Stable isotope ratios of H, C, N and O in Italian citrus juices.

Stable isotope ratios (SIRs) of C, N, H and O have been exensively used in fruit juices quality control (ENV and AOAC methods) to detect added sugar and the watering down of concentrated juice, practices prohibited by European legislation (EU Directive 2012/12). The European Fruit Juice Association (AIJN) set some reference guidelines in order to allow the judging of the genuiness of a juice. Moreover, various studies have been carried out to determine the natural variability of SIRs in fruit juices, but none of these has investigated SIRs extensively in authentic citrus juices from Italy. In this work, about 500 citrus juice samples were officially collected in Italy by the Italian Ministry of Agricultural and Forestry Policies from 1998 onwards. (D/H)(I) and (D/H)(II) in ethanol and δ(13) C(ethanol), δ(13) C(pulp), δ(13) C(sugars), δ(18) O(vegetalwater), δ(15) N(pulp), and δ(18) O(pulp) were determined using Site-Specific Natural Isotope Fractionation-Nuclear Magnetic Resonance and Isotope Ratio Mass Spectrometry, respectively. The characteristic ranges of variability in SIRs in genuine Italian citrus juice samples are here presented as well as their relationships and compliance with the limits indicated by the AIJN and others proposed in the literature. In particular, the Italian range of values was found to be not completely in agreement with AIJN guidelines, with the risk that genuine juices could be judged as not genuine. Variety seems not to influence SIRs, whereas harvest year and region of origin have some influence on the different ratios, although their data distribution shows overlapping when principal component analysis is applied.

Usefullness of the ultrasonically activated scalpel in laparoscopic cholecystectomy: our experience and review of literature.

Laparoscopic cholecystectomy (LC) actually represents the most used and proper treatment for gallbladder lithiasis, because its many and known advantages in comparison with 'open' abdominal surgery. But there are some problems during and after LC due to the use of the electric scalpel and these have brought to the search of an alternative system of dissection and coagulation. The ultrasonically activated scalpel (Harmonic Scalpel, HS) allows to perform dissection and coagulation with a minimal thermal side effect for surrounding tissues, unlike the electrocoagulation. Furthermore, the use of the HS brings a series of advantages in comparison to the other electromagnetic forms of energy (electro-scalpel, laser). HS cuts and coagulates with the same effectiveness of the electro-scalpel but, unlike this, it doesn't introduce risks of wandering currents. Moreover, HS contributes to have a more clean and clear (smokes-free) field of operation and it reduces the operative time, the bleeding and the costs of the operation without an increase of the complications and of the percentages of 'open' conversion, and perhaps leads to a less negative influence on the postoperative systemic immune response. The Authors report their experience that confirm these observations, according also with results reported in a brief review of the recent scientific literature, and support wider diffusion and technical development of this ultrasonically-operating surgical team.

Intestinal obstruction due to idiopathic sclerosing encapsulating peritonitis. Clinical report and review of literature.

The sclerosing peritonitis (SP) is a rare illness secondary to the peritoneal dialysis or due to intraperitoneal chemotherapy or the positioning of a peritoneal-jugular shunt in cirrhotic patient with refractory ascites or due to unknown other factors (idiopathic form) like in our patient. The clinical pattern is various and insidious, but when an intestinal occlusive symptomatology is presents an urgent operation is mandatory. The surgical operation is often not easy and asks for a lot of attention especially in the dialyzed subject or in patients with cirrhosis, due to the possibility of postoperative bleeding and other serious complications that can result in fatal outcome. In this report we describe surgical treatment, pathologic pattern and clinical findings of this rare disease.

About a case of GIST occurring during pregnancy with immunohistochemical expression of epidermal growth factor receptor and progesterone receptor.

The coexistence of gastrointestinal stromal tumors (GISTs) and pregnancy is very rare. We are the first to add to the literature a case report of GIST occurring during pregnancy with immunohistochemical staining for epidermal growth factor receptor (EGFR) and progesterone receptor (PgR). A role of PgR and EGFR in tumor growth should not be excluded, and these findings indicate that the expression of these receptors could provide pertinent biological information required to determine adequate therapeutic regimens. In conclusion, considering that GIST occurring during pregnancy is a rare event, with frequent delay in diagnosis, it is important to consider this diagnosis for early recognition, correct diagnosis, and a better outcome.

Laparoscopic cholecystectomy (LC): predictive role of preoperative ultrasounds.

AIM: We studied several ultrasounds patterns concerning gallbladder, biliary tract and gallstones to identify some predictive signs of difficulties during LC. PATIENTS & METHODS: 112 patients (24 females), 25-75 years old, upper abdomen operated patients not included. From 7 ultrasounds patterns 4 degrees of potential intra-operative difficulty (0-3) were obtained. During the operation 7 conditions of true intra-operative problems were also classified. RESULTS: Patients showing grade 0: regular gallbladder wall stones < 20 mm, regular Main Biliary Tract (MBT) = 62 LC and 2 open surgery conversion (OSC); grade 1: wall < 4 mm, stones > 20 mm= 24 LC and 7 OSC; grade 2: hydrops, wall > 4 mm, infundibular stone = 6 LC and 6 OSC, grade 3: wall > 4 mm, stones > 20 mm, empyema of gallbladder, MBT > or = 6 mm = 3 LC and 0 OSC. Inflammation near gallbladder and wall > 4 mm were mainly responsible for transition of LC in OSC. CONCLUSION: Several predictive conditions for intraoperative difficulties are often detectable by accurate preoperative ultrasounds examination, with the aim of best surgical planning and to select those patients to entrust to surgeons during their learning phase.

Non-HDL cholesterol predicts coronary heart disease in primary prevention: findings from an Italian 40-69 year-old cohort in general practice.

OBJECTS: Non-HDL cholesterol is now recommended as an index of risk associated with combined dyslipidemia, and it has also been found useful in predicting coronary heart disease (CHD) risk in patients with diabetes. We studied the association between known CHD risk factors, enclosed non-HDL cholesterol, and a "high CHD risk condition", i.e. a "5-years CHD risk >15%" in general practice. METHODS: We studied 4,085 40-69 year-old diabetic (no. 489) and non-diabetic (no. 3,596) individuals from an opportunistic cohort. Cross-sectional descriptive statistics, and age- and gender-adjusted multiple logistic exponential betas have been calculated. RESULTS: About 12% of the participants had diabetes. Age- and gender-adjusted comparison showed that all the study variables were significantly worse in diabetic vs. non-diabetic individuals (except cigarette smoking, total blood cholesterol and the ratio of total to HDL cholesterol). They had a mean "5-year CHD-risk" significantly higher than non-diabetic individuals (18.8+/-11.9% vs 7.5+/-6.9%, P<0.01), and a four-fold prevalence of "5-years CHD risk >15%" (55.4% vs 11.1%, P<0.01). As to diabetic individuals, the study variables associated to a "high CHD risk condition" were cigarette smoking, systolic blood pressure, and non-HDL blood cholesterol levels. As to non-diabetic individuals cigarette smoking, systolic blood pressure, and HDL (inversely) and non-HDL blood cholesterol levels were associated to a "high CHD risk condition". CONCLUSIONS: Non-HDL cholesterol--and cigarette smoking and systolic blood pressure--strongly predicted a "high CHD risk condition" both in diabetic and non-diabetic individuals.

Surgical management of entero and colocutaneous fistulae in Crohn's disease: 17 year's experience.

BACKGROUND AND AIMS: Fistulous disease is common in Crohn's disease, and entero- and colocutaneous fistulae are particularly debilitating and difficult to manage. We present the results of surgical management of these fistulas. PATIENTS AND METHODS: Retrospective chart review of all 51 patients with Crohn's disease (56 surgical procedures) undergoing surgery for cutaneous fistulae between 1983 and 2000. RESULTS: Previous surgery for Crohn's disease had been carried out in 43 patients (84%). The fistula site was enterocutaneous in 36 patients (64%), colocutaneous in 12 (21%), and anastomotic in 8 (14%); 9 patients (16%) also had associated enteroenteric fistulas. The onset of the fistula followed abscess drainage in 15 (27%) and occurred at the site of recurrent disease in 41 (73%). Forty patients (71%) initially underwent conservative management prior to surgery; 16 (28%) underwent surgery directly. Surgical procedures were: 25 ileocolic resections, 8 stoma revisions with resection, 8 small bowel resections 7 subtotal colectomies, 4 partial colectomies, 3 proctocolectomies, and one fistula tract excision. Mean total length of stay was 18 days (postoperative 10.7 days). Six (11%) patients had eight postoperative complications. Mean follow-up was 48.6 months (range 3-187). Recurrence as defined by either clinical examination or reoperation was documented in nine fistulas (16%), with a mean time to recurrence of 27 months. CONCLUSION: Entero-and colocutaneous fistulae usually occur from a site of active disease. Surgical management with bowel resection, including the fistula, is the preferred method of treatment. Morbidity has been low and recurrence rate lower than expected.

Splenic trauma following colonoscopy.

A case of splenic trauma after colonoscopy is reported. After description of their experience, the Authors report a review of the literature and some considerations about clinical diagnosis and surgical or medical therapy for this pathology.

[Early gastric cancer. The therapeutic options]. / Early gastric cancer. Opzioni terapeutiche.

The best therapeutic treatments for early gastric cancer are evaluated. Due to the difficulty of preoperative and intraoperative staging, it's reasonable to consider early gastric cancer as a composite disease; while some mucous localizations can benefit of minor therapeutic treatments, the submucous cancer must be treated as the parietal gastric cancer.

Effects of adhesive fixed prosthesis retainer design on resultant resin luting agent thickness.

STATEMENT OF PROBLEM: Resin cement thickness may influence the success or otherwise of adhesive fixed prostheses and needs to be quantified for future stress analyses. PURPOSE: This study evaluated the effect of different complexities of retainer preparation design on resultant resin lute thickness. MATERIAL AND METHODS: Five retainer designs were evaluated for resin luting thickness (Panavia Ex) after cementation to appropriately selected natural teeth as follows: (1) flat plate retainer; mandibular canine; (2) occlusal rests, mandibular premolar; (3) occlusal rests, proximal grooves, mandibular premolar; (4) modified three-quarter crown, mandibular premolar; and (5) occlusal strut, maxillary premolar. Five samples of each design were prepared in vitro. A mesiodistal and a buccolingual section were obtained from each sample with a diamond saw. Measurements were carried out on the fluorescent cement lute with a confocal microscope. Mean resin thickness and cervical resin thickness were analyzed with analysis of variance and Tukey tests. RESULTS: Resin thickness (micron) for each of the retainer designs were as follows (mean +/- SD): design 1, 58 +/- 40; design 2, 67 +/- 42; design 3, 80 +/- 28; design 4, 87 +/- 15; and design 5, 85 +/- 29. There were no significant differences among the designs (mean global value 75.4). The three-quarter crown (design 4) had a significantly wider cervical resin thickness (P < or = .01) than designs 1, 2, and 3.

Evaluation of the efficacy of a redox agent in the treatment of chronic periodontitis.

A redox dye, methylene blue, was compared with subgingival root surface debridement and sterile water in the treatment of adult periodontitis. Plaque and gingival indices, bleeding on probing, and microbiological samples were obtained at baseline, and at 1, 4, 8 and 12 weeks following treatment. All subjects had matched pockets in each of the 4 quadrants, of 5 mm or more. One treatment consisted of 0.1% methylene blue gel irrigated professionally at 0, 1 and 4 weeks, and by subjects at days in between up to 4 weeks, at chosen sites within a randomly selected quadrant (split-mouth design). A 2nd treatment was sterile water irrigation as above. A 3rd quadrant received subgingival debridement, and sites in the 4th received methylene blue incorporated into a slow-release device of a biodegradable collagen alginate vicryl composite. All sites showed improvements in clinical and microbiological parameters. However, no statistically significant differences between treatment types were found for clinical measurements. Although plaque index tended to increase after week 1, gingival index was reduced, as was the papilla bleeding index. Probing depth reductions were approximately 1.2 mm for all treatments. Microbiological variables showed an increase in cocci and a decrease in motile organisms for all groups, the latter reaching statistical significance for subgingival debridement. The reductions in spirochaetes were significant for subgingival debridement and methylene blue by slow-release. Culture demonstrated an increase in the aerobe:anaerobe ratio for all groups, which was statistically significant initially (weeks 1 and 4) for subgingival debridement. Methylene blue was also effective statistically in improving this ratio, both by irrigation and slow-release (week 4). Methylene blue also significantly reduced the numbers of black-pigmented anaerobes during the trial period, both by irrigation and slow-release, which sterile water and subgingival debridement failed to do. No serious adverse experiences were seen, however, significantly greater morbidity was associated with subgingival debridement. These results clearly demonstrate that in altering the microflora to one that is more compatible with periodontal health, methylene blue treatment is comparable, or even better, than the currently standard treatment of subgingival debridement, and is better tolerated.

[Clinical results of selective distal splenorenal and latero-lateral portacaval anastomoses. Comparative prospective study of 93 patients]. / Résultats cliniques des anastomoses spléno-rénale distale sélective et porto-cave latéro-latérale. Etude prospective comparée de 93 patients.

The distal splenorenal shunt (DSRS) was compared with the side-t-side portacaval shunt (PCS) in 93 prospectively matched cirrhotic patients with portal hypertension. After a mean follow-up of 38 months, no differences were observed in operative mortality, long term survival and variceal rebleeding between the two groups. There was no significant difference in terms of acute encephalopathy (22% in PCS group and 33% in DSRS group) and chronic encephalopathy (35% in PCS and 17% in DSRS). However, the only cases of severe and disabling chronic encephalopathy (CE) arose after PCS (p = 0.049). Actuarial curves of CE showed that the maximum rate of this complication (18%) in the DSRS group was reached 27 months after shunt surgery, whereas this value was reached and passed in PCS group only 4 months after shunt. CE occurred for a total duration of 20.1 months after PCS and only 11.1 months after DSRS (p = 0.003) and occupied 46.3% of the follow-up of PCS patients in contrast to 18.7% of the follow-up of DSRS patients (p = 0.001). DSRS is associated with a lower global incidence of CE without severe forms and provides a better quality of life than does a nonselective shunt.

Emergency portosystemic shunt in patients with variceal bleeding.

Thirty-five patients for whom emergency sclerotherapy or conservative treatment, or both, failed to arrest variceal bleeding, or who had early rebleeding and required emergency portosystemic shunts (EPSS) were studied. EPSS permanently controlled the variceal bleeding in all but one patient. In this patient, the shunt was patent as demonstrated by angiography. Esophageal varices disappeared in 18 patients and were reduced in 14. Three patients died before the endoscopic examination could be performed. The causes of death were hepatic failure in two and bleeding ulcerations of the gastric fundus in the other patient. One patient was classified in Child's category B and two in Child's category C. Thirty-two patients submitted to EPSS and were discharged alive. Twelve of these patients subsequently died, at an average of 11.2 months after undergoing the shunt procedure. Four of 12 patients died of hepatic failure; two patients died of hepatomas; two, other neoplasia; three, hemorrhaging duodenal ulcers, and one patient, renal failure. Analysis of actuarial survival rates showed that the five year survival rate was 43 per cent. The long term survival rates were fewer for patients with Child's category C than for those with combined Child's categories A and B (five year survival rates were 21 versus 55 per cent; p less than 0.05). During the follow-up period, none of the patients had variceal bleeding. Chronic encephalopathy developed in six, which was mild in three, moderate in one instance and severe in two. It developed soon after EPSS, with onset in the first month after discharge in three. Thus, when conservative treatment fails to arrest variceal bleeding, EPSS should be performed to guarantee definitive control of hemorrhage and prolong the survival period.

[The noninvasive assessment of the effects of penbutolol on liver hemodynamics in cirrhotic patients using angioscintigraphy. A randomized controlled double-blind study]. / Valutazione non-invasiva delgi effetti del penbutololo sull'emodinamica epatica nei cirrotici mediante angioscintigrafia. Studio randomizzato, controllato, in doppio cieco.

This randomized double-blind controlled study analyzed the hemodynamic effects of penbutolol, a new levo-rotatory betablocker, using radionuclide angiography. Twenty cirrhotics with esophageal varices were randomized: 10 received 40 mg/day of penbutolol orally and the others a placebo. Angioscintigraphy was performed before and after an 8-day treatment period. Three cases in the penbutolol group were lost due to software damage, hence the data of 17 patients were analyzed. The two groups were similar for age, sex, etiology of cirrhosis and hepatic function. The index of portal perfusion decreased significantly (-29%; p = 0.018), and the hepatic artery index increased significantly (+23%; p = 0.018), whereas no changes were observed after placebo. The heart rate decreased significantly after penbutolol (-9%; p = 0.021); while neither penbutolol nor placebo modified the ejection fraction. In conclusion, penbutolol decreased portal perfusion index (the compensatory increase of hepatic artery index confirmed this change) without significant modification of total hepatic blood flow and systemic hemodynamics. Angioscintigraphy is reasonably accurate, reproducible, safe and can be considered suitable for routine use in the assessment of liver hemodynamics.