Evaluation on prognostic efficacy of lymph nodes ratio (LNR) and log odds of positive lymph nodes (LODDS) in complicated colon cancer: the first study in emergency surgery.

BACKGROUND: Lymph node involvement is one of the most important prognostic factors in colon cancer. Twelve is considered the minimum number of lymph nodes necessary to retain reliable tumour staging, but several factors can potentially influence the lymph node harvesting. Emergent surgery for complicated colon cancer (perforation, occlusion, bleeding) could represent an obstacle to reach the benchmark of 12 nodes with an accurate lymphadenectomy. So, an efficient classification system of lymphatic involvement is crucial to define the prognosis, the indication to adjuvant therapy and the follow-up. This is the first study with the aim to evaluate the efficacy of lymph nodes ratio (LNR) and log odds of positive lymph nodes (LODDS) in the prognostic assessment of patients who undergo to urgent surgery for complicated colonic cancer. METHODS: This is a retrospective study carried out on patients who underwent urgent colonic resection for complicated cancer (occlusion, perforation, bleeding, sepsis). We collected clinical, pathological and follow-up data of 320 patients. Two hundred two patients met the inclusion criteria and were distributed into three groups according to parameter N of TNM, LNR and LODDS. Survival analysis was performed by Kaplan-Meier curves, investigating both overall survival (OS) and disease-free survival (DFS). RESULTS: The median number of harvested lymph nodes was 17. In 78.71% (n = 159) of cases, at least 12 lymph nodes were examined. Regarding OS, significant differences from survival curves emerged for ASA score, surgical indication, tumour grading, T parameter, tumour stage, N parameter, LNR and LODDS. In multivariate analysis, only LODDS was found to be an independent prognostic factor. Concerning DFS, we found significant differences between survival curves of sex, surgical indication, T parameter, tumour stage, N parameter, LNR and LODDS, but none of these confirmed its prognostic power in multivariate analysis. CONCLUSIONS: We found that N, LNR and LODDS are all related to 5-year OS and DFS with statistical significance, but only LODDS was found to be an independent prognostic factor for OS in multivariate analysis.

Combined Strengthening Techniques to Improve the Out-of-Plane Performance of Masonry Walls.

The purpose of this study is to improve the performance of walls under out-of-plane loads especially when subjected to the hammering action of the floors. The idea behind the paper is to provide the masonry walls with a device that behaves like a buttress, without having to build a traditional buttress. The solution presented in this paper consists of a mechanical coupling between the three-dimensional net of steel ribbons of the CAM (Active Confinement of Masonry) system and the CFRP (Carbon Fiber Reinforced Polymer) strips. Since the steel ribbons of the CAM system have a pre-tension, the mechanical coupling allows the steel ribbons to establish a semi-rigid transverse link between the CFRP strips bonded on the two opposite sides of a wall. Therefore, two vertical CFRP strips tied by the steel ribbons behave like the flanges of an I-beam and the flexural strength of the ideal I-beam counteracts the out-of-plane displacements of the wall. The experimental results showed that the combined technique inherits the strong points of both constituent techniques. In fact, the delamination load is comparable to that of the specimens reinforced with the CFRP strips and the overall behavior is as ductile as for the specimens reinforced with the CAM system. They also inspired a more performing combined technique.

Some of the Latest Active Strengthening Techniques for Masonry Buildings: A Critical Analysis.

The present paper deals with the retrofitting of unreinforced masonry (URM) buildings, subjected to in-plane shear and out of-plane loading when struck by an earthquake. After an introductive comparison between some of the latest punctual and continuous active retrofitting methods, the authors focused on the two most effective active continuous techniques, the CAM (Active Confinement of Masonry) system and the Φ system, which also improve the box-type behavior of buildings. These two retrofitting systems allow increasing both the static and dynamic load-bearing capacity of masonry buildings. Nevertheless, information on how they actually modify the stress field in static conditions is lacking and sometimes questionable in the literature. Therefore, the authors performed a static analysis in the plane of Mohr/Coulomb, with the dual intent to clarify which of the two is preferable under static conditions and whether the models currently used to design the retrofitting systems are fully adequate.

A rare diaphragmatic hernia with a delayed presentation of intestinal symptoms following spleno-distal pancreatectomy: a case report.

Acquired diaphragmatic hernia, non-related to trauma, is a very rare condition. It can constitute a therapeutic problem and the surgical solution is not always immediately clear. We report the case of a 73-year-old woman with a history of spleno-distal pancreatectomy for a neuroendocrine tumour performed in 2009, who came back to Emergency Room 2 years later, complaining of abdominal pain. Chest radiography and computed tomography were performed; they showed a diaphragmatic hernia with visceral migration into the thorax. The diaphragmatic defect was surgically repaired and the patient had an uneventful post-operative recovery.

Benign multicystic mesothelioma of peritoneum complicating acute appendicitis in a man: a case report.

BACKGROUND: Benign multicystic mesothelioma is a rare pathology. Few cases are reported in the medical literature and acute presentation is extremely uncommon. CASE PRESENTATION: We describe an acute clinical presentation of the neoplasm that revealed itself with signs and symptoms attributable to acute appendicitis in a 41-year-old white man. Abdominal echography and computed tomography scans demonstrated the presence of a mass in direct contiguity with cecal fundus, but diagnosis remained unclear. Our patient underwent surgery and complete removal of the neoplasm. Only a definitive histological examination defined the nature of the lesion. No signs of relapse were demonstrated 1 year after the operation. CONCLUSIONS: We showed that an acute presentation of a benign neoplasm represents a diagnostic and therapeutic challenge for the surgeon, because of the difficult differential diagnosis that acute presentation can sometimes pose and the trouble that an emergence treatment can imply.

Solitary fibrous tumour of gluteus: a case report about an uncommon localization of a rare neoplasm.

Solitary fibrous tumour (SFT) is a rare benign tumour that occurs most frequently in the pleura. It is considered rare in soft tissues. We report a case of a middle-aged woman that presented a solitary fibrous tumor of gluteus. The tumour was composed of mesenchymal spindle-shaped cells positive for CD34 and bcl-2. Although rare, SFT should be included in the differential diagnosis of mesenchymal soft tissue tumours. The clinical presentation and imaging can be helpful for a better pre-operative diagnosis.

The soluble transferrin receptor (sTfR)-ferritin index is a potential predictor of celiac disease in children with refractory iron deficiency anemia.

The soluble transferrin receptor (sTfR) distinguishes iron deficiency anemia from other types of anemia. Refractory iron deficiency anemia is often the onset symptom in malabsorption-induced celiac disease. We evaluated whether sTfR levels distinguish celiac disease-associated iron deficiency anemia from iron deficiency anemia of other origin. To this aim we measured sTfR and ferritin levels and their ratio (the sTfR/ferritin index) and other hematological parameters in 42 anemic children (20 with and 22 without celiac disease) vs. 22 non-anemic children with celiac disease and 31 healthy controls (age range 4-12 years). Hemoglobin parameters, mean cell volume, and serum iron and ferritin levels were decreased to a similar extent in the anemic patients (celiac and non-celiac). The sTfR level in non-anemic celiac patients was similar to that of normal controls (1.7+/-0.35 mg/L), whereas it was significantly increased in non-celiac and celiac anemic patients (2.2+/-0.5 mg/L, p<0.05 and 2.7+/-1.2 mg/L, p<0.001, respectively). The sTfR/ferritin index was also increased more in the anemic celiac patients (mean 4.4, range 1.5-12.0) than in anemic non-celiac children (mean 2.6, range 1.4-4.0) compared with non-anemic children (mean 1.2, range 0.7-2.0). Differences were more pronounced when ferritin was <5 ng/mL. Thus, the sTfR/ferritin index may be a predictive measure in discriminating anemic patients with celiac disease from those without celiac disease.