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Objective: The aim of this study was to assess the anatomical space above the perineal floor, under the properitoneal pelvic tissues, while attempting to capture its details and related surgical relevance in gynaecological oncology. Materials And Methods: The authors used 12 fresh surgical specimens of female cancer patients submitted to an extralevator abdomino-perineal rectal resection, "en monobloc" with a total hysterectomy and posterior colpectomy, or a total cystectomy plus hysterectomy. They obtained as many histological macro-slides, which have been investigated with anatomo-topographic intent. Results: The authors successfully identified a small anatomical structure with a simple texture of adipose tissue, a scanty network of blood and without proper lymph nodes or nervous plexuses, wrapping the lower parts of the pelvic organs and directly continuing back and up with the retroperitoneum. Conclusion: The lower pelvic space is a real anatomic structure, with a corresponding radiological imaging. It can be affected by primary tumors of the pelvic organs, and its excision can be considered in radical pelvic surgery. [ABSTRACT FROM AUTHOR]

Modern immunohistochemical techniques allow a detailed study of the lymphatic system in many organs and areas of the body. We performed an in-depth study on lymphatic vessels of the ileal and colonic mesenteries, together with the greater omentum where they appear particularly numerous and mainly represented by capillaries interconnected among themselves and with lymph nodes. The capillary wall consists of a fine single sheath of endothelial cells wrapped around by a subtle collagen membrane and deprived of valves. The progression of lymph flow is promoted by external forces acting on the capillary walls. Only at the mesenteric roots can pre- and post-lymph nodal collector vessels be observed. Our observations help to explain different patho-physiological correlations and the possible presence of skip lymph node metastases. [ABSTRACT FROM AUTHOR]

The acantholytic dermatosis of the vulvocrural area (ADVA) is a rare skin disorder of unknown etiology, described for the first time by Chorzelski et al. in 1984. It is characterized by solitary or multiple skin-coloured to white, smooth papules or plaques, involving the genitocrural region, in particular the vulva. Here, the authors refer a case of ADVA in an 80-year-old female patient affected by recurrent endometrial carcinoma. The immunohistochemical investigation demonstrated the exclusive presence of G immunoglobulins inside the skin lesions, so indicating a paraneoplastic immunological action. The findings shed light on the etiopathogenetic mechanisms at the basis of this still scantly known nosological entity. [ABSTRACT FROM AUTHOR]

The media carry stories of patients who, thanks to early diagnosis of malignancy, claim to have been saved by their cancer-sniffing pets. It is established that the brain of a dog features a wide olfactory cortex, compared to that of humans, where the visual cortex predominates. The cat also possesses an acute sense of smell, due to its well-developed olfactory bulb and a large surface of olfactory mucosa. A series of diagnostic hallmarks of malignancy have been defined, among which tumor necrosis. It is a form of hypoxic death resulting in an accumulation of cell debris and decomposing tissue. It is well known that the decomposition process produces foulsmelling molecules, such as cadaverine and putrescine. Given their remarkable sense of smell, it is more than likely that some pets are able to detect on themselves and in their owner's body the odor of tumor necrosis deriving from aggressive cancers. [ABSTRACT FROM AUTHOR]

Neoplastic spread to lymph nodes is one of the most important prognostic factors in female cancer and one of the well known TNM classification parameters, together with tumor size and distant metastases. The nodal status is in faet a significant predictor, which supports clinicians to decide on the most appropriate surgical approach and subsequent therapy. The precise intraoperative assessment of sentinel lymph node and eventual metastatic burden is therefore decisive for providing high diagnostic quality and reliable staging. Since methodologies differ across institutions, standardization of results is also a challenge. Today, one step nucleic acid amplification (OSNA) meets all these needs. [ABSTRACT FROM AUTHOR]

I Editor i The interesting study by Hobeika suggests non-invasive methods to evaluate the liver haemodynamics, important in cirrhosis and other conditions or prior to laparoscopic liver surgery1-3. We implemented a CT morpho-quantitative study of the intra-parenchymal venous network in a group of 30 patients with Child-B/-C liver cirrhosis. Using simple mathematical equations, we calculated the decrease in size of venous pedicles feeding liver segments and of the hepatic veins compared with the portal vein and the inferior vena cava. [Extracted from the article]

Objectives: Our aim was to investigate pathophysiology of pseudoaneurysm of the thoracic aorta, an acute or chronic pathology, respectively, secondary to blunt thoracic trauma and aortitis, or complicating a deep penetrating aortic ulcer, intraparietal hematoma, aortic aneurysm, and even aortic graft, often with atherosclerosis as a common background., Methods: Given the relative rarity of this disease, an "inductive" retrospective method made it possible to retrieve clinical, radiological, and histopathological elements, which were mutually compared and validated through a "deductive" process of reinterpretation., Results: We have identified three main structural constituents of this disease: a cavity, a single blood entry port, communicating with the aortic lumen, and a pseudocapsule. It is often caused by a chronic degenerative pathology of the intima and medial layers of the aorta, typically involving elastic fibers and smooth muscle cells, with possible intermediate stages of deep aortic ulcer or intraparietal hematoma. Otherwise, the acute onset may be secondary to acute aortitis or aortic injury., Conclusions: Today, thanks to the current angiographic tools represented by 3-D high resolution multidetector CT and MRI angiography, the diagnosis of thoracic aortic pseudoaneurysm is easier, as well as its surgical indications., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Coronavirus disease 2019 (COVID-19) is the most dramatic pandemic of the new millennium and patients with serious infection can stay in intensive care unit (ICU) for weeks in a clinical scenario of systemic inflammatory response syndrome, likely related to the subsequent development of critical illness polyneuropathy (CIP). It is in fact now accepted that COVID-19 ICU surviving patients can develop CIP; moreover, prone positioning-related stretch may favor the onset of positioning-related peripheral nerve injuries (PNI). Therefore, the urgent need to test drug candidates for the treatment of these debilitating sequelae is emerged even more. For the first time in medical literature, we have successfully treated after informed consent a 71-year-old Italian man suffering from post-COVID-19 CIP burdened with positioning-related PNI of the left upper extremity by means of ultramicronized palmitoylethanolamide 400 mg plus ultramicronized luteolin 40 mg (Glìalia), two tablets a day 12 hours apart for 6 months. In the wake of our pilot study, a larger clinical trial to definitively ascertain the advantages of this neuroprotective, neurotrophic, and anti-inflammatory therapy is advocated., (© 2024 Society for Indian Hand Surgery and Micro Surgeons. Published by Elsevier B.V. All rights reserved.)

SARS-CoV-2 virulence is known to increase with lowering of environmental temperature and solar ultraviolet radiation; therefore, we have focused our real-world nationwide study concerning with COVID-19 trend and dynamics on the coldest seasons of the year in Italy, the Western country hardest hit at the onset of the pandemic, comparing the autumn-winter of 2020 (before mass vaccination but when the emergency machinery was fully operative in terms of tracing and swabs) with the autumn-winter of 2021 (after mass vaccination), and analyzing the mortality burden by age groups and life stages in the years 2019 (pre-COVID-19), 2020 (before mass vaccination), and 2021 (after mass vaccination)., Methods: During the state of national health emergency, the Civil Defense Department released the aggregate data coming from the Higher Institute of Health, the Ministry of Health, the Italian Regions, and the Independent Provinces, to inform the population about the pandemic situation, daily. Among these data, there were the number of contagions, performed swabs, hospitalizations in Intensive Care Units (ICU), non-ICU patients, and deaths. By means of a team effort, we have collected and elaborated all these data, comparing the COVID-19 pandemic in Italy during the autumn-winter of 2020 with the autumn-winter of 2021. Moreover, we have extracted from the database of the National Institute of Statistics the total number of annual deaths in Italy during the years 2019, 2020, and 2021, comparing them to each other in order to evaluate the mortality burden attributable to COVID-19., Results: From the autumn-winter of 2020 to the autumn-winter of 2021, the contagions increased by ≈285%, against a ≈290% increase in the performed swabs; therefore, the mean positivity rate passed from 8.74% before mass vaccination to 8.59% after mass vaccination. The unprecedent vaccination campaign allowed a ≈251% abatement in COVID-19 deaths, and a reduction of ≈224% and ≈228% in daily ICU and non-ICU hospitalizations due to COVID-19, respectively. Regarding COVID-19 deaths, in 2020, there was a mortality excess of ≈14.3% quantifiable in 105,900 more deaths compared to 2019, the pre-COVID-19 year; 103,183 out of 105,900 deaths occurred in older adults (≥60 years), which is equivalent to ≈97.4%, while in adults over 50, the segment of population just below older adults, in 2020, there were 2807 more deaths than in 2019. Surprisingly, from the analysis of our data, it is emerged that in people under the age of 40 in the years 2019, 2020, and 2021, there were 7103, 6808, and 7165 deaths, respectively. This means that in subjects under 40 during 2020, there were 295 fewer deaths than in 2019, while during 2021, there were 357 more deaths than in 2020, equivalent to ≈5.2% more., Conclusions: COVID-19 is a potential life-threatening disease mainly in older adults, as they are the most vulnerable due to inherent immunosenescence and inflammaging. Extensive vaccination in this segment of population with up-to-date vaccines is the means to reduce deaths, hospitalizations, and ICU pressure in the public interest. In the event of future threats, a new mass vaccination campaign should not be implemented without taking into account the individual age; it should primarily be aimed at people over 60 and at patients of any age with immune deficits, and secondly at people over 50. COVID-19 vaccination shows a favorable benefit-risk ratio in older adults, while the balance steps down under the age of 40; this younger segment of the population should be therefore exempt from any mandatory vaccination.

Vascular sequelae following (SARS-CoV-2 coronavirus disease) (COVID)-19 infection are considered as "Long Covid (LC)" disease, when occurring 12 weeks after the original infection. The paucity of specific data can be obviated by translating pathophysiological elements from the original Severe Acute Respiratory Syndrome-Corona Virus (SARS-CoV-2) infection (In a microcirculatory system, a first "endotheliitis," is often followed by production of "Neutrophil Extracellular Trap," and can evolve into a more complex leukocytoklastic-like and hyperimmune vasculitis. In medium/large-sized vessels, this corresponds to endothelial dysfunction, leading to an accelerated progression of pre-existing atherosclerotic plaques through an increased deposition of platelets, circulating inflammatory cells and proteins. Associated dysregulated immune and pro-coagulant conditions can directly cause thrombo-embolic arterial or venous complications. In order to implement appropriate treatment, physicians need to consider vascular pathologies observed after SARS-Cov-2 infections as possible "LC" disease., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.