Resolving sphincter of Oddi incontinence for primary duodenal Crohn's disease with strictureplasty

AbstractINTRODUCTIONCrohn's involvement of duodenum is a rare event and may be associated to proteiform symptoms and uncommon pathological aspects which make diagnosis and treatment complex.PRESENTATION OF CASEThe peculiar aspect of this case was a suspected duodeno-biliary fistula. The patient (female, 22 years old) was affected by duodenal Crohn's disease. Magnetic resonance imaging showed a dilated common bile duct, whose final part linked to a formation containing fluid, and characterized by filling of the contrast medium in the excretory phase. Abdominal ultrasound showed intra-hepatic and intra-gallbladder aerobilia. At surgery, the duodenum was mobilized showing an inflammatory stricture and a slight dilatation of the common bile duct, with no signs of fistulas. The opened duodenum was anastomized side to side to a transmesocolic loop of the jejunum. After surgery, the general condition of the patient improved.DISCUSSIONOnly two cases of fistula between a narrow duodenal bulb and the common bile duct have been described in literature and the Authors were not be able to verify the occurrence of a duodenal biliary fistula at surgery. The association between duodenal Crohn's disease and Sphincter of Oddi incontinence is a very rare finding with different etiology: chronic intestinal pseudo-obstruction, common bile duct stones, progressive systemic sclerosis.CONCLUSIONThe treatment to resolve Sphincter of Oddi incontinence for primary duodenal Crohn's disease is not clear. Strictureplasty could be the treatment of choice, because, resolving the stricture, the duodenal pressure is likely to decrease and the reflux through the incontinent sphincter can be avoided

Mehanizmi reakcija 27Al(14N, X) pri energiji snopa od 129,3 MeV

Absolute values of differential cross–sections for the formation of 6,7Li, 7,9Be, 10,11B and 12C nuclei were measured by the 14N + 27Al reaction at 129.3 MeV. The analysis of the inclusive energy spectra and angular distributions shows that the carbon and boron fragment production is well described by the projectile break–up leading to three–body final states reactions, while the lighter fragments are due both to the above–mentioned break–up and the evaporation from the 41Ca compound nucleus.Reakcijom 14N +27 Al odredili smo apsolutne vrijednosti diferencijalnih udarnih presjeka za tvorbu jezgri 6,7Li, 7,9Be, 10,11B i 12C pri energiji 129,3 MeV. Analiza inkluzivnih energijskih spektara i kutnih raspodjela pokazuje da se tvorba ugljikovih i borovih fragmenata može dobro opisati rascjepom upadne čestice koji vodi do tri tijela u konačnom stanju, dok su lakši fragmenti posljedica tog procesa i isparavanja iz složene jezgre

Mehanizmi reakcija 27Al(14N, X) pri energiji snopa od 129,3 MeV

Absolute values of differential cross–sections for the formation of 6,7Li, 7,9Be, 10,11B and 12C nuclei were measured by the 14N + 27Al reaction at 129.3 MeV. The analysis of the inclusive energy spectra and angular distributions shows that the carbon and boron fragment production is well described by the projectile break–up leading to three–body final states reactions, while the lighter fragments are due both to the above–mentioned break–up and the evaporation from the 41Ca compound nucleus.Reakcijom 14N +27 Al odredili smo apsolutne vrijednosti diferencijalnih udarnih presjeka za tvorbu jezgri 6,7Li, 7,9Be, 10,11B i 12C pri energiji 129,3 MeV. Analiza inkluzivnih energijskih spektara i kutnih raspodjela pokazuje da se tvorba ugljikovih i borovih fragmenata može dobro opisati rascjepom upadne čestice koji vodi do tri tijela u konačnom stanju, dok su lakši fragmenti posljedica tog procesa i isparavanja iz složene jezgre

Burden of Production in Merger Cases Litigating Divestiture Fixes: Amicus Brief

In this amicus brief to the D.C. District Court judge, Amy Berman Jackson, in the U.S. v Assa Abloy, we explain the legal and policy rationales for courts to place the burden of on the merging parties to produce sufficient evidence that the divestiture will preserve competition to rebut the anticompetitive structural presumption based on the market shares of the unremedied merger that was reported to the agencies in the Hart-Scott-Rodino filing

Evaluation of the AIDS risk perception among healthcare workers in the hospital University Unit of Messina (Italy)

No Summar

Correction to: Long-term results after stapled hemorrhoidopexy: a survey study with mean follow-up of 12 years

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Mesoglycan for pain control after open excisional HAEMOrrhoidectomy (MeHAEMO). An observational multicentre study on behalf of the Italian Society of Colorectal Surgery (SICCR)

Background: Excisional haemorrhoidectomy is the gold standard technique in patients with III and IV degree haemorrhoidal disease (HD). However, it is associated with a significant rate of post-operative pain. The aim of our study was to evaluate the efficacy of mesoglycan in the post-operative period of patients who underwent open excisional diathermy haemorrhoidectomy (OEH). Methods: This was a retrospective multicentre observational study. Three hundred ninety-eight patients from sixteen colorectal referral centres who underwent OEH for III and IV HD were enrolled. All patients were followed-up on the first post-operative day (T1) and after 1 week (T2), 3 weeks (T3) and 6 weeks (T4). BMI, habits, SF-12 questionnaire, VAS at rest (VASs), after defecation (VASd), and after anorectal digital examination (VASe), bleeding and thrombosis, time to surgical wound healing and autonomy were evaluated. Results: In the mesoglycan group, post-operative thrombosis was significantly reduced at T2 (p < 0.05) and T3 (p < 0.005), and all patients experienced less post-operative pain at each time point (p < 0.001 except for VASe T4 p = 0.003). There were no significant differences between the two groups regarding the time to surgical wound healing or post-operative bleeding. There was an early recovery of autonomy in the mesoglycan group in all three follow-up periods (T2 p = 0.016; T3 p = 0.002; T4 p = 0.007). Conclusions: The use of mesoglycan led to a significant reduction in post-operative thrombosis and pain with consequent early resumption of autonomy. Trial registration NCT0448169

Acute subdural hematoma in the elderly. outcome analysis in a retrospective multicentric series of 213 patients

OBJECTIVE: The objective of this study was to analyze the risk factors associated with the outcome of acute subdural hematoma (ASDH) in elderly patients treated either surgically or nonsurgically. METHODS: The authors performed a retrospective multicentric analysis of clinical and radiological data on patients aged ≥ 70 years who had been consecutively admitted to the neurosurgical department of 5 Italian hospitals for the management of posttraumatic ASDH in a 3-year period. Outcome was measured according to the Glasgow Outcome Scale (GOS) at discharge and at 6 months' follow-up. A GOS score of 1-3 was defined as a poor outcome and a GOS score of 4-5 as a good outcome. Univariate and multivariate statistics were used to determine outcome predictors in the entire study population and in the surgical group. RESULTS: Overall, 213 patients were admitted during the 3-year study period. Outcome was poor in 135 (63%) patients, as 65 (31%) died during their admission, 33 (15%) were in a vegetative state, and 37 (17%) had severe disability at discharge. Surgical patients had worse clinical and radiological findings on arrival or during their admission than the patients undergoing conservative treatment. Surgery was performed in 147 (69%) patients, and 114 (78%) of them had a poor outcome. In stratifying patients by their Glasgow Coma Scale (GCS) score, the authors found that surgery reduced mortality but not the frequency of a poor outcome in the patients with a moderate to severe GCS score. The GCS score and midline shift were the most significant predictors of outcome. Antiplatelet drugs were associated with better outcomes; however, patients taking such medications had a better GCS score and better radiological findings, which could have influenced the former finding. Patients with fixed pupils never had a good outcome. Age and Charlson Comorbidity Index were not associated with outcome. CONCLUSIONS: Traumatic ASDH in the elderly is a severe condition, with the GCS score and midline shift the stronger outcome predictors, while age per se and comorbidities were not associated with outcome. Antithrombotic drugs do not seem to negatively influence pretreatment status or posttreatment outcome. Surgery was performed in patients with a worse clinical and radiological status, reducing the rate of death but not the frequency of a poor outcome

Clinical, molecular and glycophenotype insights in SLC39A8-CDG

Background: SLC39A8, a gene located on chromosome 4q24, encodes for the manganese (Mn) transporter ZIP8 and its detrimental variants cause a type 2 congenital disorder of glycosylation (CDG). The common SLC39A8 missense variant A391T is associated with increased risk for multiple neurological and systemic disorders and with decreased serum Mn. Patients with SLC39A8-CDG present with different clinical and neuroradiological features linked to variable transferrin glycosylation profile. Galactose and Mn supplementation therapy results in the biochemical and clinical amelioration of treated patients. Results: Here, we report clinical manifestations, neuroradiological features and glycophenotypes associated with novel SLC39A8 variants (c.1048G > A; p.Gly350Arg and c.131C > G; p.Ser44Trp) in two siblings of the same Italian family. Furthermore, we describe a third patient with overlapping clinical features harbouring the homozygous missense variant A391T. The clinical phenotype of the three patients was characterized by severe developmental disability, dystonic postural pattern and dyskinesia with a more severe progression of the disease in the two affected siblings. Neuroimaging showed a Leigh syndrome-like pattern involving the basal ganglia, thalami and white matter. In the two siblings, atrophic cerebral and cerebellum changes consistent with SLC39A8-CDG were detected as well. Serum transferrin isoelectric focusing (IEF) yielded variable results with slight increase of trisialotransferrin isoforms or even normal pattern. MALDI-MS showed the presence of hypogalactosylated transferrin N-glycans, spontaneously decreasing during the disease course, only in one affected sibling. Total serum N-glycome depicted a distinct pattern for the three patients, with increased levels of undergalactosylated and undersialylated precursors of fully sialylated biantennary glycans, including the monosialo-monogalacto-biantennary species A2G1S1. Conclusions: Clinical, MRI and glycosylation features of patients are consistent with SLC39A8-CDG. We document two novel variants associated with Leigh syndrome-like disease presentation of SLC39A8-CDG. We show, for the first time, a severe neurological phenotype overlapping with that described for SLC39A8-CDG in association with the homozygous A391T missense variant. We observed a spontaneous amelioration of transferrin N-glycome, highlighting the efficacy of MS-based serum glycomics as auxiliary tool for the diagnosis and clinical management of therapy response in patients with SLC39A8-CDG. Further studies are needed to analyse more in depth the influence of SLC39A8 variants, including the common missense variant, on the expression and function of ZIP8 protein, and their impact on clinical, biochemical and neuroradiological features