Could Transplantation into the Thyroid Gland Benefit Pancreatic Islet Grafting in Unstable Type 1 Diabetes (T1DM), Complicated Type 2 Diabetes (T2DM), and Patients with Total Pancreatectomy?

BACKGROUND: Insular allograft for unstable type 1 diabetes and autograft in pancreatectomy patients are nowadays considered established procedures with precise indications and predictable outcomes. The clinical outcome of islet transplantation is similar to that of pancreas transplantation, avoiding the complications associated with organ transplantation. OBJECTIVE: We hypothesised that transplantation of islets of Langerhans within an endocrine organ could better promote their engraftment and function. This could help to resolve or ameliorate known pathological conditions such as unstable type 1 diabetes and complicated type 2 diabetes. RATIONALE: Pancreatic islet transplantation is currently performed almost exclusively in the liver. The liver provides a sufficiently favourable environment, although not entirely. The hepatic parenchyma has a lower oxygen tension than the pancreatic parenchyma and the vascular structure of the liver is not typical of an exclusively endocrine organ. Moreover, islet transplantation into the liver is not without complications, including hematoma or portal vein thrombosis. PROPOSED PROJECT: The thyroid gland is the endocrine gland proposed as a 'container'. In fact, it has all the characteristics of 'physio-compatibility' which can address the objectives assumed. It is indeed an ideal site because it is an easily accessible anatomical site that allows islets to be implanted using ultrasound-guided transcutaneous inoculation technique. Moreover, it has physiological and anatomical endocrine affinities with pancreatic islets and, if necessary, it can be removed, using hormone supplementation or replacement therapy. CONCLUSIONS: The thyroid gland may be proposed as an ideal site for islet implantation due to its anatomical and physiocompatibility characteristics.

Morbidity and mortality analysis in general surgery operations. Is there any room for improvement?

BACKGROUND: The aim of this work is to examine the performance of surgeries, by evaluating the results. The evaluation of the results, with particular attention to complications, is the corner stone to identify the causes leading to correction of any predisposing factors and reducing risks, to improve quality of care. METHODS: We performed a retrospective analysis of 952 consecutive patients who had elective or emergency surgery from November 1, 2018, to October 31, 2019. We classified surgical intervention according to their complexity. The Clavien Dindo classification was used to categorize the complications. We performed a stepwise multivariate logistic-regression analysis, with the presence of postoperative complications as dependent variable and age, gender, BMI, ASA, type of surgery procedures, complexity of surgery, operative time as covariates. RESULTS: A total of 952 surgical procedures were included in this study. Abdominal procedures were the most frequent type of surgery performed (52.1%). Postoperative complications occurred in 120 surgical procedures (12.6%), these are related to the increase of the ASA score and the longer average operative time, with an increase of developing complication of 5% for each additional 10 minutes of surgery. CONCLUSIONS: Many factors influence postoperative morbidity and mortality. Particular attention was due to complication's evaluation, about all in abdominal surgery and high complexity procedures. We argue that key factors which influence the favorable surgical outcome are compliance with standardized safety procedures, volume of activity of the structure, presence of interdisciplinary care groups, and ability of health professionals in recognizing and promptly treating complications.

Blunt splenic trauma 2.0. State of the art.

AIM: To evaluate the advantages and potential risks of "Non Operative Management" (NOM) in order to redifine the technique into the true gold standard and to extend its application to the emergency care of blunt splenic trauma. MATERIALS AND METHODS: Blunt trauma cases treated between 2004 and 2019 have been retrospectively evaluated. Every patient has been distributed at the hospital admission in 3 different groups: stable, unstable and transient responder according to ATLS. NOM exclusion criteria were only introduced in 2013: we therefore assessed datas before and after this year. RESULTS: Over a period of 15 years, approximately 6 patients per year were admitted to our hospital with a spleen injury. After the introduction of the NOM protocol in 2013, the proportion of splenectomies progressively decreased. This rate also increased for higher injury grades. The overall number of patients who underwent NOM was 40 (43%), but while between 2004 and 2012 only 25% of patients were managed with NOM, between 2013 and 2019 70.3% of patients were treated with NOM. CONCLUSIONS: Nowadays any blunt splenic trauma could, theoretically, undergo NOM, regardless of the grade of the injury; the only strict criteria for OM should be haemodynamic instability; this assumption depends, of course, on hospital's human and technological resources. KEY WORDS: Non operative management, Splenic trauma, Splenectomy.