High Incidence of Appendix Carcinoid Tumors Among Candidates for Bariatric Surgery: Diagnostic and Therapeutic Implications

Although the appendix has been recognized as a preferential site for carcinoid tumors in obese patients, no definitive guidelines are so far available regarding the management of these patients when candidates for bariatric surgery. This study was designed to fill that gap. Between 2000-2008, 558 patients underwent bariatric procedures. Appendectomy was routinely performed in 477 cases. Their charts were retrospectively retrieved and histopathology responses on surgical specimens were recorded. We aimed to assess: incidence of appendix carcinoid tumors (ACTs) and any possible risk-factor; modality of diagnosis (pre-, intra- or post-operatively); impact on the planned bariatric procedure; treatment reserved to such cases. Typical ACTs were diagnosed in 7 patients (1.4%) (median age: 33 years; median BMI: 49 kg/m2; males/females: 1/6). Four were diagnosed intra-operatively. Because of dimensions (<2 cm) and absence of mesoappendiceal or serosal involvement, simple appendectomy was performed during bariatric procedure, as planned. Three were diagnosed post-operatively (all <2 cm). In 1 case right hemicolectomy was performed 1 month later due to mesoappendiceal involvement. No appendectomy-related complication was encountered. All patients remained tumor-free during follow-up (mean: 64 months; range, 25-92). Young age, female sex, high BMI and diabetes mellitus resulted significantly associated with ACT. Our study sustains routine appendectomy or at least careful investigation of the appendix during bariatric surgery. For tumors <2 cm without mesoappendiceal or serosal involvement, simple appendectomy proved sufficient. Bariatric surgery did not have a negative effect on the treatment of malignancies that are discovered intra- or post-operatively.     

Prediction of clinical outcomes in Crohn’s disease by using confocal laser endomicroscopy: results from a prospective multicenter study

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Primary cardiac T-cell lymphoma

Primary cardiac lymphoma (PCL), defined as a lymphoma clinically mimicking cardiac disease, with the bulk of the tumor located intrapericardially, is extremely rare in immunocompetent patients. Clinical manifestations vary depending on sites of involvement in the heart and include chest pain, arrhythmias, pericardial effusion, and heart failure. Diagnosis is often difficult and may require invasive procedures; in some cases, diagnosis is not made until autopsy. Histologically, nearly all cases of PCL reported thus far have been of B-cell origin. In this report, we describe a case of PCL of T-cell origin in an adult immunocompetent patient, the second reported in the literature to the best of our knowledge, and provide a brief overview of the features of previously published PCL cases.     

Smart Drugs and Synthetic Androgens for Cognitive and Physical Enhancement: Revolving Doors of Cosmetic Neurology

Cognitive enhancement can be defined as the use of drugs and/or other means with the aim to improve the cognitive functions of healthy subjects in particular memory, attention, creativity and intelligence in the absence of any medical indication. Currently, it represents one of the most debated topics in the neuroscience community. Human beings always wanted to use substances to improve their cognitive functions, from the use of hallucinogens in ancient civilizations in an attempt to allow them to better communicate with their gods, to the widespread use of caffeine under various forms (energy drinks, tablets, etc.), to the more recent development of drugs such as stimulants and glutamate activators. In the last ten years, increasing attention has been given to the use of cognitive enhancers, but up to now there is still only a limited amount of information concerning the use, effect and functioning of cognitive enhancement in daily life on healthy subjects. The first aim of this paper was to review current trends in the misuse of smart drugs (also known as Nootropics) presently available on the market focusing in detail on methylphenidate, trying to evaluate the potential risk in healthy individuals, especially teenagers and young adults. Moreover, the authors have explored the issue of cognitive enhancement compared to the use of Anabolic Androgenic Steroids (AAS) in sports. Finally, a brief overview of the ethical considerations surrounding human enhancement has been examined.     

Allergic rhinitis phenotypes based on mono-allergy or poly-allergy

Inflammation Research - Allergic rhinitis (AR) is characterized by typical symptoms that are dependent on inflammation. Poly-allergy is a frequent phenomenon. Phenotyping AR represents an...     

Pre-hospital times and clinical characteristics of severe trauma patients: A comparison between mountain and urban/suburban areas

Objective

We investigated pre-hospital times, clinical characteristics and therapeutic interventions in multisystem trauma patients injured in mountainous areas in comparison to both urban and suburban trauma patient admissions.