The beneficial effect of Mediterranean Diet on Colon-rectal Cancer

Dear Editor, We have read with great interest the paper \u201cMediterranean diet adherence and risk of pancreatic cancer: A pooled analysis of two Dutch cohorts.\u201d by Schulpen M and coworkers [1] and we found their conclusion of importance with a view to clinical prevention. They examined the association between Mediterranean Diet (MedD) adherence and pancreatic cancer incidence by pooling data from the Netherlands Cohort Study (NLCS, 120,852 subjects) and the Dutch cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC\u2010NL 40,011 subjects). MedD adherence was assessed using alternate and modified Mediterranean diet scores including and excluding alcohol. MedD adherence was not significantly associated with pancreatic cancer risk in pooled and study specific analyses, regardless of sex and MedD score. Authors concluded that MedD adherence was not associated with pancreatic cancer risk in a pooled analysis of two Dutch cohorts. With reference to the findings reported in the paper, we would like to make the following contribution to the discussion. In a recent paper we analysed 3 components of the Mediterranean Diet that seems to be associated with reduction of Colon Cancer [2]. We analysed the effects of olive oil (polyphenols), red grapes (resveratrol), and tomatoes (lycopene). Specifically, the consumption of olive oil exerts a protective effect in reducing risk for CRC many other types of cancer, including prostatic and breast. Olive oil may exert its protective effect, influencing polyamine metabolism in cells leading to a reduction in cancerogenesis progression. [3] Accepted Article This article is protected by copyright. All rights reserved. 3 The Mediterranean Diet is characterized by high intake of antioxidants and polyphenols. [4,5] It is well known that these components exert many positive effects on cardiovascular system and prevent the development of atherosclerosis both in men and women [4,5]. Schulpen M and coworkers observed no association between MedD adherence and pancreatic cancer in both women and men. It is well known that the there is a sex differences in oxidative stress and inflammation. [6,7,8] Oxidative stress and inflammation play a crucial role in the pathogenesis of atherosclerosis vascular inflammation leading to infarction and ischemia. Oxidative stress seems to be higher in male than female rats, being that the levels of SOD, GPx and lipid peroxidation are lower and higher in males versus females, respectively. [6] In humans, the biomarkers of oxidative stress are higher in young men than in women of the same age, although this is not a univocal result. Resveratrol has many pleiotropic pharmacologic properties. It promotes protection against damage from reactive oxygen species and from inflammation, resulting in cardiovascular protective benefits and, certainly, anticancer activities. In our review of the literature we concluded that the beneficial effects of Mediterranean Diet in patients with colon cancer belong to the synergistic effects of several components

Mediterranean Diet and wine intake could improve atrial function in patients with atrial fibrillation

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Choledochocele: Choledochal Cyst Ora Distinct Entity?

Choledochocele represents a cystic dilatation of the distal common bile duct and it’s included in Todani’s classification as type III choledochal cysts. We report a case of a 66-years-old man who presented a suspected gallbladder lithiasis with colic abdominal pain, vomit, fever, jaundice and abnormal liver function tests. However the endoscopic retrograde cholangio-pancreatography revealed the absence of stones in the common bile duct and the presence of a 15mm-wide choledochocele that was successfully treated with an endoscopic sphincterotomy. Additionally a comprehensive review of the literature of the last 15 years was performed, collecting 105 cases of choledochocele. The available data were classified in 10 variables and subsequently analysed. Summarizing all data, we noticed that choledochocele presents different characteristics if compared with other types of choledochal cysts: The population affected is older, there isn’t a strong female prevalence, the most frequent manifestation is pancreatitis instead of jaundice and cholangitis, the association with anomalous pancreato-biliary duct junction is rare and the risk of malignancy is lower. The standard for the diagnosis is endoscopic retrograde cholangio-pancreatography instead of magnetic resonance cholangio-pancreatography and the most accepted treatment is endoscopic sphincterotomy in order to allow the correct outflow of the biliary juice. In conclusion, even if choledochocele is commonly considered a type of cystic dilatation of the common biliary duct and it is usually included in the choledochal cysts classification, it has to be considered as a distinct entity with its own features

Choledochocele: Choledochal Cyst Ora Distinct Entity?

Choledochocele represents a cystic dilatation of the distal common bile duct and it’s included in Todani’s classification as type III choledochal cysts. We report a case of a 66-years-old man who presented a suspected gallbladder lithiasis with colic abdominal pain, vomit, fever, jaundice and abnormal liver function tests. However the endoscopic retrograde cholangio-pancreatography revealed the absence of stones in the common bile duct and the presence of a 15mm-wide choledochocele that was successfully treated with an endoscopic sphincterotomy. Additionally a comprehensive review of the literature of the last 15 years was performed, collecting 105 cases of choledochocele. The available data were classified in 10 variables and subsequently analysed. Summarizing all data, we noticed that choledochocele presents different characteristics if compared with other types of choledochal cysts: The population affected is older, there isn’t a strong female prevalence, the most frequent manifestation is pancreatitis instead of jaundice and cholangitis, the association with anomalous pancreato-biliary duct junction is rare and the risk of malignancy is lower. The standard for the diagnosis is endoscopic retrograde cholangio-pancreatography instead of magnetic resonance cholangio-pancreatography and the most accepted treatment is endoscopic sphincterotomy in order to allow the correct outflow of the biliary juice. In conclusion, even if choledochocele is commonly considered a type of cystic dilatation of the common biliary duct and it is usually included in the choledochal cysts classification, it has to be considered as a distinct entity with its own features

Effects of Caffeine on Colon: A Potential Clinical Use of Coffee in Surgical Patients

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Laparoscopic Cholecystectomy With Harmonic Scalpel

This study suggests that the Harmonic scalpel is a safe and effective instrument for laparoscopic cholecystectomy, because it provides complete hemobiliary stasis

TRANSPERITONEAL LAPAROSCOPIC ADRENALECTOMY IN CHILDREN: INITIAL EXPERIENCE

PURPOSE: The use of mini-invasive approach for adrenalectomy is poorly defined in pediatric patients, although laparoscopic adrenalectomy is considered a standard procedure in adults. The aim of our study is to describe the safety and feasibility of minimally invasive adrenalectomy in children based on surgical skills and results. MATERIALS AND METHODS: This is a retrospective study of four pediatric laparoscopic adrenalectomies performed in our centre between 2009 and 2012. All patients underwent transperitoneal lateral laparoscopic adrenalectomy two of which were right adrenalectomies and two were left. RESULTS: Four laparoscopic adrenalectomies were performed. Indications for surgery were neuroblastoma in two patients, secernent adrenocortical tumor in one patient and adrenocortical nodular hyperplasia in the last one. Patients had a mean age of 87 months (range 17-156) at diagnosis and the average lesion size was 3.23 cm (range 0.7-6.4). All laparoscopic adrenalectomies were successful, no conversions to open surgery were required and no post- operative complications or deaths occurred. The average operating time was 105 minutes (range 80-130), blood loss during surgery was minimal and the mean post-operative hospital stay was 3.75 days (range 3-5). None of the patients showed signs of recurring disease at 15-months follow- up. CONCLUSIONS: Laparoscopic adrenalectomy is a safe, feasible and reproducible technique offering numerous advantages including shortening of operating times and post-operative hospital stays, as well as reduction of blood loss and complications. It also provides good visibility and easy access to other organs

Case Report: Metastatic breast cancer to the gallbladder

Cholecystitis is one of the leading causes of emergency surgical interventions; the occurrence of metastases to the gallbladder is rare and has only been reported in the literature exceptionally. Metastatic breast cancer to the gallbladder is even less frequent; in fact, breast cancer usually metastasizes to bone, lung, lymph nodes, liver and brain. We report the case of an 83-year-old female patient with a previous history of breast surgery with axillary dissection in 1997, followed by adjuvant chemotherapy due to invasive ductal carcinoma of the left breast. The patient was admitted at the emergency department for sepsis and an episode of acute kidney failure, anuria and fever. Right-upper quadrant abdominal pain triggered by food intake and abdominal tenderness was also present, placing the diagnostic suspicion of biliary sepsis due to acute cholecystitis. The histological examination of the surgical specimen highlighted the presence of metastasis from an infiltrating ductal breast carcinoma with positive hormone receptors. We also report here the results of a review of the literature looking at articles describing cases of gallbladder metastasis from breast cancer

FIRST CASE OF LAPAROSCOPIC PARTIAL SPLENECTOMY IN A CHILD WITH HAMARTOMA: CASE REPORT AND REVIEW OF THE LITERATURE

INTRODUCTION To date, laparoscopic surgery has played a key role in the treatment of not only splenic hematologic pathologies but also solid ones. Hamartoma is a rare disease; only twenty percent of them are of pediatric relevance; it is a benign tumor, but radiological features never allow proper differentiation from malignant neoplasms. In children, hamartoma may be associated with other morbid conditions, such as sickle cell disease or other hematological alterations. PRESENTATION OF THE CASE We report a case of hamartoma in a 7-year-old child treated with partial laparoscopic splenectomy After a multidisciplinary evaluation, the indication of laparoscopic splenectomy was decided; upon evaluating the age of the patient and the affected spleen portion, a partial splenectomy was proposed. The histological examination during surgery was performed to exclude any form of malignancy. The intraoperative frozen section of the specimen was negative for malignancies, and a partial splenectomy was performed. DISCUSSION Surgery remains the first choice in the definitive treatment of solid lesions of the spleen; minimally invasive technique, namely, laparoscopy, has set itself as the technique of choice for surgical treatment. In this case, the possibility of obtaining an intraoperative pathological diagnosis by frozen section of the specimen, confirming the benign nature of the lesion, allowed the surgeon to decide in favor of a laparoscopic partial splenectomy. CONCLUSION Partial laparoscopic splenectomy can be considered a safe, effective and reproducible alternative in patients suffering from benign solid diseases, safeguarding the hematological functions of the organ itself in pediatric age