LACK OF AN ASSOCIATION BETWEEN INHERITED THROMBOPHILIC RISK FACTORS AND IDIOPATIC SUDDEN SENSORINEURAL HEARING LOSS IN ITALIAN PATIENTS

Objectives: We investigated the presence of congenital thrombophilic risk factors in a population of consecutive Italian patients affected by idiopathic sudden sensorineural hearing loss (SSNHL). Methods: We investigated 48 patients with idiopathic SSNHL for the presence of congenital thrombophilic risk factors. The factor V Leiden G1691A, the prothrombin G20210A allele, and methylenetetrahydrofolate reductase (MTHFR) C677T genotypes were investigated. Allele frequencies and genotype distribution of all factors found in patients were compared to those of 48 healthy subjects of the same ethnic background by Chi2 and odds-ratio analysis. Odds ratios and 95% confidence intervals were calculated for allele and genotype frequencies of all thrombophilia variants. Statistical significance was accepted with a p value of less than .05. We also performed the following blood tests: hemacytometric analysis including platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen, erythrocyte sedimentation rate, C-reactive protein, protein S, protein C, antithrombin III, and activated protein C resistance. Results: In our series, we did not find an association between SSNHL and abnormal levels of antithrombin III, protein C, protein S, D-dimer, or fibrinogen; activated protein C resistance; or factor V G1691A, prothrombin G20210A, or MTHFR C677T mutations. Conclusions: At present, the few studies regarding genetic polymorphisms of congenital thrombophilic factors in SSNHL are not conclusive. According to our data, factor V G1691A, prothrombin G20210A, and MTHFR C677T variants should be not considered risk factors for SSNHL. Further large prospective studies are needed to provide currently lacking information and to improve our knowledge in the field before we recommend the determination of genetic polymorphism in SSNHL as routine practice

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Delayed presentation of a metastatic choroidal melanoma to the liver: The latency of an elective metastatic localization

Introduction: Choroidal melanoma is the most common primary intraocular malignant tumour and the second most common type of primary malignant melanoma in the body. Biologically, cutaneuous and ocular melanoma may be considered different, in terms of both metastatic diffusion and metastatic latency. The principal target organ for metastasis of the ocular melanoma is the liver.This distinctive behaviour is also sustained by different metastatic latency, as some patients present with metastatic ocular melanoma several years after the treatment of the primary tumor. Presentation of case: A 60 year-old male who had undergone left ocular enucleation for choroid melanoma 20 years ago was referred to our department with a three months history of diffuse abdominal pain, fever, weight loss and massive ascites. Abdominal ultrasonography (US) and total body computed tomography (CT) scan were performed and revealed diffuse liver metastases, associated with peritoneal carcinosis, bilateral adrenal metastases and a large mass in the left kidney compatible with another secondary localization. An ultrasound guided fine needle agobiopsy (FNA) of liver lesions was performed and the pathological findings led to the diagnosis of liver metastasis from choroidal melanoma. The patient died a few weeks later for hepatic failure. Discussion: Currently, there is no consensus regarding the optimal follow-up in terms of screening modality or time interval after the treatment of the primary ocular melanoma. Conclusion: Patients with gastrointestinal symptoms and a history of choroidal melanoma should be investigated for the presence of gastrointestinal or liver metastases, although the original primary malignancy was diagnosed years before the patient’s presentation

Gut–Liver Axis and Non-Alcoholic Fatty Liver Disease: A Vicious Circle of Dysfunctions Orchestrated by the Gut Microbiome

Non-alcoholic fatty liver disease (NAFLD) is a prevalent, multifactorial, and poorly understood liver disease with an increasing incidence worldwide. NAFLD is typically asymptomatic and coupled with other symptoms of metabolic syndrome. The prevalence of NAFLD is rising in tandem with the prevalence of obesity. In the Western hemisphere, NAFLD is one of the most prevalent causes of liver disease and liver transplantation. Recent research suggests that gut microbiome dysbiosis may play a significant role in the pathogenesis of NAFLD by dysregulating the gut–liver axis. The so-called “gut–liver axis” refers to the communication and feedback loop between the digestive system and the liver. Several pathological mechanisms characterized the alteration of the gut–liver axis, such as the impairment of the gut barrier and the increase of the intestinal permeability which result in endotoxemia and inflammation, and changes in bile acid profiles and metabolite levels produced by the gut microbiome. This review will explore the role of gut–liver axis disruption, mediated by gut microbiome dysbiosis, on NAFLD development

Learning curve for laparoscopic cholecystectomy has not been defined: A systematic review

Background: Laparoscopic cholecystectomy is one of the most performed surgeries worldwide but its learning curve is still unclear. Methods: A systematic review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Two independent reviewers searched the literature in a systematic manner through online databases, including Medline, Scopus, Embase, and Google Scholar. Human studies investigating the learning curve of laparoscopic cholecystectomy were included. The Newcastle-Ottawa scale for cohort studies and the GRADE scale were used for the quality assessment of the selected articles. Results: Nine cohort studies published between 1991 and 2020 were included. All studies showed a great heterogeneity among the considered variables. Seven articles (77.7%) assessed intraoperative variables only, without considering patient's characteristics, operator's experience, and grade of gallbladder inflammation. Only five articles (55%) provided a precise cut-off value to see proficiency in the learning curve, ranging from 13 to 200 laparoscopic cholecystectomies. Conclusions: The lack of clear guidelines when evaluating the learning curve in surgery, probably contributed to the divergent data and heterogeneous results among the studies. The development of guidelines for the investigation and reporting of a surgical learning curve would be helpful to obtain more objective and reliable data especially for common operation such as laparoscopic cholecystectomy

Preoperative basal computed tomography.

<p>The involvement of the psoas muscle and retroperitoneum from the Morrison's pouch up to the right iliac fossa and to the iliac region is evident (I, II). The same CT scan shows the involvement of the right thigh with the cysts localized deeply and behind the muscular aponeurotic plane of the femoral quadriceps and abductor muscles up to the knee (III, IV).</p