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This essay's main goal the present review is to highlight the connections between intestinal dysbiosis and the ensuing activation of the mucosal lymphatic system. One of the study's goals is to investigate the impact on mood caused by a serotonergic deficit driven by mucosal inflammation. It assesses the relationship between food consumption and the onset of psychological and mental illness as a secondary end aim. Patients with inflammatory bowel diseases and psychological and psychiatric mood disorders appear to benefit therapeutically from the sort of diet they consume.

Background: inflammatory bowel diseases (IBD) are chronic disorders that affect the gastrointestinal tract but which also present extraintestinal manifestations. One of the problems related to IBD is the presence of bothfemale and male infertility. Aim: determine the correlation between IBD and male and female infertility by analyzing the literature. Material and method: studies carried out in the last twenty years have been selected through the PubMed search engine. Only studies were selected that in their conclusions showed a real correlation between IBD and infertility. Results: the first cause of infetility in both sexes is related to the surgical interventions that patients have to face during the course of the disease, but there are also psycological causes or causes related to the use of drugs used for therapy. Conclusions: further studies are needed to understand what are the real mechanism underlying infertility in subjects suffering from IBDS.

Jejunoileal diverticulosis is a rare, often asymptomatic condition, consisting of acquired false diverticula. Diagnosis of ileal perforation is usually made incidentally or after complications, including obstruction, haemorrhage and diverticulitis. A previously healthy 17-year-old man presented to the Emergency Department with diffuse abdominal pain and fever. CT scan showed air-fluid level in the RLQ and free intraperitoneal air and fluid. The patient underwent an urgent exploratory laparotomy with an intestinal resection and primary anastomosis. We report a rare case of ileal perforation, due to diverticular disease in a healthy young man, treated an urgent surgery. Such an event requires immediate surgical intervention, especially if it presents as an acute abdomen. Although it can become a surgical emergency, jejunoileal diverticulosis remains underdiagnosed.

Amyand's hernia is an inguinal hernia, containing the appendix within the hernial sac. Claudius Amyand described the first clinical case in 1735. Despite the high incidence of inguinal canal hernia disease in the population with approximately 20 milion patients that undergo hernia repair annually, Amyand's hernia is a rare clinical conditions. It is characterized by an incidence of 1 % (0,19-1.7) and in 0,13 % of all cases, the appendix is inflamed. In this article, we will present our experience related to the treatment of a complicated Amyand's hernia, occasionally found during an emergency surgery for the repair of an incarcerated inguinal hernia. In addition, we will conduct a medical review of this pathology that often represents an unpleasant surprise for the surgeon.

The purpose of this article is to write a short guide on the macroscopic anatomy of the stomach, describing its structures, its relationships within the abdominal cavity and the dissection methods used during the internship performed by a group of students from the University of Palermo, Palermo, Italy, at the University of Malta, Msida, Malta, during the summer of 2018. Indeed,, they had the opportunity to spend a period of two weeks at the department of Anatomy in the Maltese University for studying and practining on some corpses, with the aim of improving their anatomical knowledge.

The purpose of this technical report is to present that, in summer 2018, a group of students from the University of Palermo did at the University of malta. The students have the experience to dissected a thorax under a guide to expert dissectors. This work would be also a small dissection guide for young students who want to learn the main bases of dissection

Aim: The present study aimed to demonstrate that computed tomography-guided transthoracic needle biopsy (TTNB) is a safe procedure that gives a more accurate pre-operative tissue diagnosis for peripheral lung nodules than transthoracic needle aspiration, obtaining suitable samples for molecular test in lung adenocarcinomas. Patients and methods: Between December 2016 and March 2018 at Thoracic Surgery Department of the University of Palermo - Policlinico Paolo Giaccone Hospital, TTNB was performed in 42 patients with computed tomography-detected peripheral lung nodules > 10 mm, using 16-18 -Gauge tru-Cut needles. Results: With TTNB, we have estimated an accuracy for tissue diagnosis of 97,6%. At the molecular test, EGFR overexpression and ALK mutation resulted positive for 12/23 patients with lung adenocarcinoma. Conclusion: TTNB has showed a low rate of complications and it is adoptable as standard diagnostic procedure for peripheral lung nodules.

The purpose of this article is to show the abdominal cavity's dissection method. In the summer of 2018 a group of students from the University of Palermo, who had already taken the anatomy exam and had good knowledege of English, went for a period of two weeks to do a dissection course at the University of malta. The students dissected skin, subcutaneously, muscle layers, parietal peritoneum and abdominal organs. this works proves to be a small dissection guide for young medical students who want to learn the main bases of dissection and important information for topographical anatomy.

The oral microbiota is represented by the set of bacteria and microrganisms that reside in the oral cavity. It is formed from bird and stabilizes during the period of permanent dentition. The oral microbiota poresents from 500 to 700 bacterial species, belonging to six main phyla, Firmicutes, Bacteroidetes, Proteobacteria, Actinobacteria, Spirochaetes and Fusobacteria. These bacteria partecipate in the formation of dental plaque, a sort of biofilm that deposits on the rigid surfaces of the oral cavity, and contributes to the healthy maintenance of the oral cavity. An alteration of the oral microbiota contributes to the pathogenesis of periodontitis, caries, gingivitis and also of systemic diseases such as cardiovascular disorders and problems in pregnancy.

Background: Despite the well-known negative prognostic value of the V600EBRAF mutation in patients with metastatic colorectal cancer (mCRC), its outcome is quite heterogeneous, and the basis for this prognostic heterogeneity should be better defined. Methods: Two large retrospective series of V600EBRAF-mutated mCRC from 22 institutions served as an exploratory and validation set to develop a prognostic score. The model was internally and externally validated. Results: A total of 395 V600EBRAF-mutated mCRCs were included in the exploratory set. Performance status, CA19.9, lactate dehydrogenase, neutrophil/lymphocyte ratio, grading and liver, lung and nodal involvement emerged as independent prognostic factors for overall survival (OS). Two different scoring systems were built: a ‘complete’ score (0–16) including all significant covariates and a ‘simplified’ score (0–9), based only on clinicopathological covariates, and excluding laboratory values. Adopting the complete score, proportions of patients with a low (0–4), intermediate (5–8) and high (9–16) score were 44.7%, 42.6% and 12.6%, respectively. The median OS was 29.6, 15.5 (hazard ratio [HR] for intermediate vs low risk: 2.16, 95% confidence interval [CI]: 1.44–3.22, p < .001) and 6.6 months (HR for high vs low risk: 4.72, 95% CI: 2.72–8.20, p < .001). Similar results were observed also after adjusting for the type of first-line treatment and adopting the simplified score. The simplified prognostic score derived from the exploratory set was then applied to the validation set for external confirmation. Conclusions: These scoring systems are based on easy-to-collect data and defined specific subgroups with relevant differences in their life expectancy. These tools could be useful in clinical practice, would allow better stratification of patients in clinical trials and may be adopted for proper adjustments in exploratory translational analyses.

The purpose of this article is to show the mediastinal dissection method used during the stage performed by a group of students from the Univrersity of palermo that, during the sumer of 2017, had the opportunity to spend a period of 4 weeks at the Department of Anatomy of The University of malta. The students were guided to practice dissection of some corpes to study various mediastinal organs. This experience permitted to the students to verify practically what they lernt in the books, and reperesented a unique opportunity for them to perform practice with cadavers, that is actually very difficult to do in italian universities.

Fibromyalgia is a rheumatic syndrome and its pathogenesis is controversial. The recent literature has placed considerable attention on the link between alteration of the intestinal microbiota and fibromyalgia, emphasizing the close connection between the neuroenteric system and the CNS. This study aims to evaluate the probable relationship between intestinal dysbiosis and altered secretion of hormones and vitamins such as cortisol, serotonin, Vitamin D and thyroid hormones in a patient with fibromyalgia.

Fluoroscopically-guided interventional procedures are performed in large numbers in Europe and in the United States. Radiation doses received by interventional radiologists can vary for the same type of procedure and for similar patient doses. Occupational radiation protection is a necessity whenever radiation is used in the practice of medicine. The International Commission on Radiological Protection is engaging against occupational radiation damages, publishing regular recommendations on dose limits. These limits are expressed as effective doses for the whole body and also as equivalent doses for particular regions or tissues of practitioners’ bodies. Shielding and personal protective clothes are the most common tools for radiation protection employed up to now. Radiation protection is a dynamic field. It has undergone a significant evolutionary period during the past few decades and general improvement of protection techniques and technology is expected to continue. Further progress in the application of protection principles and concepts will contribute to balanced protection.

The aim of this article is to show methods for dissection of the neck. In the summer of 2017 a group of students of the University of Palermo that have already passed the exam of Human Anatomy took a 4 weeks dissection course at the University of Malta. The students were provided with a dissection kit, video recording equipment and cameras for taking pictures. They dissected the skin, the subcutaneous tissue, the muscular bundles, the muscles, the vascular and nervous bundles, the nerves, the larynx, the trachea and the esophagus. This paper presents the results of the dissection course and a small and simple guide to young students and medical doctors who want to learn the bases of neck dissection.

Few data are available about the clinical course of severe colonic Crohn’s disease (CD). The aim of this study is to describe the clinical course of severe Crohn’s colitis in a patient cohort with isolated colonic or ileocolonic CD, and to compare it with the clinical course of patients with severe ulcerative colitis (UC). Thirty-four patients with severe Crohn’s colitis were prospectively identified in our cohort of 593 consecutive hospitalized patients through evaluation of the Crohn’s Disease Activity Index score and the Harvey-Bradshaw Index. One hundred sixty-nine patients with severe ulcerative colitis were prospectively identified in our cohort of 449 consecutive hospitalized patients through evaluation of the Lichtiger score and the Truelove-Witts score. We evaluated the following data/aspects: response to steroids, response to biologics, colectomy rate in acute, colectomy rate during follow-up, megacolon and cytomegalovirus infection rate. We did not find significant differences in the response to steroids and to biologics, in the percentage of cytomegalovirus infection and of megacolon, while the rate of colectomy in acute turned out to be greater in patients with severe Crohn’s colitis compared to patients with severe UC, and this difference appeared to be the limit of statistical significance (Chi-squared 3.31, p = 0.069, OR 0.39); the difference between the colectomy rates at the end of the follow-up was also not significant. In the whole population, by univariate analysis, according to the linear regression model, a young age at diagnosis is associated with a higher overall colectomy rate (p = 0.024) and a higher elective colectomy rate (p = 0.022), but not with a higher acute colectomy rate, and an elevated ESR is correlated with a higher overall colectomy rate (p = 0.014) and a higher acute colectomy rate (p = 0.032), but not with a higher elective colectomy rate. This correlation was significant on multivariate analysis. The overall rate of colectomy in the cohort of patients with severe Crohn’s colitis was greater than that of the cohort of patients with severe UC, but this figure is not supported by a different clinical response to steroid therapy or rescue therapy with biologics. The clinical course of severe Crohn’s colitis requires to be clarified by prospective studies that include a larger number of patients in this subgroup of disease.

Prostate cancer is one of the most common cancers in the world. Its pathogenesis is multifactorial and is linked to risk factors such as age, diet, cigarette smoking, family history and the onset of oxidative stress. In recent times, therefore, we are investigating the use of antioxidants as a primary and tertuary prevention of prostate cancer. Numerous studies in the literature focused on lycopene, a molecule belonging to the family of carotenoids that is commonly foud in tomatoes and products derived from it. The literature analyzed in the last two years shows how lycopene inhibits different mecchanism linked to carcinogenesis and tumor progression. However, there are still many points to be clarified the real antitumoral capacity of this substance.

Nothwithstanding the definite aethiopathogenetic path of certain diseases, the relationship between Helicobacter Pylori (H. Pylori) and barrett's esophagus (BE), a condition that increases the risk for dysplasia and consequently adenocarcinoma of the distal esophagus and esophagogastric junction, remains uncertain. this paper reviews the current scientific literature with emphasis on the protective correlation between H. Pylori infection and BE, and demonstrates that a causal relathionship has not been disproved with certainty. Furthermore, H. Pylori infection could pose a risk for the onset of gastroesophageal reflux disease (GERD), which could in turn trigger BE, a precancerous lesion and subsequently cause cancer. by analyzing the current available data, this article tries to verify that H. Pylori infection is the underlying cause of esophageal cancer.

The precise etiology of Inflammatory Bowel Disease (IDB) remains unclear and several factors are believed to play a role in its development and progression, including the composition of microbial communities resident in the gastrointestinal tract. Human intestinal microbiota are extensive with at least 15,000-36,000 bacterial species. However, thanks to the new development in sequencing and molecular taxonomic methodologies, our understanding of the microbiota population composition, dynamics, and ecology has greatly increased. Intestinal microbiota play a critical role in the maintenance of the host intestinal barrier homeostasis, while dysbiosis, which involves reduction in the microbiome diversity, can lead to progression of inflammatory disorders, such as IBD and colorectal cancer. It is hypothesized that fingerprinting characterization of the microbiota community composition is the first step in the study of this complex bacterial ecosystem and a crucial step in the targeted therapy. Molecular fingerprinting of human gastrointestinal tract microbiota could be performed by different techniques including the semi quantitation, 16SrRNA, the DNA- microarray as well as other relatively new methods which were developed to study many complex bacterial ecosystems. These techniques provide individual data and profiles, using fast and sensitive tools for the high taxonomic level fingerprint of the human intestinal microbiota and provide estimation of the relative presence of the microbial target groups within each individual. Such personalized information serves as a remarkable and unprecedented opportunity to improve targeted medical treatment and probably develop strategies to prevent disease.

Surgical site infection (SSI) are among the most preventable health-care-associated infections and are a substantial burden to health-care systems and service payers worldwide in terms of patient morbidity, mortality, and additional costs. SSI prevention is complex and requires the integration of a range of measures before, during and after surgery. No international guidelines are available and incosistencies in the interpretations of evidence and recommendations of national guidelines have been identified. Given the burden of SSI worldwide, the numerous gaps in evidence-based guidance, and the need for standardisation and a global approach, WHO decided to prioritise the development of evidence-based recommendations for thew prevention of SSI. The guidelines take into account the balance between benefits and harms, the evidence quality, costs and resource use implications, and patgients values andf preferences. on the basis of systematic literature reviews and expert consensus, we present 23 recommendations on preoperative, intraoperative and postoperative preventive measures. The WHO recommendations were developed with a global perspective and they take into account the balance between benefitgs and harms, the evidence quality level, cost and resource use implications, and patient values and preferences.

This article summarizes the activities of the four-week whole body dissection course the main authors participated in in August 2016 at the dissection hall of the University of Malta (UoM). Our team comprised 10 second-year medicine students from University of Palermo chosen among who had passed the Human Anatomy exam brilliantly. The need to move to the UoM to take part in such activity derives from the lack of practice approach in Italian schools of medicine, focused mostly on the theoretical studies, neglecting practical experience. The heart dissection reveal itself as a huge opportunity to finally apply our anatomical knowledge, improving it and enabling us to compare images took from books to the actual organ. We had the chance to handle a real heart, to appreciate its weight and consistence. We took part in coronary artery courses focusing on their functions within the heart machinery. This article summarizes the activities of the four-week whole body dissection course the main authors partecipated in August 2016 at the dissection hall of the University of Malta (UoM). Our team comprised 10 second-year medicine students from University of Palermo chosen among who had passed the Human Anatomy exam brilliantly. The need to molve to the UoM to take part in such activity derives from the lack of practice approach in Italian schools of medicine, focused mostly on the theoretical studies, neglecting practical experience. The heart dissection reveal itself as a huge opportunity to finally apply our anatomical knowledge, improving it and enabling us to compare image took from books to the actual organ. We had the chance to handle a real heart, to appreciate its weight and consistence. We took part in coronary artery courses focusing on their functions within the heart machinery.

The term focal active colitis (FAC) is conventionally used to describe the presence of isolated cryptitis, characterized by an inflammatory infiltrate consisting of intraepithelial neutrophils and/or neutrophils invading the lumen of the criptae, with no other microscopic alteration of the colonic mucosa and, in particular, without the presence of signs of chronic inflammation. To date, only four studies, including one conducted in a pediatric population, have been performed to evaluate the clinical significance of this disease. The aim of this retrospective study on prospectively-collected data is to evaluate the clinical implications of the focal active colitis, since there still remains a marked uncertainty regarding this topic and about how often such a diagnosis will presage a diagnosis of inflammatory bowel disease (IBD). Clinical, endoscopic, and pathological data were retrospectively reviewed from 30 patients with focal active colitis, who had no other diagnostic findings on colorectal biopsy and no history of chronic inflammatory bowel disease. The histological findings were correlated with clinical diagnoses. Thirty patients (11 males, 19 females; age 24-80 years, median 56 years) (0.5%) out of 5,600 undergoing colonoscopy between January 2012 and December 2016 presented a definitive diagnosis of FAC. Follow-up ranged from 6 to 60 months (median 24 months). At endoscopy, 19 patients (63%) had mild and non-specific changes, such as mild mucosal erythema, while 11 (37%) had normal findings. Eight patients were documented as having irritable bowel syndrome, while nine cases could be attributed to the effects of drugs, five presented FAC as incidental finding, one a diagnosis of infectious colitis, and seven a diagnosis of IBD (4 with Crohn’s disease). FAC was confirmed to be a more significant predictor of IBD than the previous literature would indicate, even if larger prospective studies, targeted to study this relationship, are needed to understand more clearly its clinical significance.

Dysbiosis has been linked to IBD. The intestinal microbiota plays a fundamental role in health and the progression of diseases such as IBD and CRC. Many cancers arise from sites of infection and chronic inflammation. Patients with inflammatory Bowel Disease (IBD) have an increased risk of 10%-15% developing colorectal cancer. Therefore, a complete understanding of the composition and function of the gut microbiota is critical.