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Pancreatic cancer (PC) is the fourth cause of cancer death in Western countries, the only chance for long term survival is an R0 surgical resection that is feasible in about 10%-20% of all cases. Five years cumulative survival is less than 5% and rises to 25% for radically resected patients. About 40% has locally advanced in PC either borderline resectable (BRPC) or unresectable locally advanced (LAPC). Since LAPC and BRPC have been recognized as a particular form of PC neoadjuvant therapy (NT) has increasingly became a valid treatment option. The aim of NT is to reach local control of disease but, also, it is recognized to convert about 40% of LAPC patients to R0 resectability, thus providing a significant improvement of prognosis for responding patients. Once R0 resection is achieved, survival is comparable to that of early stage PCs treated by upfront surgery. Thus it is crucial to look for a proper patient selection. Neoadjuvant strategies are multiples and include neoadjuvant chemotherapy (nCT), and the association of nCT with radiotherapy (nCRT) given as either a combination of a radio sensitizing drug as gemcitabine or capecitabine or and concomitant irradiation or as upfront nCT followed by nRT associated to a radio sensitizing drug. This latter seem to be most promising as it may select patients who do not go on disease progression during initial treatment and seem to have a better prognosis. The clinical relevance of nCRT may be enhanced by the application of higher active protocols as FOLFIRINOX.

Background: Iloprost, a prostacyclin analog, reduces hepatic microcirculatory damage after ischemia-reperfusion injury in animal liver models. The objective of this study was to evaluate whether the portal flow velocity changes after Iloprost infusion in patients with systemic sclerosis and Raynaud's phenomenon, who usually have increased risk of microvascular thrombosis and transient liver disturbances. Patients and Methods: Fifteen patients (3 males and 12 females, median age 58 years, range 47-66 years), with systemic sclerosis and Raynaud's phenomenon, were exclusively treated with an infusion of Iloprost (2 ng/kg/min, 6 h/day) for 5 days. In each subject, the portal flow velocity (PV, cm/sec) and portal flow volume (PFV, mL/min) were obtained by using portal color Doppler ultrasonography equipment. Results: Iloprost administration significantly (p

As duration of inflammatory bowel disease (IBD), in particular ulcerative colitis (UC), is a major risk factor for the development of colorectal cancer (CRC), it is rational to propose a screening colonoscopy when the risk starts to increase, i.e., after 8-10 years from the onset of disease. If low-grade dysplasia is detected, the 9-fold increased risk of developing CRC reported in the most recent meta-analysis could reasonably be viewed as justification for colectomy even if some follow-up studies have shown a lower rate of CRC. A reasonable compromise could be to continue surveillance with extensive biopsy sampling at shorter (perhaps 3-6 month) intervals. If high grade dysplasia is present, the decision is easier, because the risk of concomitant CRC may be as high as one third, assuming that the biopsies were indeed obtained from flat mucosa and not from an adenoma. Total proctocolectomy with ileal pouch anal anastomosis (IPAA) has become the most commonly performed procedure for patients with ulcerative colitis requiring elective surgery for dysplasia. Nevertheless, a recent systematic review alerted that the risk of dysplasia in anal transition zone and rectal cuff in patients undergone to restorative proctocolectomy was remarkable, mainly in patients operated on for dysplasia or colorectal cancer.

The intima-media thickness (IMT) measurement of the common carotid artery is recognized as a reliable marker of systemic atherosclerosis and may be useful in predicting the likelihood of cardiovascular events, since it is related to the extent and severity of coronary artery disease. The aims of this study were to analyze whether correlations exist between the IMT of the common carotid artery and the main clinical and biochemical parameters in patients with primary hyperparathyroidism (PHPT), and to evaluate the possible improvement of the IMT values following parathyroidectomy at long-term follow-up.Twenty-seven patients (5 men, 22 women; median age 59 years, range 36-82 years) with biochemically confirmed PHPT (Group A, cases), and 27 gender- and age-matched healthy volunteers (Group B, controls) were prospectively enrolled in the study. All patients underwent ultrasound examination and the IMT of each carotid artery were recorded, averaging all values. The measurements were repeated 18-22 months (median 20) later in all patients.A significant (p0.05) correlation between age and both systolic BP and IMT, and between IMT and fasting glycaemia was found in each Group. There was an inverse relationship between IMT and serum parathyroid hormone (R = -0.56, p0.01), but no correlation (p=NS) was found between IMT and serum calcium (R = -0.14) or serum phosphate (R = 0.07). At follow-up a slight (10.4%) improvement in the mean IMT was observed among Group A patients (0.86 +/- 0.18 vs. 0.77 +/- 0.24; p = 0.12), but the difference was not significant.At long term follow-up, the IMT values did not improve significantly and no correlation was found between serum calcium and IMT. These results suggest that hypercalcemia does not represent a reliable risk of carotid atherosclerosis in patients with PHPT.