Helminth infections in Italian donkeys: Strongylus vulgaris more common than Dictyocaulus arnfieldi.

Donkeys have been used as working animals for transport and farm activities worldwide. Recently, in European countries, there has been an increasing interest in donkeys due to their use as pets, onotherapy or milk production. During 2014-2016, a countrywide survey was conducted to determine prevalence and risk factors of principal helminth infections in 1775 donkeys in 77 Italian farms. A questionnaire on management and parasite control practices was filled out for each farm. Faecal samples were examined using a modified McMaster technique, a centrifugation/flotation method and a sedimentation technique. Pooled coprocultures were performed for differentiation of strongylid eggs. Strongyles were the most common parasites detected (84.9%), followed by Dictyocaulus arnfieldi (6.9%), Oxyuris equi (5.8%), Parascaris spp. (3.6%), Anoplocephala spp. (1.0%), Strongyloides westeri (0.3%). Coprocultures revealed an omnipresence of cyathostomins (100%), followed by Strongylus vulgaris (31.0%), Poteriostomum spp. (25.0%), Triodontophorus spp. (9.0%), Strongylus edentatus (7.0%), Strongylus equinus (5.0%). Logistic regression analysis identified breed, co-pasture with horses, living area, herd size and number of treatments as significantly associated with strongyles. Sex, age, living area and herd size were significantly associated with Parascaris spp. Dictyocaulus arnfieldi was significantly associated with sex, grass, co-pasture with horses, living area and herd size. Strongylus vulgaris was significantly associated with living area and herd size. The mean number of anthelmintic treatments/year was 1.4; most of the donkeys (71.8%) were dewormed using an ivermectin drug. It is important to design parasite programs to specifically address both D. arnfieldi and S. vulgaris in donkeys, and this is especially important if donkeys co-graze with horses.

Hepatozoon canis in hunting dogs from Southern Italy: distribution and risk factors.

Hepatozoon canis is a hemoprotozoan organism that infects domestic and wild carnivores throughout much of Europe. The parasite is mainly transmitted through the ingestion of infected ticks containing mature oocysts. The aims of the present survey were to determine the prevalence of H. canis in hunting dogs living in Southern Italy and to assess potential infection risk factors. DNA extracted from whole blood samples, collected from 1433 apparently healthy dogs living in the Napoli, Avellino, and Salerno provinces of Campania region (Southern Italy), was tested by a quantitative real-time polymerase chain reaction (qPCR) assay to amplify H. canis. Furthermore, the investigated dog population was also screened by qPCR for the presence of Ehrlichia canis, a major tick-borne pathogen in Southern Italy, in order to assess possible co-infections. Two hundred dogs were H. canis PCR-positive, resulting in an overall prevalence of 14.0% (CI 12.2-15.9). Breed category (P < 0.0001), hair coat length (P = 0.015), and province of residence (P < 0.0001) represented significant risk factors for H. canis infection. The presence of H. canis DNA was also significantly associated with E. canis PCR positivity (P < 0.0001). Hunting dogs in Campania region (Southern Italy) are frequently exposed to H. canis, and the infection is potentially associated with close contact with wildlife. Further studies are needed to assess the pathogenic potential of H. canis, as well as the epidemiological relationships between hunting dogs and wild animal populations sharing the same habitats in Southern Italy.

Quality of life following ostomy reversal with purse-string vs linear skin closure: a systematic review.

BACKGROUND: The importance of the defunctioning stoma on minimizing anastomotic leak in colorectal surgery is well established. However, a defunctioning stoma can substantially impact on quality of life (QoL). Circumferential purse-string approximation (PSA) and linear skin closure (LSC) are the most commonly performed surgical technique for reversal of stoma. The aim of this review was to systemically review and meta-analyze available randomized controlled trials (RCTs) comparing PSA and LSC. METHODS: An electronic systematic search using MEDLINE databases (PubMed, EMBASE, and Web of Science) of RCTs comparing PSA and LSC was performed. Eight RCTs totalling 647 patients met the inclusion criteria and were included in this meta-analysis. RESULTS: Patient's satisfaction is significantly lower in PSA group during the first postoperative week, but it sharply improves afterwards and no difference were noted at 1 and 6 months between the two groups. Relative risk (RR) of developing a SSI is significantly lower in PSA compared to LSC group (RR 0.16 95% CI 0.09; 0.30; p = 0.0001), whereas incisional hernia (RR 0.53 95% CI 0.08; 3.53; p = 0.512), operative time (MD - 0.06 95% CI - 0.30; 0.17; p = 0.593), and hospital stay (MD - 0.09 (95% CI - 0.29-0.11; p = 0.401) remain similar. DISCUSSION: QoL was similar in both patients groups after the first postoperative week. PSA significantly reduced SSI rate. No difference was observed in incisional hernia rate, operative time, or length of hospital stay.

Text mining and word embedding for classification of decision making variables in breast cancer surgery.

INTRODUCTION: Decision making in surgical oncology of the breast has increased its complexity over the last twenty years. This Delphi survey investigates the opinion of an expert panel about the decision making process in surgical procedures on the breast for oncological purposes. METHODS: Twenty-seven experts were invited to partake into a Delphi Survey. At the first round they have been asked to provide a list of features involved in the decision making process (patient's characteristics; disease characteristics; surgical techniques, outcomes) and comment on it. Using text-mining techniques we extracted a list of mono-bi-trigrams potentially representative of decision drivers. A technique of "natural language processing" called Word2vec was used to validate changes to texts using synonyms and plesionyms. Word2Vec was also used to test the semantic relevance of n-grams within a corpus of knowledge made up of books edited by panel members. The final list of variables extracted was submitted to the judgement of the panel for final validation at the second round of the Delphi using closed ended questions. RESULTS: 52 features out of 59 have been approved by the panel. The overall consensus was 87.1% CONCLUSIONS: Text mining and natural language processing allowed the extraction of a number of decision drivers and outcomes as part of the decision making process in surgical oncology on the breast. This result was obtained transforming narrative texts into structured data. The high level of consensus among experts provided validation to this process.

Tumor regression grade and survival after neoadjuvant treatment in gastro-esophageal cancer: A meta-analysis of 17 published studies.

INTRODUCTION: Major pathologic regression after neoadjuvant therapy is a strong and favorable prognostic factor in several types of cancer (breast, rectal and bladder). This information is less clear and has yet to be systematically evaluated in upper gastrointestinal tumors. We performed a meta-analysis to evaluate the prognostic impact of tumor regression after preoperative therapy on disease-free survival (DFS) and overall survival (OS) in gastro-esophageal cancer patients. METHODS: we searched for relevant articles in PubMed, SCOPUS, Web of Science, CINAHL, LILACS, Ovid, Cochrane Library, Google Scholar and Embase up to June 2, 2016. Data of tumor regression (complete or near-complete pathologic response) that independently correlated with OS and DFS in multivariate analysis were extracted, and the proper hazard ratios (HRs) with corresponding 95% confidence intervals (95% CIs) were pooled according to the random effect model. RESULTS: a total of 17 studies-which included 3145 patients-were considered in the final analysis. Major pathologic response was significantly related with better OS (HR 0.46, 95% CI 0.32-0.66, P < 0.001) and DFS (HR = 0.40, 95% CI 0.26-0.62, P < 0.001). Pathologic complete response (pCR) or major tumor regression were associated with the same degree of benefit in outcome compared to no or minimal pathologic regression, regardless of histology. CONCLUSION: major pathologic response is associated with a significant improvement in OS compared to no response or minor pathologic changes after neoadjuvant therapy in gastro-esophageal cancers. This should be considered a robust prognostic factor to guide postoperative treatment and follow-up.

Endoscopy and surgery. A combined strategy for diagnosis and therapy of polyposis-cancer sequence in the colon.

BACKGROUND: The aim of the paper is to evaluate retrospectively the series of patients affected by colon polyps and colon cancer to purpose a planned follow-up for patients who underwent colon polypectomy. METHODS: Out of 198 patients affected by colon carcinoma, the authors describe 95 cases of previous, synchronous or metachronous polyps, with a global prevalence of 47.9%, and respectively of 13.6%, 16.6%, and 17.6%. RESULTS: The evolutive sequence between colon polyp and carcinoma is shown through both clinical experience and experimental tests. The epidemiologic curve of adenoma rate precedes by five years the curve of carcinoma, and such is the average period of time for the transformation of an adenoma into invasive carcinoma. In clinical practice, it is frequent to note synchronous or metachronous polyps with respect to colon carcinoma. It is also possible to note carcinoma in patients with previous polypectomies. CONCLUSIONS: On the basis of the retrospective evaluation of the clinical cases, and reviewing international literature, the authors suggest their diagnostic-therapeutic and endoscopic follow-up protocol for patients affected by colon neoformations (Fig. 1).

A case of asymptomatic giant aneurysm of the common hepatic artery.

The authors are presenting a case of asymptomatic giant aneurysm of the common hepatic artery in a 72 year-old woman. The patient came under our observation with a complete, recent diagnosis. However, two years earlier in another clinic, a para-hilar hepatic mass with partially calcified walls was incidentally found during an abdominal ultrasound. An abdominal TC without contrast medium showed the mass to be hepatic hydatid cysts. TC images after 2 years showed a growth in diameter from 7 to 12 cm. Having undergone an hysterectomy and a rectal prosthesis, technical difficulties occurred because of the aneurysm's characteristics. The authors would like to emphasize that the rarity of the lesion must not exclude it from the diagnostic protocol of abdominal masses: ultrasound must be accompanied by a Doppler and the TC must be made using a contrast medium. Furthermore, revascularization surgery may create difficulties that cannot be previously prevented.

Wall lesions of abdominal aortic aneurysms threatening an impending rupture: prognostic evaluations.

BACKGROUND: Final events preceding aneurysm rupture are not completely known. The current study relates to incomplete aortic aneurysm wall lesions (i.e. malacia, dark staining and blebs or blisters) as possible sites of aneurysm rupture. METHODS: 162 abdominal aortic aneurysms, resected between 1988 and 1996, have been reviewed and 27 cases of aneurysms presenting wall thickness lesions are reported. The lesions were scheduled by operative reports and compared to ultrasound and CT scans. RESULTS: The authors classify aortic aneurysms into three phases, depending on the degree of wall degeneration viz 1. Flawless wall aneurysms. 2. (a-b-c) Aneurysms with intraparietal lesions. 3. Ruptured aneurysms. CONCLUSIONS: It is concluded that stage 2 aortic aneurysms must be urgently operated on. They carry a high surgical risk and, consequently, higher morbidity and mortality compared with stage 1 aneurysms.

[Current knowledge and unresolved problems in the pathogenesis of abdominal aortic aneurysm]. / Stato delle conoscenze e problemi aperti sulla patogenesi dell'aneurisma dell'aorta addominale.

This is a wide literature review on abdominal aortic aneurysm (81 references). The main branches in which research is in progress are presented, and new concepts in pathogenesis are illustrated. These come out of the development of knowledge in basic sciences and their interdisciplinary application to this disease. Biochemistry, pathology, immunology, genetics, mathematics, mechanics, fluidodynamics are the routes now followed in the effort to cast light on the inner mechanism of birth and growth of this disease, presently unpredictable and uncontrollable, but successfully treatable by vascular surgery.

[Primary aorto-enteric communication]. / Comunicazioni aorto-enteriche primitive.

BACKGROUND: Primary aortoenteric communications are a rare and severe complication of abdominal aortic aneurysms or erosions by neoplastic diseases. Early diagnosis and surgical treatment are crucial. Postoperative morbidity and mortality are high. Diagnosis if often made intraoperatively, because the typical clinical feature (digestive haemorrhage, abdominal aneurysmal mass, abdominal pain) is often incomplete and critically ill patients require quick surgical decision and do not allow the use of sophisticated diagnostic tools. MATERIAL AND METHODS: Eight cases, observed through 13 years, are presented: six males and two females. Mean age was 61 years; male to female ratio was 3:1. In four cases (50%) a herald bleeding occurred during the days preceding hospital admission. Presenting symptoms were haematemesis (63%), melaena (87%), abdominal pain (63%); six subjects (75%) presented hemorrhagic shock. Only three patients (37%) were aware to be affected with abdominal aortic aneurysm before admission. Diagnosis was always made by clinical feature and urgent laparotomy: two preoperative duodenoscopies were not diagnostic. Aortoduodenal communication occurred in six cases: one of these was secondary to erosion of the aorta by a carcinoma of the pancreas. Aortogastric communication occurred once; the remainder case was a communication between a hypogastric artery aneurysm and the last ileal loop. RESULTS: Surgical operation was carried out in emergency in seven patients: the eight (tumour of the pancreas and aortoduodenal erosion) died before operation. Enteric defect repair, aneurysmectomy and aortic grafting was performed in six cases. In the last case (hypogastric-ileal communication) ligation of the hypogastric artery and ileal segmental resection was performed. Thirty days operative mortality was 58%. CONCLUSION: Despite early recognition and operation, primary aorto-enteric communication remains a severe life threatening disease, bringing high mortality rates. These are clearly affected by shock condition, but a correct surgical technique and prolonged postoperative antibiotic medication to avoid graft infection are mandatory to minimize mortality.

[Proximal anastomotic pseudoaneurysms]. / Gli pseudoaneurismi anastomotici prossimali.

Abdominal aortic pseudoaneurysms development in patients submitted to endoaneurysmectomy or bifurcated aorto-peripheral by pass was, for a long time, considered a rare complication of aortic surgery. In old papers it was referred prevalence of abdominal PSA which rambled on values less than 1%. The diagnosis was always reached in concomitance with fissurations, ruptures or aorto-digestive fistulas. Recent papers, in which were reported results of accurate instrumental (echo and TC) follow-up of patients with aortic prosthesis, demonstrated a really higher prevalence of abdominal aortic pseudoaneurysms (about 6%). A retrospective analysis of PSA admitted to the General and Cardiovascular Institute of the University of Milan and the First Surgical Division of the General Hospital of Treviglio-Caravaggio (BG), demonstrated a high morbidity and mortality of complicated aortic pseudoaneurysms surgery. Considering the data reported in the international literature and the results of the surgery of complicated aortic PSA, the Authors point out the necessity of accurate periodical instrumental follow-up of subjects with aortic prosthesis in order to identify anastomotic pseudoaneurysm and to evaluate incidental evolution of aneurysmatic disease.

[Anastomotic pseudoaneurysm, true para-anastomotic aneurysm and recurrent aneurysm following surgery for abdominal aortic aneurysm. Is a unifying theory possible?]. / Pseudoaneurismi anastomotici, aneurismi veri para-anastomotici e aneurismi ricorrenti in soggetti operati per aneurisma dell'aorta addominale. E possibile una teoria unificante?

BACKGROUND. Recurrent aneurysms (RA) and true para-anastomotic aneurysms (TPA) are currently reported as anecdotal findings during occasional follow-up of subjects previously operated for abdominal aortic aneurysm (AAA). In several instances concomitant false anastomotic aneurysms (FAA) are found, not attributable to infection nor to suture or graft degradation. PURPOSE. To discuss the possibility that RA of inborn arteries, TPA, and non infectious FAA, when concomitantly present in the same subject, may reflect a peculiar late presentation of multiarterial aneurysmal disease. MATERIAL. Three cases of occasionally discovered concomitant RA, TPA, and FAA in subjects previously operated for AAA are reported. The finding of new aneurysms and FAA in subjects previously operated for AAA may be theoretically justified by the currently recognized pathogenetic mechanisms, molecular, enzymatic or genetically determined, implicated in the formation of AAA. This points out the need for a correct surgical management of AAAs and for accurate accomplishment of follow-up programmes supported by ultrasound echography of graft-arterial anastomoses and of the arteries at risk of aneurysmal disease.

[Recurrent aneurysmal disease of the native arteries in subjects operated on for abdominal aortic aneurysm]. / Reaneurismizzazione di arterie native in soggetti operati per aneurisma dell'aorta addominale.

Abdominal aortic aneurysm repairs are presently increasing in number all over the western countries; long life expectancy and high quality of life, warranted to patients surviving operation, stressed the possibility that aneurysmal disease affects other arteries as well as the para-anastomotic aorta itself. OBJECTIVE. The observation that, in the last four years, five patients were operated on for recurrent aneurysms of native arteries, gives the opportunity to discuss the matter and review the literature on this topic. MATERIAL AND METHODS. Five cases of recurrent aneurysms of native arteries in patients that had undergone abdominal aortic aneurysmectomy 4 to 11 (mean: 8) years before are discussed. A total of 16 new aneurysms were found. Although all these patients regularly attended their clinical follow-up program, these observations have to be considered retrospective and incidental, because B-mode echography was not yet routinely requested by the followup protocol. RESULTS. Neither hypertension nor type of graft implanted in the first operation were correlated to the development of new aneurysms in these five subjects. Rupture as causative of the original aneurysmectomy was recorded in two cases (40%), that developed 8 recurrent aneurysms (50%), one of which ruptured. CONCLUSIONS. Although recurrent aneurysms are occasionally reported in the literature, the lack of prospective follow-up series, based on non invasive serial imaging of the arterial system, prevents clarifying whether these observations are isolated or recurrence is likely to be a long-term outcome of aneurysmal disease.

[Surgical treatment of lithiasis of the common bile duct: our experience]. / Il trattamento chirurgico della litiasi della via biliare principale: nostra esperienza.

On the basis of their personal experience of biliary pathology, the authors present their opinion of surgical treatment of benign diseases of the common bile duct. From 1980 to 1988 a total of 930 patients were assessed, 140 of whom were affected by choledocholithiasis. Data confirmed that, with the exception of choledochotomy as a direct approach for removing stones, good results were achieved using papillosphincterotomy, since this technique best restores the physiology of the biliary tract. In cases where common duct dilation exceeded 20 mm or where the patient was in poor clinical condition, bile was drained into the gut forming a side-to-side choledochoduodenostomy.

[A rational approach to cholecystectomy in the patient with an abdominal aortic aneurysm]. / Approccio razionale alla colecistectomia nel portatore di aneurisma dell'aorta addominale.

A retrospective series of 30 (2.8%) cases of cholelithiasis out of 1064 abdominal aortic aneurysmectomies is presented. 21 subjects underwent aneurysmectomy and prosthetic grafting combined with cholecystectomy. Complications related to the combined operation, early or late (6 months to 8 years follow-up was available for the whole series), were not recorded in this subgroup. 9 (30%) patients with coincidental gallstones underwent simple aneurysmectomy: 2 (22%) patients complained of symptoms of biliary colic, eight and fifteen weeks after operation respectively, and successfully underwent medical treatment. A third patient (11%), operated on urgently for ruptured abdominal aortic aneurysm, developed acute cholecystitis, gallbladder perforation and biliary peritonitis on the 17th day of operation: he died of multiple organs failure on the 8th day of urgent cholecystectomy. Acute alithiasic cholecystitis was recorded only once (0.1%) among the 1034 abdominal aortic aneurysmectomies without gallstones: fatal outcome was ascribed to massive multiple organ cholesterol embolization. If careful asepsis and correct surgical tactics are observed, cholecystectomy can safely be performed in combination with abdominal aortic aneurysmectomy in subjects with a positive history of cholecystitis or in poor general conditions, but it cannot be considered as a prophylactic treatment towards postoperative acute cholecystitis in good-risk subjects with a negative history of cholecystitis.

[Latero-lateral choledochoduodenostomy in benign pathology of the common bile duct. A prospective study]. / La coledocoduodenostomia latero-laterale nella patologia benigna della via biliare principale. Studio prospettico.

Biliodigestive derivations for benign diseases of the biliary tract are currently accepted in case of extended to recurrent choledochal stenosis, excessive dilation of the choledochus, impacted ampullary stones. This paper concerns 19 subjects that underwent laterolateral choledochoduodenostomy (CDS) according to the Roesner technique over the period January 1986 through December 1987 in order to evaluate long-term functional results of this operation. Hepatic serum enzymes and bilirubin were determined at intervals of two weeks during the first three months and of four weeks until the sixth month postoperatively. At this time a battery of controls was performed, namely standard plain X-ray of the abdomen, hepatobiliary sequential scintigraphy with HIDA, endoscopic examination of the anastomosis. The level of serum enzymes was then determined at 18 months postoperatively and scintigraphy was repeated as well. Based on the results of this study and the review of the recent literature, our opinion is that CDS has shown as a safe procedure with good long-term results in the treatment of benign disease of the biliary tract, mostly if high-risk aged subjects are concerned.

[Volvulus of the gallbladder. Presentation of a case and review of the literature]. / Il volvolo della colecisti. Presentazione di un caso e revisione della letteratura.

A case of acute torsion of the gallbladder in a 83-year old woman is presented. According to the literature, the pathogenetic mechanism, the anatomical bases and the clinical presentation of this disease are discussed. The age intervals more often affected are the pediatric and teen-ager and, mostly, the elderly over the 70's. The basic anatomical defect is the gallbladder flotation, congenital or acquired. The clinical feature is that of right acute abdomen, and emergency cholecystectomy is the treatment of choice.

[Primary carcinoma of the gallbladder]. / Il carcinoma primitivo della colecisti.

Primary carcinoma of the gallbladder, while infrequent, is the most representative among the malignant neoplasms of the biliary tract. The diagnosis of carcinoma of the gallbladder was made in 22 out of 1252 operations performed for gallbladder disease (1.8%) since January 1980 through June 1988: only in 9% of the subjects a malignant tumor of the gallbladder was suspected preoperatively. In 21 cases the carcinoma was associated with chronic lithiasic cholecystitis. The 22 cases were assessed according to the classification proposed by Nevin. The operations performed were: 4 routine cholecystectomies (stages I and II) 4 cholecystectomies with lymphadenectomy (stages I and II); 4 cholecystectomies with lymphadenectomy and liver wedge resection of the bed of the gallbladder (stages II, III, IV, V); 7 explorative laparotomies and 3 gastrojejunal anastomoses (stage V). A complete follow-up was available for each of the 22 subjects: cumulative survival rates were calculated according to Kaplan-Meyer. The overall 5-year cumulative survival rate after operation was 19% for the whole group, whereas it reached 76% for the subgroup of 9 patients classified in stages I and II. This analysis reinforces the statement that surgical therapy can achieve excellent results if brought about before cancer overwhelms the muscular layer of the gallbladder wall. Thus, as the preoperative diagnosis of gallbladder carcinoma is extremely difficult and uncertain, any delay in performing cholecystectomy seems to be unwise in all those cases of chronic benign disease of the gallbladder (whether lithiasic in nature or not) that are suspected to be a major risk factor for cancer degeneration because of their frequent association with the carcinoma of the gallbladder.

[Current indications for percutaneous transhepatic cholangiography (PTC)]. / Indicazioni attuali alla colangiografia percutanea transepatica (PTC).

Percutaneous transhepatic cholangiography (PTC) showed its widest diffusion during the late '70s while since the early '80s it was gradually replaced by endoscopic retrograde cholangiopancreatography (ERCP). Anyway, a well definite role for PTC still exists. PTC was performed in 60 of 131 cases of obstructive disease of the biliary tree: the indications are illustrated in detail. The statistical indicators utilized to choose this examination were: echographic determination of the diameter of the biliary tree, bilirubinemia, alkaline phosphatase (ALP) and serum gamma-GT. Data collected during this study showed that biliary dilation has a significant correlation to serum levels of ALP, while bilirubin has not. Biliary dilation is currently well established by echography: in some instances, however, biliary obstruction is earlier suggested by elevated serum enzymes of biliary stasis, while it is clearly demonstrated that biliary dilation is a precursor of jaundice, better defined as an expression of biliary hypertension. Based on these observations and on the review of the literature, the Authors believe that PTC still remains a second choice examination as compared to ERCP: when the latter be not effective for diagnosis or decompression of the biliary tree, then PTC can be resolutive.