Short-Term Outcomes of Laparoscopy Combined with Enhanced Recovery Pathway after Ileocecal Resection for Crohn’s Disease: a Case-Matched Analysis

Background

Laparoscopy combined with an enhanced recovery pathway (ERP) is widely considered to be the first-choice option for patients with colorectal cancer. However, no previous reports have focused on patients with Crohn’s disease (CD) treated by laparoscopy and ERP.

Methods

Twenty patients with CD underwent laparoscopic ileocecal resection with an ERP at two institutions. The ERP protocol included no bowel preparation nor fasting, no nasogastric tube, no abdominal drains, early removal of urinary catheter, early solid dietary intake and mobilization, opioid-sparing analgesia and restrictive fluid management. This group was compared with a matched historical control group of 70 CD patients who underwent laparoscopic ileocecal resection treated with conventional care.

Results

Compliance with the ERP was high (≥80 %) for all items except no drain placement. A significantly earlier return of bowel function (time to first flatus and stool) was observed in the ERP group. Mean postoperative and total length of stay were significantly shorter in the ERP group. Postoperative complications were similar in both groups.

Conclusions

This is the first reported experience of laparoscopy with ERP in CD patients and suggests that optimized perioperative care combined with minimally invasive techniques may lead to further improvements in surgical outcomes for CD patients.     

Iatrogenic collapse of the nasal valve after aesthetic rhinoplasty

We present our experience of reconstruction of the nasal valve after iatrogenic collapse, and evaluate the feasibility and outcome of composite grafts. We selected all collapsed nasal valves that occurred after primary aesthetic rhinoplasties of the total number done at the University Tor Vergata in Rome. We excluded collapses that followed septoplasty for nasal deviation, reconstructions, and rhinoplasties for trauma. We selected 15 patients of 1252 who presented from January 1998 to December 2003. Eleven patients who had collapse of both the external and internal valve were treated with a composite graft (septum plus retroauricular) inserted by an “open tip” technique. Four patients (1 with both internal and external valve collapse, 3 with only internal) were treated with a section and opening of the upper lateral cartilages, transposition and repositioning of mucocartilaginous flaps. Good functional and aesthetic results were achieved in almost all patients without complications. Composite cartilaginous grafts are an easy and safe technique for the treatment of iatrogenic collapse of the nasal valve.     

COPD immunopathology

The immunopathology of chronic obstructive pulmonary disease (COPD) is based on the innate and adaptive inflammatory immune responses to the chronic inhalation of cigarette smoking. In the last quarter of the century, the analysis of specimens obtained from the lower airways of COPD patients compared with those from a control group of age-matched smokers with normal lung function has provided novel insights on the potential pathogenetic role of the different cells of the innate and acquired immune responses and their pro/anti-inflammatory mediators and intracellular signalling pathways, contributing to a better knowledge of the immunopathology of COPD both during its stable phase and during its exacerbations. This also has provided a scientific rationale for new drugs discovery and targeting to the lower airways. This review summarises and discusses the immunopathology of COPD patients, of different severity, compared with control smokers with normal lung function.     

Reaching the covert, fragile side of patients: the case of narcissistic personality disorder

A multifaceted self allows selection of those sides that are most suited to a situation and an interpersonal context, thus improving adaptation. Patients suffering from personality disorders display a limited range of self-aspects, and their relationships are stereotyped and maladaptive. Another problem is that some of these sides scarcely reach consciousness and usually remain in the background. In the case of narcissistic personality disorder (NPD) the self-part that is fragile is unlikely to reach consciousness, so that people suffering from this disorder are impervious and detached. We present a case of a psychotherapist working with a woman suffering from NPD by facilitating the emergence of the fragile part of her self, hidden by angry and scornful characters. We demonstrate, moreover, how reaching such a self-part is associated with an improvement in the patient's interpersonal relationships outside the consulting room.     

Telemedicine for Facio-Scapulo-Humeral Muscular Dystrophy: A multidisciplinary approach to improve quality of life and reduce hospitalization rate?

Background

Facio-Scapulo-Humeral Muscular Dystrophy (FSHD) is an autosomal dominant inherited disorder characterized by a variable and asymmetric involvement of facial, trunk, upper and lower extremity muscles. Although respiratory weakness is a relatively unknown feature of FSHD, it is not rare. Telemedicine has been used in a variety of health care fields, but only recently, with the advent of sophisticated technology, its interest among health professionals became evident, even in such diseases.

Histomorphology and immunohistochemical patterns in degenerative disc disease and clinical-radiological correlations: a prospective study

European Spine Journal - Degenerative disc disease (DDD) is a common condition causing low-back pain, disability and, eventually, neurological symptoms. This investigation aimed to investigate...     

Recognition and optical sensing of amines by a quartz-bound 7-chloro-4-quinolylazopillar[5]arene monolayer

Covalent bonding of 7-chloro-4-quinolylazo-octamethoxypillar[5]arene molecules to silylated quartz substrates readily produced a new chromogenic reusable pillararene-coated quartz slide, for the direct UV detection of “transparent” analytes in solution. This device provides an analyte-selective optical response towards linear (di)amines with a highly reproducible optical read-out.

Pillar[5]arene-decorated quartz slides for the direct detection of linear amines and diamines are now available.     

Amyloid beta -peptide inhibition of the PKA/CREB pathway and long-term potentiation: reversibility by drugs that enhance cAMP signaling

Changes in hippocampal function seem critical for cognitive impairment in Alzheimer's disease (AD). Although there is eventual loss of synapses in both AD and animal models of AD, deficits in spatial memory and inhibition of long-term potentiation (LTP) precede morphological alterations in the models, suggesting earlier biochemical changes in the disease. In the studies reported here we demonstrate that amyloid beta-peptide (Abeta) treatment of cultured hippocampal neurons leads to the inactivation of protein kinase A (PKA) and persistence of its regulatory subunit PKAIIalpha. Consistent with this, CREB phosphorylation in response to glutamate is decreased, and the decrease is reversed by rolipram, a phosphodiesterase inhibitor that raises cAMP and leads to the dissociation of the PKA catalytic and regulatory subunits. It is likely that a similar mechanism underlies Alphabeta inhibition of LTP, because rolipram and forskolin, agents that enhance the cAMP-signaling pathway, can reverse this inhibition. This reversal is blocked by H89, an inhibitor of PKA. These observations suggest that Alphabeta acts directly on the pathways involved in the formation of late LTP and agents that enhance the cAMP/PKA/CREB-signaling pathway have potential for the treatment of AD.