Avoidable blood transfusions

Si discute l'importanza di una analisi accurata nel definire il fattore di rischio di trasfusioni nella genesi della trombosi profonda delle vene degli arti inferior

Letter to the editor on "Stents and surgical interventions in the palliation of gastric outlet obstruction. A systematic review"

We read with interest the paper, “Stents and surgical interventions in the palliation of gastric outlet obstruction: a systematic review” by Minata MK et al, which appeared in Endoscopy International Open (2016; 4: E1158 – 1170) [1]. The Authors should be congratulated for an extensive and careful review. In recent studies, we prospectively analyzed the clinical outcomes of 72 patients [2, 3] and we came to similar conclusions. We have abandoned the use of covered stents. Distal migration of a covered stent can lead to serious consequences and a stent rarely can be retrieved endoscopically [4]. Endoscopic stenting offers many advantages in comparison to surgery: shorter hospital stay, faster return to oral intake, a less invasive procedure. However, life expectance may be longer than 1 year in some patients with malignant gastric outlet obstruction, particularly those with distal gastric cancer or gastric obstruction from metastatic disease. In this selected group of patients, food obstruction is common. The reason for it in rare cases derives from tumor ingrowth within the stent; in the majority of patients, food obstruction is secondary to dismotility of the pyloric region. The dismotility depends on many factors, including nerve infiltration by the tumor. Food obstruction is not easily diagnosed. The stomach can enlarge significantly before vomiting occurs. Stomach dilation can lead to nausea, discomfort, and dyspnea, symptoms that easily can be attributed to the cancer itself. For all these reasons, patients who have endoscopic stenting in this clinical setting should have a very careful follow-up with repeated endoscopies and computed tomography scan. This careful follow-up may not be well tolerated by a patient whose general condition is slowly deteriorating or for his or her family. Laparoscopic surgery can be performed with minimal discomfort for patients and it should be seriously considered in patients whose conditions are generally acceptable. Before such a procedure, the patient and family should be consulted and all positive and negative aspects of the surgery should be thoroughly explained, leaving them to choose the preferred treatment

Inflammatory cytokines and atherosclerotic plaque progression. therapeutic implications

Inflammatory cytokines play a major role in atherosclerotic plaque progression. This review summarizes the rationale for personalized anti-inflammatory therapy

Leonardo da Vinci (1452-1519). A modern scientist

Vengono descritte le difficoltà di Leonardo da Vinci nel fare accettare le sue ide

Training in Surgery

LA LETTERA FA NOTARE L'IMPORTANZA DI UNA APPROPRIATA SELEZIONE DEGLI SPECIALIZZANDI IN CHIRUGI

Introduction. Carotid endarterectomy versus carotid stenting. A never-ending story

L'articolo discute le controversie relative all'accettazione in pratica clinica dello stentig carotide

Progress in the Study of Cardiovascular Physiology During the Italian Renaissance

This short report underlines the importance of collaboration and communication among scientists. The ideals of progress in medicine and in the care of suffering people have represented continuous stimuli allowing to overcome prejudices, religious and political differences. The modern concepts of blood circulation have been established through a close collaboration and exchanges of ideas among scientists coming from different countries, different religious and political backgrounds. In those days Europe was theater of continuous wars based on political and religious contrasts. There were continuous outbreaks of Plague in several countries. Religious contrasts occurred inside the Christianity and between the Christianity and Islam; contrasts which were based on theological disputes associated with economic and expansionist ambitions, resulting in extreme and rigid religious orthodoxy. Despite these difficulties, medical scientists collaborated overcoming the close boundaries of everyday general confrontations. The ambition for advancement in science and for progress with the potential consequent common good inspired a general sense of community and drove to overcome the boundaries based on contrasts. Science, scientific thinking, dedication to research and to improve knowledge represented yesterday and continue to represent today the common ambition to break down cultural, religious and economic walls. The generosity of science is superior to the superstition of contrasts and arrogance. A message we can bring from the past back to the future and back to today

Systematic review and metanalysis of clinical outcomes after enucleation of pancreatic metastases from renal cell carcinoma

Introduction: A systematic review of the literature was carried out to determine the clinical and oncological outcome of patients who had enucleation of solitary pancreatic metastases from renal cell carcinoma. Methods: Operative mortality, postoperative complications, observed survival and disease free survival were analyzed. The clinical outcomes of patients who had enucleation were compared to those of 857 patients collected from the literature who had standard or atypical pancreatic resection for the same disease using propensity score matching Results: There was no postoperative mortality in the 56 patients who had enucleation of pancreatic metastases from renal cell carcinoma . In 51 patients postoperative complications could be analyzed. Ten patients (10/51=19.6%) had postoperative complications. Three patients (3/51 = 5.9%) had major complications (Clavien-Dindo III or more). Five year observed survival rates and disease free survival for patients with enucleation were 92% and 79% respectively. These results compared favourably with those obtained in patients who had standard resection and other forms of atypical resection (also using propensity score matching). Patients who had partial pancreatic resection (atypical or not) with pancreatic-jejunal anastomosis had increased rates of postoperative complications and local recurrences. Conclusions: Enucleation of pancreatic metastases offers a valid solution in selected patients

Improved Results for Endoscopic Colorectal Stenting with Establishment of a Common Endoscopic Centre for Gastroenterologists and Surgeons

n/

Basic fibroblast growth factor mediates carotid plaque instability through metalloproteinase-2 and –9 expression

OBJECTIVE(S): We hypothesized that basic fibroblast growth factor (bFGF) may exert a role in carotid plaque instability by regulating the expression of matrix metalloproteinases (MMP). METHODS: Plaques obtained from 40 consecutive patients undergoing carotid endarterectomy were preoperatively classified as soft or hard. Serum bFGF was pre- and postoperatively measured. The release of MMP-2 and MMP-9 in the blood serum, and the activity, production and expression in the carotid specimens was analyzed. Specific anti-bFGF inhibition tests were performed in vitro on human umbilical artery smooth muscle cells (HUASMC) to evaluate the role of bFGF in the activity, production and expression of MMP-2 and -9. RESULTS: Twenty-one (53%) patients had a soft carotid plaque and 19 (48%) a hard plaque. Preoperative bFGF serum levels were higher in patients with soft plaques [soft=34 (28-39) pg/mL and hard=20 (17-22) pg/mL-p<0.001] and postoperatively returned to normal values (when compared to 10 healthy volunteers). The serum levels of MMP-2 in patients' with soft plaques were higher than those in patients' with hard plaques [soft=1222 (1190-1252) ng/mL and hard=748 (656-793)ng/mL-p<0.0001]. MMP-9 serum values were 26 (22-29) ng/mL for soft plaques and 18 (15-21) ng/mL for hard plaques (p<0.0001). We found increased activity, production and expression of MMP-2 and -9 in soft plaques compared to hard plaques (p<0.001). In vitro inhibition tests on HUASMC showed the direct influence of bFGF on the activity, production and expression of MMP-2 and -9 (p<0.001). CONCLUSIONS: bFGF seems to exert a key role in carotid plaque instability regulating the activity, production and expression of MMP thus altering the physiologic homeostasis of the carotid plaque