Acute inflammatory response in the subcutaneous versus periprosthethic space after incisional hernia repair: an original article

BACKGROUND: The acute inflammatory response following mesh implantation has been often evaluated in vitro and in animal models. The aim of this study was to evaluate the acute inflammatory response near the prosthesis in human by analysing some inflammatory indicators.METHODS: We used a cohort of twelve male patients affected by midline incisional hernia, who were admitted for surgical mesh repair. A suction drain was placed between the mesh and rectal muscles whereas, the other one was placed between the subcutaneous tissue and the oblique external sheath. The acute inflammatory response was analyzed by measuring the production of interleukin [IL]-1, IL-10, IL-1ra, C-Reactive Protein (CRP), total proteins, albumin and pH in the drain fluids.RESULTS: The dynamics of CRP and ILs production resulted similar in both drainages. Comparing drain over mesh and subcutaneous drain at all times, IL-1 and CRP values always resulted significantly higher in the first one, whereas IL-1ra and IL-10 values were significantly higher in the last one. Total protein and albumin were similar in both drains at all time; only in the drain over mesh fluid, pH values resulted significantly reduced in the fourth post-operative day.CONCLUSIONS: Our data showed that an acute inflammatory reaction is present in both sites examined. However, it was significantly higher in the space after mesh implantation

Advancement flap in the management of chronic anal fissure: A prospective study

Lateral internal sphincterotomy is the surgical treatment of choice of chronic anal fissure after failure of conservative measures. Several randomized trials identified an overall risk of incontinence of 10 % mostly for flatus. Fissurectomy is the most commonly used procedure to preserve the integrity of the anal sphincters. However, a possible complication is keyhole defect that may lead to faecal soiling. In this study, chronic anal fissure (CAF) was treated by fissurectomy and anal advancement flap to preserve the anatomo-functional integrity of sphincters and to reduce healing time and the risk of anal stenosis. In patients with hypertonia, surgical treatment was combined with chemical sphincterotomy by injection of botulinum toxin to enhance tissue perfusion. Forty eight patients with CAF underwent fissurectomy and anal advancement flap. In 22 subjects with hypertonia of the internal anal sphincter, intrasphincter injection of 30 UI of botulinum toxin at the completion of the surgical operation was used. All patients were followed up to 24 months. Since the first defecation, the intensity and duration of pain were significantly reduced. Two patients had urinary retention, five had infections and three had partial breakdowns. No anal stenosis, keyhole deformity or necrosis flap was recorded. At the 24 months follow-up visit, anal incontinence was similar to those detected preoperatively. Only four recurrences were detected at 18 and 20 months. After medical treatment failure, fissurectomy with advancement flap is a valid sphincter-conserving procedure for treatment of anterior or posterior CAF, regardless of hypertonia of the internal anal sphincter. © 2011 Springer-Verlag

Concomitant Small Cell Neuroendocrine Carcinoma of Gallbladder and Breast Cancer

The neuroendocrine carcinoma is defined as a high-grade malignant neuroendocrine neoplasm arising from enterochromaffin cells, usually disposed in the mucosa of gastric and respiratory tracts. The localization in the gallbladder is rare. Knowledge of these gallbladder tumors is limited and based on isolated case reports. We describe a case of an incidental finding of small cell neuroendocrine carcinoma of the gallbladder, observed after cholecystectomy for cholelithiasis, in a 55-year-old female, who already underwent quadrantectomy and sentinel lymph-node biopsy for breast cancer. The patient underwent radiotherapy for breast cancer and six cycles of chemotherapy with cisplatin and etoposide. Eighteen months after surgery, the patient was free from disease. Small cell neuroendocrine carcinoma of the gallbladder has poor prognosis. Because of the rarity of the reported cases, specific prognostic factors have not been identified. The coexistence of small cell neuroendocrine carcinoma of the gallbladder with another malignancy has been reported only once.The contemporary presence of the two neoplasms could reflect that bioactive agents secreted by carcinoid can promote phenotypic changes in susceptible cells and induce neoplastic transformation

Systemic inflammatory response in erderly patients following hernioplastical operation

The number of old and oldest old patients undergoing surgery of varying severity is increasing. Ageing is a process that changes the performances of most physiological systems and increases susceptibility to diseases and death; accordingly, host responses to surgical stress are altered with ageing and the occurrence of age-related increase in susceptibility to post-operative complications has been claimed. Twenty-four male patients undergoing Lichtenstein (LH) hernioplasty for unilateral inguinal hernia were included in this study and divided in two groups (Young and Old respectively), according to their age. As expression of the acute phase response, we measured changes in concentration of pro-inflammatory cytokines Tumor necrosis factor-α and Interleukin-1β, leukocytes, acute phase proteins C-reactive protein and α 1-antitrypsin. Elderly humans showed prolonged and strong inflammatory activity compared to younger subjects in response to surgical stress, indicating that the acute-phase response to surgical stress of elderly humans varies from that of the young, showing initial hyperactivity and a delayed termination of the response. Thus, the acute phase response to surgical stress is higher in old subjects, but the clinical significance of this remains unclear. It is not known whether a causal relationship exists between this stronger acute phase response and the increases in susceptibility to post-operative complications observed in aged patients

Variability of water mass properties in the Strait of Sicily in summer period of 1998–2013

The Strait of Sicily plays a crucial role in determining the water-mass exchanges and related properties between the western and eastern Mediterranean. Hydrographic measurements carried out from 1998 to 2013 allowed the identification of the main water masses present in the Strait of Sicily: a surface layer composed of Atlantic water (AW) flowing eastward, intermediate and deep layers mainly composed of Levantine intermediate water (LIW), and transitional eastern Mediterranean deep water (tEMDW) flowing in the opposite direction. Furthermore, for the first time, the signature of intermittent presence of western intermediate water (WIW) is also highlighted in the northwestern part of the study area (12.235◦ E, 37.705◦ N). The excellent area coverage allowed to highlight the high horizontal and vertical inter-annual variability affecting the study area and also to recognize the permanent character of the main mesoscale phenomena present in the surface water layer. Moreover, strong temperature-salinity correlations in the intermediate layer, for specific time intervals, seem to be linked to the reversal of surface circulation in the central Ionian Sea. The analysis of CTD data in deeper water layer indicates the presence of a large volume of tEMDW in the Strait of Sicily during the summers of 2006 and 2009.peer-reviewe

Relazione tecnica sulle attività della campagna oceanografica “Evatir 2011”

La campagna oceanografica “Evatir 2011”, condotta a bordo della N/O “G. Dallaporta”, è stata la seconda campagna di valutazione acustica della biomassa pelagica nelle acque del Tirreno condotta grazie alla collaborazione tra i ricercatori dell’IAMC-CNR e del VNIRO di Mosca. Le ricerche condotte in tale periodo sono state finalizzate principalmente alla valutazione della biomassa e della distribuzione spaziale delle popolazioni di piccoli pelagici. Le specie target sono le principali specie commerciali di piccoli pelagici in Mediterraneo, ovvero l’acciuga (Engraulis encrasicolus) e la sardina (Sardina pilchardus). Si tratta di specie a ciclo di vita breve caratterizzate da ampie oscillazioni interannuali nella biomassa. Negli anni in cui i livelli di biomassa sono particolarmente bassi l’effetto di un elevato sforzo di pesca porterebbe ad un collasso di tali risorse anche da un anno all’altro. Il collasso di tali specie è stato ben documentato in letteratura mostrando che i tempi di recupero sono molto lunghi e hanno effetti socio-economici catastrofici anche sulle comunità marinare che vivono grazie agli introiti derivanti dalla pesca e commercializzazione di prodotti in scatola. Sono stati nel contempo acquisiti dati CTD al fine di studiare possibili influenze delle variabili ambientali sulla distribuzione spaziale delle specie oggetto di studio

Stretto di Sicilia: Rapporto tecnico sui campionamenti acustici e biologici – Echo-survey “Ancheva 2011”

La campagna oceanografica Ancheva 2011, condotta dal Gruppo di Acustica Applicata alla valutazione delle Risorse dell’IAMC-CNR (U.O.S. di Capo Granitola - Campobello di Mazara) ha avuto come principale obiettivo la valutazione della distribuzione ed abbondanza di piccoli pelagici (prevalentemente sardine e acciughe) nell’area dello Stretto di Sicilia e della Piattaforma Maltese con l’impiego di strumentazione elettroacustica. L’attività di ricerca, svolta nel periodo 20 Giugno – 12 Luglio 2011 a bordo della N/O “Dallaporta”, è parte integrante del progetto MEDIterranean Acoustic Surveys (MEDIAS), finanziato all’interno dell’European Data Collection Regulation. In particolare, la campagna ha permesso di effettuare un Echosurvey nello Stretto di Sicilia (GSA 16 – FAO sub area 37.2.2) il cui scopo principale è quello di eseguire un’investigazione interdisciplinare per stimare abbondanza e distribuzione di organismi pelagici sulla piattaforma meridionale della Sicilia, da Marsala a oltre Capo Passero. Grazie al supporto del programma MEDIAS ed alla collaborazione tra i ricercatori dell’IAMC-CNR ed il Malta Centre for Fisheries Sciences (MCFS), un survey acustico è stato svolto anche nelle acque Maltesi

Piattaforma per l’inserimento dei parametri di campionamento del Bongo e della Calvet sul Sistema Informativo di Capo Granitola

L’Istituto IAMC di Capo Granitola da più di quindici anni effettua delle campagne scientifiche a bordo di navi oceanografiche (Urania, G. Dallaporta e Minerva Uno). Nel corso dei campionamenti ittioplanctonici e zooplanctonici è previsto l’utilizzo di strumenti campionatori come retini Bongo 40, Bongo 60, Bongo 90 e Calvet. Ciò che differenzia i tre diversi strumenti “Bongo” è il diametro dei cilindri. L’obiettivo del campionamento è acquisire informazioni utili per la valutazione della distribuzione e abbondanza dei primi stadi di sviluppo delle popolazioni di piccoli pelagici e del plancton, nonché la valutazione mediante il Daily Egg Production Methods (DEPM) della biomassa dei riproduttori delle popolazioni pelagiche. Successivamente, sarà possibile correlare le stesse con dati oceanografici per la determinazione di possibili influenze derivate dalla struttura chimico- fisiche a mesoscala