Role of minimally invasive surgery in the treatment of gallbladder metastatic melanoma. A review of the literature and a case report.

BACKGROUND: Primary and secondary gallbladder melanomas are rare, and only 58 cases have been reported in scientific literature to date. This paper aimed to explore the role of minimally invasive surgery in the management of gallbladder metastatic melanomas. CASE: Herein, we present the case of a 68-year-old man with metastatic gallbladder melanoma who was treated with laparoscopic cholecystectomy. Our case management was then compared with that of other cases reported in the literature. CONCLUSION: Currently, metastatic melanomas can be considered as a potentially curable disease. Palliation of symptoms and fast recovery following minimally invasive procedures could be beneficial for these patients. Particularly, laparoscopic procedures appear to prolong the survival of gallbladder melanoma patients.

Three-dimensional printing as an educational tool in colorectal surgery.

3D printing is a rapidly advancing technology which represents a significant technological achievement that could be useful in a variety of biomedical applications. In the field of surgery, 3D printing is envisioned as a significant step in the areas of surgical planning, education and training. The 3D printed models are considered as high quality and efficient educational tools. In this paper A randomized controlled trial was performed to compare the educational role of 3D printed models with that of the conventional MRI films in the training of surgical residents. Statistical analysis revealed that Resident surgeons who studied only the anal fistula printed models, (Group B) achieved a higher overall score in the fistula assessment test (87,2 (82,6-91,6)) compared to resident surgeons (Group A) who studied only MRI images (74,85 (66,8-73,5)).  3D printing technology can lead to improvement in preoperative planning accuracy, followed by efficient optimization of the treatment strategy. It is believed that 3D printing technology could be used in the case of various other surgical applications, thus representing a novel tool for surgical education.

The effect of bronchodilation and spirometry on fractional exhaled nitric oxide (FeNO50), bronchial NO flux (JawNO) and alveolar NO concentration (CANO) in children and young adults.

OBJECTIVE: Fractional exhaled nitric oxide (FeNO), bronchial nitric oxide (JawNO) and alveoar nitric oxide (CANO) are biomarkers of eosinophilic inflammation, usually measured simultaneously with spirometry and bronchodilation. Our aim was to investigate the effect of bronchodilation and spirometry on FeNO, CANO and JawNO in children and young adults with well-controlled asthma and in healthy volunteers. METHODS: FeNO was measured in 95 subjects (62 controls, 33 asthmatics). CANO and JawNO were assessed in 41 of the subjects (35 healthy, 6 asthmatics.) Measurements were performed before spirometry (1), right after spirometry (2), 20 min after the first spirometry and bronchodilation (3), right after the post-bronchodilation spirometry (4) and 30 min after the last spirometry (5). RESULTS: The presence of well-controlled asthma was not associated with different pattern of reaction after spirometry and bronchodilation. A statistically significant difference was observed only between FeNO4 and FeNO5, as well as between CANO1 and CANO3 (19.14 ± 1.68 vs 20.62 ± 1.85 ppb, p = 0.001 and 4.42 ± 0.40 vs 3.09±0.32 ppb, p = 0.001, respectively). CONCLUSIONS: Spirometry and bronchodilation have an insignificant effect on FeNO and JawNO. Even if a slight change occurs in FeNO and JawNO, this does not modify clinician's decision and therapeutic strategy. CANO values (CANO1) are significantly decreased 20 min after spirometry and bronchodilation.

Divergence of estimated fetal weight and birth weight in singleton fetuses.

OBJECTIVE: To evaluate differences in distribution of estimated fetal weight (EFW) and birth weight (BW) of ongoing fetuses and neonates of the same gestational age. METHODS: Reference curves for EFW (Hadlock BPD-HC-AC-FL formula, N = 1191) and BW (N = 1036) in singleton pregnancies from 24+0 to 40+6 gestational weeks were calculated. Multiple pregnancies, fetuses with major or multiple abnormalities or syndromes and iatrogenic preterm deliveries due to preeclampsia or abnormal fetal Doppler were excluded. The standardized residuals for EFW and BW were calculated and compared. RESULTS: EFW and BW can be accurately described by quadratic equations (R2 = 0.944 and 0.807, respectively). The distribution of standardized residuals for BW using the EFW formula was negative from 28+0 to 35+6 weeks. The 50th and 5th centiles of BW were lower than those of EFW throughout prematurity, and they converged at approximately 38 gestational weeks. The 5th centile for BW was 30% lower than the 5th centile for EFW at 27 weeks, 27.5% lower at 30 weeks and 19.4% at 34 weeks. CONCLUSIONS: Preterm infants have lower BW distribution compared to the expected EFW of ongoing pregnancies of the same gestational age, supporting the concept of hidden intrauterine morbidity for a proportion of these infants.

Simultaneous Hepatic and Mesenteric Hydatid Disease-A Case Report.

INTRODUCTION: Hydatid cysts most commonly present in the liver and the lungs; however, they can appear more rarely in other locations, such as the mesentery, with a rather unclear mechanism of manifestation. Herein, we present a case of simultaneous presence of hydatid cysts in the liver and the mesentery of a young man. CASE REPORT: A 39-year-old man was referred to our Department for further investigation of intermittent abdominal pain, especially in the right upper quadrant, and abdominal distension. Abdominal CT imaging revealed three calcified lesions, one in the liver, a similar adjacent to an ileal loop and one close to the urinary bladder, while antibody control was positive for echinococcal infection. The lesions were excised and the patient was discharged on the seventh post-operative day in good general condition. Post-operative control after 6 months did not show any signs of recurrence. CONCLUSION: Simultaneous presence of hydatid cysts in two organs occurs in 5-13% of cases. Presence in the mesentery is extremely rare, although, should be included in the classic differential diagnosis, especially in endemic areas.

Presence of an Isolated Hydatid Cyst in the Left Kidney: Report of a Case of This Rare Condition Managed Surgically.

Introduction. Hydatid cyst disease caused by Echinococcus granulosus is rarely presented in the kidneys, whereas isolated renal occurrence is estimated to be about as low as 2-4% of all cases. We present a case of a female patient suffering from this condition that was treated successfully in our department. Case Presentation. A 44-year-old woman was incidentally diagnosed with a 14 cm left renal cystic mass through ultrasound imaging performed during upper abdominal pain investigation. Laboratory examinations were normal and CT imaging set the diagnosis of an isolated left renal hydatid cyst. The cyst was excised and the postoperative period was uneventful. Discussion. Isolated renal hydatid cyst is a very rare condition and could possibly be misdiagnosed with other renal masses. The clinical history, laboratory tests, and thorough radiologic imaging are crucial for the accurate preoperative diagnosis.

Left Colon Diverticulitis Presenting as Perforated Lumbar Abscess: A Case Report and Review of the Current Literature.

Diverticular perforation is a common complication of diverticulitis and can lead to the creation of abscesses. The presence of such abscesses on the abdominal wall is rare and can lead to misdiagnosis. We present the case of a patient with abdominal pain and the formation of a large left lumbar abscess due to perforation of a diverticulum of the left colon and our surgical treatment of choice with favorable results.

In vivo induction of the autophagic machinery in human bone marrow cells during Leishmania donovani complex infection.

Autophagy is a homeostatic process promoting cell survival in periods of stress. The induction of the autophagic machinery has also been implicated in both innate and adaptive immunity. Leishmania donovani, which is the causative pathogen of visceral leishmaniasis, is an intracellular parasite that invades and multiplies in bone marrow macrophages. We describe the induction of host cell autophagic machinery during acute natural bone marrow infection by L. donovani complex, detected by LC3B immunoblot. The successful treatment with liposomal amphotericin B resulted in the resolution of this phenomenon. Even though the role of autophagy in parasite biology has been previously studied, our findings show for the first time the in vivo host cell LC3B conversion as a marker of the induction of the autophagic machinery during infection with Leishmania parasite in real time conditions.

TLR2 and TLR4 polymorphisms in familial Mediterranean fever.

It has been suggested that MEVF mutations offer advantage against infections, including tuberculosis. Bearing in mind the central role of TLR-2 and TLR-4 in the recognition of pathogens, we conducted this study to examine whether the TLR2-R753Q, TLR4-D299G, TLR4-T399I common polymorphisms are associated with susceptibility to familial Mediterranean fever (FMF) or affect the course of the disease. A cohort of 169 FMF patients and 245 healthy bone marrow donors were enrolled in the study. FMF patients appeared with a significantly lower frequency of the TLR4-D299G mutated allele (3.2% vs 6.9%, p = 0.032). No association was observed with the other analyzed polymorphisms. Moreover, we found no association between polymorphisms and the frequency of attacks or the development of amyloidosis. Our results may reinforce the hypothesis that FMF patients display a better defense against pathogens, providing an additional mechanism and suggesting a positive selection advantage in the area of the Mediterranean basin.