Search

Este artigo analisa duas produções da Cia Livre, apresentadas em 2019, baseadas na peça de aprendizado Os Horácios e os Curiácios (1933), de Brecht, e que tematizam a luta pela terra no Brasil hoje. Esse confronto foi sintetizado, em Morte e Dependência na Terra do Pau-Brasil e Os Um e Os Outros, como uma disputa entre o povo dos Um (povo que considera a si mesmo como universal) e o povo dos Outros (todos os outros povos, com suas culturas humanas, extra-humanas, animais, vegetais e minerais). A crítica ao modelo estético-filosófico do teatro Euro-ocidental aqui efetivada observa as contradições urdidas pelas presenças de intérpretes indígenas e não-indígenas, que espelham os dissensos e coalizões entre diferentes perspectivas das lutas emancipatórias. Como as experiências delas foram traduzidas na cena? Que tipo de sociabilidade foi ali projetada? Que forma teatral pode emergir da experiência de descentralização do sujeito ocidental que o grupo indica nesses trabalhos?

Background: Pancreatic ductal adenocarcinoma (PDAC) has an extremely poor prognosis. The outcomes of patients with cancer are determined not only by tumor-related factors but also by systemic inflammatory response. The objective of the study was to identify whether the preoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are associated with the prognosis of PDAC of the pancreas head after curative pancreatoduodenectomy. Materials and Methods: Seventy-six patients were enrolled in this prospective, observational clinical study. The optimal NLR and PLR cut-off values were calculated using a receiver operating characteristic (ROC) curve analysis. ROC curve analysis revealed an optimal NLR and PLR cut-off point of 5.41 and 205.56, respectively. Consequently, the NLR and PRL scores were classified as NLR Results: Low preoperative NLR and PLR levels both correlated with better pathological features, including decreased depth of invasion (p < 0.001), less lymph node metastasis (p < 0.001), earlier stage (p < 0.001), and lymphovascular invasion (p = 0.004). Kaplan-Meier plots illustrated that higher preoperative NLR and PLR had does not influence OS and DFS. Univariate analysis revealed that depth of invasion, lymph node metastasis, stage, PLR, and NLR are risk factors affecting OS and DFS. Multivariate analysis revealed that only stage was independently associated with OS and DFS. Conclusions: NLR and PLR measurements cannot provide important prognostic results in patients with resectable PDAC.

Structuring Si in arrays of vertical high aspect ratio pillars, ranging from nanoscale to macroscale feature dimensions, is essential for producing functional interfaces for many applications. Arrays of silicon 3D nanostructures are needed to realize photonic and phononic crystals, waveguides, metalenses, X-ray wavefront sensors, detectors. In particular, arrays of Si nanopillars are used as bio-interfaces in neural activity recording, cell culture, microfluidics, sensing and on-chip manipulation. Here, we demonstrate a strategy for realizing arrays of protruding sharp Si nanopillars, using displacement Talbot lithography combined with metal-assisted chemical etching (MacEtch) in gas phase. Such combination enables reliable and low cost pathway for fabrication of ordered nanopillars arrays on large scale. With the double exposure of a linear grating mask in orthogonal orientations and the lift-off technique, we realized a catalyst pattern of holes in a Pt thin film with a period of 1 μm and hole diameter in the range of 100–250 nm. MacEtch in gas phase by using vapor HF and oxygen from air allows to etch arrays of protruding Si nanopillars 200 nm-thick and aspect ratio in the range of 200 (pillar height/width) with an etching rate up to 1 μm/min. Gas-MacEtch has the advantage of no capillary stiction, no ion beam damage of the Si substrate, nanometric resolution and high fidelity of pattern transfer. In combination with controlled uniformity of feature size on large area, spatial frequency doubling and high resolution of Talbot lithography, the proposed method is an easy-to-scale-up processing that can support the fabrication of Si pillars arrays for many valuable applications both at micro and nano-scale., Materials Science in Semiconductor Processing, 157, ISSN:1369-8001

Introduction Intra-abdominal abscesses complicating Crohn’s disease (CD) present an additional challenge as their presence can contraindicate immunosuppressive treatment whilst emergency surgery is associated with high stoma rate and complications. Treatment options include a conservative approach, percutaneous drainage, and surgical intervention. The current multicentre study audited the short-term outcomes of patients who underwent preoperative radiological drainage of intra-abdominal abscesses up to 6 weeks prior to surgery for ileocolonic CD. Methods This is a retrospective, multicentre, observational study promoted by the Italian Society of Colorectal Surgery (SICCR), including all adults undergoing ileocolic resection for primary or recurrent CD from June 2018 to May 2019. The outcomes of patients who underwent radiological guided drainage prior to ileocolonic resection were compared to the patients who did not require preoperative drainage. Postoperative morbidity within 30 days of surgery was the primary endpoint. Postoperative length of hospital stay (LOS) and anastomotic leak rate were the secondary outcomes. Results Amongst a group of 575 included patients who had an ileocolic resection for CD, there were 36 patients (6.2%) who underwent abscess drainage prior to surgery. Postoperative morbidity (44.4%) and anastomotic leak (11.1%) were significantly higher in the group of patients who underwent preoperative drainage. Conclusions Patients with Crohn’s disease who require preoperative radiological guided drainage of intra-abdominal abscesses are at increased risk of postoperative morbidity and septic complications following ileocaecal or re-do ileocolic resection.

Background Coronavirus disease 2019 is revolutionizing healthcare delivery. The aim of this study was to reach a consensus among experts as to the possible applications of telemedicine in the proctologic field. Methods A group of 55 clinical practice recommendations was developed by a clinical guidance group based on coalescence of evidence and expert opinion. The Telemedicine in Proctology Italian Working Group included 47 Italian Society of Colorectal Surgery nominated experts evaluating the appropriateness of each clinical practice recommendations based on published RAND/UCLA methodology in 2 rounds. Results Stakeholder median age was 53 years (interquartile range limits 40–60), and 38 (81%) were men. Nine (19%) panelists reported no experience with telemedicine before the pandemic. Agreement was obtained on a minimum of 3 to 5 years of practice in the proctologic field before starting teleconsultations, which should be regularly paid, with advice and prescriptions incorporated into a formal report sent to the patient by e-mail along with a receipt. Of the panelists, 35 of 47 (74%) agreed that teleconsultation carries the risk of misdiagnosis of cancer, thus recommending an in-person assessment before scheduling any surgery. Fifteen additional clinical practice recommendations were re-elaborated in the second round and assessed by 44 of 47 (93.6%) panelists. The application of telemedicine for the diagnosis of common proctologic conditions (eg, hemorrhoidal disease, anal abscess and fistula, anal condylomas, and anal fissure) and functional pelvic floor disorders was generally considered inappropriate. Teleconsultation was instead deemed appropriate for the diagnosis and management of pilonidal disease. Conclusion This e-consensus revealed the boundaries of telemedicine in Italy. Standardization of infrastructures, logistics, and legality remain to be better elucidated.

Objectives. The prevalence of morbid obesity has dramatically increased over the last several decades worldwide, currently reaching epidemic proportions. Gastric leak (GL) remains the potentially fatal main complication after sleeve gastrectomy (SG) for morbid obesity. To our knowledge, there are no standardized guidelines for GL treatment after laparoscopic sleeve gastrectomy (LSG) yet. The aim of this study was to represent our institutional preliminary experience using the endoscopic double-pigtail catheter (EDPC) as the method of internal drainage and propose it as first-line treatment in case of GL after LSG. Methods. One hundred and seventeen patients were admitted to our surgical department and underwent laparoscopic sleeve gastrectomy (LSG) for morbid obesity from March 2014 to June 2019. In 5 patients (4.3%) of our series, GL occurred as a complication of LSG. EPDC was the stand-alone procedure of internal drainage and GL first-line treatment. The internal pig tail was endoscopically removed from 30th to 40th POD in all cases. Results. Present data (clinical, biochemical, and instrumental tests) showed a complete resolution of GL, with promotion of a pseudodiverticula and complete re-epithelialization of leak. Follow-up was more strict than usual (clinical visit and biochemical test on 7th, 14th, and 21st day after discharge; a CT scan with gastrografin on 30th day from discharge if clinical visit and exams were normal). Conclusion. This was a preliminary retrospective observational study, conducted on 5 patients affected by GL as a complication of LSG for morbid obesity. EDPC maintains the safety, efficacy, and nonexpensive characteristic and may be proposed as better first-line treatment in case of GL after bariatric surgery.

Highlights • Acute abdomen is any acute abdominal condition requiring a quick response. • The abdominal discomfort associated with extra-abdominal pathologies could mimic acute abdomen. • Cardiac tamponade is a medical emergency. • The differential diagnosis could be kept in mind to avoid a delayed treatment., Introduction Acute abdomen is any acute abdominal condition requiring a quick response. The incidence varies according to age and disease aetiology. The abdominal discomfort associated with extra-abdominal pathophysiology and thoracic conditions could mimic acute abdomen. In this case we report a rare case of a young patient with cardiac tamponade masquerading as acute abdomen. Presentation of case A 25-years-old African man presented to the Emergency Department with abdominal pain. An EKG was performed, which revealed sinus tachycardia, with electrical alternans and borderline reduced voltage. At the time of the admission to our unit, he had a clinical worsening and a CT scan of abdomen was performed, which demonstrated hepatomegaly, abundant pericardial effusion and thin right pleural effusion at the lung bases. An echocardiogram confirmed a circumferential pericardial effusion with initial collapse of the right ventricular free wall. It was decided to immediately transport the patient to the Cardiosurgery Unit of another hospital to undergo pericardiocentesis. Discussion Our experience with this case underlines the important point that patients with a large pericardial effusion may present with the clinical features of acute abdomen and peritonitis. Abdominal pain was the primary symptom that prompted this patient to seek medical attention. Conclusion Acute abdomen is any acute abdominal condition requiring a rapid, often surgical, treatment. Cardiac tamponade is a medical emergency. The differential diagnosis could be kept in mind by any emergency physician, surgeon and anaesthesiologist, because an incorrect diagnosis and therefore an incorrect treatment or a delay in pericardial evacuation can be life-threatening.

Esophago-jejunostomy leakage (EJL) it the most dreaded septic complication after total gastrectomy for gastric cancer. Early detection and treatment of this complication may improve outcomes. Systemic Inflammation Response Index (SIRI) is a marker that reflects systemic inflammation.The SIRI was developed in a training cohort of 180 patients who underwent elective open total gastrectomy with esophago-jejunal anastomosis for gastric cancer from January 2009 to December 2013. To verify the prognostic value of SIRI score we recruited 192 patients treated from January 2014 to December 2021 as the validation cohort. The optimal cut-off value of SIRI was determined by receiver operating characteristic curve. Univariate and multivariate analysis was performed.An optimal cut-off point for the SIRI of 0.82 divided the patients into a low SIRI group and high SIRI group in the training cohort. Patients with a SIRI ≥0.82 was found to be significantly associated with EJL. Univariable analysis showed that NLR, PLR, MLR, SII, and SIRI were prognostic factors for EJL in the training cohort. In multivariable analysis, EJL high level of SIRI was identified as independent prognostic factor.Preoperative SIRI may be helpful in identifying patients at greater risk for developing EJL after total gastrectomy.

Background The laparoscopic approach in the treatment of mid- or low-rectal cancer is still controversial. Compared with open surgery, laparoscopic resection of extraperitoneal cancer is associated with improved short-time non-oncological outcomes, although high-level evidence showing similar short- and long-term oncological outcomes is scarce. Objective The aim of our paper is to study the oncological and non-oncological outcomes of laparoscopic versus open surgery for extraperitoneal rectal cancer. Data sources A systematic review of MedLine, EMBASE, and CENTRAL from January 1990 to October 2020 was performed by combining various key words. Study selection Only randomized controlled trials (RCTs) comparing laparoscopic versus open surgery for extraperitoneal rectal cancer were included. The quality of RCTs was assessed using the Cochrane reviewer's handbook. This meta-analysis was based on the recommendation of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Intervention(s) This study analyzes laparoscopic versus open surgery for extraperitoneal rectal cancer. Main outcome measures Primary outcomes were oncological parameters. Results Fifteen RCTs comprising 4,411 patients matched the selection criteria. Meta-analysis showed a significant difference between laparoscopic and open surgery in short-time non-oncological outcomes. Although laparoscopic approach increased operation time, it decreases significantly the blood loss and length of hospital stay. No significant difference was noted regarding short- and long-term oncological outcomes, but 4 and 5 years disease-free survival were statistically higher in the open group. Limitations There are still questions about the long-term oncological outcomes of laparoscopic surgery for extraperitoneal rectal cancer being comparable to the open technique. Conclusions Considering that all surgical resections have been performed in high volume centers by expert surgeons, the minimally invasive surgery in patients with extraperitoneal cancer could still be not considered equivalent to open surgery in terms of oncological radicality.

The anisotropic nature of plasma etching is usually exploited to realize vertical nano -/micro-silicon structures by deep reactive ion etching. However, some applications require tilted instead of perpendicular profiles with respect to the substrate. Here, a controlled tilted etching is realized by introducing a set of metal electric field modulator(s), which modify the near sample surface potential. The ions from the plasma body are accelerated under the influence of the distorted electric field, and hit the silicon surface with a certain incident angle. A model is built with finite elements method, taking into account the geometry of the experiment and the chamber conditions during the etching process. The thickness and the inter-distance of Al slabs have been varied in a range of 0.5-3 mm and 10-25 mm, respectively. A tilt angle ranging from 0?degrees to 22.6?degrees has been measured and validates the simulation results, showing that a desired tilt profile can be achieved with a proper parameters tuning. Examples of 1D and 2D modulations are reported with linear and chessboard slanted gratings for X-ray imaging applications., Applied Surface Science, 588, ISSN:0169-4332, ISSN:1873-5584

Ingested toothpicks are a relatively rare event, but they may cause serious gut injuries and can be listed among rare causes of perforation, peritonitis, sepsis or death. Unless the foreign bodies were intentionally swallowed, many patients who ingested them fail to remember the event and they do not refer it during the medical history collection; this makes diagnosis problematic. In this work, a case of perforation of the sigmoid colon is described, caused by a toothpick ingestion. The patient had to be surgically treated because of a complication: the formation of an entero-iliac fistula with subsequent development of a pseudoaneurysm of the right external iliac artery. Vascular perforation due to toothpick ingestion has rarely been reported. In similar cases, it could be difficult to establishing the correct diagnosis because of the low sensitivity and accuracy rates of diagnostic investigations. The ingestion of foreign bodies should be kept in mind as an important differential diagnosis in patients with acute abdomen or chronic abdominal pain of unknown origin., Highlights • Ingested toothpicks are a relatively rare event. • These can be listed among rare causes of perforation, peritonitis, sepsis or death. • It could be difficult to establishing the correct diagnosis because of the low sensitivity of diagnostic investigations. • Vascular perforation due to toothpick ingestion has rarely been reported. • The ingestion of foreign bodies should be kept in mind as an important differential diagnosis.

Highlights • Agenesis of the dorsal pancreas is a rare congenital anomaly. • The possibility of finding this disorder is increasing with the use of advanced radiological techniques. • Some patients experience no symptoms. • Rarely, they may also develop pancreatic exocrine insufficiency or pancreatic adenocarcinoma. • This diagnosis could be missed by US, due to difficulty on visualization of body and tail of pancreas., Introduction Agenesis of the dorsal pancreas (ADP) is a rare congenital anomaly resulting in missing corpus and cauda of the pancreas. The possibility of finding this disorder is increasing with the use of advanced radiological techniques like CT scan or MRI. Presentation of case We reported 2 cases of a partial ADP as radiological finding: the first one was a 79-year-old asymptomatic patient who presented to perform a CT staging scan for bladder tumor, while the second case was a 73-year-old patient with obstructive jaundice and with suspected common bile duct calculi. In the second patient US, CT scan and MRI were performed, and after that also an ERCP was scheduled. Discussion The prevalence of agenesis of the dorsal pancreas is not exactly known; in the literature, only 50 cases have been reported. Its cause and pathogenesis are not fully understood. Some patients experience no symptoms, while others may develop hyperglycemia, diabetes mellitus, bile duct obstruction, abdominal pain, pancreatitis, or other conditions. Conclusion Considering that dorsal agenesis is sporadically found, often do not have related symptoms and it does not require a specific treatment, whether further examinations are needed to determine the type of agenesis remains questioned.

It is known that Duodenal adenocarcinoma (DA) is a rare malignant solid tumor that cause occlusion symptoms with orthodox dysphagia when locally advanced. Pancreatic neuroendocrine tumors (PanNETs) account for about 2% of all pancreatic neoplasms. The combination of these two lesions, with the synchronous presence of ectopic pancreatic tissue (EPT) of the duodenum, has never been described in literature, to our knowledge. Here we report a case of combined DA, EPT and PanNET affecting a 71-year-old woman., Highlights • Simultaneous presence of Duodenal adenocarcinoma pancreatic neuroendocrine tumor ectopic pancreatic tissue of duodenum. • Biochemical tests did not reveal abnormalities: CA 19-9 was normal, CEA was 153 U/L. • Ultrasonography confirmed a nodule dislocating pancreas investigated with contrast-enhanced CT and esophagogastroduodenoscopy. • The association between duodenal adenocarcinomas, PanNET and ectopic pancreatic tissue (EPT) of the duodenum is really rare.

Highlights • Metastatic involvement of peripheral nerves by perineural invasion from an adjacent cancer is not uncommon. • Nerve root metastasis without extension from an adjacent process has been seldom reported in case of solid tumors. • No cases of gastric adenocarcinoma metastasis to the nerves have been reported to date. • In case of known malignancy and refractory pain, the possibility of a nerve root metastasis should be considered., Introduction Nerve root metastasis without extension from an adjacent process has been seldom reported in case of solid tumors. We describe a case of solitary nerve root metastasis of gastric adenocarcinoma, likely due to hematogenous spread. Case presentation A 75-year-old man presented with radiculopathy refractory to medical treatment. MRI and CT demonstrated a right-sided S1 nerve root mass involving the spinal ganglion in its intra-foraminal region with avid enhancement, initial erosive bone changes on sacral foramina and focal hyperaccumulation on 18F – FDG CT-PET, suspicious for metastasis. The histopathological examination confirmed a metastasis of gastric adenocarcinoma. Discussion A review of the current literature revealed only ten cases of hematogenous metastases to spinal nerve root ganglia; the primary lesions in those cases were an oat cell carcinoma of the lung, two cases of colonic adenocarcinoma, a case of uterine adenocarcinoma, a ductal breast carcinoma, a Ewing’s sarcoma, a Renal Cell Carcinoma, a gastro-intestinal stromal tumor, a follicular thyroid carcinoma, a pulmonary adenocarcinoma. Conclusion In the setting of a known malignancy, a nerve root metastasis should be considered in the differential diagnosis of a nerve root mass, although it occurs very rarely.

Lymphangiomatosis is a benign proliferation of lymph vessels. Lymphatic diseases can vary from small lymphangioma to generalized lymphangiomatosis, which is a rare condition and can have several clinical manifestations. The gastrointestinal tract may be affected, but the incidence in the intestinal wall is very low. We propose in our study a case of ileal lymphangiomatosis presenting with perforation, in which the diagnosis was made after the pathological analysis of the resected intestinal tract. Although rare and not described in the literature, intestinal lymphangiomatosis could manifest itself with acute abdomen and could be a surgical urgency. This disease should be considered when intestinal perforation is observed., Highlights • Lymphangiomatosis is a multisystemic disorder. • The GI tract may be affected, but the incidence of lymphangioma of the intestinal wall is very low. • Lymphangiomatosis of the small bowel is a rare disease, so it is easy for a clinician to make a misdiagnosis. • Intestinal lymphangiomatosis could manifest itself with an acute abdomen and surgical urgency. • The pathologist should keep it in mind in the differential diagnosis, when he analyses a case of perforation.

We show how Newton-Cartan geometry can be generalized to String Newton-Cartan geometry which is the geometry underlying non-relativistic string theory. Several salient properties of non-relativistic string theory in this geometric background are presented and a discussion of possible research for the future is outlined.

The orientation mismatch between the cone beam of an X-ray tube and the grating lines in a flat substrate remains a big challenge for laboratory grating-based X-ray interferometry, since it severely limits the imaging field of view. Here, we fabricated fan-shaped G 0 source gratings by modulating the electric field during the deep reactive ion etching of silicon. The gold electroplated fan-shaped G 0 grating (3.0 µm pitch) in a 20 keV interferometer improves the uniformity of the field of view with an increase of average visibility from 16.2% to 18.5% and a better angular sensitivity (by a factor 5.8) at the edges.

Displacement Talbot lithography can rapidly pattern periodic nanostructures with high depth of focus over large area. Imperfections in the phase mask profile and the stage movement inaccuracies during the exposure cause linewidth variation in every second line of binary gratings. While this beating is barely visible in patterned photoresist, it leads to substantial depth variation when transferred into high aspect ratio silicon structures, because of micro-loading in deep reactive ion etching. A proper scan range compensated the defect, and a beating-free grating with pitch size of 1 μm and aspect ratio of 54:1 is demonstrated. © 2021 The Japan Society of Applied Physics, Japanese Journal of Applied Physics, 60 (SC), ISSN:0021-4922, ISSN:1347-4065

We present a method to produce small pitch gratings for X-ray interferometric imaging applications, allowing the phase sensitivity to be increased and/or the length of the laboratory setup to be minimized. The method is based on fabrication of high aspect ratio silicon microstructures using deep reactive ion etching (Bosch technique) of dense grating arrays and followed by conformal electroplating of Au. We demonstrated that low resistivity Si substrates (, Micromachines, 12 (5), ISSN:2072-666X

Introduction Single-incision laparoscopic surgery (SILS) aims to minimize the surgical access trauma by reducing the number of abdominal incisions to a single site, potentially offering better cosmetic results and decreased postoperative pain. In this study, we compare the results of SILS ileocolic resection for Crohn’s disease (CD) to conventional laparoscopy and open surgery using a propensity score–matched analysis in a retrospective national multicentre study. Methods All consecutive patients undergoing elective SILS ileocaecal or redo ileocolic resection for primary and recurrent CD from 1 June 2018 to 31 May 2019 were included. Patients were matched 1:1:1 with laparoscopy and open surgery according to perianal disease, recurrent disease, penetrating phenotype of CD, history of previous abdominal surgery, preoperative medical treatment with steroids and anti-TNF. Postoperative morbidity within 30 days of surgery was the primary endpoint. Results Fifty-eight patients were included in each group, for a total of 174 patients. The conversion rate for SILS and laparoscopy was 10.3% and 12%, respectively, with no difference in the incidence of postoperative complications (13.8% and 12%, p = 0.77), whilst open surgery demonstrated a worse morbidity profile, with a complication rate of 25.9% (p < 0.0001). Median length of hospital stay following SILS ileocolic resection was 5 days, significantly shorter compared to 7 days for laparoscopy and 9 for open surgery (p < 0.0001). Conclusions SILS ileocolonic resection for CD demonstrated a comparable morbidity profile compared to laparoscopy in selected patients, with a reduced length of postoperative hospital stay.

Introduction: The laparoscopic approach has become the gold standard for cholecystectomy. However, it could have some major complications. Among them, it can be considered postoperative pseudoaneurysms of the cystic or hepatic arteries. Haemobilia secondary to a cystic artery pseudoaneurysm is extremely rare. Case Report: Here we present a case from our centre of haemobilia in association with a cystic artery pseudoaneurysm, as a late complication of VLC. An 18-year-old girl underwent laparoscopic cholecystectomy; during surgery, due to viscero-perietal tight adhesions and due to the close proximity of the cystic duct to the biliary ducts, we suspected a bile duct injury. So, decision was taken to convert to open surgery: a suture was performed to repair the coledocic duct injury and an endoscopic papillotomy was performed with subsequent positioning of an endoscopic plastic biliary endoprothesis at the hepatocholedochus. One month after surgery, the patient showed clinical signs of hypovolemic shock. She underwent Computed Tomography Angiography, showing a possible arterial lesion, just adjacent to surgical clip. Therefore, patient underwent angiographic examination, which confirmed an 8 mm pseudoaneurysm arising from cystic artery, just adjacent to surgical clips. Superselective catheterization of vessel was performed, and two coils were released, until obtaining complete exclusion of the vascular lesion. The patient was discharged five days after procedure, with good general condition. Conclusion: Pseudoaneurysms of the cystic artery are uncommon entities, rarely reported in the literature, and often caused by cholecystitis or iatrogenic biliary injury. All conditions that are responsible for vessels’ injuries could also cause haemobilia. Even if pseudoaneurysm of cystic artery with haemobilia is a rare event, it has to be considered as a complication of VLC. Angiographic approach should be the treatment of choice.

Laparoscopic Nissen fundoplication (LNF) is considered the surgical treatment of choice for gastroesophageal reflux disease (GERD). However, persistent dysphagia (PD) occurs in up to 20% of patients. The aim of this study was to evaluate the incidence of PD after LNF, the causes, and the methods of prevention and management. This study was a retrospective analysis of prospectively collected data. From April 1994 to November 2019, 868 patients underwent laparoscopic short-floppy Nissen fundoplication (LSFNF). A postoperative dysphagia score was obtained by using the “difficulty swallowing” question from the GERD-Health Related Quality of Life. The postoperative clinical outcomes were obtained from 822 to 868 patients (94.7%) after LSFNF. The mean follow-up period was 17.3 years (range 1–26). Only 12 patients (1.4%) with PD were treated. Seven patients (0.8%) required endoscopic dilatation. Too tight fundoplication was the most frequent cause of dysphagia. Dysphagia was resolved completely in all patients. Five patients (0.6%) required reoperation for prolonged dysphagia (three for a tight wrap and two for a tight esophageal hiatus) after failed dilatation attempts. All underwent laparoscopic conversion from Nissen procedure to Toupet with enlargement of hiatal opening in two. Dysphagia was resolved completely in all patients. Postoperative esophageal manometry was performed in all patients with PD. Pre- and postoperative manometric data were not significantly different between patients with moderate-severe PD, mild PD, and without dysphagia. PD is a common complication after LNF. The most frequent cause is too tight fundoplication. The LSFNF could prevent postoperative dysphagia.

Background: Surgical treatment of anal fistulas is still a challenge. The aims of this study were to evaluate the adoption and healing rates for the different surgical techniques used in Italy over the past 15 years. Methods: This was a multicenter retrospective observational study of patients affected by simple and complex anal fistulas of cryptoglandular origin who were surgically treated in the period 2003–2017. Surgical techniques were grouped as sphincter-cutting or sphincter-sparing and as technology-assisted or techno-free. All patients included in the study were followed for at least 12 months. Results: A total of 9,536 patients (5,520 simple; 4,016 complex fistulas) entered the study. For simple fistulas, fistulotomy was the most frequently used procedure, although its adoption significantly decreased over the years (P < .0005), with an increase in sphincter-sparing approaches; the overall healing rate in simple fistulas was 81.1%, with a significant difference between sphincter-cutting (91.9%) and sphincter-sparing (65.1%) techniques (P = .001). For complex fistulas, the adoption of sphincter-cutting approaches decreased, while sphincter-sparing techniques were mildly preferred (P < .0005). Moreover, there was a significant trend toward the use of technology-assisted procedures. The overall healing rate for complex fistulas was 69.0%, with a measurable difference between sphincter-cutting (81.1%) and sphincter-sparing (61.4%; P = .001) techniques and between techno-free and technology-assisted techniques (72.5% and 55.0%, respectively; P = .001). Conclusion: Surgical treatment of anal fistulas has changed, with a trend toward the use of sphincter-sparing techniques. The overall cure rate has remained stable, even if the most innovative procedures have achieved a lower success rate.

Objectives: Laparoscopic sleeve gastrectomy is gaining popularity as a bariatric option. Gastric leak is the most dreaded septic complication after this procedure. This study investigated levels of drain amylase that could be useful for predicting gastric leak before its clinical presentation. Subjects and Methods: This prospective observational study was carried out in 167 patients who underwent sleeve gastrectomy for morbid obesity between February 2014 and March 2020. Measurement of drain amylase levels (DALs) was adapted as a routine procedure. The results of the receiver operative characteristic (ROC) curve analysis revealed an optimal drain amylase levels cutoff point of 814.18 IU/L. Consequently, the DALs were classified as DALs &lt814.18 or DALs ≥814.18 for all subsequent analyses. Results: Gastric leak occurred in 6 patients. Drain amylase levels of 167 patients were tested. The mean value for patients without leak was 71.13 ± 72.11 IU/L; for patients with leak, it was 4,687 ± 6,670 IU/L (p &lt 0.001). Using ROC curve analysis, the mean ± standard error of the area under the curve for DALs on postoperative day 1 was 0.9927 ± 0.0075, CI = 0.978–1.00, and a cutoff level at 814.18 IU/L for predicting gastric leak achieved 83.33% sensitivity and 100% specificity with positive predictive value of 100% and negative predictive value 99.38%. All patients with a leak, but one, had a drain amylase level >814.18 IU/L. Conclusion: The determination of drain amylase levels after sleeve gastrectomy is a significant indicator of gastric leak with high sensitivity and specificity.

Chemotherapy is associated with different patterns of histopathological changes of the non-tumor-bearing liver. Hepatic infarction represents a relatively rare condition; the prevalence in several series of consecutive autopsies is 1.1%. To the best of our knowledge, no cases of liver infarction secondary to chemotherapy have been reported to date. We report a case of segmental hepatic infarction following the adjuvant chemotherapy with Oxaliplatin and Capecitabine in a patient who had undergone total gastrectomy and distal esophagectomy for gastric cancer. Liver infarction is usually managed by conservative therapy; interventional procedures such as percutaneous imaging-guided drainage or surgical evacuation should be reserved in cases where septic complications occur, with development of a hepatic abscess from the necrotic area. It is important to avoid misdiagnoses with liver metastases in order to define the most appropriate clinical management strategy. KEY WORDS: Adjuvant chemotherapy, Gastric cancer, Liver infarction, Hepatic necrosis.La chemioterapia è associata a diversi modelli di alterazioni istopatologiche del fegato non tumorale. L’infarto epatico rappresenta una condizione relativamente rara; la prevalenza in diverse serie di autopsie consecutive è dell’1,1%. Per quanto a nostra conoscenza, fino ad oggi non sono stati segnalati casi di infarto epatico secondario alla chemioterapia. Segnaliamo un caso di infarto epatico segmentario a seguito della chemioterapia adiuvante con oxaliplatino e capecitabina in un paziente che aveva subito gastrectomia totale ed esofagectomia distale per cancro gastrico. L’infarto del fegato è di solito gestito da terapia conservativa; procedure interventistiche come drenaggio guidato dall’imaging percutaneo o evacuazione chirurgica dovrebbero essere riservate nei casi in cui si verificano complicanze settiche, con sviluppo di un ascesso epatico dall’area necrotica. È importante evitare diagnosi errate delle metastasi epatiche al fine di definire la strategia di gestione clinica più appropriata.