Elective laparoscopic-assisted colectomy for sigmoid diverticulitis.

OBJECTIVES: The aim of this study was to evaluate the safety and effectiveness of laparoscopic-assisted sigmoid colectomy for diverticulitis and to assess its postoperative advantages. METHODS: From 1999 to 2001, 5 patients were selectively operated on with a laparoscopic-assisted procedure for uncomplicated sigmoid diverticulitis. In the preceding period (September 1997 through December 1998), 4 patients underwent open procedures for the same pathology. The surgical indication with the same criteria was restrictive: at least 2 acute episodes had occurred that were treated with hospital admission and that were separated by an adequate period (2 months) of medical therapy. RESULTS: No conversions of laparoscopy to an open procedure were necessary. Age, sex, weight, morbidity, and mortality were similar between the 2 groups. Operative time was 180 minutes for laparoscopy and 120 minutes for laparotomy. Postoperative resumption of peristalsis was 24 hours versus 4 days, resumption of alimentation was on the second postoperative day versus the fifth postoperative day, and hospital stay was 7 days versus 12 days for laparoscopy and laparotomy, respectively. CONCLUSION: This study shows the feasibility and the advantages of elective laparoscopic-assisted colonic resection for uncomplicated sigmoid diverticulitis. The advantages of the laparoscopic approach are the lower need for analgesics and the more precocious ambulation, canalization, resumption of alimentation, and the shorter hospital stay.     

Differential release of mast cell mediators and the pathogenesis of inflammation

Summary:  Mast cells are well known for their involvement in allergic and anaphylactic reactions, during which immunoglobulin E (IgE) receptor (FcɛRI) aggregation leads to exocytosis of the content of secretory granules (1000 nm), commonly known as degranulation, and secretion of multiple mediators. Recent findings implicate mast cells also in inflammatory diseases, such as multiple sclerosis, where mast cells appear to be intact by light microscopy. Mast cells can be activated by bacterial or viral antigens, cytokines, growth factors, and hormones, leading to differential release of distinct mediators without degranulation. This process appears to involve de novo synthesis of mediators, such as interleukin-6 and vascular endothelial growth factor, with release through secretory vesicles (50 nm), similar to those in synaptic transmission. Moreover, the signal transduction steps necessary for this process appear to be largely distinct from those known in FcɛRI-dependent degranulation. How these differential mast cell responses are controlled is still unresolved. No clinically available pharmacological agents can inhibit either degranulation or mast cell mediator release. Understanding this process could help develop mast cell inhibitors of selective mediator release with novel therapeutic applications.     

Viral hepatitis

Viral hepatitis is the most common serious contagious disease caused by viruses that attack the liver. Approximately 70,000 cases are reported to the Centers for Disease Control each year, representing only a fraction of U.S. cases. There are five types of viral hepatitis currently known: Hepatitis A--formerly called infectious hepatitis; Hepatitis B--formerly called serum hepatitis, and the most serious form; Hepatitis C--formerly called non-A, non-B hepatitis; Hepatitis D--formerly called delta hepatitis; Hepatitis E--formerly called enteric or epidemic non-A, non-B hepatitis. The following Open Forum, prepared by leading EMS experts, explores the differences among the types of hepatitis, signs and symptoms, and EMS implications.     

La ricostruzione del LCA con legamento sintetico: vantaggi,svantaggi, limiti

Synthetic ligaments must have a good elongation, torsion and abrasion resistance and be biocompatible, that is, chemically inert. They should be as similar as possible to natural ligaments. The effective benefits in their use for anterior cruciate ligament reconstruction are represented by a reduction in iatrogenic damage, faster recovery times, less pain and faster surgical technique. The disadvantages and limits are represented by the cost and the impossibility to define if mechanical failure may occur in the future as no long-term studies with a long follow-up have been reported in the literature yet.