Search

Background and Purpose: In this study we want to evaluate the efficacy of yoga practice on dysfunctional stress, inflammation and QOL in breast cancer patients undergoing adjuvant radiotherapy., Patients and Methods: Patients with stage 0 to III breast cancer were recruited before starting radiotherapy (XRT) and were randomly assigned to yoga group (YG) two times a week during XRT or control group (CG). Self-report measures of QOL, fatigue and sleep quality, and blood samples were collected at day 1 of treatment, day 15, end of treatment and 1, 3 and 6 months later. Cortisol blood level, IL6, IL10, IL1RA, TNFα and lymphocyte-to-monocyte ratio were analyzed as measures of dysfunctional stress and inflammation., Results: Patients started XRT and yoga classes in October 2019. Due to COVID-19 pandemic we closed the enrollment in March 2020. We analysed 24 patients, 12 YG and 12 CG. The analysis of blood cortisol levels revealed an interaction (p = 0.04) between yoga practice and time, in particular YG had lower cortisol levels at the end of XRT respect to CG (p - adj = 0.02). The analysis of IL-1RA revealed an interaction effect (p = 0.04) suggesting differences between groups at some time points that post-hoc tests were not able to detect., Conclusions: To our knowledge, this is the first study to evaluate the effects of yoga in a cancer population studying inflammation markers, cortisol trend and QOL during and until 6 months after XRT. This study suggests that yoga practice is able to reduce stress and inflammation levels over time. Besides including a larger number of patients to increase the power, future studies should consider other inflammatory or pro inflammatory factors and long-term yoga program to gain more evidence on yoga practice benefits., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors. Published by Elsevier B.V. on behalf of European Society for Radiotherapy & Oncology.)

Background: Allergic rhinitis (AR) affects up to 40% of the general population, there are large-scale multicenter studies that have described its characteristics and few studies have focused on studying patients with AR in Latin America (LA)., Methodology: A cross-sectional, descriptive, multicenter study was carried out in four LA countries (Colombia, Argentina, Cuba and Peru). Patients diagnosed with AR between November 2017 and June 2020 were included. Sociodemographic and clinical data, sensitization profile and current treatment were collected in the Electronic Data Collection (BDClinic). Patients also filled out this questionnaires: Rhinitis Control Assessment Test (RCAT), Reflexive Total Nasal Symptom Score (rTNSS), Modified ARIA Criteria for AR Severity (mARIA) and ESPRINT-15. Risk of bias was examined by applying the STROBE checklist., Results: The study included 412 patients. Median age was 25 years (15-39). Two hundred and twenty four (54.3%) were women. Nasal obstruction was present in 303 (73.5%). Three hundred and thirty four (81%) had a persistent AR. One hundred and twenty one (31.3%) had associated asthma. The most frequently positive skin tests were: Dermatophagoides pteronyssinus in 365 (88.6%) and Dermatophagoides farinae in 331 (81.3%). Four hundred and eleven patients (99%) reported that AR affected their quality of life. The median score of ESPRINT-15 was 1.87 (0.93-2.93), The mean values of RCAT and rTNSS were 19.01 (±4.59) and 5.4 (±2.97) respectively. Two hundred and fifty (60%) were receiving only oral antihistamines. Physicians decided to start nasal corticosteroids in 296 (71.8%). Only seventy patients (16.9%) were receiving immunotherapy., Conclusion: These findings confirm that most of patients with AR in LA have a persistent disease with a negative impact on quality of life. Dust mites are the main sensitizers. These findings will allow to know the true impact of AR and can lead to a better disease management., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Silva, De Barayazarra, Valero, Garcia, Uriarte, Peñaranda, Chapman, Garcia, Ocampo, Valencia, Moreno, Corelli, Lopez, Ramirez, Perez, Jares and Serrano.)

Surgical wounds dehiscence is a serious post-operatory complication, with an incidence between 0.4% and 3.5%. Mortality is more than 45%. Complex wounds treatment may require a multidisciplinary management. VAC Therapy could be an alternative treatment regarding complex wound. VAC therapy has been recently introduced on skin's graft tissue management reducing skin graft rejection. The use of biological prosthesis has been tested in a contaminated field, better than synthetic meshes, which often need to be removed. The Permacol is more resistant to degradation by proteases due to its cross-links. Surgery is still considered the best treatment for digestive fistula. A 58 years old obese woman come to our attention, she was operated for an abdominal hernia. She had a post-operatory entero-cutaneous fistula. She was submitted to bowel resection, the anastomosis has been tailored and the hernia of the abdominal wall has been repaired with biological mesh for managing such condition. She had a wound dehiscence with loss of substance and the exposure of the biological prosthesis, nearly 20 cm diameter. She was treated first with antibiotic therapy and simple medications. In addiction, antibiotic therapy was necessary late associated to 7 months with advanced medications allowed a small reduction's defect. Because of its, treatment went on for two more months using VAC therapy. Antibiotic's therapy was finally suspended. The VAC therapy allowed the reduction of the gap, between skin and subcutaneous tissue, and the defect's size preparing a suitable ground for the skin graft. The graft, managed with the vac therapy, was necessary to complete the healing process.

Malignant melanoma is characterized by metastases also to the gastrointestinal tract, especially in the small bowel. The diagnosis is often delayed because unspecific clinical presentation (frequently as chronic iron deficiency anemia, rectal bleeding or intestinal obstruction). We present a case of melanoma of unknown primary site, with clinical presentation of intestinal obstruction. A segmental resection of the ileum was performed including mesentery with lymph nodes. Histology revealed metastatic melanoma from unknown primary. PET and MRI confirmed disseminated disease without brain metastasis.

The biliodigestive fistula is not a rare affection in the context of acute pathology of the gastrointestinal tract. It often affects patients between 63 and 85 years old , particularly the female sex, and the most common cause is acute or chronic cholecystolithiasis. Open issues are the delayed in the pre-operative diagnosis, and controversies exist regarding the best surgical approach. The choice of treatment options is influenced by the age of the patients and their clinical conditions and also by the presence of comorbidities and of a delayed right diagnosis. In the 1 to 3% of cases, the biliodigestive fistula presents a gallstone ileus as complication, whose diagnosis is particularly difficult for the lack of specific signs and symptoms. The contrast-enhanced CT is considered the gold standard for a specific pre-operative diagnosis, as it directly shows the fistula. Surgical treatments include one-stage procedure or two-stage procedure. Many studies seem to favor a deferred definitive procedure. The Authors describe 4 cases: in 3 cases, women between 70 and 80 years old presenting an history of recurrent cholecystitis, in 2 cases, and in 1 case presenting a bowel obstruction; in 1 case a 50-years-old man, with no significant past medical history, presenting a bowel obstruction. The Authors have performed in the 2 cases of gallstone ileus an enterolithotomy with cholecysto-duodenal fistula repair and cholecystectomy, in one-stage, and this has been possible because of the good clinical conditions of the patients and their low operative risk. In the case of fistula without the complication of gallstone ileus, the treatment approach has been cholecysto-gastric fistula closure with a gastroplastic using separate stitches and cholecystectomy, in one-stage. We are in agreement with data in the literature regarding the delay into the diagnosis of biliodigestive fistula and with the importance to suspect it or gallstone ileus presence, although the clinical presentation is extremely non-specific. In our experience, cholangiopancreatography-CT and CECT have made easier the pre-operative diagnosis and so reducing the delay of the treatment.

Aim: To demonstrate the surgical treatment validity and the post-operative complication decrease., Material of Study: Seventythree women who underwent P.O.P.S. + S.T.A.R.R. treatment, follow-up one year., Results: We observed an important reduction or a completely disappearance about pre-operative signs and symptoms., Discussion: We are aware that the proposed technique, if taken into account by urogynecologists, will raise several arguments and will raise many doubts and perplexities. For this reason we wanted develop a follow-up sufficiently long and many case studies with data to support our claims., Conclusions: We believe that the procedure proposed by us, given the results, was excellent in patients with multiorgan pelvic prolapse, especially with the vagina walls elongated and that retain a good trophism.

Several studies have demonstrated the clinical and technical benefits of the laparoscopic surgery for complicated and uncomplicated appendicitis. Our retrospective study included 12 patient who underwent SILS appendectomy (SILS-A), 14 who received conventional laparoscopic surgery (VL-A), and 12 who received laparotomic appendectomy (OA); performed in all cases by the same surgeon (C.F.). The aim of this study was the comparison between this three different surgical techniques on same features: post operative leukocytosis, post operative pain, need abdominal drainage, esthetic viewpoint, incidence of complication, hospital stay. The results showed no significant differences between SILS-A and VLS-A, while an evident improvement shows versus O-A, even though not statistically significative. SILS was more effective in decreasing the risk of postoperative wound infection.

The abdominal compartment syndrome (ACS) is defined a situation of high degrade abdominal hypertension (IAH) with clinicals signs of multiorganic dysfunction. It's observed like in the intensive care, in particular surgycals and postraumatics, there is ever a bigger frequence of complications presented by criticals patients. The various trials remark a changeable incidence, but the common factor is characterized by a particular severity of scores. All the possibles mechanicals, haemorragicals, infiammatories, and postraumatics causes act, but don't enable the stability among abdominal content, abdominal compliance and parietal tension. The initial triad of effects is constitued by the elevation of diaphragm and the visceral and vascular compression; after this triad provoke a pathophysiologic system that, through various levels, bring to a respiratory, renal and cardiocirculatory dysfunction and to a parietal, hepatic and intestinal ischemia with consequent bacterical translation: sepsis and MOF. The Burch's classification (1996) report four levels of gravity by the slight (< 15 mmHg) to the heavyest (> 35 mmHg): the firsts two levels are of intensivistic competence and for the detention are used conservatives metodics and pharmacological approach; instead in the lasts two levels it's necessary to foresee a surgycal treatment of laparotomy, washing and drainage with following temporary paret's closure. The mortality is now very elevated (29-62%) especially when it's already established a multiorganical dysfunction; therefore it's necessary forward its appearance through the monitorization of abdominal pression (IAP) with the measurement of vescical pression in alls criticals patients at the aim to treat immediately the firsts signs of IAH.

The emergency treatment for neoplastic occlusions of rectum still needs debugging. While we finds perfect accord in to directly treat with a right hemicolectomy (more or less widened) the tumours from cecum to the first portion of the right colon, not the indications are likewise shared in presence of neoplastic stenosis of sigma-rectum. The treatment of urgency of these tumours is lent to so many variable and the tendencies too are constantly in evolution in relationship to the improvement of the technologies and the surgical devices. We have to chose from the two-three times intervention (now with less succession), or the total or subtotal colectomy otherwise the most used left hemicolectomy and anterior resection for sigmoid colon. Presenting our historical cases of 31 years of activity (Institute of Surgical Emergency Department--University La Sapienza of Rome), 564 neoplastic occlusions of the colon (75.7% sigma-rectum), the Authors describe their attitude both of approach and of surgical therapy in urgency that has brought them to practise in the 65.6% of the cases the anterior resection without protection colostomy, with extraperitoneal anastomosis and reconstitution of the pelvic peritoneum, in all the stenosis under descendant--sigma. In the last period it is frequent more and more the tendency to the positioning of a stent on the neoplastic stenosis: this treatment allows us to overcome the emergency to operate then under fitter conditions.

Colon lesions resulting from blunt trauma in the abdomen can be defined as infrequent. Actually, they represent 3-5% of all hollow organ trauma. They present, however, serious social burden because of its prevalence in males with medium age ranging from 40 to 70 years. Study was conducted from 1971 to present at the University of Rome "La Sapienza" Institute of Clinical Emergency Surgery. 42 cases were observed in which 72% had motor vehicle accidents (with less than 1/4 of these resulting from seat belt). Numerous lesions were associated, especially in the abdomen (31), and the skull (20), both with Medium OIS 4.2. Most part of the cases was within the OIS-Class III category. The clinical parameters recorded upon admission revealed particular serious situations with average values of SAP-92 mm Hg, HR-114, RR-28, GCS-12, RTS-10.8. 17% had shock upon arrival with unsuccessful resuscitation. Ultrasound results at emergency indicated 62% with effusion/major parenchymal lesion, and 22% with severe peritonitis. 41% were treated with direct suture, 26% with resection-anastomosis, 19% with primary Hartman resection, and 14% with simple colostomy. 24% had abdominal complications including 14% sepsis, 5% hemorrhage, and 2 cases of post-surgical caval thrombus. The overall mortality was 26%. In general these lesions were frightening because of their uncertain manifestations. In most instances clinical signs related to associate lesions are overlooked, and these often present late symptoms from 24 to 48 hours. Delayed treatment for untimely diagnosis is one of the yet prevailing complications. The methods of surgical repair depend on the timing, the nature of associated lesions and, above all, eventual peritoneal contamination. The primary treatment involves surgical option actually recommended according to the EAST guideline with specific preference of reconstruction using the primary principle, and resorting to earlier interventions only in the presence of associated critical factors.