Impact of 2021 European Academy of Neurology/Peripheral Nerve Society diagnostic criteria on diagnosis and therapy of chronic inflammatory demyelinating polyradiculoneuropathy variants

Background and purpose: there are different criteria for the diagnosis of different variants of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). The 2021 European Academy of Neurology/Peripheral Nerve Society (EAN/PNS) guidelines provide specific clinical criteria for each CIDP variant even if their therapeutical impact has not been investigated. Methods: we applied the clinical criteria for CIDP variants of the 2021 EAN/PNS guidelines to 369 patients included in the Italian CIDP database who fulfilled the 2021 EAN/PNS electrodiagnostic criteria for CIDP. Results: according to the 2021 EAN/PNS clinical criteria, 245 patients achieved a clinical diagnosis of typical CIDP or CIDP variant (66%). We identified 106 patients with typical CIDP (29%), 62 distal CIDP (17%), 28 multifocal or focal CIDP (7%), four sensory CIDP (1%), 27 sensory-predominant CIDP (7%), 10 motor CIDP (3%), and eight motor-predominant CIDP (2%). Patients with multifocal, distal, and sensory CIDP had milder impairment and symptoms. Patients with multifocal CIDP had less frequently reduced conduction velocity and prolonged F-wave latency and had lower levels of cerebrospinal fluid protein. Patients with distal CIDP more frequently had reduced distal compound muscle action potentials. Patients with motor CIDP did not improve after steroid therapy, whereas those with motor-predominant CIDP did. None of the patients with sensory CIDP responded to steroids, whereas most of those with sensory-predominant CIDP did. Conclusions: the 2021 EAN/PNS criteria for CIDP allow a better characterization of CIDP variants, permitting their distinction from typical CIDP and more appropriate treatment for patients

Laparoscopic reversal of Hartmann procedure: is it safe and feasible?

Abstract The Hartmann procedure (HP) consists of a sigmoidectomy followed by a terminal colostomy in the left iliac fossa and closure of the rectal stump. Although done as a temporary procedure, up to 74 % of patients will not have stoma reversal with subsequent negative impact on the quality of life. A literature search was performed using MEDLINE (PubMed), The Cochrane Library, and Google Scholar, and the articles from January 2000 until December 2015, edited in English, Italian and French, prospective or retrospective, were analyzed. Outcome variables included number of patients, mean age, sex, etiology of Hartmann's procedure, time interval between initial procedure and reversal procedure (in days), mean operative time (in minutes), number of patients converted to open surgery, causes of conversion, length of hospital stay, mortality, and complication rates. For the purpose of this review, only 21 studies were considered for the final analysis and a total of 681 patients were evaluated. The mean time interval between the initial procedure and the reversal (reported in 18 articles) was 181.6 days (range 95-330 days), while the mean operative time (reported in 20 articles) was 163.2 min (range 62-285). Overall, 80 patients (11.7 %) were converted to open technique. The length of hospitalization was between 3 and 12 days. The mortality rate was reported in 19 articles and was 0.7 % (5 patients). 113 patients (16.6 %) underwent post-operative complications. The HP reversal is a challenging procedure, but it can be safely performed laparoscopically providing various advantages when compared to the open technique and it should be proposed only to a selected group of patients, young and without a severe peritonitis at the first operation

Postoperative Complications

In this chapter we classify the complications of rectal surgery into early and late, according to the moment when they usually occur. For all the complications we have indicated the therapy, in some cases more than one, recently reported in literature. Late complications connected to lesions of the nerve plexus are treated in the dedicated chapter

Epidemiology

This chapter analyzes the epidemiology of rectal cancer, first of all on a global scale, then concentrating on the situation in the USA, with reference to the great number of publications available, and finally looking at the situation in Italy, which the authors are most familiar with

Efeito da substituição de NaCl nas propriedades físico-químicas e sensoriais de Copa curada tradicional

This study aimed to reduce sodium content in pork coppa without affecting consumer acceptance. NaCl reduction, partial replacement with KCl, and reduction in salting process time were evaluated. Six treatments were performed: Standard - 100% NaCl with a 2-day salting process and a 5-day re-salting process; T1 - a mixture of 70% NaCl/30% KCl; T2, T3, T4 - mixtures of 85% NaCl/15% KCl; T5 - 100% NaCl. T1 to T5 applied a 2-day salting process and a 2-day re-salting process. All treatments complied with Brazilian sodium guidelines. No statistically significant difference in consumer acceptance was observed. A reduction of 4 days in salting and re-salting processes maintained sensory characteristics and reduced sodium content by 50%. Even with reduced salt content, no changes in physicochemical parameters or effects on product preservation and microbiological quality were observed. NaCl reduction and replacement up to 30% KCl did not affect coppa characteristics or acceptance.Este estudo teve como objetivo reduzir o teor de sódio em Coppa suína sem afetar a aceitação do consumidor. Foram avaliadas a redução de NaCl, a substituição parcial por KCl e a redução do tempo de processo de salga. Foram realizados seis tratamentos: Padrão - 100% NaCl com processo de salga de 2 dias e processo de re-salga de 5 dias; T1 - mistura de 70% NaCl/30% KCl; T2, T3, T4 - misturas de 85% NaCl/15% KCl; T5 - 100% NaCl. T1 a T5 aplicou-se um processo de salga de 2 dias e um processo de re-salga de 2 dias. Todos os tratamentos cumpriram as diretrizes brasileiras de níveis de sódio. Não houve diferença estatisticamente significativa na aceitação do consumidor. Uma redução de 4 dias nos processos de salga e re-salga manteve as características sensoriais e reduziu o teor de sódio em 50%. Mesmo com teor reduzido de sal, não foram observadas alterações nos parâmetros físico-químicos ou efeitos na preservação do produto e na qualidade microbiológica. A redução e substituição de NaCl até 30% KCl não afetaram as características ou aceitação do Coppa

Intragastric Balloon Device: Weight Loss and Satisfaction Degree

An intragastric balloon is a non-surgical device enhancing a sensation of early satiety and reducing food intake. The aim of this study is to analyze the results in terms of weight loss and patient satisfaction undergoing intragastric balloon implantation

Unclassified clinical presentations of chronic inflammatory demyelinating polyradiculoneuropathy

Background: To assess the ability of the 2021 European Academy of Neurology/Peripheral Nerve Society (EAN/PNS) clinical criteria for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) to include within their classification the whole spectrum of clinical heterogeneity of the disease and to define the clinical characteristics of the unclassifiable clinical forms. Methods: The 2021 EAN/PNS clinical criteria for CIDP were applied to 329 patients fulfilling the electrodiagnostic (and in some cases also the supportive) criteria for the diagnosis of CIDP. Clinical characteristics were reviewed for each patient not strictly fulfilling the clinical criteria ('unclassifiable'). Results: At study inclusion, 124 (37.5%) patients had an unclassifiable clinical presentation, including 110 (89%) with a typical CIDP-like clinical phenotype in whom some segments of the four limbs were unaffected by weakness ('incomplete typical CIDP'), 10 (8%) with a mild distal, symmetric, sensory or sensorimotor polyneuropathy confined to the lower limbs with cranial nerve involvement ('cranial nerve predominant CIDP') and 4 (1%) with a symmetric sensorimotor polyneuropathy limited to the proximal and distal areas of the lower limbs ('paraparetic CIDP'). Eighty-one (65%) patients maintained an unclassifiable presentation during the entire disease follow-up while 13 patients progressed to typical CIDP. Patients with the unclassifiable clinical forms compared with patients with typical CIDP had a milder form of CIDP, while there was no difference in the distribution patterns of demyelination. Conclusions: A proportion of patients with CIDP do not strictly fulfil the 2021 EAN/PNS clinical criteria for diagnosis. These unclassifiable clinical phenotypes may pose diagnostic challenges and thus deserve more attention in clinical practice and research