102,069 research outputs found
Training in bariatric and metabolic endoscopy
No full textThe limited penetration of bariatric surgery and the scarce outcome of pharmacological therapies created a favorable space for primary bariatric endoscopic techniques. Furthermore, bariatric endoscopy is largely used to diagnose and treat surgical complications and weight regain after bariatric surgery. The increasingly essential role of endoscopy in the management of obese patients results in the need for trained professionals. Training methods are evolving, and the apprenticeship method is giving way to the simulation-based method. Existing simulation platforms include mechanical simulators, ex vivo and in vivo models, and virtual reality simulators. This review analyzes current training methods for bariatric endoscopy and available training programs with dedicated bariatric core curricula, giving a glimpse of future perspectives
Optimal workup for a hiatal hernia
No full textHiatal hernias are common and generally correlated with obesity and increasing age. However, many individuals have no symptoms and are never diagnosed, thus it’s hard to establish the real prevalence of hiatal hernias. To pursue a diagnosis of hiatal hernia is not necessary in asymptomatic patients, but symptomatic ones need evaluation and should be considered for surgical repair. The clinical workup is based on the patient's symptomatology and clinical presentation. For elective HH repair we advocate the use of few standard pre-operative tests as first line. More specific functional and morphological studies scan should be used case by case depending on the hernia size, patients’ symptoms and setting
PUBBLICO CONCORSO , PER TITOLI ED ESAMI, AD N° 1 POSTO DI COLLABORATORE TECNICO ENTI DI RICERCA IN PROVA - VI LIVELLO PROFESSIONALE DELL'ISTITUTO SUPERIORE DI SANITA' - PER IL SERVIZIO QUALITA' E SICUREZZA SPEIRMENTALE ANIMALE - PUBBLICATO NELLA G.U. - 4° SERIE SPECIALE - N° 102 DEL 28/12/2001.
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A biomechanical assessment of laparoscopic sleeve gastrectomy with a patient-specific approach
No full textObesity has become a global epidemic and bariatric surgery (BS) is one of the most commonly performed gastrointestinal operations thanks to the loss of a large amount of weight and an improvement of patients’ clinical situation. Among different BSs, laparoscopic sleeve gastrectomy (LSG) is currently the most performed procedure worldwide [1], but some limitations still remain and late complications may arise (e.g., GERD). For these reasons, the development of computational patient-specific models represents a valuable solution to overcome these limits and controversies [2]. Indeed, within this work, patient-specific pre- and post-surgical models were extracted from MRI scans of twenty-three patients who underwent LSG [3]. Forty-six computational analyses were realized, focusing on the volumetric gastric reduction after LSG, the mechanical response of the stomach during an inflation process and the elongation strain (LE) distribution at different intragastric pressures. Results were significant in assessing a different mechanical behaviour of pre- and post-surgical stomachs subjected to the same internal gastric pressure. This response can be correlated to unusual activations of mechanoreceptors and thus variation of satiety after LSG. All these insights aim at improving the current knowledge about BS, enhancing postsurgical success and quality of life in the long run.
REFERENCES
[1] H. Buchwald, D.M. Oien, Metabolic/bariatric surgery worldwide 2011, Obes. Surg. 23 427–436, 2013 https://doi.org/10.1007/s11695-012-0864-0.
[2] I. Toniolo, C. Salmaso, G. Bruno, A. De Stefani, C. Stefanini, A.L.T. Gracco, E.L. Carniel, Anisotropic computational modelling of bony structures from CT data: An almost automatic procedure, Comput. Methods Programs Biomed. 189 1–11, 2020 https://doi.org/10.1016/j.cmpb.2020.105319.
[3] G. Quero, C. Fiorillo, B. Dallemagne, P. Mascagni, J. Curcic, M. Fox, S. Perretta, The Causes of Gastroesophageal Reflux after Laparoscopic Sleeve Gastrectomy: Quantitative Assessment of the Structure and Function of the Esophagogastric Junction by Magnetic Resonance Imaging and High-Resolution Manometry, Obes. Surg. 30 2108–2117, 2020 https://doi.org/10.1007/s11695-020-04438-y
Injectable hybrid alginate hydrogels and uses thereof
No full textThe invention relates to a hybrid hydrogel, in particular degradable or non-degradable, comprising a first hydrogel polymer of formula (I) in association with an alginate hydrogel polymer, and optionally organosilica particles in particular degradable or non-degradable nanoparticles, or porous silicon particles; pharmaceutical, veterinary and/or cosmetic compositions thereof; and uses thereof as a medicament. The invention notably relates to the use of such hybrid hydrogel in the treatment of fistulas and physiological leaks/leakages, notably in the gastrointestinal tract. The present invention finds applications in the therapeutic and diagnostic medical technical fields and also in cosmetic and veterinary technical fields
From peptides to small molecules: An intriguing but intricated way to new drugs
No full textA variety of peptides active in biological pathways have been identified e.g. receptor antagonists or inhibitors of protein-protein interactions and several peptide or peptide-derived compounds are on the drug market or in clinical trials. Through the rational design or the combinatorial preparation and High-throughput screening of arrays of compounds, peptides play a pivotal role for the rapid identification of ligands, but, despite these favorable properties, they often present poorer bioavailability and lower metabolic stability respect to traditional drugs. The process of conversion of a peptide in a small molecule provides the reduction of the peptide to the minimum active sequence (MAS) testing truncated peptides from the C- and N- termini alternatively. Then the influence of individual amino acid on the biological activity is determined by systematically replacing each residue in the peptide with specific amino acids. After structure-activity relationship (SAR) of each amino acid in the sequence has been assessed, the bioactive conformational flexibility is reduced by introducing constraints at various positions. These features are used for the design of a pharmacophore model in which functional groups crucial for activity are pre-positioned. Here we propose a panoramic review of the common principles for the conversion of peptides into small organic molecules and the most interesting findings in peptide-based leads of the last decades
Multimedia Article. The Fear of Transgastric Cholecystectomy: Misinterpretation of the Biliary Anatomy
No full textIntroduction: Prevention of injury during cholecystectomy relies on accurate dissection of the cystic duct and artery and avoidance of major biliary and vascular structures. The advent of natural orifice translumenal surgery (NOTES) has led to a new look into the biliary anatomy, especially Calot's triangle. Here we show the clinical case of a NOTES transgastric cholecystectomy for uncomplicated cholelithiasis, in which misinterpretation of the biliary anatomy occurred.
Methods and procedure: A 5-mm port was introduced at the umbilicus to ascertain the feasibility of transgastric cholecystectomy and to ensure safe gastrotomy creation and closure. Transgastric access was obtained using a percutaneous endoscopic gastrostomy (PEG)-like technique on the anterior mid body of the stomach to pass a 12-mm gastroscope (Karl Storz, Tuttlingen, Germany). The laparoscope was switched to a grasper for gallbladder retraction. Dissection was started close to the gallbladder using the endoscope at the junction between the infundibulum and what was thought to be the cystic duct. During dissection, the size and the orientation of the cystic duct appeared to be unclear. The decision was made to switch to a laparoscopic view to reorient the dissection plane and clarify the anatomy. At laparoscopy, dissection of the triangle of Calot, although started close to the gallbladder, appeared far too low. The common bile duct had been mistaken for the cystic duct. Once the biliary anatomy was clarified, the vision was switched back to the endoscope, but an additional 2-mm grasper was introduced to improve exposure while cholecystectomy was performed in a standard fashion.
Conclusions: Specific anatomic distortions due to NOTES technique together with the lack of exposure provided by current methods of retraction tend to distort Calot's triangle by flattening it rather than opening it out. At this stage, whenever the anatomy of the biliary tract is unclear, a temporary "conversion" to a laparoscopic view, more familiar to the surgeon's eye, is recommended
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