More Favorable Short and Long-Term Outcomes for Screen-Detected Colorectal Cancer Patients.

BACKGROUND: Screening significantly reduces mortality from colorectal cancer (CRC). Screen detected (SD) tumors associate with better prognosis, even at later stage, compared to non-screen detected (NSD) tumors. We aimed to evaluate the association between diagnostic modality (SD vs. NSD) and short- and long-term outcomes of patients undergoing surgery for CRC. MATERIALS AND METHODS: This retrospective cohort study involved patients aged 50-69 years, residing in Veneto, Italy, who underwent curative-intent surgery for CRC between 2006 and 2018. The clinical multi-institutional dataset was linked with the screening dataset in order to define diagnostic modality (SD vs. NSD). Short- and long-term outcomes were compared between the two groups. RESULTS: Of 1,360 patients included, 464 were SD (34.1%) and 896 NSD (65.9%). Patients with a SD CRC were more likely to have less comorbidities (p = 0.013), lower ASA score (p = 0.001), tumors located in the proximal colon (p = 0.0018) and earlier stage at diagnosis (p < 0.0001). NSD patients were found to have more aggressive disease at diagnosis, higher complication rate and higher readmission rate due to surgical complications (all p < 0.05). NSD patients had a significantly lower Disease Free Survival and Overall Survival (all p < 0.0001), even after adjusting by demographic, clinic-pathological, tumor, and treatment characteristics. CONCLUSIONS: SD tumors were associated with better long-term outcomes, even after multiple adjustments. Our results confirm the advantages for the target population to participate in the screening programs and comply with their therapeutic pathways.

Bacteriobilia resistance to antibiotic prophylaxis increases morbidity after pancreaticoduodenectomy: a monocentric retrospective study of 128 patients.

Several studies attempted to determine whether there is a relationship between the use of preoperative biliary drainage and morbidity after pancreaticoduodenectomy (PD). We retrospectively evaluated post-PD outcome in patients with and without preoperative biliary drainage and the role of bacteriobilia and antibiotic prophylaxis in post-operative complications. Data relating to the PDs performed at the Hepato-Bilio-Pancreatic Surgical Department of Treviso Hospital between 2010 and 2017 were retrospectively evaluated. Morbidity and intra-hospital mortality related to preoperative biliary stent were the primary outcomes. Between 2010 and 2017, 128 patients (mean age 68 years) underwent PD; 72 were treated with early surgery (ES) and 56 underwent preoperative biliary drainage (PBD). Overall morbidity was 50% in the ES cohort and 43% in the PBD (ns, p = 0.43). In the PBD group, bacteriobilia was found in the 100% of the bile cultures (48; 8 unavailable). The microbiota was represented by: Klebsiella spp (48%), Enterococcus spp (29%), E. coli (27%) and Candida spp (21%). In 52% of cases, at least one of the isolated bacteria was resistant to the perioperative antibiotic prophylaxis (69% of cases Amoxicillin-Clavulanic Ac.). The majority of postoperative surgical complications occurred in patients with prophylaxis-resistant bacteriobilia (68% vs 39%; p = 0.04). Antibiotic resistance is a determining factor in morbidity after PD. We therefore propose to pay particular attention to the preoperative prophylaxis, diversifying it between drained and non-drained patients. In fact, in the former, appropriate broad spectrum preoperative antibiotic coverage is strongly suggested.

PGE(1) therapy for Martorell's ulcer.

Martorell's ulcer is a type of ischaemic ulcer of the lower leg, defined by severe pain and female-to-male predominance. The aim of this article is to assess the therapeutic effectiveness of PGE(1), both in pain control and in the healing times of Martorell's ulcers for patients already undergoing antihypertensive treatment. Between January 2004 and December 2008, we recruited 10 patients with Martorell's ulcers. These patients were organized into two groups (A and B). Group A included six patients who underwent only antihypertensive treatment with calcium channel blockers or angiotensin converting enzyme inhibitors. Group B consisted of four patients who underwent continuous administration of PGE(1) through a single-day elastomer (120 µg/24 hours) for 7 days. In both groups, we observed a progressive reduction in the surface area of Martorell's ulcers until complete recovery, but there was a significant difference with regards to healing time. We also observed a significant improvement in symptomatic pain after only 2 days of PGE(1) therapy. It has now been proved that antihypertensive treatment leads to ulcers healing but, according to our experience, intravenous infusion of prostaglandins improves peripheral perfusion and symptomatic pain and decreases healing time.

Diagnosis and Treatment of Type II Necrotizing Fasciitis in a Child Presenting With a Minor Abrasion, Edema, and Apparent Bruising .

 Pyoderma gangrenosum (PG) is associated with systemic disease, mostly rheumatoid arthritis (RA) and inflammatory bowel disease (IBD), in many patients (more than 50%). Lesions associated with arthritis are often ulcerative. Although these lesions typically affect the lower limbs, they can also affect the entire body. Successful therapy involving monoclonal antibodies seems to favor an autoimmune etiopathogenesis that has disorders of neutrophils' chemotactic activity and interleukins, which are acted upon by TNF-α cytokines. The ulcers grow rapidly, exacerbate after trauma, and necrosis can invade each skin layer up to the fascia. Therefore, debridement is contraindicated because it introduces the so-called "pathergy" mechanism. The diagnosis is quite difficult and is often made late due to the lack of indicative clinical and laboratory findings. The following is a report of a case of multiple, ulcerative, PG ulcers induced by arthritis. The ulcers occurred over several occasions with large and aggressive necrosis reaching the osseous plane in the heel and elbow. The high IgE values (between 2000 UI/mL and 3000 UI/mL) suggested that a type I immunitary reaction, such as in-skin anaphylaxis, was involved. Nevertheless, the antigen remains unknown and the genesis may be multifactorial. A corticosteroid (prednisolone) was the first-line systemic treatment used in this case and caused rapid improvement. Further investigations will be necessary to understand the meaning of this immunologic disorder .