Single incision laparoscopic anterior resection for cancer using a 'QuadiPort Access System®'

BACKGROUND: Single incision laparoscopic surgery (SILS) is developing rapidly and different devices are already available. However there is limited data in the literature about single port laparoscopic colorectal surgery. AIMS: We report the first case of a single incision laparoscopic anterior resection for cancer using the device 'QuadiPort Access System?'. METHODS: A 66 year old female affected by adenocarcinoma of the rectosigmoid junction underwent a radical single incision laparoscopic anterior resection performed by an experienced laparoscopic team. RESULTS: The preoperative staging was T2N0M0. The total operative time was 135 min. Length of hospital stay was 6 days. The length of the specimen was 27 cm and 21 nodes were isolated. The pathological examination showed adenocarcinoma staged T3N2MX; G2. There was no postoperative morbidity and at the 6 month follow-up, the patient presented in well condition with no complications and free from cancer. CONCLUSION: Single incision laparoscopic anterior resection for locally advanced high rectal cancer seems to be feasible and the 'QuadiPort Access System?' seems to be a valid device. To evaluate outcomes and costeffectiveness of SILS versus the standard laparoscopic colorectal surgery multicenter prospective randomised trials are necessary and the 'QuadiPort Access System?' could prove to be the device of choice

Laparascopic colon resection for cancer: Evidence based results

About 90-92% of patients with carcinoma of the colon are treated surgically. For other surgeons, laparoscopic surgery for the treatment of malignancies remains controversial because of concerns about the adequacy of lymphadenectomy, the extent of resection, early findings of port-site metastasis and the lack of data on long-term results. In our experience, there are no differences between the laparoscopic and laparotomic techniques, and only advantages if the laparoscopic technique is use correctly. We essentially agree with the good results of many studies published in the last ten years, but we are extremely confident that it is necessary to have a good learning curve and a high-volume cases hospital to obtain good results through a laparoscopic approach. So laparoscopic colorectal surgery should be performed only by surgeons who have completed training in this approach and who perform the procedure often enough to maintain a good level of competence

Interpersonal sensitivity in the at-risk mental state for psychosis

Background Interpersonal sensitivity is a personality trait described as excessive awareness of both the behaviour and feelings of others. Although interpersonal sensitivity has been found to be one of the vulnerability factors to depression, there has been little interest in its relationship with the prodromal phase of psychosis. The aims of this study were to examine the level of interpersonal sensitivity in a sample of individuals with an at-risk mental state (ARMS) for psychosis and its relationship with other psychopathological features. Method Method. Sixty-two individuals with an ARMS for psychosis and 39 control participants completed a series of self-report questionnaires, including the Interpersonal Sensitivity Measure (IPSM), the Prodromal Questionnaire (PQ), the Ways of Coping Questionnaire (WCQ) and the Depression and Anxiety Stress Scale (DASS). Results Individuals with an ARMS reported higher interpersonal sensitivity compared to controls. Associations between interpersonal sensitivity, positive psychotic symptoms (i.e. paranoid ideation), avoidant coping and symptoms of depression, anxiety and stress were also found. Conclusions This study suggests that being 'hypersensitive' to interpersonal interactions is a psychological feature of the putatively prodromal phase of psychosis. The relationship between interpersonal sensitivity, attenuated positive psychotic symptoms, avoidant coping and negative emotional states may contribute to long-term deficits in social functioning. We illustrate the importance, when assessing a young client with a possible ARMS, of examining more subtle and subjective symptoms in addition to attenuated positive symptoms. © 2012 Cambridge University Press

I Say “no”. You Say “it Isn't”. About a New Understanding of the Concept of Negation

Introduction: In our opinion there is still confusion about the exact meaning of the term negation. As a consequence of this the importance of negation in the psychotherapeutic work is until now underestimated. Objectives For psychiatrists who work according to Fagioli's human birth theory the concept of negation is fundamental. Negation is a notion that refers to unconscious reality. Aims: The task of the psychiatrist is to identify and to interpret the negation in the deformed dream images during the psychotherapeutic process. Methods: In contrast to an intentional lie, which is communicated through verbal speech, negation corresponds to unconscious thoughts, which we can find in dreams. During sleep a transformation occurs, language is altered and expressed through images. Negation deforms the image. This deformation of the image happens in an unconscious process. This negation distorts the reality of the patient and his ability to interact with the other. Corresponding the relationship will be aggressive/destructive. The only way to identify this deformation is dream interpretation. Results: Through this therapeutic process the patient will be able to intuit and realize instead of negate the positive qualities of the other and integrate these into his reality. Only human interaction that is free from negation enable the patient to overcome the ideo-affective splitting, which allows recovery of positive affects and the possibility of developing evolutive relationships. Conclusions: Only a clarification of the term negation allows a psychotherapeutic process with the aim of developing evolutive relationships

Morbidity related to defunctioning ileostomy closure after ileal pouch-anal anastomosis and low colonic anastomosis

Purpose Defunctioning ileostomies are widely performed in order to prevent or treat anastomotic leakage after colorectal surgery. The aim of the present study was to determine morbidity related to stoma closure and to identify predictive factors of a complicated postoperative course. Methods A consecutive series of 138 patients were retrospectively analyzed after stoma reversal. Data collection included general demographics and surgery-related aspects. Morbidity related to stoma closure was retrieved from our prospectively collected registry of complications. Results In 74 of 138 patients, defunctioning ileostomy was performed after restorative proctocolectomy and ileal pouchanal anastomosis (IPAA). The remaining ileostomies (n=64) were constructed after a low colorectal or coloanal anastomosis. A total of 46 complications were recorded in 28 patients resulting in an overall complication rate of 20.3%. Anastomotic leakage rate was 4.3%, and reoperation rate was 8.0%. The number of complications according to the Clavien-Dindo classification was 5 for grade I (10.9%), 26 for grade II (56.5%), 13 for grade III (28.3%), 1 for grade IV (2.2%), and 1 for grade V (2.2%). Multivariate analysis revealed a significantly higher ASA score in the complicated group (P=0.015, odds ratio 2.6, 95% confidence interval 1.2-5.6). Conclusions Closure of a defunctioning ileostomy is associated with 20% morbidity and a reoperation rate of 8%. There is an urgent need for criteria on which a more selective use of a defunctioning ileostomy after low colonic anastomosis or IPAA can be based given its associated morbidit

Low temperature method for the production of calcium phosphate fillers

BACKGROUND: Calcium phosphate manufactured samples, prepared with hydroxyapatite, are used as either spacers or fillers in orthopedic surgery, but these implants have never been used under conditions of mechanical stress. Similar conditions also apply with cements. Many authors have postulated that cements are a useful substitute material when implanted in vivo. The aim of this research is to develop a low cristalline material similar to bone in porosity and cristallinity. METHODS: Commercial hydroxyapatite (HAp) and monetite (M) powders are mixed with water and compacted to produce cylindrical samples. The material is processed at a temperature of 37–120 degrees C in saturated steam to obtain samples that are osteoconductive. The samples are studied by X-ray powder diffraction (XRD), Vickers hardness test (HV), scanning electron microscopy (SEM), and porosity evaluation. RESULTS: The X-ray diffractions of powders from the samples show patterns typical of HAp and M powders. After thermal treatment, no new crystal phase is formed and no increase of the relative intensity of the peaks is obtained. Vicker hardness data do not show any relationship with treatment temperature. The total porosity decreases by 50–60% according to the specific thermal treatment. Scanning electron microscopy of the surfaces of the samples with either HAp 80%-M 20% (c) or Hap 50%-M 50% (f), show cohesion of the powder grains. CONCLUSIONS: The dissolution-reprecipitation process is more intesive in manufactured samples (c) and (f), according to Vickers hardness data. The process occurs in a steam saturated environment between 37 degrees and 120 degrees C. (c) (f) manufactured samples show pore dimension distributions useful to cellular repopulation in living tissues

Study on psychoeducation enhancing results of adherence in patients with schizophrenia (SPERA-S): study protocol for a randomized controlled trial.

BACKGROUND: Poor adherence to pharmacotherapy negatively affects the course and the outcome of schizophreniaspectrum psychoses, enhancing the risk of relapse. Falloon and coworkers developed a Psychoeducation Program aimed at improving communication and problem-solving abilities in patients and their families. This study set out to evaluate changes in adherence to pharmacotherapy in patients diagnosed with schizophrenia-spectrum psychoses, by comparing one group exposed to the Falloon Psychoeducation Program (FPP) with another group exposed to family supportive therapy with generic information on the disorders. METHODS: 340 patients diagnosed with schizophrenia and related disorders according to standardized criteria from 10 participating units distributed throughout the Italian National Health System (NHS), will be enrolled with 1:1 allocation by the method of blocks of randomized permutations. Patients will be reassessed at 6, 12 and 18 months after start of treatment (duration: 6 months).The primary objective is to evaluate changes in adherence to pharmacotherapy after psychoeducation. Adherence will be assessed at three-month intervals by measuring blood levels of the primary prescribed drug using high pressure liquid chromatography, and via the Medication Adherence Questionnaire and a modified version of the Adherence Interview. Secondary objectives are changes in the frequency of relapse and readmission, as the main indicator of the course of the disorder.Enrolled patients will be allocated to the FPP (yes/no) randomly, 1:1, in a procedure controlled by the coordinating unit; codes will be masked until the conclusion of the protocol (or the occurrence of a severe negative event). The raters will be blind to treatment allocation and will be tested for blinding after treatment completion. Intention-to-treat will be applied in considering the primary and secondary outcomes. Multiple imputations will be applied to integrate the missing data. The study started recruitment in February 2013; the total duration of the study is 27 months. DISCUSSION: If the psychoeducation program proves effective in improving adherence to pharmacotherapy and in reducing relapse and readmissions, its application could be proposed as a standard adjunctive psychosocial treatment within the Italian NHS