Prolonged pre-firing pancreatic compression with linear staplers in distal pancreatectomy: a valuable technique for post-operative pancreatic fistula prevention

Purpose: Post-operative pancreatic fistula (POPF) remains the main complication after distal pancreatectomy (DP). The aim of this study is to evaluate the potential benefit of different durations of progressive stapler closure on POPF rate and severity after DP. Methods: Patients who underwent DP between 2016 and 2023 were retrospectively enrolled and divided into two groups according to the duration of the stapler closure: those who underwent a progressive compression for < 10 min and those for ≥ 10 min. Results: Among 155 DPs, 83 (53.5%) patients underwent pre-firing compression for < 10 min and 72 (46.5%) for ≥ 10 min. As a whole, 101 (65.1%) developed POPF. A lower incidence rate was found in case of ≥ 10 min compression (34-47.2%) compared to < 10 min compression (67- 80.7%) (p = 0.001). When only clinically relevant (CR) POPFs were considered, a prolonged pre-firing compression led to a lower rate (15-20.8%) than the < 10 min cohort (32-38.6%; p = 0.02). At the multivariate analysis, a compression time of at least 10 min was confirmed as a protective factor for both POPF (OR: 5.47, 95% CI: 2.16-13.87; p = 0.04) and CR-POPF (OR: 2.5, 95% CI: 1.19-5.45; p = 0.04) development. In case of a thick pancreatic gland, a prolonged pancreatic compression for at least 10 min was significantly associated to a lower rate of CR-POPF compared to < 10 min (p = 0.04). Conclusion: A prolonged pre-firing pancreatic compression for at least 10 min seems to significantly reduce the risk of CR-POPF development. Moreover, significant advantages are documented in case of a thick pancreatic gland

Adhesive small bowel obstruction in octogenarians: A 6-year retrospective single-center analysis of clinical management and outcomes

Background: Few evidences are available on adhesive bowel obstruction (ASBO)management and outcomes in geriatric patients. Methods: One-hundred-twenty-eight patients aged 65–79 years were retrospectively compared to 77 patients aged ≥80 years. Aim of this study was to compare ASBO management and in-hospital course between patients aged 65–79 years and those over 80 years. Results: Upfront surgery in octogenarians related with a higher rate of major complications (23.7%vs4.9%; p = 0.009) and longer hospitalization (8.8vs7.3 days; p = 0.01). No difference according to age was noted in terms of clinical outcomes when the non-operative management (NOM) was employed. Patients aged ≥80 years managed conservatively presented shorter hospitalization (7.3vs8.8 days; p = 0.04), lower rate of intensive care unit (ICU) admission (0vs18.4%; p = 0.005) and cumulative major complications (2.6%vs23.7%; p = 0.007) as compared to ≥80 years old patients treated with upfront surgery. In this same group, NOM failure did not lead to worse outcomes in comparison to upfront surgery. Conclusions: NOM in≥80 years patients is associated with better in-hospital course. The acceptable clinical outcomes in case of NOM failure further support NOM as first treatment strategy to employ in this same subset of patients

DIFFERENTIATION OF RAT SALIVARY-GLANDS BY THERMOANALYTICAL ANALYSIS

La libération d'eau dans les glandes sublinguales, parotides et sous-maxillaires de rats mâles et femelles a été étudiée par l'analyse thermoanalytique pour définir le contenu total et les types d'eau. Différents types d'eau ont été observés et la distribution relative semble être une fonction de l'énergie de liaison de l'eau aux composants glandulaires. En outre, la présence d'un dimorphisme sexuel dans la glande sublinguale de rat a été démontrée

THERMOGRAVIMETRY STUDY ON THE WATER IN SECRETORY-TISSUES OF RABBIT

Isothermic and dynamic thermogravimetry was applied to rabbit parotid and submandibular glands to quantitate and characterize the water present inside them. Isothermic thermogravimetry demonstrated that at 95-degrees-C a quota of water is still present in the samples. Dynamic thermogravimetry evidenced that temperatures higher than 200-degrees-C are required for the release of the highest energy bound water from both glands. In addition during present research it was found that submandibular gland, an organ considered histologically homogeneous, reveals an heterogeneous distribution of water

CHARACTERIZATION OF MOUSE SALIVARY-GLANDS BY WATER-CONTENT AND TYPE

The thermoanalytical analysis was applied to samples of sublingual, submandibular and parotid glands from sexually mature mice of both sexes. Findings indicated that the three salivary glands show a behaviour of water release characteristic for each type of gland. Derivative thermogravimetry curves concerned with the sublingual and parotid glands belonging to male and female subjects exhibited overlapped results. As regards submandibular gland, instead, some differences emerged between subjects of different sex. Water content and types in sublingual, submandibular and parotid glands were discussed and related to the different morphological expression, histochemical reactivity and chemical composition of these organ tissues

A THERMOANALYTICAL APPROACH TO THE STUDY OF THE TISSUTAL WATER OF MOUSE SALIVARY-GLANDS

The salivaryglands participate to a different extent when secreting the different components of saliva. The cellular water plays a very important role in this process, but studies concerned with water analysis and characterization in these organ tissues have not been reported in the literature. The different kinds of water, their percentages and their stabilities were determined by thermal analysis of mousesalivaryglands: submandibular, sublingual and parotid. The water was released from the different types of gland in different temperature ranges; the most stable being the submandibular gland, followed by the parotid gland, and then the sublingual gland. The total water per cent was approximately the same (about 72.5%) in the submandibular and sublingual glands even if bound with different energies to the matrix, but a remarkable difference was found between the water per cent corresponding to the first process of the submandibular and sublingual glands. The parotid glands showed a lower per cent (66.6%) for total water. Finally, the thermogravimetric curves were found using the same analysis, to obtain the ashes content of the glands

THERMAL-BEHAVIOR OF THE RABBIT SUBLINGUAL GLAND

The purpose of this study was to show how some aspects of the biological matrix water can be investigated by thermoanalytical methods when using thermogravimetry and differential scanning calorimetry. Such methods allow to investigate the water in the rabbit sublingual gland and to quantitate it. The results supported the view that the water contained in this secretory organ show a large number of energetic interactions established on the basis of differential steps of water release by thermal disruption

QUANTITATIVE AND QUALITATIVE FLUCTUATION OF WATER IN THE MOUSE SUBMANDIBULAR-GLAND UNDER SECRETAGOGUE EFFECT

The short-term effects of two different secretagogues on the water contained in the mouse submandibular gland were studied using the thermal analysis as investigation method. Isoproterenol induced a retention while pilocarpine promoted a release of weakly and strongly bound water. In addition, submandibular glands of subjects administered with isoproterenol were characterized by a thermal behaviour different in males and females above all as concerns the time of reaction to the secretagogue; the reaction delay observed in females was correlated with the effects of this pharmacological substance on the convoluted granular tubules that are responsible for the sexual dimorphism in mice

The Role of Simultaneous Integrated Boost in Locally Advanced Rectal Cancer Patients with Positive Lateral Pelvic Lymph Nodes

Aims: Between 11 to 14% of patients with locally advanced rectal cancer (LARC) have positive lateral pelvic lymph nodes (LPLN) at diagnosis, related to a worse prognosis with a 5-year survival rate between 30 to 40%. The best treatment choice for this group of patients is still a challenge. The optimal radiotherapy (RT) dose for LPLN patients has been investigated. Methods: We retrospectively collected data from LARC patients with LPLN at the primary staging MRI, treated in our center from March 2003 to December 2020. Patients underwent a neoadjuvant concomitant chemo-radiotherapy (CRT) treatment on the primary tumor (T), mesorectum, and pelvic nodes, associated with a fluoride-based chemotherapy. The total reached dose was 45 Gy at 1.8 Gy/fr on the elective sites and 55 Gy at 2.2 Gy/fr on the disease and mesorectum. Patients were divided in two groups based on whether they received a simultaneous integrated RT boost on the LPLN or not. Overall Survival (OS), Disease Free Survival (DFS), Metastasis Free Survival (MFS), and Local Control (LC) were evaluated in the whole group and then compared between the two groups. Results: A total of 176 patients were evaluated: 82 were included in the RT boost group and 94 in the non-RT boost group. The median follow-up period was 57.8 months. All the clinical endpoint (OS, DFS, MFS, LC), resulted were affected by the simultaneous integrated boost on LPLN with a survival rate of 84.7%, 79.5%, 84.1%, and 92%, respectively, in the entire population. From the comparison of the two groups, there was a statistical significance towards the RT boost group with a p < 0.006, 0.030, 0.042, 0.026, respectively. Conclusions: Concomitant radiotherapy boost on positive LPLN has shown to be beneficial on the survival outcomes (OS, DFS, MFR, and LC) in patients with LARC and LPLN. This analysis demonstrates that a higher dose of radiotherapy on positive pelvic lymph nodes led not only to a higher local control but also to a better survival rate. These results, if validated by future prospective studies, can bring a valid alternative to the surgery dissection without the important side effects and permanent disabilities observed during the years