Obstructing left sided colorectal cancer. A retrospective single center study.

Background: In recent years, with population aging, there has been an increased number of colorectal cancer cases in elderly patients with severe occlusion symptoms. About 75% of obstructions due to malignant colorectal cancer (10-30%) occur distal to splenic flexure. Methods: The authors evaluated the best surgical therapeutic strategy to be used in cases of left-sided colorectal carcinoma in patients over 65 years old, especially considering the emergency condition, age of patients and efficacy in terms of postoperative morbidity, mortality and 5 years survival rate. Results: The management of left-sided obstructing colorectal carcinoma is controversial. Hartmann’s procedure is the best therapeutic choice in elderly patients. However, resection with intraoperative colonic wash-out and primary anastomosis has favorable outcome in low risk patients. Conclusions: A review of the literature reveals that primary resection and anastomosis for left-sided obstructing CRC is the correct therapeutic strategy in low risk patients with localized, resectable carcinoma, without peritonitis; Hartmann’s procedure should be adopted in doubtful cases and in high risk patients

Collaborative Interlaboratory Studies for the Validation of ELISA Methods for the Detection of Allergenic Fining Agents Used in Wine According to the Criteria of OIV Resolution 427–2010 Modified by OIV–Comex 502–2012

The clarification or fining of wine removes undesired substances (mainly proteins, phenols, and tannins), which would roil the wine and cause bitterness and astringency. A common fining agent, egg white, can be directly added to wine through the inlet of a circulating pump, but more typically egg white comes as commercial preparation in powdered form (commercially named egg albumin). Skimmed milk or more frequently purified caseinates are used to remove bitterness and hardness of white wine and sherry. Both egg white and caseinates are fining agents with optimal enological properties, but their residues could represent a risk for subjects suffering from food allergy. The rules for allergen labeling were detailed in Directives 2003/89/EC, and Directive 2005/26/EC established a list of food ingredients provisionally excluded from labeling, that included wine fining agents. Extended till June 2012, wine labeling exemption can be now maintained only if (1) egg and milk derivatives are not used and cross-contamination is under control; and (2) wine clarified with such products is negative for the presence of residues using techniques with detection and quantification limits of 0.25 and 0.5 ppm, respectively. Analytical requirements were defined in the OIV resolution 427–2010 (OIV 2010) modified by OIV/COMEX 502–2012 (OIV 2012). On the basis of a previous experience, an interlaboratory collaborative trial was organized to validate a commercial ELISA kit designed to measure allergenic residues in red wine fined with egg white proteins. In the meantime, the performance of the commercial caseinate ELISA kit for white wine was rechecked according to the new limit of detection and limit of quantification values, recommended by OIV in 2012. The collaborative interlaboratory studies showed that both ELISA kits had good reproducibility, repeatability, and robustness in detecting residues of allergenic fining agents in wine, in good agreement with the requirements of the OIV resolution 427–2010 modified by OIV/COMEX 502–2012

The incidence of thyroid carcinoma in the nodules. A retrospective study

Fine needle aspiration (22G), is the diagnostic procedure chosen to study the nature of suspicious thyroid nodules. In 2008 the SIAPEC-IAP work group issued the results of Italian Consensus about the clinical management of patients with thyroid nodular disease, and introduced diagnostic categories aimed to standardize the diagnostic and therapeutic process of patients affected by thyroid nodules. This retrospective study is aimed to assess the incidence of carcinoma at definitive histological examination after total thyroidectomy of nodules with TIR3 cytological diagnosis

Tumori retroperitoneali: un caso di liposarcoma mixoide

I sarcomi retroperitoneali sono neoplasie piuttosto rare, localmente aggressive, con un alto tasso di recidiva locale ed una bassa incidenza di metastasi a distanza. Gli autori descrivono un caso di liposarcoma mixoide retroperitoneale in un uomo di 57 anni ricoverato per comparsa di dolori lancinanti ai quadranti addominali superiori. La TC conferma la presenza di una massa tumorale definendone anche i rapporti anatomici. Il tumore è completamente asportato con diagnosi istologica di liposarcoma mixoide (G2). A 2 anni dall’intervento e dopo cicli di chemioterapia, il paziente non ha sviluppato alcuna recidiva. Dopo una breve discussione sull’argomento e una revisione della letteratura internazionale, gli autori esaminano le opzioni diagnostiche e terapeutiche per questo gruppo di neoplasie, concludendo che una chirurgia radicale è in grado di incidere in modo significativo sia sulla sopravvivenza globale che sulla riduzione del tasso di recidiva locale mentre l’utilizzo della chemioterapia e/o radioterapia adiuvante comporta solo un ritardo nella comparsa di recidiva locale ma non una reale riduzione della sua incidenza

Decision making in borderline ovarian tumors: report of a rare case of mesosigma psammocarcinoma

Psammocarcinoma is a rare variant of serous carcinoma arising either from ovary or peritoneum, characterized by massive psammoma body formation, low-grade of cytologic differentiation and invasiveness. Its clinical behavior is similar to the serous borderline tumors, whose prognosis is significantly better compared to invasive forms, with a 5-year survival in stage I greater than 95%. A typical feature of borderline ovary tumors is the presence, in more than 30% of cases, of borderline peritoneal implants similar to primary ovarian cancer or of invasive forms. We report a case of a 44-years-old woman who referred to our clinic for mesosigmoid mass , accidentally discovered by ultrasonography. Sigmoidectomy with fertility sparing surgery was performed in september 2010. The mass was hystologically characterized by many psammoma bodies and low grade cytological features with diagnosis of psammocarcinoma of mesosigma. One year after the primary surgery, the patient showed with left adnexial mass; optimal debulking surgery was performed including omentectomy, total abdominal hysterectomy, bilateral adnexectomy and appendicectomy. The patient did not receive any adjuvant chemotherapy and to date she is alive and with no evidence of disease. The conclusion is that psammocarcinoma is a very rare tumor that behaves less aggressively than typical serous carcinoma, the mainstay of treatment is surgical debulking , with fertility sparing surgery as possible option in young patients with ovaries macroscopically free of disease

Association between posterior crossbite, masticatoy muscle pain, and disc displacement: A systematic review

BACKGROUND: Among different malocclusions, posterior crossbite is thought to have a strong impact on the correct functioning of the masticatory system. OBJECTIVE: To assess, by systematically reviewing the literature, the association between posterior crossbite and different temporomandibular disorder (TMD) diagnosis: disc displacement and masticatory muscle pain. MATERIALS AND METHODS: A literature survey covering the period from January 1965 to April 2012 was performed. Two reviewers extracted the data independently and assessed the quality of the studies. RESULTS: The search strategy resulted in 2919 citations, of which 43 met the inclusion criteria. The scientific and methodological quality of these studies was found to be medium-low, independently by association reported. In several studies, posterior crossbite is reported to be associated to the development of disc displacement, muscular pain, and tenderness, possibly linked to a skeletal and muscular adaptation of the stomatognathic system. However, the lack of consistency of the results reported deeply reduces the external validity of the studies, with a consequent impossibility to draw definite conclusions. CONCLUSIONS: It is not possible to establish an association between posterior crossbite, muscle pain, and disc displacement because the distribution of the studies supporting or not supporting the association is similar. The consequences of posterior crossbite on the development of TMDs deserve further investigations, with high sample size, well-defined diagnostic criteria, and rigorous scientific methodologies. Finally, long-term controlled studies are needed to identify posterior crossbite as a possible risk factor for TMDs

Three-dimensional imaging reconstruction and laparoscopic robotic surgery: a winning combination for a complex case of multiple myomectomy

OBJECTIVE: To demonstrate the intraoperative use of three-dimensional (3D) imaging reconstruction for a complex case of multiple myomectomy assigned to robot-assisted laparoscopic surgery. DESIGN: Stepwise demonstration of the technique with narrated video footage. SETTING: University tertiary care hospital. PATIENT(S): A 36-year-old nulliparous infertile woman with multiple uterine myomas (\u3e20) presented with menorrhagia and pelvic discomfort for many months. Because of the huge number of fibroids present, the patient was considered eligible for laparoscopic robotic-assisted myomectomy. INTERVENTION(S): A robotic-assisted laparoscopic myomectomy was performed with the use of intraoperative 3D imaging reconstruction. After opening the retroperitoneum through the adnexal triangle and identifying the ureters, to reduce intraoperative bleeding, bulldog clamps were used to temporarily reduce uterine vascularization. A multiple myomectomy was then performed with the use of tenaculum and Maryland bipolar forceps. During the intervention, the surgeon used the 3D uterine reconstruction to adapt its surgical strategy. Multilayer running closure was achieved using a bidirectional barbed suture ensuring introflexion of the serosa. Patients\u27 consent was obtained for publication of the case; institutional review board approval was not required for this case report as per our institution\u27s policy. MAIN OUTCOME MEASURE(S): Description of a robotic-assisted myomectomy with the intraoperative use of 3D imaging reconstruction. RESULT(S): The total operative time was 105 minutes. A total of 21 fibroids were removed with 150 mL of intraoperative blood loss. The patient was discharged the day after. CONCLUSION(S): The application of 3D imaging technology could overcome one of the limitations of robot-assisted minimally invasive surgery, the lack of haptic feedback, enabling the surgeon to rapidly locate myomas and guide the intraoperative plan to optimize the results. Additional studies evaluating the clinical impact of this technique and its improvement are required

Current Standards for and Clinical Impact of Emergency Radiology in Major Trauma

In industrialized countries, high energy trauma represents the leading cause of death and disability among people under 35 years of age. The two leading causes of mortality are neurological injuries and bleeding. Clinical evaluation is often unreliable in determining if, when and where injuries should be treated. Traditionally, surgery was the mainstay for assessment of injuries but advances in imaging techniques, particularly in computed tomography (CT), have contributed in progressively changing the classic clinical paradigm for major traumas, better defining the indications for surgery. Actually, the vast majority of traumas are now treated nonoperatively with a significant reduction in morbidity and mortality compared to the past. In this sense, another crucial point is the advent of interventional radiology (IR) in the treatment of vascular injuries after blunt trauma. IR enables the most effective nonoperative treatment of all vascular injuries. Indications for IR depend on the CT evidence of vascular injuries and, therefore, a robust CT protocol and the radiologist’s expertise are crucial. Emergency and IR radiologists form an integral part of the trauma team and are crucial for tailored management of traumatic injuries