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Purpose: Poor response to bariatric surgery, characterized by insufficient weight loss (IWL) or weight regain (WR), poses a significant challenge in obesity treatment. This study aims to assess the effectiveness of liraglutide in addressing this issue., Materials and Methods: A retrospective, multicenter cohort study investigated the impact of liraglutide 3 mg on weight loss in adults with suboptimal responses or weight regain after bariatric surgery (BS). Additionally, a systematic review and meta-analysis were conducted for a comprehensive evaluation., Results: A total of 119 patients (mean age 41.03 ± 11.2 years, 71.4% female) who experienced IWL or WR after BS received pharmacologic therapy with liraglutide 3 mg. Mean percent weight loss in the entire cohort was 5.6 ± 2.6% at 12 weeks and 9.3 ± 3.6% at 24 weeks with a significant reduction in waist circumference (p < 0.0001). No serious side effects were reported. A meta-analysis, utilizing the fixed effect model with the metafor package in R, included 6 and 5 papers for the change in body weight and BMI after liraglutide treatment, respectively. The analysis demonstrated a considerable reduction in body weight (7.9; CI - 10.4; - 5.4, p < 0.0001) and BMI (3.09; CI 3.89; - 2.28, p < 0.0001)., Conclusion: Liraglutide 3 mg emerges as a viable option for significant weight loss in patients experiencing IWL or WR after BS. Its inclusion in a multimodal, sequential obesity treatment approach proves promising., (© 2024. The Author(s).)

European brown hare syndrome (EBHS) is a highly contagious and fatal viral disease, mainly affecting European brown hares ( Lepus europaeus ). The etiological agent, EBHS virus (EBHSV), belongs to the Lagovirus genus within the Caliciviridae family. The Italian hare ( Lepus corsicanus ) is endemic to Central-Southern Italy and Sicily and is classified as a vulnerable species. L. corsicanus is known to be susceptible to EBHS, but virological data available is scarce due to the few cases detected so far. In this study, we describe the occurrence of EBHS in two free-ranging L. corsicanus, found dead in a protected area of Central Italy. The two hares were identified as L. corsicanus using phenotypic criteria and confirmed through mitochondrial DNA analysis. Distinctive EBHS gross lesions were observed at necropsy and confirmed by subsequent histological examination. EBHSV was detected in the livers of the two animals initially using an antigen detection ELISA, followed by an EBHSV-specific reverse transcription-PCR, thus confirming the viral infection as the probable cause of death. The EBHS viruses detected in the two hares were identical, as based on blast analysis performed for the VP60 sequences and showed 98.86% nucleotide identity and 100% amino acid identity with strain EBHSV/GER-BY/EI97.L03477/2019, isolated in Germany in 2019. Phylogenetic analysis places our virus in group B, which includes strains that emerged after the mid-1980s. This study supports previous reports of EBHS in L. corsicanus and further expands the knowledge of the pathological and virological characteristics of the etiological agent. The ability of EBHSV to cause a fatal disease in the Italian hare represents a serious threat to the conservation of this vulnerable species, especially in populations kept in enclosed protected areas., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Domanico, Cavadini, Nardini, Cecca, Mastrandrea, Eleni, Galietta, Attili, Pizzarelli, Onorati, Amoruso, Stilli, Pacchiarotti, Merzoni, Caprioli, Ricci, Battisti, Lavazza and Scicluna.)

Background: Toumeyella parvicornis is an invasive soft scale insect native to North America that is rapidly spreading in Italy and France, provoking severe infestations on Pinus pinea L. To date, the control of this pest is entrusted to three endotherapic techniques whose short-term efficacy is partially known. No information on long-term efficacy is currently available, although fundamental. This work aims to report on the long-term effect that abamectin-based insecticides, injected with the three different techniques, have on adult female populations., Results: The study was carried out in an infested P. pinea forest in the area of Rome, Italy. Results showed that the tested methods had a similar long-term effect, and only in one case there were differences with the untreated control. Multiresidue analysis reported a zero level of abamectin in plant tissues 14 months apart from injection, except for one treatment where pesticide concentration was just above the limit of quantification., Conclusions: This study represents the first long-term evaluation about endotherapic control strategy against T. parvicornis. In fact, the pest may quickly bring the death and fall of the stone pines, representing a concerning risk for citizens, however, control actions to manage it are still partially known and deserve more in-depth investigations. © 2023 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry., (© 2023 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.)

One of the most important abilities of a tumor is to establish a state of immunosuppression inside the tumor microenvironment. This is made possible through numerous mechanisms of tumor immune escape that have been identified in experimental studies during the last decades. In addition, the hepatic microenvironment is commonly oriented towards a state of immune tolerance because the liver receives blood from the hepatic arteries and portal veins containing a variety of endogenous antigens. Therefore, the hepatic microenvironment establishes an autoimmune tolerance, preventing an autoimmune reaction in the liver. On this basis, hepatic tumor cells may escape the immune system, avoiding being recognized and destroyed by immune cells. Moreover, since the etiology of Hepatocellular Carcinoma (HCC) is often related to cirrhosis, and hepatitis B or C, this tumor develops in the context of chronic inflammation. Thus, the HCC microenvironment is characterized by important immune cell infiltration. Given these data and the poor prognosis of advanced HCC, different immunotherapeutic strategies have been developed and evaluated for these patients. In this review, we describe all the clinical applications of immunotherapy for advanced HCC, from the drugs that have already been approved to the ongoing clinical trials.

Rationale: According to scientific literature, cryoablation (CA) and electrochemotherapy (ECT) have been used for the treatment of small renal masses. However, no data have been published regarding the combination of these techniques as therapy of primary kidney cancers. Therefore, we report the case of an old woman affected by localized kidney cancer and discuss the potential therapeutic application of CA combined with subsequent deep ECT in this setting., Patient Concerns: An 85 years-old-woman was evaluated because of a localized kidney cancer. Her background history included long-time hypertension and diabetes mellitus in drug treatment., Diagnoses: In February 2018, the follow-up contrast enhancement computed tomography (ceCT) documented a suspected 18×10 mm metastasis at the lower right lobe of the lung. The ceCT also showed a suspected primary malignancy of 25×18 mm at right kidney., Interventions: The kidney cancer was treated with a two-phase procedure: percutaneous CA and subsequent deep ECT., Outcomes: Patient obtained a complete response according to modified Response Evaluation Criteria in Solid Tumors, without renal function or quality of life impairment. No procedure-related complications were observed. Moreover, a shorter period of hospitalization and convalescence were needed respect to standard surgery. No sign of relapse was observed during follow-up period., Lessons: This combined strategy proved to be safe and effective. Moreover, the application of these blended loco-regional techniques showed several other advantages such as reduced hospitalization and a shorter period of convalescence respect to standard surgery., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

The complexity of cancer patients and the use of advanced and demolitive surgical techniques frequently need post-operatory ICU hospitalization. To increase safety and to select the best medical strategies for the patient, a multidisciplinary team has performed a new peri-operatory assessment, arising from evidence-based literature data. Verifying that most of the cancer patients, admitted to the intensive care unit, undergo major surgery with localizations in the supramesocolic thoraco-abdominal area, the team focused the attention on supramesocolic peridiaphragmatic cancer surgery. Some scores already in use in clinical practice were selected for the peri-operatory evaluation process. None of them evaluate parameters relating to the entire peri-operative period. In detail, only a few study models were found that concern the assessment of the intra-operative period. Therefore, we wanted to see if using a mix of validated scores, it was possible to build a single evaluation score (named PERIDIAphragmatic surgery score or PERIDIA-score) for the entire peri-operative period that could be obtained at the end of the patient's hospitalization period in post-operative ICU. The main property sought with the creation of the PERIDIA-score is the proportionality between the score and the incidence of injuries, deaths, and the length of stay in the ward. This property could organize a tailor-made therapeutic path for the patient based on pre-rehabilitation, physiotherapy, activation of social assistance services, targeted counseling, collaborations with the continuity of care network. Furthermore, if the pre-operative score is particularly high, it could suggest different or less invasive therapeutic options, and if the intra-operative score is particularly high, it could suggest a prolongation of hospitalization in ICU. The retrospective prospective study conducted on 83 patients is still ongoing. The first data would seem to prove an increase of clinical complications in patients who were assigned a one-third score with respect to the maximum (16/48) of PERIDIA-score. Moreover, patients with a 10/16 score within each phase of the evaluation (pre, peri, and post) more frequently develop injuries. In the light of these evidence, the 29-point score assigned to our patient can be considered as predictive for the subsequent critical and fatal complications the patient faced up., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Andresciani, Calabrò, Laforgia, Ronchi, De Summa, Cariddi, Boccuzzi, De Rosa, Rizzo, Losito, Bradascio, Napoli, Simone, Carravetta and Mastrandrea.)

Incisional hernia after laparotomy closure continues to be an important postoperative complication. Historically, the best results have been obtained with the open Rives-Stoppa technique. This approach is done by fixing a prosthetic mesh behind the posterior fascia of the rectus muscle. The laparoscopic approach allows similar mesh placement with minimal dissection. In this study, we review the scientific literature and report our experience, describing the clinical outcome of patients who have undergone laparoscopic repair of ventral hernias. After describing the standard technique of laparoscopic insertion of a prosthesis, we reviewed the records of all our patients who underwent such a procedure from March 2004 to January 2006. A laparoscopic approach was attempted in all patients. The patients' demographic characteristics, operative details and outcomes were recorded. Of 55 patients scheduled to undergo laparoscopic incisional herniorrhaphy, conversion to an open procedure was necessary in 2/55 (3.6%). All the remaining 53 patients (31 men and 22 women; mean age 51.8 years) underwent laparoscopic repair of ventral hernias. The mean fascial defect size was 98.3 cm (range: 5-200 cm). In 52/53 patients (98%) a dual mesh was used. 40% of patients (22/53) had multiple wall defects. The mean operative time was 90 minutes (range: 32-190 minutes). The average hospital stay was 2.6 days (range: 1-16 days). 50/53 patients (94.3%) tolerated an oral diet 24 hours after the operation. 49/53 (92.4%) returned to normal working activity within two weeks. The percentage of complications amounted to 13% (7/55), with 5.6% (5/53) minor and 3.7% (2/55) major complications. In one patient it was necessary to remove the mesh 6 months after surgery because of pain. The recurrence rate of 5.6% confirms the permanence of the repair. The follow-up was 12 months for 44/53 patients and 6 months for 9/53 patients. The procedure for incisional hernia repair used in our study may be performed safely with low complication and recurrence rates and should be considered for the majority of incisional hernia repairs requiring a mesh prosthesis.

Objective: The authors report their experience about the treatment of choledochocele., Design: Case report and 6-months follow up., Setting: Operative Unit of General and Thoracic Surgery, Department of Surgical and Anatomical Disciplines. Policlinico, University of Palermo., Interventions: ERCP + ES with complete resolution of pathology., Result: Complete resolution of symptoms; 6-months follow up negative., Conclusions: ERCP is choice treatment of choledochocele, only in well experienced teams.

Background: Colon diverticular disease represents an affection with high prevalence in the western countries. It appears particularly insidious in the elderly population for the presence of concomitant illnesses., Clinical Case: A patient (> 80 years old) is submitted to surgical intervention in emergency sec. Hartman for acute diverticulitis and pelvic abscess. The post-operating time has been complicated for the arising of a fever resistant to the common antibiotic therapy, in absence of abdominal and respiratory objectivity. An accurate clinical examination has set the suspect of bacterial endocarditis, confirmed to the echocardiographic examination., Discussion: The acute complicated diverticulitis therapy variates in according to the clinical presentation, the complications and the experience of the different Authors. A first conservative approach foresees the Total Parenteral Nutrition (TPN) and the wide spectrum antibiotic therapy and the eventual percutaneous drainage. The surgical treatment, realized with "open" or laparoscopic method, foresees the resection of the sick intestinal tract and the packing of a temporary preternatural anus. However, some Authors prefer an intestinal anastomosis performed in single time with the resection. Among all the complications, the most frequent are those affecting the respiratory and cardiovascular apparatus, as well as the sepsis. The bacterial endocarditis is not signalled in most recent international Literature., Conclusion: The bacterial endocarditis must be suspected in case of common antibiotic therapy resistant fever, with negative abdominal and pulmonary objectivity, arising after a septic surgical intervention.

The authors describe a case of intestinal cystic pneumatosis in a patient submitted to gastric banding and then proceed with a critical review of the literature on the subject, examining the state of the art with regard to the pathogenetic hypotheses and the clinical manifestations of the disease and outlining the advantages of the instrumental investigations employed. On the basis of clinical considerations, an integrated pathogenetic hypothesis is advanced which takes account of the various indications expressed in the literature. In particular, recurrent vomiting is believed to bring about epithelial microlesions which, in the presence of severe respiratory impairment, the execution of endoscopic examinations and a mainly carbohydrate-based diet, are thought to cause onset of cystic pneumatosis.

In this paper the authors report a case of carcinoid neoplasm in a rare localization like sigmoid colon. They describe the clinical and biological aspects of this kind of tumors, with particular regard to the tumor site and its biochemical products. A rational and prompt clinical approach to this neoplasm is considered important for the good chance of long survivals, achievable in the case of early diagnosis.

Thirty-three consecutive patients with recurrent and/or metastatic colorectal carcinoma (CRC) refractory to previous chemotherapy have been treated with levofolinic acid (I-FA) 100 mg/m2 i.v. over 1 h infusion followed by 5-fluorouracil (5-FU) 600 mg/m2 i.v. bolus every week for 6 weeks followed by a 2 week interval. Patients also received rIL-2 s.c. at 3 MU daily from day 1 to day 5 of each week for at least four consecutive weeks per cycle. Enrolled patients were divided in two groups: (i) group 1 including patients with progressive tumor refractory to chemotherapy with I-FA + 5-FU given for metastatic disease and (ii) group 2 consisting of patients with diagnosis of metastatic disease within 3 months from the completion of adjuvant chemotherapy with 5-FU + levamisole (LEV) after primary surgery. No objective response was observed in the group of 11 patients with CRC resistant to previous I-FA + 5-FU, thus no further patient with progressive disease after I-FA + 5-FU was included in the trial. In the group of patients pretreated with 5-FU + LEV, four patients experienced a PR with a mean duration of 7.3 months (range > or = 4.0-8.6) for an overall response rate of 18% (95% CI 12-26%). A stabilization of disease was observed in five cases (23%) with a mean duration of > or = 5.6 months (range > or = 2.0-7.0). The remaining 13 patients progressed. No complete responses were achieved. The mean overall survival was > or = 9.5 months (range > or = 2.0-14.0). Toxicity was generally mild. This study demonstrates that the combination of s.c. rIL-2 and intravenous 5-FU + I-FA on a weekly schedule may be safely given to patients with metastatic CRC on an outpatients basis. The addition of low-dose rIL-2 does not modify the toxicity profile of 5-FU + I-FA, even if IL-2-related side-effects such as systemic symptoms or cardiac abnormalities are to be expected. The clinical activity of the combination is not good, at least in terms of response rate, even if the duration of partial responses may suggest to test rIL-2 in a prospective study with response duration and overall survival as the final end-points.

Obesity, a pathology with a multifactorial etiopathogenesis currently has an incidence of around 6% in the adult population in Italy. Considering that this disease provokes a statistically significant reduction of life expectancy, there is an evidence need to create structures which can deal with this problem. For this purpose, the Centre for the prevention and cure of obesity was set up by the Department of Surgery and Anatomy at the University of Palermo in 1990. It makes use of the specialist skills of experts in internal medicine, dieticians, cardiologists, psychologists and surgeons. In particular the authors give a detailed description of the diagnostic iter used and the methods of follow-up adopted for patients undergoing biliopancreatic diversion (BPD) surgery. In conclusion, the authors emphasize the need for a multidisciplinary approach to this pathology since this is the only way of minimizing complications arising during BPD surgery and obtaining the best results.

The authors discuss the problem of venous thromboembolism as a complication of bariatric surgery. They consider obese patients at risk for these complications, even if different opinions exist about this topic in the literature. They report their experience in bariatric surgery consisting of 53 patients submitted to biliopancreatic diversion. Antithrombotic prophylaxis consisted for every patient in elastic bandaging of the lower limbs, preoperative hemodilution, early post-operative mobilization, and subcutaneous heparin. Complications consisted in one popliteo-femoral deep venous thrombosis (DVT) (1.6%), and two pulmonary embolisms (PE) (3.2%) of which one caused patient's death; total morbidity for venous thromboembolism. These results compared with literature are similar with other series of bariatriac surgery and slightly higher than general surgery series. This difference is not however significant. Even in the absence of this significance, thromboembolism, as desumed from more than 2900 cases considered in the literature, remains the main cause of morbidity and mortality in the post-operative course of bariatric surgery patients, deserving particular attention in terms of prevention, also because of difficulty existing in early clinical diagnosis of DVT in obese people. Further studies intended to identify pathogenesis and risk factors of venous thromboembolism in obese people will allow a more correct prophylactic and therapeutic approach.

In this paper the authors consider the problem of incisional hernias as late complications of bariatric surgery. After a description of relationships between obesity and incisional hernias they report their experience on this topic, consisting of 56 patients submitted to bilio-pancreatic diversion between March 1989 and September 1991, for surgical treatment of morbid obesity. Incisional hernias developed in 28% of cases. Analysis of some risk factors like infections, epidemiological patterns, materials and techniques used to suture the abdominal wall, has not allowed identification of significant associations with incisional hernias occurrence. Only early reinterventions (3 cases) have always determined a subsequent development of incisional hernias. The authors confirm the close relationship existing between obesity and incisional hernias. They suggest incisional hernia repair to be undertaken once weight loss has terminated and stabilized, and in the absence of other specific or aspecific morbid obesity surgery complications.

In this paper the authors discuss about prophylactic cholecystectomy in bariatric surgery. Having analyzed the mechanisms that increase bile lithogenicity after bariatric surgery, they evaluate advantages and disadvantages of prophylactic cholecystectomy. They present 53 obese patients submitted to biliopancreatic diversion and prophylactic cholecystectomy for surgical treatment of morbid obesity, because of the high incidence of pathological findings in the specimens and the absence of surgical complications related to cholecystectomy, the authors, in agreement with the literature, suggest routine cholecystectomy as an obvious adjunct to bariatric surgery. This attitude protects against the higher risk of subsequent cholecystectomy and against the misinterpretation of non-invasive diagnostic tests too, because of known limits of echography in obese people.

The Authors discuss the instrumental diagnosis of portal hypertension, comparing echo-Doppler and splenoportography by celiac artery catheterization, performed on 42 patients with cirrhosis. From the data obtained, there may be observed a clear correlation between angiographic and echographic criteria, correlated to the degree of illness. In particular echo-Doppler whether it possible, in a non-invasive way, to control the evolution of progressive haemodynamic resistance, and hepatic and splenic parenchyma, leaving to splenoportography the role to depict anatomic characteristics of portal circulation for a correct surgical program.

The Authors consider the complex diagnostic problems of cerebrovascular disorders, with particular concern to angiography and echography. After a complete analysis of different aspects of angiographic and echographic lesions, considering their experience, they identify chances and limits of the two methods, they draw the conclusion that each of the two techniques has a proper role, and only a correct correlation between them can depict correctly the pathologic lesions.

We describe our experience with 12 patients with severe fibrotic lymphedema treated between 1979 and 1987. Each patient initially underwent nonoperative treatment (postural drainage and pneumatic compression) and in 10 patients who required operation, these measures were continued postoperatively. Operation included excision of subcutaneous tissue (debulking), which was extensive in 8 and limited in 2 patients. Only 2 patients were satisfactorily managed by nonoperative treatment alone. Based on the extensive pathophysiologic changes that occur in the tissue microenvironment with lymph stasis, it is unlikely that at this advanced stage of lymphedema that nonoperative treatment alone or "physiologic" operations such as lymphatic-venous shunt or lymphatic collector reconstruction is satisfactory. Rather, nearly all such patients require limited or extensive excision of the fibrotic-edematous subcutaneous tissue.

In this paper the Authors discuss about femoral anastomotic pseudoaneurysms. They throughly consider the etiopathogenesis of this late complication of arterial prothesic surgery, pointing out the different hypothesis currently discussed. Particularly from this analysis it can be concluded that the choice of appropriate prothesic grafts and the weakness of an eventually endarterectomized arterial wall are the principal determinants in causing pseudoaneurysms. Between the different therapeutic choices the opportunity of an interposition graft is underlined, except for (rare) cases when an extra-anatomic bypass must be preferred.

The authors state the results of their research on the modification of the aqueous humor caused by the instillation of the Clonidine in a group of ten rabbits. The results of these studies illustrate the variations of pH, the ocular tone, the concentration of lactic and ascorbic acid. In all the rabbits examined was instillated Clonidine for one hour in RE while in LE distilled water was instilled for the control. For two hours from the beginning of the experiment every 10 minutes measurements of the ocular tone in both eyes were taken. At the end of two hours a sample of aqueous humor was taken from LE and RE. It was found that: 1) The drugs produced a vary quick and prolonged decrease of the ocular tone. 2) There are no significant variations in the pH or in the concentration of lactic acid. 3) There was a notable reduction of the concentration of ascorbic acid.

The Authors state the results of their research on the modification of the aqueous humor caused by the instillation of the Clonidina to the concentrations of 0,I25% in a group of ten rabbits. The results of these studies illustrate the variations of pH, the ocular tone, the concentration of lactic and ascorbic acid. In all the rabbits examined Clonidina was instillated in the RE while in the LE distilled water was instillated for the control. For two hours from the beginning of the experiment, every IO minutes measurements of the ocular tone in both eyes were taken. At the end of the two hours a sample of aqueous humor was taken from the RE and LE; It was found that: I) The drugs produced a very quick and prolonged decrease of the ocular tone. 2) There are no significant variations in the pH or in the concentration of lactic acid. 3) There was a notable reduction of the concentration of ascorbic acid.

The authors state the results of their research on the modification of the aqueous humor caused by the instillation of the Epinephrine in a group of ten rabbits. The results of these studies illustrate the variations of pH, the ocular tone, the concentration of lactic and ascorbic acid. In all the rabbits examined Epinephrine was instillated in the RE while in the LE distilled water was instillated for the control. For two hours from the beginning of the experiment, every 10 minutes measurements of the ocular tone in both eyes were taken. At the end of the two hours a sample of aqueous humor was taken from the RE and LE; It was found that: 1) The drugs produced a vary quick and prolonged decrease of the ocular tone. 2) There are no significant variations in the pH or in the concentration of lactic acid. 3) There was a notable reduction of the concentration of ascorbic acid.

Aetiopathogenetic mechanisms and clinical aspects of carotid artery aneurysms are examined and personal experience of arterial reconstruction in one case reported.