Rhinomyiasis by Oestrus ovis in a tourist returning from Corsica.

In the Mediterranean basin, one of the most important agents of myiasis is Oestrus ovis Linnaeus 1758 (Diptera, Oestridae). Herein, we report a rare case of nasal myiasis with a secondary infection complication in a patient from northern Italy who had been visiting Corsica. A healthy, 39-year-old Italian woman spent 2 weeks of vacation in Corsica in June 2018. During her stay, she suddenly felt a foreign body inside her nose, followed by cough, pain, burning at the pharyngeal level, cephalalgia, and nasal congestion with secretions from the nostrils. The clinical examination showed a hyperemic and irritated mucosa and endoscopic examination of the patient's nose and right maxillary sinus revealed three tiny mobile larvae, morphologically and molecular identified as L1 instar larvae of Oestrus ovis. The patient's infestation was probably imported from Corsica, as Mediterranean islands are ideal geographical areas for the development of O. ovis, and the timing of infestation match with the period of O. ovis larviposition. Although rhinomyiasis is rare, it should be considered in people returning from abroad presenting with an acute-onset and foreign body sensation in the nose.

[Teaching in the operative room: the benefit of daysurgery on surgical trainees]. / Attività didattica in sala operatoria: utilità della day-surgery nell'iter formativo dello specializzando in chirurgia.

AIM: Aim of the study was to evaluate the operative time and the incidence of post-operative complications in a group of patients undergoing Lichtenstein inguinal hernia repair performed either by surgical residents or senior surgeons in a day-surgery setting. PATIENTS AND METHODS: The study population consisted of 198 patients: group I (n=102), in which the operator was a senior surgeon, group II (n=96), in which the operator was a resident supervised by a senior surgeon. We recorded the duration of the operation and the complications following the procedure, and statistically compared them between group I and II. RESULTS: Our analysis showed that there was a statistically significant difference between the two groups only for the mean operative time, being shorter in group I (62 vs 82 min, p>0.05), while no significant difference was found for the incidence of complications. CONCLUSION: In conclusion, the day-surgery setting allows a high quality training of young surgeons, based on performing minor surgical procedures such has inguinal hernia repair. This training allows a step by step supervised learning process that does not jeopardize the efficacy of the treatment as well as the patient safety. The major cost due to the increase in operative time should be considered as an investment in young surgeons education.

[Esophageal perforations and fistulas: clinical management]. / Perforazioni e fistole esofagee: importanza nella pratica clinica.

Aim of this study was the literature review regarding esophageal perforations and fistulas. We examined the most common causes, clinical findings (symptoms and signs), laboratory and imaging studies for differential diagnosis and complications. Finally, we examined the surgical or endoscopic treatment and the prognosis.

[Photodynamic therapy in cardiac and vascular surgery]. / Terapia fotodinamica in chirurgia cardiaca e vascolare.

One of the major drawbacks to therapeutic cardiovascular intervention is intimal hyperplasia and constrictive remodeling, which result in vascular restenosis. Neointimal hyperplasia is characterized by proliferation and migration of smooth muscle cells. These cells also produce new extracellular matrix, leading to narrowing of vessels. Photodynamic therapy (PDT) represents one of the most promising approaches to the inhibition of intimal hyperplasia. PDT requires the interaction among 3 factors: a source of light, usually a laser, a photosensitizer and oxygen. When the inert photosensitizer absorbs light of a specific wavelength, it is activated to an excited triplet state, generating reactive oxygen species. These free radicals are able to induce apoptosis of the smooth muscle cells that had absorbed the photosensitizer; they also induce changes in the extracellular matrix, reducing cell migration. Because of continued success of PDT in inhibiting intimal hyperplasia in experimental animal models, it is now being tested in clinical trials for vascular diseases. PDT offers many advantages to the surgeon since it can act on numerous factors responsible for vascular lesions. In the future PDT could be used in helping to overcome the inherent failures associated to vascular reconstruction. This treatment modality is emerging as an encouraging therapeutic option, either alone or as an adjunct to conventional treatment. However, more detailed clinical investigation are necessary to determine its full potential.

[Comparison between virtual and conventional colonoscopy in the screening of colorectal polyps]. / Confronto tra colonscopia virtuale e convenzionale nello screening dei polipi del colon-retto.

Aim of this study was to compare virtual and conventional colonoscopy for the detection of colon-rectal polyps. The authors studied 20 patients with these two methods and it was found that virtual colonoscopy is dependent on the size of lesions regarding sensitivity and specificity, is expensive and the learning process with reading images is very long.

Adenomas with severe dysplasia and early carcinoma of the colon-rectum: our experience of 27 patients.

Authors report their experience in the treatment of adenomas with severe dysplasia and early cancer of the colon-rectum confirming that the endoscopic resection of these lesions is safe and curative when completely removed and no submucosal invasion is found. Between 1995 and 1999, 219 patients underwent colonoscopy and 287 polyps were removed. Histologic examination showed 217 adenomatous polyps (75.6%), 58 non adenomatous (20.2%) and 12 early carcinomas (4.2%). Severe dysplasia was found in 15 adenomas. There were no complications. The Authors focused on 12 patient with early carcinoma and 15 with severe dysplasia. The mean follow-up was 34 months. No recurrences were observed, supporting that this procedure is the treatment of choice in selected cases.

[The role of endoscopic sphincterotomy in the therapy of choledocholithiasis: a review of our experience]. / Il ruolo della sfinterotomia endoscopica nella terapia della calcolosi coledocica: revisione della nostra esperienza.

The treatment of common bile duct stones is nowadays endoscopic sphincterotomy. The authors reviewed their series from 1992 to 1999 and confirm that this is a safe, definitive, with low complication rate treatment if is performed in specialized centers and reduces the duration of hospitalization. Operative ERCP is successful is about 96-97% of the cases. There was no mortality related to the technique.

[The emergency management of foreign bodies: our own experience in 46 cases]. / Il management dei corpi estranei in urgenza: la nostra esperienza in 46 casi.

Foreign bodies ingestion is a common cause of emergency endoscopic therapy. Usually ingestion is accidental for children and elderly patients, instead is voluntary in some others as psychopathic people or prisoners. The authors report their experience with 46 cases from January 1992 to December 1998: this technique is safe, with low rate of complications and hospitalization.

[Endoscopic polypectomy in benign adenoma and in early colo-rectal lesions]. / La polipectomia endoscopica negli adenomi benigni e nelle lesioni "early" del colon-retto.

The Authors report their results in 219 patients who underwent endoscopic polypectomy for benign adenomatous polyps and early colorectal cancer. This is safe and curative technique associated with low-risk of complications and in an ideal therapy to prevent the development of colorectal cancer. In fact, nowadays, dysplasia-carcinoma sequence has been described. All polyps were histologically identified and the grade of dysplasia always detected.

[Endoscopic treatment of polyps of the large intestine: authors' experience with 250 cases of polypectomy]. / Il trattamento endoscopico dei polipi del grosso intestino: nostra esperienza su 250 polipectomie.

The Authors report their experience of endoscopic polipectomy. This technique represents a gold standard treatment for polyps of the colon-rectum because it is safe and effective, being correlated with low-risk of complications as perforation and hemorrhage. Hospitality stay was only 24-48 hours. The polyps were histologically examined and grade of dysplasia was determined. The patients underwent surgical resection of the colon when an invasive carcinoma was found.

Solid cystic tumor of the head of the pancreas in a young woman.

This a case report of a solid papillary tumor of the pancreas in a young woman of 18 years, who was referred to after having suffered for a period of 8 months with a rather vague symptomatology, characterized by dyspepsia, fatigue and, towards the end of the 8 month period, weight loss (approximately 2 kg). In the last week, as a consequence of a modest abdominal trauma, the patient was submitted to abdominal CT that showed a burden at the head of the pancreas, demonstrating a round neoformation about 6 cm in diameter with solid echogenicity slightly hypodense. Subsequently, she underwent an operation with the diagnosis of pseudocystis of the pancreas. During surgery, a big cystic formation of the head of the pancreas, into which a drain was introduced, was revealed. The histological postoperative examination was compatible with pancreatic tumor with a low grade of malignancy, cystic papillary or solid papillary type. Therefore, the patient came under our observation and underwent an operation of pancreatoduodenectomy. Two years after the operation, the patient had completely recovered. In this case, we discussed the problem of performing certain preoperative diagnoses despite the aid of modern diagnostic imaging, this being a very rare illness that almost exclusively plagues young women (median age 19 years). This diagnosis has an uncertain histological origin and is generally accompanied by a modest and vague symptomatology. The surgical procedure, given the low grade of malignancy of the neoplasm and the excellent long-term prognosis, must be, with respect to the oncological radicality, as conservative as possible.

Processing of the pre-beta-amyloid protein by cathepsin D is enhanced by a familial Alzheimer's disease mutation.

A major pre-beta-amyloid protein695 (APP695) processing activity from Alzheimer's disease brain extracts was identified and found to be indistinguishable from the activity of cathepsin D.APP695 processing activity cleaved APP695 into a series of fragments that reacted on immunoblots to a monoclonal antibody (C286.8a) against beta-amyloid-(1-7)-peptide and cleaved N-dansyl-APP-(591-601)-amide at the Glu-Val and Met-Asp bonds. Fragments of 5.5 kDa and 10-12 kDa were formed from the cleavage of APP695 by cathepsin D at the Glu593-Val594 bond, and had the same N-terminus as a minor form of beta-amyloid released by cells. The Lys595-->Asn and Met596-->Leu substitutions found in a pedigree of familial Alzheimer's disease, increased the cathepsin D-catalyzed rate of accumulation of 5.5 kDa and 10-12 kDa C286.8a-reactive fragments 5-10fold. This substitution also increased the rate of N-dansyl-APP-(591-601)-amide cleavage at the Xaa-Asp bond by up to 41-fold. These observations suggest a role of cathepsin D in beta-amyloid formation under certain circumstances.

Reversible inhibition of the urea cycle and gluconeogenesis by N,N-diethyl-m-toluamide.

Addition of DEET to suspensions of rat hepatocytes completely abolished synthesis of urea from ammonia and production of glucose from lactate. Both activities were fully restored after cells were washed and resuspended in DEET-free medium. These results suggest the DEET-induced impairment is a reversible biochemical defect at a site common to both pathways.

On the mechanism of inhibition of gluconeogenesis and ureagenesis by sodium benzoate.

Synthesis of glucose from lactate and generation of urea from ammonia were inhibited when sodium benzoate was added to suspensions of rat hepatocytes. Assays with isolated mitochondria suggested pyruvate carboxylase and the N-acetyl-L-glutamate (NAG)-dependent carbamoylphosphate synthetase (CPS-I) as potential sites of inhibition for both pathways, owing to a shared dependency on aspartate efflux from the mitochondria and its subsequent conversion to oxaloacetate in the cytosol. Assays with isolated hepatocytes indicated inhibition to be initiated by accumulation of benzoyl CoA with a resultant depletion of free CoA and acetyl CoA. Measurements of adenine nucleotides showed that benzoate metabolism did not sufficiently alter energy status to account for the observed inhibition. Consistent with these interpretations, acceleration of the conversion of benzoyl CoA to hippurate by the addition of glycine restored the levels of free CoA and acetyl CoA and the rates of gluconeogenesis and ureagenesis. Reduction of the levels of aspartate and glutamate, presumably by interference with the anapleurotic function of pyruvate carboxylase, most likely accounted for inhibition of gluconeogenesis by benzoate. Whether reduced flux through the urea cycle also contributed to inhibition of gluconeogenesis (by diminishing cytosolic conversion of aspartate to oxaloacetate) requires further study. Depression of glutamate and acetyl CoA to levels at or below the Km for NAG synthetase probably accounted for the observed inhibition of ureagenesis. Rates of urea production were observed to vary with changes in the levels of NAG, suggesting NAG-dependent CPS-I to be the primary site of inhibition of ureagenesis by benzoate.