Preliminary results of a program for the implementation of laparoscopic colorectal surgery in an Italian comprehensive cancer center during the COVID-19 pandemic.

Despite operative benefit and oncological non-inferiority, videolaparoscopic (VLS) colorectal surgery is still relatively underutilized. This study analyzes the results of a program for the implementation of VLS colorectal surgery started in an Italian comprehensive cancer center shortly before COVID-19 outbreak. A prospective database was reviewed. The study period was divided in four phases: Phase-1 (Open surgery), Phase-2 (Discretional phase), Phase-3 (VLS implementation phase), and Phase-4 (VLS consolidation phase). Formal surgical and perioperative protocols were adopted from Phase-3. Postoperative complications were scored by the Clavien-Dindo classification. 414 surgical procedures were performed during Phase-1, 348 during Phase-2, 360 during Phase-3, and 325 during Phase-4. In the four phases, VLS primary colorectal resections increased from 11/214 (5.1%), to 55/163 (33.7%), 85/151 (57.0%), and 109/147 (74.1%), respectively. The difference was statistically significant (P < 0.001). All-type VLS procedures were 16 (3.5%), 61 (16.2%), 103 (27.0%), and 126 (38.6%) (P < 0.001). Conversions to open surgery of attempted laparoscopic colorectal resections were 17/278 in the overall series (6.1%), and 12/207 during Phase-3 and Phase-4 (4.3%). Severe (grades IIIb-to-V) postoperative complications of VLS colorectal resections were 9.1% in Phase-1, 12.7% in Phase-2, 12.8% in Phase-3, and 5.3% in Phase-4 (P = 0.677), with no significant differences with open resections in each of the four phases: 9.4% (P = 0.976), 11.1% (P = 0.799), 13.8% (P = 1.000), and 8.3% (P = 0.729). Despite the difficulties deriving from the COVID-19 outbreak, our experience suggests that volume of laparoscopic colorectal surgery can be significantly and safely increased in a specialized surgical unit by means of strict operative protocols.

[Dietary sources of fatty acids in childhood]. / Fonti dietetiche di acidi grassi in età pediatrica.

The first oral supply of fatty acids (FA) is provided by human milk. It contains a large variety of FA, perfectly adequate to the newborn's metabolic needs. Saturated and monounsaturated chains derive from the local mammary gland synthesis, while polyunsaturated very long-chains come from the hydrolysis of circulating lipoproteins and are more dependent on the maternal dietary habits. Trans FA have been shown in human milk too. The fat content of human milk progressively increases during the breast-feeding period; it varies during the day and from feed to feed. Infant formulas contain a very narrow range of FA. No commercially available formula contains the very long-chain polyunsaturated FA. Formulas for pre-term babies enriched with these molecules have been recently studied. The role of medium-chain FA in the early diet of the pre-term infant must still be defined. With weaning, green leafy vegetables become a balanced source of essential FA, while animal foods (both meat and fish) supply not only saturated but also polyunsaturated very long-chain FA. Analogously, vegetal oils are a fundamental source of monounsaturated and essential FA, animal fats (butter, lard) are a rich source of saturated fats and fish oils contain a mixture of n-3 polyunsaturated very long-chain FA. Correct dietary habits for children should provide a rich variety of foods, to reach a balanced supply of all the families of FA. Oleic acid should represent the main FA in the diet.(ABSTRACT TRUNCATED AT 250 WORDS)

Continuous infusion with implantable pumps: expanding the radiologist's role.

Drug infusion systems attract increasing attention as biomedical technology offers miniaturized devices for targeted delivery of therapeutic substances on an outpatient basis. We have used a totally implantable, subcutaneous pump, externally programmable by radiofrequency link, learning the technique of implantation and management and using various imaging modalities for the diagnosis and control of complications. The procedure for implanting systems for continuous intrathecal analgesia and systemic intravenous chemotherapy is described. Our experience of the latter is made up of 296 implants in 290 patients. The selected infusion pump proved reliable and acceptable to patients and the quality of life, given the reduced drug toxicity, more than good. The complications were few both in frequency and in severity. The setting-up of a long-term infusion system, when major surgery is not needed, can fall within the interventional radiologist's field, partly because of a good cost-benefit ratio.