Kinematic, bioenergetic and oxidative evaluations of donkey sperm preserved at +4°C.

Information on donkey sperm bioenergetics, kinetics and oxidative status is scarce even though crucial for development of reproductive technologies and germplasm conservation. For these reasons, it is interesting to monitor sperm kinetics, bioenergetics, and oxidative status during sperm storage at +4°C and with several sperm extenders and concentrations. Donkey semen was collected from three jackasses, three times each. It was diluted with four extenders (Kenney, Equiplus, INRA96 or Hippex), set at three sperm concentrations (30, 50 or 70 × 106 spermatozoa/ml) and evaluated for its functionality after 0, 3, 24, 48 and 72 h storage at +4°C. Sperm kinetics was analyzed by Sperm Computer Analysis; sperm bioenergetics was assessed by mitochondrial membrane potential (MMP); sperm oxidative status was evaluated by lipid peroxidation (LPO), anti-LPO potential and nitroblue tetrazolium (NBT) assays. Incubation produced a progressive (P < 0.01) decline in sperm kinetics and MMP, whereas parameters related to oxidative status either increased (LPO, NBT) or decreased (anti-LPO). The anti-LPO potential was the index better related to sperm motility and kinetics. Extenders proved to be differently (P < 0.01) effective in preserving sperm kinetics, MMP, and oxidative status. The concentration of 30 × 106 spermatozoa/ml provided an optimum preservation of sperm functions. Significant correlations emerged between most parameters examined. This study identified reference criteria for storing donkey spermatozoa at +4°C. A low sperm concentration together with a proper extender are crucial requirements for optimum sperm cryopreservation efficiency. Field trials are, however, required to validate these findings, making them operational in practice.

Resolution of late-onset heart and liver failures after reversion of jejuno-ileal bypass: a case report.

OBJECTIVES: Jejuno-ileal bypass (JIB) was a kind of bariatric surgery performed from 1960s to 1980s, able to induce sustainable weight loss by creating a surgical short bowel syndrome. MATERIALS AND METHODS: We report a case of an octogenarian woman who underwent in the early eighties this kind of surgery with consequent 40 kg weight loss. After 27 years, she first developed a reversible metabolic cardiomyopathy that began with signs and symptoms of heart failure. Thereafter, she was diagnosed with severe intractable liver insufficiency. RESULTS: Despite her old age, the patient underwent reversal of JIB with consequent early improvement of hepatic function. CONCLUSIONS: This case demonstrate that in case of long-term and life-threatening complications, it is possible to successfully reverse JIB surgery after upto 30 years. The hypothesis on pathophysiology of heart and liver insufficiency are discussed.

Evaluation of the basal ganglia in neurofibromatosis type 1.

PURPOSE: Alterations of the brain microstructure and metabolism have been identified in patients with neurofibromatosis type 1 (NF1). In this study, we analyzed the basal ganglia of NF1 subjects without cognitive delay throughout a combined approach with magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) in order to better define the metabolic and microstructural characteristics of these regions and, furthermore, to verify if metabolic and microstructural abnormalities may be present in normally developed NF1 patients. METHODS: A 3-T MRI with multivoxel MRS and DTI was performed in 14 NF1 patients and eight controls. N-acetyl-aspartate (NAA), choline (Cho), creatine (Cr) values and ratios, fractional anisotropy, and apparent diffusion coefficient (ADC) were calculated, for a total of four regions of interest (ROI) for each hemisphere. RESULTS: NF1 patients, compared to healthy controls, showed (a) decreased NAA in all the four ROI, (b) increased Cho and decreased Cr in three of the four ROI, (c) decreased NAA/Cho ratio in three ROI, and (d) increased ADC in all the four ROI. A trend of increased ADC was present in three of the four ROI of NF1 patients with unidentified bright objects (UBOs) and younger than 18 years. CONCLUSION: These data confirm the presence of neuroaxonal damage with myelin disturbances in NF1 patients. We showed that metabolic and microstructural anomalies can be present in the same time in NF1 patients without developmental delay or cognitive deficits. Relations between brain anomalies, UBOs, and cognitive functions need further studies.

Obstructive jaundice by lymph node recurrence of gastric cancer: can surgical derivation still play a role?

BACKGROUND/AIMS: In some cases of bile duct compression by lymph node recurrence of gastric cancer, a second line chemotherapy can lead to prolonged survival; thus, a surgical derivation could represent a reasonable alternative to non surgical drainage, owing to its better long term efficacy. Our study retrospectively compares the surgical approach (SA) and percutaneous transhepatic biliary drainage (PTBD) in this particular oncological condition. METHODOLOGY: 11 patients undergoing biliary-jejunal anastomosis for obstructive jaundice by lymph node recurrence of gastric cancer at our Institution were compared with 10 patients undergoing PTBD. Clinical records and outcome parameters (success rate, complications, survival) were statistically matched in order to assess possible advantages for each technique and to evaluate any particular variable influencing survival. RESULTS: The SA patients experienced a better jaundice resolution (91% vs 50%, p.0.063), a lower major complication rate (9% vs 30%, p:0.311), and a significantly longer survival (317 days vs 85 days, p:0.001). Procedural success and complication rates were found to be correlated with survival. CONCLUSIONS: According to our experience the SA represents a valid alternative to PTBD in the case of lymph node recurrence of gastric cancer, being favoured for patients with better performance status and longer life expectancy.

Non-invasive cardiac output evaluation in postoperative cardiac surgery patients, using a new prolonged expiration-based technique.

The gold standard methods to measure cardiac output (CO) are invasive and expose the patient to high risks of various complications. The aim of this study is to assess an innovative non-invasive method for CO monitoring in mechanically ventilated patients after cardiac surgery and its agreement with values obtained by thermodilution technique. Continuous monitoring of respiratory gas concentrations and airflow allows the estimation of CO through a newly developed algorithm derived from a modified version of the Fick equation. It consists of two phases: the first involves measurements during steady breathing state, and the second starts when a sudden perturbation into the carbon dioxide elimination process is introduced by a prolonged expiration. This prospective clinical study involved thirty-five adult patients, undergone cardiac surgery. The measurements were performed in curarized and haemodynamically stable patients, during the post-surgery recovery in intensive care unit. The study protocol, which lasted 1 h for each patient, consisted of 20 measurements obtained by prolonged expiration-based method and 10 by thermodilution. The estimation of CO using the proposed method (COK) agreed with the thermodilution (COT) as demonstrated by: a low mean bias between COK and COT considering all patients (i.e., -0.11 L min(-1)); a best fitting line having slope = 0.98, r = 0.81, p < 0.0001; the lower and upper limits of agreement were -0.77 and +0.54 L min(-1), respectively. COK shows a mean percentage error of 34 %. In stable mechanically ventilated patients, undergone cardiac surgery, the proposed method is reliable if compared to the thermodilution. Considering the non-invasivity of the technique, further evaluations of its performances are encouraged.

Ontogenetic profile of innate immune related genes and their tissue-specific expression in brown trout, Salmo trutta (Linnaeus, 1758).

The innate immune system is a fundamental defense weapon of fish, especially during early stages of development when acquired immunity is still far from being completely developed. The present study aims at looking into ontogeny of innate immune system in the brown trout, Salmo trutta, using RT-PCR based approach. Total RNA extracted from unfertilized and fertilized eggs and hatchlings at 0, 1 h and 1, 2, 3, 4, 5, 6, 7 weeks post-fertilization was subjected to RT-PCR using self-designed primers to amplify some innate immune relevant genes (TNF-α, IL-1ß, TGF-ß and lysozyme c-type). The constitutive expression of ß-actin was detected in all developmental stages. IL-1ß and TNF-α transcripts were detected from 4 week post-fertilization onwards, whereas TGF-ß transcript was detected only from 7 week post-fertilization onwards. Lysozyme c-type transcript was detected early from unfertilized egg stage onwards. Similarly, tissues such as muscle, ovary, heart, brain, gill, testis, liver, intestine, spleen, skin, posterior kidney, anterior kidney and blood collected from adult brown trout were subjected to detection of all selected genes by RT-PCR. TNF-α and lysozyme c-type transcripts were expressed in all tissues. IL-1ß and TGF-ß transcripts were expressed in all tissues except for the brain and liver, respectively. Taken together, our results show a spatial-temporal expression of some key innate immune-related genes, improving the basic knowledge of the function of innate immune system at early stage of brown trout.

Laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis: a new step in the treatment of slow-transit constipation.

BACKGROUND: Subtotal colectomy with antiperistaltic cecorectal anastomosis (SCCRA) has proved to be an effective alternative to total colectomy for the treatment of severe slow-transit constipation. The laparoscopic approach has made this procedure even more attractive. This is the first controlled trial on laparoscopic SCCRA. The study compares the laparoscopic and the open approach. METHODS: Since 2001, all SCCRAs have been performed laparoscopically at our institution. Only severely symptomatic patients are offered surgery, after stringent patient selection. Laparoscopic SCCRA was performed following the same steps that we first described for the open approach, by utilizing a five-trocar technique. Outcome parameters were prospectively collected every 3 and 6 months. Wexner constipation and incontinence scales (WCS, WI) and gastrointestinal quality of life index (GIQLI) were adopted for functional results. We conducted a case-control study of 15 consecutive patients who underwent laparoscopic SCCRA (VL) and 15 patients previously operated on by the open approach (Op) to compare postoperative and functional outcomes. RESULTS: The VL group had better postoperative outcomes (pain, ileus) while complication rates were similar. Resolution of constipation was impressive in both groups, with no significant difference at follow-up. The VL group presented with a higher number of bowel movements at 3 months (3.8 vs. 2.8, p = 0.039), resulting in a significantly higher incontinence rate at 3 months (WI 6.4 vs. 2.73, p = 0.004), although the difference was no longer significant at 1-year follow-up. The quality of life was good for both groups; the VL group showed a significant improvement at 1-year follow-up (64.18 vs. 114.79, p < 0.01). CONCLUSIONS: Laparoscopic SCCRA confirmed the good functional results of the open approach, with no increase in morbidity rate and a faster postoperative recovery. An early higher incontinence rate did not affect quality of life.

Nickel and cadmium tissue bioaccumulation and blood parameters in Chelon auratus and Mugil cephalus from Anzali free zone in the south Caspian Sea (Iran) and Faro Lake (Italy): A comparative analysis.

BACKGROUND: Analysis of heavy metal concentrations in fish blood is a valuable tool in environmental pollution monitoring. Among different type of fish, detritivorous fish are a very good indicator for monitoring pollution and environmental stress, along with hematological studies, which are an important indicator in eco-toxicological and biological studies. AIM: The aim of this study was to evaluate the influence of environment on bioaccumulation of Ni and Cd and on blood parameters in Chelon auratus and Mugil cephalus (a detritivorous fish which is widely distributed in the world) captured in Caspian Sea and Faro Lake. METHODS: For the research blood and tissues samples were collected from 40 mullets (20 Mugil cephalus from Italy and 20 Chelon auratus from Iran) in 2019. The hematological (white blood cell, WBC; red blood cell, RBC; thrombocyte count, TC; hematocrit, Hct; hemoglobin concentration, Hb; mean corpuscular volume, MCV; mean corpuscular hemoglobin, MCH and mean corpuscular hemoglobin concentration, MCHC) and biochemical parameters (aspartate aminotransferase, AST; alanine aminotransferase, ALT; alkaline phosphatase, ALP; lactate dehydrogenase, LDH and creatine phosphokinase, CPK were assessed. RESULTS: Although the concentration of Ni and Cd in the muscle of fish have no significant health risks and were low in both regions, the most elevated concentration was found in the liver of Caspian Sea mullet. In all cases, the results obtained for all biochemical and most hematological parameters of individual Faro Lake, were considerably lower than the Caspian Sea, demonstrating that habitats and environmental conditions affect the blood metabolites. CONCLUSIONS: The results of this study show that these measurements can be used as criteria for the quantitative evaluation of fish /health and provide information on the extent of potential poisoning and the risks posed to the populations and fisheries.

Sporadic colorectal carcinomas with low-level microsatellite instability: a distinct subgroup with specific clinicopathological and molecular features.

PURPOSE: The biologic significance of low-level microsatellite instability (MSI) in sporadic colorectal cancers (CRCs) is not clearly defined. In particular, the relationship of MSI-low to MSI-high and microsatellite stable (MSS) tumours is currently under debate and the prognostic impact of these genetic changes remains unclear. The objective of this study was to investigate whether sporadic MSI-low CRCs have different clinicopathological and molecular features from MSS and MSI-high tumours. METHODS: A series of 184 primary sporadic CRCs were divided, according to the level of MSI, into three groups (94 MSS, 22 MSI-low and 68 MSI-high) and were analyzed for baseline clinicopathological features and outcome, allelic losses at 18q, 8p and 4p chromosomes and immunohistochemical expression of MGMT, hMlh1, hMsh2, Fhit, Cox-2, p21 and p27 proteins. RESULTS: MSI-low tumours were more frequently distal (59.1%) whereas MSS tumours had a strong predilection for distal (72.3%) and MSI-high tumours for proximal location (54.4%; p = 0.003). When compared with MSI-high tumors, MSI-low CRCs were adenocarcinoma, not otherwise specified (p = 0.0138) and well to/moderately differentiated (p = 0.027). MSI-low CRCs also showed specific molecular features including intermediate 18q allelic losses, altered MGMT and Cox-2 expression. Finally, the 5-year overall survival rates were 79% for MSI-low, 40.3% for MSS and 71% for MSI-high CRCs (p = 0.0160 MSS vs. MSI-low groups). CONCLUSIONS: Sporadic MSI-low CRCs display characteristic clinicopathological and genetic features that distinguish them from MSS CRCs.

Computed tomography volumetric fat parameters versus body mass index for predicting short-term outcomes of colon surgery.

BACKGROUND: At present, the impact of obesity on short-term outcomes of general surgery remains controversial, especially in the field of laparoscopy. Most studies on the subject have used the body mass index (BMI) to define obesity without distinguishing between visceral and subcutaneous storage. Computed tomography (CT) volumetric analysis permits accurate evaluation of site-specific volume of adipose tissue. The purpose of this study was to compare CT volumetric fat parameters and the BMI for predicting short-term outcomes of colon surgery. METHODS: A retrospective analysis was conducted of 231 consecutive patients undergoing elective colon resection, with open or laparoscopic technique, from January 2007 to April 2009. CT volumetric quantification of abdominal visceral and subcutaneous adipose tissue was performed. Intraoperative and perioperative data were collected. RESULTS: A total of 187 patients were enrolled. BMI showed a direct correlation with fat volumetric parameters but not with the visceral/subcutaneous fat ratio. Operating time was correlated with subcutaneous fat storage and BMI in the laparoscopic right colectomy subgroup. No associations were found with the conversion rate. Length of the hospital stay was correlated with the visceral/subcutaneous fat ratio in the laparoscopic left colectomy subgroup. Whereas the overall postoperative complication rate and mortality were not associated with fat parameters, the postoperative surgical complication rate was associated with visceral volumetric parameters in the laparoscopic left colectomy subgroup. CONCLUSIONS: Short-term outcomes of colon surgery are better predicted by fat volumetric parameters than by the BMI. This study has provided new elements for discussion on the impact of visceral and subcutaneous adiposity in laparoscopic and traditional colon surgery.

Assessment of total (anti)oxidant status in goat kids.

The redox potential of goat serum was assessed by different spectrophotometric assays. Among them, three methods are commonly applied for the evaluation of the oxidative (reactive oxygen metabolites, ROMs, and total oxidant status, TOS) and nitrosative (NO ⚫ metabolites, NO x ) stress, and four methods for the evaluation of the antioxidant status: the total antioxidant capacity (TAC) based on the ferric reducing ability of plasma (FRAP), the total antioxidant activity (TAA) based on the reduction of the coloured ABTS ⚫ + radical cation, the free radical scavenging activity (FRSA) based on the reduction of the purple DPPH ⚫ , and the total thiol levels (TTLs) based on their interaction with DTNB to form a highly coloured anion. Besides, myeloperoxidase (MPO) and ceruloplasmin oxidase (CP) activities were also assessed. Except for TAA, analytical data showed a great inter-individual variation for both oxidant and antioxidant assays. ROMs were strongly correlated with CP, while TOS with MPO and TAC. Furthermore, a tendency between TOS and FRSA was shown. NO x was correlated with TAC and TAA, and a tendency with TOS was shown. No correlations appeared among the antioxidant assays, even if a tendency between TAC and TAA was evidenced, but TAC was correlated with MPO activity. The observed correlation between ROMs and CP is discussed as a possible analytical interference. The absence of correlation among the antioxidant biomarkers suggests the simultaneous use of a panel of tests to verify any changes in the redox balance, mainly in livestock in which reference values for each biomarker are lacking.

Relationships between Seminal Plasma Metabolites, Semen Characteristics and Sperm Kinetics in Donkey (Equus asinus).

This study aimed to evaluate donkey seminal plasma metabolites and relate this information to the main characteristics of sperm quality. Sperm kinetics from 10 donkey stallions were analyzed with a computerized system at the time of collection (T0) and after 24 h storage at 4 °C (T24). Seminal plasma was frozen at -80 °C for subsequent proton nuclear magnetic resonance (1H NMR) spectroscopy. On three stallions, semen collection was repeated monthly for three times and sperm analysis also included mitochondrial activity and oxidative status. One stallion was azoospermic and a second semen collection was performed after one month. In the seminal plasma, 17 metabolites were identified; their levels showed numerous significant variations between the azoospermic and the normospermic individuals and grouped in well-defined clusters in a multivariate analysis. Comparing individuals with high and low sperm motility, the only discriminating metabolite was phenylalanine, whose levels were lower in the latter, as in the azoospermic individual. Phenylalanine was also the only metabolite highly correlated with all sperm kinematic parameters at T24. In conclusion, the present study has provided relevant information on the chemical characteristics of donkey semen, identified relationships between seminal metabolites, semen parameters, and sperm kinetics, and offered insights for future technological applications.

Design and structural bioinformatic analysis of polypeptide antigens useful for the SRLV serodiagnosis.

Due to their intrinsic genetic, structural and phenotypic variability the Lentiviruses, and specifically small ruminant lentiviruses (SRLV), are considered viral quasispecies with a population structure that consists of extremely large numbers of variant genomes, termed mutant spectra or mutant cloud. Immunoenzymatic tests for SRLVs are available but the dynamic heterogeneity of the virus makes the development of a diagnostic "golden standard" extremely difficult. The ELISA reported in the literature have been obtained using proteins derived from a single strain or they are multi-strain based assay that may increase the sensitivity of the serological diagnosis. Hundreds of SRLV protein sequences derived from different viral strains are deposited in GenBank. The aim of this study is to verify if the database can be exploited with the help of bioinformatics in order to have a more systematic approach in the design of a set of representative protein antigens useful in the SRLV serodiagnosis. Clustering, molecular modelling, molecular dynamics, epitope predictions and aggregative/solubility predictions were the main bioinformatic tools used. This approach led to the design of SRLV antigenic proteins that were expressed by recombinant DNA technology using synthetic genes, analyzed by CD spectroscopy, tested by ELISA and preliminarily compared to currently commercially available detection kits.

Seminal plasma of brown trout, Salmo trutta fario (L.) contains a factor able to retain iron at acid pH, typical feature of lactoferrin.

Blood and seminal plasma of brown trout Salmo trutta fario were analyzed for their iron binding potential adopting two different methods. Seminal plasma showed an iron binding capacity that was retained even if samples were exposed at acid pH, similarly to mammalian lactoferrin that binds ferric iron also at acid pH. This suggests that the iron binding capacity is determined by a factor having a lactoferrin-like activity. Moreover, trout seminal plasma proteins were also analyzed in their pattern by sodium dodecyl sulphate polyacrylamide gel elecrophoresis (SDS-PAGE) and electroblotted onto nitrocellulose membrane. When seminal plasma was subjected to immunoblotting using goat anti-bovine lactoferrin antibodies as a probe, only a single band having an apparent molecular weight of around 80 kDa was specifically detected, showing that this protein has homology with bovine lactoferrin.

Biofeedback therapy plus anal electrostimulation for fecal incontinence: prognostic factors and effects on anorectal physiology.

BACKGROUND: The current literature does not provide unequivocal data on prognostic factors in conservative management of fecal incontinence. Moreover, the physiopathologic effects of pelvic floor rehabilitation on anorectal function are not well understood. Our aim is to identify some prognostic parameters and assess their effects on anorectal physiology of biofeedback therapy plus anal electrostimulation for fecal incontinence. METHODS: We studied prospectively 45 consecutive adult patients with fecal incontinence treated at our institution with biofeedback plus electrostimulation. The outcome parameter was modification of the Wexner Incontinence Score (WIS) at the end of treatment. In addition, we studied the modifications of anorectal manometry and the rectal sensitivity threshold after treatment. RESULTS: At univariate analysis, age, the pretreatment WIS, and the pretreatment resting and maximum squeeze pressures were correlated with the clinical outcome. Patients showed a significant reduction in the rectal sensitivity threshold but no significant change in manometric parameters after treatment. CONCLUSIONS: We identify good sphincter function and mild to moderate symptomatology as favorable prognostic factors in biofeedback and anal electrostimulation therapy. Improvement in rectal sensitivity can be implicated in symptomatic improvement. The impossibility of correlating the clinical results with the effects on anorectal physiology suggests a nonspecific effect of conservative treatment.

Assessment of Total Antioxidant Capacity in Serum of Heathy and Stressed Hens.

Total antioxidant capacity (TAC) in healthy and dexamethasone-stressed hens was measured by applying four different spectrophotometric methods-the ferric reducing ability (FRAP) assay, the 2,2'-azino-bis (3-ethylbenzotiazoline-6-sulphonic acid) (ABTS) radical cation decolorization assay, the free radical scavenging activity (FRSA), and the total thiol levels (TTL). TAC assessed by all four methods did not change throughout the experimental period in the control group, whereas significant changes were shown by all adopted assays in the stressed group with some remarkable differences. TAC increased in the stressed group when FRAP and ABTS assays were applied, while it was reduced when sera were assessed by FRSA and TTL assays. Furthermore, FRAP assay was the only test able to show a significant change in TAC immediately after the end of the induced stress. At the end of the experimental period, TAC assessed by ABTS and FRSA assays showed a complete recovery in the stressed group, whereas TAC assessed by FRAP and TTL assays still showed significant persistent differences when compared to the control group. The observed differences in TAC are discussed in the light of the different contribution in each assay of the various antioxidant substances present in the samples.

Serum disposition of bovine lactoferrin after oral and anal administration and its proteolytic cleavage by gastric transit in rainbow trout (Oncorhynchus mykiss W.).

Several studies have shown an immunomodulatory effect of orally administered bovine lactoferrin (LF) in fish, but the process of digestion was not characterized. In the present study, we investigated the fate of bovine LF after oral and anal administration, and studied the appearance of intact LF in the bloodstream and its proteolytic attack during the gastric transit in rainbow trout (Oncorhynchus mykiss) held at 9 degrees C and 18 degrees C. Data obtained showed the presence of intact bovine LF in the bloodstream only after anal administration in fish held at 18 degrees C and the presence of several peptides derived from bovine LF in the gastric content. Immunoblotting analysis showed that only a part of bovine LF-derived peptides reacted with the applied anti-bovine LF antibody. The concentration of intact bovine LF, after 30 min of administration, in the gastric content of fish reared at 18 degrees C, being extremely low, if any, led us to suspect that the immunoregulatory effect of dietary bovine LF shown in fish by several authors is not due to the intact form but to bioactive fragments, originated by the proteolytic attack during the gastric transit, as demonstrated in higher vertebrates.

Abdominal pain and internal hernias after Roux-en-Y Gastric Bypass: are we dealing with the tip of an iceberg?

BACKGROUND: Abdominal pain is the most frequent cause of hospital admission after Roux-en-y gastric bypass (RYGB). Among numerous possible underlying causes, internal hernias represent one of the most peculiar and insidious conditions, setting challenging diagnostic and therapeutic problems for the surgeon. The aim of this study is to analyze aspecific abdominal pain incidence and characteristics after RYGB, discriminating peculiar aspects suggestive of internal hernias. METHODS: 13 patients submitted to internal hernia repair after laparoscopic antecolic RYGB and a group of 49 controls (non-complicated RYGB) have been assessed using a specific questionnaire. Overall aspecific abdominal pain incidence and characteristics have been analysed. Typical pain traits and predisposing conditions for internal hernias have been investigated. RESULTS: 33% of controls reported aspecific abdominal pain after RYGB, mainly early postprandial, deep, remittent, colicky, located in the upper left abdomen. 77% of the case patients reported prodromal episodes of pain similar to the controls. The only significant differences between prodromal and acute episodes were pain intensity and quality (continuous). Excess weight lost at 3 months significantly correlated with internal hernia occurrence (p: 0.002). CONCLUSIONS: Based on abdominal pain characteristics, we can reasonably postulate the presence of remittent bowel torsions (remittent internal hernia) in many patients after antecolic RYGB, only occasionally complicating. Therapeutic management of these cases remains controversial, being laparoscopic exploration a reasonable option when symptomatology is suggestive.

Megarectosigmoid in anorectal malformations: the role of laparoscopic resection.

Surgical treatment for anorectal malformations may lead to chronic constipation or stool incontinence. The first condition is mostly linked to an abnormal dilation of rectum and sigma and it is primarily managed with medical therapy (laxatives, diet and enemas). When medical therapy fails to improve the symptoms, a surgical resection of the dilated colon is advocated. When performing the procedure it is mandatory to consider all the previous operations the patient undergone. We present a laparoscopic left emicolectomy for an extremely dilated megarectosimoid after posterior sagittal anorectoplasty in childhood for a recto-urethral fistula.

Laparoscopic diagnosis and treatment of primary torsion of the greater omentum.

Clinical presentation of primary torsion of the greater omentum is nonspecific, thus rarely allowing for a preoperative diagnosis. Three patients presented with acute but nonspecific abdominal symptoms. Because ultrasonographic and radiologic findings were unclear, all patients underwent diagnostic laparoscopy. In all cases, laparoscopy enabled us to achieve the diagnosis and to perform a resection of necrotic omentum. The mean duration of the procedure was 56 minutes (range: 42 to 76). The postoperative course was uneventful and the patients were discharged on postoperative day 1 (2) and 3. The value of diagnostic laparoscopy increases when the disease can be treated laparoscopically. The laparoscopic vision allowed us to explore the whole peritoneal cavity, so achieving the diagnosis, and to place the operative trocars at the most convenient sites. The laparoscopic resection of the greater omentum is an easy task even for inexperienced laparoscopic surgeons, allowing patients to benefit from the advantages of a mini-invasive approach.