Centella asiatica in the Conservative Treatment of Anal Fissure and Hemorrhoids in Comparison with Flavonoids

Background: In this review, we report about therapeutic effects of Centella asiatica (Ca) in comparison with Flavonoids (Fs) to find out which of them best deals with some items such as bleeding and pain healing time in the treatment of outpatients with chronic Anal Fissure (AF) on one hand. On the other hand, we report about the same parameters in outpatients treated for hemorrhoidal disease (HD). Methodology: Ninety-eight outpatients who complained of AF were randomly assigned to the treated group (either Fs or Ca) and control group [1]. The control group (group C, n = 32) underwent standard treatment. Patients assigned the treated group were divided into subgroups that were treated, additionally, either with Fs (group A, n = 30) or Ca (group B, n = 36) and observed over 8 weeks. In another study on 130 outpatients (who underwent hemorrhoidectomy and operated for hemorrhoidal thrombosis) bleeding and pain were studied [2]. The treated group (both conservative and surgical) was randomized into two subgroups: the one treated with Fs (group A), the other with Ca (group B). Sixty patients (the control group C, both conservative and surgical) received the standard treatment. Time-to-stop bleeding was checked at the start (day 0) up to day 42 (end of the 6th week). Results: Outpatients complained of AF, the median time-to-stop bleeding in group A resulted in 1 week, in 3 weeks group B, and 4 weeks in group C respectively. Among groups, for the time-to-end-bleeding (A vs B: p-value = 0.022; A vs C: p-value < 0.001; B vs C: p-value = 0.070) significant differences were observed. As for the pain score, from day 0 up to the end of the 2nd week, on the one hand among groups A and B, and on the other hand among groups A vs C, and B vs C significant differences respectively were observed (A vs C: p-value = 0.004; B vs C: p-value 0.035). All patients healed within the end of 8th week [1]. The paper about patients with HD showed “time-to-stop bleeding of 2 weeks for groups A and B; 3 weeks for group C” [2]. As for the VAS score (irritation) comparison among groups (A vs C: p = 0.007; B vs C: p = 0.041; and A vs B: p = 0.782) respectively resulted [2]. The patients underwent hemorrhoidectomy, “the time-to-stop bleeding was 3 and 4 weeks in groups A and B and 5 in group C”, respectively [2]. “Histopathology showed a tight association between flavonoids and piles’ fibrosis (p = 0.008)” [2]. Discussion: “The outpatients with AF treated with either Fs or Ca experienced an earlier healing and disappearance of pain in comparison with patients underwent to the traditional treatment” [1]. Fs showed the most efficacy for bleeding. Ca showed the most efficacy for edemas. Fs and Ca did not show side effects. Conclusion: The outpatients with AF as well as those with HD treated either with Fs or Ca (phlebotonics) experienced early pain disappearance in comparison with the standard treatment group respectively. In the treatment of HD as well as after anal surgery, Fs and Ca showed significant beneficial effects. Fs among phlebotonics are the most effective against bleeding and anal irritation in HD. As for the Ca, among phlebotonics, seems the most effective for tissues’ edema

Benefits and biosafety of use of buckypaper for surgical applications. A pilot study in a rabbit clinical trial model

Background: One of the main problems related to prosthetic abdominal surgery is mesh fixation. Suture line tension, mesh separation, displacement, or improper application of stitches are the leading causes of complications, including seroma, postoperative pain, and recurrence. A surface able to adhere firmly to living tissue represents an effective alternative to conventional perforating fixations. As a bio-adhesive tape, we report experimental evidence on the potential applicability of the BuckyPaper (BP), a felt composed of entangled multi-walled carbon nanotubes. Matherial and methods: BP is implanted to assess its biosafety and effectiveness as an adhesive prosthetic device. Results: During 35 days we observed no rabbit behavioral alteration, BP stability in the implantation site, good adhesion, and integration of the device with the surrounding tissue, and no adverse reactions. Conclusions: BP could be used as an adhesive to secure the prostheses to tissues in abdominal wall prosthetic surgery, but large-size animal studies are needed

Comparison of Centella with flavonoids for treatment of symptoms in hemorrhoidal disease and after surgical intervention: A randomized clinical trial

Gli effetti dei flebotonici sono stati valutati per il tempo di arresto del sanguinamento e il tempo di scomparsa dell'irritazione anale in 130 pazienti affetti da malattia emorroidaria, tempo di arresto del sanguinamento e tempo di scomparsa del dolore dopo intervento [emorroidectomia (in 31 pazienti) oppure incisione e drenaggio di trombosi emorroidaria (in 34 pazienti)]. Queste valutazioni sono state fatte nel breve periodo di tempo 0-42 gg. Sessanta pazienti randomizzati hanno ricevuto la procedura di routine (sia conservativa che chirurgica) (gruppo di controllo C). Il gruppo dei pazienti che hanno ricevuto il trattamento con flebotonici (sia conservativo che chirurgico) è stato suddiviso in due sottogruppi: quello trattato con flavonoidi (Gruppo A, n = 73) e quello trattato con Centella (Gruppo B, n = 66). Il tempo di scomparsa del sanguinamento è stato verificato dal Giorno 0 fino al Giorno 42. La guarigione è stata stimata con il metodo Kaplan-Meier, il test Kruskal-Wallis è stato utilizzato per valutare le variazioni del punteggio VAS per studiare il dolore (dopo intervento per emorroidectomia oppure incisione e drenaggio di trombosi emorroidaria), oppure irritazione anale nei pazienti trattati conservativamente. Il tempo medio di emorragia è stato di 2 settimane per i gruppi A e B; 3 settimane per il gruppo C. Il confronto dei punteggi VAS tra i gruppi (irritazione): A vs C, p = 0,007; B vs C, p = 0,041; e A vs B, rispettivamente p = 0,782. Per quanto riguarda gli operati con emorroidectomia, il tempo di arresto del sanguinamento è stato rispettivamente di 3 e 4 settimane nei gruppi A e B, 5 settimane nel gruppo C. L'istopatologia ha mostrato un'associazione tra flavonoidi e fibrosi emorroidaria (p = 0,008). I flebotonici hanno mostrato significativi effetti benefici sia negli operati che nei pazienti trattati conservativamente. Tra i flebotonici, i flavonoidi sono stati più efficaci contro il sanguinamento e l'irritazione anale.Phlebotonics' effects were evaluated to reduce time-to-stop bleeding and anal irritation in 130 patients who complained of hemorrhoidal disease (HD); bleeding and pain after hemorrhoidectomy (31 patients) and hemorrhoidal thrombosis (34 patients) in the short time. Sixty patients were randomized to receive the routine treatment (both conservative and surgical) (control Group C). The treated group (both conservative and surgical) was divided into two subgroups: one treated with flavonoids (Group A, n = 73), the other with Centella (Group B, n = 66). Time-to-stop bleeding was checked at baseline and checkups (0 up to day 42). Healing was estimated with Kaplan-Meier method, the Kruskal-Wallis test estimated changes in the VAS scores. The HD median time-to-stop bleeding was 2 weeks for Groups A and B; 3 weeks for Group C. VAS scores comparison among Groups (irritation): A vs C, p = 0.007; B vs C, p = 0.041; and A vs B, p = 0.782 resulted respectively. As for operated hemorrhoids, the time-to-stop bleeding was 3 and 4 weeks in Groups A and B and 5 in Group C. Histopathology showed an association between flavonoids and piles' fibrosis (p = 0.008). Phlebotonics in HD, as well as after surgery, showed significant beneficial effects. Flavonoids are the most effective phlebotonics against bleeding and anal irritation

Gel piastrinico. Trattamento del piede diabetico e dell’osteomielite fistolizzata. Revisione della letteratura e nostra esperienza in 61 casi clinici

GEL PIASTRINICO: TRATTAMENTO DEL PIEDE DIABETICO E DELL’OSTEOMIELITE FISTOLIZZATA. REVISIONE DELLA LETTERATURA E NOSTRA ESPERIENZA IN 61 CASI CLINICI Introduzione: la nostra esperienza evidenzia l’utilità del gel piastrinico (GP) nel trattamento ambulatoriale delle piaghe torpide della pianta del piede in paziente diabetico e delle ulcerazioni torpide che richiedevano periodi lunghissimi di medicazioni complesse, senza raggiungere il risultato atteso. Materiali e Metodi: la metodica personale prevede il curettage dopo disinfezione e debridement della piaga, l’inoculazione di 1-4 UI di insulina pronta alla base del cratere ulcerativo e quindi l’applicazione di 5 ml di GP con 1 ml di Trombina autologa attivata. L’applicazione si esegue facendo gocciolare il concentrato piastrinico su Hyalofill-F Fidia® Italia sul quale si fa, quindi, gocciolare l’attivatore ottenendo un panno morbido, elastico-gelatinoso, pronto a riempire la cavità da trattare. Il supporto inerte riassorbibile in acido ialuronico impedisce la dispersione della parte liquida o non completamente gelificata, ricca dei fattori di crescita (PDGF, TGF, EGF) che stimolano la moltiplicazione dei fibroblasti i quali aumentano di numero e depositano matrice connettivale, trasformando la piaga torpida con la fioritura dei bottoni di granulazione. In caso di ferite più piccole o man mano che l’ampiezza della ferita si riduce, il prodotto può essere aliquotato e congelato per successive somministrazioni. Nel caso di paziente affetto da ulcerazione da osteomielite occorre un lungo periodo di terapia antibiotica parenterale con Ampicillina-Sulbactam o Piperacillina-Tazobactam o Ertapenem o Meropenem associata a Vancomicina, oppure, alternativamente Daptomicina. Discussione: in generale, la terapia deve essere mirata sulla base dell’isolamento del germe patogeno, ma spesso l’infezione è polimicrobica e quindi si somministra una terapia empirica ad ampio spettro. Principio guida nella terapia empirica è la somministrazione di antibiotici contro lo Staphylococcus aureus meticillino resistente (MRSA). Nei pazienti ambulatoriali è essenziale tenere in considerazione la presenza di germi meticillino resistente associati alla comunità di appartenenza (CA-MRSA) e quindi occorrono colture batteriche ripetute. Conclusioni: l’approccio multidisciplinare tra chirurgo, immunotrasfusionista, infettivologo, dermatologo, ortopedico, diabetologo e cardiologo, risolve brillantemente la problematica. Lo stretto coordinamento tra ambulatorio chirurgico ed il centro trasfusionale, evita inutili attese al Paziente, accorcia i tempi di esecuzione della medicazione, abbatte i costi per l’impiego di materiali e diventa conveniente rispetto al trattamento tradizionale.Our study proves the usefulness of platelet gel in the treatment of the diabetic foot. We started in January 2006 to treat diabetic wounds of the foot in the outpatients’ surgical department with encouraging results. Despite its expensive and complex preparation, the platelet gel is useful and convenient because it succeeds in shortening the ambulatory treatment period. Besides, in our opinion, the multidisciplinary approach of this treatment is rather important: actually, it implies the cooperation of dermatologist, surgeon, orthopaedist, immunologist, diabetologist and, if necessary, the cardiologist. That is why it reduces wastes of work-time and the expenses for consultants, medications and dressing material

Primary omental torsion (POT): a review of literature and case report

Eitel first described omental torsion in 1899, since then, fewer than 250 cases have been reported. Although omental torsion is rarely diagnosed preoperatively, knowledge of this pathology is important to the surgeon because it mimics the common causes of acute surgical abdomen. For this reason, in the absence of diagnosed preexisting abdominal pathology, including cysts, tumors, foci of intra-abdominal inflammation, postsurgical wounds or scarring, and hernial sacs, omental torsion still can represent a surprise. Explorative laparotomy represents the diagnostic and definitive therapeutic procedure. Presently laparoscopy is the first choice procedure

La colecistectomia laparoscopica a “bassa pressione” nei pazienti ad alto rischio (ASA III e IV) nella nostra esperienza

The insufflation pressure used for laparoscopic cholecystectomy is usually 12-15 mm Hg, and a pneumoperitoneum with carbon dioxide has a significant effect on both cardiovascular and respiratory function. These effects are transient in young, healthy patients, but may be dangerous in ASA III and IV patients with a poor cardiac reserve. This study was designed to assess the feasibility of performing laparoscopic cholecystectomy at 6.5-8 mm Hg insufflation pressure in "high-risk" patients. Thirteen patients, 10 ASA III and 3 ASA IV, with cholelithiasis, were included in this study The insufflation pressure was 6.5-8 mm Hg, with a 10 degrees anti-Trendelenburg position. The cardiovascular and blood gas variables studied were: mean arterial blood pressure, heart rate, respiratory rate, and end-tidal CO2 pressure. The authors reported no conversions and no intra- or postoperative complications. During insufflation heart rate and mean arterial blood pressure increased minimally if compared with laparoscopic cholecystectomy at 12-15 mm Hg. Pa CO2 increased after insufflation (+5 mm Hg), and the end-tidal CO2 pressure gradient was moderate (3.5 mm Hg) and unchanged during surgery. A low-pressure pneumoperitoneum is feasible for laparoscopic cholecystectomy and minimizes the adverse haemodynamic effects of peritoneal insufflation

Cellular Responses Induced by Zinc in Zebra Mussel Haemocytes. Loss of DNA Integrity as a Cellular Mechanism to Evaluate the Suitability of Nanocellulose-Based Materials in Nanoremediation

: Zinc environmental levels are increasing due to human activities, posing a threat to ecosystems and human health. Therefore, new tools able to remediate Zn contamination in freshwater are highly recommended. Specimens of Dreissena polymorpha (zebra mussel) were exposed for 48 h and 7 days to a wide range of ZnCl2 nominal concentrations (1–10–50–100 mg/L), including those environmentally relevant. Cellulose-based nanosponges (CNS) were also tested to assess their safety and suitability for Zn removal from freshwater. Zebra mussels were exposed to 50 mg/L ZnCl2 alone or incubated with 1.25 g/L of CNS (2 h) and then removed by filtration. The effect of Zn decontamination induced by CNS has been verified by the acute toxicity bioassay Microtox®. DNA primary damage was investigated by the Comet assay; micronuclei frequency and nuclear morphological alterations were assessed by Cytome assay in mussels’ haemocytes. The results confirmed the genotoxic effect of ZnCl2 in zebra mussel haemocytes at 48 h and 7-day exposure time. Zinc concentrations were measured in CNS, suggesting that cellulose-based nanosponges were able to remove Zn(II) by reducing its levels in exposure waters and soft tissues of D. polymorpha in agreement with the observed restoration of genetic damage exerted by zinc exposure alon

A prospective multicentre study evaluating the outcomes of the abdominal wall dehiscence repair using posterior component separation with transversus abdominis muscle release reinforced by a retro-muscular mesh: filling a step

Background This study aimed to evaluate the results of posterior component separation (CS) and transversus abdominis muscle release (TAR) with retro-muscular mesh reinforcement in patients with primary abdominal wall dehiscence (AWD). The secondary aims were to detect the incidence of postoperative surgical site occurrence and risk factors of incisional hernia (IH) development following AWD repair with posterior CS with TAR reinforced by retromuscular mesh. Methods Between June 2014 and April 2018, 202 patients with grade IA primary AWD (Björck’s first classification) following midline laparotomies were treated using posterior CS with TAR release reinforced by a retro-muscular mesh in a prospective multicenter cohort study. Results The mean age was 42 ± 10 years, with female predominance (59.9%). The mean time from index surgery (midline laparotomy) to primary AWD was 7 ± 3 days. The mean vertical length of primary AWD was 16 ± 2 cm. The median time from primary AWD occurrence to posterior CS + TAR surgery was 3 ± 1 days. The mean operative time of posterior CS + TAR was 95 ± 12 min. No recurrent AWD occurred. Surgical site infections (SSI), seroma, hematoma, IH, and infected mesh occurred in 7.9%, 12.4%, 2%, 8.9%, and 3%, respectively. Mortality was reported in 2.5%. Old age, male gender, smoking, albumin level < 3.5 gm%, time from AWD to posterior CS + TAR surgery, SSI, ileus, and infected mesh were significantly higher in IH. IH rate was 0.5% and 8.9% at two and three years, respectively. In multivariate logistic regression analyses, the predictors of IH were time from AWD till posterior CS + TAR surgical intervention, ileus, SSI, and infected mesh. Conclusion Posterior CS with TAR reinforced by retro-muscular mesh insertion resulted in no AWD recurrence, low IH rates, and low mortality of 2.5%. Trial registration Clinical trial: NCT05278117