Granular cell tumor of stomach: a case report and review of literature.

Granular cell tumor (GCT) was described for the first time by Abrikosoff in 1926. It is a relatively rare neoplasm that may occur at many sites, but most commonly in the skin or soft tissues. The occurrence of GCT in the gastrointestinal tract is rare, accounting approximately for 8% of all tumors, among which the most common site is the esophagus, whereas gastric localization is very rare. Gastric GCTs can be solitary or, more frequently, associated with other gastrointestinal localization. Although GCTs are usually clinically and histologically benign, some malignant cases have been reported. Histologically, these tumors consist of polygonal and fusiform cells disposed in compact "nests" and immunohistochemical staining for S-100 protein supports the proposed derivation from Schwann cells. A correct preoperative diagnosis of this tumor can only be made in 50% of all patients and it is always based on endoscopic biopsy. Laparoscopic or conventional wedge resection represents the treatment of choice. In this study, the authors reported a case of a 49-year-old woman with a solitary granular cell tumor of the stomach with infiltrative pattern, successfully treated with surgical resection. A review of literature is also presented with emphasis on diagnostic criteria concerning the malignant form

What's in organic wine consumer mind? A review on purchasing drivers of organic wines

Consumer interest in organic wine is growing, but the effects of organic label, consumer quality perception and the support for the benefits claim of organic wine are not yet fully understood and at times doubtful. The literature shows a very heterogeneous picture regarding consumer behaviour and preferences for organic wine. This study seeks to understand the link between organic wine and consumer' purchasing drivers. Using a systematic literature review, the paper explores the characteristics of consumer of organic wine, the motivation on consumer behaviour and preferences for organic wine, as well as the sensory quality and the presence of additives when evaluating wine quality and in shaping consumers' attitudes. The results show how socio-economic and psychological characteristics of consumer as well as quality perception affect their behaviour for organic wine. Little consensus on the benefits in terms of improved sensory quality of organic wine compared to conventional one. Among sensory qualities, taste has been found to be both a key driver and barrier to organic wine consumption. Based on literature studies, consumers have positive opinions toward organic wine, which is perceived as healthy and environmental friendly. However, despite the growing market interest in wine, scientific information about the organoleptic differences between conventional and organic remains scarce and the topic requires more in-depth analysis. Understanding the profile of consumer and the factors that influence consumer' behaviour provide information to the organic wine industry

The role of credence attributes in consumer choices of sustainable fish products: A review

This review aims to assess consumer choices of sustainable fish products, considering a number of attributes that have been considered in the academic literature on this topic. In order to examine the effectiveness of sustainable labels, the research question was focused on the relation between sustainable fish labels and consumers’ willingness to pay (WTP). The findings showed how, overall, consumers have positive perceptions regarding sustainable fish products and show a willingness to pay a premium price for the attribute of sustainability. According to the results, the country of origin attribute was found to be the most important attribute in relation to consumer choice. The results indicated a high WTP for local fish products, relative to imported alternatives. Consumers prefer wild-caught fish for its perceived quality, better safety and health aspects, and taste perception than the farm-raised option. As for animal welfare, the results show that consumers are willing to pay a moderate premium price for products that have an improved fish welfare or those that avoid by-catch, such as products with eco-labels like “turtle safe”. With regard to organic labels, the studies identified a positive organic price premium for fish products. However, organic labels do not play a major role in consumer choice, when compared with other attributes

Manometric evaluation of internal anal sphincter after fissurectomy and anoplasty for chronic anal fissure: a prospective study

Chronic anal fissure (CAF) is a common painful clinical disease and its pathogenesis remains poorly understood. After failure of pharmacological therapy, that is the first-line treatment, sur- gical sphincterotomy remains the treatment of choice although it is followed by a high rate of anal incontinence resulting from the sphincter damage; therefore, the research of a sphincter-saving surgical option has become an important goal. The aim of this study was to evaluate the mano- metric modifications and the incidence of anal incontinence after fissurectomy and anoplasty with advancement skin flap in patients affected by CAF with hypertonia of the internal anal sphincter (IAS). Fifteen patients affected by CAF with hypertonia of IAS, unresponsive to medical therapy, were enrolled. All subjects underwent fissurectomy and anoplasty with advancement skin flap. Anorectal manometry was performed preoperatively and after 6 and 12 months from surgery. Maximum resting pressure (MRP), maximum squeeze pressure (MSP), ultraslow wave activity (USWA), fissure healing, anal continence, and postoperative complications were recorded. All patients healed within 30 days from surgery. No intra- or postoperative complications were recorded except for a case of partial donor site break. No significant modifications of MSP were detected. Six months after surgery, MRP was higher with respect to healthy subjects but signif- icantly reduced in comparison to baseline levels. At 12 months, it was higher have versus 6-month values but significantly lower versus preoperative values. USWA was significantly represented in patients with CAF versus healthy subject. Both at 6 and 12 months, they decreased significantly with respect to preoperative values without significant differences versus healthy subjects. Both at 6 and 12 months, anal continence did not differ with respect to preoperative time. The fissurectomy with anoplasty resulted in a high healing rate without surgical sequelae or anal incontinence. Also, it was able to reduce IAS pressure in the same manner as surgical sphincterotomy or forceful dilatation

Safety and effectiveness of saving sphincter procedure in the treatment of chronic anal fissure in female patients

Lateral internal sphincterotomy (LIS) is still the approach of choice for the treatment of chronic anal fissure (CAF) regardless to the internal anal sphincter tone but it is burdened by high risk post-operative faecal incontinence (FI). In female patient there are some anatomical and functional differences of the sphinteric system which make them more at risk of FI and vaginal birth could cause sphinteric lesions affecting the anal continence function. The aim of our study is to evaluate the results of saving sphincter procedure as treatment for female patients affected by CAF

Double localization and multiple recurrences of dermatofibrosarcoma protuberans of the female breast: A rare clinical case

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Acute inflammatory response in the subcutaneous versus periprosthethic space after incisional hernia repair: an original article

BACKGROUND: The acute inflammatory response following mesh implantation has been often evaluated in vitro and in animal models. The aim of this study was to evaluate the acute inflammatory response near the prosthesis in human by analysing some inflammatory indicators.METHODS: We used a cohort of twelve male patients affected by midline incisional hernia, who were admitted for surgical mesh repair. A suction drain was placed between the mesh and rectal muscles whereas, the other one was placed between the subcutaneous tissue and the oblique external sheath. The acute inflammatory response was analyzed by measuring the production of interleukin [IL]-1, IL-10, IL-1ra, C-Reactive Protein (CRP), total proteins, albumin and pH in the drain fluids.RESULTS: The dynamics of CRP and ILs production resulted similar in both drainages. Comparing drain over mesh and subcutaneous drain at all times, IL-1 and CRP values always resulted significantly higher in the first one, whereas IL-1ra and IL-10 values were significantly higher in the last one. Total protein and albumin were similar in both drains at all time; only in the drain over mesh fluid, pH values resulted significantly reduced in the fourth post-operative day.CONCLUSIONS: Our data showed that an acute inflammatory reaction is present in both sites examined. However, it was significantly higher in the space after mesh implantation

Circular economy models in agro-food systems: A review

Around the world, interest is growing in the circular economy in response to the current unsustainable model of production and consumption based on increased use and depletion of resources. This paper provides a review of the academic literature on the circular economy in agri-food systems, with the aims of understanding its main characteristics and perspectives, and summarizing and discussing the literature in this field. This review provides a deeper understanding of the opportunities provided by the circular economy as a solution to the current need to reduce the environmental impacts of business-as-usual economic systems and the state of the art of the circular economy in the academic debate. The results are discussed based on the chosen topiccore investigated in this review: business model and organization management, food loss and waste along the supply chain, analytical tools for the circular economy, stakeholder acceptance of the circular economy, and mitigation strategies and political approach. The findings show the need for the implementation of cleaner production models and consequent increases in stakeholder responsibilities and awareness, from both producers and consumers, as well as the need for the implementation of suitable policies and tools

Splenic rupture after colonoscopy: Report of a case and review of literature

Splenic rupture is a rare complication of colonoscopy. For this reason the diagnosis could be delayed and the outcome dismal. Fifty-four cases of splenic rupture after colonoscopy have been described in the literature. The majority of the cases required emergent or delayed splenectomy, 13 of these cases were treated conservatively. The main feature that stands out from the review of the literature is the "surprise" of this unexpected complication. This factor explains the elevated mortality (2 out of 54 cases), likely due to the delay in diagnosis. The case here described is probably among the most complex published in the literature; in fact the presence of dense intra-abdominal adhesions not only contributed to the complication itself, but also explain the confinement of the hemoperitoneum to the left supra-mesocolic space and the delayed presentation (13 days from the time of the trauma)

Advancement flap in the management of chronic anal fissure: A prospective study

Lateral internal sphincterotomy is the surgical treatment of choice of chronic anal fissure after failure of conservative measures. Several randomized trials identified an overall risk of incontinence of 10 % mostly for flatus. Fissurectomy is the most commonly used procedure to preserve the integrity of the anal sphincters. However, a possible complication is keyhole defect that may lead to faecal soiling. In this study, chronic anal fissure (CAF) was treated by fissurectomy and anal advancement flap to preserve the anatomo-functional integrity of sphincters and to reduce healing time and the risk of anal stenosis. In patients with hypertonia, surgical treatment was combined with chemical sphincterotomy by injection of botulinum toxin to enhance tissue perfusion. Forty eight patients with CAF underwent fissurectomy and anal advancement flap. In 22 subjects with hypertonia of the internal anal sphincter, intrasphincter injection of 30 UI of botulinum toxin at the completion of the surgical operation was used. All patients were followed up to 24 months. Since the first defecation, the intensity and duration of pain were significantly reduced. Two patients had urinary retention, five had infections and three had partial breakdowns. No anal stenosis, keyhole deformity or necrosis flap was recorded. At the 24 months follow-up visit, anal incontinence was similar to those detected preoperatively. Only four recurrences were detected at 18 and 20 months. After medical treatment failure, fissurectomy with advancement flap is a valid sphincter-conserving procedure for treatment of anterior or posterior CAF, regardless of hypertonia of the internal anal sphincter. © 2011 Springer-Verlag