Laparoscopic right hemicolectomy: the SICE (Societ\ue0 Italiana di Chirurgia Endoscopica e Nuove Tecnologie) network prospective trial on 1225 cases comparing intra corporeal versus extra corporeal ileo-colic side-to-side anastomosis

Background: While laparoscopic approach for right hemicolectomy (LRH) is considered appropriate for the surgical treatment of both malignant and benign diseases of right colon, there is still debate about how to perform the ileo-colic anastomosis. The ColonDxItalianGroup (CoDIG) was designed as a cohort, observational, prospective, multi-center national study with the aims of evaluating the surgeons\u2019 attitude regarding the intracorporeal (ICA) or extra-corporeal (ECA) anastomotic technique and the related surgical outcomes. Methods: One hundred and twenty-five Surgical Units experienced in colorectal and advanced laparoscopic surgery were invited and 85 of them joined the study. Each center was asked not to change its surgical habits. Data about demographic characteristics, surgical technique and postoperative outcomes were collected through the official SICE website database. One thousand two hundred and twenty-five patients were enrolled between March 2018 and September 2018. Results: ICA was performed in 70.4% of cases, ECA in 29.6%. Isoperistaltic anastomosis was completed in 85.6%, stapled in 87.9%. Hand-sewn enterotomy closure was adopted in 86%. Postoperative complications were reported in 35.4% for ICA and 50.7% for ECA; no significant difference was found according to patients\u2019 characteristics and technologies used. Median hospital stay was significantly shorter for ICA (7.3 vs. 9 POD). Postoperative pain in patients not prescribed opioids was significantly lower in ICA group. Conclusions: In our survey, a side-to-side isoperistaltic stapled ICA with hand-sewn enterotomy closure is the most frequently adopted technique to perform ileo-colic anastomosis after any indications for elective LRH. According to literature, our study confirmed better short-term outcomes for ICA, with reduction of hospital stay and postoperative pain. Trial registration: Clinical trial (Identifier: NCT03934151)

Inter-examiner variability of Transcranial Doppler procedure and reports: A multicenter survey

Objective. To assess the clinical use of Transcranial Doppler (TCD) and the reproducibility of TCD reports. Methods. A multicenter survey involving 45 Italian laboratories (the Italian Transcranial Doppler Group - ITDG) was carried out by investigating the examination procedure, the parameters and normative data, and the interpretation criteria applied to reach diagnostic conclusions. The inter-examiner agreement on 10 TCD reports was computed using Kappa statistics. Results. Investigators consider both qualitative (flow direction, signal detectability) and quantitative measurements (mean flow velocity and pulsatility index values), applying their own normative criteria reference which may differ slightly between centers. TCD reports appear to be highly reproducible when based upon the interpretation of qualitative data (Kappa index. 0.95-1.00), whereas a moderate agreement is obtained when considering alterations in quantitative parameters (Kappa: 0.44-0.81). Conclusions. The application of the same criteria in different laboratories may facilitate the standardization of TCD examinations and support the reproducibility of clinical reports based on TCD parameters

Prevalence of bifid median nerve at wrist assessed through ultrasound

We performed a prospective study to evaluate the prevalence of bifid median nerve (BMN) and if it has a higher prevalence in carpal tunnel syndrome (CTS) patients than symptom-free subjects. We evaluated by ultrasound (US) 162 median nerves at wrist of 89 consecutive patients with symptoms suggestive of CTS and 104 of 52 consecutive symptom-free ubjects. Neurophysiological evaluation confirmed CTS diagnosis. All patients underwent ultrasonographic evaluation of median nerve in the elbow-palm segment through high-frequency probe; BMN was arbitrarily classified as ''complete'' and ''incomplete'' on the basis of US results. BMN was observed in 16/104 wrists (15.4%) in control group and in 30/162 (18.5%) wrists in CTS group. Our study showed that BMN is frequent, not always bilateral, more often is ''incomplete'' and it has similar prevalence in CTS and control group. These findings suggest that BMN is not a risk factor of developing CTS. © 2011 Springer-Verlag

Transcranial Doppler Sonography As A Diagnostic-tool In Vascular Dementia

Transcranial Doppler monitoring of the flow velocity at the level of the middle cerebral artery was performed in 40 demented patients, 20 with multi-infarct dementia (MID) and 20 with senile dementia of the Alzheimer type (SDAT), and in 25 age-matched controls. The following conditions were evaluated: (1) rest; (2) 60 s hyperventilation; (3) longest possible apnea, and (4) 5 min closed-circuit air rebreathing. We also measured: PaCO2 levels at rest and under stimulus conditions; mean flow velocity and pulsatility index (PI) at rest, and percentage velocity variations. The PIs were higher and the velocity decrease during hyperventilation was lower in all demented patients than in the healthy group; no side-related asymmetry in rest values or in vasomotor responses to CO2 changes was regularly detected in any group. On the contrary, rest flow velocities and vasomotor responses to hypercapnia induced by both apnea and rebreathing tests proved to be lower in MID patients than in SDAT and healthy groups. These alterations were neither exclusive to MID patients nor homogeneous, therefore some caution should be taken when evaluating single cases

Focal Muscle Vibration in the Treatment of Upper Limb Spasticity: A Pilot Randomized Controlled Trial in Patients with Chronic Stroke

OBJECTIVE: To examine the clinical effect of repetitive focal muscle vibration (rMV) on the motor function of the upper extremity 1 month after treatment in patients with chronic stroke. DESIGN: We performed a pilot randomized controlled trial using a double-blind, parallel-group study design. SETTING: Medical center. PARTICIPANTS: Patients with chronic stroke (N=49). INTERVENTIONS: Patients randomly assigned to the study group (SG) received rMV, while patients in the control group (CG) received a placebo vibratory treatment. The patients and the clinical examiner were blind to the intervention. MAIN OUTCOME MEASURES: The primary endpoint was an improvement of more than .37 points on the Functional Ability Scale of the Wolf Motor Function Test (WMFT FAS). The Modified Ashworth Scale and the visual analog scale were the secondary outcome measures. All measures were administered before the treatment (t0) and 1 week (t1) and 1 month (t2) after the treatment. RESULTS: Twenty-eight patients were allocated to the SG and 21 to the CG. The analysis of variance for repeated measurements revealed a significant difference in the expression of the WMFT FAS score over time only in the SG (P=.006). The treatment was successful for 7 (33%) of 21 patients recruited in the SG and for 2 (13%) of 15 patients recruited in the CG. The relative risk was 2.5 (95% confidence interval, .60-10.39), and the number needed to treat was 5. The Wilcoxon test showed a statistically significant difference between t0 and t2 in the SG (P=.02). No adverse event was observed in the 2 groups. CONCLUSIONS: Our results suggest that rMV treatment of the upper limb may improve the functional ability of chronic stroke patients, but a larger, multicenter, randomized controlled study is needed

Prevalence of bifid median nerve at wrist assessed through ultrasound

We performed a prospective study to evaluate the prevalence of bifid median nerve (BMN) and if it has a higher prevalence in carpal tunnel syndrome (CTS) patients than symptom-free subjects. We evaluated by ultrasound (US) 162 median nerves at wrist of 89 consecutive patients with symptoms suggestive of CTS and 104 of 52 consecutive symptom-free subjects. Neurophysiological evaluation confirmed CTS diagnosis. All patients underwent ultrasonographic evaluation of median nerve in the elbow-palm segment through high-frequency probe; BMN was arbitrarily classified as "complete" and "incomplete" on the basis of US results. BMN was observed in 16/104 wrists (15.4%) in control group and in 30/162 (18.5%) wrists in CTS group. Our study showed that BMN is frequent, not always bilateral, more often is "incomplete" and it has similar prevalence in CTS and control group. These findings suggest that BMN is not a risk factor of developing CTS

Focal Muscle Vibration in the Treatment of Upper Limb Spasticity: A Pilot Randomized Controlled Trial in Patients with Chronic Stroke

Objective To examine the clinical effect of repetitive focal muscle vibration (rMV) on the motor function of the upper extremity 1 month after treatment in patients with chronic stroke. Design We performed a pilot randomized controlled trial using a double-blind, parallel-group study design. Setting Medical center. Participants Patients with chronic stroke (N=49). Interventions Patients randomly assigned to the study group (SG) received rMV, while patients in the control group (CG) received a placebo vibratory treatment. The patients and the clinical examiner were blind to the intervention. Main Outcome Measures The primary endpoint was an improvement of more than .37 points on the Functional Ability Scale of the Wolf Motor Function Test (WMFT FAS). The Modified Ashworth Scale and the visual analog scale were the secondary outcome measures. All measures were administered before the treatment (t0) and 1 week (t1) and 1 month (t2) after the treatment. Results Twenty-eight patients were allocated to the SG and 21 to the CG. The analysis of variance for repeated measurements revealed a significant difference in the expression of the WMFT FAS score over time only in the SG (P=.006). The treatment was successful for 7 (33%) of 21 patients recruited in the SG and for 2 (13%) of 15 patients recruited in the CG. The relative risk was 2.5 (95% confidence interval, .60\u201310.39), and the number needed to treat was 5. The Wilcoxon test showed a statistically significant difference between t0 and t2 in the SG (P=.02). No adverse event was observed in the 2 groups. Conclusions Our results suggest that rMV treatment of the upper limb may improve the functional ability of chronic stroke patients, but a larger, multicenter, randomized controlled study is needed