24H pHmetric Evaluation of GERD after Laparoscopic Nissen-Rossetti Fundoplication: 1 Year Follow Up. 21st National Congress of the Italian Polyspecialist Society of Young Surgeons (IPSYS). June 15-18, 2008, Perugia

Introduction: Laparoscopic Nissen Fundoplication is the gold standard for surgical treatment of GERD. Results 1 year after Nissen-Rossetti Fundoplication is reported. Material and Methods: 92 N-R performed, underwent to a pre and postoperative work-up including symptom quest, barium meal, endoscopy and 24-h pH-metry. 64 patients were considered. 92% of treated patients was asymptomatic. Results: 24-h pH-metry was positive in 3 cases: total number of reflux episodes decreased from 40,00 ± 4,5 to 8,79 ± 2,3; the duration of longest episode decreased from 98,73 mins to 11,50 mins; the percentage of time with esophageal pH<4 was 1,8% ± 0,7 for total time, 1,4% ± 1,3 for supine time and 1,88% ± 0,6 for erect time; DeMeester & Johnson’s Score decreased from 79,4 ± 1,0 to 13,2 ± 3,1; endoscopy with histological samples evidenced a strong improvement of esophagitis, a stationary aspect of Barrett’s Esophagus in 1 patients, a complete regression in 2 patients; 17 patients complained dysphagia spontaneously relieved within 1 month; there was no need of reintervention, only one patient recurred to PPI therapy and one to benzodiazepine administration, however 95% of patients were completely satisfied by surgical results. Conclusion: Based on our personal experience, laparoscopic N-R Fundoplication can totally control acid reflux after 1 year with relatively few complications and a high degree of patient satisfaction

Laparoscopic combined Nissen-Rossetti fundoplication and cholecystectomy: our experience - [Plastica Nissen-Rossetti e colecistectomia in un unico tempo laparoscopico: esperienza personale]

The aim of this study is to valuate the opportunity to associate both laparoscopic Nissen-Rossetti fundoplication and cholecystectomy in patients with gallbladder cholelithiasis and gastro-oesophageal acid reflux (endoscopically and pHmetrically assessed), considerating that the gallbladder removal makes duodenal-gastric reflux worse. From 2005 until 2007 we associated laparoscopic Nissen-Rossetti fundoplication and cholecystectomy in 10 patiens, who presented surgical indications for gallbladder cholelithiasis and gastro-oesophageal reflux. Clinical data, surgical procedures and post-operative complications were compared to our esperiency on the singular procedure (laparoscopic Nissen-Rossetti fundoplication and cholecystectomy). Results were valuated at 3, 6 and 12 months after surgical interventions by clinical and instrumental follow up (24-pH-metry and oesophagus-gastro-duodenoscopy). The analysis of instrumental data of these associated procedures doesn't present significative differences between the singular surgical approach. In all the patients treated by combined procedure, the follow-up shows a normal pHmetric exam, a good control on the acid reflux by fundosplication, absence of distal oesophagitis and gastric reflux symptoms. The association of laparoscopic Nissen-Rossetti fundoplication and laparoscopic cholecystectomy is indicated in patients who present both pathologies and needs to be considerating in relations to the good results and the low postoperatoric morbidity

[Intragastric balloon in bariatric surgery].

Gli Autori presentano la loro casistica sul palloncino intragastrico (BIB) nel trattamento dell’obesità. Il BIB è un dispositivo meccanico restrittivo, costitutito da un involucro in silicone che viene introdotto in cavità gastrica per via endoscopica, riempito con 500 cc di soluzione fisiologica colorata con blu di metilene e mantenuto in situ per 6 mesi. Nell’arco di 2 anni sono stati posizionati 98 palloncini intragastrici a 88 pazienti la cui età media era di 37.1 anni e l’indice di massa corporea (BMI) medio di 41.9; l’eccesso ponderale medio era 47,6 kg. Le complicanze registrate sono state l’intolleranza, il reflusso gastro-esfageo (RGE), la rottura e/o la desufflazione del palloncino e meteorismo. Il BIB è risultata una procedura efficace nel trattamento temporaneo dell’obesità potendo indurre un soddisfacente calo ponderale e un miglioramento a breve termine delle comorbilità. Intragastric balloon (BIB) is a mechanical restrictive device formed by a silicone wrapper inserted endoscopically in the stomach, filled with 500 cc of phisiological blue metilene solution and kept in situ for 6 months. In two years 98 intragastric balloon have been set in 88 patients at the average age of 37.1 years, of 41.9 of BMI and 47.6 kg of weight. Complications were intolerance, gastro-oesophageal reflux, break and/or deflation and meteorism. BIB is an effective procedure in obesity temporary treatment leading a satisfactory loss of weight and a short-term comorbility improvement

The Footprints of Poly-Autoimmunity: Evidence for Common Biological Factors Involved in Multiple Sclerosis and Hashimoto’s Thyroiditis

Autoimmune diseases are a diverse group of chronic disorders and affect a multitude of organs and systems. However, the existence of common pathophysiological mechanisms is hypothesized and reports of shared risk are emerging as well. In this regard, patients with multiple sclerosis (MS) have been shown to have an increased susceptibility to develop chronic autoimmune thyroid diseases, in particular Hashimoto’s thyroiditis (HT), suggesting an autoimmune predisposition. However, studies comparing such different pathologies of autoimmune origin are still missing till date. In the present study, we sought to investigate mechanisms which may lead to the frequent coexistence of MS and HT by analyzing several factors related to the pathogenesis of MS and HT in patients affected by one or both diseases, as well as in healthy donors. In particular, we analyzed peripheral blood mononuclear cell gene-expression levels of common candidate genes such as TNFAIP3, NR4A family, BACH2, FOXP3, and PDCD5, in addition to the regulatory T cell (Treg) percentage and the 25-hydroxy vitamin D serum levels. Our findings support the plausibility of the existence of common deregulated mechanisms shared by MS and HT, such as BACH2/PDCD5-FOXP3 pathways and Tregs. Although the biological implications of these data need to be further investigated, we have highlighted the relevance of studies comparing different autoimmune pathologies for the understanding of the core concepts of autoimmunity