Laparoscopic Cholecystectomy in the Cirrhotic: Review of Literature on Indications and Technique

Cholelithiasis is twice more common in patients suffering from liver cirrhosis compared to overall population and in those patients, acute cholecystitis occurs significantly more often. Our goal was to review the literature and to overview the indications, contra-indications, and alternatives in the cirrhotic with biliary stones. We conducted a systematic review of the literature using the key words "Cirrhosis", "cholecystectomy", "laparoscopy"and "indications". Selected articles were reviewed for information specific to indications, contra-indications, and alternatives to laparoscopic cholecystectomy in cirrhotics. Results showed that laparoscopic cholecystectomy might offer several advantages in cirrhotic population, however cholecystectomy can be challenging: specific indications and alternatives to surgery must be discussed case by case. Laparoscopic cholecystectomy can be performed safely in selected patients with cirrhosis; special precautions are warranted regarding pneumoperitoneum pressure, trocar placement and increased safety with Indocyanine-green (ICG) fluorescence cholangiography. Nevertheless, in high-risk cirrhotic patients (Child C) and/or in common bile duct lithiasis endoscopic and non-surgical conservative treatments are preferable

Acute Bilateral Carpal Tunnel Syndrome Associated with Human Parvovirus B19 Infection

Human parvovirus B19 has been described as a causative agent of erythema infectiosum (a disease common in children), aplastic crisis in patients with hemolytic disorders, and arthralgias and arthritis. Joint involvement may be a prominent clinical feature of parvovirus Bi9 infection and may last for several weeks. We describe three cases of acute bilateral carpal tunnel syndrome associated with parvovirus B19 infection as evidenced by serological data and, in one case, by detection of parvovirus B19 DNA in blood with use of PC

Certolizumab pegol : an evidence-based review of its place in the treatment of Crohn’s disease

Introduction: Crohn\u2019s disease (CD) is a chronic inflammatory bowel disease characterized by a relapsing/remitting course with transmural inflammation of potentially any section of the digestive tract. Certolizumab pegol (CZP) is a pegylated Fc-free Fab\u2019 fragment of a humanized anti-TNF-alfa monoclonal antibody that is in development for clinical use in CD. Aims: To review the available data with CZP in CD, to investigate its possible place in therapy. Evidence review: Available studies suggest that CZP has the potential to achieve and maintain clinical response and remission in moderate to severe CD, and to improve quality of life compared with placebo. Further studies with CZP are also ongoing. Place in therapy: Although only suggested by currently available studies, successive clinical practice and further ongoing trials may confirm a positive role for CZP as a new anti-TNF treatment in CD. The impact on clinical management or on resources cannot be estimated until the results from all phase III clinical trials are available and the price is determined

Smoke Evacuation During Laparoscopic Surgery: A Problem Beyond the COVID-19 Period. A Quantitative Analysis of CO2 Environmental Dispersion Using Different Devices

Background. The COVID-19 pandemic leads to several debates regarding the possible risk for healthcare professionals during surgery. SAGES and EAES raised the issue of the transmission of infection through the surgical smoke during laparoscopy. They recommended the use of smoke evacuation devices (SEDs) with CO2 filtering systems. The aim of the present study is to compare the efficacy of different SEDs evaluating the CO2 environmental dispersion in the operating theater. Methods. We prospectively evaluated the data of 4 group of patients on which we used different SEDs or standard trocars: AIRSEAL system (S1 group), a homemade device (S2 group), an AIRSEAL system + homemade device (S3 group), and with standard trocars and without SED (S4 group). Quantitative analysis of CO2 environmental dispersion was carried out associated to the following data in order to evaluate the pneumoperitoneum variations: a preset insufflation pressure, real intraoperative pneumoperitoneum pressure, operative time, total volume of insufflated CO2, and flow rate index. Results. 16 patients were prospectively enrolled. The [CO2] mean value was 711 ppm, 641 ppm, 593 ppm, and 761 ppm in S1, S2, S3, and S4 groups, respectively. The comparison between data of all groups showed statistically significant differences in the measured ambient CO2 concentration. Conclusion. All tested SEDs seem to be useful to reduce the CO2 environmental dispersion respect to the use of standard trocars. The association of AIRSEAL system and a homemade device seems to be the best solution combining an adequate smoke evacuation and a stable pneumoperitoneum during laparoscopic surgery

Serum protein profiling of early and advanced stage Crohn's disease

AbstractCrohn's disease (CD) represents a highly debilitating disease of difficult diagnosis and increasing incidence. Serum protein profiling of early stage Crohn's disease (ES) CD was investigated in order to improve the comprehension of the very early pathologic mechanisms and to support the difficult diagnostic procedures currently available. Inflammatory proteins and complement 3 chain C (C3c) were over-represented during ES CD, clusterin, retinol binding protein, α1-microglobulin and transthyretin were under-represented. A C3c isoform was found to be present only during ES CD. By now, lack of specific antibodies to detect isoforms made it impossible to perform alternative validation

Transanal total mesorectal excision (TaTME) : tips and tricks of a new surgical technique

Laparoscopic total mesorectal excision (TME) can be technically challenging especially in obese and patients with narrow pelvis. Transanal TME (TaTME) is a technique that combines abdominal and transanal endoscopic approach to overcome limitations and facilitate standard laparoscopic TME. The authors present some specific tips and tricks to perform this complex procedure using a double team approach and a new reusable transanal port

The Italian clinical experience with adalimumab in Crohn's disease: Eleven clinical cases

This supplement contains 11 clinical cases from 11 Italian inflammatory bowel disease (IBD) specialists, giving an overview of clinical practice with regard to the use of adalimumab in the management of Crohn’s disease (CD)