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Background: Colorectal cancer (CRC) is the second most common gastrointestinal tumor in men and the third in women. Left-hemicolectomy (LC) and low anterior resection (LAR) are considered the gold standard curative treatment. In this retrospective study, we evaluated the presence or absence of post-operative complications, in all patients who underwent Video-laparoscopic (VLS) LAR/LC with No Coil trans-anal tube positioning, and compared the data with the current literature on the topic. Methods: Thirty-nine patients diagnosed with CRC of the descending colon, splenic flexure, sigma, and rectum were recruited. LC was performed for sigmoid and descending colon cancers, while LAR was applied for tumors of the upper two-thirds of the rectum. The No Coil trans-anal tube (SapiMed Spa, Alessandria, Italy) was placed in all patients of the study at the end of surgical treatment. Results: Eighteen patients received a LAR-VLS (46%) and 21 patients received a LC-VLS (54%). The average length of hospital stay after surgery was 7 days. PPOI occurred in only one in 39 patients (2.6%) who had undergone LAR-VLS. As for complications, in no patient of the study did AL (0%) occur. Conclusion: In patients undergoing LAR-VLS and LC-VLS, we performed colorectal anastomosis and in the same surgical operation we introduced the No-Coil device. Although this is a preliminary study and subject to further investigation, we believe that the No Coil tube positioning may reduce the time of presence of first flatus and feces and the risk of AL. [ABSTRACT FROM AUTHOR]

This paper proposes a semiparametric analysis of proportional hazards models. This approach consists in specifying the relation between a duration and explanatory variables, without specifying the data distribution. The parameters involved in this relation are then considered as parameters of interest, and the data distribution is treated as a nuisance parameter. We propose a Bayesian estimation method, the principle of which is to specify a prior distribution on the nuisance parameter. We then obtain semiparametric estimators for the parameters of interest, by computing their posterior distribution, conditional on the data and integrated with respect to the nuisance parameter.

Aim: Post-operative surgical wound management is still a much debated topic and in clinical practice there is no definitive treatment guideline. There are several methods for dressing the post-operative wound: bare wound or wound covered with sterile gauze; in the first case, self-management is simple, but the infection rate is slightly higher; in the second case self-medication is more difficult. We have not found any studies in the literature that analyze the efficacy, safety and comfort of home self-medication of post-operative surgical wounds: the purpose of this work is the evaluation of the three aforementioned items with the use of a biodynamic rechargeable taping. Method: We subjected 628 patients, operated in elective clean surgery, to post-operative medication, from the second day, with biodynamic* microcell taping with gradual release of Ozoile®, refillable with Ozoile®-based Spray**; daily refill and replacement every five days. At the sutures removal (random with silk, prolene and metal clips) each patient was subjected to a questionnaire to evaluate the surgical wound management, and the possible appearance of infection of the surgical site was evaluated with ASEPSIS SCORE. Results: all 628 patients evaluated the home management of the medication as extremely simple; no induced pain, no postoperative complications of the surgical wound, no adverse events and no allergies. Conclusion: Post-operative dressings with rechargeable biodynamic taping can be considered effective, safe, easy to manage even in self-medication and with a high evaluation of well-being by the patient. *Rigenoma Nastro Ricaricabile **Rigenoma Spray (Erbagil, Italy) [ABSTRACT FROM AUTHOR]

Scopo: management of distal phalangeal amputations depends on its level. When the nail is intact, it's necessary to preserve it but when the lesion is more proximal, maintaining the nail is normally useless and hypersensitivity or pain may appear: so it's preferable to remove the small part of the nail with its root and cover it with a split thickness skin graft. Aim of this work is to demonstrate the effectiveness of Ozoile®-based dressings for the treatment of fifth finger distal phalanx amputation with nail residue preservation. Metodi: parcel amputation of the fifth finger distal phalanx including the nail (Allen 3) in a 7-year-old girl, due to a domestic accident; the amputated part had partial nail residue. After RX showing partial amputation of the distal phalanx bone as well, the patient underwent skin grafting with the amputated phalanx and preservation of a minimal residue of the nail root. Medication with spray and gauzes containing Ozoile®, a pool of stable ozonides derived from olive oil*. Dressing change every 48 hours. We evaluated infection signs onset, pain and Healing Time. Risultati: Complete healing within one month (HT 28 days); pain was greatly reduced already after the first medications (NRS <4). Once healed, a sensitivity check was performed which revealed a complete recovery of neurosensory activity. Conclusioni: Contrary to the surgical treatment indications, we observed the effectiveness of Ozoile®-based dressings in the treatment of the fifth finger distal phalanx amputation even if there's a nail residue. * Rigenoma Spray/Gauzes (Erbagil-Italy) [ABSTRACT FROM AUTHOR]

Chronic venous insufficiency ( CVI) is the most advanced form of chronic venous disease ( CVD), and is often associated with skin changes such as hyperpigmentation, eczema, lipodermatosclerosis and venous skin ulceration that cause discomfort, pain, sleep disturbances, absenteeism in the workplace, disability and deteriorated quality of life ( QoL). The purpose of this study is to evaluate the prevalence of CVI and skin changes in patients who turn to Continuous Assistance Services due to the presence of disturbing symptoms of their condition. Data were evaluated by consulting the medical records, during a 16-month period, available with three Continuous Assistance Services of the Italian territory. The overall population of the referring centres consisted of 1186 patients [739 females (62·31%) and 447 males (37·69%)]. Seventy-nine patients (6·66%) consulted the emergency unit for venous symptoms related to CVD. Patients with more severe disease ( CVI, categories C4-C6) represented the majority accounting for 60·75%, while patients with moderate disease ( C3) accounted for 35·44% and patients with mild disease ( C1-C2 stages) accounted for 3·79%. The main finding of this study is that despite CVI not being a disease that commonly requires medical emergency/urgency intervention, patients with CVI, especially in advanced stage with skin changes, may turn to Continuous Assistance Service for treating bothersome symptoms related to their condition. [ABSTRACT FROM AUTHOR]

Introduction: Smartphones changed the method by which doctors communicate with each other, offer modern functionalities sensitive to the context of use, and can represent a valuable ally in the healthcare system. Studies have shown that WhatsApp™ application can facilitate communication within the healthcare team and provide the attending physician a constant oversight of activities performed by junior team members. The aim of the study was to use WhatsApp between two distant surgical teams involved in a program of elective surgery to verify if it facilitates communication, enhances learning, and improves patient care preserving their privacy. Methods: We conducted a focused group of surgeons over a 28-month period (from March 2013 to July 2015), and from September 2014 to July 2015, a group of selected specialists communicated healthcare matters through the newly founded ‘‘WhatsApp Surgery Group.’’ Each patient enrolled in the study signed a consent form to let the team communicate his/ her clinical data using WhatsApp. Communication between team members, response times, and types of messages were evaluated. Results: Forty six (n = 46) patients were enrolled in the study. A total of 1,053 images were used with an average of 78 images for each patient (range 41–143). 125 h of communication were recorded, generating 354 communication events. The expert surgeon had received the highest number of questions (P, 0.001), while the residents asked clinical questions (P, 0.001) and were the fastest responders to communications (P, 0.001). Conclusion: Our study investigated how two distant clinical teams may exploit such a communication system and quantifies both the direction and type of communication between surgeons. WhatsApp is a low cost, secure, and fast technology and it offers the opportunity to facilitate clinical and nonclinical communications, enhance learning, and improve patient care preserving their privacy. [ABSTRACT FROM AUTHOR]

Gallstone ileus is a complication of cholelithiasis which is due to gallstone migration through a fistula between the gallbladder and the gastrointestinal tract followed by intraluminal impaction. This uncommon form of mechanical bowel obstruction occurs in <1% of patients with cholelithiasis. Gallstone ileus due to cholecystocolonic fistula is rare, and therefore appropriate surgical treatment is still a matter of debate. We describe a unusual case of gallstone ileus in a 74-year-old man with a history of cholelithiasis, admitted to our hospital with suspected largebowel obstruction. The diagnosis was made with abdominal computed tomography scan that showed a very large gallstone impacted in the sigmoid causing mechanical bowel obstruction. After endoscopic removal was attempted but proved unsuccessful, enterotomy was performed to remove the gallstone. At surgery a Meckel's diverticulum was discovered incidentally and removed and trasversostomy was performed. The patient was discharged on postoperative day 10. KEY WORDS: Gallstone ileus, Endoscopy, Large bowel obstruction, Cholecystocolonic fistula, Meckel's diverticulum.

Introduction: Smartphones changed the method by which doctors communicate with each other, offer modern functionalities sensitive to the context of use, and can represent a valuable ally in the healthcare system. Studies have shown that WhatsApp™ application can facilitate communication within the healthcare team and provide the attending physician a constant oversight of activities performed by junior team members. The aim of the study was to use WhatsApp between two distant surgical teams involved in a program of elective surgery to verify if it facilitates communication, enhances learning, and improves patient care preserving their privacy., Methods: We conducted a focused group of surgeons over a 28-month period (from March 2013 to July 2015), and from September 2014 to July 2015, a group of selected specialists communicated healthcare matters through the newly founded "WhatsApp Surgery Group." Each patient enrolled in the study signed a consent form to let the team communicate his/her clinical data using WhatsApp. Communication between team members, response times, and types of messages were evaluated., Results: Forty six (n = 46) patients were enrolled in the study. A total of 1,053 images were used with an average of 78 images for each patient (range 41-143). 125 h of communication were recorded, generating 354 communication events. The expert surgeon had received the highest number of questions (P, 0.001), while the residents asked clinical questions (P, 0.001) and were the fastest responders to communications (P, 0.001)., Conclusion: Our study investigated how two distant clinical teams may exploit such a communication system and quantifies both the direction and type of communication between surgeons. WhatsApp is a low cost, secure, and fast technology and it offers the opportunity to facilitate clinical and nonclinical communications, enhance learning, and improve patient care preserving their privacy.

Unlabelled: Pancreatic ductal adenocarcinoma is the fourth leading cause of cancer-related mortality in the western countries for both men and women. Until in 2015, it remains one of the most challenging malignancies with a dismal prognosis and limited therapeutic options. The 5-year survival rate for pancreatic cancer is around 5%, which is the lowest among all different cancer sites. The poor prognosis of PDAC is largely attributed to delayed diagnosis due to nonspecific symptoms in the early stages of the disease, biological aggressiveness leading to rapid metastases, lack of effective screening methods, and resistance to radiation and chemotherapies. In the event of metastases, patients were traditionally referred to palliative treatments. Thanks to continuous progresses in the surgical expertise, synchronous and metachronous metastases resections seem technically feasible nowadays. These reports describe 2 several clinical cases in which patients with Pancreatic Adenocarcinoma, and synchronous and metachronous liver metastases respectively, were treated with a surgical approach. Patients showed a better survival rate compared current data in the literature. Our results, often in conflict with the guidelines and recent evidences, confirm the need for a new vision of the metastases "problem" in patients with Pancreatic Adenocarcinoma., Key Words: Metastases, Pancreatic Adenocarcinoma, Surgical resection.

Unlabelled: RCC has a range of clinical manifestations including vague abdominal symptoms, haematuria, flank pain and a palpable abdominal mass. Generally, 25-30% of patients are found to have metastases at diagnosis but a further 30-50% of patients with local disease will develop metastases during the course of their illness. Spread in RCC is lymphatic, haematogenous, transcoelomic or by direct invasion and the most common sites of metastasis in RCC are the lung, lymph nodes, bones and liver. Metastasis to the small intestine is rare and the duodenum is the segment least often affected. RCC metastasis to the duodenum occurs most commonly in the periampullary region, followed by the bulband usually manifest as gastrointestinal bleeding or obstruction. Bleeding may be the first symptom of metastatic disease in patients who have previously undergone nephrectomy for RCC. Survival is better for patients with localized disease compared with those with regional and distant metastases. This report describes a case of duodenal metastasis from RCC in which the patient presented with upper gastrointestinal bleeding and duodenal obstruction and was treated with pancreaticoduodenectomy with an excellent long-term outcome. Long-term survival was better than survival data reported in the current literature. ., Key Words: Duodenal metastasis, Gastrointestinal bleeding, Renal cell carcinoma, Pancreaticoduodenectomy.