Spontaneous expulsion from rectum: a rare presentation of intestinal lipomas

Lipomas are rare, subserosal, usually solitary, pedunculated small lesions appearing mainly in the large intestine with a minimal malignancy potential. They usually run asymptomatic and become symptomatic when they become enlarged or complicated causing intestinal obstruction, perforation, intusucception or massive bleeding. In rare cases they can be self-detached and expulsed via the rectum as fleshy masses. This event mainly occurs in large, pendunculated lipomas which detach from their pedicle. The reason for this event remains in most of cases unclear although in some cases a predisposing factor does exist. Abdominal pain and obstructive ileus may be observed while in many cases bleeding occurs. The expulsed mass sets the diagnosis and in most of the cases all symptoms subside. Diagnosis is rarely established before surgery with the use of barium enema, computed tomography and colonoscopy which additionally provides measures of treatment and diagnosis. In atypical cases though, in cases where the malignancy can not be excluded or in complicated cases, surgery is recommended. Usually the resection of the affected intestinal part is adequate. If during surgery a lipoma is encountered simple lipomatectomy seems also to be adequate

Evidence of Increased Muscle Atrophy and Impaired Quality of Life Parameters in Patients with Uremic Restless Legs Syndrome

BACKGROUND: Restless Legs Syndrome is a very common disorder in hemodialysis patients. Restless Legs Syndrome negatively affects quality of life; however it is not clear whether this is due to mental or physical parameters and whether an association exists between the syndrome and parameters affecting survival. METHOD#ENTITYSTARTX003BF;LOGY/PRINCIPAL FINDINGS: Using the Restless Legs Syndrome criteria and the presence of Periodic Limb Movements in Sleep (PLMS/h >15), 70 clinically stable hemodialysis patients were assessed and divided into the RLS (n = 30) and non-RLS (n = 40) groups. Physical performance was evaluated by a battery of tests: body composition by dual energy X ray absorptiometry, muscle size and composition by computer tomography, while depression symptoms, perception of sleep quality and quality of life were assessed through validated questionnaires. In this cross sectional analysis, the RLS group showed evidence of thigh muscle atrophy compared to the non-RLS group. Sleep quality and depression score were found to be significantly impaired in the RLS group. The mental component of the quality of life questionnaire appeared significantly diminished in the RLS group, reducing thus the overall quality of life score. In contrast, there were no significant differences between groups in any of the physical performance tests, body and muscle composition. CONCLUSIONS: The low level of quality of life reported by the HD patients with Restless Legs Syndrome seems to be due mainly to mental health and sleep related aspects. Increased evidence of muscle atrophy is also observed in the RLS group and possibly can be attributed to the lack of restorative sleep

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

Minimal information for studies of extracellular vesicles (MISEV2023): From basic to advanced approaches

Extracellular vesicles (EVs), through their complex cargo, can reflect the state of their cell of origin and change the functions and phenotypes of other cells. These features indicate strong biomarker and therapeutic potential and have generated broad interest, as evidenced by the steady year-on-year increase in the numbers of scientific publications about EVs. Important advances have been made in EV metrology and in understanding and applying EV biology. However, hurdles remain to realising the potential of EVs in domains ranging from basic biology to clinical applications due to challenges in EV nomenclature, separation from non-vesicular extracellular particles, characterisation and functional studies. To address the challenges and opportunities in this rapidly evolving field, the International Society for Extracellular Vesicles (ISEV) updates its 'Minimal Information for Studies of Extracellular Vesicles', which was first published in 2014 and then in 2018 as MISEV2014 and MISEV2018, respectively. The goal of the current document, MISEV2023, is to provide researchers with an updated snapshot of available approaches and their advantages and limitations for production, separation and characterisation of EVs from multiple sources, including cell culture, body fluids and solid tissues. In addition to presenting the latest state of the art in basic principles of EV research, this document also covers advanced techniques and approaches that are currently expanding the boundaries of the field. MISEV2023 also includes new sections on EV release and uptake and a brief discussion of in vivo approaches to study EVs. Compiling feedback from ISEV expert task forces and more than 1000 researchers, this document conveys the current state of EV research to facilitate robust scientific discoveries and move the field forward even more rapidly

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Αθλητές Και Μέσα Κοινωνικής Δικτύωσης : Η χρήση του Twitter από τους Έλληνες Αθλητές

Η παρούσα εργασία εξετάζει την σχέση του Έλληνα αθλητή με τον δυναμικό χώρο των Μέσων Κοινωνικής Δικτύωσης. Συγκεκριμένα, ασχολείται με την σχέση που δημιουργούν οι Έλληνες αθλητές στο Μέσο Κοινωνικής Δικτύωσης του Twitter, καθώς εκείνο αποτελεί μία πλατφόρμα που δίνει την ευκαιρία στους αθλητές να περάσουν αδιαμεσολάβητα τα μηνύματά τους και αν αυτοί το επιθυμούν να αλληλεπιδράσουν απευθείας με τους ακολούθους τους. Στην εργασία θα γίνει μία αναφορά στην ανάπτυξη και τα βασικά χαρακτηριστικά του Twitter καθώς και μία αναφορά σε κάποιες εναλλακτικές πλατφόρμες που δημιουργήθηκαν από αθλητές ή σε συνεργασία με αθλητές, ώστε να αναπτυχθεί και ένας καινούργιος δίαυλος παραγωγής περιεχομένου απευθείας από τον αθλητή. Τέλος, θα διενεργηθεί ανάλυση των αποτελεσμάτων μίας έρευνας πάνω στην λειτουργία των λογαριασμών Twitter 9 Ελλήνων αθλητών στο διάστημα Αύγουστος 2018 – Απρίλιος 2019.The subject of the current paper refers to the Greek Athletes and their relationships with the dynamic and constantly progressing area of the Social Media. In particular, this paper focuses on the way the average Greek athlete handles the Social Media of Twitter, as this is the Social Media Network that gives athletes and other celebrities the opportunity to express their messages and opinions without the interference of any other party, while also interact actively with their following, in case they are inclined to. On the paper there will be a brief mention at the development and the basic characteristics of Twitter Social Media Network, as well as a brief analysis of other – recently created – platforms that operate on the same – non interfering – basis of sharing a message from an athlete to its following. Those platforms are either organized by athletes or organized in collaboration with them. Finally, I am going to proceed with an analysis of the findings of the qualitative data that was accumulated by 9 Twitter accounts of Greek professional athletes between the period of August 2018 until April 2019

Study of peritoneal permeability during adhesion formation and the role of MMP's

Introduction: Adhesion formation is a complicated process that can be influenced by many factors such as MMP’s concentrations.Purpose: The purpose of this study was to evaluate the alterations of the peritoneum permeability and of matrix metalloproteinase 2 and 9 serum levels on an experimental model of adhesion formation and inhibition. The direct effect of matrix metalloproteinase on peritoneal permeability was also to be evaluated.Material and method: The experimental model includes de novo adhesion formation in rabbits and inhibition of the process with the use of intravenous administration of dimethindene maleate and peritoneal lavage with icodextrin solution 4%. Peritoneal tissue and blood samples were taken during and 10 days after the adhesion provoking laparotomy. We used the Zulke scale to score the magnitude of the adhesions during the second laparotomy while the Ussing chamber was used to assess the alterations of the peritoneal permeability.Results: Peritoneal trauma provokes a generalized reduction in the peritoneal permeability. Intraoperative wash of the peritoneal cavity with icodextrin solution augmented the peritoneal resistance while the intravenous administration of dimethindene did not cause any notable alterations. Matrix metalloproteinase serum levels were higher in the low adhesion group of rabbits. MMP- 2 and -9 augmented the permeability of normal peritoneum.Conclusion: Peritoneal cavity wash with icodextrin and direct peritoneal trauma during laparotomy decrease peritoneal permeability while the intravenous administration of dimethindene surmounts this effect in the given experimental model. Matrix metalloproteinase seems to have a dual role on adhesion formation i.e. inhibit matrix deposition and augment peritoneal permeability.Εισαγωγή: Η συμφυσιογένεση είναι μια πολύπλοκη διαδικασία που επηρεάζεται από πολλούς παράγοντες. Ένας από αυτούς είναι και οι συγκεντρώσεις των μεταλλοπρωτεϊνασών. Το περιτόναιο παίζει σημαντικό ρόλο σε αυτή τη διαδικασία καθώς λειτουργεί σαν ηθμός ανάμεσα στην περιτοναϊκή κοιλότητα και την συστηματική κυκλοφορία.Σκοπός: Σκοπός της μελέτης είναι η αξιολόγηση των επιπέδων των μεταλλοπρωτεϊνασών 2 και 9 στο αίμα όσο και των αλλαγών στη διαπερατότητα του περιτοναίου μετά από επέμβαση συμφυσιογένεσης και προσπάθεια αναστολής της. Η απευθείας επίδραση των μεταλλοπρωτεϊνασών 2 και 9 στην διαπερατότητα του φυσιολογικού περιτοναίου μελετήθηκε επίσης.Υλικό και μέθοδος : Το πειραματικό μοντέλο περιελάμβανε την de novo συμφυσιογένεση σε κονίκλους και προσπάθεια αναστολής της με την ενδοφλέβια χορήγηση διμεθινδένης και ενδοπεριτοναϊκή έκπλυση με διάλυμα ικοδεξτρίνης 4%, λήψη δειγμάτων τοιχωματικού περιτοναίου και αίματος κατά την διάρκεια της επέμβαση καθώς και 10 ημέρες μετά. Για την αξιολόγηση των αλλαγών στην διαπερατότητα του περιτοναίου χρησιμοποιήθηκε ο θάλαμος τύπου Ussing.Αποτελέσματα: Το περιτοναϊκό τραύμα φαίνεται να μειώνει την διαπερατότητα ολόκληρης της περιτοναϊκής κοιλότητας. Η περιτοναϊκή πλύση με ικοδεξτρίνη μείωσε τη διαπερατότητα του περιτοναίου, ενώ στους κονίκλους που έγινε ενδοφλέβια χορήγηση διμεθινδένης είτε μόνης της είτε σε συνδυασμό με ικοδεξτρίνη, το περιτόναιο διατήρησε την διαπερατότητά του. Τα επίπεδα των μεταλλοπρωτεϊνασών στο αίμα ήταν υψηλότερα στους κονίκλους που εμφάνισαν τις λιγότερες συμφύσεις με βάση την κλίμακα Zuhlke. Στο φυσιολογικό περιτόναιο οι MMP-2 και -9 αυξάνουν την διαπερατότητα του περιτοναίου.Συμπεράσματα: Ο τραυματισμός και η διεγχειρητική πλύση του περιτοναίου μειώνει την διαπερατότητά του επηρεάζοντας την αμφίδρομη κυκλοφορία υγρών και ουσιών από και προς την περιτοναϊκή κοιλότητα. Η διμεθινδένη αντιρροπεί αποτελεσματικά αυτό το φαινόμενο στο πειραματικό μας μοντέλο. Ο ρόλος των μεταλλοπρωτεϊνασών στην αναστολή της συμφυσιογένεσης φαίνεται να είναι διπλός. Από την μια αποδομούν τηνθεμέλια ουσία αναστέλλοντας τη δημιουργία στερεών συμφύσεων και από την άλλη επιδρούν απευθείας στο περιτόναιο αυξάνοντας την διαπερατότητα του

Risk of colorectal neoplasm in patients with acromegaly: A meta-analysis

AIM: To examine the risk of colorectal neoplasm in acromegalic patients by meta-analyzing all relevant controlled studies