L'ecografia nella diagnosi prenatale di displasie scheletriche

Le displasie scheletriche sono un gruppo di oltre 400 patologie rare, a prognosi variabile e diverso rischio di ricorrenza. Scopo del presente lavoro è stato rivedere la casistica degli ultimi 30 anni in un singolo Centro di riferimento di ecografia ostetrica, per valutare le possibilità di diagnosi prenatale alle diverse età gestazionali. Sono stati inclusi nello studio 29 feti riferiti per sospetto di malformazione e 11 feti di donne che avevano avuto un precedente feto con displasia scheletrica (2 casi di ricorrenza). Due neonati sono sopravvisuti, si sono avute 3 morti perinatali, in 18 casi la donna ha richiesto l’interruzione volontaria di gravidanza; gli ultimi 2 casi sono persi al follow-up. Le diagnosi erano: displasia tanatofora (n=8), osteogenesi imperfecta di tipo II (n=4), acondroplasia (n=3), sindrome di Shwachman-Diamond (n=2), disostosi spondilocostale (n=2) ed un caso ognuno di sindrome di Apert, ipocondrogenesi, ipofosfatasia ed ipostaturismo familiare. In 8 casi non è stato possibile effettuare una diagnosi esatta. La diagnosi è stata confermata con biologia molecolare in 13 casi, di cui 3 in epoca prenatale. Aspetti ecografici particolari erano riscontrabili nei casi di ipomineralizzazione, in 2/3 di acondroplasia (soltanto nel 3° trimestre), nei 2 di disostosi spondilocostale e nella sindrome di Apert

Robot-assisted pancreaticoduodenectomy with vascular resection: technical details and results from a high-volume center

Background: Pancreaticoduodenectomy with vein resection (PD-VR) is widely accepted as a standard procedure to achieve a higher rate of R0 resections in borderline resectable pancreatic tumors. Thanks to the availability of newer technologies, such as the da Vinci Surgical System, several high-volume centers are reporting small series of minimally invasive PD-VR. Methods: A retrospective review of a prospectively maintained database was performed to identify patients who underwent robot-assisted PD-VR (RAPD-VR) between May 2011 and December 2019. The following factors were specifically analyzed: intraoperative results, post-operative complications, mortality at 90 days, patency of vascular reconstructions, overall survival (OS) and disease-free survival (DFS). Results: During the study period 184 patients underwent RAPD, including 22 who received a RAPDVR (12.0%). The superior mesenteric vein was resected in 9 patients (40.9%), the portal vein in 3 patients (13.6%) and the spleno-mesenteric junction in 10 patients (45.5%). Based on the classification provided by the International Study Group on Pancreatic Surgery these procedures were classified as follows: 1 type I (4.5%), 3 type II (13.6%), 10 type III (45.5%) and 8 type IV (36.4%). In no patient the splenic vein was ligated and left behind. The splenic vein was always reimplanted either on the porto-mesenteric axis or in the inferior vena cava. All but one procedure, were completed under robotic assistance (conversion rate 1/22; 4.5%) after a mean operative time of 610.0±83.5 minutes. Median estimated blood loss was 899.7 mL (719.4–1,430.2 mL), with 2 patients (9.1%) receiving intraoperative blood transfusions. Sixteen patients developed post-operative complications (72.7%), graded ≥III (according to Clavien-Dindo) in 5 patients (22.7%). Two patients died within 90 days, accounting for a postoperative mortality of 9.1%. Interestingly, post-operative pancreatic fistula (grade B) occurred in only 1 patient (4.5%). Repeat surgery was required in 4 patients (18.2%) and hospital readmission in 1 patient (4.5%). At the longest available follow-up, vein reconstruction was patent in 19 patients (86.4%). Eighteen patients had a final diagnosis of pancreatic ductal adenocarcinoma (81.8%). After circumferential study of resection margins, microscopic tumor residual ≤1 mm was found in 11 patients (50.0%). The mean number of examined lymph nodes was 42.2 (±16.3), and vascular infiltration was confirmed in 13 patients (59.1%). Median OS was 39.7 (27.5–not available) and DFS 32.9 (11.5–45.8). Tumor recurrence was identified in 6 patients (27.3%). One patient (4.5%) developed isolated local recurrence. Conclusions: We have shown the feasibility of RAPD-VR. The results reported herein need to be confirmed in larger series and their generalizability remains to be established

Duodenocefalopancreasectomia robotica: definizione di un modello predittivo preoperatorio di difficolta'

Alcune evidenze mostrano che la duodenocefalopancreasectomia minimamente invasiva è associata a risultati migliori rispetto all'intervento chirurgico "open". Tuttavia, durante la fase di apprendimento, la sicurezza del paziente o l'efficacia oncologica potrebbero essere compromesse, sollevando così preoccupazioni sull'attuazione sicura dell'intervento. Il sistema chirurgico Da Vinci potrebbe abbreviare la curva di apprendimento e facilitare questo processo, anche se mancano prove chiare della superiorità della duodenocefalopancreasectomia robotica rispetto ad altri tipi di duodenocefalopancreasectomie mini-invasive (laparoscopica o ibrida) o open. Chiaramente ci sono diverse variabili correlate al paziente ed alla patologia di base che possono rendere un'operazione relativamente "semplice", con esito favorevole, o estremamente complessa, con un difficoltoso decorso postoperatorio. La capacità di prevedere la difficoltà della duodenocefalopancreasectomai robotica in ogni singolo paziente è estremamente importante sia per la selezione dei pazienti che per l'implementazione della learning curve

Sustainable methodologies for stability assessment of masonry vaulted structures

The analyses carried out on damaged masonry churches, after earthquakes that affected Italy in recent years, highlighted that vaulted structures are among the most vulnerable elements. This paper analyses a methodology for stability assessment of masonry vaults and domes, using non-invasive methods to calculate their static equilibrium, without any destructive investigations. The survey is based on a knowledge process, which provides the researchers with a series of information, from the historical to the geometrical ones, accounting for peculiarities of each specific typology and related constructional techniques

Safety and Efficacy of Proctosoll Allevia in the Management of Haemorrhoidal Disease in Adults: A Prospective Randomized Clinical Trial

Introduction: Hemorrhoidal Disease (HD) is a very common anorectal disorder that affects millions of people around the world and represents a major medical and socioeconomic problem. The aim of the present study was to assess the safety and efficacy of Proctosoll Allevia® in patients affected by symptomatic HD in comparison with the results obtained from a control group. Materials and methods: From January to February 2019, all the patients referred to the outpatient clinic of Rajalakshmi Hospital, who were complaining of first or second degree hemorrhoidal symptoms, were enrolled in the study. They were randomly assigned to either of the 2 arms. Group 1: patients were treated with the Proctosoll Allevia® and were under a controlled diet. Group 2: patients were only under a controlled diet without any treatment - control group. Results: A total of 51 subjects were screened and 45 (13 F- 32 M) enrolled in the study. All the patients treated with topical application of the cream showed a statistically significant improvement of symptoms within 14 days from the beginning of the therapy if compared to patients who were treated only with a controlled diet. No major adverse events associated with the use of the new product were recorded. Conclusion: The treatment of I-II degree symptomatic HD with Proctosoll Allevia® has demonstrated to be promising with a good profile of tolerability, safety and efficacy. Keywords: Cortisone-free cream; Proctosoll Allevia®; hemorrhoidal prolapse; hemorrhoids; randomized clinical trial; safety and effica

Robot-assisted spleen preserving distal pancreatectomy: case report

A 28-year-old female patient was incidentally diagnosed with a unilocular pancreatic cystic lesion located in the body-tail of the pancreas. Findings at contrast-enhanced computed tomography scan and magnetic resonance were both consistent with the diagnosis of mucinous cystadenoma. The patient was then scheduled for a robot-assisted distal pancreatectomy with preservation of the spleen and the splenic vessels. The procedure was completed safely in 255 minutes with minimal blood loss. The post-operative course was uneventful and the patient was discharged on post-operative day 6. Final pathology confirmed the diagnosis of mucinous cystadenoma. In the video presented herein we show the technique for robot-assisted distal pancreatectomy with preservation of the spleen and the splenic vessels

Safety and Efficacy of Proctosoll Allevia in the Management of Haemorrhoidal Disease in Adults: A Prospective Randomized Clinical Trial

Introduction: Hemorrhoidal Disease (HD) is a very common anorectal disorder that affects millions of people around the world and represents a major medical and socioeconomic problem. The aim of the present study was to assess the safety and efficacy of Proctosoll Allevia® in patients affected by symptomatic HD in comparison with the results obtained from a control group. Material and Methods: From January to February 2019, all the patients referred to the outpatient clinic of Rajalakshmi Hospital, who were complaining of first or second degree hemorrhoidal symptoms, were enrolled in the study. They were randomly assigned to either of the 2 arms. Group 1: patients were treated with the Proctosoll Allevia® and were under a controlled diet. Group 2: patients were only under a controlled diet without any treatment - control group. Results: A total of 51 subjects were screened and 45 (13 F- 32 M) enrolled in the study. All the patients treated with topical application of the cream showed a statistically significant improvement of symptoms within 14 days from the beginning of the therapy if compared to patients who were treated only with a controlled diet. No major adverse events associated with the use of the new product were recorded. Discussion: The treatment of I-II degree symptomatic HD with Proctosoll Allevia® has demonstrated to be promising with a good profile of tolerability, safety and efficacy. </jats:sec