Staging chronic pancreatitis with exocrine function tests: Are we better?

Chronic pancreatitis (CP) is an inflammatory disease of the pancreas evolving in progressive fibrotic disruption of the gland with exocrine and endocrine pancreatic insufficiency. Although imaging features of CP are well known, their correlation with exocrine pancreatic function tests are not obvious, particularly in the early stage of the disease. There are many clinical classification of CP, all suggested for better distinguish and manage different forms based on etiological and clinical factors, and severity of the disease. Recently, a new classification of CP has been suggested: the M-ANNHEIM multiple risk factor classification that includes etiology, stage classification and degree of clinical severity. However, more accurate determination of clinical severity of CP requires a correct determination of exocrine function of the pancreas and fecal fat excretion. Recently, Kamath et al demonstrated that the evaluation of exocrine pancreatic function by acid steatocrit and fecal elastase-1 (EF-1) was helpful, but EF-1 was able to detect exocrine pancreatic insufficiency in more patients, upgrading some patients in higher stage of disease according to M-ANNHEIM classification. So, EF-1 is a more accurate test to determine exocrine pancreatic insufficiency and to stage chronic pancreatitis in the M-ANNHEIM classification. On the contrary, EF-1 determination shows low sensitivity in detecting exocrine pancreatic insufficiency in early stage of the disease

Pancreatic resection in very elderly patients: A critical analysis of existing evidence

The aging of the population results in a rise of number of elderly patients (aged 80 years and older) with pancreatic or periampullary cancer, and more pancreatectomies could eventually be performed in such complex patients. However, early and long-term results after pancreatic resection in octogenarians are still controversial, and may trouble the surgeon when approaching this type of population. Evaluation of reported experiences shows that for almost all Authors, pancreatectomy can be performed safely in elderly population, although overall morbidity and mortality rates were 34.9% and 13.2% respectively, with a mean length of hospital stay of 18 d. These features appear higher in older patients compared to the younger counterpart. Less than 50% of patients underwent adjuvant therapy after operation. Long-term survival is reported not significantly different in aged 80 years and older patients, with a median overall survival time of 17.6 mo. The quality of life after pancreatic resection is only sporadically evaluated but, when considered, it highlights the need of health facility service after operation for these "frail" patients. Prospective studies on the quality of life of pancreatectomized octogenarians are welcome. Proper selection of patients, geriatric assessment with multidisciplinary approach, centralization of pancreatic surgery in high-volume centres and rehabilitation programs after surgery appear to be crucial points in order to improve surgical treatments of pancreatic tumors in very elderly patients

Un altare funerario con scena di filatura dal territorio friulano

In this paper I will examine a Roman funerary altar preserved in a church of a town near Tolmezzo (in the Friuli Venezia-Giulia region) that presents in the left side a very unusual motiv, the image of a spinning woman. The classicistic style of this figure recalls the style of a small group of altars in the Archaeological Museum of Aquileia, and shows the continuity of Greek imagery of the Classical period in the Roman funerary monuments of early Imperial age

El papel de los tribunales constitucionales en la superación de la discriminación contra las parejas del mismo sexo y la reciente experiencia italiana

El presente artículo analiza la evolución del debate teórico-jurídico sobre los derechos relacionados con la orientación sexual partiendo de la jurisprudencia constitucional. En particular, la autora ana-liza la transición de los tribunales cons-titucionales desde el reconocimiento del derecho a la privacidad de gais y lesbianas a la definición de parejas del mismo sexo como «familias» y el reconocimiento de su igualdad y dignidad en relación con el matrimonio. El artículo también enfatiza cómo los tribunales constitucionales han contribuido decisivamente a la superación de los conflictos sociales y políticos sobre los derechos LGTBI. La reciente experiencia italiana al hilo de la legalización de las lla-madas uniones civiles homosexuales, aun con algunas contradicciones, es igualmente ilustrativa y merece una reflexión particular.The article aims at analysing the debate on the recognition of sexual orientation equality in Constitutional cas-es. In particular the Author analyses the transition of constitutional courts from the recognition of the right of privacy of gays and lesbians to the definition of same-sex couples as «families» and the recognition of their equality and dignity in relation to marriage. The article also emphasises how constitutional courts contribute to the solution of social and political conflicts on LGBT rights. Finally, if focuses on recent legislative developments in Italy and the role of the Italian constitutional court in the adoption of the first regulation of same-sex civil unions

Judicial dialogue and evolutionary interpretations of the Constitutions in cases on same- sex marriage and rights of homosexuals couples

Lo studio si propone di approfondire il contributo della comparazione giuridica nella giurisprudenza costituzionale e nell'evoluzione delle legislazioni nazionali in tema di riconoscimento del matrimonio tra persone dello stesso sess

Vassilis Alexakis et Nancy Huston au miroir de l’autotraduction

Cet article compare la pratique autotraductive de Vassilis Alexakis avec celle de Nancy Huston. Bilingues tardifs, ils partagent le début littéraire en français et une autotraduction atypique, bidirectionnelle, contemporaine à la rédaction de l’original où l’exil, bien que choisi, joue un rôle motivationnel important. L’analyse se penche sur les asymétries psychologiques et linguistiques qui ont poussé ces deux écrivains à écrire et à s’autotraduire pour repérer la relation que leurs textes développent avec les réseaux littéraires des pays respectifs et pour mieux comprendre leur attente d’autotraducteurs. Une lecture des différences entre les titres français et les titres anglais des romans hustoniens fait ressortir un déséquilibre significatif. Quelques considérations sur les rapports entre autotraduction et réécriture dans la production de Vassilis Alexakismet en lumière un dynamisme scriptural qui est à la base de nombreuses rééditions revues par l’auteur