A critical and comprehensive systematic review and meta-analysis of studies comparing intracorporeal and extracorporeal anastomosis in laparoscopic right hemicolectomy

Purpose: Two main techniques are commonly used during laparoscopic right hemicolectomy in order to perform the ileocolic anastomosis: intracorporeal (IA) and extracorporeal (EA). The aim of this study was to evaluate the safety of the two techniques. Methods: A systematic review was carried out to identify studies comparing IA and EA. The primary endpoint was anastomotic leakage. The secondary endpoints were intra- and postoperative results. A meta-analysis was carried out using the random-effects model. Results: Fourteen studies matched the selection criteria, enrolling 1717 patients (50.3\ua0% IA, 49.7\ua0% EA). The anastomotic leakage was similar in the IA and the EA groups (3.4 vs. 4.6\ua0%, respectively) with a risk difference (RD) of 120.01 (95\ua0% CI = 120.03 to 0.01; P = 0.120). IA group had lower overall complication rate (27.6 vs. 38.4\ua0%; RD = 120.15; 95\ua0% CI = 0.27 to 120.04; P = 0.009) and wound infection rate (4.9 vs. 8.9\ua0%; RD = 0.52; 120.03; 95\ua0% CI = 120.06 to 120.01; P = 0.030). Time to first oral intake (weighted mean difference (WMD) = 121; 95\ua0% CI = 121.59 to 120.41; P < 0.001), length of hospital stay (WMD = 121.13; 95\ua0% CI = 121.90 to 120.35; P = 0.004) and minilaparotomy size (WMD = 1226; 95\ua0% CI = 1238 to 1213; P < 0.001) were shorter in IA patients. The incisional hernia rate was lower in the IA group (2.3 vs. 13.7\ua0%) with an RD of 120.09 (95\ua0% CI = 120.17 to 120.02; P = 0.020). There were no differences in operative time, blood loss, conversion, internal hernia, reoperation, mortality, time to first flatus and defecation, analgesic required, number of lymph nodes harvested and length of distal margin. Conclusions: Laparoscopic right hemicolectomy with IA is a safe alternative to EA. Additional well-structured, prospective randomised trials are needed to confirm all the advantages regarding postoperative results which were pointed out in our study

Retrograde Intrarenal Surgery Through an Incision of the Ureter as a Good Treatment Option for Large Ureteropelvic Impacted Stones in Transplanted Kidneys

Urolithiasis is a rare complication after kidney transplant. Over the years, treatment of kidney stones has evolved radically, but a standard approach for transplanted kidneys has not yet been defined. Here, we present a 69-year-old male patient who received successful treatment of nephrolithiasis of the transplanted kidney. The patient, who had received a kidney from a deceased donor, was admitted to our department following a posttransplant Doppler ultrasonography showing severe hydronephrosis of the transplanted kidney associated with acute renal function decay. Computed tomography scan confirmed the hydronephrosis of the transplanted kidney, showing a large, impacted, ureteropelvic 3-cm-diameter stone and other concretions around the ureteral stent. The patient was then treated with retrograde intrarenal surgery during an open ureterotomy. His postoperative course was uneventful, and he showed good functional reprise and a rapid decrease of serum creatinine levels. Intraoperative retrograde intrarenal surgery could be a valid option for treatment of kidney stones of the transplanted kidney during open surgery of the ureter or during ureterovesical anastomosis.Urolithiasis is a rare complication after kidney transplant. Over the years, treatment of kidney stones has evolved radically, but a standard approach for transplanted kidneys has not yet been defined. Here, we present a 69-year-old male patient who received successful treatment of nephrolithiasis of the transplanted kidney. The patient, who had received a kidney from a deceased donor, was admitted to our department following a posttransplant Doppler ultrasonography showing severe hydronephrosis of the transplanted kidney associated with acute renal function decay. Computed tomography scan con-firmed the hydronephrosis of the transplanted kidney, showing a large, impacted, ureteropelvic 3-cm-diameter stone and other concretions around the ureteral stent. The patient was then treated with retrograde intrarenal surgery during an open ureterotomy. His postoperative course was uneventful, and he showed good functional reprise and a rapid decrease of serum creatinine levels. Intraoperative retrograde intrarenal surgery could be a valid option for treatment of kidney stones of the transplanted kidney during open surgery of the ureter or during ureterovesical anastomosis

Hybrid cholesterol-based nanocarriers containing phosphorescent Ir complexes: In vitro imaging on glioblastoma cell line

Recently the use of phosphorescent heavy-metal complexes in bioimaging techniques has been a promising research field and has been attracted increasing interest. Among these, phosphorescent iridium(III) complexes have shown many photophysical characteristics that made them promising candidates for fluorescence probes. In this study an innovative copolymer consisting of cholesterol, a natural component of biological membranes, and the well-known biocompatible Polyethylene (PEG), has been synthesized. Cholesterol\u2013PEG amphiphilic copolymer has been used to formnovel nanocarriers characterized by the incorporation and/or linkage of the phosphorescent iridium(III) derivatives through covalent or non-covalent interactions. Finally the nanocarrier's surface has been functionalized with the peptide chlorotoxin (Cltx), a targeting agent selective for glioblastoma cells (U87MG). The so obtained targeted water soluble nanocarrier has been tested for in vitro imaging on the glioblastoma cell line and has shown no toxic effect on cells

Validation of the 2010 WHO classification and a new prognostic proposal: A single centre retrospective study of well-differentiated pancreatic neuroendocrine tumours

Backgound In 2010, the World Health Organization (WHO) modified the classification for pancreatic neuroendocrine tumours (NETs). Recently, some modifications were proposed to improve its prognostic value. The aim of this study was to test the prognostic value of both the original and the modified 2010 WHO grading systems. Methods One hundred and twenty consecutive patients surgically resected for well-differentiated NETs were evaluated in multivariate Cox regression models. Age, sex, hormonal status, size, lymph node ratio, stage, margin status and grading were evaluated in order to predict disease-free survival (DFS). Four models were evaluated: model 1: grading according to the 2010 WHO; model 2: modified grading with cut-off at 5% of the Ki-67 index; model 3: modified grading in which the G2 category was divided into two subgroups (2-5% and 5-20%) and model 4: the Ki-67 index as a continuous variable. Decision curve analysis (DCA) was carried out to evaluate the clinical utility of the various cut-offs. Results All the grading systems remained independent factors in predicting DFS. Model 2 (c index = 0.814 and P = 0.012) and model 3 (c index = 0.865 and P = 0.015) showed higher predictive powers with respect to model 1 (c index = 0.799). Model 4 had a high predictive value (c index 0.848, P = 0.013). Decision curve analysis confirmed that biological behaviour represented the best prognostic parameter. Conclusion This study presented some limitations: single centre, retrospective design and a long period of enrolment. The result showed that, by increasing the cut-off of the G2 category to 5% or by creating two subgroups in the G2 category, it was possible to obtain a better stratification of patients