Laparoscopic Technique for Permanent Nonrefluxing Gastrostomy: Experimental Study in Pigs

Purpose: This experimental study tested a modification of the Janeway technique for creation of permanent nonrefluxing gastrostomy performed laparoscopically in pigs. Materials and Methods: Six pigs (Large White-Landrace, mean weight 20 kg) were operated on under general anesthesia. The animals were kept under mechanical ventilation with oxygen and halothane by orotracheal intubation, and their vital functions were monitored continuously. A vascularized isoperistaltic tube was prepared with a flap from the gastric wall at the greater curvature, and a full-thickness tunnel was created on its extension toward the gastric antrum using automatic linear stapling devices (Endo-GIA and Endo-TA). The tunnel provides a unidirectional valvular mechanism at the proximal end of the gastric tube. Patency of the gastrostomy was proved by passing a N\ue9laton tube through it and draining the gastric contents. Continence was tested by filling the stomach with 5 L of saline through an orogastric tube while measuring intragastric pressure up to values >40 cm H2O. All the animals were sacrificed at the end of the operation, the stomach was removed, and the gastrostomy was examined grossly. Results: All the operations were entirely performed laparoscopically with an average operative time of 45 minutes. All the gastrostomies were patent and continent. No major intraoperative complications occurred. Conclusion: This modification of the Janeway operation for permanent nonrefluxing gastrostomy is feasible with a laparoscopic technique. The gastrostomy is effective in providing continence, as demonstrated by the gastric filling test

Head and neck vascular anomalies : A multidisciplinary approach and diagnostic criteria

Vascular anomalies represent a heterogeneous group of pathologies of the circulatory system that can affect any type of hematic and /or lymphatic vessel of different diameter or anatomic site. The extreme variability of tissue types and districts involved by these lesions determines a wide heterogeneity of clinical manifestations, resulting in involvement of different medical expertise. In this context, a commonly agreed terminology is crucial for the appropriate evaluation and multidisciplinary management of patients. The ISSVA Classification that has its roots in the previous Classification of Mulliken and Glowacky distinguishes vascular anomalies in two main groups: vascular tumors and vascular malformations. In head and neck, where vascular anomalies are the most common benign lesions of infancy and childhood, correct diagnosis with the use of unequivocal terminology is more crucial for treatment considering the relevance of structures that can be involved. The aim of this work has been to clarify information and knowledges currently available in the field of vascular anomalies. Referring to ISSVA Classification, clinico-histopathological aspects of each entity have been elucidated

Head and neck vascular anomalies : A multidisciplinary approach and diagnostic criteria

Vascular anomalies represent a heterogeneous group of pathologies of the circulatory system that can affect any type of hematic and /or lymphatic vessel of different diameter or anatomic site. The extreme variability of tissue types and districts involved by these lesions determines a wide heterogeneity of clinical manifestations, resulting in involvement of different medical expertise. In this context, a commonly agreed terminology is crucial for the appropriate evaluation and multidisciplinary management of patients. The ISSVA Classification that has its roots in the previous Classification of Mulliken and Glowacky distinguishes vascular anomalies in two main groups: vascular tumors and vascular malformations. In head and neck, where vascular anomalies are the most common benign lesions of infancy and childhood, correct diagnosis with the use of unequivocal terminology is more crucial for treatment considering the relevance of structures that can be involved. The aim of this work has been to clarify information and knowledges currently available in the field of vascular anomalies. Referring to ISSVA Classification, clinico-histopathological aspects of each entity have been elucidated

CD10 and CD34 as markers in vascular malformations with PIK3CA and TEK mutations

Aims: Vascular malformations (vMs) encompass a wide range of diseases often associated with somatic or, more rarely, germinal genetic mutations. A mutation in the PIK3Ca/mTOR pathway is more often involved in various vMs. CD10 and CD34 are cellular markers that may play a role in mesenchymal differentiation and proliferation. The aim of our study was to find a possible link between the immunohistochemical expression of CD10 and CD34 in vMs and their relationship with mutations in the PIK3CA/mTOR signaling pathway. Methods and results: Our study on 58 samples of vMs showed that in endothelial cells, CD10 was significantly expressed in PIK3CA-mutated samples compared with samples without any mutation (p < 0.05), especially and even more consistently when compared with samples with mutation in other pathways (p < 0.0001). Conversely, in the same PIK3CA-mutated samples, CD34 expression in endothelial cells was significantly reduced compared with samples either without any mutation or mutations in other pathways (p < 0.05 and p < 0.0005). Compared with samples with mutations in other pathways, a significant overexpression of endothelial CD10 was also found in samples with TEK/TIE2 mutation, a gene linked to the PIK3CA/mTOR pathway (p < 0.01). However, CD34 expression was not altered. In samples with PIK3CA mutation, the CD10 expression was significantly increased in the stroma compared with samples with TEK/TIE2 gene or other gene mutations (p < 0.05). Conclusion: Therefore, the CD10 and CD34 immunohistochemical profile could suggest/support the presence of mutations in the PIK3CA/mTOR pathway in samples of vMs

Linee Guida SICVE: 11. Anomalie vascolari

Gli obiettivi principali delle presenti Linee Guida per la gestione diagnostico-terapeutica delle anoma- lie vascolari sono: — indicare i criteri di classi cazione per un cor- retto inquadramento nosologico di tali patologie; — suggerire protocolli diagnostici speci ci per ottimizzare l’iter degli esami strumentali; — de nire le indicazioni e i risultati delle diffe- renti metodiche di trattamento per indirizzare verso la strategia terapeutica più idonea nei vari casi