Essential omega-3 fatty acids tune microglial phagocytosis of synaptic elements in the mouse developing brain.

Omega-3 fatty acids (n-3 PUFAs) are essential for the functional maturation of the brain. Westernization of dietary habits in both developed and developing countries is accompanied by a progressive reduction in dietary intake of n-3 PUFAs. Low maternal intake of n-3 PUFAs has been linked to neurodevelopmental diseases in Humans. However, the n-3 PUFAs deficiency-mediated mechanisms affecting the development of the central nervous system are poorly understood. Active microglial engulfment of synapses regulates brain development. Impaired synaptic pruning is associated with several neurodevelopmental disorders. Here, we identify a molecular mechanism for detrimental effects of low maternal n-3 PUFA intake on hippocampal development in mice. Our results show that maternal dietary n-3 PUFA deficiency increases microglia-mediated phagocytosis of synaptic elements in the rodent developing hippocampus, partly through the activation of 12/15-lipoxygenase (LOX)/12-HETE signaling, altering neuronal morphology and affecting cognitive performance of the offspring. These findings provide a mechanistic insight into neurodevelopmental defects caused by maternal n-3 PUFAs dietary deficiency.

Pseudoaneurysm of the hepatic artery and hemobilia: a rare complication of laparoscopic cholecystectomy; clinical case and literature review.

Laparoscopic cholecystectomy is the Gold Standard for the treatment of symptomatic cholelithiasis. There is still an increase in the rate of incidence of biliary and vascular injuries with laparoscopy. Hepatic artery pseudoaneurysm is a rare but serious complication associated with laparoscopic cholecystectomy and bile duct injury. The diagnosis may be difficult. Our experience of a case of iatrogenic lesion of the right hepatic artery with the formation of pseudoaneurysm treated by means of embolization of the artery is presented here.

[Intestinal perforation by ingested foreign bodies in the digestive tract: an insidious pathology always of interest. Our experience]. / La complicanza perforativa da ingestione di corpi estranei alimentari: una patologia insidiosa sempre attuale. Nostra esperienza.

The authors want to present five cases (from May 1999 to May 2009) of acute abdomen from perforation of the foreign body introduced with food. They highlight how the accidental ingestion is very common but the perforation is rare. The preoperative diagnosis, in these cases, is always very difficult and the radiological examinations are not always able to resolve the diagnostic doubt with other acute intestinal diseases that are responsible of perforation. Then, the surgery procedure is, necessarily, the only possible diagnostic and therapeutic means. The mortality and the morbidity remain still high first of all for the delay in the diagnosis and the advanced age of patients.

[Organizational model and clinical evaluation in Day Surgery: our experience]. / Aspetti organizzativi e valutazione clinica in Day Surgery: la nostra esperienza.

Surgical treatments in Day Surgery (DS) are characterised by limited hospitalisation during daytime on the base of an organizational model established by appropriate protocols. According to it, the patient at low operational risk and the patient whose post-operative management is easy is admitted to the programme. The Authors report their experience of DS focusing on the surgical and anaesthesiological qualifications that help to control the risk factors reducing the complications and thus guaranteeing the safety and effectiveness of the service.

Multiple treatment of gas gangrene at a rare anatomic location. Case report.

The authors report a clinical case of gas gangrene in a rare anatomic location in a 79-year-old woman, admitted because 3 days earlier she had developed a painful swelling with erythematous cutis in her right iliac fossa and suffered from a seriously increasing fever. The physical examination showed a large area of gas gangrene. In accordance with international literature, excellent results have been obtained by adopting an early multiple therapy (including surgical debridement, intensive therapy, antibiotic treatment and hyperbaric oxygen treatment).

Treatment of pilonidal disease in short-stay surgery: personal method.

HYPOTHESIS: We state that our personal method constitued by excision and primary closure in the treatment of pilonidal sinus, is able to obtain a low rate of recurrence and a fast return to work. PATIENTS AND METHODS: Our report has been conducted on 315 patients. Excision and primary closure in the treatment of pilonidal sinus by local-regional anesthesia. The patients have been discharged on second day. RESULTS: We have not had intraoperative complication; about morbilità there have been 4% of seromas treated conservatively. CONCLUSIONS: With this personal method we have obtained very good results, in short and long time, with less of recurrences and fast return to work.

[Strangulated pelvic internal hernia: early postoperative complication of sacral colpopexy with prosthesis]. / Ernia interna pelvica strozzata quale complicanza postoperatoria precoce di colposacropessi con protesi.

The Authors report a case of internal strangulated hernia in a patient operated of colposacropexy for vaginal prolapse following total hysterectomy. The diagnosis was formularized by abdominal TC consenting the surgical treatment by bowel loop resection completed by pelvic floor reconstruction.

[Inguinal hernioplasty: Shouldice vs. tension-free techniques. A personal experience]. / L'ernioplastica inguinale: metodiche a confronto (Shouldice vs. tecniche "tension-free"). La nostra esperienza.

The Authors report their experience with the use of Shouldice technique and tension-free procedures (Lichtenstein, Trabucco). They evaluate long time results with both procedures making a comparasion of Shouldice versus tension-free. The results evaluation underlines the best performance of tension-free procedures with elimination of recurrence. The Authors achieve that the tension-free techniques are now the gold standard for surgical treatment of groin hernia.

[Primary non-Hodgkin's lymphoma of the colon: a rare but possible location. Therapeutic approach. Description of a clinical case and review of the literature]. / Linfoma non-Hodgkin primitivo del colon: una rara, ma possibile localizzazione. Iter terapeutico. Descrizione di un caso clinico e revisione della letteratura.

On the basis of a case of large cell, highly malignant, non-Hodgkin's lymphoma of the colon, the authors describe the special features of this rare location; the general aspects of this rare pathology of the colon are then considered. The clinical case relates to a large cell, highly malignant, non-Hodgkin's colic lymphoma located in the caecum at two thirds proximally of the ascending colon of which it occupies half the lumen. The patient had come to our observation for a quite aspecific symptomatology characterised by digestive disturbances and a tendency to stipsis. In disaccord with certain literature reports, surgical treatment was considered by the authors the key to the therapeutic approach. Surgical exeresis should be as radical as possible to permit complementary therapies (chemotherapy and radio-therapy) to act with most effectiveness and thus offer the patient a better life.

[Acute bleeding in gastrointestinal stromal tumor: case report]. / Enterorragia acuta da tumore stromale gastrointestinale (GIST). Contributo clinico.

A.A. refer a case report on a patient observed in emergency condition for acute bleeding from digiunal bowel by a GIST. Starting from clinical case, describe a brief profile of clinical, histogenetic, diagnostic and prognostic characteristics of the GIST also delineated by recent reports from literature; agree with other A.A. about treatment procedure represented always by resection of affected intestinal tract and never by enucleation for inconstant and unforeseeable biologic comportment by this tumours.

[Gastrointestinal stromal tumors]. / I tumori stromali gastrointestinali.

The Authors report two cases of GIST and underline cytogenetic, clinic and prognostic aspects of this disease; they describe as well new histo-cyto-genetic data that identify as origin tissue interstitial cells of Cajal, by immunohistochemical and genetic tests. They also consider new diagnostic and therapeutic options based on surgical treatment. Finally controversial prognostic problems are discussed.

[Diaphragm rupture caused by closed trauma. A more and more frequent condition]. / La rottura del diaframma da trauma chiuso. Una patologia di sempre più frequente riscontro.

The Authors report a case of rupture of the diaphragm in blunt trauma of the abdomen, to examine the more significant features of this condition whose incidence proves to be increasing, after a review of the literature data, parallel to the increase of accidents on the road and at work. They examine the most important pathogenic problems and these related to the mechanism leading to diaphragmatic lesion and they highlight the deeper pathophysiological changes suffered from the patient with such a condition. They draw attention to what they consider to be the most important aspect, and therefore the diagnosis. In fact, in accordance with the various series of cases reported in the literature, it is crucial in the diagnostic problem is when the possible cause of the rupture is suspected and necessary diagnostic cascade (Rx, echotomography, TC) is activated so to highlight the lesion. Therefore a quick diagnostic fitting is necessary for the survival of the acute patient with hernia of the thorax cavity, as well as quick surgical correction of the lesion that, as in the case described, serves to achieve the best possible anatomic-functional results.

[A case of appendiceal mucocele associated with adenocarcinoma of the left colon]. / Su di un caso di mucocele appendicolare associato ad adenocarcinoma del colon sinistro.

The Authors report an unusual case of appendiceal mucocele associated with a large bowel carcinoma occasionally observed in the course of examinations for the first pathology. Due to the rareness of the association of the two affections, the clinical problems and pathogenetic theories are reviewed, also analysing the histological differences of the various mucoceles which need a different surgical approach. They conclude stating that the preoperative diagnosis of appendiceal mucocele, is easier today than in the past, thanks to the routine use of ultrasonography and tomography through which it is possible to reveal concomitant pathologies often clinically silent.

[Authors' experience with the role of preoperative ultrasonography in the study of benign lesions of the gallbladder]. / La nostra esperienza sul ruolo dell'esame ecografico preoperatorio nello studio delle lesioni parietali benigne della colecisti.

The benign parietal lesions of the gallbladder are diseases that, as known, found their pathogenetic moment on hyperplasia of constituent tissues of the gallbladder wall and comprises the controversial chapter of "cholecystosis". The Authors, to contribute to their better clinical and pathogenetic staging, report their experience on 25 cases. They debate on the usefulness of ultrasonography, surely a diagnostic progress for these formations, which are small structures more or less echogenic and that they develop in the gallbladder; the echographic imaging, for its sharpening, has substituted the cholecystographic procedure. The aim of present study is to analyse the results obtained by using echography as diagnostic preoperative procedure of "cholecystosis". The ultrasonography supplies the surgeon an indication to prophylactic surgical treatment as single, effective procedure in preventing the gallbladder carcinoma.

[A case of strangulated trans-omentum hernia]. / Su di un caso di ernia transomentale strozzata.

After a review of the Literature, the Authors report a case of intestinal obstruction caused by trans-omentum hernia. This unusual disease is due to a defect of the greater omentum with herniation and secondary strangulation of small bowel. The clinical presentation was that of an intestinal obstruction with rare possibility of preoperative diagnosis. Therefore, a correct knowledge of this pathology and immediate surgery are necessary for the prognosis.

[Spontaneous rupture of the spleen in a patient treated with chemotherapy and growth factors for stem cell mobilization]. / Rottura spontanea di milza in soggetto trattato con chemioterapia e fattori di crescita per mobilizzazione di cellule staminali.

The Authors report a case of spontaneous spleen rupture in a woman with breast cancer treated with chemotherapy and growth factors for stem cell mobilization. After a wide review of the literature, they suppose this therapy, causing a considerable increase of immature cells, that promote the stasis of the splenic microcirculation, can sometime elicit a spontaneous rupture of the organ.

[Spigelian hernia: clinical, diagnostic and therapeutical aspects]. / L'ernia di Spigelio: aspetti clinici, diagnostici e terapeutici.

The Authors describing a case of Spigelian hernia observed point out clinical, diagnostic and therapeutic considerations about this rare pathology of abdominal wall. They specify the anatomic characteristics of the region and underline as any diagnostic difficulties are by passed by use of USG and TC imaging for formulation of correct preoperative diagnosis. They confirm as surgical treatment by a correct access isn't different by a normal hernioplasty and guarantee the long term surgical outcome.

[Necrotizing fasciitis: apropos of a case]. / La fascite necrotizzante: a proposito di un caso.

Necrotizing fasciitis is an infection which involves soft tissues up to the fascia, with wide areas of necrosis, and is mainly caused by group A beta-hemolytic Streptococcus. The Authors report a case recently observed and after an accurate review of the Literature, taking into account the most recent pathogenetic knowledges, confirm the necessity of an early diagnosis based on clinical criteria but above all on histological biopsy. The treatment is mainly surgical, and allows, together with the medical treatment, to subdue the rapid progression of the infection which notwithstanding maintains an high mortality rate.