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AIM: The aim of this study is to evaluate if the Intraoperative Continuous Intestinal Loop Warming (ICLM is a valid trick to decrease the postoperative paralytic ileus.. METHODS: The subjects were patients who underwent emergency open abdominal surgery for either benign or malignant diseases. Patients were divided into two groups; group A patients who was secluded for ICLW and a control group B who was not secluded for ICLW The primary outcomes were the time of recovery of bowel movement, 30 days postoperative mortality and morbidity, morbidity was graded by the Clavien-Dindo classification of surgical complications. Secondary outcomes were operative time, and length of hospital stay. RESULTS: A total numbers of 100 patients were randomly assigned in this prospective study. The mean time of bowel function recovery in the group A was 41.52 hours, whereas for group B was 67.20 hours, these differences were statistically significant with a P value < 0.05. In group B the bowel function recovery for 64% of the patients took between 72-96 hours furthermore, the longest time for peristaltic recovery was 96 hours which was only observed in patients of group B. There were no intra-operative complication in both groups. There is no difference in the two groups in term of 30 day postoperative morbidity. CONCLUSIONS: Intra-operative continuous intestinal loop warming technique is a simple, safe and low cost technique. It seems that intra-operative continuous intestinal loop warming technique maintain tissues hydration and conserve the body temperature limiting the stress response and help in decreasing the incidence of postoperative paralytic ileus.

Severe hypocalcemia due to parathyroid gland damage may be a serious complication after thyroidectomy. In order to save parathyroid integrity we developed a no-touch parathyroid (NTP) thyroidectomy technique.We performed a total extracapsular thyroidectomy with NTP technique in consecutive 50 cases of benign goiter between July 2014 and June 2015. Parathyroid glands were firstly indentified, then they were separated from the thyroid avoiding manipulation or trauma and preserving their vascularization. Traditional scissors were preferentially used for dissection around the glands. Patients operated with NTP technique were matched by a propensity score to a control group.NTP was feasible in all foreseen patients except one. Propensity score selected a group of 23 patients/group for matching. No mortality has been observed in either group. Operative time were comparable between groups. Blood loss were significantly less abundant in the NTP group. No laryngeal permanent paralysis was experienced. Hospital stay was shorter yet not significantly in NTP group. Neither hypocalcemic crisis nor permanent hypoparathyroidism were described in either group. Serum calcium levels (NTP Vs control) were significantly higher in NTP group at day 1 (p=0.03) and day 2 (p=0.002), respectively. Similarly, intact parathormone dosages were significantly higher at day 1 (p=0.004) and day 7 (p=0.001), respectively.We conclude that NTP thyroidectomy is a feasible in the majority of the patientsand, allows a significant reduction of blood loss without prolonging the operative time. After the procedureboth values of calcemia and intact parathormonewere stable and no hypocalcemic crisis was experienced.Parathyroid, Hypoparathyroidism, Hypocalcemia, Total thyroidectomy.L’ipocalcemia è una complicanza severa dopo tiroidectomia. Al fine di preservare l’integrità delle paratiroidi senza influenzare la durata della procedura, abbiamo sviluppato un semplice metodo, caratterizzato dalla riduzione della manipolazione intraoperatoria delle ghiandole, una volta individuate. Il metodo è stato denominato “no-touch” paratiroideo (NTP). Abbiamo eseguito tiroidectome totali extracapsulari con la tecnica NTP in 50 casi consecutivi di gozzo benigno, tra luglio 2014 e giugno 2015. Le paratiroidi sono state identificate evitando manipolazioni o traumi e preservando la loro vascolarizzazione. Per la dissezione delle ghiandole sono state utilizzate preferenzialmente strumenti non elettrificati. I pazienti operati con la tecnica NTP sono stati abbinati con “propensity score” ad un gruppo di controllo. NTP è stato fattibile in tutti i pazienti previsti tranne uno. Il “propensity score” ha selezionato un gruppo di 23 pazienti/gruppo per il confronto. In entrambi i gruppi non è stata osservata mortalità. Il tempo operatorio era paragonabile tra i gruppi. La perdita di sangue è risultata significativamente meno abbondante nel gruppo di NTP. Non è stata osservata paralisi permanente dei nervi laringei. La degenza ospedaliera è stata più breve, ma non in modo significativo, nel gruppo NTP. In entrambi i gruppi non sono state descritte né crisi di ipocalcemia, né ipoparatiroidismo permanete. I livelli sierici di calcio (NTP VS controllo) erano significativamente più alti nel gruppo NTP al giorno 1 (p = 0,03) ed al giorno 2 (p = 0.002). I dosaggi di paratormone intatto sono stati significativamente più elevati il giorno 1 (p = 0,004) e il giorno 7 (p = 0.001). Conclusioni: La tiroidectomia con NTP è realizzabile nella maggior parte dei pazienti, consentendo una significativa riduzione della perdita di sangue senza prolungare i tempi operatori. Dopo la procedura, entrambi i valori di calcemia e paratormone intatto sono stati stabili e non è stata evidenziata nessuna crisi di ipocalcemia.

One crucial component within the efforts aiming at the valorisation of lignin is a rather precise knowledge regarding its structural features in terms of the amounts of aliphatic and phenolic hydroxyl groups, the amount of non-phenolic end groups, and the nature of interunit bonding motifs including their abundances. For achieving a complete characterisation, these data are best to be interpreted in connection with the molecular mass key data describing the oligomeric lignin chains, namely the number average molecular weight Mn, the weight average molecular weight Mw, and the polydispersity PD. Especially the latter one is often referred to when the discussion comes to the quality of polymeric or oligomeric sample: the smaller the PD, the better the polymer with respect to subsequent (chemical) modifications. Within the GPC-based determination of the above-mentioned key data like the PD for a given lignin sample, a meaningful calibration of the instrumentation, as well as the use of suitable detectors, are of paramount importance: a misled estimation of the “expected” molecular weight of a lignin sample might lead to a poor choice of the range of molecular weights of the standards used for calibration; the wrong detector-type lacks sensitivity. The range of the molecular weights covered in the calibration, however, does affect significantly the results obtained in the measurements of the lignin samples especially with respect to the polydispersity, and a non-suitable detector neglects the extremes. So-obtained astonishingly good, or unexpectedly bad polydispersities eventually lead to wrong conclusions and decisions concerning future actions. We have developed a transparent and robust protocol for the gel-permeation chromatography-based characterisation of plant-derived polyphenols in general, and lignins in particular. After systematically evaluating i) the influence of the range of molecular weights used for the calibration of the analytical set-up, ii) the influence of the flow-rate on the molecular mass-related key figures of certain lignin samples, and iii) the influence of the nature of the detector used for recording (UV-based of refractive index-based), we propose a generally applicable method and set-up for determining molecular weight key-figures based on GPC, that correspond to molecular weight data obtained via NMR spectroscopy-based methods.

Intraoperative nerve monitoring (IONM) aimed at reducing the injuries of recurrent laryngeal nerve during thyroidectomy is controversial. We conducted a meta-analysis to assess the incidence of nerve injuries with or without IONM. Studies published from January 1994 to February 2012 in English language on humans were identified. Heterogeneity of studies was checked by the Higgins test. Summary estimates of predictive values of injury were made using the Mantel-Haenszel test based on the fixed-effects model. Publication bias was assessed by a funnel plot and Egger's method. Eight articles were selected accounting a total of 5257 nerves at risk. IONM revealed a significant impact in preventing transient injuries (positive predictive value = 5% [95% CI: 2-8], negative = 96% [95% CI: 91-100], relative risk = 0.73 [95% CI: 0.54-0.98], p = 0.035), whereas they failed to demonstrate effect on permanent injuries (positive predictive value = 2% [95% CI: 0.6-3.8], negative 99% [95% CI: 97-100], relative risk = 0.73 [95% CI: 0.44-1.23], p = 0.235). This meta-analysis demonstrated the merit of IONM in preventing transient injury during thyroidectomy. No advantage was found in permanent injuries.L'utilità del monitoraggio intraoperatorio dei nervi periferici (IONM), allo scopo di ridurre il danno dei nervi ricorrenti nel corso della chirurgia tiroidea, rappresenta ancora un aspetto controverso. Abbiamo, quindi, compiuto una metaanalisi, allo scopo di definire l'incidenza di danno nervoso con e senza IONM. Sono stati dapprima identificati gli studi eseguiti dal gennaio 1994 fino al febbraio 2012 in lingua inglese. L'eterogeneità degli studi presi in considerazione è stata valutata con il test di Higgins. Una valutazione complessiva del valore predittivo di danno è stata eseguita utilizzando il test di Mantel-Haenszel, basato sul modello effetti-fissi. Eventuali problemi legati alla pubblicazione sono stati valutati con un funnel plot e il metodo di Egger. Sono stati, alla fine, selezionati 8 lavori, per un numero complessivo di tronchi nervosi a rischio pari a 5.257. L'indagine ha mostrato un ruolo rilevante dello IONM nel prevenire danni nervosi transitori (valore predittivo positivo = 5% [95%CI:2-8], negativo = 96% [95%CI:91-100], rischio relativo = 0,73 [95%CI:0,54-0,98], p = 0,035), mentre non è stato possibile mettere in evidenza un effetto sul danno permanente [valore predittivo positivo = 2% (95%CI:0.6- 3.8), negativo 99% (95%CI:97-100), rischio relativo = 0,73 (95%CI:0,44-1,23), p = 0,235]. La meta analisi ha dimostrato l'importanza dello IONM nel prevenire il danno nervoso transitorio durante la tiroidectomia, mentre non è stato possibile rendere evidente un suo ruolo per quanto riguarda il danno permanente.

To determine whether body fat distribution, measured by waist circumference (WC) and waist/hip ratio (WHR), is a better predictor of mortality and morbidity after colorectal surgery than body mass index (BMI) or body surface area (BSA).Obesity measured by BMI is not a consistent risk factor for postoperative mortality and morbidity after abdominal surgery. Studies in metabolic and cardiovascular diseases have shown WC and WHR to be better outcome predictors than BMI.A prospective multicenter international study was conducted among patients undergoing elective colorectal surgery. The WHR, BMI, and BSA were derived from body weight, height, and waist and hip circumferences measured preoperatively. Uni- and multivariate analyses were performed to identify risk factors for postoperative outcomes.A total of 1349 patients (754 men) from 38 centers in 11 countries were included. Increasing WHR significantly increased the risk of conversion [odds ratio (OR) = 15.7, relative risk (RR) = 4.1], intraoperative complications (OR = 11.0, RR = 3.2), postoperative surgical complications (OR = 7.7, RR = 2.0), medical complications (OR = 13.2, RR = 2.5), anastomotic leak (OR = 13.7, RR = 3.3), reoperations (OR = 13.3, RR = 2.9), and death (OR = 653.1, RR = 21.8). Both BMI (OR = 39.5, RR = 1.1) and BSA (OR = 4.9, RR = 3.1) were associated with an increased risk of abdominal wound complication. In multivariate analysis, the WHR predicted intraoperative complications, conversion, medical complications, and reinterventions, whereas BMI was a risk factor only for abdominal wall complications; BSA did not reach significance for any outcome.The WHR is predictive of adverse events after elective colorectal surgery. It should be used in routine clinical practice and in future risk-estimating systems.

Rectus sheath haematoma (RSH) is an uncommon condition caused by lesion of the superior or inferior epigastric arteries or their branches or by rupture of the rectus muscle. Treatment is usually supportive; however, if haemodynamic compromise develops, intravascular embolisation or surgery may be required. Furthermore, in some cases, bleeding may be so conspicuous that it can determine the patient's death before an adequate treatment is performed. We performed a retrospective study on 78 consecutive patients with the diagnosis of RSH admitted to the General Surgery Unit of our hospital between January 2000 and December 2010 in order to identify possible prognostic risk factors that could affect the operational approach before the onset of haemodynamic instability.Demographic characteristics, patient history, laboratory and diagnostic imaging examinations were investigated. The variables considered were: gender, age, anti-coagulation or anti-platelet therapy, trauma, international normalised ratio (INR) and bleeding time in the first 72 h of observation and concomitant diseases. The data were used for statistical analysis.Sixty patients received a conservative treatment, while 18 underwent operative treatment for haemodynamic instability (embolisation in 2 patients and surgery in 16 patients). Three of these 18 patients (17 %) died for consumption coagulopathy after surgery. None of the variables included in the univariate statistical analysis was significant (p = ns).Ultrasonography or computed tomography are the most common methods used to establish the diagnosis of RSH, so it is no longer a diagnostic dilemma. Most patients can be treated conservatively and an operative treatment is justified only in case of haemodynamic instability. Our retrospective study could not identify any prognostic risk factor of haemodynamic instability in RSH. We believe that only a close observation of the patients with RSH and "common sense" can prevent a possible fatal outcome.