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Objective: To investigate whether (1) phosphorylated α-synuclein (p-syn) deposits in skin nerves could be useful in differentiating dementia with Lewy bodies (DLB) from different forms of dementia and (2) small fiber neuropathy (SFN) is associated with DLB., Methods: We studied 18 well-characterized patients with DLB (11 with autonomic dysfunction), 23 patients with nonsynucleinopathy dementia (NSD; 13 with young-onset Alzheimer disease dementia, 6 frontotemporal dementia, and 4 vascular dementia), and 25 healthy controls. All participants underwent skin biopsies from proximal (i.e., cervical) and distal (i.e., thigh and distal leg) sites to study small nerve fibers and deposits of p-syn, considered the pathologic form of α-synuclein., Results: No p-syn was detected in any skin sample in patients with NSD and controls but was found in all patients with DLB. SFN was found in patients with DLB and the autonomic denervation of skin was more severe in patients with autonomic dysfunctions., Conclusions: (1) In autonomic skin nerves, p-syn is a sensitive biomarker for DLB diagnosis, helping to differentiate DLB from other forms of dementia, although this needs to be confirmed in a larger, more representative sample; and (2) skin autonomic neuropathy is part of the DLB pathology and may contribute to autonomic symptoms., Classification of Evidence: This study provides Class III evidence that p-syn in skin nerve fibers on skin biopsy accurately distinguishes DLB from other forms of dementia., (© 2017 American Academy of Neurology.)

The replacement of small-diameter vessels is one of the main challenges in tissue engineering. Moreover, the surface modification of small-diameter vascular grafts (SDVG) is a key factor in the success of the therapy due to their increased thrombogenicity and infection susceptibility caused by the lack of a functional endothelium. In this work, electrospun scaffolds were prepared from blends of poly(L-lactic acid) (PLLA) and segmented polyurethane (PHD) with a composition designed to perform as SDVG inner layer. The scaffolds were then successfully surface-modified with heparin following two different strategies that rely on grafting of heparin to either PLLA or PHD functional groups. Both strategies afforded high heparin density, being higher for urethane methodology. The functionalized scaffolds did not cause hemolysis and inhibited platelet adhesion to a large extent. However, lysozyme/heparin-functionalized scaffolds obtained through urethane methodology achieved the highest platelet attachment inhibition. The increase in hydrophilicity and water absorption of the surface-functionalized nanostructures favored adhesion and proliferation of human adipose-derived stem cells. Heparinized surfaces conjugated with lysozyme presented microbial hydrolysis activity dependent on heparin content. Overall, a better performance obtained for urethane-modified scaffold, added to the fact that no chain scission is involved in urethane methodology, makes the latter the best choice for surface modification of PLLA/PHD 50/50 electrospun scaffolds. Scaffolds functionalized by this route may perform as advanced components of SDVG suitable for vascular tissue engineering, exhibiting biomimetic behavior, avoiding thrombi formation and providing antimicrobial features., (Copyright © 2017 Elsevier B.V. All rights reserved.)

To these days, the production of a small diameter vascular graft (<6mm) with an appropriate and permanent response is still challenging. The mismatch in the grafts mechanical properties is one of the principal causes of failure, therefore their complete mechanical characterization is fundamental. In this work the mechanical response of electrospun bilayered small-diameter vascular grafts made of two different bioresorbable synthetic polymers, segmented poly(ester urethane) and poly(L-lactic acid), that mimic the biomechanical characteristics of elastin and collagen is investigated. A J-shaped response when subjected to internal pressure was observed as a cause of the nanofibrous layered structure, and the materials used. Compliance values were in the order of natural coronary arteries and very close to the bypass gold standard-saphenous vein. The suture retention strength and burst pressure values were also in the range of natural vessels. Therefore, the bilayered vascular grafts presented here are very promising for future application as small-diameter vessel replacements., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Introduction: Tissue engineering offers the possibility of developing a biological substitute material in vitro with the inherent properties required in vivo. However, the inadequate performance in vascular replacement of small diameter vascular grafts (VG) reduces considerably the current alternatives in this field. In this study, a bilayered tubular VG was produced, where its mechanical response was tested at high pressure ranges and compared to a native femoral artery., Materials and Method: The VG was obtained using sequential electrospinning technique, by means of two blends of Poly(L-lactic acid) and segmented poly(ester urethane). Mechanical testing was performed in a biodynamic system and the pressure-strain relationship was used to determine the elastic modulus., Results: Elastic modulus assessed value of femoral artery at a high pressure range (33.02×106 dyn/cm(2)) was founded to be 36% the magnitude of VG modulus (91.47×106 dyn/cm(2)) at the same interval., Conclusion: A new circulating mock in combination with scan laser micrometry have been employed for the mechanical evaluation of bioresorbable bilayered VGs. At same pressure levels, graft elasticity showed a purely "collagenic" behavior with respect to a femoral artery response.

We report a case of invasive strongyloidiasis in a patient from the French Antilles who had been living in France for many years, with no history of immunosuppression, and who was hospitalised in the intensive care unit for septic shock with multimicrobial hypoxaemia pneumonia and exudative enteropathy. Initiation of systemic corticosteroid therapy for septic shock seems to have precipitated onset of the parasitic infection, with recurrence of hypoxaemic pneumonia complicated by hypoxic cardiac arrest. The diagnosis was confirmed after roundworm larvae were found on bronchoalveolar lavage. Treatment with ivermectin was initiated, but the patient died in a context of postanoxic encephalopathy., (2015 BMJ Publishing Group Ltd.)

Development of successful small-diameter vascular grafts constitutes a real challenge to biomaterial engineering. In most cases these grafts fail in-vivo due to the presence of a mechanical mismatch between the native vessel and the vascular graft. Biomechanical characterization of real native vessels provides significant information for synthetic graft development. Electrospun nanofibrous vascular grafts emerge as a potential tailor made solution to this problem. PLLA-electrospun nanofibrous tubular structures were prepared and selected as model bioresorbable grafts. An experimental setup, using gold standard and high resolution ultrasound techniques, was adapted to characterize in vitro the poly(L-lactic acid) (PLLA) electrospun structures. The grafts were subjected to near physiologic pulsated pressure conditions, following the pressure-diameter loop approach and the criteria stated in the international standard for cardiovascular implants-tubular vascular prostheses. Additionally, ovine femoral arteries were subjected to a similar evaluation. Measurements of pressure and diameter variations allowed the estimation of dynamical compliance (%C, 10(-2) mmHg) and the pressure-strain elastic modulus (E(Pε), 10(6) dyn cm(-2)) of the abovementioned vessels (grafts and arteries). Nanofibrous PLLA showed a decrease in %C (1.38±0.21, 0.93±0.13 and 0.76±0.15) concomitant to an increase in EPε (10.57±0.97, 14.31±1.47 and 17.63±2.61) corresponding to pressure ranges of 50 to 90 mmHg, 80 to 120 mmHg and 100 to 150 mmHg, respectively. Furthermore, femoral arteries exhibited a decrease in %C (8.52±1.15 and 0.79±0.20) and an increase in E(Pε) (1.66±0.30 and 15.76±4.78) corresponding to pressure ranges of 50-90 mmHg (elastin zone) and 100-130 mmHg (collagen zone). Arterial mechanics framework, extensively applied in our previous works, was successfully used to characterize PLLA vascular grafts in vitro, although its application can be directly extended to in vivo experiences, in conscious and chronically instrumented animals. The specific design and construction of the electrospun nanofibrous PLLA vascular grafts assessed in this work, showed similar mechanical properties as the ones observed in femoral arteries, at the collagen pressure range., (Copyright © 2014 Elsevier B.V. All rights reserved.)

The present study is focused on the electrospinning process as a versatile technique to obtain nanofibrous tubular structures for potential applications in vascular tissue engineering. A bilayered scaffolding structure composed of poly(L-lactic acid) (PLLA)/bioresorbable segmented polyurethane (SPEU) blends for small-diameter (5mm) vascular bypass grafts was obtained by multilayering electrospinning. Polymer blend ratios were chosen to mimic the media and adventitia layers. The influence of the different electrospinning parameters into the fiber formation, fiber morphology and fiber mean diameter for PLLA, SPEU and two PLLA/SPEU blends were studied. Flat and two-parallel plate collectors were used to analyze the effect of the electrostatic field on the PLLA nanofiber alignment in the rotating mandrel. Membrane topography resulted in random or aligned nanofibrous structures depending on the auxiliary collector setup used. Finally, composition, surface hydrophilicity, thermal properties and morphology of nanofibrous scaffolds were characterized and discussed. Since the development of tissue engineered microvascular prostheses is still a challenge, the prepared scaffolding tubular structures are promising candidates for vascular tissue engineering., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Introduction: In-vivo implanted vascular grafts fail due to the mechanical mismatch between the native vessel and the implant. The biomechanical characterization of native vessels provides valuable information towards the development of synthetic grafts., Materials and Methods: Five samples of electrospun nanofibrous poly(L-lactic acid)(PLLA) tubular structures were subjected to physiological pulsating pressure using an experimental setup. Four ovine femoral arteries were also tested in the experimental setup under the same conditions. Instantaneous diameter and pressure signals were obtained using gold standard techniques, in order to estimate the dynamic pressure-strain elastic modulus (E(Pε)) of both native vessels and grafts., Results: Synthetic grafts showed a significant increase of E(Pε) (10.57±0.97 to 17.63±2.61 10(6) dyn/cm(2)) when pressure was increased from a range of 50-90 mmHg (elastin-response range) to a range of 100-130 mmHg (collagen-response range). Furthermore, femoral arteries also exhibited a significant increase of EPε (1.66±0.30 to 15.76±4.78 10(6) dyn/cm(2)) with the same pressure variation, showing that both native vessels and synthetic grafts have a similar behavior in the collagen-acting range., Conclusion: The mechanical behavior of PLLA vascular grafts was characterized In vitro. However, the procedure can be easily extrapolated to In vivo experiences in conscious and chronically instrumented animals.

Metformin Associates lactic acidosis (MALA) is a metabolic acidosis with higher anion gap, high levels of blood lactates and treatment by metformin. MALA is a very rare entity but is associated with high mortality (30 to 50%). The extrarenal blood purification may be necessary in emergency. Relatively good clinical tolerance contrasts with a very elevated serum lactate. There is always a trigger and hypovolemia is prevalent. MALA often occurs when its prescription is not indicated (renal failure, cardiac failure, hypovolemia, or patient aged over 80 years). Metformin must be stopped in situations of acute hypovolemia or frail patients as diuretics or blockers of the rennin-angiotensin-aldosterone system., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

In this era of modern technologies, laparoscopic adrenalectomy is a gold standard surgical treatment for benign adrenal lesions. However, being aware of its difficulties and their managements is a very important issue for the surgeons who are interested in minimal invasive surgery. In this article, we are presenting a case of a 57-year-old woman who has undergone laparoscopic left adrenalectomy and in the third postoperative month, had an acute gastric volvulus requiring surgical open treatment. To the best of our knowledge, this report is the first article about a gastric volvulus case after left laparoscopic adrenalectomy.

From January 2000 to July 2005 in U.O. Emergency Surgery of Foggia Hospital 40 pz affects by abdominal abscess have been treated (39 post-operative, 1 in diverticulitis) by percutaneous drainage. This treatment has been made only in patients not affects by the serious septic shock, or by wide-spread peritonitis or in the locations to get by to reach by this method. The catheter permanently has been put in 14 pts and the drainage extempore of abdominal abscesses has been made in 26 pts in 28 cases the process cleared up by the one only treatment (6 catheter and 22 percutaneous drainage), in 12 cases has been necessary more drainage treatments (in 4 cases the extempore drainage and in 8 cases the drainage + catheter). One patient has been reoperated because the abscess was intractable by the percutaneous drainage. The serious complications not has been annotated. The persistent slight temperature only has been annoted after the drainage in 3 pts. The percutaneous drainage, consequently, represent a safe, manageable treatment with effectiveness comparable with surgery drainage with less morbility and mortality.

The authors report on their experience in the treatment with self-expanding enteral stent for acute left-sided large bowel obstruction and believe that this procedure is effective as a "bridge to surgery". From January to November 2005 3 patients have been treated with colorectal stents in obstructing left-sided large bowel carcinoma: over the following 24 hours we observed canalization and consequent disocclusion of the colonrectum. Stented patients were treated with elective colonic resection with primary anastomosis avoiding decompressive stoma and Hartmann's procedure.

An inflammatory pseudotumour of the lung was occasionally observed at radiology and is reported. Such lesions account for 1% of all lung tumours and are frequently asymptomatic; the findings on physical and laboratory examinations are usually nonspecific. Radiographic findings and invasive diagnostic procedures--including bronchoscopy and transthoracic fine needle biopsy--may be not sufficient for histological diagnosis. Surgery is then important for both diagnostic and therapeutic reasons; the treatment of choice is complete but non extensive excision. Radiotherapy should be considered in patients who had incomplete surgical resection or postoperative recurrences and in patients non resectable due to associated medical conditions.

Peritoneal mesothelioma is a rare neoplasm with generic and non-specific symptoms. In some cases it is associated with various and particular clinical syndromes. These findings make it so insidious that the diagnosis is rarely make the preoperative course. Usually, there has been previous exposure to asbestos, during even if other causes are reported. Rarely, a peritoneal mesothelioma appears with signs and symptoms suggestive of acute abdomen, such as the present case. On admission the patient presented clinical features apparently requiring emergency surgery. In fact, at laparotomy, the tumour, arising from the mesenterium, had perforated the peritoneal cavity and communicated with the digiunal lumen, causing a septic hemoperitoneum. A radical resection was performed and the continuity of the intestinal tract was restored through an end-to-end entero-anastomosis. The patient, with a history of exposure to asbestos, was alive four years later. But over the last twelve months diffuse metastasis has occurred in the lung and liver, and there was no response to systemic chemotherapy. This case may be considered singular of the clinical syndrome, the long-term survival and the circumscribed aspect of the tumour. Through a review of the literature, the features of the present diagnostic procedure are underlined and the importance of multidisciplinary treatment as the best approach to peritoneal mesothelioma is emphasized.

A case of non-Hodgkin's lymphoma involving the caecum and the rectum was resected. The disease occurs in 1-4% of gastrointestinal neoplasms and comprises 0.2-0.65% of colorectal tumours. The caecum is frequently involved while primary malignant lymphoma localized to the caecum and the rectum is more uncommon. The most representative histological types are histiocytic or lymphocytic tumours. The disease commonly presents as a painful abdominal mass and is associated with weight loss and diarrhoea. Barium enema and pancolonoscopy are sufficient for diagnosis, but echotomography and Tc scan are useful for staging. Surgery is the treatment of choice and overall 5-years survival is 30-40%. The role of adjuvant therapy has not yet been clearly defined, although data from some studies indicate increased survival in those patients given adjuvant therapy compared with patients treated with surgical resection alone.

Spontaneous perforation of colon is a rare disease and physiopathologic basis are actually unknown. Surgical treatment is standardized and post-operative survival is over 60%, morbidity and mortality rate depends on peritoneal contamination. In 1984 J.A. Berry classified spontaneous perforations into "stercoral" and "idiopathic" perforations on the basis of etiopathogenetical causes of lesions. Anatomopathologically stercoral and idiopathic perforations present different characteristics. Macroscopically stercoral perforation origines from an ulcerative lesion often situated on the sigmoid colon or rectum. Microscopical characteristic is represented by a superficial ischemic necrosis of mucosa (caused by fecalomas) followed by an extension to sub-mucosa and muscular tissues of the colonic wall. On the contrary, "idiopathic perforation", frequently situated on the sigma, is a linear laceration of anti-mesenteric side of the colon without pathologic modifications of the colon. Physiopathologic basis of spontaneous perforations of the colon were also discussed. Stercoral perforation is often a consequence of chronic constipation. Instead, two hypoteses are advanced as regards idiopathic perforations. S.V. Kessing e coll. (1962) hypotized a parietal suffering caused by ischemia of anti-mesenteric side of the colon, depending on ipoperfusion of colonic tissues; they also hypotized a constitutional weakness of colonic wall as a cause of idiopathic perforation. Others hypotized an intraluminal hypertension caused by intestinal hernias (J.W. Eadie, 1955; K. Cronin, 1959), rectal prolapse or abnormal depth of Douglas cavity (D.C. Lyon, 1969). In these cases, lesion is caused by contraction of abdominal muscles during defecation, which presses colonic wall during distension.(ABSTRACT TRUNCATED AT 250 WORDS)

One case of acquired oesophago-bronchial fistula is reported. Diagnostic images are presented. Pathogenesis, clinical and therapeutics features are discussed.

The authors address the topic of acute acalculous cholecystitis and examine the related aetiopathogenetic and clinical problems, taking as their starting point two cases of the disease observed in their department.