The impact of the multidisciplinary tumor board (MDTB) on the management of pancreatic diseases in a tertiary referral center.

BACKGROUND: The implementation of multidisciplinary tumor board (MDTB) meetings significantly ameliorated the management of oncological diseases. However, few evidences are currently present on their impact on pancreatic cancer (PC) management. The aim of this study was to evaluate the impact of the MDTB on PC diagnosis, resectability and tumor response to oncological treatment compared with indications before discussion. PATIENTS AND METHODS: All patients with a suspected or proven diagnosis of PC presented at the MDTB from 2017 to 2019 were included in the study. Changes of diagnosis, resectability and tumor response to oncological/radiation treatment between pre- and post-MDTB discussion were analyzed. RESULTS: A total of 438 cases were included in the study: 249 (56.8%) were presented as new diagnoses, 148 (33.8%) for resectability assessment and 41 (9.4%) for tumor response evaluation to oncological treatment. MDTB discussion led to a change in diagnosis in 54/249 cases (21.7%), with a consequent treatment strategy variation in 36 cases (14.5%). Change in resectability was documented in 44/148 cases (29.7%), with the highest discrepancy for borderline lesions. The treatment strategy was thus modified in 27 patients (18.2%). The MDTB brought a modification in the tumor response assessment in 6/41 cases (14.6%), with a consequent protocol modification in four (9.8%) cases. CONCLUSIONS: MDTB discussion significantly impacts on PC management, especially in high-volume centers, with consistent variations in terms of diagnosis, resectability and tumor response assessment compared with indications before discussion.

Colonoscopy quality assessment and accuracy: analysis of the influencing factors and surgical sequelae on 216 colonoscopies.

OBJECTIVE: Colonoscopy is recognized as the primary screening test for colorectal cancer. However, its inaccuracy in identifying the exact tumor localization is still high. As a consequence, repeated colonoscopies and changes in the surgical management have been reported. This study aims to evaluate the quality of 216 colonoscopies, to define colonoscopy accuracy and to investigate the surgical sequelae of an incorrect localization. PATIENTS AND METHODS: A retrospective analysis of 216 colonoscopies has been conducted. Colonoscopy quality was assessed on: quality of bowel preparation, completeness of the examination, video and/or photographic documentation, and reported the distance of the lesion from the anal verge. Colonoscopy accuracy was evaluated in terms of correspondence between the endoscopic and intra-operative tumor localization. RESULTS: Bowel preparation adequateness was reported in 121 out of 216 (56%) colonoscopies, with an adequate grade in 68.6% of cases. A complete colonoscopy was accomplished in 86.9% of cases with photo documentation in only 59 colonoscopies (27.3%). The lesion distance from the anal verge was documented only in 93 out of 216 colonoscopies. Of the 157 lesions described at the colonoscopy, 117 matched with the intra-operative localization (accuracy 74.5%). Fifteen of the 40 incorrectly localized lesions (37.5%) required changes in the surgical management. At multivariate analysis, the colonoscopy completeness was the only influencing factor on the concordance between endoscopic and intra-operative localization. CONCLUSIONS: Colonoscopy demonstrated adequate accuracy in localizing lesions. However, the incorrect tumor localization leads to a high rate of changes in surgical management. Increase in.

[Clinical reflexions on a case of primary achalasia of the esophagus diagnosed late]. / Riflessioni cliniche su di un caso di acalasia primitiva dell'esofago tardivamente diagnosticata.

We describe an unusual case of achalasia. The patient, a 33-year-old woman, presented with a clinical history of esophageal disease verified by gastroscopy. The diagnosis of hysterical anorexia that had been made some years previously did not correspond with the nosological classifications (DSM III-R, DSM IV). This case underscores the importance of the correct use of clinical methodology, particularly when conclusive diagnosis is essential for successful treatment.

[Reproductive conditioning of the partridge (Perdix perdix) with GnRH and an increase in the photoperiod]. / Condizionamento riproduttivo della starna (Perdix perdix) mediante Gn-RH ed aumento del fotoperiodo.

Follicular growth and egg deposition were induced in the Grey Partridge (Perdix Perdix) after stimulation with Gn-RH and artificial light. The experiment was carried out from November to December 1983, during the short day period, and during the non egg laying period for this bird-sp. Two groups consisting of ten pairs of Grey Partridge each (female and male), received 3.8 mcg of Gn-RH (pGlu-His-Trp-Ser-Tyr-Gly-Leu-Arg-Pro-Gly-NH2) every 8 hours for 10 and 15 days, respectively. With interruption of the Gn-RH treatment we observed follicular regression. For this reason the birds were stimulated with artificial light daily from the 15th day of treatment until egg deposition. Fifty-five days after the start of the Gn-RH treatment the Grey Partridge laid eggs. Forty days of this period the birds were supplemented with artificial light. Twenty pairs of Grey Partridge were used as controls. Periodically two experimental female subjects (treated and control) were sacrificed to observe the development of ovary and oviducts.