Early surgical management of acute cholecystitis in ultra-octogenarian patients: Our 5-year experience

BACKGROUND: Acute calculous cholecystitis is a leading cause for hospital admission especially in developed countries. As older age population increases, medical research should consider the efficacy of all therapeutic options, including early surgical procedure in an emergency context, for the treatment of acute cholecystitis in elderly high-risk patients. METHODS: From 01/01/2012 to 31/12/2016, 245 patients were admitted to our Institution with diagnosis of acute cholecystitis and managed with cholecystectomy within the same hospitalization. The study population was divided into 2 subgroups: group A (patients aged more than 80 years) and group B (patients within the limit of 80 years of age); the objective of the study was to evaluate and compare the surgical outcomes of the 2 groups in terms of conversion rate, mortality rate, overall morbidity and procedure-related complication rates. RESULTS: Statistical analysis did not show significant differences between ultra octogenarian and younger patients in terms of conversion to open procedure, iatrogenic bile duct lesions, postoperative peritoneal bleeding, bile leakage and peritoneal collection; no differences in terms of hospital stay have been demonstrated. Mortality and overall morbidity rates, even if similar to what observed in Literature and within acceptable values, were significantly higher in elderly patients, due to the presence of severe comorbidities leading to potentially fatal postoperative events. CONCLUSIONS: Minimally invasive approach in an emergency setting for acute cholecystitis seems to be a feasible and adequate therapeutic approach for extremely aged high-risk patients

Emergency surgery for bowel obstruction in extremely aged patients

BACKGROUND: As a result of the increasing of life expectancy, the incidence of pathologies that can lead to operation for bowel obstruction is also increasing. Comorbidities and reduced physiological reserve can decrease elderly patients' ability to tolerate operations especially in an emergency context. We retrospectively evaluated the treatment and outcomes of a cohort of patients aged more than 85 years who underwent emergency surgery for intestinal occlusion. METHODS: Two hundred seventy-eight patients who were admitted to our Institution and operated for acute bowel obstruction have been included in our study. We divided the study population in 2 groups (group A: patients aged>85 years old; group B patients aged 6485 years). We evaluated the differences between the two groups in terms of intestinal occlusion aetiology, surgical procedures, morbidity and mortality rates. RESULTS: Group A consisted of 57 patients, group B of 221; elderly patients trend in ASA score classification was significantly towards high risk for elderly group; statistical analysis did not show differences in terms of bowel obstruction etiology (except colon volvulus, more frequent in advanced age), type of procedure, duration of hospital stay, procedure-related complication rate. Perioperative mortality was significantly higher in elderly group, due to the mayor incidence of cardiovascular and respiratory fatal events directly related to pre-existing comorbidities. CONCLUSIONS: Despite the high surgical risk, early diagnosis and treatment of the obstructive disease can lead to achieve encouraging outcomes also in extremely advanced age; an aggressive evaluation of comorbidities and the cardiorespiratory risks reduction, when possible, could be useful in improve postoperative outcomes in terms of mortality

Xylan extraction from pretreated sugarcane bagasse using alkaline and enzymatic approaches

[Background] New biorefinery concepts are necessary to drive industrial use of lignocellulose biomass components. Xylan recovery before enzymatic hydrolysis of the glucan component is a way to add value to the hemicellulose fraction, which can be used in papermaking, pharmaceutical, and food industries. Hemicellulose removal can also facilitate subsequent cellulolytic glucan hydrolysis.[Results] Sugarcane bagasse was pretreated with an alkaline-sulfite chemithermomechanical process to facilitate subsequent extraction of xylan by enzymatic or alkaline procedures. Alkaline extraction methods yielded 53% (w/w) xylan recovery. The enzymatic approach provided a limited yield of 22% (w/w) but produced the xylan with the lowest contamination with lignin and glucan components. All extracted xylans presented arabinosyl side groups and absence of acetylation. 2D-NMR data suggested the presence of O-methyl-glucuronic acid and p-coumarates only in enzymatically extracted xylan. Xylans isolated using the enzymatic approach resulted in products with molecular weights (Mw) lower than 6 kDa. Higher Mw values were detected in the alkali-isolated xylans. Alkaline extraction of xylan provided a glucan-enriched solid readily hydrolysable with low cellulase loads, generating hydrolysates with a high glucose/xylose ratio.[Conclusions] Hemicellulose removal before enzymatic hydrolysis of the cellulosic fraction proved to be an efficient manner to add value to sugarcane bagasse biorefining. Xylans with varied yield, purity, and structure can be obtained according to the extraction method. Enzymatic extraction procedures produce high-purity xylans at low yield, whereas alkaline extraction methods provided higher xylan yields with more lignin and glucan contamination. When xylan extraction is performed with alkaline methods, the residual glucan-enriched solid seems suitable for glucose production employing low cellulase loadings.This work was supported by FAPESP (Contract Numbers 08/56256-5 and 14/06923-6), CNPq, and CAPES. Daniela Sporck and Felipe Reinose thank CAPES for their student fellowships.Peer reviewe

Anthropometric measures, medical history and risk of basal cell carcinoma in an Italian case-control study

Background/Aims: A few epidemiological studies investigated etiological factors for basal cell carcinoma (BCC) other than sunlight exposure and sunburns. Information on anthropometric measures and medical history is scant. Methods: We examined the issue in a case-control study including 528 patients with incident, histologically confirmed BCC and 512 controls hospitalized with acute conditions. Results: Odds ratios (OR) for the highest versus the lowest quartiles were 0.77 for weight, 0.99 for height, 0.87 for body mass index and 0.81 for body surface area. Corresponding estimates for trunk BCC were 0.42, 0.81, 0.50 and 0.47. Subjects with asthma (OR = 0.26) and diabetes mellitus (OR = 0.23) showed a decreased risk of trunk BCC but not face and neck BCC. Conclusion: The inverse relations between trunk, but not face and neck BCC, and obesity, diabetes mellitus and asthma may indirectly reflect the different role of past sunlight exposure to different body locations and variable etiologic pathways for BCCs according to body areas