Groin Pain Syndrome Italian Consensus Conference on terminology, clinical evaluation and imaging assessment in groin pain in athlete.

The nomenclature and the lack of consensus of clinical evaluation and imaging assessment in groin pain generate significant confusion in this field. The Groin Pain Syndrome Italian Consensus Conference has been organised in order to prepare a consensus document regarding taxonomy, clinical evaluation and imaging assessment for groin pain. A 1-day Consensus Conference was organised on 5 February 2016, in Milan (Italy). 41 Italian experts with different backgrounds participated in the discussion. A consensus document previously drafted was discussed, eventually modified, and finally approved by all members of the Consensus Conference. Unanimous consensus was reached concerning: (1) taxonomy (2) clinical evaluation and (3) imaging assessment. The synthesis of these 3 points is included in this paper. The Groin Pain Syndrome Italian Consensus Conference reached a consensus on three main points concerning the groin pain syndrome assessment, in an attempt to clarify this challenging medical problem.

Role of cyclooxygenase isoforms in the altered excitatory motor pathways of human colon with diverticular disease.

BACKGROUND AND PURPOSE: The COX isoforms (COX-1, COX-2) regulate human gut motility, although their role under pathological conditions remains unclear. This study examines the effects of COX inhibitors on excitatory motility in colonic tissue from patients with diverticular disease (DD). EXPERIMENTAL APPROACH: Longitudinal muscle preparations, from patients with DD or uncomplicated cancer (controls), were set up in organ baths and connected to isotonic transducers. Indomethacin (COX-1/COX-2 inhibitor), SC-560 (COX-1 inhibitor) or DFU (COX-2 inhibitor) were assayed on electrically evoked, neurogenic, cholinergic and tachykininergic contractions, or carbachol- and substance P (SP)-induced myogenic contractions. Distribution and expression of COX isoforms in the neuromuscular compartment were assessed by RT-PCR, Western blot and immunohistochemical analysis. KEY RESULTS: In control preparations, neurogenic cholinergic contractions were enhanced by COX inhibitors, whereas tachykininergic responses were blunted. Carbachol-evoked contractions were increased by indomethacin or SC-560, but not DFU, whereas all inhibitors reduced SP-induced motor responses. In preparations from DD patients, COX inhibitors did not affect electrically evoked cholinergic contractions. Both indomethacin and DFU, but not SC-560, decreased tachykininergic responses. COX inhibitors did not modify carbachol-evoked motor responses, whereas they counteracted SP-induced contractions. COX-1 expression was decreased in myenteric neurons, whereas COX-2 was enhanced in glial cells and smooth muscle. CONCLUSIONS AND IMPLICATIONS: In control colon, COX-1 and COX-2 down-regulate cholinergic motility, whereas both isoforms enhance tachykininergic motor activity. In the presence of DD, there is a loss of modulation by both COX isoforms on the cholinergic system, whereas COX-2 displays an enhanced facilitatory control on tachykininergic contractile activity.

A1 and A2a receptors mediate inhibitory effects of adenosine on the motor activity of human colon.

Experimental evidence in animal models suggests that adenosine is involved in the regulation of digestive functions. This study examines the influence of adenosine on the contractile activity of human colon. Reverse transcription-polymerase chain reaction revealed A(1) and A(2a) receptor expression in colonic neuromuscular layers. Circular muscle preparations were connected to isotonic transducers to determine the effects of 8-cyclopentyl-1,3-dipropylxanthine (DPCPX; A(1) receptor antagonist), ZM 241385 (A(2a) receptor antagonist), CCPA (A(1) receptor agonist) and 2-[(p-2-carboxyethyl)-phenethylamino]-5'-N-ethyl-carboxamide-adenosine (CGS 21680; A(2a) receptor agonist) on motor responses evoked by electrical stimulation or carbachol. Electrically evoked contractions were enhanced by DPCPX and ZM 241385, and reduced by CCPA and CGS 21680. Similar effects were observed when colonic preparations were incubated with guanethidine (noradrenergic blocker), L-732,138, GR-159897 and SB-218795 (NK receptor antagonists). However, in the presence of guanethidine, NK receptor antagonists and N(omega)-propyl-L-arginine (NPA; neuronal nitric oxide synthase inhibitor), the effects of DPCPX and CCPA were still evident, while those of ZM 241385 and CGS 21680 no longer occurred. Carbachol-induced contractions were unaffected by A(2a) receptor ligands, but they were enhanced or reduced by DPCPX and CCPA, respectively. When colonic preparations were incubated with guanethidine, NK antagonists and atropine, electrically induced relaxations were partly reduced by ZM 241385 or NPA, but unaffected by DPCPX. Dipyridamole or application of exogenous adenosine reduced electrically and carbachol-evoked contractions, whereas adenosine deaminase enhanced such motor responses. In conclusion, adenosine exerts an inhibitory control on human colonic motility. A(1) receptors mediate direct modulating actions on smooth muscle, whereas A(2a) receptors operate through inhibitory nitrergic nerve pathways.

[Colorectal carcinoma in the elderly. Assessment of prognostic factors]. / Carcinoma colorettale nell'anziano. Valutazione dei fattori prognostici.

Between 1976 and December 1992 a total of 80 patients aged 80 or over underwent surgery for colorectal cancer at the Surgical Clinic of Pisa University. Twelve patients died, 18 presented non-lethal complications and 48 had a normal postoperative recovery. The type of surgery did not appear to be correlated with mortality. Urgency, associated with the advanced stage of cancer (according to Duke's classification modified by Aster-Coller), was the factor which most severely influenced mortality. A marked prognostic improvement can be obtained by an early diagnosis and careful evaluation of the patient's overall conditions.

[Importance of endoscopic follow-up in the diagnosis of metachronous colorectal cancer]. / Importanza del follow-up endoscopico nella diagnosi di cancro metacrono del colon-retto.

Between 1976 and December 1992 a total of 748 patients with colorectal cancer were observed at the Surgical Clinic of Pisa University; in 9 of these a second colorectal tumour appeared between 30 months and 18 years after the original tumor. Coloscopy is the treatment of choice for evaluating the colon operated due to cancer since it allows an early diagnosis of any metachronous tumours, reveals synchronous tumours which have been overlooked prior to the operation and performs a therapeutic and prophylactic function in terms of the endoscopic removal of adenomatous polyps which have appeared in the meantime.

[Intensive postoperative treatment in obstetrics and gynecology: proposal for a score system for medico-surgical assessment of the abdominal surgery patient]. / Terapia intensiva post-operatoria in ostetricia e ginecologia. Proposta di uno score per la valutazione medico-chirurgica dellia paziente addominale.

It is often necessary in routine clinical practice to take a decision on therapeutic conduct regarding patients with abdominal type postoperative complications. A score system has been devised which increases with the gravity of objective findings and the laboratory data most frequently observed in this pathology. The theoretical score is applied a posteriori to 12 serious cases of abdominal surgery. The values suggest an appropriate therapeutic approach: in effect, a score of less than 50 would point to wait-and-see medical treatment, not to be prolonged beyond 72 hours; values higher than 50 point to medical treatment preparatory to indispensable surgery.