Gastrointestinal peptides,gastrointestinal motility,and anorexia of aging in frail elderly persons

Background The mechanisms involved in anorexia in frail elderly people remain unclear. The objective of this study was to establish whether fasting and postprandial levels of gastrointestinal peptides, gastrointestinal motility, and hunger are modified by age and frailty. Methods Three groups of subjects were studied: (a) frail elderly (>70 years) persons, (b) non‐frail elderly (>70 years) persons, and (c) healthy adults (aged 25–65 years). After an overnight fast, participants ingested a 400 Kcal liquid meal and appetite, hormonal, and gastrointestinal responses were monitored during early (0–60 min) and late (60–240 min) postprandial periods. Key Results Frail persons showed poor nutritional status, sarcopenia, and almost absence of hunger during fasting and postprandial periods. Older persons presented higher levels of glucose and insulin during fasting, enhanced postprandial CCK release in early postprandial period and postprandial hyperglycemia and hyperinsulinemia, but similar ghrelin levels than younger adults. Ultrasound scan showed that the fasting antral area was higher and antral compliance lower in old persons. The paracetamol absorption test showed enhanced postprandial gastric emptying in the frail. Non‐gallbladder contractors showed no CCK peak in younger and non‐frail groups, but the same high CCK peak as contractors in the frail. Conclusions & Inferences Frailty was associated with anorexia, risk of malnutrition, and sarcopenia. Frail persons showed impaired gastric motility (larger antral area at rest, impaired antral compliance, and enhanced postprandial emptying), impaired gallbladder motility, and fasting and/or postprandial alterations in CCK, glucose, and insulin release. Further studies are needed to determine if these factors may contribute to anorexia of aging in frail persons.     

Liver Transplantation in Children With Congenital Cardiac Defects: A Case Report and a Short Literature Review

Advances in surgical techniques and follow-up of patients with complex congenital heart disease who were corrected in childhood increasingly survive to adolescence or adulthood. Increasingly anesthesiologists encounter these cases for major noncardiac surgery, including orthotopic liver transplantation (OLT) wherein there is an augmented risk of significant perioperative hemodynamic instability. We performed a successful OLT in a 12-year-old boy with end-stage cryptogenetic liver fibrosis and hepatopulmonary syndrome who was born with a double outflow right ventricle, pulmonary atresia, and pulmonary artery hypoplasia corrected at the age of 1 month. By the time he was considered for OLT his altered pulmonary valve apparatus resulted in severe pulmonary regurgitation, dilated right atrium and ventricle, and elevated right heart pressures. After a temporarily successful angioplasty he was at first placed on the waiting list, then removed, and finally relisted following implantation of a prosthetic pulmonary valve that resulted in significant reduction of right heart pressures.     

Epidemiological features and specificities of HCV infection: a hospital-based cohort study in a university medical center of Calabria region

The epidemiological status of HCV in Europe, and in particular in Mediterranean countries, is continuously evolving. The genotype distribution is related to improvement of healthcare conditions, expansion of intravenous drug use and immigration. We review and characterize the epidemiology of the distribution of HCV genotypes within Calabria, an area of Southern Italy. We focus on the pattern of distinct HCV genotype changes over the last 16 years; particularly subtype 1b and genotype 4. We collected data by evaluating a hospital-based cohort of chronic hepatitis C patients; in addition, we report an update including new patients enrolled during last eight months.     

Thoracodorsal artery perforator (TDAP) flap in immediate breast reconstruction and the role of preoperative mapping: a clinical experience

Background

Oncoplastic approach to reconstruct partial breast resection is always challenging. Nowadays, pedicle perforator flaps have been described for partial breast mastectomy reconstruction

Methods

The study comprised all patients who received partial breast resection due to external quadrant breast cancers and who were reconstructed with thoracodorsal perforator flap between August 2010 and August 2011. Twenty-two patients received the thoracodorsal artery perforator (TDAP) for breast reconstruction. The mean surgical time (including oncology resection and reconstruction) was 160 min. Eleven patients (50 %) underwent Doppler and Computed tomographic angiography (AngioCT) presurgical planning, the rest Doppler alone.

Results

The mean stay was 3.27 days. Seroma formation in the donor site was found in five cases. No flap failures were detected. No breast size changes were observed after surgical and radiotherapy treatment.

Conclusions

We conclude that TDAP flap is suitable for partial breast reconstruction (quadrantectomy) in moderate breast cancer. Level of Evidence: Level IV, therapeutic study.     

Chronic venous leg ulcers are associated with high levels of metalloproteinases‐9 and neutrophil gelatinase‐associated lipocalin

Venous ulcers are related to dysfunctions in extracellular matrix. Both matrix metalloproteinases (MMP) and neutrophil gelatinase‐associated lipocalin (NGAL) could play a role in the healing process in patients with chronic venous ulcers. We evaluated the role of MMP‐9 and NGAL in the healing process in venous ulceration. We performed an open‐label, parallel groups, single clinical center study. Patients with chronic venous leg ulcers represented the test group (Group I), whereas patients without chronic ulcers represented the control group (Group II). In Group I plasma and wound fluid samples were collected at the time of admission, at the time of the surgery, and at the follow‐up, while ulcer tissues were taken at the time of the surgery. In Group II, plasma and wound fluid were collected at admission and at the time of the surgery, whereas skin tissues were collected at the time of the surgery. Enzyme‐linked immunosorbent assay test was used to evaluate the levels of MMP‐9 and NGAL in plasma and wound fluid, whereas Western blot analysis was performed to estimate the expression of MMP‐9 and NGAL in tissues. Enzyme‐linked immunosorbent assay tests revealed significantly higher levels of MMP‐9 and NGAL in both plasma and wound fluid of patients with ulcers compared to patients without ulcers (p < 0.01). Moreover, Western blot analysis documented an increased expression of MMP‐9 and NGAL in biopsy tissue of patients with ulcers compared to patients without ulcers (p < 0.01). In conclusion MMP‐9 and NGAL may correlate with the clinical course of venous ulcers.