Laparoscopy in bilio-pancreatic surgery in elderly

Articolo presente su PubMed Central. Sourcerecord id Scopus 28558 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194374/ Background.More minimally invasive techniques are currently available for the surgical oncologist in the optimal staging of biliopancreatic cancer. With the increased age of population we can see an increase of age-related diseases, such a cardiovascular disease, hypertension, arthritis and other malignancies. With the development of endoscopy, laparoscopy, ultrasonography and biopsy equipment, more minimally invasive techniques are currently available for the surgical oncologist to provide a better optimal diagnosis and strategy, followed by an appropriate surgical treatment of biliopancreatic cancer. Improvement in the diagnostic and surgical care of elderly cancer patients will have a final impact on disease and overall survival rates of the different types of cancer treatment. Materials and methods.We retrospectively reviewed the records of patients between January 2001 and December 2008 who had either a mass in the biliopancreatic area classified as clinically resectable. Tumours were considered to be resectable when there was no evidence of distant extra pancreatic disease or involvement of lymphnodes outside the classic margins of resections. Occlusion or encasement of the superior mesenteric artery or vein, celiac artery or portal vein were used as a criteria for unresectability. Twenty-eight patients over 65 and under 75 years (middle age 69) with primary biliopancreatic cancer were submitted to operations for potentially operative resection. In all cases staging laparoscopy was performed just prior to planned open exploration and resection. Results.Twenty seven patients underwent laparoscopy exploration for potential resection. Two of five patients (40%) with distal cholangiocarcinoma survived at 5 years after DCP. Eighteen patients (66.6%) had unresectable disease identified at laparoscopy and fourteen were able to convert to laparotomy palliative surgery while for the others laparoscopy spared an unnecessary laparotomy. In four patients it was possible to perform a laparoscopy palliative surgery. Conclusions.Laparoscopy may have a role in the staging of patients with biliopancreatic malignancies, in particular, for reduction of unnecessary exploratory laparotomy. Moreover, even in old age, duodenocephalopancreasectomy, properly planned and executed, resulted in reduction of operative mortality and morbility and a clear long-term survival

Sentinel node biopsy and radical lymph node dissection for advanced melanoma in the elderly

Articolo presente su PubMed Central. Sourcerecord Id Scopus: 28558 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194399/ Background.The majority of indications for surgery in melanoma are for the treatment of primary tumor and lymph node metastases. During the last decade, the Sentinel Node Biopsy (SNB), from a research procedure, has become standard of care in most institutions. SNB is normally considered for patients with melanoma > 1 mm and generally about 20% are positive; however, the risk of a positive SNB in a melanoma < 1 mm is still 5%. Usually when SNB is positive a complete lymphadenectomy is performed. Materials and methods.In the period 2004-2009, 18 elderly patients (median age 68 years) affected by cutaneous melanoma (mean Breslow’s thickness = 3.77 mm), after SNB histologically confirmed regional lymph node involvement, underwent complete lymph node dissection (CLND). We treated 11 of them with groin dissection, in 3 cases bilateral; 4 patients underwent axillar dissection, in one case bilateral; 2 patients underwent neck dissection and another patient underwent groin-axillar dissection. We treated bilateral groin involvement with laparoscopic access for dissection of lumbar-aortic, iliac and obturator lymph nodes. Results.Disagreeing with literature, 12/18 (67%) of these patients had positive lymph nodes, a high percentage if compared with younger patients’ data. Currently the average follow-up is 25 months. In our sample CLND has a crucial prognostic role (16% vs 41% of deceased in CLND – and CLND + patients respectively). Conclusions.Elderly melanoma patients are characterized by a higher tumor stage and, in patients with nodal metastases, the prognosis is independently affected by older age. In case of positive SNB the CLND plays a notable prognostic role and a presumable therapeutic role

TEM in the treatment of recurrent rectal cancer in the elderly

Articolo presente su PubMed Central. Surcerecord id Scopus 28558 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194378/ Introduction.Transanal endoscopic microsurgery is a useful technique of minimally invasive surgery that allows the realization of complex interventions, from transanal excisions to full thickness resections with anastomotic reconstructions. TEM can have a diagnostic and therapeutic value in the elderly for the treatment of primary rectal cancer as well as for recurrences. Materials and methods.During the period between January 2002 and December 2009 six patients, average age of 66 years, four men and two women, with early diagnosed rectal cancer recurrence were selected to undergo this palliative surgical procedure. 3 men and 1 woman underwent "ultra-low anterior resection”, followed by chemo / radio therapy (T3N1M0); in one woman a TEM (T1NxM0) and in one old man the local escission was performed after neoadiuvant chemo/radio therapy (T2NxM0). The selection of the patients was made by: rigid sigmoidoscope, transrectal us, colonoscopy, abdominal us to rule out liver metastases, CT and MRI abdomen and pelvis with and without contrast agents, PET CT. In all patients the lesions were superficial, smaller than 2 cm and located at the posterior wall of the rectum. Results.Follow-up was approximately 12-28 months; the pathologic staging confirmed the complete excision of recurrences. Patients were then referred for more complementary therapies. Only one patient presented a retro rectal abscess treated with conservative techniques, too. Conclusions.The alternative to conservative surgery is an abdomino-perineal resection sec. Miles, but also this really invasive procedure can be considered palliative in the most part of recurrences. So, based on equal oncological results, the reduction of surgical trauma and preservation of anatomical integrity are really important goals

EUSO-SPB1 mission and science

The Extreme Universe Space Observatory on a Super Pressure Balloon 1 (EUSO-SPB1) was launched in 2017 April from Wanaka, New Zealand. The plan of this mission of opportunity on a NASA super pressure balloon test flight was to circle the southern hemisphere. The primary scientific goal was to make the first observations of ultra-high-energy cosmic-ray extensive air showers (EASs) by looking down on the atmosphere with an ultraviolet (UV) fluorescence telescope from suborbital altitude (33 km). After 12 days and 4 h aloft, the flight was terminated prematurely in the Pacific Ocean. Before the flight, the instrument was tested extensively in the West Desert of Utah, USA, with UV point sources and lasers. The test results indicated that the instrument had sensitivity to EASs of ⪆ 3 EeV. Simulations of the telescope system, telescope on time, and realized flight trajectory predicted an observation of about 1 event assuming clear sky conditions. The effects of high clouds were estimated to reduce this value by approximately a factor of 2. A manual search and a machine-learning-based search did not find any EAS signals in these data. Here we review the EUSO-SPB1 instrument and flight and the EAS search

EUSO-SPB2 Telescope Optics and Testing

The Extreme Universe Space Observatory - Super Pressure Balloon (EUSO-SPB2) mission will fly two custom telescopes that feature Schmidt optics to measure Cherenkov- and fluorescence emission of extensive air showers from cosmic rays at the PeV and EeV-scale, and search for τ-neutrinos. Both telescopes have 1-meter diameter apertures and UV/UV-visible sensitivity. The Cherenkov telescope uses a bifocal mirror segment alignment, to distinguish between a direct cosmic ray that hits the camera versus the Cherenkov light from outside the telescope. Telescope integration and laboratory calibration will be performed in Colorado. To estimate the point spread function and efficiency of the integrated telescopes, a test beam system that delivers a 1-meter diameter parallel beam of light is being fabricated. End-to-end tests of the fully integrated instruments will be carried out in a field campaign at dark sites in the Utah desert using cosmic rays, stars, and artificial light sources. Laser tracks have long been used to characterize the performance of fluorescence detectors in the field. For EUSO-SPB2 an improvement in the method that includes a correction for aerosol attenuation is anticipated by using a bi-dynamic Lidar configuration in which both the laser and the telescope are steerable. We plan to conduct these field tests in Fall 2021 and Spring 2022 to accommodate the scheduled launch of EUSO-SPB2 in 2023 from Wanaka, New Zealand

Infectious esophagitis by papilloma virus. A clinical case

Introduction: The esophagus may be affected by several infective agents, which cause mucosa alterations of various degree, and which can determine either light symptons or critical clinical problems with a high mortality risk. These diseases very often affect patients with reduced immunocompetence. Some of the infectious agents most frequently involved in esophageal infections are Herpes virus, Candida, CMV, HIV. Infectious esophagitis from HPVs are rare in the western countries. The greater number of registered cases have been discovered in the East. Hypotesis is that HPV is a possible etiologic agent in esophageal carcinogenesis, most probaby acting synergistically with physical, chemical, and/or nutritional factors in some high-risk areas of China. Although there are specific endoscopic aspect for infectious esophagitis from different agents, it is difficult to make a differential diagnosis and therefore biopsies, cultures and brushing have a particular importance. The bioptic area is a critical point for histological diagnosis of infectious oesophagitis. Infact, in case of suspected infection from herpes virus, the biopsies must be made on the mucosa surrounding the ulcerative lesion, whereas, for the cytomegalovirus, the specimen must be obteined from the ulcerative crater. Other important procedure, in case of supposed infectiouse disease, is culture, especially with the “shell vial” technique. Epidemiological and experimental evidences suggest the possibility that HPV infection increases the cancer risk for the oral cavity, pharynx and upper aerodigestive tract. However, histologic changes, suggesting HPV infection, are occasionally found adjacent to squamous cell carcinoma or in squamous papilloma of the esophagus, but the relationship between HPV infection and benign and malignant squamous lesions of the esophagus is not yet clear. It is important to differenziate infective esophagitis from gastroesophageal reflux esophagitis in order to perform an up-to-date treatment. Clinical Case: A 25 year old woman was hospitalized in the Federico II University Dept. of General Surgery for arising of retrosternal pain, odynophagia and dysphagia, both for solids and liquids. These symptoms had begun six days before admission. Bioumoral routine tests showed no abnormalities. No pathognomonic symptoms for gastroesophageal reflux nor caustic assumption was referred. The esophago-gastro-duodenoscopy showed, in midium esophagus, a large and deep ulcerative lesion, which involved the whole lumen between 26 and 30 cm. The lesion was thickened and covered by fibrin. Several bioptic tests were performed: IgG anti-varicella-zoster virus, anti-herpes simplex virus, anti-Epstein-Barr-vca were positive. The anti-HIV 1-2 test was negative. No lymphocytic alteration was observed. The histological diagnosis was “active chronic inflammatory infiltration and fibrinoleukocyte exudate”, which is direct sign of ulcerative lesion. Cytologic changes of coilocytic type (giving evidence for HPV infection) were observed. Examination of oral cavity, pharynx and upper respiratory tract gived no evidence of lesions by HPV or other causes. The patient received therapy consisting in mucosal protectives (sucralphate) and Total Parenteral Nutrition. At EGDS, performed two weeks later, the lesion appeared completely healed. References 1. Chang F., Syrjanen S., Shen Q., et al. Evaluation of HPV, CMV, HSV and EBV in esophageal squamous cell carcinomas fom a high-incidence area of China. Anticancer Res 2000 20(5C): 3935-40. 2. Chen L., Yang L., Sun Z. et al. Detection of human papillomaviral infection on Kazakh patients with esophageal squamous cell carcinoma in Xinjiang Chinese Journal of Clinical Oncology 2009; 6 (1): 64-67 3. de Villiers E.M., Lavergne D., Chang F., et al. An interlaboratory study to determine the presence of human papillomaviruses DNA in esophageal carcinoma from China. Int J Cancer 1999; 81(2): 225-8. 4. Franceschi S., Munoz N., Bosch XF et al. Human papillomavirus and cancers of the upper aerodigestive tract: a review of epidemiological and experimental evidence. Cancer Epidemiol Biomarkers Prev 1996; 5 (7): 567-75. 5. Kamangar F., Qiao Y.L., Schiller J.T. et al. Human papillomavirus serology and the risk of esophageal and gastric cancers: Results from a cohort in a high-risk region in China. International Journal of Cancer 2006; 119 (3): 579-58

Enhancing user awareness during internet browsing

With the advent of e-commerce and social networks, people often unconsciously disseminate their sensitive data through different platforms such as Amazon, eBay, Facebook, Twitter, Instagram, and so on. In this scenario, it would be useful to support users with tools providing awareness on how their sensitive data are exchanged. In this paper, we present a visual analytics tool that allows users to understand how their sensitive data are exchanged or shared among different network services. In particular, the proposed tool visualizes the communication flow generated during Web browsing activities, highlighting the providers tracking their data. The tool provides a real-time summary graph showing the information acquired from the network. A user study is presented to highlight how the proposed tool improves the user’s perception of privacy issues