[Venous thromboembolism prophylaxis after general surgery: where are we now?]. / Profilassi antitrombotica nel paziente chirurgico: a che punto siamo?

Venous thromboembolism (VTE) is a frequent complication in patients undergoing major surgery, with the possibility of long-term disability or fatal outcome. The rationale of the thromboprophylaxis in all patients can be summarized in three points: 1) the VTE is common in some types of surgery; 2) the VTE can be fatal; 3) thromboprophylaxis is highly effective and safe and, besides these clinical benefits, leads to lower total costs of treatment without further diagnostic and a new shelter for treating venous thrombosis. The surgical patients may present at admission one or more risk factors for VTE, The effect of this risk is cumulative, it is important to stratify the risk and to established an adequate prophylactic strategy. Today there is a unanimous consensus that the low molecular weight heparins are both effective and safe in preventing VTE in surgical patients. Unanimously approved guidelines can help surgeons in making decisions regarding VTE prophylaxis.

A study about mechanisms of des-gamma-carboxy prothrombin's production in hepatocellular carcinoma.

AIM: Des-gamma-carboxy prothrombin (DCP) is an abnormal prothrombin, increased in serum of patients with hepatocellular carcinoma (HCC) as result of an acquired defect of post-translational carboxylation of prothrombin's precursor. It is unclear if the reduced activity of gamma-carboxylase is secondary to vitamin K deficiency or to an altered gene encoding this enzyme. The aim of this study was to evaluate the effect of vitamin K administration on DCP and alpha-fetoprotein (AFP) levels, to identify a relationship between vitamin K and DCP serum levels and to investigate mechanisms of serum elevation of DCP levels. METHODS: The authors determined DCP and AFP serum levels and vitamin K concentration in 64 cirrhotics with HCC and in 60 cirrhotic subjects without HCC. In HCC subjects DCP and AFP levels were measured before and after vitamin K administration. A t-test for unpaired data was applied (P values <0.05 statistically significant). RESULTS: Only HCC patients had detectable levels of DCP and significant AFP levels. Administration of vitamin K reduced DCP but not AFP levels in HCC patients. No correlation was observed between vitamin K concentration and DCP levels: vitamin K concentration was similar both in HCC patients and in control group without HCC; HCC patients had the same vitamin K concentration regardless of elevated o reduced DCP levels after vitamin K administration. CONCLUSION: DCP detectable serum levels are the result not only of vitamin K deficiency or selective defects of carboxylase, because probably alterations of membrane receptors or cytoplasmatic transfers, that are necessary for the function of vitamin K, are involved.

[Our experience on the treatment of epigastric hernia]. / Nostra esperienza sul trattamento dell'ernia epigastrica.

The epigastric hernia represents a rare surgical affection, sometimes insidious, whose pathogenesis has been discussed for a long time, revealing, in the course of the years, multiple predisposing and responsible factors of its appearance. From our experience and the data reported in the literature, it is clear that a standard surgery does not exist for this pathology, and it is often necessary to perform preliminary uncommon diagnostic exams. Our retrospective study consists in the analysis of the surgical treatments executed, from 2003 to 2006, on 37 patients suffered from epigastric hernia, for everyone of which, on the basis of the clinical features, of the preoperative diagnostic results and of the characteristics of the hernia defect, it has been encouraged a personalized surgical procedure,obtaining therefore, for the same pathology, different treatment protocols (open or laparoscopic procedures, ordinary hospital stay or day-surgery, prosthetic or not surgical repair).

[The use of dermic substitutes in the repair of cutaneous defect due to a phlebostatic wound]. / L'utilizzo di sostituti dermici nella riparazione del difetto cutaneo da ulcera flebostatica.

The use of dermic substitutes is a valid and effective choice in the treatment of the cutaneous defects with loss of substance. In our experience, the aesthetic and functional results of dermic substitutes is really positive and encouraging, with better tolerance by patients than the autologue grafts.