Early diagnosis of anastomotic leakage after colorectal surgery by the Dutch leakage score, serum procalcitonin and serum C-reactive protein: study protocol of a prospective multicentre observational study by the Italian ColoRectal Anastomotic Leakage (iC.

BACKGROUND: Anastomotic leakage (AL) is a dreaded major complication after colorectal surgery. There is no uniform definition of anastomotic dehiscence and leak. Over the years many risk factors have been identified (distance of anastomosis from anal verge, gender, BMI, ASA score) but none of these allows an early diagnosis of AL. The DUtch LeaKage (DULK) score, C reactive protein (CRP) and procalcitonin (PCT) have been identified as early predictors for anastomotic leakage starting from postoperative day (POD) 2-3. The study was designed to prospectively evaluate AL rates after colorectal resections, in order to give a definite answer to the need for clear risk factors, and testing the diagnostic yeld of DULK score and of laboratory markers. Methods and analysis. A prospective enrollment for all patients undergoing elective colorectal surgery with anastomosis carried out from September 2017 to September 2018 in 19 Italian surgical centers. OUTCOME MEASURES: preoperative risk factors of anastomotic leakage; operative parameters; leukocyte count, serum CRP, serum PCT and DULK score assessment on POD 2 and 3. Primary endpoint is AL; secondary endpoints are minor and major complications according to Clavien-Dindo classification; morbidity and mortality rates; readmission and reoperation rates, length of postoperative hospital stay (Retrospectively registered at ClinicalTrials.gov Identifier: NCT03560180, on June 18, 2018). Ethics. The ethics committee of the "Comitato Etico Regionale delle Marche - C.E.R.M." reviewed and approved this study protocol on September 7, 2017 (protocol no. 2017-0244-AS). All the participating centers submitted the protocol and obtained authorization from the local Institutional Review Board.

Apple and peach consumption habits across European countries.

The aim of this study was to gain information concerning apple and peach consumption frequency within different European countries in relation to age and gender. The survey was a part of a complex experiment with the aim of evaluating consumers' preferences towards new varieties, and the data is based on the self-reported declarations of respondents, male and female, between 15 and 70 years old. 4271 consumers from 7 European countries were invited to supply information about their apple consumption habits, whereas 499 respondents from 5 countries answered questions relating to frequency of peach and nectarine consumption. In both, the apple and the peach surveys, data analysis of declared intake showed significant differences between nationalities. The highest apple consumption was in Poland, where over 55% declared a consumption of more than 5 apples per week. In comparison, Italian consumers most often indicated eating 3-5 apples per week (39.3%). The lowest apple consumption was in the Netherlands and Spain. In the case of peaches, the highest consumption was indicated in France where 48% of respondents declared a peach consumption of 3-5 per week with 40% eating more than 5 fruits per week. The lowest peach intake was declared in Germany. Irrespective of country women were shown to eat more apples that men. Furthermore, the group of older people (61-70 years) consume apples more often than the adult group (36-60), while within the youngest group of consumers (16-35) eating apples was not at all popular. As with apples females declared a higher peach consumption, and again significantly lower fruit consumption by the youngest group (16-35) was indicated. Although the availability of fruit at the market remains a prime factor in determining apple and peach consumption, our survey confirmed the trends of declining this popular fruit intake by the younger generation, as well as the persistent tendency of lower frequency of fruit consumption among men than women.

A rare case of blunt thoracoabdominal trauma with small bowel perforation from air bags.

Vehicle collisions represent more than 75% of mechanism of blunt abdominal trauma. In spite of the incomparable improvement of car safety devices, recent studies pointed out that the air bags might cause injuries, specially when it is not associated with seatbelt. In fact, some studies pointed out that crash victims using air bags alone have increased injury severity, hospitalisations, thoracoabdominal procedure, and rehabilitation. Some of the most frequently injured organs reported from air bag deployment are the liver (38%), the spleen (23%) and digestive system (17%). Injury of the hollow viscera are far less common. In particular, blunt abdominal trauma resulting in small bowel perforation is an infrequent lesion. These injuries are difficult to diagnose because specific signs are poor and a delay in treatment increases mortality and morbidity of the patients. We describe a case of thoracoabdominal trauma that occurred during a head-on collision after an air bag deployment without seatbelt use.

[Non palpable testis in adult: laparoscopic treatment]. / Testicolo non palpabile nell'adulto: trattamento laparoscopico.

Cryptorchidism has an incidence of 0.8 - 2%, being undescendent testis nonpalpable in 20% of the cases. The latters have an increased risk of malignant transformation, infertility and epididymal malformation. Surgical treatment of nonpalpable testis is prone to failure compared to the palpable ones. Many diagnostic methods have been described; the most promising is the use of diagnostic laparoscopy which, compared to the imaging modalities, is more reliable to determine the site of the nonpalpable testis.

Locoregional IL-2 therapy in the treatment of colon cancer. Cell-induced lesions of a murine model.

BACKGROUND: Local therapy with IL-2 may be very effective in the treatment of different forms of cancer. The aim of this study was to determine the effectiveness of IL-2 locoregional application in the treatment of colon cancer. MATERIALS AND METHODS: Twenty eight syngenic BDIX rats were utilized in this study. The rats were divided into two groups of fourteen animals: group T (treatment) and group C (control). All rats of both groups were injected, under the splenic capsule, with T 10(7) DHD/K2/ TRb neoplastic cells. Then, within and around the site of the previous inoculation, the T group was injected with 1 ml of glucosate solutions + 0.1% albumin (BSA) containing 2.5 x 10(6) IU of IL-2 ( Proleukin-Chiron), whereas the C group was injected with 1 ml of BSA alone. After three weeks, rats were sacrificed and the liver and spleen were removed. The following parameters were considered: volume and weight, neoplastic-non neoplastic tissue index of the spleen, mitotic index and vascular density of splenic and hepatic lesions. RESULTS: All the studied parameters showed statistically significant differences in treated and untreated animals. CONCLUSION: This study of a murine model demonstrated that IL-2 locoregional therapy may be effective in the treatment of colon cancer.

Liquid chromatography-tandem mass spectrometry for the identification of impurities in d-allethrin samples.

A previous GC/MS study highlighting the impurity profile of the synthetic pesticide d-allethrin is extended here to validate and confirm the impurities identity through the development of soft ionisation HPLC-MS methods. To accomplish this, we developed a reverse phase LC-MS analysis in gradient elution with two distinct soft ionisation techniques, the atmospheric pressure ionisation with electrospray source (API-ESI) and the chemical ionisation (APCI). A single quadrupole and an ion trap, which allowed the simultaneous determination of the molecular masses and structural information of the impurities by acquisition of collisionally induced (CID) product ions spectrum and in-source fragmentation, were employed as analysers. Single quadrupole and ion trap analysers resulted perfectly matching in the d-allethrin impurity fragmentation patterns. All the main impurities over 0.1% identified by GC/MS were confirmed. Results indicate that the proposed HPLC/MS method was found appropriate to confirm the presence of impurities such as chrysolactone, chloro allethrin derivatives, allethrolone and chrysanthemic acid, excluding their formation under GC/MS strong ionisation condition.

Stereoselective determination of allethrin by two-dimensional achiral/chiral liquid chromatography with ultraviolet/circular dichroism detection.

A two-dimensional achiral/chiral HPLC method with circular dichroism (CD) detection was optimized for the stereochemical resolution and determination of the elution order of the eight stereoisomers of synthetic allethrin. A monolithic silica HPLC column (Chromolith, Merck, 100 mm x 4.6 mm i.d.) was put orthogonally to an enantioselective OJ Daicel column (250 mm x 4.6 mm i.d.) by means of a switching valve. The resolution of cis and trans diastereoisomers on the silica column was obtained by using a mobile phase consisting of n-hexane:tert-butyl methyl ether (96:4) (v/v) at a flow rate of 1 ml min(-1). The cis and trans peaks were then switched to the enantioselective OJ column separately in two subsequent injections. The resolution of the four trans stereoisomers was accomplished by using n-hexane:tert-butyl methyl ether (90:10) (v/v), while the mobile phase composition for the four cis stereoisomers consisted of n-hexane:isopropanol (99.3:0.7) (v/v). The CD based detection system allowed the determination of the elution order on the basis of the CD signals of the single stereoisomers, together with the injection of pure stereoisomers. Under the final conditions, the validated method was applied to the determination of stereoisomeric composition and absolute configuration of the prevailing stereoisomers of real samples, i.e. commercial batches of different sources of d-allethrin.

Subjective scales for the evaluation of therapeutic effects and their use in complementary medicine.

Using existing systems for appraising the efficacy of various therapies, regardless of their typology, the authors considered approximately 10 methods commonly used to evaluate quality of life. They provide guidelines on how to build another index for judging quality of life, taking into account the patient's conditions of life. These indexes share similar problems in finding objective measures for assessing personal situations without regard to patients' or observers' subjective impressions. Nevertheless, the authors demonstrate that for randomized controlled clinical trials and for meta-analyses this deficiency is also a problem, at least qualitatively, for scientific methods that are considered quite objective. Therefore, according to the methodological manifesto of the World Health Organization, the authors conclude by suggesting the simultaneous adoption, for complementary medicine studies, of some methods already known for their use in conventional medicine, despite general limited validity.

[Isolated rupture of aneurysm of the internal iliac artery]. / Rottura isolata di aneurisma della arteria ipogastrica.

Isolated aneurysms of the internal iliac artery are rare and often asymptomatic. They are frequently diagnosed as a result of complications such as rupture. The authors describe in detail two cases of ruptured aneurysms of the internal iliac artery treated by emergency surgery with no perioperative mortality or morbidity.

Benign biliary stricture. Personal experience and technical notes.

BACKGROUND: Benign biliary strictures are a binding situation for clinicians when choosing the best treatment. This is a benign disease and needs safe, effective and lasting therapy. Up to day non surgical treatment have been suggested as the first therapeutical option but surgery seems to support the best late results. METHODS: The authors report their experience in 206 patients, 64 males and 142 females, aged from 27 to 77 years, affected by postoperative (160 patients) or inflammatory (46 patients) biliary strictures. All the patients but three had been treated by surgical procedures. RESULTS: Postoperative morbidity and mortality were 18.4% and 3.4% respectively. Follow-up ranged from 2 to 16 years. Late stricture of bilio-enteric anastomosis has been observed in 8.2% of patients and peptic ulcer or cholangitis in 4.9% of cases. Restenosis appeared after a mean time of 2.5 years (range 20 months-6 years), supporting the need for a long term follow-up. Effective late results have been reported in 91.5% of patients. No late complications of ineffective results have been observed after transduodenal sphincterotomy. CONCLUSIONS: The authors propose some guidelines for choice charce of treatment, analysing the limits of non surgical therapy and underlying the best surgical tactics. Bilio-enteric anastomosis is a safe, effective and lasting therapy for biliary strictures; Hepp-Couinaud hepatico-jejunostomy is the best choice for high-medium stricture; transduodenal sphincterotomy preserves its important role in low biliary stenosis.

[Intralobular pulmonary sequestration: apropos a case]. / La sequestrazione polmonare intralobare: a proposito di un caso.

The authors report their experience with a patient suffering from an intralobar bronchopulmonary sequestration (IBS). The lesion was misdiagnosed as metapneumonic lung abscess. IBS is a rare, diagnostically binding lung congenital malformation. So far, TC and MR angiography achieve pathognomonic findings with low invasivity. The best treatment of IBS could be surgical resection.

[Mannhein index in the prognosis and treatment of acute peritonitis]. / L'indice di Mannheim nella prognosi e nel trattamento della peritonite acuta.

BACKGROUND: Early prognostic evaluation of patients affected by acute peritonitis is really desirable to program a correct therapeutic plan, selecting high-risk patients for more aggressive therapeutic procedures. The Mannheim peritonitis index is reliable and easy to apply, so its use is possible without the need of intensive care units. METHODS: Between 1991 and 1995 a total of 235 patients were operated on for acute peritonitis. A retrospective study on this group of patients was performed in order to estimate prognostic reliability of Mannheim peritonitis index. RESULTS: The overall mortality was 8.1%; for patients with a score less than 26 the mean mortality rate was 2% and for score greater than 26, 40.5%. This score is the threshold over which the therapeutic approach have to be more aggressive; planned multiple laparotomies or the open abdomen technique could be the best options to explore and clean up the peritoneal cavity from septic debris. In personal experience, all patients who died had residual sepsis in peritoneal cavity.

Intraoperative ultrasonography for pancreatic insulinomas.

BACKGROUND/AIMS: Islet cell adenomas of the pancreas are both single and benign tumors in more than 90% of the cases. Even with the use of increasingly innovative diagnostic techniques, a percentage of tumors are not located in the preoperative or, sometimes, even intraoperative phase. This study compares the results of various diagnostic techniques and provides a brief review of the literature. MATERIALS AND METHODS: Between January 1978 and December 1994, 15 patients (11 females and 4 males) averaging 49 years of age (range 27-70) affected by pancreatic insulinoma underwent surgery at the Department of General Surgery of the "R. Silvestrini" Hospital. RESULTS: In 8 cases the tumor intrapancreatic position was indicated in the preoperative stage. On the contrary, intraoperative ultrasonography allowed the correct location in all the cases, but one. Surgery allows for the complete cure from the diseases when the removal of adenoma is complete. All of our patients underwent surgery which involved enucleation or resection of the distal portion of the pancreas. CONCLUSION: The choice of the type of operation to perform, as well as the consequential morbidity and mortality, seems to depend essentially on the size and position of the insulinoma. All of the patients, except for one who died because of a pancreatic fistula, are alive and normoglycaemic.

[Is surgery duration really a complication factor?]. / Il tempo operatorio è realmente un fattore di complicanza?

Of the numerous factors which may cause postoperative complications, some authors sustain that the durations of surgery plays a fundamentally important role. On the basis of a retrospective survey and analysis of cases operated, the authors observe that this factor, if considered alone, does not appear to cause a significant increase in septic complications, anastomotic dehiscence or mean postoperative hospital stay. Four homogeneous groups of patients were examined. Two groups included 100 who had undergone abdominal surgery which had not contaminated the peritoneal cavity. The other two groups included 150 patients who had undergone partially polluting colorectal surgery. The general preparation of patients was similar, with the exception of antibiotic prophylaxis. The mean time was calculated by analysing anesthesiological records. From an analysis of the most recent data, which are characterized by the absence of anastomotic dehiscence and operative mortality, it can be seen that the incidence of sepsis has fallen to 4% even if mean operating time was long. Mean postoperative hospital stay was also reduced from 17.3 days to 13 days. The prolongation of operating times does not depend on the complexity of surgery, intraoperative complications or the surgeon's inexperience, but may be the result of the meticulous implementation of procedures and steps taken to prevent complications which, given that they require extreme care and attention, necessarily contribute to increasing the duration of surgery. With regard to antibiotic prophylaxis and the duration of surgery, it was observed that if antibiotic prophylaxis preceded the operation by more than one hour, the incidence of sepsis was about 20%. If treatment coincided with the induction of anesthesia or the start of surgery, then the incidence of sepsis fell to 13%.(ABSTRACT TRUNCATED AT 250 WORDS)

["Multiorgan failure" in surgery: its physiopathology, prevention and treatment. A review of the literature]. / La "MultiOrgan Failure" in chirurgia: fisiopatologia, prevenzione e trattamento. Revisione della letteratura.

At present multiorgan failure (MOF) is the complication with the highest mortality after emergency or elective general surgery. The syndrome seems to find its pathogenesis out of the very complex interactions of endogenous and exogenous mediators; instead the physiopathology seems to depend on cellular oxygen deficiency. The authors refer the common criteria defining organ and/or system damage during MOF and analyse the available possibilities for their treatment. In this regard they stress the role of prevention, which relies on the opportune treatment of earlier stage of shock, constantly preceding the syndrome, and on the intensive organ/systems functions monitoring to obtain an early and rational correction of the alterations taken away.

[Reconstruction after pancreaticoduodenectomy for cancer: Whipple-Child vs Traverso-Longmire technique (a National questionnaire 1990 on data of 1,095 cases of surgery)]. / Ricostruzione dopo cefaloduodenopancreatectomia per cancro: Whipple-Child v.s. Traverso-Longmire (questionario nazionale 1990 per una raccolta di 1.095 esperienze).

The Authors report the results of a National multicentric experience in 1.095 cases of pancreaticoduodenectomy for cancer. In order to evaluate the reliability of pyloric preservation mortality, morbidity, and functional results are discussed.

[Use of ultrasonography to estimate fetal weight in premature infants. Development of a new mathematical formula]. / Valutazione ultrasonografica del peso in feti pretermine. Elaborazione di una nuova formula matematica.

In 73 pregnant patients at a gestational age under 36 weeks, who gave birth within 72 hours from the last US examination, mathematical equations were elaborated. The equations were aimed at predicting fetal weight by measuring the main US biometric parameters; the results were compared to the actual birth weight. A statistical analysis was performed using the "backward elimination" method. The linear equation that has provided with the best estimation of fetal weight is the following: fetal weight = 12.9875 BPD +29.5642 AD +28.8023 FL -3496.1265. According to this equation, about 95.22% of the variability of the unknown quantity (i.e. birth weight) can be ascribed to its correlation to the variables: biparietal diameter (BPD), abdominal diameter (AD) and femur length (FL). Estimated fetal weight by US, as calculated on the basis of biparietal diameter, abdominal diameter and femur length measurements, showed, in our study, a standard error of 143 g (9.02%) (R = 0.95).

HLA-alloimmunization in pregnancy.

The authors analyzed the correlations between the presence of anti-HLA antibodies and fetal neonatal problems. There are specific data in the literature on the protective effect of anti-HLA antibodies against abortion. Nevertheless our study shows a significant correlation between their presence and perinatal problems.