Estimation of maximum thermo-hygrometric index thresholds affecting milk production in Italian Brown Swiss cattle.

It is known that heat stress affects dairy cow performance in multiple ways: physiological, behavioral, reproductive, and productive. The aim of the present study was to determine if a threshold of temperature-humidity index (THI) exists for multiple milk production traits (milk yield, fat-corrected milk, protein and fat yield and percentage, energy-corrected milk, cheese production, and cheese yield) in Italian Brown Swiss dairy cows from the period 15 d before the day of the Italian Breeders Association test-day sampling. A 10-yr data set (2009-2018) containing 202,776 test-day records of 23,296 Brown Swiss cows was matched with the maximum THI. In all parities considered, no THI thresholds were observed for milk yield in Brown Swiss. In contrast, a THI threshold of 75 was identified for fat-corrected milk. No THI threshold was found for fat percentage, but fat yield showed the highest THI thresholds in cows of first and second parity. Protein yield and cheese production were affected by heat stress with average THI threshold of 74. The THI thresholds identified indicate that the Brown Swiss breed has higher thermal tolerance versus literature values reported for Holstein cows. As THI rises, Brown Swiss cows tend to produce the same volume of milk, but with a decreasing quality with regard to components. Further study is necessary to estimate the genetic component of heat tolerance, in Brown Swiss cattle, considering that the correct estimation of THI thresholds represents the first step to identify components that could be included in selection procedures.

Platelet number is positively and independently associated with glycated hemoglobin in non-diabetic overweight and obese subjects.

BACKGROUND AND AIMS: A significant increase in platelet count may be a risk factor for atherosclerotic cardiovascular disease. This study investigates the association between platelet number and glucose metabolism, evaluated by glycated hemoglobin (HbA1c) levels, in a apparently healthy population represented by overweight and obese subjects with normal glucose and HbA1c levels. METHODS AND RESULTS: As many as 240 subjects, 177 women and 63 men, aged 18-70 years, were enrolled. Body mass index (BMI), waist circumference (WC), systolic and diastolic blood pressure levels, platelet count and fasting blood glucose, insulin, insulin resistance, HbA1c, uric acid, triglyceride, total cholesterol, high and low density lipoprotein cholesterol concentrations were evaluated. Concerning the univariate correlation analyses between platelets number and all other variables, platelet count was significantly (and positively) correlated only with HbA1c (P < 0.05) and female sex (P < 0.01). HbA1c (P < 0.05), female sex (P < 0.001), and diastolic blood pressure (P < 0.01), positively, and age (P < 0.05) and systolic blood pressure (P < 0.05), negatively, were significantly and independently associated to platelet count in a final multiple regression analysis. CONCLUSION: This is the first study showing a strong positive and independent relationship between HbA1c and platelet number in non-diabetic overweight and obese subjects.

Platelet number is negatively and independently associated with carotid intima-media thickness in apparently healthy overweight/obese subjects.

BACKGROUND AND AIM: A significant change of platelet number may be a risk factor for atherosclerotic cardiovascular disease. The aim of this study was to investigate the association between platelet number and early signs of atherosclerosis, evaluated by carotid intima-media thickness (c-IMT), in a apparently healthy population mainly represented by obese subjects. METHODS AND RESULTS: As many as 961 subjects, 686 women and 275 men, aged between 18 and 74 years, were enrolled in the study. Of these, 54 individuals (5.6% of all subjects) were normal weight, 259 individuals (27.0% of all subjects) were overweight, and 648 individuals (67.4% of all subjects) were obese. Waist circumference (WC) and blood glucose, insulin, total cholesterol, high and low density lipoprotein cholesterol, triglycerides and platelet count were also detected in all subjects, who underwent carotid echo color doppler ultrasound to measure c-IMT. c-IMT was significantly and positively associated to age (r = 0.204, P < 0.0001), fasting glucose (r = 0.073, P < 0.0240), total cholesterol (r = 0.096, P = 0.0031), and systolic and diastolic blood pressure (r = 0.140, P < 0.0001 and r = 0.119, P < 0.0003 respectively); c-IMT was significantly and negatively correlated with platelet count (r = -0.165, P < 0.0001). Only age (P < 0.0001) and systolic blood pressure (P = 0.0393), positively, and platelet number (P < 0.0001), negatively, were significantly and independently associated to c-IMT in a final multiple regression analysis. CONCLUSION: Lower platelet number represented an independent determinant of c-IMT in a population, mainly represented by obese patients. These results suggest that a decrease of platelet number may well be an early defensive mechanism in subjects developing the thickening of carotid artery.

Laparoscopic treated so-called reformed gallbladder in patient with postcholecystectomy chronic pain.

INTRODUCTION: Inadequate calculi removal, bile stasis, inflammation and strictures are causes of postcholecystectomy biliary syndrome. A cystic duct remnant is defined as a residual duct greater than 1 cm; it may predispose to chronic postcholecystectomy symptoms. CASE REPORT: We describe a case of a 33-years-old woman with recurrent epigastric pain radiating to right back. In the past medical history, an uncomplicated cholecystectomy was reported 11 years earlier. Imaging demonstrated a 2 cm impacted calculus within a cystic duct remnant, mimicking a so-called reformed gallbladder. At the magnetic resonance imaging the biliary tract was regular without dilatation. The patient was scheduled to laparoscopic exploration. Intraoperatively, the cystic duct stump containing the impacted calculus was easily found and meticulously dissected from extrahepatic bile structures. CONCLUSION: In our experience the laparoscopic removal was safely performed with complete cystic duct remnant excision and definitive cure of chronic painful symptoms. Therefore we think that, in selected cases, the reoperation is feasible by means of mininasive surgical procedures.

Endoscopic therapy for type B surgical biliary injury in a patient with short cystic duct.

Anatomical variations of the cystic duct are well-defined. The presence of short or absent cystic duct is unusual and represents a co-factor of biliary injury especially during laparoscopic cholecystectomy. Thus, its knowledge is important to avoid ductal injury in hepato-biliary surgery. We experienced the case of a 40-year-old woman with symptomatic cholelitiasis, who underwent to laparoscopic cholecystectomy. At surgery, an accidental bile duct lesion was carried, during Calot's triangle dissection, due the particular difficulties in dissecting an extremely short cystic duct found at the junction of the common hepatic duct and common bile duct. No vascular anomalies were present. The biliary leakage from the common bile duct was intraoperative identified and subsequentially treated by the endoscopic method. Laparoscopic cholecystectomy with sequential biliary endoprosthesis insertion was completed without conversion to open surgery. The endoscopic stenting was the definitive treatment for the leakage. No evidence of biliary stent complication was observed during the follow-up. This report documents a case of short cystic duct with particular emphasis to the biliary injury risk during the laparoscopic dissection of "unusual" Calot's triangle, and examines our mini-invasive therapeutic strategies in the management of bile leakage after laparoscopic cholecystectomy.

Hospitalisation for COPD in Puglia: the role of hospital discharge database to estimate prevalence and incidence.

BACKGROUND AND AIM: Chronic Obstructive Pulmonary Disease (COPD), although largely preventable, is a great health burden in all the countries worldwide. Statistics of morbidity and mortality of COPD show the need for correct management of the disease. Chronic Obstructive Respiratory Diseases (DRG 88) are in 9th place for discharge in in-patient hospital admission. It is necessary to establish specific indicators which are efficacious and relevant for the patient, the doctor and the health manager. This study will analyse the information in respect of hospital admissions (Hospital discharge database) in Puglia for the period 2000-2005. METHODS: The analysis was carried out utilising the Puglia Region hospital patient discharge database, selecting those patients with admission for chronic respiratory disease as principal or secondary diagnosis. RESULTS: Chronic respiratory diseases are more frequent in males and in people over 45 years old with frequency increasing with age. Geographical distribution shows that there are greater rates of hospitalisation in big cities and in the neighbourhood of industrial areas. Although the trend over time is slight. A higher percentage of re-admission has been found for patients with COPD, and the interval between the two admissions occurs within one or two months; the diagnosis at the second admission is the same as for the first. 10.6% of discharge forms report one diagnosis, especially in patients older than 65 years of age. Little could be said about diagnostic procedures because these are not reported on the discharge form. CONCLUSION: Hospitalisation data confirms expectations regarding age and sex of patients. The high hospitalisation rates indicate that in-patients care still remains the only viable treatment for COPD and other chronic respiratory diseases. The high number of exacerbations reflect the absence of out-patients service or community care, and the same diagnosis in more than one episode shows the lack of efficiency of health services and disease management. This data is necessary to understand disease distribution and the modification of disease management in order to reduce health care costs, to increase efficacy in disease control and to limit repeated exacerbation and so to obtain the maximum benefit for the patients.

Laparoscopic colectomy in colon cancer. A single-center clinical experience.

INTRODUCTION: Aim of our study was to compare the results of the laparoscopic technique to those obtained by traditional open approach in patients with colon cancer. The advantages, disadvantages, and the contraindications (real and presumptive) of this mini-invasive approach are described, by comparing the data obtained from the international literature with our clinical experience. PATIENTS AND METHODS: From February 2000 to May 2006, we performed 73 laparoscopic colectomies for cancer in the Operative Unit of General and Laparoscopic Surgery, Department of Surgical Sciences of the University of Chieti, Italy. The data of these patients were compared with the data obtained from 141 other patients who underwent open procedure for the same pathology in the same period and in the same Unit. Factors such as obesity, previous major abdominal surgery, T4 cancers, perforation and obstruction of the colon, tumor located in the transverse colon or in the left flexure of the colon were considered contraindications to laparoscopic approach. RESULTS: The length of surgical specimens and the number of lymph nodes removed did not show significant differences in the two groups. Two patients in the open procedure group died in the postoperative period. No postoperative death was noted in the group of patients operated by laparoscopic method. Postoperative complications requiring re-operation were observed in 9 patients in the open group and in 3 patients of laparoscopic group. Postoperative complications not requiring re-operation were observed in 16 patients in the open group and in 4 patients in laparoscopic group. Hospital stay was shorter for laparoscopic right or left colectomy compared to corresponding open procedures. At the follow-up (a mean 30 months), the overall survival was 78% for open colectomies and 82.1% for laparoscopic colectomies. Disease-free survival, excluding patients with stage IV tumor and patients died in the postoperative period, was 77.6% for open colectomies and 82.5% for laparoscopic colectomies. In the group of laparoscopic patients, we observed 1 case of port-site recurrence. CONCLUSIONS: Our clinical experience, even if limited by the number of patients and by the duration of follow-up period, contributes in confirming the reliability of laparoscopic procedures in the treatment of tumours of the colon and the safety of oncological results.

[Anisakiasis presenting as perforated ulcer of the cecum]. / Su di un caso di anisachiasi con perforazione del cieco.

A case of cecal anisakiasis is presented. Symptoms were compatible with appendicitis. The patient was operated and a perforated ulcer of the cecum was found. Ileocolic resection was performed. The histologic result showed the presence of Anisakis simplex larva in the muscle of the cecum. The patient was discharged the fifth day without complications. At present he is asymptomatic. He had eaten uncooked anchovies some days before the onset of the disease.

[A case of perforated small bowel adenocarcinoma as first symptom of Crohn's disease]. / Adenocarcinoma perforato del piccolo intestino come prima evidente manifestazione del morbo di Crohn: case report.

A case of perforated small bowel adenocarcinoma presenting as first symptom of Crohn's disease is reported in a 53 years old male patient with abdominal pain and alteration of bowel habits. Endoscopic bioptical sampling demonstrated a Crohn's disease in active stage. The patient underwent medical therapy with resolution of the complained symptomatology; 20 days after discharge the patients is rehospitalized for acute abdomen. A narrowing perforated neoplasia in terminal ileum was discovered at laparotomy. Diffuse peritonitis and metastatic peritoneal implantations were also revealed. An ileocolic resection is performed with ileo-transverse colon anastomosis. The patient dies 4 months later for advanced disease.

Sporadic melanoma in South-Eastern Italy: the impact of melanocortin 1 receptor (MC1R) polymorphism analysis in low-risk people and report of three novel variants.

Environmental and genetic risk factors are involved in the development of melanoma. The role of the melanocortin 1 receptor (MC1R) gene has been investigated and differences according to geographic areas have been described. To evaluate the role of some clinical and genetic risk factors in melanoma development, we performed a case-control study involving 101 melanoma patients and 103 controls coming from South-Eastern Italy (Puglia), after achieving informed consent. We confirmed the role of known clinical risk factors for melanoma. Furthermore, 42 MC1R polymorphisms were observed. Three of these variants (L26V, H232L, D294Y) were not previously reported in the literature. Their predicted impact on receptor function was evaluated using bioinformatic tools. We report an overall frequency of MC1R variants in our population higher than in Northern or Central Italy. The most common polymorphism found was V60L, that has been recently reported to spread among South Mediterranean population. This variant influenced phenotypic characteristics of our population while it did not impinge on melanoma risk. An increased risk of melanoma was associated with two or more MC1R variants, when at least one was RHC, compared to people carrying the MC1R consensus sequence or a single MC1R polymorphism. Interestingly, we observed an increased risk of melanoma in subjects with darker skin and lower nevus count, usually considered at low risk, when carrying MC1R polymorphisms.

[Large inguino-scrotal bladder herniation]. / Voluminosa ernia inguino-scrotale vesicicale.

The authors describe a case of voluminous inguinoscrotal bladder erniation. They write about the subjet with the help of the literature and above all they show the possible dangers of a vesical underestimated injury.

[Rupture of the upper urinary tract during renal colic. Two cases]. / Rottura dell'alta via escretrice in corso di colica renale.

The rupture of the upper urinary tract is an uncommon event. The authors describe 2 cases during renal colic and they write, particularly, about the diagnostic and therapeutic aspects of this pathology.

[Urologic complications of diverticulosis of the colon]. / Complicanze urologiche nella diverticolosi del colon.

In this paper the complications of colonic diverticulosis are reported, on the basis of two clinical cases personally observed. In the first case, a 68 year-old man, the typical symptomatology with pneumaturia, cloudy urine and watery diarrhea suggested a uro-colonic fistula, therefore a fistula between sigma and bladder, caused by a perforate diverticulum, has been diagnosed by means of cystography and barium enema. In the second case, a 64 year-old woman, the irritative symptomatology, hematuria and endoscopic picture suggested a vesical neoplasia. An accurate examination with abdominal TAC and barium enema, showed a perforate diverticulum between uterus and bladder, without affecting the bladder lumen. The surgical treatment required, in both cases, a left hemicolectomy, a minimal bladder resection in the first case, and a greater one in the second case. During the discussion, the main etiopathogenetic causes of uro-colonic fistulae together with the variants in the onset symptomatology, have been stressed.

[Laparoscopic management in acute cholecystitis]. / Il management laparoscopico della colecistite acuta.

The authors discuss the possibility of changing out laparoscopic cholecystectomy during the first clinical manifestation of acute cholecystitis. The international published series report similar results to those found with the laparotomic operation. There is no common operating conduct either or regards surgical technique or the diagnosis of possible pathologies of biliary ducts. It is shown the effective improvement of the pain, the lowest complications and the duration of the postoperative course which, especially in old patients, results considerably diminished with consequent advantage for them.

[Acute phlegmonous appendicitis due to a villous adenoma in a hernial sac. A case report]. / Appendicite acuta flemmosa da adenoma villoso in sacco erniario. Descrizione di un caso.

The authors report a case of a 93-year-old man with villous adenoma causing acute phlegmonous appendicitis. The appendicular localization, extremely uncommon, is the cause of an acute appendicitis in 50% of cases. Therefore, they analyse the anatomo-pathological, clinical, diagnostic and therapeutic aspects of this pathology with the help of the literature.

[Hemangioma of the masseter: a rare location of a pathology not always accurately diagnosed]. / Emangioma del massetere: una rara localizzazione di una patologia non sempre esattamente diagnosticata.

The hemangiomas of the skeletal muscles are rare. The authors describe a case of masseter muscle hemangioma, dwelling upon the problems of differential diagnosis that are present for the straight rapport that the muscle contract with the parotid gland. Thus, the surgeon is led to confuse the malformation with a neoplasm of the parotid gland.

[Acute torsion of the greater omentum]. / Torsione acuta del grande omento.

Primary torsion of the greater omentum is an uncommon cause of acute abdomen and frequently it is misunderstood. In fact, from the analysis of the literature the authors can evict that the preoperative diagnosis is generally wrong. The authors write about the subject and they describe four cases come to their observation and all mistaken for acute appendicitis.

[Clinical study on laparoscopic approach to cholelithiasis in the elderly]. / Studio clinico sull'approccio laparoscopico alla colelitiasi nei pazienti geriatrici.

The Authors report 66 cases of patients aged 75 years or older who underwent laparoscopic cholecystectomy: 28 cases presented a clinical picture of acute cholecystitis, 3 cases had associated common bile duct stones. A high percentage of patients had cardiovascular disease: 29 patients presented with cardiopaties, of these 9 cases had a history of myocardial infarction, 31 patients had artheriosclerotic hypertension, associated, in 7 patients with signs of brain ischemia. Five patients were suffering from Parkinson's disease, 7 were carriers of diabetes, 2 had liver cirrosis. Three patients were converted due to extensive presence of adhesions from previous surgery. Morbidity and mortality rates were respectively 12% and 1.5%. The Authors think that laparoscopic technique widens indications and reduces risks of cholecystectomy also in elderly patients.

[Peritoneal mesothelioma]. / Il mesotelioma peritoneale.

Peritoneal mesothelioma is a quite rare tumor with an incidence of one or two cases per million inhabitants; approximately in the 30-45% of the cases diagnosed it is associated with the corresponding pleural mesothelioma. A predisposing factor is a previous occupational exposure to materials containing asbestos. Clinical symptomatology and instrumental findings may be confusing. Diagnosis is often possible only after direct vision and histologic examination during laparoscopy or laparotomy but it is always tardy, whereas therapy is still unsuccessful. Surgical excision and radiotherapy are less effective than intraperitoneal chemotherapy which seems to lengthen the average survival rate.