TEM in the treatment of recurrent rectal cancer in elderly

INTRODUCTION: Transanal microscopic surgery is an important application of minimally invasive surgery of rectum, allowing realization of complex transanal intervention. PATIENTS AND METHODS: During the period between January 2002 and December 2010, seven patients, five men and two women, average age 75 years, with early rectal cancer recurrence were selected for this type of surgical palliative procedure. The selection of the patients is made by: transrectal ultrasonografy, colonoscopy and abdominal ultrasonografy, to rule out liver metastases, CT with and without enema, PET CT. Follow-up is approximately 12-30 months. RESULTS: The pathologic staging confirms the complete excision of recurrences. Then patients are referred for more complementary therapies. DISCUSSION: The significance of conservative treatment for local recurrence of rectum adenocarcinoma is still controversial because the recurrence is an expression of tumor spread not controlled by oncological surgical and radio/chemo therapy. CONCLUSION: In selected subjects such as the elderly, based on equal oncological treatment, the reduction of surgical trauma, preservation of anatomical integrity and resolution of symptoms are important results

La tradizione europea del pensiero economico

Spalletti \ue8 segretario organizzativo, membro del collegio dei docenti del dottorato e co-curatore della cotutela del titolo di dottorato con l'Universit\ue0 Sorbona di Parigi. Lo scopo \ue8 formare studiosi con una preparazione adeguata alla complessit\ue0 che la ricerca nella Storia del pensiero economico ha raggiunto negli ultimi anni, conformemente anche con le nuove funzioni che la disciplina ha assunto nella formazione di economisti e scienziati sociali. La Storia del pensiero economico svolge infatti il ruolo di riflessione critica sui fondamenti della teoria economica; di riconoscimento dell\u2019influenza esercitata dall'evoluzione delle altre scienze; di approfondimento della teoria che nasce dall\u2019inquadramento del contesto culturale e storico che l\u2019ha determinata. In altre parole, la Storia del pensiero contribuisce a mantenere viva la tradizione europea di considerare la scienza economica come una scienza sociale. Tuttavia i corsi di laurea attuali non sono in grado di fornire un\u2019adeguata preparazione alla ricerca \u2013 ed eventualmente all\u2019insegnamento universitario \u2013 in questo settore. La materia richiede sia la conoscenza della teoria economica contemporanea (non fornita dai corsi di laurea propriamente umanistici) sia un\u2019adeguata preparazione alla ricerca storica (non fornita dai corsi di laurea in economia). Studi recenti hanno messo in evidenza i limiti di un approccio alla Storia del Pensiero economico confinato alla tradizione nazionale (considerata come un\u2019esperienza isolata poich\ue9 sovente gli Italiani studiano gli economisti italiani, i Tedeschi studiano gli economisti tedeschi etc.) ovvero alla tradizione anglosassone dominante. Ci\uf2 ha fatto passare in secondo piano interessanti correnti di pensiero che hanno avuto meno fortuna, o che sono legate a realt\ue0 nazionali diverse. La diffusione delle idee economiche tra i Paesi europei e la ricostruzione delle reti internazionali di collaborazione e di influenze costituiscono i campi di ricerca pi\uf9 innovativi e interessanti e sono ancora quasi interamente da esplorare. In particolare i rapporti tra Germania, Francia, Spagna e Italia sono tutti da ricostruire. Occorre, dunque, essere pronti ad accogliere le indicazioni provenienti dalla Comunit\ue0 scientifica internazionale, che gi\ue0 da tempo ha cominciato a interrogarsi sui meccanismi di trasferimento delle idee economiche attraverso i confini nazionali. Proprio l'istituzione scientifica pi\uf9 autorevole in materia, la Societ\ue0 Europea per la Storia del pensiero economico (ESHET), ha organizzato nel 1999 il convegno: "National Traditions in Economic Thought and the Diffusion of Ideas". Si tratta di filoni di ricerca che richiedono una complessa preparazione (disciplinare e linguistica) per essere adeguatamente affrontati. Non esistono dottorati in Europa che abbiano queste caratteristiche di apertura internazionale e di interdisciplinarit\ue0 tra economia e storia. In Italia i giovani studiosi/e che nutrono interesse in questo campo vi accedono generalmente tramite dottorati in economia e sono costretti ad acquisire faticosamente e isolatamente la strumentazione necessaria e a dedicare tempo e risorse ad approfondire conoscenze che non sono funzionali ai loro interessi di ricerca. Inoltre l\u2019alta specializzazione di questo dottorato, che ha quasi come solo sbocco professionale la ricerca, rende efficiente la scelta di concentrare gli sforzi tra diversi Paesi in un unico corso di studio a valenza internazionale

TEM in the treatment of recurrent rectal cancer in elderly

INTRODUCTION: Transanal microscopic surgery is an important application of minimally invasive surgery of rectum, allowing realization of complex transanal intervention. PATIENTS AND METHODS: During the period between January 2002 and December 2010, seven patients, five men and two women, average age 75 years, with early rectal cancer recurrence were selected for this type of surgical palliative procedure. The selection of the patients is made by: transrectal ultrasonografy, colonoscopy and abdominal ultrasonografy, to rule out liver metastases, CT with and without enema, PET CT. Follow-up is approximately 12-30 months. RESULTS: The pathologic staging confirms the complete excision of recurrences. Then patients are referred for more complementary therapies. DISCUSSION: The significance of conservative treatment for local recurrence of rectum adenocarcinoma is still controversial because the recurrence is an expression of tumor spread not controlled by oncological surgical and radio/chemo therapy. CONCLUSION: In selected subjects such as the elderly, based on equal oncological treatment, the reduction of surgical trauma, preservation of anatomical integrity and resolution of symptoms are important results

Acute shock efficacy of the subcutaneous implantable cardioverter-defibrillator according to the implantation technique

Background: The traditional technique for subcutaneous implantable cardioverter defibrillator (S-ICD) implantation involves three incisions and a subcutaneous (SC) pocket. An intermuscular (IM) 2-incision technique has been recently adopted. Aims: We assessed acute defibrillation efficacy (DE) of S-ICD (DE ≤65 J) according to the implantation technique. Methods: We analyzed consecutive patients who underwent S-ICD implantation and DE testing at 53 Italian centers. Regression analysis was used to determine the association between DFT and implantation technique. Results: A total of 805 patients were enrolled. Four groups were assessed: IM + 2 incisions (n = 546), SC + 2 incisions (n = 133), SC + 3 incisions (n = 111), and IM + 3 incisions (n = 15). DE was ≤65 J in 782 (97.1%) patients. Patients with DE ≤65 J showed a trend towards lower body mass index (25.1 vs. 26.5; p = .12), were less frequently on antiarrhythmic drugs (13% vs. 26%; p = .06) and more commonly underwent implantation with the 2-incision technique (85% vs. 70%; p = .04). The IM + 2-incision technique showed the lowest defibrillation failure rate (2.2%) and shock impedance (66 Ohm, interquartile range: 57-77). On multivariate analysis, the 2-incision technique was associated with a lower incidence of shock failure (hazard ratio: 0.305; 95% confidence interval: 0.102-0.907; p = .033). Shock impedance was lower with the IM than with the SC approach (66 vs. 70 Ohm p = .002) and with the 2-incision than the 3-incision technique (67 vs. 72 Ohm; p = .006). Conclusions: In a large population of S-ICD patients, we observed a high defibrillation success rate. The IM + 2-incision technique provides lower shock impedance and a higher likelihood of successful defibrillation

Contrast-Induced Acute Kidney Injury and Endothelial Dysfunction: The Role of Vascular and Biochemical Parameters

Introduction: Contrast-induced acute kidney injury (CIAKI) is one of the main causes of acute renal failure in hospitalized patients, following the administration of iodinated contrast medium used for CT scans and angiographic procedures. CIAKI determines a high cardiovascular risk and appears to be one of the most feared complications of coronary angiography, causing a notable worsening of the prognosis with high morbidity and mortality. Aim: To evaluate a possible association between the renal resistive index (RRI) and the development of CIAKI, as well as an association with the main subclinical markers of atherosclerosis and the main cardiovascular risk factors. Materials and Methods: We enrolled 101 patients with an indication for coronary angiography. Patients underwent an assessment of renal function (serum nitrogen and basal creatinine, 48 and 72 h after administration of contrast medium), inflammation (C reactive protein (CRP), serum calcium and phosphorus, intact parathormone (iPTH), 25-hydroxyvitaminD (25-OH-VitD), serum uric acid (SUA), total cholesterol, serum triglycerides, serum glucose and insulin). All patients also carried out an evaluation of RRI, intima-media thickness (IMT), interventricular septum (IVS) and the ankle-brachial index (ABI). Results: 101 patients (68 male), with a mean age of 73.0 ± 15.0 years, were enrolled for the study; 35 are affected by type 2 diabetes mellitus. A total of 19 cases of CIAKI were reported (19%), while among diabetic patients we reported an incidence of 23% (8 patients). In our study, patients with CIAKI had significantly higher RRI (p < 0.001) and IMT (p < 0.001) with respect to the patients who did not develop CIAKI. Furthermore, patients with CIAKI had significantly higher CRP (p < 0.001) and SUA (p < 0.006). Conclusions: We showed a significant difference in RRI, IMT, SUA and CRP values between the population developing CIAKI and patients without CIAKI. This data appears relevant considering that RRI and IMT are low-cost, non-invasive and easily reproducible markers of endothelial dysfunction and atherosclerosis

OnabotulinumtoxinA reduces temporal pain processing at spinal level in patients with lower limb spasticity

Spasticity is a muscle tone disorder associated with different neurological conditions. Spasticity could be associated with pain, high disability, poor functional recovery, and reduced quality of life. Botulinum neurotoxin type A (BoNT-A) is considered a first-line treatment for spasticity and, more recently, it also represents a therapeutic option for various chronic pain conditions. In this open label study, we aim to evaluate the effect of the BoNT-A on the spinal nociception in patients affected by spasticity of the lower limbs with associated pain with predominantly neuropathic features. Ten patients with stroke, 10 with multiple sclerosis and 5 with spinal cord injury were enrolled in the study. They were tested with clinical scales (neuropathic pain scale inventory (NPSI), numerical rating scale (NRS), modified Ashworth scale (MAS) and with the nociceptive withdrawal reflex at lower limbs to explore the spinal temporal summation threshold at baseline and 30 day after BoNT-A injection. OnabotulinumtoxinA (50 to 200 units per site) was injected in the lower limb muscles according to the distribution of spasticity. No significant differences were found at baseline for neurophysiological features across groups. After the BoNT-A injection, we recorded a significant reduction in MAS and NRS scores. Regarding the neurophysiological parameters, we described a significant increase in the temporal summation threshold after the BoNT-A injection. Our data supports the hypothesis that peripherally injected OnabotulinumtoxinA modulates the excitability of spinal cord nociceptive pathways. This activity may take place irrespective of the effect of the drug on spasticity

The successful introduction of an adapted form of the mini extra corporeal circulation used for cardiac surgery in an obese patient

Obese patients undergoing cardiac surgery have been shown to have a high risk of developing postoperative complications, specifically: increased length of hospital stay, readmission to intensive care unit, acute renal failure, deep sternal wound infections and new onset of atrial fibrillation

Perturbations in cosmologies with a scalar field and a perfect fluid

We study the properties of cosmological density perturbations in a multi-component system consisting of a scalar field and a perfect fluid. We discuss the number of degrees of freedom completely describing the system, introduce a full set of dynamical gauge-invariant equations in terms of the curvature and entropy perturbations, and display an efficient formulation of these equations as a first-order system linked by a fairly sparse matrix. Our formalism includes spatial gradients, extending previous formulations restricted to the large-scale limit, and fully accounts for the evolution of an isocurvature mode intrinsic to the scalar field. We then address the issue of the adiabatic condition, in particular demonstrating its preservation on large scales. Finally, we apply our formalism to the quintessence scenario and clearly underline the importance of initial conditions when considering late-time perturbations. In particular, we show that entropy perturbations can still be present when the quintessence field energy density becomes non-negligible.Comment: RevTex4, 9 pages, 3 figures. Significant additions on the quintessence scenario (new appendix and additional numerical example). Conclusions unchanged, but more robus

Trends and safety of bariatric revisional surgery in Italy: multicenter, prospective, observational study

Background: revisional bariatric surgery (RBS) represents a further solution for patients who experience inadequate weight loss (IWL) following primary bariatric surgery (BS) or significant weight regain (WR) following initial satisfactory response. RBS guidelines are lacking; however, an increased trend in further BS offerings has been reported recently. Objective: analyze trend, mortality, complication, readmission, and reoperation rates for any reason at 30 days after RBS in Italy. Setting: ten Italian high-volume BS centers (university hospitals and private centers). Methods: prospective, observational, multicenter study enrolling patients undergoing RBS between October 1, 2021, and March 31, 2022, registering reasons for RBS, technique, mortality, intraoperative and perioperative complications, readmissions, and reinterventions for any reason. Patients undergoing RBS during the same calendar interval in 2016-2020 were considered control patients. Results: a total of 220 patients were enrolled and compared with 560 control-group patients. Mortality was .45% versus .35% (n.s), with an overall mortality of .25%, while open surgery or conversion to open surgery was registered in 1%. No difference was found for mortality, morbidity, complications, readmission (1.3%), and reoperation rates (2.2%). IWL/WR was the most frequent cause, followed by gastroesophageal reflux disease; Roux-en-Y gastric bypass was the most used revisional procedure (56%). Sleeve gastrectomy was the most revised procedure in the study group, while gastric banding was the most revised in the control group. RBS represents up to 9% of the total BS in the Italian participating centers. Conclusions: laparoscopy represents the standard approach for RBS, which appears safe. Current Italian trends show a shift toward sleeve gastrectomy being the most revised procedure and Roux-en-Y gastric bypass being the most frequent revisional procedure