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Considering ileocolic resection as a surgical standard for the treatment of ileocecal valve Crohn's disease, we propose a limited resection of the terminal ileum and ileocecal valve with ileocecal anastomosis.Three patiens between 20 and 37 years of age, diagnosed with Crohn's disease unresponsive to medical therapy, who have stenoses or fissures confined to the terminal ileum and ileocecal valve, seen during instrumental investigations.The proposed procedure allowed us to perform a minimal resection and reconstruction of a new ileocecal valve. Once the symptoms have resolved, at endoscopic follow ups, at 6 and 12 months after surgery, there were no changes in the mucosa of the ileocecal neo-anastomosis.Since Crohn's disease is a systemic disease with a chronic relapsing course complicated by a high rate of post-surgical relapses, it is essential to limit the extension of resections to the macroscopically involved tissues and reduce the anastomotic surfaces. The proposed surgical procedure allows to preserve the caecum and the colon with an optimal postoperative course.We believe that, with specific clinical and endoscopic conditions, the treatment we illustrated can be proposed to other patients as an alternative to the standard VL ileocolic resection.Crohn's Disease, Ileocaecal Valve, Ileocaecal Anastomosis.La malattia di Crohn (MC) è, insieme alla Rettocolite ulcerosa, una malattia infiammatoria cronica dell’intestino (MICI) ad eziopatogenesi multifattoriale. Si distinguono tre profili di malattia associati o meno alla localizzazione a livello perianale non stricturing/non penetrating, stricturing, penetrating. Il quadro clinico e l’evoluzione della patologia sono strettamente correlati al fenotipo. Il trattamento medico, nella maggioranza dei casi, rappresenta il primo step nella gestione del paziente; esso si compone di un ampio ventaglio di scelta tra farmaci anti-infiammatori, cortisonici, immunomodulatori e terapia biologica; la scelta del tipo di farmaco da impiegare viene fatta in funzione del quadro clinico ed anatomopatologico. Il ricorso all’intervento chirurgico è invece indispensabile in presenza di complicanze responsabili di fenomeni occlusivi, perforativi o ascessuali e in caso di fallimento della terapia medica. Tuttavia, in casi selezionati e documentati in letteratura, la terapia chirurgica rappresenta una scelta migliore come primo approccio terapeutico al paziente. Giungono alla nostra attenzione tre pazienti tra i 20 e i 40 anni con diagnosi di Malattia di Crohn non responsiva a trattamento farmacologico. Alle indagini strumentali si individuano stenosi o fissurazioni in corrispondenza dell’ileo terminale e della valvola ileocecale. Le anse a monte delle stenosi appaiono dilatate; alla colonscopia, la mucosa del cieco risulta indenne da malattia o solo lievemente infiammata. L’intervento chirurgico standard per questo tipo di patologia consiste in una resezione ileocolica eseguita in laparoscopia. Dopo una attenta valutazione multispecialistica, accompagnata anche da una revisione della letteratura, si decide di sottoporre i pazienti ad una procedura mininvasiva videolaparoscopica consistente nella resezione dell’ileo terminale stenotico/fistolizzato, asportazione della valvola ileocecale e successivo confezionamento di anastomosi volta a ricreare la valvola rimossa. La tipologia di intervento proposto ci ha consentito di ricreare la valvola effettuando un’anastomosi ileo-cecale e al tempo stesso di risparmiare quanto più intestino possibile considerando l’andamento cronico recidivante proprio della MC. Nel periodo post-operatorio non sono state riscontrate complicanze ed ai controlli endoscopici, a 6 e a 12 mesi dall’intervento, non sono presenti alterazioni della mucosa in corrispondenza dell’anastomosi ileocecale. Riteniamo che, in specifiche condizioni cliniche ed endoscopiche, il trattamento da noi illustrato possa essere proposto ad altri pazienti in alternativa alla resezione ileocolica standard eseguita in VL.

To evalue the short-term results obtained in endovenous laser ablation (EVLA) procedure of the varicose insufficiency of the lower limbs with Diode 1470 μm laser compared to Diode 1940 μm laser.A total of 55 patients were enrolled in the study. The patients were divided into two groups: those subjected to 1470 μm laser treatment in group A and those with 1940 μm laser treatment in group B. The endpoints were: Closure of the target vessel, complications and post-operative pain.There are no intra-and post-operative complications. The occlusion rate of the target veins was 100% at 7- and 60-day controls. The pain perceived in the immediate post-operative and at the controls showed no statistically significant differences between the two groups. However in group B it was necessary to apply lower values of Power (W) and Linear Energy Density (LEED) with a statistically significant difference compared to group A.Short-term results demonstrate closure rates comparable to those obtained with 1470 μm lasers. There were no statistically significant differences in the two groups in terms of primary and secondary endpoints. The advantage of using 1940 μm laser technology is that it is possible to dispense a lower linear energy density (LEED) at a lower power (Watt).Endovenous laser ablation with Diode 1940 μm is particularly suitable and advantageous in the treatment of superficial and small vessels, as well as venous segment adjacent to nerve structures.Diode laser, Intravenous ablation, Varicose, Venous insufficiency, Veins.La termoablazione laser (EVLA) rappresenta oggi la tecnica di prima scelta nel trattamento dell’insufficienza venosa. In questo articolo riportiamo l’analisi retrospettiva dei risultati a breve termine ottenuti dal trattamento laser endovenoso (EVLA) della patologia varicosa degli arti inferiori con laser 1470 μm e laser 1940 μm.Sono stati arruolati nello studio un totale di 55 Pazienti. I pazienti sono stati divisi in due gruppi: quelli sottoposti a trattamento con laser 1470 μm nel gruppo A e quelli con laser 1940 μm nel gruppo B. Gli endpoint sono stati: closure del vaso target, complicanze e dolore post-operatorio.Non si riportano complicanze intra e postoperatorie. Il tasso di occlusione delle vene target è stato del 100% ai controlli a 7 e 60 giorni. Il dolore percepito nell’immediato postoperatorio ed ai controlli non ha mostrato differenze statisticamente significative tra i due gruppi. Tuttavia nel gruppo B è stato necessario applicare minori valori di Potenza (W) e Densità di Energia Lineare (LEED) con una differenza statisticamente significativa rispetto al gruppo A.I risultati a breve termine dimostrano tassi di closure sovrapponibili a quelli ottenuti con laser 1470 μm. Non si sono registrate differenze statisticamente significative nei 2 gruppi in termini di endpoint primari e secondari. Il vantaggio dell’utilizzo della tecnologia laser 1940 μm deriva dalla possibilità di erogare una minore densità di energia lineare (LEED) ad una minore potenza (Watt). Per tale motivo questa metodica risulta particolarmente indicata e vantaggiosa nel trattamento di vasi di calibro più piccolo, più superficiali e attigui a strutture nervose.

Although stapled anastomoses have been widely evaluated in the context of the elective surgery, few reports compared manual with stapled anastomoses in patients undergoing emergency surgery. The aim of this study is to compare the outcome of hand-sewn end-to-end anastomoses with stapled side-to-side and stapled end-to-side anastomoses in patients undergoing small bowel resection for acute mesenteric ischemia secondary to intestinal obstruction.From January 2015 to June 2021 all the hemodynamically stable patients undergoing emergency surgery with small bowel resection for intestinal obstruction were enrolled in this study. According to surgical technique in performing anastomosis, the patients were divided into three groups: group 1: hand-sewn end-to-end anastomosis, group 2: stapled end-to-side anastomosis, and group 3: stapled side-to-side anastomosis.Although the anastomosis failure rate was higher in group 3, it was not significantly different between the three groups (P = 0.78: chi-square test). Likewise, no significant differences in the median hospital stay were found between the patients' groups (P = 0.87: Kruskal-Wallis test). The median operating time was similar in patients undergoing stapled anastomoses and was significantly higher in patients undergoing hand-sewn anastomoses (P = 0.0009: Kruskal-Wallis test).In patients undergoing emergency small bowel resection for complicated intestinal obstruction, a similar outcome in terms of dehiscence rate and hospital stay can be achieved performing stapled or hand-sewn anastomoses, even if restoring the intestinal continuity with stapled technique is associated with lower operating time.

Inguinal hernia formation is a common event in patients with Ehlers-Danlos syndrome. Minimally invasive surgical technique for inguinal hernia repair is the same used in patients without EDS but it is related to more intraoperative and postoperative complications.Inour study, we present a case of inguinal hernia in a EDS patient successfully treated with a robotic transabdominal preperitoneal procedure (TAPP procedure).We decided to perform a robotic TAPP with the DaVinci Xi® platform (Intuitive Surgical, Sunnyvale, USA) under general anaesthesia. A robotic docking was performed and three arms were positioned in the abdomen. Total operative timing was 45 mins.During the robotic procedure no intraoperative complications were recorded and no drains were applied. The postoperative period was uneventful and the patient was discharged in the first postoperative day.Inguinal hernia occurs more frequently in patients with EDS, mainly men. Many surgeons believe that EDS may have a negative effect on the clinical outcome of hernioplasty because of postoperative complication and recurrence rates. Our strategy has been robotic technology to facilitate the surgical approach.Robotic technology is feasible and associated with a shorted recovery and better cosmetic results. The endowrist movement of the robotic arms allows wide instrument articulation in a confined space, bypassing the limitis of laparoscopic instruments. In this way, it is possible to realize an accurate dissection of important elements, to reduce operative timing and intraoperative and postoperative complications.Ehlers-Danlos syndrome, Inguinal hernia, TAPP.

Gastric cancer represents the fourth most common form of cancer and the second most common cause of death in the world. It is also one of the most common cancers leading to mortality in Italy. Therefore, this study aimed to determine the survival rate of patients with advanced gastric cancer and its affecting factors in our experience at AOU Federico II.26 patients with late-stage T4N2M0 and T4N2M1 gastric cancer that were diagnosed and registered during 2008 to 2018 in Federico II Surgical department, were studied. All patients were followed to the end of 2019. Kaplan-Meier method was used to draw survival curves and to determine the effective factors on the survival rate of surveyed patients. Moreover, Log-rank test was used to evaluate whether or not survival curves for different patients, related to residual tumor, are statistically equivalent (p0.05).The mean age of the study population was 49±29, and most of them were males (57,8% (15 patients). After diagnosis, the survival rates for 1, 2, 3 and 4 years, were 26,9%, 11,5 %, 3,8%, 19,2 %; 11,5% of patients with residual tumors survived 6 months respectively. Overall average survival was of 20.61 sd 17.52 months with a median of 12. No statistical difference was detected in terms of survival among M0 and M1 sub-groups.Based on the findings of the present study, T4 gastric cancer has a poor prognosis. Survival rate was decreased over time after diagnosis. Tumoral stage at the time of diagnosis is the most important factor affecting the survival of surveyed patients. This shows that there is a crucial need to diagnose the gastric cancer in early stages.Advanced gastric cancer, Surgical techniques, Therapy.Il cancro gastrico (CG) è la quarta causa principale di morte per cancro in tutto il mondo, anche se negli ultimi decenni è stato osservato un calo della sua incidenza e del tasso di mortalità. I casi di tumore avanzato sono difficilmente gestibili in elezione per la presenza di complicanze che impongono spesso un trattamento in urgenza. Lo studio si propone di esaminare 26 casi di cancro gastrico avanzato, trattati tra il 2008 e il 2018 presso il dipartimento di chirurgia generale “Federico II” e sottoposti a follow up fino alla fine del 2019. Le curve di sopravvivenza sono state costruite usando il metodo di Kaplan-Meier. Inoltre il test di Log-rank è stato utilizzato per valutare se le relative curve di sopravvivenza per pazienti con residuo tumorale e non, fossero statisticamente equivalenti. Si è registrata una sopravvivenza media di circa 20.61 sd 17.52 mesi con una mediana di 12. Non sono state evidenziate differenze significative tra pazienti M0 ed M1, in termini di sopravvivenza. Pertanto, alla luce dei dati raccolti, si evidenzia come la diagnosi precoce di tumore gastrico, rappresenti uno dei principali fattori per migliorare la prognosi e la sopravvivenza dei pazienti.

The recent Sars-CoV2 pandemic has dramatically slowed patients' access to our clinic for vascular pathology when the contagion curve peaked. The need to restore the assistance activity has led us to adopt new individual prophylaxis and hygiene measures.Doctors and staff must wear dedicated clothes. Mask and gloves are mandatory for patients. A visit is scheduled every 60 minutes to allow the sanitation of the rooms. The day before the visit patients are contacted by telephone for the Covid-19 risk triage. In the presence of symptoms the visit is postponed. In the presence of other risk factors a IgG/IgM Rapid Test for Covid-19 is performed on admission to the clinic. In the presence of fever, if an extraordinary rapid test cannot be performed, the visit must be postponed. Rapid test positive patients cannot be visited: they are placed in solitary confinement at their home waiting for a nasopharyngeal swab for Covid-19. When the rapid test is positive, immediate room sanitation also occurs. The rooms dedicated to the outpatient clinic as well as medical and not medical instruments are disinfected.The one adopted can be a useful management model for any type of care activity in order to guarantee the safety of patients and all the staff.COVID-19, Management, vascular, Outpatient clinic.La recente pandemia da SARS-CoV2 ha complicato l’accesso dei pazienti presso il nostro Ambulatorio di Patologia Vascolare, specialmente durante i giorni in cui la curva di contagio raggiungeva il picco. La necessità di fornire un’adeguata attività assistenziale ci ha spinti ad adottare una serie di misure igieniche e di profilassi che riteniamo possano essere d’esempio nella gestione di qualsiasi tipo di ambulatorio durante un pandemia. I medici ed il personale devono indossare abiti dedicati e dispositivi di protezione individuali. Mascherina chirurgica e guanti sono obbligatori anche per i pazienti. All’ingresso viene misurata la temperatura a tutti i soggetti che accedono presso la struttura. Sono previsti percorsi differenti. Vi è una zona-filtro con la sala d’attesa ed altre stanze, ed una via specifica che conduce agli ambulatori. Sono disposti numerosi erogatori di gel idro-alcolico per la disinfezione delle mani. Una visita è programmata ogni 60 minuti per consentire la sanificazione degli ambienti. Il giorno prima della visita i pazienti vengono contattati telefonicamente per la valutazione del rischio Covid-19. Esiste una scheda di triage dedicata. In presenza di sintomi la visita viene rimandata. Se esistono altri fattori di rischio viene eseguito un test rapido IgG/IgM per Covid-19 al momento dell’accesso. In presenza di febbre, se non è possibile eseguire un test rapido straordinario, la visita deve essere rimandata. I pazienti positivi al test rapido non possono essere visitati: sono posti in isolamento in domiciliare in attesa di un tampone nasofaringeo per Covid-19. Quando il test rapido è positivo avviene la sanificazione immediata delle stanze in cui è sostato il paziente. Gli ambienti dedicati all’ambulatorio e gli strumenti vengono disinfettati tra una visita e l’altra. L’adozione rigorosa di tutte queste misure riteniamo sia la chiave per garantire un’adeguata assistenza sanitaria evitando che i pazienti ed il personale siano esposti al rischio di contagio.

To summarize and compare the most recent data from the literature to clarify the management of male breast cancer.A review article.Diagnosis and Treatment of Male Breast Cancer have been derivative for years. Nowadays MBC is a nosological entity in its own right with biological, molecular and clinical features that require a multidisciplinary approach and the involvement of specific skills. Multimodal treatment involves surgery, radiotherapy and chemotherapy. It is evident that the outcome of the MBC is worse than the female one. MBC is often diagnosed in advanced stages. Screening programs in the male population need to be strengthened to obtain an earlier diagnosis. It is necessary to know even more in depth the endocrine-metabolic and behavioral risk factors related to the neoplasm. Finally in the coming years it is reasonable to expect an improvement in multigenic tests: the sensitivity of these methods could predict the risk of recurrence even more precisely. This could lead to substantial changes in the choice and duration of treatment with results that could be surprising.Male breast cancer, Management, Review, Update.Le strategie di diagnosi e trattamento del carcinoma mammario maschile sono derivative da anni: in assenza di studi di controllo randomizzati si applicavano le evidenze scientifiche ricavate sulla popolazione femminile. In particolare il comportamento biologico del tumore della mammella maschile veniva paragonato alla controparte femminile dell’eta postmenopausale. Negli ultimi venti anni questa convinzione e stata progressivamente accantonata. Oggi la neoplasia mammaria del sesso maschile è considerata un’entità nosologica a sé stante, con caratteristiche biologiche, molecolari e cliniche che richiedono un approccio multidisciplinare e il coinvolgimento di competenze specifiche. Il trattamento multimodale prevede terapia chirurgica, radioterapica e chemioterapica proprio come avviene per il carcinoma mammario femminile, con la differenza che nel maschio la diagnosi avviene quasi sempre ad uno stadio più avanzato. L’assenza di un programma di screening paragonabile a quello esistente per le donne rivela delle sostanziali differenze prognostiche tra i due sessi. Pertanto il nostro studio si propone di raccogliere e confrontare tra loro i dati più recenti della letteratura al fine di facilitare la gestione dei pazienti con carcinoma mammario maschile.

Laparoscopic adjustable gastric band complications like oesophageal dilatation, intractable nausea and vomiting, band migration, late slippages, and port problems with a cumulative rate of 19.2%. Rarely, LAGB complications may be related to the connection tube system and in this case the clinical presentation and the effects of the problem can generate difficulties in diagnosis.A 47 years old woman who had a LAGB placed 2 years before the symptoms was admitted in our centre with nausea, vomit, leukocytosis and distended abdomen with a generalized tenderness. Computed tomography images showed an anomalous course of banding tube and a contemporary compression of a small bowel tract secondary to the traction exerted by an adipose tissue band attracted by the tube.A laparoscopic exploration of the abdominal cavity showed a tight loop of LAGB tubing causing a small bowel obstruction with an ischemic damage, so surgeons provided to LAGB removal and a 50 cm ileum resection CONCLUSIONS: Small bowel obstruction resulting from LAGB tubing is an uncommon complication which was reported in few cases. Although bariatric surgery currently represents the best treatment option for morbid obesity and its related- diseases, peri- and post-operative complications have always to be taken into account.Adjustable gastric band complications, Bariatric surgery, Bowel obstruction, CT scan, LAGB tube.Al giorno d’oggi, il bendaggio gastrico regolabile laparoscopico (LAGB) sta assistendo ad un progressivo declino nella maggior parte dei centri di chirurgia bariatrica; questo è principalmente dovuto ai suoi scarsi risultati, nel follow-up a lungo termine, in termini di riduzione dell’Indice di massa corporea (IMC) e all’ampio spettro delle sue complicanze. Quello che viene presentato è un raro caso di complicanza da LAGB correlata al suo tubo di collegamento con il port di regolazione esterno; nel dettaglio, il decorso anomalo del catetere del dispositivo ha determinato una compressione di un’ansa digiunale per trazione esercitata da una banda di tessuto adiposo attratta dal catetere stesso. La presentazione clinica e gli effetti delle complicanze legate al bendaggio gastrico possono generare difficoltà nella diagnosi e nel trattamento; per tali motivi risulta fondamentale, quando le condizioni cliniche lo permettano e la diagnosi non sia chiara, richiedere l’intervento di uno specialista in chirurgia bariatrica.

Introduction Hepatic artery aneurysms are rare, and their treatment represents a challenge for the surgeons. Materials and methods A new technique is presented for common hepatic artery (CHA) aneurysm: it requires minimal vascular surgical dissection and only one linear vascular stapler is applied at the bottom of aneurysm. Aneurysm exclusion is easily obtained, which allowed retrograde thrombosis. Liver blood supply is ensured to the right and left hepatic artery, through the gastroduodenal artery, and can be previously monitored, with temporary clamping of the section area, by visual control, enzyme evaluation and intraoperative ultrasound examination. We reported an open surgical treatment, with simultaneous removal of hepatic and adrenal metastases, secondary to colon cancer. Results The duration of vascular surgery was 30 min and did not involve complications. Postoperative controls confirmed the efficacy of the procedure. Discussion This original technique can be added to the various open and endovascular techniques so far described for the treatment of a CHA aneurysm. It is advisable as open surgery, mostly in case of associated pathologies. Conclusions The authors believe that this “one shot” technique by vascular staple of the distal part of CHA is minimally invasive and effective to obtain the exclusion of the aneurysm.

The aim of this study is to verify whether the postural alterations can influence the development of the varicose disease with unilateral and bilateral saphenous incompetence.39 patients suffering from saphenous incompetence diagnosed by hemodynamic study with eco-color doppler (20 patients with bilateral venous insufficiency (VI), 19 patients with unilateral VI) have performed the gait analysis though wireless inertial sensor and baropodometry to assess the plantar pressure distribution both statically and dynamically.The 68% and the 60% of subjects suffering from unilateral or bilateral VI present a plantar pressure dysfunction a single foot or both feet in static and/or in dynamic. In 63% of subjects with unilateral VI the propulsion is reduced on the lower limb damaged. The number of asymmetries in walking and dysfunctions in planar pressure in both groups has been calculated. The average number of asymmetries in walking in the group of patients with unilateral VI is significantly greater (p-value=0.0075) compared to the group of patients with bilateral VI.Plantar pressure and increased valvo-muscular pump pressure (VMPP) are not the main etiological factors that modify the hemodynamic in walking. In unilateral cases the postural alterations may contribute to worsening or to appearance of the varicose veins. Postural disorders treatment in children of phlebopaths during the childhood could maintain the mild condition of varicose disease silent. The treatment in adults suffering from unilateral VI may reduce or prevent the appearance of relapses KEY WORDS: Gait analysis, Hemodynamic of the gait, Postural alterations, Saphenous incompetence, Venous insufficiency.Lo studio è stato quello di verificare se le alterazioni posturali possono influenzare lo sviluppo della malattia varicosa con incontinenza safenica monolaterale e bilaterale MATERIALI E METODI: 39 pazienti affetti da incontinenze safeniche diagnosticate con studio emodinamico con eco-color doppler (20 affetti da insufficienza venosa (IV) bilaterale, 19 affetti da IV monolaterale) hanno effettuato un’analisi del cammino attraverso sensore inerziale wireless e baropodometro per valutare la distribuzione delle pressioni plantari sia staticamente che dinamicamente RISULTATI: Il 68% e il 60% dei soggetti affetti da IV monolaterale e bilaterale presentano una disfunzione di appoggio su uno o su entrambi i piedi in statica e/o in dinamica. Nel 63% dei casi di IV monolaterale la propulsione è ridotta dal lato colpito. È stato calcolato il numero di asimmetrie del cammino e disfunzioni dell’appoggio plantare di entrambi i gruppi. Il numero delle asimmetrie medio nel gruppo di soggetti con IV monolaterale è significativamente maggiore (p-value= 0.0075) rispetto al gruppo di soggetti con IV bilaterale CONCLUSIONI: Appoggio plantare e aumento della pressione della pompa valvolo-muscolare (PPVM) non sono i principali fattori eziologici che modificano l’emodinamica del cammino. Nei casi di monolateralità le alterazioni posturali possono contribuire al peggioramento o alla comparsa delle varici. La loro correzione nei figli dei flebopatici durante l’età evolutiva potrebbe mantenere allo stato latente la malattia varicosa di lieve grado, mentre negli adulti con malattia varicosa monolaterale trattata con terapia ablativa o conservativa potrebbe ridurre o arrestare la comparsa delle recidive.

The BioEnterics Intragastric Balloon (BIB) and the Spatz Adjustable Balloon System (ABS) are in fact recommended for weight reduction as a bridge to bariatric surgery. We retrospected studied patients with body mass index (BMI) and age ranges of 37–46 and 70–80 years, respectively, who had undergone BIB from January 2010 to July 2012 and prospected studied patients who had undergone Spatz balloon from July 2012 to August 2014. The aim of this study is to compare BIB and Spatz in terms of weight loss, complications, and maintenance of weight after removal. For both procedures, the median weight loss was 20 ± 3 kg, median BMI at the end of the therapy was 32 ± 2, and no severe complication occurred.

Here our proposal of a new approach to the incontinent saphenous-femoral junction (SFJ) based on the combination of surgery and sclerotherapy for treatment of incontinent varices. It is a two-step procedure with a surgical ligation and transection of SFJ followed by a sclerosis of saphenous trunk and extra-fascial tributaries.From January to December 2017, 95 patients (63 females and 32 males) with a mean age of 56.43 ± 6.07 years for a total of 121 limbs were treated with the SHSC approach. Under local anesthesia, after surgical selective hemodynamic crossectomy and a retrograde cannulation of the saphenous trunk by means of 8-10 ch nelaton-like catheter, 0.5-1% polydocanol foam, obtained with Tessari's technique, is injected into the vein. During injection, the catheter must be progressively withdrawn, so that the entire vein comes in contact with the foam.121 limbs have been treated with the above technique. A complete obliteration of the saphenous trunk was observed after 116 (95.86%) treatments in the immediate postoperative time. With regard to collateral veins sclerosis, 99 (81.81%) complete obliterations were observed. 28 (23.14%) collateral varices had to be refined by sclerotherapy.SHSC associates the execution of a selective hemodynamic crossectomy with an intraoperative foam sclerotherapy for the treatment of the saphenous trunk and collateral varicose veins. SHSC, compared to classical US-guided foam sclerotherapy seems to be safer, with fewer risks of pulmonary and / or cerebral embolic complications. SHSC prevents blood wash out which could destabilize the consolidation of the saphenous trunk sclerosis.SHSC can be considered an effective treatment of varicose veins, simple to perform, minimally invasive and well tolerated KEY WORDS: Crossectomy, Saphenous vein, Sclerotherapy, SFJ.Il lavoro che presentiamo riporta la nostra esperienza circa un nuovo approccio alla giunzione safeno-femorale incontinente basata sulla combinazione di chirurgia e scleroterapia per il trattamento delle varici incontinenti. Si tratta di una procedura in due fasi con legatura chirurgica e transezione della giunzione safeno-femorale seguita dalla sclerosi del tronco safenico e delle affluenti extra-fascali. Da gennaio a dicembre 2017, 95 pazienti (63 femmine e 32 maschi) con un’età media di 56.43 6.07 anni per un totale di 121 arti sono stati trattati con l’approccio della sclero-crossectomia emodinamica selettiva Dopo l’intervento chirurgico di crossectomia emodinamica In anestesia locale e una cannulazione retrograda del tronco safenico mediante catetere 8-10 ch nelaton, la schiuma di polidocanolo 0,5-1%, ottenuta con la tecnica di Tessari, viene iniettata nella vena. Durante l’iniezione, il catetere deve essere progressivamente estratto, in modo che l’intera vena entri in contatto con la schiuma. 121 arti sono stati trattati con la tecnica illustrata. È stata osservata una completa obliterazione del tronco safenico in 116 trattamenti (95,86%) già a partire dall’immediato postoperatorio. Per quanto riguarda la sclerosi delle vene collaterali, sono state osservate 99 obliterazioni complete (81,81%). 28 varici collaterali (23,14%) hanno necessitato di finissage scleroterapico. La sclero-crossectomia emodinamica selettiva associa l’esecuzione della crossectomia emodinamica selettiva con una foam sclerotherapy intraoperatoria per il trattamento del tronco safenico e delle collaterali varicose. Rispetto alla classica foam sclerotherapy eco-guidata, sembra essere più sicura, con minori rischi di complicanze emboliche polmonari e / o cerebrali. La crossectomia Impedisce il wash-out del sangue che potrebbe inficiare il consolidamento della sclerosi del tronco safenico, per cui la tecnica proprosta può essere considerata un trattamento efficace delle vene varicose, semplice da eseguire, minimamente invasivo e ben tollerata.

Hydatid disease (HD) is caused by Echinococcus Granulosus (EG), which is a larva endemic in many undeveloped areas. The most common target is the liver (59%–75%). The retroperitoneal space is considered as a rare localization. We report an uncommon case of HD located in the adrenal gland space. Presentation of case. This is a 78-year-old Moroccan woman, with right flank pain for eight months previously. She denied contact with dogs or sheep. Her physical examination was normal. There was no pathological alteration of laboratory exams. CT scan measuring 5 cm without clear signs for a sure diagnosis found a round lesion in the right adrenal gland. An abdominal MRI showed a round mass of 34 x 27 mm with fluid component without a clear plane of dissection from kidney and liver. A laparoscopic procedure was performed to obtain a histological diagnosis. We reached a conclusive diagnosis of Hydatid cyst of right adrenal gland space. Hydatid cysts often develop in the liver. The location in the adrenal bed is rare without clinical signs related to alteration of the gland’s secretion. Hydatid cyst identification in the adrenal gland space is based on ultrasonography, CT or MRI scans. The differential diagnosis includes various benign and malignant lesions. Laparoscopic procedure is the best approach available to obtain a histological diagnosis and a curative treatment. The best treatment for HD is the pericystectomy. Laparoscopic surgery can guarantee a radical resection of these lesions when it performed by an expert surgeon.

Aging is one of the major risk factors for varicose veins. The same is for Knee and Hip Osteoarthritis. Most of the patients undergoing to Hip (THA) or Knee (TKA) arthroplasty are over sixteen. Varicose veins, excluding thrombophilia, are the most significant risk factors for VTE after THA and TKA. This study investigates on the usefulness of prophylactic treatment of GSV insufficiency in elderly patients undergoing to orthopedic surgery. A retrospective study enrolling 44 over-sixty five patients, undergoing to TKA or THA. 24 patients underwent to traditional surgery and 20 to EVLA. The presence of evident varicosities and/or a saphenic reflux lasting > 500 ms has been considered as operability criterion. Both in surgery and EVLA group has been performed the ablation of visible varicosities and only saphenic refluxing traits. Results: 1 case of symptomatic DVT was recorded after arthroplasty. A statistically significant difference (p = 0.006) of recovery time between surgery and EVLA groups has been detected. There is not a statistically significant difference in long-term recurrence rate between surgery and EVLA. Conclusions: It is useful to program GSV surgery, before treat hip or knee. This study showed a 50% decrease in the incidence of postoperative DVT.

Introduction: An arteriovenous fistula (AVF) for placed for hemodialysis may be burdened by one particular complication-the formation of a venous aneurysm. It has been shown that matrix metalloproteinases (MMPs) and neutrophil gelatinase-associated lipocalin (NGAL) could represent markers of disease in both venous and arterial vessels. Materials and methods: This case study reports a rare case of enormous venous aneurysm-correlated MMP and NGAL levels in a woman with an AVF. Results: Significantly higher levels of plasma MMP-1, MMP-8, MMP-9, and NGAL were detected in this patient during aneurysmal evaluation before the surgery; these levels significantly decreased 1, 3 and 6 months after surgery. Conclusion: MMP and NGAL levels could represent a marker of aneurysmal disease, and their plasma evaluation could help physicians to stratify the risk of complications in patients with an AVF.

The intraoperative staging of the pancreatic cancer is important to make a proper treatment. For this reason the intraoperative echography is playing an important role in the right treatment choice. The intraoperative echography, that can be performed with an open or laparoscopic probe, is used to confirm the preoperative diagnosis and assess the pancreatic cancer resecability. The intraoperative echography (IOUS) or laparoscopic intraoperative echography (LIOUS) are useful to identify the patients with a non resecable cancer and perform a faster neoadjuvant treatment. The LIOUS can also avoid an useless laparotomy. The aim of this study is to assess, both in our experience and in the cited literature, the concordance rate between the pancreatic cancer preoperative staging, performed with TC and MRI (when it is available), and intraoperative staging, performed with intraoperative laparotomic or laparoscopic echography. Material and methods We have analyzed the treatment management of 34 patients, who were candidate to major surgery for suspected pancreatic head cancer and who underwent to intraoperative LIOUS or IOUS staging from 2001 to 2012. Results LIOUS and IOUS have allowed to detect cases in which preoperative diagnosis, proved by CT and MRI, was not agreeing with intraoperative diagnosis (22 patients on 34, 64% discordance rate), avoiding the execution of a demolitive and uneseful surgery in order to guarantee the surveillance and life's quality of patients. Conclusion We suggest to perform in every patients undergone to pancreatic surgery an intraoperative ultrasound exam, to detect unresecable and unpredicted lesions.

Conservative therapies for patients affected by Peripheral Arterial Occlusive Disease (PAOD) aim first to correct the risk factors and to slow down the disease progression. Among these, exercise has positive effects on blood flow, muscle metabolism and well demonstrated systemic effects. These include reduction of chronic inflammation markers, improvement of walking mechanics and heart function. Controlled physical training increases the ability to perform the daily activities improving life expectancy of these patients. The aim of this study is to evaluate the effects and the effectiveness of physical training performed in thermal water compared to traditional treadmill walking exercise.98 patients affected by IIb stage PAOD, according to Leriche-Fontaine classification, were enrolled. Patients were randomized into two groups: the first arm carried out an intensive training program under medical supervision (group A); the second one carried out a rehabilitative exercise associated with crenotherapy (group B). The following parameters were detected: Ankle-Brachial pressure index (ABI), actual claudication distance (ACD), maximum walking distance (MWD), flow mediated dilatation (FMD) and the intima-media thickness (IMT). All patients underwent Doppler echocardiography and complete biochemical assay.In both groups, there was a statistically significant improvement of lipidaemia compared to baseline. When compared with each other, the two groups did not show statistically significant differences. There were no significant differences between the two groups regarding echocardiographic findings. Vascular reactivity study showed a statistically significant improvement of FMD after 3 months of exercise in both groups. In crenotherapy group (B) FMD values were significantly higher than the treadmill ones (A). In both groups a statistically significant improvement in ACD was observed CONCLUSIONS: Our experience shows that crenotherapy has similar effects compared to traditional physical training in the treatment of PAOD, being equally well tolerated and safe; it gives an advantage over conventional physical training in terms of ACD and MWD improvement, although not statistically significant, and it is extremely welcome to patients compared to traditional physical training.Arterioscleroses, Intermittent Claudicatio, Peripheral Arterial Diseasen, Physical Exercise, Rehabilitation.Le terapie conservative per i pazienti affetti da Arteriopatia Obliterante Periferica mirano, a correggere I fattori di rischio e a rallentare la progressione della storia naturale della malattia. Tra queste, l’esercizio fisico ha effetti positive sul flusso sanguigno, il metabolismo muscolare ed altri ben dimostrati meccanismi sistemici che includono la riduzione dei markers di infiammazione cronica, il miglioramento della meccanica del cammino e la funzione cardiaca. L’esercizio fisico controllato incrementa l’abilità di svolgere le comuni attività quotidiane, migliorando l’aspettativa di vita di questi pazienti. Lo scopo di questo studio è valutare gli effetti e l’efficacia dell’esercizio fisico eseguito in acqua termale confrontato con l’esercizio tradizionale eseguito su tapis roulant. Sono stati arruolati 98 pazienti affetti da Arteriopatia Obliterante Periferica allo stadio IIb della classificazione di Leriche-Fontaine. Dopo la randomizzazione, i pazienti sono stati divisi in due gruppi: il primo braccio ha eseguito un programma di allenamento intensive sotto supervisione medica (gruppo A); il secondo ha eseguito un allenamento riabilitativo associate a crenoterapia (gruppo B). Sono stati rilevati i seguenti parametri: Indice Caviglia/Braccio (ABI), Actual Claudication Distance (ACD), Maximum Walking Distance (MWD), Flow-Mediated Dilation (FMD) e lo Spessore Medio- Intimale (IMT). Tutti i pazienti sono stati sottoposti ad un Ecografia Color Doppler Cardiaca e un completo assessment biochimico ematico. In entrambi i gruppi, esiste un miglioramento statisticamente significativo della lipidemia in confronto al tempo 0. Quando confrontati tra di loro, i due gruppi non dimostrano differenze statisticamente significative. Non esistono differenze statisticamente significative tra i due gruppi per quanto riguarda i reperti ecocardiografici. Lo studio di reattività vascolare ha dimostrato un miglioramento statisticamente significativo del FMD dopo 3 mesi di allenamento. Nel gruppo B i valori sono significativamente più alti rispetto a quelli ottenuti nel gruppo A. In entrambi i gruppi sono stati osservati incrementi statisticamente significativi dell’ACD. La nostra esperienza ha dimostrato che la crenoterapia associate all’esercizio fisico ha effetti simili comparati al tradizionale allenamento riabilitativo nei pazienti affetti da Arteriopatia Obliterante Periferica, essendo egualmente ben tollerato e sicuro; la crenoterapia conferisce all’esercizio fisico un vantaggio rispetto all’esercizio tradizionale in termini di miglioramento dell’ACD e dell’MWD, sebbene non statisticamente significativo; inoltre è meglio accettato e tollerato dai pazienti rispetto all’esercizio tradizionale.

The aim of our study was to evaluate the efficacy of a new treatment of recurrent varicose vein after stripping of the great saphenous vein with rigid radiofrequency needles.37 patients enrolled (11 males and 26 females). 10 patients had recurrent varicose veins for the presence of residual reflux in the Saphenous-Femoral Junction (SFJ) stump, whilst 21 patients for the presence of a single or multiple re-chanalized and refluxing perforator veins, and 6 had mixed rechanalization due to perforator veins and refluxing saphenous stump. All patients have been treated by percutaneous ultrasound-guided obliteration with radiofrequency needles. Treatment efficacy have been assessed by US evaluation, and/or the appearance of recurrent varicose veins and classified as REVAS questionnaire. Follow up has been carried out at 30, 60, 180 days and 1 year after treatment.A complete obliteration of the perforator(s) stump(s) was observed in 12 procedures immediately after the treatment, and confirmed at 30 and 60 days. In 1 case (7.69 %) obliteration was not complete at 60 days. After 1 year of follow-up 3 perforators (23.07%) showed an incomplete or failed obliteration. A complete obliteration of the treated SFJ was observed in 27 cases at the end of the procedure and confirmed after 60 days of follow-up patients (Fig. 4). In 2 cases (6.89%), obliteration was non complete at 60 days. After 1 year of follow up 5 treated SFJ (17.24%) stumps showed an incomplete or a failed obliteration.Results show a reduction of the number of limbs affected by ulcer, skin pigmentation and stasis eczema, demonstrating correction of haemodynamic overload to be effective.This treatment is a new and effective solution to the problem of post-stripping recurrent varicose veins.Perforator veins, Radiofrequency, Recurrent post-stripping varicose veins, Saphenofemoral stump.

BACKGROUND: In this study is evaluated the role of Endoscopic Mucose Resectin (EMR) in the treatment of flat lesions and sessile colorectal cancer, diagnosed during colonoscopy and evaluated with Flexible Spectral Imaging Color Enhancement (FICE) and High-frequency Endoscopic Ultrasonography (HFEUS), to determine the invasiveness degree of the colon wall. Colorectal polypoid lesions are not always identified during a colonoscopy. The complete endoscopic resection of intramucosal carcinoma is accepted as curative, when there is a low degree of invasion of the submucosal layer, so evaluation of the infiltration depth submucosa is crucial. For this purpose we used the FICE and HFEUS. METHODS: Forty-seven patients (27 males, 20 females) with lesions of the colorectal polypoid were included in the study. The localization of the tumor, the shape, the size and penetration have been determined by endoscopy and endoscopic ultrasound, before performing a mucosectomy intervention. RESULTS: The comparison between FICE and HFEUS magnification revealed significant differences in the sensitivity, specificity, positive predictive value and negative predictive value between the two techniques. Mucosectomy was performed successfully in 45 patients, it was not able to proceed in 2 patients endoscopically, for failure to lift, and were subjected to surgical resection, revealing adenocarcinoma T2 in both cases. There was a complication with bleeding endoscopically treated. CONCLUSIONS: Non-polypoid colorectal lesions and cancers at an early stage can be treated with endoscopic resection. The colonic adenomas are considered as precursors of most colorectal cancers. Certainly early diagnosis and endoscopic treatment can reduce mortality from colorectal cancer. The most used techniques include endoscopic polypectomy for resection of the polypoid lesions and the EMR (EMR) for the treatment of sessile lesions. EMR is a safe procedure for the treatment of carcinomas in situ too. Many authors have demonstrated the effective implementation of the EMR technique in colorectal cancers with results comparable to surgical procedures. In this study we assessed the usefulness of EMR for the treatment of neoplastic colorectal flat and sessile, evaluated for the degree of invasion of the wall with FICE and HFEUS.

The aim of our study was to evaluate the efficacy of a new method of compression sclerotherapy of GSV and SSV.345 lower extremities with primary varicose veins, with a long reflux of the GSV (C2-6; Ep; As 2, 3; ± p; Pr), have been submitted to sclerotherapy applying the following method: injection of foam (Polidocanol 2%), or liquid sclerosant (iodate solution 4-6% or Polodocanol 3%) in the trunk of the GSV; echoguided compression of sapheno-femoral junction (performed using an inflatable device, the Safeguard); immediate eccentric positive compression on the trunk of the GSV; and short elastic bandage.The results have shown that applying this method of sclerotherapy the failure rate decreases, independently to physical form of sclerosing agent.The use of Safeguard® interrupts reflux to the lower veins, and these can so be well sclerosed and compressed with short elastic bandage.Long compression, Foam, Saphenous vein Sclerotherapy varicose veins.L’obiettivo del lavoro è stato quello di valutare l’efficacia di una nuova strategia nella scleroterapia dei tronchi safenici.Trecentoquarantacinque arti varicosi, con reflussi lunghi di VGS, sono stati sottoposti a scleroterapia col seguente metodo. Iniezione del tronco safenico di coscia di Polidiconalo in forma liquida al 3% in 85 casi (Gruppo A), di Polidocanolo in forma di schiuma al 2% in 80 casi (Gruppo B) e di soluzione iodata al 4-6% in 180 casi (Gruppo C). Essa è seguita da compressione immediata della vena con tamponi e bendaggio cortoelastico, associata a compressione emodinamica, consistente nell’interruzione del reflusso di crosse, ottenuta con l’applicazione di una medicazione (Safeguard) in corrispondenza della giunzione safenofemorale, e dotata di palloncino gonfiabile sotto controllo ecografico per controllare l’efficacia nell’interruzione selettiva del reflusso.L’adozione di questa strategia (detta HCS Hemodinamic Compression Sclerotherapy) ha ridotto il tasso di recidive delle VGS sclerosate con soluzione iodata. Inoltre alcuna differenza significativa era rilevata nel tasso di recidive fra i tre Gruppi.L’applicazione del Safeguard, in corrispondenza della giunzione safeno-femorale, migliora i risultati della scleroterapia, indipendentemente dall’uso di sclesclerosanti liquidi o in forma di schiuma, grazie all’interruzione del reflusso di crosse nelle vene sottostanti, consentendone così l’efficace compressione da parte del bendaggio ed evitando che il wash out da reflusso destabilizzi il consolidamento della sclerosi.

To explain the mode of using and the obtained results during EVLA procedures and sclerotherapies with support of Visioven®, a laser transillumination instrument.205 patients suffering from Chronic Venous Insufficiency - CEAP-C stage 1-2 enrolled (103 females and 102 males) and divided into two groups. A Group: patients candidate for sclerotherapy; B Group: patients to be subjected to endovascular laser ablation (EVLA). In both groups patients were divided into two sub-groups on the basis of the use of Visioven® or not during the procedure. The analyzed outcome variables were the total number of cannulations necessary to treat a whole limb, and the total procedure time.There is a statistically significant difference between the sub-groups in which Visioven® was used and the ones in which the procedure has been performed without using of any tools. Both in the sclerotherapy group than in the EVLA one, there is not a statistically significant difference for the time required to complete the procedures carried out with Visioven® compared with the ones performed without the use of any transillumination.Complete closure of the vein was highlighted. Total number of cannulations in sclerotherapy and EVLA procedures was reduced, as a consequence of a "smart" and "targeted" treatment achieved with Visioven® CONCLUSION: The VISIOVEN® system leads to have a more rational approach to sclerotherapy or Laser Ablation of teleangectasias and reticular veins as we can immediately verify the effectiveness of the treatment and adapting it to the desired effects.Chronic Vein Insufficiency, EVLA, EVLT, Laser, Varicose vein.Il lavoro presentato ha come scopo quello di illustrare le potenzialità dell’utilizzo e i risultati ottenuti con Visioven®, uno strumento transilluminazione venosa laser. Sono stati arruolati 205 pazienti (103 femmine e 102 maschi) affetti da insufficienza venosa cronica - con classe CEAP-C3 e divisi in due gruppi. Gruppo A: pazienti candidati alla scleroterapia; Gruppo B: pazienti da sottoporre a ablazione laser endovascolare (EVLA). In entrambi i gruppi i pazienti sono stati divisi in due sottogruppi sulla base dell’uso di Visioven® o meno durante la procedura. Le variabili di risultato analizzate sono state il numero totale di incannulazioni necessarie per trattare un intero arto, e il tempo totale necessario a terminare l’intera procedura. È stata evidenziata una differenza statisticamente significativa tra il sottogruppo in cui è stato usato Visioven® e quello in cui la procedura è stata eseguita senza l’utilizzo della transilluminazione, sia nel gruppo scleroterapia che nel EVLA. Per quanto riguarda il tempo necessario per completare la procedura, sia nel gruppo scleroterapia che nel gruppo EVLA, non vi è alcuna differenza statisticamente significativa nella procedura eseguita con Visioven® rispetto a quella eseguita in visione diretta. Il numero di cannulazioni nelle varie sessioni di scleroterapia è stato ridotto, a seguito di un trattamento “intelligente” e “mirato” Per questo si può concludere che il sistema Visioven® porta ad avere un approccio più razionale alla scleroterapia delle teleangectasie e vene reticolari, dal momento che si può verificare immediatamente l’efficacia del trattamento e modificarlo in corso d‘opera, necessario.

The authors have evaluated by ultrasound the CCSVI in Meniere's Disease.140 patients with diagnosis of Meniere's Disease, who have had not improvement to usual therapy, underwent echo color Doppler sonografy by Zamboni's protocol for the diagnosis of CCSVI . 128 were positive.Ultrasound diagnosis of CCSVI was performed in patients with Meniere's Disease with a positivity in 128 patients on 140 examinated (90% of cases). In healthy population the presence of CCSVI has been evident in 3% of cases.There is a significant prevalence of CCSVI in patients with Meniere's Disease KEY WORDS: CCSVI, Duplex US, Meniére Disease, Multiple Sclerosis.In questo lavoro gli autori hanno valutato la possibilità di diagnosticare l’insufficienza venosa cronica cerebro-spinale (CCSVI) nei pazienti affetti da sindrome di Meniére resistente alle terapie mediche. Da aprile 2013 al luglio 2014 sono stati valutati 140 pazienti, 85 femmine, 55 maschi di età compresa tra 32 a 68 anni, con un’età media di 46 aa, affetti da sindrome di Meniere clinicamente definita secondo i criteri AAO 1995. I pazienti sono stati sottoposti ad un esame eco-colordoppler delle vene del collo e dei vasi venosi intracranici secondo il metodo di Zamboni. L’esame è stato eseguito anche in 100 pazienti sani, non affetti da malattia neurologica o audiovestibolare, di età simile a quella dei pazienti arruolati nello studio. L’incidenza della CCSVI, diagnosticata secondo il protocollo sviluppato dal Prof. Zamboni, nei pazienti con sindrome di Meniere è stata del 90%, con una presenza di lesioni più gravi sul lato interessato in casi unilaterali. Nella popolazione di controllo sono state rilevate anomalie compatibili con la CCSVI in soli tre pazienti (3%) comunque asintomatici. Vi è un’alta incidenza di CCSVI nei pazienti con malattia di Meniere clinicamente definita, in una percentuale tale da mettere in dubbio un evento casuale, soprattutto data la bassa prevalenza nel gruppo di controllo.

To demonstrate the importance of preoperative ultrasound haemodynamic mapping of venous system in surgery of varicose veins.Doppler ultrasound evaluation of haemodynamic features of lower limb venous system according to Franceschi's subdivision.The importance of Doppler mapping in varicose veins surgery shows a similarity with the Plebographic classification of venous system developed by W. Hach. The study also reassesses the role of varicectomy in the surgery of varicose veins.Preoperative Doppler ultrasound mapping is essential to avoid accident and prevent recurrence of varicose veins.Doppler US, Surgery, Great Saphenous Vein, Varicose Veins, Stripping.Nella chirurgia delle varici, la conoscenza anatomica e ultrasonografica della giunzione safeno-femorale e delle sue tributarie, della giunzione safeno-poplitea e dei sistemi perforanti è essenziale per un buon trattamento, per evitare incidenti e prevenire recidive varicose. Il trattamento ablativo nella chirurgia delle vene varicose, è nato grazie al genio di Wolfgang Hach, precursore della procedura chirurgica conservativa finalizzata alla exeresi del solo tratto venoso patologico dopo valutazione clinica e flebografica. Successivamente la chirurgia ablativa emodinamica si è evoluta grazie agli studi emodinamici di Claude Franceschi e agli studi anatomici di Giuseppe Genovese. Nella pratica quotidiana, abbiamo notato una sovrapposizione tra i modelli di malattia varicosa studiati con Eco-color-Doppler e la classificazione anatomico-flebografica di Wolfgang Hach.

This paper aims to compare EVLA to traditional surgery, by evaluating the incidence of recurrences.We performed a meta-analysis to challenge both surgical and LASER treatment, using, as clinical outcome, the presence or the absence of reflux. A systematic review of literature about the treatment of varicose veins was performed, searching in the following databases: PUBMED-MEDLINE, Cochrane Library. Search terms considered were: stripping, HL/S, surgery, LASER, EVL*, varicose vein, GSV, saphenous vein. Only RCTs based at least on sixmonths follow-up were considered eligible in the study. Methodological quality of the included studies was evaluated using Cochrane Collaboration Bias Risk Assessment Tool. Effects of the dichotomous variables taken in consideration were evaluated using pooled risk-ratios with 95% C.I. Articles were evaluated initially from abstracts; eligible papers were fulltext examined.We have considered 2 groups, A and B. A Group: 756 legs treated with conventional surgical procedure; B Group: 755 legs treated with EVLA technique. A Group showed 175 post-procedure recurrences, while B showed 97 recurrences. The average O.R. was 1.72; minimum O.R. was of .497 while the maximum was of 8.064.The obtained OR average value is 1.72 with a 95% C.I. of 0.94-3.12, which includes the value 1, contrary to the criteria for rejection of the null hypothesis. For this reason there is not a statistically significant difference between the results obtained by the two techniques.The endovascular laser ablation (EVLA) does not prove to be superior in terms of recurrence, to the surgical technique. However, it remains a viable treatment option in patients with impaired great saphenous vein, reducing postoperative pain and hospital stay.Laser therapy, Meta-analysis, Saphenous vein, Surgery, Venous insufficiency.Questo lavoro si propone di confrontare la tecnica ablativa della vena safena interna con Laser Endovascolare alla chirurgia tradizionale, valutando l’incidenza di recidive.È stata eseguita una meta-analisi per confrontare la validità della tecnica endovascolare Laser con il trattamento chirurgico, utilizzando, come risultato clinico, la presenza o l’assenza di reflusso. È stata effettuata una revisione sistematica della letteratura sul trattamento delle vene varicose, con ricerca nei seguenti database: PUBMED-MEDLINE, Cochrane. I termini di ricerca considerati sono stati: stripping, HL / S, surgery, laser, EVL*, varicose vein*, GSV, saphenous vein. Sono stati considerati ammissibili nello studio Trials Randomizzati e Controllati (RCT) basati almeno su sei mesi di followup. La qualità metodologica degli studi inclusi è stata valutata utilizzando il Cochrane Collaboration Bias Risk Assessment Tool. Gli effetti delle variabili dicotomiche prese in considerazione sono state valutate calcolando il rischio relativo con un intervallo di confidenza al 95% .Gli articoli sono stati valutati inizialmente dagli abstracts; i documenti idonei sono stati esaminati full-text.Abbiamo considerato due gruppi, A e B. Gruppo A: 756 arti trattati con intervento chirurgico convenzionale; Gruppo B: 755 arti trattati con la tecnica EVLA. Il gruppo A ha mostrato 175 recidive postprocedura, mentre B ha mostrato 97 recidive. L’ODDS Ratio (O.R.) medio è 1,72; O.R. minimo è di 0,497, mentre il massimo è stato di 8,064.Il valore OR medio ottenuto è di 1,72 con un Indice di Confidenza al 95% di 0,94-3,12, che comprende il valore 1, contrariamente ai criteri di rifiuto dell’ipotesi nulla. Per questo motivo non vi è una differenza statisticamente significativa tra i risultati ottenuti con le due tecniche.L’ablazione endovascolare laser (EVLA) non dimostra di essere superiore, in termini di recidive, alla tecnica chirurgica. Tuttavia resta una valida opzione terapeutica nei pazienti con insufficienza della safena interna, riducendo la sintomatologia dolorosa postoperatoria e i tempi di degenza.

Considerations based on years of experience, have led our school to spare the superior collateral vein: the superficial epigastric vein.1536 selective epigastric-sparing crossectomies performed with the support of Duplex US to detect the normal functioning of terminal saphenous-fermoral junction and femoral valves.The selective-haemodynamic sapheno-femoral junction ligation" (although this is not strictly done), saves from ligation (but only in the presence of functioning femoral and saphenous terminal valves) and division the termination of the superficial epigastric vein into the common femoral vein.Superficial epigastric vein is a descending draining vessel, assisted by gravity (unlike the inferior collaterals). In case of obesity or portal hypertension, the spared superficial epigastric vein could drain into the common femoral vein keeping its anatomical and haemodynamic functions.The resulting anterograde flow will provide some flow through the residual saphenous stump, preventing its thrombosis.Duplex US, Ligation, Saphenous vein.Considerazioni basate su anni di esperienza, hanno portato la nostra scuola a preservare la vena collaterale superiore: la vena epigastrica superficiale. Questa rappresenta un vaso discendente che drena con l’ausilio della gravità (a differenza dei collaterali inferiori). In caso di obesità o ipertensione portale, la vena epigastrica superficiale risparmiata può defluire nella vena femorale comune mantenendo le sue funzioni anatomiche e emodinamiche. Questo concetto ci ha portato, ma solo in presenza delle valvole terminale femorale e safenica competenti, ad un “legatura selettiva emodinamica della giunzione safeno-femorale“ (anche se questo non viene fatto in modo rigido e sistematico), che evita la legatura dello sbocco della vena epigastrica superficiale nella vena femorale comune. Il flusso anterogrado risultante fornice un certo flusso attraverso il moncone di safena residuo, impedendone la trombosi.

Research of a starting point to debate about the possibility of identifying a unique sign of previous DVT.A retrospective study involving 202 outpatients with venous insufficiency of the lower limbs (CEAP classes C 4/6), classified according to the affected venous district. Patients positive for deep vein thrombosis (DVT) were subjected to Compression Ultra Sound test (CUS test) with measurement of the wall thickness at the point of formation of the thrombus and at fixed points of common femoral and popliteal veins used also in the patients with negative history of DVT RESULTS: Among total group, only 19 patients (9.40%) had an history of DVT. No one of them had a superficial incontinence. The measurement of wall thickness in positive DVT history patients (group A) resulted in an average value of 1.10 mm (s.d=0.06), while the average value obtained in negative DVT history (group B) was 0.55 mm (s.d.= 0.20). However, in 13 patients wall thickness was1mm (mean: 1.04 mm). The difference between the averages of group A and B was statistically significant (p0.05).In all positive DVT history patients and in 13 ones with negative history we found an increase in wall thickness, with a value1 mm. Can the wall thickening more than 1 mm be considered an indicator of previous DVT? Can it be considered a "marker" for thrombophilia status?The usefulness of a sign of previous DVT (even if asymptomatic), detected during a routine Doppler ultrasound check of lower limbs, could be a warning bell to investigate thrombophilia status.Chronic Venous Insufficiency, Duplex ultrasound, Hypercoagulability, Post-thrombotic Syndrome, Venous Thromboembolism.Lo scopo di questo studio è quello di fornire un punto di partenza per discutere circa la possibilità di individuare un segno ultrasonografico suggestivo di pregressa Trombosi Venosa Profonda (TVP). Abbiamo effettuato uno studio retrospettivo che coinvolge 202 pazienti ambulatoriali con insufficienza venosa degli arti inferiori (CEAP classi C 4/6), classificati in base al distretto venoso interessato. I pazienti positivi per TVP sono stati sottoposti ad un CUS test con misurazione dello spessore della parete nel punto interessato dal trombo e in punti specifici della vena femorale comune e della vena poplitea; tali punti sono stati utilizzati anche nei pazienti con anamnesi negativa per TVP Dell’intera popolazione esaminata, solo 19 pazienti (9,40%) presentavano in anamnesi un episodio di TVP, e nessuno di essi aveva una incontinenza del circolo superficiale. La misurazione dello spessore parietale, a 1 cm di distanza prossimalmente (in senso emodinamico) all’ostio safeno-femorale e a 1 cm distalmente allo sbocco delle vene gemellari sulla vena poplitea, nei pazienti con anamnesi positiva (gruppo A) ha dato come risultato un valore medio di 1,10 mm (sd = 0,06), mentre il valore medio delle misurazioni eseguite nei medesimi punti ottenuto nei pazienti senza anamnesi di TVP (gruppo B) è stato pari a 0,55 mm (sd = 0.20). Tuttavia, in 13 pazienti con anamnesi negativa il valore medio dello spessore della parete è stato1mm (media: 1,04 millimetri). La differenza tra le medie del gruppo A e B è statisticamente significativa (p0.05). La differenza tra la media dei valori misurati nel gruppo A e il sottogruppo della popolazione B con spessore parietale1mm non è statisticamente significativa. È lecito supporre che i pazienti del sottogruppo B avessero sofferto una trombosi venosa profonda asintomatica. Per questo motivo, la nostra ipotesi è che l’ispessimento parietale oltre 1 mm potrebbe essere considerato un indicatore di pregressa TVP. In linea con quanto supposto si potrebbe anche valutare di considerare l’ispessimento parietale “marker” per un maggior rischio di trombosi venosa profonda.

Presentation of a case of carotid stenosis in an elderly patient with multiple co-morbidities, and its management.Pre-operative management of an elderly patient affected by carotid artery stenosis with cardiac, metabolic and renal comorbidities and a recent history of buccal squamous carcinoma.Pre-operative anestesiologic assessment showed an increased risk for the presence of heart failure, cardiogenic pulmonary hypertension, mild/moderate stage renal disease.The frail elderly represents a real challenge for the surgeon, because in choosing treatment other options must be taken into account both in view of local disease and of various systemic comorbidities.Lo stroke è la terza causa di morte nel mondo occidentale dopo l’infarto del miocardio ed il cancro, con il 10-12% di tutti i decessi; l’eziologia ischemica riveste un ruolo preponderante (il 25% è su base embolica), per cui la stenosi aterosclerotica carotidea rappresenta un fattore di rischio. Lo studio NASCET ha provato l’utilità della chirurgia nel trattamento di tale patologia, tuttavia sotto precisi criteri di selezione. Il seguente caso riguarda un paziente affetto da stenosi carotidea che, pur rientrando nei criteri emodinamici di operabilità (percentuale e velocità di flusso), in considerazione delle comorbidità presenti alla diagnosi, non è stato possibile sottoporre a intervento di Trombo-Endo-Arteriectomia (TEA). Il paziente che si era affidato a noi si presentava completamente asintomatico e ciò è stato confermato anche dalla TC cerebrale cui è stato sottoposto dopo la diagnosi di stenosi. Considerando che la neoplasia del paziente, al momento della diagnosi, era al III stadio e che tale staging consente un tasso di sopravvivenza a 5 anni inferiore al 50% e che la TEA non è esente dal rischio di re-stenosi, si è ritenuto che tale procedura non poteva migliorare la prognosi del paziente. L’alternativa presa in considerazione, quindi, è stata l’angioplastica con stent. Tuttavia, se si valuta la non trascurabile possibilità di una recidiva locale della neoplasia, non si può escludere l’utilità di un ulteriore ciclo di radioterapia, con il rischio che questa possa determinare una stenosi in-stent, essendo, la neoplasia omolaterale alla stenosi da trattare. Per questi motivi è stata adottata una terapia conservativa con doppia antiaggregazione (Clopidogrel + Acido Acetil Salicilico). A 8 mesi, il paziente non ha sviluppato accidenti neuro-vascolari.

The minimally invasive approach to parathyroid glands represents an important field of application of radioguided surgery. As always happens, in all cases pertaining to hyper-specialized skills, scientific production has long been the prerogative of a few Authors, but the ever increasing technological diffusion, combined with excellent results often achieved, increases the interest in this technique. This is particularly true in the era of minimally invasive surgery. The Authors realize a review of the existing literature to allow an overall view of current knowledge on this particular topic and to guide future research.

Introduction Recent reports have demonstrated improvement in the 5-years serviva with resecate ductal adenocarcinoma. The aim of study is to determinate the factor influencing long-term survival after DCP. Materials and methods We have critically reviewed a group of 85 patients how were admitted to our department with diagnosis of ductal adenocarcinoma of the head of pancreas between January 1974 and January 1998. Results Patients were stratified according to stage using TNM classification; in stage I 31 patients with 5 T1aN0M0 disease, 11 patients with T1bN0M0 and 15 patients T2N0M0 disease. By contrast, in stage III 54 patients with 48 patients T2N1M0 and 6 patients with T3N1M0. Tumour size was recorded for 72 patients with a median of 3.8 cm. The R1 dissection was performed in 67 patients. The R2 resection was performed in 18 patients. In our series we verified and analysed the histopathologic features of 5 patients with 15-years survival (5.8%). The features regard age, male or female, tumours size, stage and positive lymph node resection. Discussion We found a specifically subset of patients where the combination of prognostic factors, in particular, negative surgical margins R0, tumour size ≤30 mm and the absence of lymph node metastasis independently reduced the mortality indicating that earlier tumour detection and histologically curative resection are important factors contributing to long term survival and healing of ductal adenocarcinoma of the head of the pancreas.

Introduction The annular pancreas is a congenital anomaly in which pancreatic tissue partially or completely surrounds the second portion of the duodenum. Its often located above of papilla of Vater (85%), rarely below (15%). This pancreatic tissue is often easily dissociable to the duodenum but there is same cases where it the tissue is into the muscolaris wall of the duodenum. Material and methods We describe three case of annular pancreas hospitalized in our facility between January 2004 and January 2009. There were 2 male 65 and 69 years old respectively and 1 female of 60 years old, presented complaining of repeated episodes of mild epigastric pain. Laboratory tests (including tumor markers), a direct abdomen X-ray with enema, EGDS and total body CT scan were performed to study to better define the diagnosis. EUS showed the presence of tissue infiltrating the muscle layer all around the first part of duodenum. Biopsies performed found the presence of pancreatic tissue with focal areas of adenocarcinoma. Subtotal gastrectomy with Roux was performed. The histological examinations shows an annular pancreas of D1 with multiple focal area of adenocarcinoma. (T1aN0M0). Results We performed a follow up at 5 years. One patients died after 36 months for cardiovascular hit. Two patients, one male and one female, was 5-years disease-free. Discussion Annular pancreas is an uncommon congenital anomaly which usually presents itself in infants and newborn. Rarely it can present in late adult life with wide range of clinical severities thereby making its diagnosis difficult. Pre-operative diagnosis is often difficult. CT scan can illustrate the pancreatic tissue encircling the duodenum. ERCP and MRCP are useful in outlining the annular pancreatic duct. Surgery still remains necessary to confirm diagnosis and bypassing the obstructed segment.

The Authors correlated intraoperative mucohaemorrhoidal prolapse morphology, specimen histology, anal canal length and purse-string height.Between September-November 2010, 18 patients (9 grade III; 9 grade IV haemorrhoids) underwent stapled haemorrhoidopexy. Mean age was 54 years (range 38-78).Proctoscopic prolapse morphology, anal canal length, pursestring height and external component were evaluated intraoperatively and specimens sent for histology.Intraoperative findings were as follows: 2/18 patients showed no procidentia, 2/18 'haemorrhoid type' prolapse, 14/18 'rectal type' prolapse. Mean anal canal lenght was 3.5 cm (range 2.5-4.5); mean purse-string height was 4.5 cm from the dentate line (range 3.5-5.5); 10/18 patients carried external component. Histology showed mucosa/submucosa in 4/18 cases, muscolaris propria in 9/18, perivisceral fat in 5/18. No procidentia/'haemorrhoid type' prolapse showed only mucosa/submucosa at histolgy; a 'rectal type' morphology showed at least the muscolaris propria. An anal canal3.5 cm related to 'haemorrhoid type' prolapse, a pursestring ≤ 4 cm and mucosa/submucosa at histology. An anal canal ≤ 3.5 cm related to 'rectal type' prolapse, a purse string4 cm from dentate line and at least the muscolaris propria. One patient required analgesics for7 days. At three months, 1/18 patient presented urgency, 2/18 stool clustering. In 1/18 patient a moderate grade of external component persisted.A possible correlation among anoscopic phenotype, specimen histology, pursestring height, might exist and influence clinical outcomes.A positive correlation between specimen thickness, purse-string height and 'rectal type' morphology was found. Patients with higher anal canal showed haemorrhoidal pattern of prolapse, a lower purse-string and mucosa/submucosa at histology.Intraoperative prolapsing tissue morphology could represent a further criteria for surgical decision.

To reassess selection criteria for Sentinel Lymph Node Biopsy (SLNB) in patients with thin melanoma (Breslow ≤ 1 mm).Between January 2004 and November 2010 we observed 6 patients with lymph node metastasis from early melanoma (Breslow ranging from 0.3 mm to 0.9 mm, not ulcerated tumor, mitosis/ mmq1). Nobody had received a prior study of sentinel lymph node so all patients underwent enlarged lymphadenectomy of concerned lymphatic stations and cancer re-staging.The pathological examination of lymph nodes has always confirmed metastatic melanoma. The average followup is currently 51,5 months: 3 of 6 patients presented recurrence that in one case led to death.In the event of a thickness1 mm the probability of finding a positive sentinel lymph node is about 7%. Recent data have demonstrated a significant survival advantage to early therapeutic lymphadenectomy in melanoma.Our experience, supported by the cases described and the literature, leads to propose the technique of SLNB to all patients with melanoma thicker than 0.5 mm, given the low morbidity and the important prognostic role of the procedure, in addition to the possibility of reducing the incidence of lymph node metastases.

Transanal microscopic surgery is an important application of minimally invasive surgery of rectum, allowing realization of complex transanal intervention.During the period between January 2002 and December 2010, seven patients, five men and two women, average age 75 years, with early rectal cancer recurrence were selected for this type of surgical palliative procedure. The selection of the patients is made by: transrectal ultrasonography, colonoscopy and abdominal ultrasonografy, to rule out liver metastases, CT with and without enema, PET CT. Follow-up is approximately 12-30 months.The pathologic staging confirms the complete excision of recurrences. Then patients are referred for more complementary therapies.The significance of conservative treatment for local recurrence of rectum adenocarcinoma is still controversial because the recurrence is an expression of tumor spread not controlled by oncological surgical and radio/chemo therapyIn selected subjects such as the elderly, based on equal oncological treatment, the reduction of surgical trauma, preservation of anatomical integrity and resolution of symptoms are important results.

Introduction Transanal microscopic surgery is an important application of minimally invasive surgery of rectum, allowing realization of complex transanal intervention. Patients and Methods During the period between January 2002 and December 2010, seven patients, five men and two women, average age 75 years, with early rectal cancer recurrence were selected for this type of surgical palliative procedure. The selection of the patients is made by: transrectal ultrasonografy, colonoscopy and abdominal ultrasonografy, to rule out liver metastases, CT with and without enema, PET CT. Follow-up is approximately 12-30 months. Results The pathologic staging confirms the complete excision of recurrences. Then patients are referred for more complementary therapies. Discussion The significance of conservative treatment for local recurrence of rectum adenocarcinoma is still controversial because the recurrence is an expression of tumor spread not controlled by oncological surgical and radio/chemo therapy. Conclusion In selected subjects such as the elderly, based on equal oncological treatment, the reduction of surgical trauma, preservation of anatomical integrity and resolution of symptoms are important results.

In this paper we wanted to evaluate the impact of pain reduction on the evolution of "difficult-to treat" ulcers, using Radiofrequency analgesia in pulse-dose modality.We have performed a randomized trial to evaluate the efficacy of the RF in PD mode to reduce the healing time of ulcers of difficult management as outpatient for spontaneous and provoked pain. We enrolled 23 patients, including 7 males (30%) and 16 females (70%), aged between 53 and 79 years (mean age = 67.2) sorted according to the first letter of the last name in ascending order and assigned alternately to one or another group.In Group A healing was obtained in 33% of patients (4/12), with an average healing time of 6 months while in Group B healing has been obtained in 81% of patients (9/11) with an average time of 3 months (range 1-5 months) Student's T was performed to compare the average recovery time among the two groups; moreover we have analyzed the proportions of healed patients in the group A and B.Healing time significantly decreased in group B (p = 0,013079). Even the cure rate has changed favorably, in a statistically significant way.According to the literature related to the use of the RF pulse dose, there is a greater effectiveness of this technique in respect of the classical PRF, in terms of immediate and long-term reduction of pain and this impacts positively on the course of ulcer healing.

http://www.sciencedirect.com/science/article/pii/S0748798312009377# ------ Background: Transanal microscopic surgery is an important application of minimally invasive surgery of the rectum, allowing complex intervention by transanal excision of full-thickness resection with anastomotic reconstruction. Transanal endoscopic microsurgery (TEM) can have a diagnostic and therapeutic value in the treatment of relapse in the elderly. Methods: Between January 2002 and December 2010, 7 patients (5 men and 2 women; mean age, 66 years) with early rectal cancer recurrence were selected for this palliative surgical procedure for recurrent tumor from adenocarcinoma of the rectum. Four men and 1 woman had undergone ultra-low anterior resection, followed by chemo- or radiotherapy (T3N1M0); one woman had received TEM (T1NxM0) and one man underwent local excision after neoadiuvant chemo/radio therapy (T2NxM0). The patients were selected according to rigid sigmoidoscope, echo transrectal colonoscopy and abdominal echo ultrasound to rule out liver metastases, computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen and pelvis, with and without contrast material, and positron- emission tromography-CT. The lesions were superficial (

Articolo presente su PubMed Central. Sourcerecord id Scopus 28558 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194374/ Background.More minimally invasive techniques are currently available for the surgical oncologist in the optimal staging of biliopancreatic cancer. With the increased age of population we can see an increase of age-related diseases, such a cardiovascular disease, hypertension, arthritis and other malignancies. With the development of endoscopy, laparoscopy, ultrasonography and biopsy equipment, more minimally invasive techniques are currently available for the surgical oncologist to provide a better optimal diagnosis and strategy, followed by an appropriate surgical treatment of biliopancreatic cancer. Improvement in the diagnostic and surgical care of elderly cancer patients will have a final impact on disease and overall survival rates of the different types of cancer treatment. Materials and methods.We retrospectively reviewed the records of patients between January 2001 and December 2008 who had either a mass in the biliopancreatic area classified as clinically resectable. Tumours were considered to be resectable when there was no evidence of distant extra pancreatic disease or involvement of lymphnodes outside the classic margins of resections. Occlusion or encasement of the superior mesenteric artery or vein, celiac artery or portal vein were used as a criteria for unresectability. Twenty-eight patients over 65 and under 75 years (middle age 69) with primary biliopancreatic cancer were submitted to operations for potentially operative resection. In all cases staging laparoscopy was performed just prior to planned open exploration and resection. Results.Twenty seven patients underwent laparoscopy exploration for potential resection. Two of five patients (40%) with distal cholangiocarcinoma survived at 5 years after DCP. Eighteen patients (66.6%) had unresectable disease identified at laparoscopy and fourteen were able to convert to laparotomy palliative surgery while for the others laparoscopy spared an unnecessary laparotomy. In four patients it was possible to perform a laparoscopy palliative surgery. Conclusions.Laparoscopy may have a role in the staging of patients with biliopancreatic malignancies, in particular, for reduction of unnecessary exploratory laparotomy. Moreover, even in old age, duodenocephalopancreasectomy, properly planned and executed, resulted in reduction of operative mortality and morbility and a clear long-term survival.

Articolo presente su PubMed Central. Sourcerecord Id Scopus: 28558 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194399/ Background.The majority of indications for surgery in melanoma are for the treatment of primary tumor and lymph node metastases. During the last decade, the Sentinel Node Biopsy (SNB), from a research procedure, has become standard of care in most institutions. SNB is normally considered for patients with melanoma > 1 mm and generally about 20% are positive; however, the risk of a positive SNB in a melanoma < 1 mm is still 5%. Usually when SNB is positive a complete lymphadenectomy is performed. Materials and methods.In the period 2004-2009, 18 elderly patients (median age 68 years) affected by cutaneous melanoma (mean Breslow’s thickness = 3.77 mm), after SNB histologically confirmed regional lymph node involvement, underwent complete lymph node dissection (CLND). We treated 11 of them with groin dissection, in 3 cases bilateral; 4 patients underwent axillar dissection, in one case bilateral; 2 patients underwent neck dissection and another patient underwent groin-axillar dissection. We treated bilateral groin involvement with laparoscopic access for dissection of lumbar-aortic, iliac and obturator lymph nodes. Results.Disagreeing with literature, 12/18 (67%) of these patients had positive lymph nodes, a high percentage if compared with younger patients’ data. Currently the average follow-up is 25 months. In our sample CLND has a crucial prognostic role (16% vs 41% of deceased in CLND – and CLND + patients respectively). Conclusions.Elderly melanoma patients are characterized by a higher tumor stage and, in patients with nodal metastases, the prognosis is independently affected by older age. In case of positive SNB the CLND plays a notable prognostic role and a presumable therapeutic role.

Recent studies suggest that insulin sensitivity is related to the fatty acid composition of phospholipids in skeletal muscle (SM) membranes. Since it is difficult to obtain muscle biopsies, it may be useful to have information on the fatty acid composition using more accessible cells such as erythrocytes. This would be possible only if the composition of erythrocyte and muscle membranes are very similar. Since no comparative data are available, we evaluated the phospholipid fatty acid composition of erythrocyte and SM membranes in 16 individuals, 10 nondiabetics (male to female ratio, 4:6; age, 50 +/- 11 years; body mass index, 27 +/- 5 kg/m2; mean +/- SD) and 6 type 2 diabetic patients (male to female ratio, 2:4; age, 64 +/- 5 years; body mass index, 27 +/- 4 kg/m2). All patients underwent abdominal surgery, during which a biopsy of the abdominal rectus muscle (50 to 100 mg) was obtained. Erythrocyte and SM phospholipid fatty acids were extracted and then methylated; the methyl fatty acids were separated and quantified by gas chromatography. Compared with erythrocyte membranes, muscle membranes showed a significantly higher proportion of omega-6 polyunsaturated fatty acid ([PUFA] 43.0% +/- 3.1% v29.7% +/- 1.6%, P.001) and lower saturated fatty acid ([SFA] 41.1% +/- 1.5% v 43.4% +/- 1.2%, P.001), monounsaturated fatty acid ([MUFA] 11.5% +/- 1.7% v 20.0% +/- 1.9%, P.001), and omega-3 PUFA (3.8% +/- 0.6% v 7.4% +/- 1.0%, P.001). The greatest increase involved linoleic acid (26.9% +/- 2.8% v 10.3% +/- 1.6%, P.001), whereas lignoceric acid (0.8% +/- 0.2% v 5.0% +/- 0.6%, P.001) and oleic acid (10.4% +/- 1.6% v 13.5% +/- 1.3%, P.001) were significantly lower. These results show that erythrocyte and muscle membrane phospholipid fatty acids are significantly different. Therefore, data on SM membranes cannot be extrapolated on the basis of measures of erythrocyte phospholipid fatty acid composition.

BACKGROUND: There are limited data on appropriate dosing of low-molecular-weight heparins (LMWHs) for venous thromboembolism (VTE) prophylaxis in bariatric surgery. The primary objective of this preliminary study was to evaluate the preoperative effects of increasing doses of the LMWH parnaparin on coagulation in severely obese patients undergoing bariatric surgery. METHODS: Severely obese patients (BMI > 50 kg/m(2)) were administered three increasing single doses of parnaparin (3200, 4250, and 6400 IU) on the three consecutive days leading up to biliointestinal bypass surgery. Activated partial thromboplastin time (APTT), anti-factor IIa and anti-factor Xa levels were measured 1 h before and 4 h after dosing. The highest dose (6400 IU/day) was continued from the day of surgery until day 30 (recovery period). Intermittent pneumatic compression and stockings were applied during surgery and the recovery period, respectively. Lower limb echoDoppler and phleboscintigraphy, and pulmonary scintigraphy were used for VTE detection. RESULTS: Ten patients (mean BMI 52.4 kg/m(2)) were recruited into this study. During the preoperative dosing phase, parnaparin dose-dependently prolonged APTT, with the 6400 IU dose significantly prolonging APTT versus the lower doses. Meanwhile, anti-factor Xa and anti-factor IIa activity was increased by the 4250 and 6400 IU doses. After surgery, one patient with heparin resistance experienced pulmonary embolization. No bleeding complications were observed. CONCLUSION: The dose-response data reported in this preliminary study suggest that parnaparin doses of 4250 and 6400 IU may provide effective prophylaxis for VTE in patients undergoing bariatric surgery. However, given the small number of patients, larger, well-controlled trials are required to confirm these findings.

Citato 93 volte in letteratura internazionale (Fonte: Scopus.com) ---- http://www.scopus.com/record/display.url?eid=2-s2.0-0034009904&origin=resultslist&sort=plf-f&src=s&sid=1BklTwBDkRxWaxt9FLi7YAz%3a70&sot=aut&sdt=a&sl=37&s=AU-ID%28%22Benassai%2c+Giacomo%22+6602920646%29&relpos=7&relpos=7&searchTerm=AU-ID(\"Benassai, Giacomo\" 6602920646) ----- Background and Objectives: Recent reports have demonstrated improvement in the 5-year actuarial survival for patients with resected ductal adenocarcinoma. The purpose of this study is to determine the factors favoring long-term survival after pancreaticoduodenectomy. Methods: Between 1974 and 1995, 75 patients with pancreatic head carcinoma underwent pancreaticoduodenectomy in our department. Results: Overall postoperative mortality rate was 5.3% and morbidity was 24%. Median survival following resection was 17 months. Estimated 1-, 2-, and 5-year survival rates were 68%, 46.7%, and 18.7%, respectively. Five-year survival was greater for node- negative than for node-positive patients (41.7% vs. 7.8%, P < 0.001) and for smaller (

http://www.sciencedirect.com/science/article/pii/S0748798312009936# ------- Background: According to current guidelines, the treatment for thin melanoma (T1a) is limited to surgical excision with a margin >1 cm. The prognostic factors in treatment planning must surely be re-evaluated, because we have encountered distant recurrence in patients with early melanoma so treated. Methods: Between January 2004 and November 2010, we observed 6 patients with lymph node metastasis from early melanoma (Breslow depth, 0.3 - 0.9 mm, not ulcerated tumor, mitosis/mm2