Acute diverticulitis management: evolving trends among Italian surgeons. A survey of the Italian Society of Colorectal Surgery (SICCR)

Acute diverticulitis (AD) is associated with relevant morbidity/mortality and is increasing worldwide, thus becoming a major issue for national health systems. AD may be challenging, as clinical relevance varies widely, ranging from asymptomatic picture to life-threatening conditions, with continuously evolving diagnostic tools, classifications, and management. A 33-item-questionnaire was administered to residents and surgeons to analyze the actual clinical practice and to verify the real spread of recent recommendations, also by stratifying surgeons by experience. CT-scan remains the mainstay of AD assessment, including cases presenting with recurrent mild episodes or women of child-bearing age. Outpatient management of mild AD is slowly gaining acceptance. A conservative management is preferred in non-severe cases with extradigestive air or small/non-radiologically drainable abscesses. In severe cases, a laparoscopic approach is preferred, with a non-negligible number of surgeons confident in performing emergency complex procedures. Surgeons are seemingly aware of several options during emergency surgery for AD, since the rate of Hartmann procedures does not exceed 50% in most environments and damage control surgery is spreading in life-threatening cases. Quality of life and history of complicated AD are the main indications for delayed colectomy, which is mostly performed avoiding the proximal vessel ligation, mobilizing the splenic flexure and performing a colorectal anastomosis. ICG is spreading to check anastomotic stumps’ vascularization. Differences between the two experience groups were found about the type of investigation to exclude colon cancer (considering the experience only in terms of number of colectomies performed), the size of the peritoneal abscess to be drained, practice of damage control surgery and the attitude towards colovesical fistula

Acute diverticulitis management: evolving trends among Italian surgeons. A survey of the Italian Society of Colorectal Surgery (SICCR)

Acute diverticulitis (AD) is associated with relevant morbidity/mortality and is increasing worldwide, thus becoming a major issue for national health systems. AD may be challenging, as clinical relevance varies widely, ranging from asymptomatic picture to life-threatening conditions, with continuously evolving diagnostic tools, classifications, and management. A 33-item-questionnaire was administered to residents and surgeons to analyze the actual clinical practice and to verify the real spread of recent recommendations, also by stratifying surgeons by experience. CT-scan remains the mainstay of AD assessment, including cases presenting with recurrent mild episodes or women of child-bearing age. Outpatient management of mild AD is slowly gaining acceptance. A conservative management is preferred in non-severe cases with extradigestive air or small/non-radiologically drainable abscesses. In severe cases, a laparoscopic approach is preferred, with a non-negligible number of surgeons confident in performing emergency complex procedures. Surgeons are seemingly aware of several options during emergency surgery for AD, since the rate of Hartmann procedures does not exceed 50% in most environments and damage control surgery is spreading in life-threatening cases. Quality of life and history of complicated AD are the main indications for delayed colectomy, which is mostly performed avoiding the proximal vessel ligation, mobilizing the splenic flexure and performing a colorectal anastomosis. ICG is spreading to check anastomotic stumps' vascularization. Differences between the two experience groups were found about the type of investigation to exclude colon cancer (considering the experience only in terms of number of colectomies performed), the size of the peritoneal abscess to be drained, practice of damage control surgery and the attitude towards colovesical fistula

Therapeutic system for the controlled release of active ingredients

A system designed to release one or more active substances in different, previously programmable modes, is described. The system is constituted by a tablet in three layers, two of which (the outer layers) vehicularise the active ingredient(s), whilst the third (the central layer) is constituted of a polymeric barrier which does not contain active substance and has the appropriate characteristics of erodibility or gelation. The tablet is completely coated with a film of polymeric material insoluble in water and/or in aqueous fluids, on which one or more incisions delimiting an area of exactly calculated geometric shape and size, have been made through the use of a laser beam of appropriate power and intensity. The removal of the film inside the incision(s) allows the release of the active ingredient(s) into aqueous fluid in predetermined amounts and umes. The procedure for the production of the aforementioned pharmaceutical form is also described

Pharmaceutical tablet suitable to deliver the active substance in subsequent and predeterminable times

Pharmaceutical tablet, capable of delivering the active substance or the active substances, according to a predeterminable release profile, comprising a core with an external partial coating in which said core consists of 3 layers, wherein the upper layer contains an amount of the active substance with suitable excipients, the intermediate layer consists of polymeric material with retarding barrier function and the lower layer contains the remaining amount of the active substance with suitable excipients and said external coating consists of controlled permeability polymeric materials, applied by compression to the lower surface and to the lateral surface of the core

Geomatrix technology. Delivery systems for the controlled release of drugs

Introduction 7 2. Drug delivery systems 11 2.1 Therapeutic advantages 2.2 Drug bioavailability 2.3 Conventional drug formats 2.4 Drug delivery systems 3. Oral drug delivery systems 17 3.1 Coated systems 3.2 Matrix systems 3.3 Hydrophilic, swellable, gellable or erodible polymers 3.4 Polymer dissolution rate 3.5 Molecule diffusion and transport in polymer systems 3.6 Drug release rate from a polymer matrix 3.7 Conventional hydrophilic, swellable, gellable matrices 3.8 In-vitro dissolution test and in-vitro/in-vivo correlation 4. GEOMATRIX technology 31 4.1 Drug release control mechanisms 4.2 Active core plus barriers 4.3 Study of the action mechanisms of barriers 4.4 Modulation of the drug release profile by the GEOMATRIX system 4.5 Swellable, gellable barriers 4.6 Erodible barriers 4.7 Manufacturing 4.8 Materials used 4.9 Development, scale-up, quality control, production and certification Versatility of the modular GEOMATRIX system 55 5.1 Examples of GEOMATRIX systems for extended release of drugs at a constant rate 5.2 Drug delivery systems for the controlled release of partially soluble drugs 5.3 Drug delivery systems for the delayed release of drugs 5.4 Drug delivery systems for the bi-phasic release of drugs 5.5 Drug delivery systems for the release of two or more drugs at different rates (binary release) 5.6 Drug delivery systems for the pulsed release of drugs 6 Conclusions 81 7 References 8

A system for the controlled release of active ingredients

A new release system is disclosed for releasing one or more active substances vehicularised in it, at a predetermined rate and duration. The system is constituted by a pharmaceutical tablet, coated with a film of polymeric material impermeable and insoluble in aqueous fluids on the coating film, one or more apertures of geometrically precise size and shape are made, through the use of a laser beam of appropriate power and intensity, in a way such that the active ingredient contained in the therapeutic system is released only from the non coated portion of the tablet surface at the desired rate and time. The technology for manufacturing such system is also describe