameters, survival and possible advantage of surgery in patients affected by symptomatic Dukes D colorectal cancer. METHODS: From July 2005 to December 2008 at our Oncological Surgery Unit we treated 69 symptomatic stage IV CRC, 46 of them resected at our Oncological Surgical Unit. Clinical variables were tested for their relationship to survival in a univariate prognostic analysis and revealed the interaction of the prognostic factors. RESULTS: In symptomatic stage IV CRC with non-curable resection, the most robust univariate predictor for poor prognosis was impossibility to cancer resection. It is associated with significative decrease of survival also in the short term. In our series we do not observe correlation between poor prognosis and age, gender, localisation of tumor, depth of invasion, 19.9 and surgeons. CEA more than 100 microg/L and impossibility to adiuvant therapy have a significative role and are associated with poor prognosis. CONCLUSION: Our results suggested that impossibility to perform cancer resection is associated with poor prognosis in symptomatic stage IV CRC and worse survival also in the short term.

[Leakage of colorectal anastomosis after neoadjuvant therapy with bevacizumab. Case report]. / Deiscenza di anastomosi colorettale dopo terapia neoadiuvante con bevacizumab. Case report.

BACKGROUND: Despite progresses achieved in last decades in treatment of rectal cancer, anastomotic leakage remains the main complication. PATIENTS AND METHODS: We report two cases of patients affected by distal rectal cancer. Both patients received neoadjuvant therapy according to ROCHE ML 18522 experimental protocol (Xeloda, Avastin and radiotherapy). After about respectively one and two months after anterior resection of the rectum, with transanal anastomosis and temporary colostomy, presacral abscess occurred. Patients were hospitalized and started antibiotic therapy. In one case it was necessary TC-guided drainage placement. RESULTS: Both patients had a favourable course and, after respectively 6 months and 1 year, underwent closure of colostomy. DISCUSSION: "Spontaneous" gastrointestinal microperforation (small leakage) is reported during treatment with bevacizumab, a monoclonal antibody against Vascular Endothelial Growth Factor (VEGF), also in patients with non gastrointestine tumours. Probably this results from inhibition of neoangiogenesis induced. CONCLUSIONS: Surgeons have to pay attention to adverse effects of combined neoadjuvant treatment of rectal cancer, considering temporary colostomy in presence of particular risk factors.

Factors predicting survival in surgical palliative resection of stage IV colorectal cancer.

AIM: Colorectal cancer (CRC) harbors accumulated genetic alterations with cancer progression, which results in uncontrollable disease. To regulate the most malignant CRC, we have to know the most dismal phenotype of stage IV disease. METHODS: A retrospective review of our Oncological Surgical Unit was performed (from 2005 to 2008) to extract the 52 resected stage IV CRC. Clinical variables were tested for their relationship to survival in a univariate prognostic analysis and revealed the interaction of the prognostic factors. RESULTS: In stage IV CRC with noncurable resection, the most robust univariate predictors for poor prognosis were preoperative high value of CEA. In our series we did not observe correlation between poor prognosis and depth of invasion, age, gender, pathologic lymph node metastasis status, Ca 19.9 and postoperative therapy. The mean average survival rate was 10.9 months. CONCLUSIONS: Our results suggested that only preoperative value CEA is associated with poor prognosis in stage IV CRC.

Lymphadenectomy in elective and urgency surgery for resective colorectal cancer.

AIM: The aim of this study was to analyze the factors affecting the number of lymph nodes examined in colorectal cancer specimens after elective or urgent surgery on the current clinical practice in our surgical unit. METHODS: The authors considered 120 patients who had undergone surgery for colorectal carcinoma from July 2005 to December 2007 divided into two groups, 102 elective oncologic resections (group A) and 18 performed in emergency (group B). All patients underwent laparotomic colorectal resection. The groups were similar in age, weight and body mass index, different in gender e in cancer stage. The authors analyze prognostic differences in number of examined lymph nodes and factors involved in differences between groups. RESULTS: There were no statistically significative differences in number of nodes harvested in specimen (15.85+/-8.17, CI 95% 14.25-17.46 for group A and 13.83+/-6.56, CI 95% 10.57-17.09 for group B, P-value 0.36). Operating time was shorter in group B (P-value 0.012). We not observed differences between groups in survival rate (P-value 0.62). CONCLUSIONS: The results of the study suggest that a correct lymphadenectomy and an adequate lymph node harvest in colorectal cancer surgery is essential also in resections performed in urgency, to allow a correct staging and an accurate selection of patients for adjuvant chemotherapy, with improvement of results at follow-up.

Total mesorectal excision with radiofrequency in rectal cancer.

AIM: The aim of this study was to compare the safety, the efficacy and the oncologic results in rectal cancer with total mesorectal excision using Ligasure (LS), a modern bipolar vessel sealing system, with monopolar electrocoagulation or stitches (ME). METHODS: From July 2005 to December 2007 one hundred twenty-nine patients underwent colon resection for cancer at the San Martino Hospital of Genoa (Italy); 43 patients underwent rectal resection. All patients underwent laparotomy rectal resection with total mesorectal excision; 9 (21%, group LS) underwent total mesorectal excision with radiofrequency, 34 (79%, group ME) with monopolar electrocoagulations, vessels ligation or stitches. Patients of group LS were similar to patients of group ME in age, gender, weight and body mass index. Cancer stage was for group A 3 stage B, 5 stage C and 1 stage D, for group B 4 stage A, 15 stage B, 8 stage C, 6 stage D and 1 non-staged tumor. RESULTS: There were no differences in intraoperative or postoperative complications. Operating time was similar in both group. Oncological results was similar in both groups. The major cost in group LS were attributable to cost of service. CONCLUSION: The Ligasure device does not reduce operating time in laparotomy rectal cancer resection but permit correct oncological results in patients submitted to total mesorectal excision. The costs of device reserved its use to surgery of low-rectal cancer or laparoscopic approach.

Anestesia epidural tras bloqueo del plexo lumbar por vía posterior / Epidural anesthesia after posterior lumbar plexus block

No disponible

Reacción anafiláctica a propofol y Beta-lactámicos / Anaphylactic reaction to propofol and beta-lactam antibiotics

No disponible

Parche sanguíneo epidural como tratamiento de un cuadro de hipotensión intracraneal espontánea / Epidural blood patch for the management of a patient with spontaneous intracranial hypotension

Una paciente de 75 años con clínica de cefalea postural incapacitante, secundaria a un cuadro hipotensión intracraneal espontánea (HIE), es remitida para la realización de parche sanguíneo epidural autólogo, tras fracaso del tratamiento conservador inicial. Aunque la etiología de la HIE no está suficientemente aclarada, se sospecha la existencia de un defecto anatómico meníngeo intracraneal o espinal, a través del cual se producirían pérdidas de líquido cefalorraquídeo (LCR) suficientes para provocar el síndrome. Usualmente el cuadro se resuelve de manera espontánea o con tratamiento sintomático. Sin embargo, si la cefalea postural persiste y sobre todo si tiene síntomas neurológicos asociados, los tratamientos epidurales son de elección, siendo el parche sanguíneo epidural el que ha demostrado ser más efectivo. Si los parches epidurales de sangre autóloga fracasan se considerará el tratamiento quirúrgico. Las inyecciones epidurales de pegamento de fibrina están teniendo últimamente unos resultados prometedores (AU)

Dolor periorbitario persistente postenucleación. Tratamiento con infiltración de corticoides y anestésicos locales / Persistent periorbital pain postnucleation. Treatment with infiltration of corticoids and local anaesthetics

Los síndromes dolorosos periorbitarios son un raro grupo de entidades que requiere generalmente un estudio multidisciplinario, sobre todo cuando se excluyen las posibles causas oftálmicas. Pueden ser el resultado de patología local o ser referido de otras zonas, mientras que la génesis idiopática sólo puede establecerse tras la exclusión de procesos sintomáticos de origen conocido. Clínicamente suele tratarse de procesos unilaterales, con dolor peri- y retroorbitario intenso y duradero. Tanto la inyección retrobulbar con alcohol al 100 por ciento, como la enucleación o la evisceración suelen ser efectivas en el tratamiento del dolor de origen oftálmico; en raros casos este se hace persistente y por tanto, de difícil tratamiento. Presentamos el caso de una paciente con un cuadro de dolor periorbitario persistente e intenso tras cirugía ocular que ha desaparecido tras una serie de infiltraciones en el punto doloroso, con corticoides y anestésicos locales (AU)

[Stenosing supra-ampullar adenocarcinoma of the second duodenal portion. A rare case of neoplastic pathology]. / Adenocarcinoma sovra-ampollare stenosante della 2a porzione duodenale. Una rara osservazione di patologia neoplastica.

The Authors present a rare case of stenosing primary adenocarcinoma of the duodenum, excluding the papilla of Vater, for its rarity. They report the diagnostic methods and the surgical procedure (D.C.P. resection).