Orbital/ocular inflammatory involvement in VEXAS syndrome: Data from the international AIDA network VEXAS registry.

VEXAS syndrome is a recently described monogenic autoinflammatory disease capable of manifesting itself with a wide array of organs and tissues involvement. Orbital/ocular inflammatory manifestations are frequently described in VEXAS patients. The objective of this study is to further describe orbital/ocular conditions in VEXAS syndrome while investigating potential associations with other disease manifestations. In the present study, twenty-seven out of 59 (45.8 %) VEXAS patients showed an inflammatory orbital/ocular involvement during their clinical history. The most frequent orbital/ocular affections were represented by periorbital edema in 8 (13.6 %) cases, episcleritis in 5 (8.5 %) patients, scleritis in 5 (8.5 %) cases, uveitis in 4 (6.8 %) cases, conjunctivitis in 4 (6.8 %) cases, blepharitis in 3 (5.1 %) cases, orbital myositis in 2 (3.4 %) cases. A diagnosis of systemic immune-mediated disease was observed in 15 (55.6 %) cases, with relapsing polychondritis diagnosed in 12 patients. A significant association was observed between relapsing polychondritis and orbital/ocular involvement in VEXAS syndrome (Relative Risk: 2.37, 95 % C.I. 1.03-5.46, p = 0.048). Six deaths were observed in the whole cohort of patients after a median disease duration of 1.2 (IQR=5.35) years, 5 (83.3 %) of which showed orbital/ocular inflammatory involvement. In conclusion, this study confirms that orbital/ocular inflammatory involvement is a common finding in VEXAS patients, especially when relapsing polychondritis is diagnosed. This makes ophthalmologists a key figure in the diagnostic process of VEXAS syndrome. The high frequency of deaths observed in this study seems to suggest that patients with orbital/ocular involvement may require increased attention and more careful follow-up.

Laparoscopic and Open Surgical Treatment in Gastroduodenal Perforations: Our Experience.

INTRODUCTION: Peptic ulcer perforation (PPU) is a common surgical emergency and the mortality rate ranges 10% to 40%, especially in elderly patients. Laparoscopic repair achieved encouraging results. MATERIALS AND METHODS: We enrolled patients performing surgical repair for PPU from January 2007 to December 2015 in our surgical unit. The aim of this retrospective observational study was to compare the results of PPU laparoscopic repair with open technique. The following characteristics of patients were evaluated: age, sex and American Society of Anesthesiologists classification. The site and the diameter of perforation were recorded: gastric, pyloric, duodenal, and the location on the anterior or posterior wall. RESULTS: In total, 59 patients (39 males and 20 females) with a mean age of 58.85 years (±SD) were treated surgically. Laparoscopic repair was accomplished in 21 patients. The mean operative time for laparoscopic repair was 72 minutes (±SD), significantly shorter than open repair time (180 min ±SD). The results demonstrated that laparoscopic repair is associated with a shorter operative time, reduced postoperative pain (4.75 vs. 6.42) and analgesic requirements, a shorter hospital stay (7.5 vs. 13.1), and earlier return to normal daily activities. DISCUSSION: Laparoscopic surgery minimizes postoperative wound pain and encourages early mobilization and return to normal daily activities. The benefit of early discharge and return to work may outweigh the consumable cost incurred in the execution of laparoscopic procedures. CONCLUSIONS: Complications in both procedures are similar but laparoscopic procedure shows economic advantages for reducing postoperative hospital stay, postoperative pain, and for a good integrity of abdominal wall.

Intermittent pneumatic compression in laparoscopic surgery for prevention of deep vein thrombosis and cellular damage from iatrogenic compartment syndrome.

AIM: This study is aimed to evaluate the incidence of the postoperative deep vein thrombosis (DVT) and the cell damage from compartment iatrogenic syndrome, analyzing two groups of patients operated laparoscopically, one of which assisted with a Sequential Compression Device (SCD). MATERIAL OF STUDY: A patients' series submitted to laparoscopic surgery over a period at least 90 minutes. The venous flow in the lower limbs was detected with the Echo Colour Doppler method, and only one of the two groups was assisted with the SCD. RESULTS: Between November 2006 and October 2007, 35 patients were evaluated, 21 of them wew assisted with SDC and the remaining 14 patients were the control group. All patients had a follow-up was extended for 5 years at the interval of 7 days, 14 days, 30 days, 3 and 5 years. DISCUSSION: The results were confirmed that the application of SCD is able to neutralize the negative effect of the PNP reducing the possible risk of thromboembolic venous stasis and the improvement of lactic acid and of myoglobinemia are attributable to a reduction of preload. With the use of IPC, it decreases venous stasis, improves venous return and cardiac output increases, preventing cell damage by hypoperfusion. CONCLUSIONS: The use of a SCD applied to the lower limbs allows an increase in venous return from the lower limbs so reducing the risk of DVT. KEY WORDS: Cellular damage, DVT, Pneumoperitoneum.