Clear cell myoepithelial carcinoma ex pleomorphic adenoma of parotid gland: Case report and review of literature

Abstract Myoepithelial carcinoma (MC), also known as malignant myoepithelioma, shows an infiltrative and destructive growth [1]. Myoepithelial neoplasms account for about 1.5% of all salivary tumors, and MC is even more rare, representing about 10% of myoepitheliomas [1–3] with a reported incidence of 0.2% of all salivary gland tumors. In this case, the cytological diagnosis (pleomorphic adenoma) and negative lymph nodes, addressed the surgeon for a parotidectomy, following guidelines and literature [27]. The best treatment for huge, relapsing tumors, notwithstanding cytological diagnosis, is not only parotidectomy, as lymphadenectomy should be performed too, given myoepithelial carcinoma's high-grade potential and unpredictable biologic behavior. Careful patient follow-up and staging, is therefore essential for better characterization and understanding of this tumor's behavior in the future. We also considered a more conservative treatment following guidelines, as this case was lacking metastases and lymphatic involvement, considering that application of guidelines, surgical and clinical expertise and appropriate technology can contain potential medicolegal implications [28]

Sinonasal mucosal melanoma extended to nose bridge: A one-time reconstruction treatment report

Sinonasal mucosal melanoma is a rare and highly aggressive tumour. This tumour often carries a poor prognosis because of local invasion and early distant metastasis. It's, in fact, an aggressive, fortunately rare, disease. It's more common among population in their seventies, with a prolonged course due to innocuous symptoms. We report a case of sinonasal mucosal melanoma in a 56-years old male who presented with a brownish sinonasal mass involving right nasal fossa, swelling and spontaneous epistaxis. We report this case for the one-time reconstruction treatment performed by our team

Animal Forest Mortality: Following the Consequences of a Gorgonian Coral Loss on a Mediterranean Coralligenous Assemblage

In this work, the consequences of a local gorgonian coral mortality on the whole coralligenous assemblage were studied. A Before/After-Control/Impact sampling design was used: the structure of the coralligenous assemblage was compared before and after the gorgonian mortality event at the mortality site and two control sites. At the mortality site, a relevant decrease in alpha and beta diversity occurred, with a shift from a stratified assemblage characterized by gorgonians and other invertebrates to an assemblage dominated by algal turfs; conversely, neither significant variations of the structure nor decrease in biodiversity were observed at the control sites. The assemblage shift involved the main taxa in different times: in autumn 2018, a large proportion of the plexaurid coral Paramuricea clavata died, but no significant changes were observed in the structure of the remaining assemblage. Then, in autumn 2019, algal turfs increased significantly and, one year later, the abundance of the gorgonian Eunicella cavolini and bryozoans collapsed. Although the mechanisms of the assemblage shift following gorgonian loss will remain uncertain and a cause-effect relationship cannot be derived, results suggest the need for detecting signs of gorgonian forests stress in monitoring programs, which should be considered early indicators of their condition. in the coralligenous monitoring programs for detecting any sign of gorgonian forests stress which should be considered an early indicator of the assemblage condition

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

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Mechanical hepaticojejunostomy: can we use a circular stapler as a viable and safe alternative? —a retrospective study of a single center

Background: Since the first years of the 1980s, some authors described the use of mechanical stapler for the creation of anastomosis in biliary surgery. However, the use of these devices has not spread during the following decades, and nowadays most centers usually craft hand-sewn anastomosis. Methods: We retrospectively collected data from medical records, surgical registries and computerized databases about the use of mechanical circular staplers for the creation of hepaticojejunostomy at our institution. Results: From 2012 to 2020, 11 stapled hepaticojejunostomy for both neoplastic and non-neoplastic diseases were performed at our institution. The mean age of the patient was 74, with a sex distribution of 5 men and 6 women. The mean preoperative common bile duct diameter was 19 mm. Preoperative blood samples showed mean total bilirubin of 6.95 mg/dL. No intraoperative complications were reported. Two patients (18%) had minor postoperative complications (1 wound dehiscence and 1 episode of melena that required blood transfusions), while no major complications occurred. No patients developed biliary fistula or anastomotic dehiscence. No one dies within 30 days from surgery. The mean postoperative length of stay was 13 days. Conclusions: According to our limited experience, stapled hepaticojejunostomy seems to be a safe and effective technique in selected patients

Acute cholecystitis as a presentation of metastatic breast carcinoma of the gallbladder: A case report

THE AUTHORS PRESENT A CASE OF ACUTE CHOLECYSTITIS AS A PRESENTATION OF METASTATIC BREAST CARCINOMA OF THE GALLBLADDE

The constraint of ignoring the subtidal water climatology in evaluating the changes of coralligenous reefs due to heating events

Abstract Predicting community-level responses to seawater warming is a pressing goal of global change ecologists. How far such predictions can be derived from a fine gradient of thermal environments needs to be explored, even if ignoring water climatology does not allow estimating subtidal marine heat waves. In this study insights about the influence of the thermal environment on the coralligenous community structure were gained by considering sites (Sardinia, Italy) at different temperature conditions. Heating events were measured (by loggers at 18 m, 23 m, 28 m, 33 m and 38 m deep) and proxies for their duration (the maximum duration of events warmer than the 90th percentile temperature), intensity (the median temperature) and variability (the number of daily ΔT larger than the mean daily ΔT, and the number of heating events larger in ΔT than the 90th percentile ΔT) were selected by GAM models. Reliable predictions of decrease in coralligenous richness of taxa/morphological groups, with relevant increment in turfs and encrusting coralline algae abundance at the expenses of bryozoans were made. Associations to the different types of heating descriptor have highlighted the aspect (intensity, duration or variability) of the heating events and the threshold for each of them responsible for the trajectories of change