Videolaparo-assisted subtotal colectomy with cecorectal anastomosis in the treatment of chronic slow transit constipation

Mechanical cecorectal anastomosis after subtotal colectomy, in the treatment of slow transit constipation, probably represents the most attractive surgical alternative to total colectomy and ileorectal anastomosis. In fact the operation allows better results in terms of postoperative diarrhoea, fecal incontinence and postoperative adherential syndrome. Literature data have demonstrated the feasibility of the laparoscopic approach with tipically advantages of less invasive surgery respect of parietal integrity,less postoperative pain and ileus, fewer postoperative adhesions, a reduced hospitalitation and finally, a better cosmesis. The Authors report a case of mechanical end to end cecorectal anastomosis after laparo-assisted subtotal colectomy (by four trocars) preserving superior rectal and ilecolic vessels, for the treatment of slow transit constipation in a 20 years old male patient .The reported operative approach which links tipical laparoscopic advantages to a more “safety” and “accurate” extracorporeal mechanical anastomosis

Genotoxicity and cytotoxicity of Aloysia polystachia: an in vivo study in rabbits

In the search of new compounds useful for the treatment of neurological disorders, medicinal plant research has progressed widely in the last decade, particularly because of the hypothesis that natural extracts possess a low or absent toxicity. Aloysia polystachia (Griseb.) Moldenke belonging to the family of Verbenaceae has been used in the traditional medicine for a variety of indications and as a sedative. Recently, some evidence reported that it exhibits some antidepressant- and anxiolytic-like effects involving the modulation of GABA system in preclinical studies in mice (1). However no investigations have been performed on its (geno)toxicity in long-term studies as it would be required for its use in neurological pathologies. In this study, we investigated the genotoxic potential of a water soluble extract of Aloysia polystachia leaves, administered orally every day for 90 days to 20 New Zealand white rabbits homogeneous for weight and age. Subjects were divided into four groups: the control group, and three experimental groups fed with a diet supplemented with 1g/kg; 1.5 g/kg and 2g/kg of Aloysia Polystachia, then peripheral blood was drawn from the vein auricularis marginalis before and after 45 and 90 days of treatment. Cytogenetic analysis was performed on each subject at each time point and chromosome aberrations (structural and numerical) and mitotic index were used as a measure of DNA damage and cytotoxicity (2). Results indicated that Aloysia polystachia extract induces a significant increase in the percentage of aberrant cells as well as in the aberration frequency (mainly chromatid breaks and fragments) associated with a decreasing trend of the mitotic index. The DNA damage was particularly higher after the first 45 days of treatment whereas it remains significantly high but almost unvaried until the end of the treatment. These data suggest that Aloysia polystachia extract has genotoxic and cytotoxic activity, even though further investigations are required to assess which compound of the extract could be responsible for the observed effects

Preoperative workup in the assessment of adrenal incidentalomas: outcome from 282 consecutive laparoscopic adrenalectomies

Abstract Background: To confirm the efficacy of preoperative workup, the authors analyse the results of a multicentre study in a surgical series of patients diagnosed with an adrenal incidentaloma. Methods: The retrospective review of a prospectively collected database was conducted. The data was obtained by six surgical units operating in the Campania Region, Italy. Five-hundred and six (506) adrenalectomies performed between 1993 and 2011 on 498 patients were analysed. Final histology in patients with a preoperative diagnosis of incidentaloma and studied according to guidelines (230/282 patients group A) was compared with final histology coming from patients presenting the same preoperative diagnosis but studied not according to guidelines (52/282 patients group B). Results: In group A preoperative diagnosis was confirmed at final histology in 76/81 (93.8%) cases of subclinical functioning lesions presenting as an incidentaloma. The preoperative detection of pheochromocytoma and primary adrenocortical cancer (ACC) reached 91.6% and 84.6% respectively. In group B conversion rate to open surgery was higher than in group A (p = 0.02). One pheochromocytoma was missed at preoperative diagnosis whereas one ACC smaller than 4 centimetres (cm) and coming from an incidental lesion was discovered. In both groups a significant association between increasing dimensions of incidentaloma and cancer has been observed (p = 0.001). Conclusions: This surgical series confirm the high efficacy of suggested guidelines. A significant preoperative detection rate of adrenal lesions presenting as incidentaloma is observed. The unnecessary number of adrenalectomies performed in understudied patients, causing higher morbidity, was not associated to a higher detection rate of primary adrenocortical cancer

Allergens in allergy diagnosis: a glimpse at emerging new concepts and methodologies

Allergic diseases are important concern of public health. A reliable diagnosis is of utmost importance for the management of allergic patients both when immunotherapy is planned and when the treatment is essentially based on the avoidance of the allergy source. However, the available diagnostic systems sometimes fail to detect specific IgE antibodies thus impairing the correct diagnosis. The traditional test systems are generally based on the use of protein extracts derived from the allergenic sources whose composition is very variable and cannot be standardized. The development of a new methodology combining the so-called allergenic molecule-based diagnosis with the multiplex microarray technology and allowing the analysis of multiple purified allergens in a single test represents an important improvement in allergy diagnosis. In addition, the biochemical and immunological characterisation of individual allergens has provided new insights into the understanding of allergen-IgE recognition that could be exploited for further improvements of allergy diagnostic tests

Allergen Micro-Bead Array for IgE Detection: A Feasibility Study Using Allergenic Molecules Tested on a Flexible Multiplex Flow Cytometric Immunoassay

Background: Allergies represent the most prevalent non infective diseases worldwide. Approaching IgE-mediated sensitizations improved much by adopting allergenic molecules instead of extracts, and by using the micro-technology for multiplex testing. Objective and Methods: To provide a proof-of-concept that a flow cytometric bead array is a feasible mean for the detection of specific IgE reactivity to allergenic molecules in a multiplex-like way. A flow cytometry Allergenic Moleculebased micro-bead Array system (ABA) was set by coupling allergenic molecules with commercially available micro-beads. Allergen specific polyclonal and monoclonal antibodies, as well as samples from 167 allergic patients, characterized by means of the ISAC microarray system, were used as means to show the feasibility of the ABA. Three hundred and thirty-six sera were tested for 1 or more of the 16 selected allergens, for a total number of 1,519 tests on each of the two systems. Results: Successful coupling was initially verified by detecting the binding of rabbit polyclonal IgG, mouse monoclonal, and pooled human IgE toward three allergens, namely nDer s 1, nPen m 1, and nPru p 3. The ABA assay showed to detect IgE t

Allergenic Lipid Transfer Proteins from Plant-Derived Foods Do Not Immunologically and Clinically Behave Homogeneously: The Kiwifruit LTP as a Model

BACKGROUND: Food allergy is increasingly common worldwide. Tools for allergy diagnosis measuring IgE improved much since allergenic molecules and microarrays started to be used. IgE response toward allergens belonging to the same group of molecules has not been comprehensively explored using such approach yet. OBJECTIVE: Using the model of lipid transfer proteins (LTPs) from plants as allergens, including two new structures, we sought to define how heterogeneous is the behavior of homologous proteins. METHODS: Two new allergenic LTPs, Act d 10 and Act c 10, have been identified in green (Actinidia deliciosa) and gold (Actinidia chinensis) kiwifruit (KF), respectively, using clinically characterized allergic patients, and their biochemical features comparatively evaluated by means of amino acid sequence alignments. Along with other five LTPs from peach, mulberry, hazelnut, peanut, mugwort, KF LTPs, preliminary tested positive for IgE, have been immobilized on a microarray, used for IgE testing 1,003 allergic subjects. Comparative analysis has been carried out. RESULTS: Alignment of Act d 10 primary structure with the other allergenic LTPs shows amino acid identities to be in a narrow range between 40 and 55%, with a number of substitutions making the sequences quite different from each other. Although peach LTP dominates the IgE immune response in terms of prevalence, epitope recognition driven by sequence heterogeneity has been recorded to be distributed in a wide range of behaviors. KF LTPs IgE positive results were obtained in a patient subset IgE positive for the peach LTP. Anyhow, the negative results on homologous molecules allowed us to reintroduce KF in patients' diet. CONCLUSION: The biochemical nature of allergenic molecule belonging to a group of homologous ones should not be taken as proof of immunological recognition as well. The availability of panels of homologous molecules to be tested using microarrays is valuable to address the therapeutic intervention

Trattamento chirurgico dell’iperparatiroidismo secondario. Esperienza clinica in 47 pazienti

Il trattamento chirurgico dell’iperparatiroidismo secondario (HPTs) resta allo stato oggetto di controversie. La paratiroidectomia subtotale con conservazione di una parte di ghiandola non nodulare e la paratiroidectomia totale con autoimpianto (muscolare o sottocutaneo) rappresentano gli interventi più diffusi nell’intento di garantire al paziente una condizione di euparatiroidismo. La paratiroidectomia totale - presunta tale - rappresenta una opzione terapeutica infrequente dati i potenziali rischi derivanti dall’aparatiroidismo e dalla necessità di una terapia sostitutiva. Gli autori esaminano i risultati chirurgici inerenti 47 pazienti trattati dal gennaio 1999 al gennaio 2006 per HPTs ad insuffucienza renale cronica (IRC). Probabilmente una corretta indicazione al tipo di intervento deriva dalla valutazione dell’“aggressività” della patologia, dall’età del paziente e dall’attesa di trapianto.La significativa incidenza di recidiva o persistenza di malattia è dovuta alla presenza di ghiandole soprannumerarie, ectopiche, all’ipertrofia di foci cellulari cervico mediastinici, dell’autoimpianto o della porzione ghiandolare residua dopo paratiroidectomia subtotale. Ogni sforzo va compiuto durante l’intervento per identificare e rimuovere eventuali ghiandole soprannumerarie che risultano inevitabile causa di iperparatiroidismo persistente