1,721,085 research outputs found
[D-Ala2,D-Leu5]-enkephalin (DADLE) and morphine-induced postconditioning by inhibition of mitochondrial permeability transition pore, in human myocardium
No full textThe aim of the study was to examine the cardioprotective effect of morphine and Delta 2 opioid d-Ala2-Leu5 enkephalin (DADLE) administered, at early reoxygenation, in isolated human myocardium exposed to hypoxia-reoxygenation. Then, we tested the involvement of mitochondrial permeability transition pore in morphine and DADLE-induced postconditioning. Human right atrial trabeculae were obtained during cardiac surgery (coronary artery bypass and aortic valve replacement). Isometrically contracting isolated human right atrial trabeculae were exposed to 30-min hypoxia and 60-min reoxygenation (control group). In treatment groups, morphine 0.5 μmol, DADLE 10 nmol, DADLE 50 nmol and DADLE 100 nmol were administered during the first 15 min of reoxygenation. In two additional groups, morphine and DADLE 100 nmol were administered in the presence of atractyloside 50 μmol, the mitochondrial permeability transition pore opener. The force of contraction at the end of 60-min reoxygenation period (FoC(60) expressed as % of baseline) was compared (mean ± standard deviation) between the groups by an analysis of variance. Morphine (FoC(60): 81 ± 9% of baseline), DADLE 50 nmol (FoC(60): 76 ± 11% of baseline) and DADLE 100 nmol (FoC(60): 81 ± 4% of baseline) increased significantly (P < 0.001) the FoC(60) as compared with the control group (FoC(60): 53 ± 3% of baseline). DADLE 10 nmol did not modify the FoC(60) (50 ± 9% of baseline; P = 0.60 versus control group). The enhanced recovery of FoC(60) induced by morphine and DADLE 100 nmol were abolished in the presence of atractyloside (FoC(60): respectively 57 ± 6% and 44 ± 7% of baseline; P < 0.001). In conclusion, the administration of morphine and DADLE, in early reoxygenation period, protected human myocardium, in vitro, against hypoxia-reoxygenation injury, at least in part, by the inhibition of mitochondrial permeability transition pore opening
Surgical treatment of small bowel neoplasms.
No full textSmall intestinal neoplasms are uncommon cancers. Benign small intestinal tumors (e.g., leiomyoma, lipoma, hamartoma, or desmoid tumor) usually are asymptomatic but may present with complications. Primary malignancies of the small intestine, including adenocarcinoma, leiomyosarcoma, carcinoid, and lymphoma, are often symptomatic and may present with intestinal obstruction, jaundice, bleeding, or pain. Metastatic neoplasms may involve the small intestine via contiguous spread, peritoneal metastases or hematogenous metastases. Because the small intestine is relatively inaccessible to routine endoscopy, diagnosis of small intestinal neoplasms is often delayed for months after onset of symptoms. During last years the increase of small bowel endoscopy and other diagnostic tools allow earlier non-operative diagnosis. Even though radical resection of small bowel cancer plays an important role, the 5 yr overall survival remains low
Anti-TNF alpha in the treatment of ulcerative colitis: a valid approach for organ-sparing or an expensive option to delay surgery?
No full textUlcerative colitis (UC) is an inflammatory bowel disease affecting large bowel with variable clinical course. The history of disease has been modified by the introduction of biologic therapy, in particular Infliximab (IFX), that has demonstrated efficacy in inducing fast symptoms remission, promoting mucosal healing and maintaining long-term remission. However, surgery is still needed for UC patients: in case of failure of medical therapy and if acute complications or a malignancy occurred. Surgical treatment is associated with a short-term post-operative mortality and morbidity respectively of 0%-4% and 30%. In this study we systematically analyzed: the role of IFX in reducing the colectomy rate, the risk of post-operative morbidity in pre-operatively IFX-treated patients and the cost-effectiveness of IFX therapy. Four of 5 analyzed randomized controlled trials demonstrated that therapy with IFX significantly reduces the colectomy rate. Moreover, pre-operative treatment with IFX doesn't seem to increase post-operative infectious complications. By an economic point of view, the cost-effectiveness of IFX-therapy was demonstrated for UC patients suffering from moderate to severe UC in a study based on a cost estimation of the National Health Service of England and Wales. However, the argument is debated
Anti-TNF-alpha therapies do not increase early postoperative complications in patients with inflammatory bowel disease. An Italian single-center experience.
No full textPURPOSE:
The impact of preoperative use of TNF-alpha inhibitors on postoperative complications in patients with inflammatory bowel disease (IBD) undergoing abdominal surgery is controversial. The aim of this study was to evaluate the 30-day postoperative outcomes for IBD patients treated with these drugs prior to surgery.
METHODS:
We analyzed retrospectively the incidence of short-term postoperative complications. Statistical analyses were performed to reveal the independent variables that influenced postoperative complications and the role of preoperative medical therapy with anti-TNF drugs within 12 weeks prior to surgery.
RESULTS:
One hundred fourteen patients (76 with Crohn's disease (CD) and 38 ulcerative colitis (UC)) underwent abdominal surgery for IBD. Fifty-four patients were treated with anti-TNF-alpha within 12 weeks prior to surgery (anti-TNF group). Postoperative mortality and morbidity were 0% and 21%, respectively. The infection rate was 15%. A significantly higher incidence of postoperative complications was found in patients treated with high-dose steroids (58% vs. 17%; p = 0.003) after univariate analysis. The infection rate was significantly higher in patients treated with high-dose corticosteroids (50% vs. 11%; p = 0.002) and concomitant anti-TNF-alpha (60% vs. 13%; p = 0.023). Multivariate analysis revealed that only therapy with high-dose corticosteroids was significantly associated with cumulative (p = 0.017) and infective postoperative complications (p = 0.046). No significant differences were found between the anti-TNF group and the control group.
CONCLUSION:
High-dose corticosteroids increased the risk of short-term postoperative cumulative and infective complications. Anti-TNF drugs within 12 weeks prior to abdominal surgery in patients with IBD did not appear to increase the rate of postoperative complications
Practice parameters for early colon cancer management: Italian Society of Colorectal Surgery (Società Italiana di Chirurgia Colo-Rettale; SICCR) guidelines
No full textEarly colon cancer (ECC) has been defined as a carcinoma with invasion limited to the submucosa regardless of lymph node status and according to the Royal College of Pathologists as TNM stage T1 NX M0. As the potential risk of lymph node metastasis ranges from 6 to 17% and the preoperative assessment of lymph node metastasis is not reliable, the management of ECC is still controversial, varying from endoscopic to radical resection. A meeting on recent advances on the management of colorectal polyps endorsed by the Italian Society of Colorectal Surgery (SICCR) took place in April 2014, in Genoa (Italy). Based on this material the SICCR decided to issue guidelines updating the evidence and to write a position statement paper in order to define the diagnostic and therapeutic strategy for ECC treatment in context of the Italian healthcare system
Assetti produttivi e dinamiche della produttività nell’epoca della transizione tecnologica
No full textPolyvinylidene Fluoride Mesh (PVDF, DynaMesh®-IPOM) in The Laparoscopic Treatment of Incisional Hernia: A Prospective Comparative Trial versus Gore® ePTFE DUALMESH® Plus.
No full textBACKGROUND:
Laparoscopic approach is now generally accepted for the treatment of incisional hernia. The ideal mesh is still to be found. The aim of this study is to compare the well-known Gore® DUALMESH® Plus (WL Gore & Associates, Flagstaff, AZ) to a new prosthesis, the DynaMesh®-IPOM (FEG Textiltechnik GmbH, Aachen, Germany), to clinically verify its potential benefits in the laparoscopic treatment of incisional hernia.
MATERIALS AND METHODS:
Comparing the results of the laparoscopic treatment of two groups of patients affected by incisional hernia using Gore® DUALMESH® Plus and DynaMesh®-IPOM.
RESULTS:
There were 45 females and 31 males, with age variable from 21 to 84 years of age. The two groups were well matched for age (median age 60 years for group A and 57.6 years for group B-p=0.44) and sex (28F and 17M group A and 13 F and 18 M group B-p=0.008), while median BMI resulted slightly higher in group B (26.12 group A and 29.74 group B-p=0.001). The median size of the defect was similar in the two groups (87.5 mm group A and 83.4 mm for group B-p=0.83), while the median operating time was slightly longer in group A (77 min group A and 67 min group B-p=0.44). No difference in the length of hospital stay was evidenced between the two groups (3.19 days for group A and 3 days for group B-p=0.74). Time to return to physical activity was similar between the two groups (13.46 days for group A and 12.7 days for group B-p=0.32). Minor complications occurred in 15 cases (19.7%): seromas (7 cases), prolonged ileus (6 cases), and hemoperitoneum (2 cases), without significant difference in the incidence of such complications in the two groups. Five recurrences (6.5% of cases) occurred. No differences in the recurrence rate was noted between the two groups (3 cases/7% for group A and 2 cases/6% for group B-p=00.7).
CONCLUSIONS:
DynaMesh®-IPOM proved to be a safe and effective mesh for the laparoscopic repair of incisional hernia even when compared to DUALMESH® Plus
Una questione nazionale. Il Mezzogiorno da «problema» a «opportunità»
No full textA distanza di più di 150 anni dall’Unità d’Italia, la questione meridionale resta questione non risolta e determinante della tenuta sociale e istituzionale del Paese. Sebbene tuttora in ritardo dal punto di vista economico e industriale, il Mezzogiorno è tutt’altro che fermo e presenta importanti potenzialità, come ha dimostrato nel triennio 2015-17: nonostante fosse stato colpito dalle conseguenze della crisi del 2008 in maniera più dura del Centro-Nord, è stato in grado in quegli anni di agganciare la pur limitata ripresa del nostro Paese in tutte le variabili rilevanti, in particolare PIL, occupazione, investimenti ed esportazioni. Il gruppo di studio di Astrid sul tema ha affrontato la questione meridionale da tre punti di vista, distinti ma fortemente interrelati: il tessuto produttivo e le politiche per lo sviluppo; il divario nei servizi, nelle infrastrutture e nelle condizioni di vita; la tenuta della qualità istituzionale. Ne è nato un volume frutto di riflessioni corali e coordinate sui principali problemi del Mezzogiorno d’Italia. L’esplosione della crisi conseguente all’emergenza sanitaria non cambia i problemi ma rende più urgenti e indifferibili le politiche necessarie ad affrontarli. L’ispirazione di questo lavoro è «risorgimentale», essendo convinzione degli autori che la questione meridionale sia questione nazionale e che sia specifica responsabilità dello Stato affrontarla. Solo nell’appartenenza alla collettività nazionale con i propri diritti e doveri si può porre la questione dell’intervento per ridurre e alla fine chiudere il divario. Il recupero del Secondo dopoguerra è avvenuto in maniera integrata col processo di unificazione reale del Paese, con la sua industrializzazione e infrastrutturazione, con le grandi reti di trasporto e di energia e con la promozione di standard uniformi nella scuola e nei servizi. Senza vagheggiare impossibili ritorni al passato, la tesi centrale è che sia arrivato il momento di enfatizzare maggiormente il senso dell’appartenenza alla comunità nazionale, che così limpidamente si è manifestato durante l’emergenza sanitaria
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