Treatment of the pancreatic stump after DCP.

OBJECTIVE: With improvement in methods, mortality after duodeno-cefalo pancreatectomy (DCP) has decreased to 5% even if complication rate is still high (30-50%). The pancreatic fistula still occurs in 25-50% of cases. Various methods of treating pancreatic stump have been proposed aimed to improve this rate. PATIENTS AND METHODS: The AA, surgeons of suburban hospital, have performed in five years, 2009-2013, 12 DCP. The pancreatic anastomosis has been in all cases an end-to-end duct-to-mucosa pancreatic-jejunostomy. RESULTS: The prevalence of fistula has been 33% (4 cases, 3 grade A and 1 grade B according with ISGPF score). CONCLUSIONS: Soft pancreas and small size of pancreatic duct are recognized as the mayor factor of risk for pancreatic fistula. In these cases are usually preferred pancreatic-jejunostomy (PJ) and pancreatic-gastro-anastomosis (PG). Both techniques show advantages and disadvantages: some randomized and prospective studies have demonstrated the absence of significative differences respect to the prevalence of pancreatic fistulas. Whipple method has been the most often used reconstructive method: a single loop with bile-pancreatic anastomosis and gastro-pancreatic anastomosis in sequence. A careful evaluation of pancretic tissue and Wirsung size with the aim of choosing the most suitable technique and an accurate execution are the most effective methods to prevent pancreatic fistula,even considering particular setting as elderly patient or HIV infection.

When surfacers do not dive: multiple significance of extended surface times in marine turtles.

Marine turtles spend more than 90% of their life underwater and have been termed surfacers as opposed to divers. Nonetheless turtles have been reported occasionally to float motionless at the surface but the reasons for this behaviour are not clear. We investigated the location, timing and duration of extended surface times (ESTs) in 10 free-ranging loggerhead turtles (Caretta caretta) and the possible relationship to water temperature and diving activity recorded via satellite relay data loggers for 101-450 days. For one turtle that dived only in offshore areas, ESTs contributed 12% of the time whereas for the other turtles ESTs contributed 0.4-1.8% of the time. ESTs lasted on average 90 min but were mostly infrequent and irregular, excluding the involvement of a fundamental regulatory function. However, 82% of the ESTs occurred during daylight, mostly around noon, suggesting a dependence on solar radiation. For three turtles, there was an appreciable (7 degrees C to 10.5 degrees C) temperature decrease with depth for dives during periods when ESTs occurred frequently, suggesting a re-warming function of EST to compensate for decreased body temperatures, possibly to enhance digestive efficiency. A positive correlation between body mass and EST duration supported this explanation. By contrast, night-active turtles that exceeded their calculated aerobic dive limits in 7.6-16% of the dives engaged in nocturnal ESTs, probably for lactate clearance. This is the first evidence that loggerhead turtles may refrain from diving for at least two reasons, either to absorb solar radiation or to recover from anaerobic activity.

Trace element (Cd, Cu, Hg, Se, Zn) accumulation and tissue distribution in loggerhead turtles (Caretta caretta) from the Western Mediterranean Sea (southern Italy).

Cadmium (Cd), copper (Cu), mercury (Hg), selenium (Se) and zinc (Zn) were determined in the liver, kidney and muscle of 29 loggerhead turtles, Caretta caretta, from the South Tyrrhenian Sea (Western Mediterranean). No significant differences (p>0.05) were detected between males and females. Trace element concentrations were not influenced by the size of the specimen except Se in the liver, which was negatively correlated with the curved carapace length (p<0.001). Muscles generally displayed the lowest trace element burdens, with the exception of Zn which contained concentrations as high as 176 microgg-1dwt. Kidneys displayed the highest Cd and Se mean concentrations (57.2+/-34.6 and 15.5+/-9.1 microgg-1dwt, respectively), while liver exhibited the highest Cu and Hg levels (37.3+/-8.7 and 1.1+/-1.7 microgg-1dwt, respectively). Whichever tissue is considered, the toxic elements had elevated coefficients of variation (i.e. from 60% to 177%) compared to those of the essential ones (i.e. from 14% to 65%), which is a consequence of homeostatic processes for Cu, Se and Zn. Globally, the concentrations of Hg remained low in all the considered tissues, possibly the result of low trophic level in sea turtles. In contrast, the diet of loggerhead turtles would result in a significant exposure to Cd. Highly significant correlations between Cd and Cu and Zn in the liver and kidney suggest that efficient detoxification processes involving MT occur which prevent Cd toxicity in loggerhead turtles.

[Complications of idiopathic chronic colitis]. / Le complicanze delle coliti croniche idiopatiche.

The Authors reviews the acute and chronic complications of chronic idiopathic colitis in a series of 112 cases of his own observation. He discusses perforation, toxic megacolon and massive hemorrhage in terms of their pathogenesis, diagnostic procedures and incidence in the course of ulcerative colorectitis (Crohn's disease). He deals to some length with surgical indications and the choice of operation, both being the subject of considerable controversy, and he outlines his own views in the matter. Among chronic local complications he lists benign stenosis, pseudopolyposis, and fistulization; all of which, unlike neoplastic complications, seldom require surgery.