Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of pilonidal disease.

Pilonidal disease (PD) is a relatively common, benign but challenging condition of the natal cleft. This consensus statement was drawn up by a panel of surgeons, identified by the Italian Society of Colorectal Surgery (SICCR) as having a "special interest" in PD, with the aim of recommending the best therapeutic options according to currently available scientific evidence. A three-step modified-Delphi process was adopted, implying: (1) choice of the panelists; (2) development of a discussion outline and of target issues; and (3) a detailed systematic review of the current literature. The agreement/disagreement level was scored on a five-point Likert scale as follows: "A + : strongly agree; A-: agree; N: unsure/no opinion; D-: disagree; D + : strongly disagree. Each panelist contributed to the production of this manuscript, and the final recommendations were reviewed by the Clinical Practice Guidelines Committee.

The treatment of pilonidal disease: guidelines of the Italian Society of Colorectal Surgery (SICCR).

The Italian Society of Colorectal Surgery (SICCR.) has prepared clinical practice guidelines to help its members to optimize the treatment of pilonidal disease, a very common condition, especially among young people, and therefore of great importance on a socioeconomic level. The SICCR committee of experts on pilonidal disease analyzed the international literature and evaluated current evidence. Nonoperative management includes gluteal cleft shaving, laser epilation as well as fibrin glue and phenol injection: reported healing rates and recurrence incidence are satisfactory but the majority of studies are small series with low-quality evidence. Surgical therapy which can be divided into two categories: excision of diseased tissue with primary closure using different techniques or excision with healing by secondary intention. On the whole, no clear benefit is demonstrated for one technique over the other.

Intelligence and psychopathy: a correlational study on insane female offenders.

BACKGROUND: The occurrence of a significant relationship between psychopathic traits and intelligence is still open to debate. Most of the relevant information has been obtained from crystallized IQ tests or on psychopathic male offenders. In this study we hypothesized a negative correlation between psychopathic traits and fluid intelligence on a sample of criminal female in-patients. METHOD: We carried out a correlational study on a selected sample of 56 criminal female offenders. Variables that were measured include the Hare Psychopathy Checklist Revised (PCL-R) total score (and, separately, the scores from its four subscales: Interpersonal, Affective, Lifestyle and Antisocial) and fluid IQ measured by Raven's Progressive Matrices (RPM). RESULTS: Pearson's correlation between RPM IQ and total PCL-R score was negative (r(54) = -0.55, p < 0.001); women with greater psychopathy traits (total PCL-R score) had lower IQ scores. Negative correlations were also found between IQ and the four PCL-R subscales, Interpersonal, Affective, Lifestyle and Antisocial (r(54) = -0.35, p < 0.01, r(54) = -0.52, p < 0.001, r(54) = -0.53, p < 0.001, and r(54) = -0.49, p < 0.001 respectively). CONCLUSIONS: The results indicate a general negative relationship between PCL-R and IQ, equally distributed across the four subcomponents of the psychopathic trait, and support the view that unsuccessful psychopathic women have poor planning and are unable to foresee and represent future consequences of their actions.

Ligasure Precise vs. conventional diathermy for Milligan-Morgan hemorrhoidectomy: a prospective, randomized, multicenter trial.

PURPOSE: Milligan-Morgan hemorrhoidectomy using radiofrequency dissection (Ligasure) has been proposed instead of conventional diathermy in view of its potential benefits in terms of postoperative anal pain and better hemostatic control, but the medical literature is still controversial. This multicenter, randomized, controlled trial was designed to compare the outcomes between Ligasure and conventional diathermy hemorrhoidectomy in the Milligan-Morgan procedures in a sufficient number of patients. METHODS: Patients with Grades III and IV hemorrhoids were randomized to two groups: Ligasure hemorrhoidectomy and conventional diathermy. Postoperative anal pain was measured by the Visual Analog Scale (VAS) and the analgesia required. Postoperative complications, wound healing, and return to working activities also were evaluated as secondary outcomes. RESULTS: A total of 273 patients, well matched for age, gender, working activity and grade of hemorrhoids, were randomized to two groups: Ligasure 146, and diathermy 127. The severity of postoperative anal pain was significantly less in the Ligasure group when measured at least 12 hours after defecation (P < 0.01), whereas it was similar at the time of defecation. The Ligasure group had significantly lower requirements for painkiller pills. There were no significant differences in early and late complications. Return to work and normal activities was significantly faster in the Ligasure group. CONCLUSION: Ligasure hemorrhoidectomy is an effective procedure for Grades III and IV hemorrhoids and facilitates a faster return to work and normal activities by reducing postoperative pain.

Local excision of rectal polyp: indications and techniques.

The local excision of a rectal polyp is often wrongly considered to be a minor surgical procedure. In reality, the malignant potential of adenomas and the not-infrequent presence of cancer in larger polyps, require, for their removal, an oncologically correct operation with strict indication and accurate execution. Despite an increasing inclination to extend the indications of endoscopic polypectomies to polyps of larger size and villous configuration, the local surgical approach remains the preferred treatment in most cases. Here the indications and the results of different surgical techniques proposed for the local excision of a rectal polyp are reported. Among these procedures, transanal endoscopic microsurgery is gaining a primary role in many circumstances.

The molecular roots of compositional inheritance.

Non-covalent compositional assemblies, made of monomeric mutually catalytic molecules, constitute an alternative to alphabet-based informational biopolymers as a mechanism of primordial inheritance. Such assemblies appear implicitly in many "Metabolism First" origin of life scenarios, and more explicitly in the Graded Autocatalysis Replication Domain (GARD) model [Segréet al. (2000). Proc. Natl Acad. Sci. U.S.A.97, 4112-4117]. In the present work, we provide a detailed analysis of the quantitative molecular roots of such behavior. It is demonstrated that the fidelity of reproduction provided by a newly defined heritability measure eta(*)(s), strongly depends on the values of molecular recognition parameters and on assembly size. We find that if the catalytic rate acceleration coefficients are distributed normally, transfer of compositional information becomes impossible, due to frequent "compositional error catastrophes". In contrast, if the catalytic acceleration rates obey a lognormal distribution, as actually predicted by a statistical formalism for molecular repertoires, high reproduction fidelity is obtained. There is also a clear dependence on assembly size N, whereby maximal eta is seen in a narrow range around N approximately 3.5 N(G)/lambda, where N(G)is the size of the primordial molecular repertoire and lambda is a molecular interaction statistical parameter. Such relationships help define the physicochemical conditions that could underlie the early steps in pre-biotic evolution.

The lipid world.

The continuity of abiotically formed bilayer membranes with similar structures in contemporary cellular life, and the requirement for microenvironments in which large and small molecules could be compartmentalized, support the idea that amphiphilic boundary structures contributed to the emergence of life. As an extension of this notion, we propose here a 'Lipid World' scenario as an early evolutionary step in the emergence of cellular life on Earth. This concept combines the potential chemical activities of lipids and other amphiphiles, with their capacity to undergo spontaneous self-organization into supramolecular structures such as micelles and bilayers. In particular, the documented chemical rate enhancements within lipid assemblies suggest that energy-dependent synthetic reactions could lead to the growth and increased abundance of certain amphiphilic assemblies. We further propose that selective processes might act on such assemblies, as suggested by our computer simulations of mutual catalysis among amphiphiles. As demonstrated also by other researchers, such mutual catalysis within random molecular assemblies could have led to a primordial homeostatic system displaying rudimentary life-like properties. Taken together, these concepts provide a theoretical framework, and suggest experimental tests for a Lipid World model for the origin of life.

Dichotomy of single-nucleotide polymorphism haplotypes in olfactory receptor genes and pseudogenes.

Substantial efforts are focused on identifying single-nucleotide polymorphisms (SNPs) throughout the human genome, particularly in coding regions (cSNPs), for both linkage disequilibrium and association studies. Less attention, however, has been directed to the clarification of evolutionary processes that are responsible for the variability in nucleotide diversity among different regions of the genome. We report here the population sequence diversity of genomic segments within a 450-kb cluster of olfactory receptor (OR) genes on human chromosome 17. We found a dichotomy in the pattern of nucleotide diversity between OR pseudogenes and introns on the one hand and the closely interspersed intact genes on the other. We suggest that weak positive selection is responsible for the observed patterns of genetic variation. This is inferred from a lower ratio of polymorphism to divergence in genes compared with pseudogenes or introns, high non-synonymous substitution rates in OR genes, and a small but significant overall reduction in variability in the entire OR gene cluster compared with other genomic regions. The dichotomy among functionally different segments within a short genomic distance requires high recombination rates within this OR cluster. Our work demonstrates the impact of weak positive selection on human nucleotide diversity, and has implications for the evolution of the olfactory repertoire.

Compositional genomes: prebiotic information transfer in mutually catalytic noncovalent assemblies.

Mutually catalytic sets of simple organic molecules have been suggested to be capable of self-replication and rudimentary chemical evolution. Previous models for the behavior of such sets have analyzed the global properties of short biopolymer ensembles by using graph theory and a mean field approach. In parallel, experimental studies with the autocatalytic formation of amphiphilic assemblies (e.g., lipid vesicles or micelles) demonstrated self-replication properties resembling those of living cells. Combining these approaches, we analyze here the kinetic behavior of small heterogeneous assemblies of spontaneously aggregating molecules, of the type that could form readily under prebiotic conditions. A statistical formalism for mutual rate enhancement is used to numerically simulate the detailed chemical kinetics within such assemblies. We demonstrate that a straightforward set of assumptions about kinetically enhanced recruitment of simple amphiphilic molecules, as well as about the spontaneous growth and splitting of assemblies, results in a complex population behavior. The assemblies manifest a significant degree of homeostasis, resembling the previously predicted quasi-stationary states of biopolymer ensembles (Dyson, F. J. (1982) J. Mol. Evol. 18, 344-350). Such emergent catalysis-driven, compositionally biased entities may be viewed as having rudimentary "compositional genomes." Our analysis addresses the question of how mutually catalytic metabolic networks, devoid of sequence-based biopolymers, could exhibit transfer of chemical information and might undergo selection and evolution. This computed behavior may constitute a demonstration of natural selection in populations of molecules without genetic apparatus, suggesting a pathway from random molecular assemblies to a minimal protocell.

Composing life.

Textbooks often assert that life began with specialized complex molecules, such as RNA, that are capable of making their own copies. This scenario has serious difficulties, but an alternative has remained elusive. Recent research and computer simulations have suggested that the first steps toward life may not have involved biopolymers. Rather, non-covalent protocellular assemblies, generated by catalyzed recruitment of diverse amphiphilic and hydrophobic compounds, could have constituted the first systems capable of information storage, inheritance and selection. A complex chain of evolutionary events, yet to be deciphered, could then have led to the common ancestors of today's free-living cells, and to the appearance of DNA, RNA and protein enzymes.

Antibodies with idiotypic and anti-idiotypic reactivity (epibodies) in conventional immune responses to dinitrophenylated carriers.

A number of monoclonal antibodies were derived from the spleen cells of dinitropheryl (DNP)-immunized mice. Both T-dependent and T-independent carriers were used, and the intensity and length of immunization were varied. It was found that some of the antibodies had only idiotypic (Ab1) reactivity, while others had both idiotypic (Ab1) and anti-idiotypic (Ab2) reactivity. Among the latter antibodies some molecules reacted specifically with DNP and with the combining site of anti-DNP antibodies (epibodies), while others bound DNP and anti-DNP Abs as well as a variety of unrelated antigens (polyreactive antibodies). The proportion of the three types of antibodies (antigen-specific, epibodies and polyreactive antibodies) varied with the nature of the carrier, the intensity of the immunization, and the length of the immunization process. Further characterization of the epibodies, which were predominant in the secondary response to DNP-keyhole limpet haemocyanin (KLH), showed that both Ab1 and Ab2 reactivities were inhibited by both soluble ligands (DNP and anti-DNP), indicating that the specific combining site of the monoclonal antibodies (mAbs) (and/or of the rabbit anti-DNP antibody in the case of Ab2) was involved in both activities. Both Ab1 and Ab2 reactivities were removed by absorption of the mAbs with either immobilized DNP or immobilized rabbit anti-DNP. The mAbs were capable of binding themselves as well as to other mAbs with the same characteristics. The affinity constants of several mAbs for both the DNP and anti-DNP ligands were determined.

Graded Autocatalysis Replication Domain (GARD): kinetic analysis of self-replication in mutually catalytic sets.

A Graded Autocatalysis Replication Domain (GARD) model is proposed, which provides a rigorous kinetic analysis of simple chemical sets that manifest mutual catalysis. It is shown that catalytic closure can sustain self replication up to a critical dilution rate, lambda c, related to the graded extent of mutual catalysis. We explore the behavior of vesicles containing GARD species whose mutual catalysis is governed by a previously published statistical distribution. In the population thus generated, some GARD vesicles display a significantly higher replication efficiency than most others. GARD thus represents a simple model for primordial chemical selection of mutually catalytic sets.

[Laparoscopy: access with open versus closed technique]. / Laparoscopia: accesso con metodo aperto verso chiuso.

Pneumoperitoneum in diagnostic or therapeutic laparoscopy can be achieved by an open or a closed technique. The authors, on the basis of their experience, compare both techniques, concluding that open method is safer, because of the lack of major complications observed in the closed method and with only few minor complications.

[The role of portography with computed tomography in the diagnosis of liver metastases from colorectal neoplasms]. / Il ruolo della portografia con Tomografia Computerizzata nella diagnosi di metastasi epatiche da neoplasie del colon-retto.

This study was performed to confirm the high sensitivity of CT during arterial portography (CTAP) versus US and dynamic CT in the diagnosis of liver metastases from colorectal cancer. Ninety patients with 108 colorectal cancers underwent US, dynamic CT and CTAP to investigate the presence of liver metastases. US depicted 39 metastases in 26 patients, dynamic CT 46 metastases in 29 patients and CTAP 54 lesions in 34 patients. CTAP detected 8 metastases missed at dynamic CT; 4 of them were < 1 cm in diameter, 3 ranged 1-2 cm and one metastasis > 2 cm in diameter. After preoperative investigations only 7 patients were considered for hepatic resection. At surgery, palpation and intraoperative US of the liver detected two more metastases in the same patients. Our experience, in agreement with recent studies, confirms CTAP as the most sensitive preoperative method in detecting liver metastases and its superiority to be most apparent in lesions < 1 cm in diameter. Therefore, we consider CTAP an essential imaging technique for planning the correct treatment of liver metastases.

[Etiopathogenesis and physiopathology of hemorrhoidal disease]. / Eziopatogenesi e fisiopatologia della malattia emorroidaria.

Many possible causes have been proposed to explain the pathogenesis of symptomatic hemorrhoids: constipation and abnormal bowel habits are commonly blamed despite largely contrary evidence. The most consistently demonstrated physiological abnormality is an increased maximum resting anal pressure. The pathophysiologic theory, made popular by Thomson's studies, in which the anal cushions break their elastic support and become more sensitive to the increase of pressure from straining and to trauma from hard stool, with a progressive downward displacement, is currently the best accepted. The intimate mechanism of functioning and control of the arteriovenous anastomoses remains unclear as does the existence of an individual susceptibility in which a part is played by socioeconomic, cultural and psychological factors.

[Perforated endometriosis of the sigmoid. Report of a case]. / Endometriosi del sigma perforata. A proposito di un caso.

The term endometriosis means the presence in an ectopic site of normal functioning endometrial tissue, the ectopic endometrial tissue, as the normal uterine mucosa, undergo hormonal stimulation and follow the proliferative and functional changes along the menstrual course; this evolution, characterize the clinical story of patients affected by endometriosis. Endometriosis is considered to be one of the most common gynecologic disorders, occurring in about 10% of women in fertile age. An involvement of adjacent organs such as the pelvic colon and rectum by endometriosis is not uncommon and may cause symptoms difficult to distinguish from malignant or inflammatory disease located in the pelvic region. The purpose of the following case report is to elucidate certain diagnostic and therapeutic problems of a disease concerning both the surgeon and gynecologists. Our case concerns a 44 year old patient with two children and a negative previous clinical gynecological history; the patients reports the occurrence in the last two years of alterations of colic evacuation consisting in a period of constipation lasting 5-7 days. The patient reached us in emergency with a sub-occlusive state that has lasted for 5 days, in the last 12 hours the appearance of a violent trafictive pain referred to the lower abdomen configure the clinical picture of a acute abdomen. The patient underwent surgery and the laparotomy demonstrated the presence of a perforated tumours located at the recto-sigmoid junction. We proceed to perform an Hartman's resection and a right ovariectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Behavior of the idiotypic network in conventional immune responses. III. Detection and enumeration of cells producing idiotypic and anti-idiotypic antibodies by a spot ELISA technique.

The idiotypic (Ab1) and anti-idiotypic (Ab2) responses of spleen cells of mice immunized with DNP-Ficoll were assayed with the spot ELISA technique in wells coated with DNP-BSA or with affinity-purified rabbit anti-DNP antibodies, respectively. In agreement with results previously obtained with the hemolytic plaque technique, large numbers of Ab1 and Ab2 ELISA spots were found. The cytokinetics of the Ab1 and Ab2 responses were very similar and the peak responses occurred simultaneously. The isotypes of Abs1 and Abs2 were also similar. Both responses were specifically inhibited by soluble DNP-lysine. Similar results were obtained with spleen cells from mice immunized with the T-dependent antigen DNP-KLH and with the T-independent antigen fluorescein-Ficoll. In contrast, no Ab2 response was detected when spleen cells from mice immunized with ovalbumin were assayed, probably because the affinity-purified rabbit anti-ovalbumin antibodies used to coat the wells for the Ab2 assay contained molecules of several specificities, corresponding to the several epitopes of the ovalbumin molecule. The many similarities between the Ab1 and Ab2 responses to the haptens suggest that they reflected two different reactivities of the same antibody molecules.

[Hemorrhagic necrotic acute pancreatitis: analysis of our case series in the light of the most recent diagnostic and therapeutic criteria]. / La pancreatite acuta necrotico emorragica: analisi della nostra casistica alla luce dei più recenti criteri diagnostici e terapeutici.

During the period between 1-1-1979 and 30-9-1992, 43 cases of hemorrhagic necrotic acute pancreatitis were referred to the authors' attention. Six patients were not operated, 12 underwent emergency surgery and laparotomy was postponed in 25 cases. The introduction of sophisticated diagnostic methods, such as Eco, CT, ERCP, intensive medical therapy and postoperative NPT have allowed a more rational surgical approach in terms of timing and extent to be adopted, operating on patients who are metabolically more stable. NPT is a useful tool in the latter postoperative stage. In the series of patients undergoing emergency laparotomy there was a mortality rate of 66%. The mortality rate fell to 16% in those patients in whom surgery was postponed.