Self-expanding stents in transjugular intrahepatic portosystemic shunt: Experience with nitinol Strecker stents

The aim of our study was to evaluate the performance and efficacy of a new self-expanding stent (nitinol Strecker stent) in the transjugular intrahepatic portosystemic shunt (TIPS) procedure. We have successfully placed 64 nitinol Strecker stents in 48 patients. The average portosystemic gradient decreased from 22 to 11 mm Hg. Balloon dilatation was necessary in 12 of 35 angiographically controlled cases at 5 days (34%), because of incomplete stent expansion, small thrombi within the stent or obstruction. At 1-6 months stent malfunctions occurred in 8 of 23 patients who underwent control angiography (34%) and at 6-24 months in 6 of 7 patients (85%). Rebleeding occurred in 2 of 39 patients (follow-up > 1 month) (5%) and temporary crises of de novo encephalopathy were observed in 11 of 48 patients (23%). Refractory ascites completely resolved in 4 of 6 patients (66%) and improved in the remaining 2 cases. Compared with other self-expanding stents, nitinol Strecker stents seem to be equally effective in TIPS; no increase in complication rate was observed, either clinical or stent-related

Nonsurgical Treatment of Staple Line Leaks after Laparoscopic Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy (LSG) is gaining popularity as a "per se" bariatric procedure due to its effectiveness on weight loss and comorbidity resolution. The most feared and life-threatening complication after LSG is the staple line leak and its management is still a debated issue. Aim of this paper is to analyze the incidence of leak and the treatment solutions adopted in a consecutive series of 200 LSG. From October 2002 to November 2008, 200 patients underwent LSG. Nineteen patients (9.5%) had a body mass index (BMI) of > 60 kg/m(2). A 48-Fr bougie is used to obtain an 80-120-ml gastric pouch. An oversewing running suture to reinforce the staple line was performed in the last 100 cases. The technique adopted to reinforce the staple line is a running suture taken through and through the complete stomach wall. Staple line leaks occurred in six patients (mean BMI 52.5; mean age 41.6 years). Leak presentation was early in three cases (first, second, and third postoperative (PO) day), late in the remaining three cases (11th, 22nd, and 30th PO day). The most common leak location was at the esophagogastric junction (five cases). Mortality was nihil. Nonoperative management (total parenteral nutrition, proton pump inhibitor, and antibiotics) was adopted in all cases. Percutaneous abdominal drainage was placed in five patients. In one case, a small fistula was successfully treated by endoscopic injection of fibrin glue only. Self-expandable covered stent was used in three cases. Complete healing of leaks was obtained in all patients (mean healing time 71 days). Nonoperative treatment (percutaneous drainage, endoscopy, stent) is feasible, safe, and effective for staple line leaks in patients undergoing LSG; furthermore, it may avoid more mutilating procedures such as total gastrectomy

Franosità e terremoti nell'Italia centro-meridionale e cartografia tematica: alta e media valle del fiume Ofanto

Edizioni Ambiente, Bologn

Transplantation of human fetal biliary tree stem/progenitor cells into two patients with advanced liver cirrhosis

Not availabl

Evaluation of “Steroid-Sparing” Effects of Xanthena® Cream in Patients with Mild to Moderate Atopic Dermatitis

Emollients play an important role in the management of atopic dermatitis (AD). The aim of this study was to evaluate the efficacy and the “steroid-sparing” activity of an emollient cream (Xanthena® cream) in patients with mild to moderate AD. Patients were asked to apply twice a day for 7 days a cream containing hydrocortisone butyrate on the lesionai skin and then to apply Xanthena® cream only on the left side of affected areas. During the 2-month study period, the use of the corticosteroid cream was resumed in case of flare-up in any side. The results obtained show significant differences of both the total severity score and the intensity of each symptom and sign of AD between the skin areas treated with Xanthena® cream and the control areas (P<0.05); a relevant reduction of steroid requirement was also noted in correlation with the use of this emollient cream (P<0.05). A significant improvement was observed even after the first month of therapy for most symptoms, except for excoriations/fissuring, oozing/crusting and burning which improved only at 2 months. Treatment was well-tolerated by the majority of patients; adverse local reactions, mostly transient and of mild intensity, were observed in 7% of cases