Experiences that “reach the heart”. Taking part in a whole body dissection course at the University of Malta

This article summarizes the activities of the four-week whole body dissection course the main authors participated in in August 2016 at the dissection hall of the University of Malta (UoM). Our team comprised 10 second-year medicine students from University of Palermo chosen among who had passed the Human Anatomy exam brilliantly. The need to move to the UoM to take part in such activity derives from the lack of practice approach in Italian schools of medicine, focused mostly on the theoretical studies, neglecting practical experience. The heart dissection reveal itself as a huge opportunity to finally apply our anatomical knowledge, improving it and enabling us to compare images took from …

The nuck's cyst: A disease easily confused for inguinal hernia. A case report

Nuck's canal cyst is a blind end adult residual of the fetal peritoneum. These rare cyst formations are usually found in the inguinal canal and can easily be mistaken for hernia, or enlarged limph nodes. Clinically, a Nuck's canal cyst appears as a painless or moderately painful swelling in inguinal area. We report the case of a 40 years-old woman with a painless swelling in her left inguinal region, believed a groin hernia but diagnosed as a Nuck's canal cyst only after intervention. Intraoperatively, the cyst was opened and sebsequently excised, closing the abdominal wall without the use of any sort of syntetic prostetic material.

Nutrition in inflammatory bowel disease patients

Inflammatory Bowel Diseases (IBD) is a chronic disorder characterized bya relapsing-remitting course, which alternates between active and quiescent states, ultimately impairing a patient's quality of life. The two main types of IBD are Crohn's disease (CD) and ulcerative colitis (UC). CD shows a transmural granulomatous inflammation that can involve any segment of the intestine affecting all layers of the intestinal wall while UC is limited to the mucosa and superficial sub-mucosa of the colon. In physiologial conditions the gut is costantly exposed to various antigens, commensal microflora and pathogens and the inflammatory response is finely balanced. Anyhow in some individuals with genet…

RADIOPROTECTION IN 2018: AN UPDATE

Fluoroscopically-guided interventional procedures are performed in large numbers in Europe and in the United States. Radiation doses received by interventional radiologists can vary for the same type of procedure and for similar patient doses. Occupational radiation protection is a necessity whenever radiation is used in the practice of medicine. The International Commission on Radiological Protection is engaging against occupational radiation damages, publishing regular recommendations on dose limits. These limits are expressed as effective doses for the whole body and also as equivalent doses for particular regions or tissues of practitioners’ bodies. Shielding and personal protective clo…

Obtaining mesenchymal stem cells from adipose tissue of murine origin: Experimental study

Stem cells have a key role in regenerative medicine and tissue engineering. Although not immortal, they are able to expand manyfold in culture retaining at the same time their growth and multilineage potential. They also show a migratory capacity when transplanted systemically in animal model with injuries. Thanks to their properties and their plasticity stem cells are of great importance since they can be used as a tool for repair damaged tissues and organs. Mesenchymal stem cells, in particular, have the ability to differentiate into lineages of mesodermal tissues, such as skeletal muscle, bone, tendons, cartilage, and fat under appropriate culturing conditions. Recent evidence suggest th…

HEAT SHOCK PROTEINS AND AUTOIMMUNE SYSTEM ACTIVATION IN IBD: ARTICULAR MANIFESTATIONS AND THE EPIDEMIOLOGICAL FREQUENCY IN ORTHPEDICS

clinical evidence suggest that arthritis is one of the complications of inflammatori bowel disease (IBD) of which the etiological causes are still not completely understood. Among the possible explanations the most probable theory is poor regulation of the intestinal immune system, which causes a cross-like immune reactivity against the resident micro flora. Arthritis is these subjects involves different joints and is asymmetric, with greater involvement of the large joints of the lower limbs. Joints may also be involved with the spinal forms of sacroileitis and ankilosing spondylitis. This clinical evidence explains the existence of Lesnioski-Crohn's disease, a variant of IBD in which pati…

Comparative analysis of the structure of temporomandibular joint in human and rabbit.

In order to increase knowledge on the morphology and structure of the articular disc of the temporomandibular joint (TMJ) for a better understanding of the functional role of the same, it proceeded with an investigation on histological samples in the block of TMJ and periarticular tissues of adult rabits and human fatustes at different stage of development. (www.actabiomedica.it)

The intestinal ecosystem and probiotics

The term "probiotic" comes from the greek "pro bios" and means "pro life": Nowadays, an increasing number of pharmaceutical preparations and functional foods are enriched with probiotics and for the patients it is increasingly important to receive information needed to know how to orient in the choice. The benefits from probiotics are many and include the modulation of the intestinal microflora (stimulation of beneficial bacteria and inhibition of pathogens), the support of bowel function and the stimulation of the immune system. This broad spectrum of beneficial effects to maintain efficient the intestinal ecosystem. Therefore, probiotics are an useful tool to prevent the formation of diso…

THE FINGERPRINT OF THE HUMAN GASTROINTESTINAL TRACT MICROBIOTA: A HYPOTHESIS OF MOLECULAR MAPPING

The precise etiology of Inflammatory Bowel Disease (IDB) remains unclear and several factors are believed to play a role in its development and progression, including the composition of microbial communities resident in the gastrointestinal tract. Human intestinal microbiota are extensive with at least 15,000-36,000 bacterial species. However, thanks to the new development in sequencing and molecular taxonomic methodologies, our understanding of the microbiota population composition, dynamics, and ecology has greatly increased. Intestinal microbiota play a critical role in the maintenance of the host intestinal barrier homeostasis, while dysbiosis, which involves reduction in the microbiome…

The influence of some dietary components on intestinal microbiota

The gut microbiota is the set of symbiotic microorganisms that resides in our intestine. The interaction between the gut microbiota and the mucosal immune system can be altered as a result of shifts in the composition or metabolic activity of the intestinal microflora. Recent studies establish that diet is one of the main involved factors in determining the microbial composition of the gut suggesting its role as external factor able to promote the onset of specific diseases by disrupting the immune homeostasis. Starting from the evidence that the 57% of the gut microbiota’s entire variation are due to dietary alterations this review aims at providing an overview of the positive impact of so…

Bleeding in orthopaedic surgery: The role of blood transfusion and erythropoietin alpha

High energy trauma is often responsable for acute bleeding. Long bone and pelvis fractures are correlated with increased blood loss. Hypovolaemia could become a life threatening complication especially in elderly patients because of the reduced physiological response. Furthemore it could compromise the course of associated morbidities. Haemorrage is also associated in both comminuted fractures and osteoporosis. An increased intraoperative bleeding often occurs when a prolonged surgical time is required to obtain an appropriate ostheosynthesis. The final consequence of a major bleeding is hypovolaemic shock. the reduced oxygen tension of the tissue may be responsible for heart attack, arrhyt…

TH-302 + Gemcitabine (G + T) vs Gemcitabine (G) in Patients with Previously Untreated advanced Pancreatic Cancer (PAC)

ABSTRACT Background TH-302 is a hypoxia targeted prodrug with a hypoxia-triggered 2-nitroimidazole component designed to release the DNA alkylator, bromo-isophosphoramide mustard (Br-IPM), when reduced in severe hypoxia. A randomized Phase 2B study (NCT01144455) was conducted to assess the benefit of G + T to standard dose G as first-line therapy of PAC. Materials and methods An open-label multi-center study of two dose levels of TH-302 (240 mg/m2 or 340 mg/m2) in combination with G versus G alone (randomized 1:1:1). G (1000 mg/m2) and T were administered IV over 30-60 minutes on Days 1, 8 and 15 of a 28-day cycle. Patients on the G could crossover after progression and be randomized to a G…

[Gastric leiomyosarcoma: case report and review of literature].

True smooth muscle neoplasms of the wall of digestive tract are rare, in particular in the stomach, and the benign ones are prevalent. We report a case of gastric leiomyosarcoma (LMS) that we observed, diagnosed to a 71 years-old man, with important comorbidities, who had already underwent the amputation of the right lower limb. In consequence of the discovery of anaemia and melaena he underwent an endoscopy of the upper GI tract and CT scan, which showed the presence of a neoformation of the gastric wall, but because of the thrombosis of the common iliac artery and the occurrence of the clinical picture of critical ischaemia, at first the patient underwent the amputation of the left lower …

CORRELATION BETWEEN IBD, INTESTINAL DYSBIOSIS, DIET AND MOOD TONE DISEASE: ANALYSIS OF LITERATURE

This essay's main goal the present review is to highlight the connections between intestinal dysbiosis and the ensuing activation of the mucosal lymphatic system. One of the study's goals is to investigate the impact on mood caused by a serotonergic deficit driven by mucosal inflammation. It assesses the relationship between food consumption and the onset of psychological and mental illness as a secondary end aim. Patients with inflammatory bowel diseases and psychological and psychiatric mood disorders appear to benefit therapeutically from the sort of diet they consume.

FOCAL ACTIVE COLITIS AS A PREDICTOR OF INFLAMMATORY BOWEL DISEASE: RESULTS FROM A SINGLE-CENTER EXPERIENCE.

The term focal active colitis (FAC) is conventionally used to describe the presence of isolated cryptitis, characterized by an inflammatory infiltrate consisting of intraepithelial neutrophils and/or neutrophils invading the lumen of the criptae, with no other microscopic alteration of the colonic mucosa and, in particular, without the presence of signs of chronic inflammation. To date, only four studies, including one conducted in a pediatric population, have been performed to evaluate the clinical significance of this disease. The aim of this retrospective study on prospectively-collected data is to evaluate the clinical implications of the focal active colitis, since there still remains …

Intraoperative cholangiography during laparoscopic cholecystectomy: What role?

Aim: Laparoscopic cholecystectomy has increased the number of iatrogenic lesion of the biliary tree. In this study, we evaluate the role of intra-operative cholangiography in prevention of biliary tree iatrogenic lesions and early identification of choledocolithiasis, during laparoscopic cholecystectomy. Material of study: 169 patients who underwent laparoscopic cholecystectomy, were evaluated by means of intra-operative cholangiography. Patients were divided into two groups basing on the risk to develop biliary tree lithiasis. Discussion: Patients with a higher risk of postoperative complications effectively showed cholangiographic anomalies, including duct stones, dilations, anatomical va…

Upper gastrointestinal diseases correlated to helicobacter pylori infection: Comparison between uremic and non-uremic patients. Review of the literature

Helicobacter Pylori is the first cause of infection of the upper gastrointestinal tract in hemodyalisis patients. The hemodialytic treatment can lead to spontaneous eradication of this bacteria, but the frequency of pathological involving the upper gastrointestinal tract is still higher in these patients compared to hemodialysis patients negative for the infection and normal patients. In consideration of virulence and pathogenicity of helicobacter pylori infection, there is the strong recommendation for eradication therapy in uremic patients, that it has been demonstrated to reduce the incidence of benign and malignant of the upeer gastrointestinal tract.

La Costituzione del 1812 tra passato e presente

Nutrition, malnutrition and dietary interventions in inflammatory bowel disease

Inflammatory Bowel Disease (IBD), which includes both Crohn's disease (CD) and Ulcerative Colitis (UC), is a chronic idiopathic inflammatory disorder affecting the gastrointestinal tract. Diet, as a source of luminal antigens, is thought to be an important factor in the pathogenesis of IBD. often the nutritional status of patients is significantly compromised, particularly in CD. several factors, including drug-nutrient interactions, disease location, symptoms, and dietary restriction can lead to protein energy malnutrition and specific nutritional deficiencies. solid evidence regarding the accountability of certain dietary components in the etiology of IBD are lacking. With regard to malnu…

Towards an improvement of hospital services and streamlining of health care costs: The DRG analysis in Italy

The term Diagnosis-related Group (DRG) refers to a classification system used to assess hospital services with the aim of a better management of health care costs and improving performance. The DRG system focuses on the utilization of resources, and is not concerned with the specific type of care provided to the patient. This system highlights any diseconomies and eventual critical aspects of the hospital system. This article, starting from the history of heath care financing in Italy and pointing out the difficulty to define the "quality" of health care services, describes the variables used to evaluate correctly hospital performance based on the DRG system. These include Average Length of…

Argon plasma coagulation in the treatment of post-radiotherapy rectal bleeding

Introduction: Chronic radiation proctitis is often associated to radiotherapy for treatment of pelvic cancer. The most common side effect of this pathological condition is rectal bleeding but despite the great number of clinical approaches and techniques that have been employed no consensus for the management of it is available. Although prospective randomized trials about hemorrhagic radiation proctitis are still lacking, endoscopic approach delivering an Argon Plasma Coagulation (APC) seems to be a successful and available option. Patients and Methods: Sixteen patients suffering from post-radiotherapy rectal bleeding were followed. In the nine cases presenting a rectum ulcerative colitis …

Lactobacillus casei and Bifidobacterium lactis supplementation reduces tissue damage of intestinal mucosa and liver after 2,4,6-trinitrobenzenesulfonic acid treatment in mice

Probiotics (PB) are living microorganisms that act as a commensal population in normal intestines and confer numerous beneficial effects on the host. The introduction of probiotics in the treatment of inflammatory bowel disease (IBD) prolongs remission. The aim of this study was to investigate the intestinal and hepatic effects of PB supplementation in an experimental IBD model in mice induced by 2,4,6-trinitrobenzene sulfonic acid (TNBS). In the first step of the experimental procedure, CD-1 male mice, 5 to 6 weeks old, were randomly divided into 3 groups and inoculated intrarectally with, respectively, saline, alcohol, or TNBS to assess the experimental IBD model. In the second step, mice…

Use of tailored intraperitoneal ePTFE dual mesh in permagna inguinal hernia

Here we report a case of a giant inguinoscrotal hernia in an elderly patients treated by means of an open positioning of intraperitoneal ePTFE dual mesh. In patients with giant inguinoscrotal hernia the forceful introduction of viscera in abdominal cavity and primary wall closure is burnened from respiratory complication, abdominal compartment syndrome, and defects in wound healing thus exposing the patients to further morbidity and mortality risk. The management of these patients is difficult because of the high occurrence of morbidity factors that affect the success on intervention independently of the technique of surgical repair. The tension- free technique we adopted consented us to ob…

Fentanyl and sufentanyl in fast track anaesthesia for major intra-abdominal surgery

Background and aim: Major intra-abdominal surgery is estimated to have high costs annually in Italy. In an attempt to decrease surgery costs and improve outcome for patients, fast-track programs have become popular. This is especially due both to the improvement of surgery and to the new anesthetic agents (regarding pharmacokinetic and pharmacodynamic) resulting in better care for patients. The aim of this study was to evaluate two different anesthetic protocols in patients undergoing scheduled anesthesia including the combination of two different opioids (fentanyl or sufentanil) with the same hypnotic and muscle relaxant. Material and Methods: 40 patients, with an American Society of Anest…

Colorectal cancer in patients with type 2 diabetes mellitus: a single-center experience

Type 2 diabetes mellitus (T2DM) is associated with an increased risk of colorectal cancer (CRC). The aim of the study is to evaluate the prevalence of CRC in a cohort of Caucasian patients with T2DM and the association with other variables previously known to be related with increased risk of CRC. We retrospectively evaluated the data of 741 consecutive Caucasian patients with T2DM who underwent colonoscopic screening in our tertiary referral center. A control cohort of 333 patients with thyroid disease was selected to evaluate the difference in the incidence of CRC. At a median follow-up of 132.5 months (range 33.3-175.7), 67 cases of cancer (prevalence 9%) occurred; among these, 14 cases …

HSP-MOLECULAR CHAPERONES IN CANCER BIOGENESIS AND TUMOR THERAPY: AN OVERVIEW

Molecular chaperones, many of which are heat-shock proteins (HSPs), are an important class of molecules with various functions. Pathological conditions in which chaperones become etiological and/or pathogenic factors are called chaperonopathies, and are classified into by defect, by excess, and by "mistake". In the latter case, the chaperone is structurally and functionally normal but paqrtecipates in pathwais that favor diseases, aòlthough in some cases the chaperone may have post-translational modifications that may lead it to change its location and function and, thus, to become pathogenic. For example, HSP-chaperones are involved in acrcinogenesis in various ways, so that some forms of …

INTESTINAL BACTERIA AND BOWEL DISEASE: ROLE OF PROBIOTICS.

The gut of a helathy adult harbours a myriad of different microbial species (aproximately 10.14 colony forming units). In healthy adults the main control of intestinal bacterial colonization occurs through the gastric acidity. Moreover, other factors can influence the intestinal micorenvironment, as pH, temperature, competition among different bacterial strains, peristalsis, drugs, radiotherapy, and much more. It was found that, when you have an impaired micorbial homeostasis, the intestinal microsystem becomes unstable, so that leads to an alteration of the permeability of tissues, togheter with the activation of the intestinal immune system (MALT). These microenvironmental changes thus pr…

A SIMPLE TECHINIQUE TO IMPROVE RESIDUAL SKIN PLASTICITY FOR SCROTAL RECONSTRUCTION IN FOURNIER'S GANGRENE

A 50 years-old man developed 24 hours after hemorrhoidectomy a severe Fournier's gangrene of the scrotum necessitating surgical exeresis of more than 2/3 of scrotal skin followed by hyperbaric oxygen therapy. After the resolution of the septic phase, scrotum reconstruction was obtained by tissue expansion to avoid more invasive advanced reconstructive techniques. The procedure consisted of an enzymatic and mechanical debridement and progressive skin expansion by package of gauzes of increasing volume covered with a collagenasecloramphenicol ointment (Iruxol®- Smith and Nephew, Italy), then closing the wound edges by temporary stitches to put under tension the skin. The reestablishment of th…

DYSBIOSIS, INFLAMMATORY BOWEL DISEASE AND COLON CANCER: THERE IS A CORRELATION?

Dysbiosis has been linked to IBD. The intestinal microbiota plays a fundamental role in health and the progression of diseases such as IBD and CRC. Many cancers arise from sites of infection and chronic inflammation. Patients with inflammatory Bowel Disease (IBD) have an increased risk of 10%-15% developing colorectal cancer. Therefore, a complete understanding of the composition and function of the gut microbiota is critical.

The value of diagnostic ultrasound for detecting occult inguinal hernia in patients with groin pain

Aims: chronic groin pain caused by an occult hernia can be a difficult clinical diagnosis and may require additional investiga- tive modalities. The aim of this study was to demonstrate the accuracy of ultrasound in diagnosing occult hernia in patients with recurrent inguinal pain and a negative clinical examination. Patients and methods: over a period of three years, a total of 76 patients were referred for ultrasound examination with clini- cally suspected occult inguinal hernia. Patients with positive US scans were offered surgery, while those with negative US findings were offered further imaging or other diagnostic tests. The ultrasound examination of the inguinal region was conducted …

REPORT OF A CASE OF MALIGNANT TUMOR-LIKE GASTRIC LESION BY CANDIDA IN A DIABETIC TREATED WITH CYCLOSPORINE FOR PSORIASIS AND REVIEW OF THE LITERATURE

Mycotic infection of the alimentary canal are rare and usually involve the upper digestive tract. Mycetes, especially of Candida family, are habitual saprophytes in the digestive tract of healthy individuals. Under certain conditions, fungal flora may overgrowth, resulting in lesions of the digestive mucosa, which, rarely, might evolve to local diffusion and/or systemic lympho-hematogenous spreading. In the stomach, sometimes, mycotic infections may appear like benign gastric ulcers. we described a case of woman, aged 64, affected by psoriasis, in chronic treatment with cyclosporine and type 2 diabetes mellitus, a well-known immunosoppressive condition, with endoscopic evidence of ulcerated…

2016 WHO GLOBAL GUIDELINES FOR THE PREVENTION OF SURGICAL SITE INFECTION: A NEW STEP TO IMPROVE PATIENT'S SAFETY BEFORE, DURING AND AFTER SURGERY

Surgical site infection (SSI) are among the most preventable health-care-associated infections and are a substantial burden to health-care systems and service payers worldwide in terms of patient morbidity, mortality, and additional costs. SSI prevention is complex and requires the integration of a range of measures before, during and after surgery. No international guidelines are available and incosistencies in the interpretations of evidence and recommendations of national guidelines have been identified. Given the burden of SSI worldwide, the numerous gaps in evidence-based guidance, and the need for standardisation and a global approach, WHO decided to prioritise the development of evid…

Helicobacter pylori and Barrett’s esophagus: a protective factor or a real cause?

Nothwithstanding the definite aethiopathogenetic path of certain diseases, the relationship between Helicobacter Pylori (H. Pylori) and barrett's esophagus (BE), a condition that increases the risk for dysplasia and consequently adenocarcinoma of the distal esophagus and esophagogastric junction, remains uncertain. this paper reviews the current scientific literature with emphasis on the protective correlation between H. Pylori infection and BE, and demonstrates that a causal relathionship has not been disproved with certainty. Furthermore, H. Pylori infection could pose a risk for the onset of gastroesophageal reflux disease (GERD), which could in turn trigger BE, a precancerous lesion and…

Pouchitis: A tridimensional view

The preferred surgical treatment of ulcerative colitis (UC) and familial adenomatous polyposis (FAP) is represented by proctocolectomy with ileal pouch-anal anastomosis (IPAA). However, patients with UYC who have undergone IPAA are prone to develop several complications, which include surgery related/mecchanical complications; inflammatory or infectious disoreders; dysplasia or neoplasia; and systemic or metabolic disorders. Pouchitis, which is defined as the acute and/or chronic inflammation of the ileal reservoir, represent the most common long-term adverese sequela after IPAA. Gut microbiota play a pivotal role in the initiation and disease progression of pouchitis. Pouchitis can be clas…

Inflammatory Bowel Disease (IBD) in pregnancy: analysis of the possible effects of the disease on the fetus and the newborn and therapeutic approaches

The Inflammatory Bowel Diseases(IBD), are a group of inflammatory diseases characterized by the presence of chronic inflammation, i the absenc of infectious ethiology. The two most well-known diseases in this group are: Crohn's disease (CD) and Ulcerative Colitis (UC). In cases where iti is not possible to distinguish between CD and UC, it is called Indeterminated Colitis. IBD can affect women pregnant. The causes of IBD are unknown, and the clinical course of the sdisease is characterized by phases of activity and remission. UC is a chronic inflammation of the mucosa of the colon and involving predominantly the left colon and rectum. It is associatred with presence of blood and mucus in th…

An unexpected surprise at the end of a "quiet" cholecystectomy. A case report and review of the literature

BACKGROUND: Anatomic unexpected variations in biliary tree may be discovered during laparoscopic cholecystectomy. CASE REPORT: A 57-year-old man was admitted for abdominal pain, vomiting and mild jaundice. Abdominal ultrasonography revealed a gallbladder containing multiple stones and biliary sludge. All pre-operative investigations showed no anatomical variations in extrahepatic biliary tree. During surgical intervention an accessory extrahepatic duct, connecting the IV segment of the liver to the fundus of gallbladder, was discovered. CONCLUSIONS: Pre-operative routine investigations for gall stones diseases may not reveal anatomic variations of biliary tree.

The management of postoperative pain after hemorrhoidectomy: Analysis of three methodics

Postoperative pain is one of the most common and disabling complications following hemorrhoidectomy. This study divided a total of 90 patients, undergone Milligan and Morgan hemorrhoidectomy, in three groups of 30 patient: Group A, undergone internal sphincterotomy after hemorrhoidectomy; Group B, treated with Diosmin 500 mg; Group C, treated with Paracetamol 1000 mg when required. The analysis of the median VAS score (Visual Analogic Scale) of postoperative pain, in every group pointed out a relationship between postoperative pain reduction and time at the three set checkpoints (1st, 3rd, 9th postoperative day) (R2= 0.9231 for Group A; R2= 0.9423 for group B; R2= 0.9423 for group C). Mean …

ORAL MICROBIOTA: CHARACTERISTICS, RELATED PATHOLOGIES AND FUTURE PROSPECTS

The oral microbiota is represented by the set of bacteria and microrganisms that reside in the oral cavity. It is formed from bird and stabilizes during the period of permanent dentition. The oral microbiota poresents from 500 to 700 bacterial species, belonging to six main phyla, Firmicutes, Bacteroidetes, Proteobacteria, Actinobacteria, Spirochaetes and Fusobacteria. These bacteria partecipate in the formation of dental plaque, a sort of biofilm that deposits on the rigid surfaces of the oral cavity, and contributes to the healthy maintenance of the oral cavity. An alteration of the oral microbiota contributes to the pathogenesis of periodontitis, caries, gingivitis and also of systemic d…