Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of pilonidal disease.

Pilonidal disease (PD) is a relatively common, benign but challenging condition of the natal cleft. This consensus statement was drawn up by a panel of surgeons, identified by the Italian Society of Colorectal Surgery (SICCR) as having a "special interest" in PD, with the aim of recommending the best therapeutic options according to currently available scientific evidence. A three-step modified-Delphi process was adopted, implying: (1) choice of the panelists; (2) development of a discussion outline and of target issues; and (3) a detailed systematic review of the current literature. The agreement/disagreement level was scored on a five-point Likert scale as follows: "A + : strongly agree; A-: agree; N: unsure/no opinion; D-: disagree; D + : strongly disagree. Each panelist contributed to the production of this manuscript, and the final recommendations were reviewed by the Clinical Practice Guidelines Committee.

The treatment of pilonidal disease: guidelines of the Italian Society of Colorectal Surgery (SICCR).

The Italian Society of Colorectal Surgery (SICCR.) has prepared clinical practice guidelines to help its members to optimize the treatment of pilonidal disease, a very common condition, especially among young people, and therefore of great importance on a socioeconomic level. The SICCR committee of experts on pilonidal disease analyzed the international literature and evaluated current evidence. Nonoperative management includes gluteal cleft shaving, laser epilation as well as fibrin glue and phenol injection: reported healing rates and recurrence incidence are satisfactory but the majority of studies are small series with low-quality evidence. Surgical therapy which can be divided into two categories: excision of diseased tissue with primary closure using different techniques or excision with healing by secondary intention. On the whole, no clear benefit is demonstrated for one technique over the other.

Intelligence and psychopathy: a correlational study on insane female offenders.

BACKGROUND: The occurrence of a significant relationship between psychopathic traits and intelligence is still open to debate. Most of the relevant information has been obtained from crystallized IQ tests or on psychopathic male offenders. In this study we hypothesized a negative correlation between psychopathic traits and fluid intelligence on a sample of criminal female in-patients. METHOD: We carried out a correlational study on a selected sample of 56 criminal female offenders. Variables that were measured include the Hare Psychopathy Checklist Revised (PCL-R) total score (and, separately, the scores from its four subscales: Interpersonal, Affective, Lifestyle and Antisocial) and fluid IQ measured by Raven's Progressive Matrices (RPM). RESULTS: Pearson's correlation between RPM IQ and total PCL-R score was negative (r(54) = -0.55, p < 0.001); women with greater psychopathy traits (total PCL-R score) had lower IQ scores. Negative correlations were also found between IQ and the four PCL-R subscales, Interpersonal, Affective, Lifestyle and Antisocial (r(54) = -0.35, p < 0.01, r(54) = -0.52, p < 0.001, r(54) = -0.53, p < 0.001, and r(54) = -0.49, p < 0.001 respectively). CONCLUSIONS: The results indicate a general negative relationship between PCL-R and IQ, equally distributed across the four subcomponents of the psychopathic trait, and support the view that unsuccessful psychopathic women have poor planning and are unable to foresee and represent future consequences of their actions.

Dichotomy of single-nucleotide polymorphism haplotypes in olfactory receptor genes and pseudogenes.

Substantial efforts are focused on identifying single-nucleotide polymorphisms (SNPs) throughout the human genome, particularly in coding regions (cSNPs), for both linkage disequilibrium and association studies. Less attention, however, has been directed to the clarification of evolutionary processes that are responsible for the variability in nucleotide diversity among different regions of the genome. We report here the population sequence diversity of genomic segments within a 450-kb cluster of olfactory receptor (OR) genes on human chromosome 17. We found a dichotomy in the pattern of nucleotide diversity between OR pseudogenes and introns on the one hand and the closely interspersed intact genes on the other. We suggest that weak positive selection is responsible for the observed patterns of genetic variation. This is inferred from a lower ratio of polymorphism to divergence in genes compared with pseudogenes or introns, high non-synonymous substitution rates in OR genes, and a small but significant overall reduction in variability in the entire OR gene cluster compared with other genomic regions. The dichotomy among functionally different segments within a short genomic distance requires high recombination rates within this OR cluster. Our work demonstrates the impact of weak positive selection on human nucleotide diversity, and has implications for the evolution of the olfactory repertoire.

Failure of limiting antigen doses to selectively stimulate high-avidity memory cells.

Mouse spleen cells secondarily stimulated with a small dose of antigen, which elicited few antibody-forming cells, produced antibodies of avidity no greater than that of antibodies synthesized by cells stimulated with an optimal antigen dose. This result is in conflict with the hypothesis that maturation of the immune response is based on competition for limiting amounts of antigen among cells with receptors of varying avidity.

Altered response to pneumococcal polysaccharide in offspring of immunologically paralyzed mice.

The dose of pneumococcal polysaccharide type III required to induce immunologic paralysis in newborn offspring of immunologically paralyzed mice was one-tenth of the corresponding paralyzing dose for newborn offspring of normal mice. Similarly, immunization of the offsprinig of the paralyzed mice was accomplished with one-tenth the dose of polysaccharide necessary to immunize normal newborn mice. The altered susceptibility of newborn mice from paralyzed mothers to the induction of both paralysis and immunity was predicted from theories of antibody formation which postulate that the induction of tolerance or immunity is controlled by the concentration of natural antibodies specific for the antigen used.

Ligasure Precise vs. conventional diathermy for Milligan-Morgan hemorrhoidectomy: a prospective, randomized, multicenter trial.

PURPOSE: Milligan-Morgan hemorrhoidectomy using radiofrequency dissection (Ligasure) has been proposed instead of conventional diathermy in view of its potential benefits in terms of postoperative anal pain and better hemostatic control, but the medical literature is still controversial. This multicenter, randomized, controlled trial was designed to compare the outcomes between Ligasure and conventional diathermy hemorrhoidectomy in the Milligan-Morgan procedures in a sufficient number of patients. METHODS: Patients with Grades III and IV hemorrhoids were randomized to two groups: Ligasure hemorrhoidectomy and conventional diathermy. Postoperative anal pain was measured by the Visual Analog Scale (VAS) and the analgesia required. Postoperative complications, wound healing, and return to working activities also were evaluated as secondary outcomes. RESULTS: A total of 273 patients, well matched for age, gender, working activity and grade of hemorrhoids, were randomized to two groups: Ligasure 146, and diathermy 127. The severity of postoperative anal pain was significantly less in the Ligasure group when measured at least 12 hours after defecation (P < 0.01), whereas it was similar at the time of defecation. The Ligasure group had significantly lower requirements for painkiller pills. There were no significant differences in early and late complications. Return to work and normal activities was significantly faster in the Ligasure group. CONCLUSION: Ligasure hemorrhoidectomy is an effective procedure for Grades III and IV hemorrhoids and facilitates a faster return to work and normal activities by reducing postoperative pain.

Age-related changes in B and T lymphocytes and decline of humoral immune responsiveness in aged mice.

The activity of the immune system declines in an age-related fashion, after reaching a peak in young-adult animals. Although this pattern has been well documented, the mechanisms responsible for the decline of immune potential in senescence have not been fully elucidated. At the same time, it has become apparent that the immune response depends on complex interactions among different cell types. We review the results of the analyses of B- and T-lymphocyte function and activity in the humoral responsiveness of aged mice that have been performed in a number of laboratories, with a variety of experimental techniques. We conclude that an increase in T-cell suppressor function is the first immunologic lesion of aging in mice. This is followed by a decrease in T-cell helper function and finally by a loss of B-cell function.

Effects of long-term treatment of mice with anti-I-J monoclonal antibody and dialyzable leukocyte extract on immune function and lifespan.

In 1969 Walford hypothesized that age-related dysfunctions of the immune system may be involved in the pathogenesis of the lesions and disease of aging. Studies were initiated to test whether immunologic interventions intended to maintain the integrity of the immune system would delay the onset of diseases of aging and prolong lifespan. Adult BC3F1 mice were treated with anti-I-J monoclonal antibody, with human dialyzable leukocyte extract, or with saline once a week for one year. Spleen cells from the mice were then assayed for suppressor, T-helper and B-cell activity. Treatment with dialyzable leukocyte extract decreased the elevated nonspecific suppressor activity. Mice treated with anti-I-J antibody had elevated T-helper cell activity. In another experiment, mice were treated weekly with anti-I-J antibody, dialyzable leukocyte extract, or saline from 18 months of age until natural death. The mice were immunized with avian gammaglobulin at 27 and again at 29 months of age. Both types of immunologic intervention resulted in a greater secondary antibody response than that of the saline-treated control mice. Mice treated with anti-I-J antibody survived longer than did mice of the other two groups. There was a correlation between the magnitude of the secondary response of individual mice and their lifespan. The results provide support for the immunologic theory of aging.

Detection and enumeration of immunoglobulin secreting cells.

A method is described in which sheep red blood cells (SRBC) are coated with anti-immunoglobulin (Ig) antibodies (Ab) for use in reverse hemolytic plaque assays (RHPA) as follows. The non-complement fixing F(ab')2 fragments of rabbit anti-mouse Ig Ab are derivatized with the N-hydroxysuccinimide ester of palmitate. The hydrophobic palmitate tails spontaneously insert into the SRBC membranes, thus coating the cells with anti-Ig F(ab')2 molecules. The SRBC are lysed by successive additions of mouse Ig, rabbit anti-mouse Ig and complement. When this procedure is carried out in agar gel, Ig-secreting mouse cells produce localized hemolytic areas (plaques). The procedure is more reproducible and more sensitive than RHPA performed with protein A-coated SRBC. In principle, this procedure should be adaptable to the detection of cells secreting any molecule for which specific antibodies are available.

Diagnosis of histoplasmosis and blastomycosis by an antiglobulin hemagglutination test.

An antiglobulin hemagglutination test was developed for detection of antibody directed to Histoplasma capsulatum and Blastomyces dermatitidis. The substances responsible for spontaneous agglutination of erythrocytes were removed from histoplasmin and blastomycin by vacuum dialysis, and partial purification of the antigens by gel filtration chromatography on Sephadex G-150 allowed removal of additional nonantigenic material which competed with the antigens for binding on the erythrocyte surface. The test was sensitive enough to detect antibodies in sera which were negative by complement fixation, immunodiffusion, or both, but it failed to discriminate reliably between antibody directed to H capsulatum and antibody directed to B dermatitidis. Erythrocytes sensitized with partially purified blastomycin produced some false-positive reactions with normal canine sera; this was corrected by diluting the antigen before sensitization of the erythrocytes.

[Gastric leiomyoma. Presentation of a case]. / Il leiomioma gastrico. Presentazione di un caso

The only case of gastric leiomyoma observed at the S. Croce Hospital of Cuneo, in over 15 years of surgical activity, is described. On the basis of the literature on the subject, the clinical aspects of the disease are then discussed.

[Protective effect of citicoline on renal ischemia]. / Effetto protettivo della citicolina sull'ischemia renale.

The protective role of cyticholine was investigated on rabbit and dog kidneys subjected to temporary ischaemia. Following right nephrectomy, the right kidneys of 13 rabbits were subjected to warm ischaemia for 60'. Death occurred for various reasons within 48 hr. Histological examination suggested that tubular epithelium damage was less in the animals treated with cyticholine. In a similar experiment on 6 dogs after local and general infusion of cyticholine, warm ischaemia for 90' was followed by death in 33%, compared with 87.5% of the controls. Blood creatinine and BUN returned to normal between the 6th and the 8th days in the four surviving animals. The data suggest that cyticholine assists the functional recovery of kidneys subjected to warm ischaemia for more than 30' and limits tubular damage.

[Laparoscopy: access with open versus closed technique]. / Laparoscopia: accesso con metodo aperto verso chiuso.

Pneumoperitoneum in diagnostic or therapeutic laparoscopy can be achieved by an open or a closed technique. The authors, on the basis of their experience, compare both techniques, concluding that open method is safer, because of the lack of major complications observed in the closed method and with only few minor complications.

[Our experience with reparative and derivative operations for non-cancerous lesions in the extrahepatic bile ducts]. / La nostra esperienza negli interventi riparativi e derivativi per lesioni non neoplastische delle vie biliari extraepatiche

17 reparative operations on the bile ducts, 7 of which were immediate (5 for peroperative lesions and 2 for "spontaneous" lesions) and 10 reoperations to deal with sclero-cicatricial lesions, were studied. 7 reconstructive operations (plastic or end-to-end anastomosis) and 10 derivative operations with a preference for hepato- or choledocho-jejunostomy on defunctionalized loop were carried out. The former were reserved for lesions without or with minimum loss of substance, the latter for extensive lesions. Operative mortality is high and higher still in immediate interventions. Long term results were good in all cases but one.

[Acute mesenteric infarct. I. Identification of predisposing factors and definition of the criteria of "cautious clinical monitoring" of the main groups of patients at risk]. / Infarto mesenterico acuto. Nota I. Identificazione dei fattori predisponenti e definizione dei criteri di "monitorizzazione clinica cautelativa" dei principali gruppi di pazienti "a rischio".

On the basis of experience acquired through 11 cases of acute mesenteric infarction personally observed over a 10-year period (1-1-1978-31-12-1987) and on the basis of a review on the literature, the usefulness for the purposes of early diagnosis and consequent early treatment of monitoring the essential, typical biological and clinical parameters of patients at risk of acute mesenteric infarction are reported.

[Our experience in tailoring definitive terminal colostomies and in the follow-up of such patients]. / Nostra esperienza nel confezionamento delle colostomie terminali definitive e nel follow-up di tali pazienti.

Between January 1983 and July 31, 1988 at the 1st Division of General Surgery of Cuneo S. Croce Hospital, 57 patients (33 m, 24 f) were subjected to abdomino-perineal amputation for rectal A.D.K. A definitive colostomy was fashioned for all patients. Neostoma complications were encountered in 33% of cases. 91% of patients completed the rehabilitative programme and 40% saw satisfactory results as regards the regularisation of the alvus and return to social life.

[Colorectal neoplasms in young patients]. / Neoplasie del colon retto in pazienti giovani.

The prognostic factors regarding colon-rectal cancers in the under-40s are examined. A personal series of 15 cases shows that the incidence of tumour recurrence is higher and the disease-free interval shorter than in patients not selected for age and that 5-year survival is much less. These results permit the hypothesis of greater aggressiveness in colorectal cancers in the young, something that justifies the severer prognosis by comparison with the elderly population.

[Anomalies in gastric stump emptying of patients who have undergone resections for duodenal ulcer previously treated with histamine H2 receptor antagonists]. / Anomalie dello svuotamento del moncone gastrico nei pazienti gastroresecati per ulcera peptica duodenale, precedentemente trattati con farmaci antagonisti dei recettori H2 dell'istamina.

The problem of obstructed emptying of the gastric stump after Billroth II operations in patients previously treated with H2 receptors is discussed. Statistical comparison using the Student's "t" test revealed a significant difference (t = 2.173) between those given and not given H2-antagonists and confirmed the existence of greater postoperative hypotonia in the gastric stumps of the former group. This clinical syndrome demands careful monitoring of the hydroelectrolytic balance and possibly the use of a double naso-gastric and nasojejunal tube as a precaution to ensure the delivery of the jejunal contents to the stomach. The gastrokinetic drugs metoclopramide and domperidone are also beneficial.