Nuove frontiere nel trattamento endoscopico delle complicanze locali della pancreatite: studio bicentrico su Lumen Apposing Metal Stent (LAMS)

La pancreatite è una patologia caratterizzata da un processo infiammatorio con carattere acuto o cronico, patogenesi parzialmente oscura, eziologia variegata e complicanze che possono aggravare drasticamente il quadro clinico dei pazienti. I progressi tecnologici nell'ambito dell’endoscopia interventistica hanno portato al concepimento di un nuova tipologia di stent per il trattamento di raccolte fluide pancreatiche: Lumen Apposing Metal Stent(LAMS). Lo studio di tesi, dopo una prima parte di ricerca bibliografica sull'argomento, espone i risultati di un'indagine bicentrica condotta dalla SOD Endoscopia interventistica e pediatrica dell’AOUP e dall’Endoscopia digestiva, Dipartimento di servizi diagnostici e terapeutici, dell’IRCCS-ISMETT di Palermo. Pancreatitis is a pathology characterized by an inflammatory process with acute or chronic character, partially obscure pathogenesis, variegated etiology and complications that can drastically aggravate the clinical outcome of patients. The technological development in the field of interventional endoscopy has led to a new type of stent for the treatment of pancreatic fluid collections: Lumen Apposing Metal Stent (LAMS) This study, after the first part of bibliographical research on the subject, exposes the results of a bicentric experimental survey conducted by "SOD Endoscopia interventistica e pediatrica of the AOUP" and "Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo"

Precision Endoscopy in Peroral Myotomies for Motility Disorders of the Upper Gastrointestinal Tract: Current Insights and Prospective Avenues—A Comprehensive Review

Our review delves into the realm of peroral endoscopic myotomies (POEMs) in the upper gastrointestinal tract (UGT). In recent years, POEMs have brought about a revolution in the treatment of UGT motility disorders. Esophageal POEM, the first to be introduced, has now been validated as the primary treatment for achalasia. Subsequently developed, G-POEM displays promising results in addressing refractory gastroparesis. Over time, multiple endoscopic myotomy techniques have emerged for the treatment of Zenker’s diverticulum, including Z-POEM, POES, and hybrid approaches. Despite the well-established efficacy outcomes, new challenges arise in the realm of POEMs in the UGT. For esophageal POEM, the future scenario lies in customizing the myotomy extent to the minimum necessary, while for G-POEM, it involves identifying patients who can optimally benefit from the treatment. For ZD, it is crucial to validate an algorithm that considers various myotomy options according to the diverticulum’s size and in relation to individual patients. These challenges align with the concept of precision endoscopy, personalizing the technique for each subject. Within our text, we comprehensively examine each myotomy technique, analyzing indications, outcomes, and adverse events. Additionally, we explore the emerging challenges posed by myotomies within the context of the evolving field of precision endoscopy

The Dual Lens of Endoscopy and Histology in the Diagnosis and Management of Eosinophilic Gastrointestinal Disorders—A Comprehensive Review

Eosinophilic Gastrointestinal Disorders (EGIDs) are a group of conditions characterized by abnormal eosinophil accumulation in the gastrointestinal tract. Among these EGIDs, Eosinophilic Esophagitis (EoE) is the most well documented, while less is known about Eosinophilic Gastritis (EoG), Eosinophilic Enteritis (EoN), and Eosinophilic Colitis (EoC). The role of endoscopy in EGIDs is pivotal, with applications in diagnosis, disease monitoring, and therapeutic intervention. In EoE, the endoscopic reference score (EREFS) has been shown to be accurate in raising diagnostic suspicion and effective in monitoring therapeutic responses. Additionally, endoscopic dilation is the first-line treatment for esophageal strictures. For EoG and EoN, while the literature is more limited, common endoscopic findings include erythema, nodules, and ulcerations. Histology remains the gold standard for diagnosing EGIDs, as it quantifies eosinophilic infiltration. In recent years, there have been significant advancements in the histological understanding of EoE, leading to the development of diagnostic scores and the identification of specific microscopic features associated with the disease. However, for EoG, EoN, and EoC, precise eosinophil count thresholds for diagnosis have not yet been established. This review aims to elucidate the role of endoscopy and histology in the diagnosis and management of the three main EGIDs and to analyze their strengths and limitations, their interconnection, and future research directions

Synthesis, properties, and some rhodium, iridium, and platinum complexes of a series of bulky m-terphenylphosphine ligands

A series of sterically demanding aryl phosphine ligands (L) bearing terphenyl substituents, PRAr′ (R = hydrocarbyl, Ar′ = 2,6-diarylphenyl radical) has been prepared and characterized. The stability of these ligands towards oxidation in the air has been tested, and theoretical and experimental studies aimed to provide information on their electronic and steric properties have been performed. Treatment of the metal dimers [MCl(COD)](M = Rh, Ir; COD = 1,5-cyclooctadiene) with ligands PMeAr(L1) and PMeAr(L5), in a 1:1 metal:ligand ratio, afforded the expected square-planar 16-electron complexes [MCl(COD)(PMeAr)] and [MCl(COD)(PMeAr)], respectively. These compounds were readily converted into the corresponding dicarbonyl derivatives, [MCl(CO)(PMeAr)] and [MCl(CO)(PMeAr)], respectively. While the expected κ-P coordination mode of the PRAr′ ligands is found for these rhodium and iridium species, the mononuclear Pt(II) derivative obtained by reaction of PtClwith PMeArhas composition [PtCl(PMeAr)], and exhibits a bidentate κ-P, η-arene coordination mode involving one of the ipso carbon atoms of a flanking terphenyl aryl ring. The corresponding carbonyl compound [PtCl(CO)(PMeAr)], was generated under a CO atmosphere and exhibits κ-P coordination mode.Peer Reviewe

Pain assessment and management in Italian Haemophilia Centres

Although the widespread use of factor VIII/IX replacement therapy has significantly reduced the severity of arthropathy in persons with haemophilia (PWH), some develop degenerative joint changes, associated with significant pain. The aim of this survey was to investigate the management and perception of pain among Italian physicians who treat PWH