The wandering spleen: case report of laparoscopic splenectomy in a pregnant woman

Abstract Background Wandering spleen is a rare condition, which is characterized by augmented mobility of the spleen, due to congenital or acquired causes. It is more frequent in multiparous women, but only a few cases are reported during pregnancy. Wandering spleen is usually asymptomatic until the onset of its possible complications, and this can mislead clinicians in reaching the correct diagnosis. Case presentation We report the case of a wandering spleen with acute splenic infarction in a pregnant woman and its minimally invasive surgical treatment, focusing on the clinical and radiological findings that could mislead or drive clinicians to the right diagnosis, or a potential disaster. Conclusions Splenic preservation in the wandering spleen where it is safe and possible is the main goal of the treatment. Clinical and radiological findings are the most relevant elements to drive surgical treatment. To reach the best and opportune treatment for the patient, the wandering spleen is an insidious condition and must be included in the differential diagnosis in the acute abdomen diagnostic process

The wandering spleen: case report of laparoscopic splenectomy in a pregnant woman

We report he case of a wandering spleen with acute splenic infarction in a pregnant woman and its minimally invasive surgical treatment, focusing on the clinical and radiological findings that could mislead or drive clinicians to the right diagnosis, or a potential disaster

Control of the root-knot nematode, Meloidogyne incognita, in organic protected crops in Sicily

The effectiveness of different methods for controlling the root-knot, Meloidogyne incognita, suitable in organic farming in protected crops, was assessed in tomato during the 2009-2010 crop cycle, on sandy soil in a coastal area of southern Sicily (Italy). The treatments tested were: 60 day soil solarization alone and combined with commercial formulations of plant extracts of Quillaja saponaria Molina, Azadiractha indica Juss., Brassica carinata A. Brown, Tagetes spp., mycorrhizal fungi (Glomus spp.), or pellets and extracts of A. indica. The formulations were applied three or four times at intervals of 30 days. Non treated plots served as a control. The application of plant extracts or the mycorrhizal fungi combined with soil solarization significantly reduced the population of M. incognita in the soil and suppressed root galling on tomatoes compared to both non treated and solarized control plots. All plant derived formulations combined with soil solarization increased marketable yield. The greatest increases were obtained using A. indica or the mycorrhizal formulations in combination with soil solarization

Role of Epidural Analgesia within an ERAS Program after Laparoscopic Colorectal Surgery: A Review and Meta-Analysis of Randomised Controlled Studies

Introduction. Epidural analgesia has been a cornerstone of any ERAS program for open colorectal surgery. With the improvements in anesthetic and analgesic techniques as well as the introduction of the laparoscopy for colorectal resection, the role of epidural analgesia has been questioned. The aim of the review was to assess through a meta-analysis the impact of epidural analgesia compared to other analgesic techniques for colorectal laparoscopic surgery within an ERAS program. Methods. Literature research was performed on PubMed, Embase, and the Cochrane Library. All randomised clinical trials that reported data on hospital stay, postoperative complications, and readmissions rates within an ERAS program with and without an epidural analgesia after a colorectal laparoscopic resection were included. Results. Five randomised clinical trials were selected and a total of 168 patients submitted to epidural analgesia were compared to 163 patients treated by an alternative analgesic technique. Pooled data show a longer hospital stay in the epidural group with a mean difference of 1.07 (95% CI 0.06–2.08) without any significant differences in postoperative complications and readmissions rates. Conclusion. Epidural analgesia does not seem to offer any additional clinical benefits to patients undergoing laparoscopic colorectal surgery within an ERAS program

Biodiversity of Indigenous Saccharomyces Populations from Old Wineries of South-Eastern Sicily (Italy): Preservation and Economic Potential

In recent years, the preservation of biodiversity has become an important issue. Despite much public discussion, however, current practices in the food industry seldom take account of its potential economic importance: on the contrary, the introduction of industrialized agriculture practices over large areas has often resulted in a dramatic reduction in biodiversity

Bowel preparation for elective colorectal resection: multi-treatment machine learning analysis on 6241 cases from a prospective Italian cohort

background current evidence concerning bowel preparation before elective colorectal surgery is still controversial. this study aimed to compare the incidence of anastomotic leakage (AL), surgical site infections (SSIs), and overall morbidity (any adverse event, OM) after elective colorectal surgery using four different types of bowel preparation. methods a prospective database gathered among 78 Italian surgical centers in two prospective studies, including 6241 patients who underwent elective colorectal resection with anastomosis for malignant or benign disease, was re-analyzed through a multi-treatment machine-learning model considering no bowel preparation (NBP; No. = 3742; 60.0%) as the reference treatment arm, compared to oral antibiotics alone (oA; No. = 406; 6.5%), mechanical bowel preparation alone (MBP; No. = 1486; 23.8%), or in combination with oAB (MoABP; No. = 607; 9.7%). twenty covariates related to biometric data, surgical procedures, perioperative management, and hospital/center data potentially affecting outcomes were included and balanced into the model. the primary endpoints were AL, SSIs, and OM. all the results were reported as odds ratio (OR) with 95% confidence intervals (95% CI). results compared to NBP, MBP showed significantly higher AL risk (OR 1.82; 95% CI 1.23-2.71; p = .003) and OM risk (OR 1.38; 95% CI 1.10-1.72; p = .005), no significant differences for all the endpoints were recorded in the oA group, whereas MoABP showed a significantly reduced SSI risk (OR 0.45; 95% CI 0.25-0.79; p = .008). conclusions MoABP significantly reduced the SSI risk after elective colorectal surgery, therefore representing a valid alternative to NBP

Abdominal drainage after elective colorectal surgery: propensity score-matched retrospective analysis of an Italian cohort

background: In italy, surgeons continue to drain the abdominal cavity in more than 50 per cent of patients after colorectal resection. the aim of this study was to evaluate the impact of abdominal drain placement on early adverse events in patients undergoing elective colorectal surgery. methods: a database was retrospectively analysed through a 1:1 propensity score-matching model including 21 covariates. the primary endpoint was the postoperative duration of stay, and the secondary endpoints were surgical site infections, infectious morbidity rate defined as surgical site infections plus pulmonary infections plus urinary infections, anastomotic leakage, overall morbidity rate, major morbidity rate, reoperation and mortality rates. the results of multiple logistic regression analyses were presented as odds ratios (OR) and 95 per cent c.i. results: a total of 6157 patients were analysed to produce two well-balanced groups of 1802 patients: group (A), no abdominal drain(s) and group (B), abdominal drain(s). group a versus group B showed a significantly lower risk of postoperative duration of stay >6 days (OR 0.60; 95 per cent c.i. 0.51-0.70; P < 0.001). a mean postoperative duration of stay difference of 0.86 days was detected between groups. no difference was recorded between the two groups for all the other endpoints. conclusion: this study confirms that placement of abdominal drain(s) after elective colorectal surgery is associated with a non-clinically significant longer (0.86 days) postoperative duration of stay but has no impact on any other secondary outcomes, confirming that abdominal drains should not be used routinely in colorectal surgery

Problemi neurocognitivi e psicosociali nella sindrone di Turner

Scopo di questo nostro studio è quello di dare un contributo personale alla definizione ed all’approfondimento dei problemi neurocognitivi e psicosociali nelle pazienti con Sindrome di Turner (ST). Abbiamo sottoposto a valutazione psicometrica 24 soggetti di età compresa tra 1.6 e 28.0 anni (X = 14.2 +/- 6.4). La valutazione è stata effettuata mediante l’impiego di alcuni test psicometrici, differenti per le diverse fasce di età, ed un colloquio psicologico. Dai risultati ottenuti è emerso che: a) il quoziente intellettivo (Q.I.) medio era ai limiti inferiori della normalità (79 +/- 19.7, range 41-101); b) 8/24 pazienti (33%) presentavano un quadro di insufficienza mentale di grado variabile (Q.I. compreso tra 41 e 77, X = 61.4 +/- 14.5); e) 2/24 pazienti (8.3%) presentavano un’insufficienza mentale di grado severo e perciò non quantizzabile; d) il Q.I. era mediamente più basso nelle pazienti con monosomia X (68.1 +/- 19.7, range 4-196) rispetto a quelle con mosaicismo (86.0 +/- 14.0, range 61-101, p < 0.0025) o con riarrangiamenti strutturali della X (95.0 +/- 4.2, range 91-101, p < 0.0025); e) i deficit specifici più frequentemente rilevati riguardavano: la coordinazione visuo-motoria, la memoria, la concentrazione, l’attenzione e il linguaggio; f) anche in alcuni pazienti senza insufficienza mentale erano rilevabili deficit specifici relativi alle suddette aree; g) il rendimento scolastico nella nostra casistica non era nel complesso soddisfacente e molte pazienti dovevano ricorrere all’insegnante di sostegno; h) il grado di socializzazione era sufficiente nel 33% dei casi. Dall’analisi dei nostri dati emerge come i problemi neurocognitivi e comportamentali abbiano una notevole rilevanza clinica nella ST. Il riscontro abbastanza frequente di deficit specifici a carico di alcune aree neurocognitive induce a pensare che tali deficit possano rappresentare una caratteristica intrinseca della suddetta sindrome senza peraltro negare un certo ruolo negativo svolto da fattori sfavorevoli generici quali il disagio psicologico e l’emarginazione sociale conseguiti al grave deficit staturale

Day Hospital chirurgico: valutazioni cliniche ed economiche

La finalit\ue0 dello studio \ue8 di rilevare la fattibilit\ue0 di un DH chirurgico nell'attuale contesto sanitario, analizzarne i costi di gestione e verificare i risultati in termini di ottimizzazione delle risorse

Sonographic diagnosis of acute cholecystitis in patients with symptomatic gallstones

Purpose: The aim of the retrospective study was to assess the diagnostic ultrasound (US) criteria for acute cholecystitis in patients admitted for symptomatic gallbladder stones. Methods: The medical records of 186 patients who had undergone cholecystectomy within 24 hours after an US examination were reviewed. Acute cholecystitis was defined on the basis of pathology findings. The correlation between standardized US signs and final diagnosis of acute cholecystitis was assessed with univariate and multivariate analyses. The diagnostic values of US based on the correlated signs were then calculated. Results: The prevalence of acute cholecystitis was 52.7% (95% confidence interval [CI], 42.8-64.2). Three US signs were found to be predictive of acute cholecystitis: gallbladder distension, wall edema, and pericholecystic fluid collection. When none of the US signs were registered, sonography proved to have a 72.4% (95% CI, 59.1-83.3) negative predictive value. When registering two or three signs, sonography had positive predictive values of 78% (95% CI, 56.3-92.5) and 100% (95% CI, 58.9-100), respectively. With just one sign, the positive predictive value was 57.6% (95% CI, 47.2-67.4), and such a finding was furthermore observed in only 53.2% of the cases. Conclusions: The sonografic diagnosis of acute cholecystitis may be achieved by registering only three standardized US signs. Nevertheless, in patients admitted for symptomatic gallstones, US is of some utility in less than half of those patients