[Hand management in recessive dystrophic bullous epydermolysis] [Il trattamento della mano nel paziente affetto da epidermolisi bollosa distrofica recessiva]

Recessive distrofic epidermolysis bullosa creates severe hand deformities with disabling functional limitations. Hand surgeon should perform surgery when deformity inibits function, in order to restore the pinch. We present our experience on 44 patients and 58 operated hands, with the following schema: hand degloving, grafting of the first web and intraoperative dynamic splinting. In 30 patient with an 8 years follow up, 25 had had good or excellent results, and the 5 remaining shows early recurrence. Association of a correct surgical approach and adequate intra and post-operative rehabilitation improve hand function and a slow down inevitable recurrence

Safety and short term effectiveness of EEA stapler vs PPH stapler in the treatment of III degree haemorrhoids. Prospective randomised controlled trial.

Abstract Introduction:  Stapled hemorrhoidopexy has gained wide acceptance due to less postoperative pain although postoperative bleeding and prolapse recurrence are among the major drawbacks of this technique compared with the standard Milligan-Morgan hemorrhoidectomy. A new stapler device has been designed to overcome these side effects . Patients and Methods:  135 patients (71 males, mean age 42) with III degree haemorrhoids were randomly allotted to stapled haemorrhoidopexy with PPH(®) 01/03 stapler (Ethicon EndoSurgery) (63 patients) or with EEA(®) stapler (Covidien) (72 patients) in 4 referral colorectal centers. The number of haemostatic overstitches apposed on the stapled suture, the area of the resected mucosa (in cm(2) ), and any postoperative bleeding within 30-days were recorded. Results:  The mean area of the resected mucosa was significantly wider in EEA than PPH patients (35,75 ± 17,51 vs 28,05 ± 10,23 cm(2) , p=0.002). The median number of haemostatic stitches apposed in the EEA group was significantly lower than in the PPH groups (median values 1, interquantile range 0-2, vs 3, interquantile range 2-5, p<0.0001). Intraoperative haemostasis was better in the EEA group compared both to PPH 01 and PPH 03 groups. Postoperative bleeding occurred only in 2 PPH patients. Discussion:  Data suggest that the EEA stapler has better haemostatic properties in comparison with PPH and allows resection of larger area of mucosal prolapsed with potential benefits over the recurrence rate of haemorrhoid prolapse

Leptin reduction after endurance races differing in duration and energy expenditure

Serum leptin concentrations are reduced in the presence of a negative energy balance. It has been demonstrated, however, that strenuous and prolonged exercise, which induces a marked negative energy balance, is not always followed by a reduction in serum leptin levels. We therefore analysed serum leptin concentrations before and after three endurance races, which differed in duration and energy expenditure (EE), with the aim of clarifying the relationship between the level of EE and the reduction in leptin levels. Forty-five males participated in one of three competitive endurance races, a half-marathon run [21.097 km, estimated EE 1,400 kcal (5,852 kJ)], a ski-alpinism race [about 45 km, estimated EE 5,000 kcal (20,900 kJ)], and an ultramarathon race [100 km, estimated EE 7,000 kcal (29,269 kJ)]. Blood samples for analysis of serum leptin, and plasma free fatty acids (FFA) were collected before and after the races. Pre-race leptin values were significantly correlated with both body mass index and body fat mass (r=0.672 and r=0.699, respectively; P<0.0001). After exercise, serum leptin levels decreased significantly in the ultramarathon [from 4.15 (0.63) \ub5g/l to 1.01 (0.15) \ub5g/l; P<0.001] and in the ski-alpinism race [from 1.10 (0.28) \ub5g/l to 0.62 (0.15) \ub5g/l; P<0.01], but not in the half-marathon [from 1.38 (0.40) \ub5g/l to 1.20 (0.36) \ub5g/l]. Plasma FFA were found to have significantly increased in all three of the races, showing a negative correlation with the percent reduction in leptin (r=0.369, P<0.02). Our data indicate that only a prolonged endurance exercise involving a high EE can induce a marked reduction in circulating serum leptin levels

Does a more extensive mucosal excision prevent haemorrhoidal recurrence after stapled haemorrhoidopexy? Long-term outcome of a randomised controlled trial.

AIM: The study aimed in a multicentric randomised controlled trial to define the role of a more extensive mucosal resection on recurrence of mucosal prolapse in patients with stage III haemorrhoids undergoing stapled haemorrhoidopexy . METHOD: 135 patients were randomised to treatment with PPH01/03 or an EEA stapler. They were reviewed after a minimum follow-up of four years to determine the rate of recurrent mucosal prolapse, and general condition (Wellness evaluation score). Postoperative bowel dysfunction was assessed using the Rome III criteria. RESULTS: 87 (65%) of the 135 patients (48 in the EEA stapler group and 37 in the PPH group) were available for long-term follow-up. The two groups were comparable for age, gender and duration of follow-up (mean 49.3±5.4 months and 49.0±5.3 months respectively). In the EEA-group, 11 (23%) patients had some degree of recurrent prolapse compared with 12 (32%) in the PPH-group (p=0.409). Persistence of anal bleeding was significantly higher in the PPH-group (p=0.04) while the postoperative Haemorrhoid Symptom Score was significantly better in the EEA-group (1.73±1.65 vs 3.17±1.94, p&lt;0.001). The wellness evaluation score was significantly better in the EEA-group (1.2±1.27 vs 0.6±1.0, p=0.028). Furthermore, seven (15%) of the patients in EEA-group complained of some evacuation disturbance compared with 13 (36%) in the PPH-group (p = 0.021). CONCLUSION: The study failed to demonstrate any significant difference in the long-term recurrence rate of stage III haemorrhoids using EEA or PPH. Nevertheless, the use of the larger volume EEA provides better symptom resolution compared with PPH. This article is protected by copyright. All rights reserved

Randomized placebo-controlled trial on local applications of opioids after hemorrhoidectomy.

BACKGROUND: Hemorrhoidectomy is associated with considerable postoperative pain. This study assessed whether a small dose of morphine or oxycodone administered in the embedded sponge set in the anus at the end of a hemorrhoidectomy intervention reduced postoperative pain. METHODS: The presence of opioid receptors was assessed in the anal mucosa excised from ten patients with perianal condyloma acuminata and 19 patients with symptomatic third-fourth degree hemorrhoids. A double-blind prospective randomized placebo-controlled trial was then conducted in 135 patients with hemorrhoids. Hemorrhoidectomy patients were randomized to morphine (MG), oxycodone (OG), or control (CG) groups, each patient having an absorbable sponge dressing left in the anus embedded with 1 mg of morphine, 1 mg oxycodone, or vehicle, respectively. The mean time for the first dose of analgesic drugs, the use of analgesics, and the mean time to void bladder was evaluated. RESULTS: The presence of kappa- and delta-opioid receptor immunoreactivity was detected in the anal mucosa excised from patients with perianal condyloma acuminata and hemorrhoids. Furthermore, there was a significant (P < 0.001) upregulation of kappa receptor immunoreactive-like material in hemorrhoidectomy patients. The mean time for the first analgesic administration was significantly increased (P < 0.001) in MG versus CG. A further significant increase (P < 0.001) was observed in the OG patient group. The mean time for voiding was significantly higher in CG when compared to the MG and OG patient groups. CONCLUSION: The local administration of very low doses of kappa-opioid agonist decreased hemorrhoidectomy postoperative pain through the interaction with specific opioid receptors located on anal mucosa

The knotty structure of the HII dwarf galaxy F348

[O III] images and blue spectra of the emission-line dwarf galaxy F348 are presented. In [O III] light, the object contains two knots about 9'' NE of the nucleus and one large extended knot 11'' to the SW. The nuclear region is hundred times less luminous in emission-line light than the knots. Despite the presence of line intensity ratios [O III] \u3bb5007 \uc5/H\u3b2 > 3 the prior classification as a Seyfert-2 object cannot be upheld. This clinches an earlier suggestion by Veron-Cetty and Veron (1986). In particular, the authors show that the line spectra can be modeled with photoionization models employing stellar input continua. Also, the line luminosities of the extranuclear knots are typical for giant H II regions. There is neither evidence for tidal tails nor for high velocity differences between the knots. In addition, the linear arrangement of the knots does not support interaction. It rather suggests self-propagating star formation. In this picture, the faintness of the nuclear region can be understood by an edge-on view. In addition, the nuclear starburst appears to be fading in contrast to the young extranuclear star formation regions. Within the scheme of Melnick (1987), F348 has to be classified as a multiple-system H II galaxy