Current Management of Pancreatic Neuroendocrine Tumors: From Demolitive Surgery to Observation

Incidental diagnosis of pancreatic neuroendocrine tumors (PanNETs) greatly increased in the last years. In particular, more frequent diagnosis of small PanNETs leads to many challenging clinical decisions. These tumors are mostly indolent, although a percentage (up to 39%) may reveal an aggressive behaviour despite the small size. Therefore, there is still no unanimity about the best management of tumor smaller than 2 cm. The risks of under/overtreatment should be carefully evaluated with the patient and balanced with the potential morbidities related to surgery. The importance of the Ki-67 index as a prognostic factor is still debated as well. Whenever technically feasible, parenchyma-sparing surgeries lead to the best chance of organ preservation. Lymphadenectomy seems to be another important prognostic issue and, according to recent findings, should be performed in noninsulinoma patients. In the case of enucleation of the lesion, a lymph nodal sampling should always be considered. The relatively recent introduction of minimally invasive techniques (robotic) is a valuable option to deal with these tumors. The current management of PanNETs is analysed throughout the many available published guidelines and evidences with the aim of helping clinicians in the difficult decision-making process

The S0_0(0) structure in highly compressed hydrogen and the orientational transition

A calculation of the rotational S$_0$(0) frequencies in high pressure solid para-hydrogen is performed. Convergence of the perturbative series at high density is demonstrated by the calculation of second and third order terms. The results of the theory are compared with the available experimental data to derive the density behaviour of structural parameters. In particular, a strong increase of the value of the lattice constant ratio $c/a$ and of the internuclear distance is determined. Also a decrease of the anisotropic intermolecular potential is observed which is attributed to charge transfer effects. The structural parameters determined at the phase transition may be used to calculate quantum properties of the rotationally ordered phase.Comment: accepted Europhysics Letter

Chronic hidradenitis suppurativa the inguinal, perineal and scrital regions. A case report and review of the literature.

Hidradenitis suppurativa is a chronic, recurrent, debilitating disease that presents with inflamed lesions in the apocrine glands of the body. The most common locations are the axillary, inguinal and anogenital areas. Hidradenitis suppurativa is caused primarily by follicular occlusion with secondary involvement of the apocrine glands. The authors report a case of 47-old-man with an 18-year history of multiple sclerosis complicated by spastic paraparesis, who presented with hidradenitis suppurativa in the inguinal, perineal, and scrotal areas which was treated by wide surgical excision. A review of the most recent literature is include

Ultrasound-Guided Robotic Enucleation of Pancreatic Neuroendocrine Tumors

Background. Pancreatic neuroendocrine tumors (PanNETs) are relatively rare neoplasms with a low to mild malignant potential. They can be further divided into functioning and nonfunctioning, according to their secretive activity. Surgery is an optimal approach, but the classic open approach is challenging, with some patients having long hospitalization and potentially life-threatening complications. The robotic approach for PanNETs may represent an option to optimize their management. Methods. We retrospectively reviewed our prospectively maintained databases from 2 high-volume Italian centers for pancreatic surgery. Demographics, pathological characteristics, perioperative outcome, and medium-term follow-up of patients who underwent robotic pancreatic enucleations were collected. Results. Twelve patients with final diagnosis of PanNET were included. The mean age of the patients was 53.8 years (25-77). The median body mass index was 26 (24-29). Three lesions were functioning insulinomas, while the others were nonfunctioning tumors. No deaths occurred. Mild postoperative complications occurred, except for 1 grade B pancreatic fistula. The mean postoperative stay was 3.9 days (2-5). Conclusions. Our results confirm that robotic enucleation is a feasible and safe approach for the treatment of PanNETs, with short hospital stay and low incidence of morbidity

Multiple hepatocellular carcinoma: Long-term outcomes following resection beyond actual guidelines. An Italian multicentric retrospective study

none10noHepatocellular carcinoma (HCC) is frequently diagnosed as multinodular. This study aims to assess prognostic factors for survival and identify patients with multiple HCC who may benefit from surgery beyond the Barcelona Clinic Liver Cancer classification indications.mixedBartolini, Ilenia; Nelli, Tommaso; Russolillo, Nadia; Cucchetti, Alessandro; Pesi, Benedetta; Moraldi, Luca; Ferrero, Alessandro; Ercolani, Giorgio; Grazi, Gian Luca; Batignani, GiacomoBartolini, Ilenia; Nelli, Tommaso; Russolillo, Nadia; Cucchetti, Alessandro; Pesi, Benedetta; Moraldi, Luca; Ferrero, Alessandro; Ercolani, Giorgio; Grazi, Gian Luca; Batignani, Giacom