Commentary: Management of mesenteric malperfusion syndrome in patients with type A aortic dissection:An unsettled issue

The modern treatment for type A aortic dissection requires careful planning, a wide range of expertise, and a multidisciplinary approach. Specialized aortic centers might be the solution

L’itinerario dei theoroi di Delfi in Sicilia. Una proposta di ricostruzione

La “grande lista di Delfi”, pubblicata da André Plassart nel 1921, è il più importante fra gli otto cataloghi di theorodokoi conservatisi, e fornisce il quadro complessivo dei contatti mantenuti dagli ambasciatori sacri (theoroi) del santuario panellenico di Delfi con tutte le comunità greche del Mediterraneo che partecipavano periodicamente alla celebrazione delle Pitiche e delle Soterie, tra la fine del III e l’inizio del II sec. a.C. La faccia anteriore della stele registra una successione di lemmi disposti in ordine itinerario, formati da un toponimo seguito da uno o più nomi personali di theorodokoi. A loro volta le singole voci sono disposte sotto sezioni territoriali, corrispondenti alle aree che le diverse commissioni di theoroi avrebbero dovuto percorrere allo scopo di annunciare la celebrazione delle festività e invitare le rispettive poleis a prendervi parte. Nel complesso, sulle quattro colonne in cui è diviso il campo epigrafico è incisa una serie di sette itinerari regionali, di cui quattro sono identificati da altrettante intestazioni.Il testo dell’ultima delle theoriai non presenta problemi di lettura sulla pietra se non per i toponimi alle linee 111-115 della quarta colonna, interessate dalla lacuna assai grave che investe tutto lo spigolo in basso a destra della Grande Stele. Per queste righe sono state proposte diverse integrazioni, volte a ricomporre la parte finale dell’itinerario siciliano. Nelle proposte di lettura, le diverse soluzioni avanzate, tutte ugualmente insoddisfacenti, restituiscono di volta in volta un percorso differente rispetto al tragitto seguito dai theoroi di Delfi. La lettura complessiva della “grande lista dei theorodokoi di Delfi” presenta elementi utili non tanto a risolvere in modo definitivo la questione, quanto piuttosto a fornire una nuova chiave di lettura relativa alla reale configurazione di questa parte dell’itinerario, risultante dalla sequenza dei toponimi della sezione siciliana. Un dato di confronto decisivo è costituito dalle evidenze contenute sulle colonne della stele, dalle quali si evince chiaramente come, in almeno due circoscrizioni regionali, le theoriai degli ambasciatori di Delfi si sono separate in gruppi più piccoli, che hanno percorso autonomamente itinerari differenti. Questa medesima soluzione si adatta anche al caso della Sicilia, dove due gruppi di theoroi sembrano seguire le vie lungo il versante ionico e tirrenico.The “great list of Delphi”, published by André Plassart in 1921, is the most important of eight catalogs of theorodokoi preserved, and provides the overall picture of the contacts maintained by the sacred ambassadors (theoroi) of the Panhellenic sanctuary of Delphi with all the Greek communities of the Mediterranean that participated regularly in the celebration of the Pythia and Soteria, between the late third and the beginning of the second century B.C. The front face of the stele records a succession of items arranged in itinerary order, formed by a place name followed by one or more personal names of theorodokoi. In turn, the individual items are placed under local sections, corresponding to the areas that the various delegations of theoroi would have to travel in order to announce the celebration of the feast and invite their poleis to take part. Overall, on the four columns in which the inscribed area is divided, it is engraved a series of seven regional routes, four of which are identified by the same number of headers. The text of the last of the theoriai has no reading problems on the stone, with exception of the place names in lines 111-115 of the fourth column, affected by a very serious gap that affects the corner at the bottom right of the Great Stele. For these lines several integrations have been proposed, designed to reconstruct the final part of the Sicilian itinerary. In our reading proposals, all the various solutions advanced, equally unsatisfactory, provide from time to time a different version of the path followed by theoroi of Delphi. The overall reading of the “great list of Delphi’s theorodokoi” offers useful notions not so much to definitively resolve the issue, but rather to provide a new interpretation on the actual configuration of this part of the route, resulting from the sequence of place names of the Sicilian section on the stone. A matter of decisive confrontation is provided by the evidence contained in the columns of the stele, from which it is clear that, in at least two regional constituencies, the theoriai of Delphi’s ambassadors were separated into smaller groups, which have traveled different routes independently. This same solution is suited to the case of Sicily, where two groups of theoroi seem to follow the paths along the Ionian and the Tyrrhenian coast

Occurrence of gastric cancer and carcinoids in atrophic gastritis during prospective long-term follow up

Objective. Atrophic gastritis (AG) is a risk condition for gastric cancer and type I gastric carcinoids. Recent studies assessing the overall risk of gastric cancer and carcinoids in AG at long-term follow up are lacking. This study aimed to investigate in a prospective cohort of AG patients the occurrence of gastric cancer and carcinoids at long-term follow up. Methods. A total of 200 AG patients from a prospective cohort (67% female, median age 55 years) with a follow up of 7.5 (range: 4-23.4) years were included. Inclusion criteria were presence of AG and at least one follow-up gastroscopy with biopsies at ≥4 years after AG diagnosis. Follow-up gastroscopies at 4-year intervals were performed. Results. Overall, 22 gastric neoplastic lesions were detected (crude incidence 11%). Gastric cancer was diagnosed in four patients at a median follow up of 7.2 years (crude incidence 2%). Eleven type I gastric carcinoids were detected at a median follow up of 5.1 years (crude incidence of 5.5%). In seven patients, six low-grade and one high-grade dysplasia were found. The annual incidence rate person-year were 0.25% (95% confidence interval [CI]: 0.067-0.63%), 0.43% (95% CI: 0.17-0.89%), and 0.68% (95% CI: 0.34-1.21%) for gastric cancer, dysplasia, and type I-gastric carcinoids, respectively. The incidence rates of gastric cancer and carcinoids were not different (p = 0.07). Conclusion. This study shows an annual incidence rate of 1.36% person-year for gastric neoplastic lesions in AG patients at long-term follow up. AG patients are similarly exposed to gastric cancer and type I gastric carcinoids

Occurrence of acute oesophageal necrosis (black oesophagus) in a single tertiary centre

Acute oesophageal necrosis (AON) is a rare condition characterised by the endoscopic finding of diffuse, circumferential, black mucosal pigmentation of the oesophagus, which typically stops at the gastro-oesophageal junction. This observational study aimed to assess the occurrence, clinical characteristics and outcomes of AON in a consecutive endoscopic cohort in a single tertiary university centre. A retrospective analysis of endoscopic data of upper gastrointestinal endoscopy (UGE) was carried out from 2008 to 2018. Out of 25,970 UGE, 16 patients (0.06%) had AON; 75.0% were men with a median age of 75 years. Almost all patients underwent diagnosis during emergency UGE performed for gastrointestinal bleeding, but one patient was diagnosed during elective UGE for persistent vomiting and diarrhoea. All patients reported one or more pre-existing comorbidities and concomitant acute events. Two patients had AON as the first presentation of Zollinger-Ellison syndrome (ZES). One patient developed an oesophageal stenosis, and another patient presented a relapse of AON. Mortality was 50%, but no patient died as a direct consequence of AON. AON is a rare cause of gastrointestinal bleeding diagnosed mainly during emergency UGE. Our study showed that ZES might manifest with this critical presentation, and endoscopists must be aware of this evidence