Endoscopy plays a pivotal role in the management of adverse events (AE) following bariatric surgery. Leaks, fistulae, and post-operative collection after sleeve gastrectomy (SG) may occur in up to ...10% of cases.
To evaluate the efficacy and safety of endoscopic internal drainage (EID) for the management of leak, fistula, and collection following SG.
Retrospective, observational, single center study on patients referred from several bariatric surgery departments to an endoscopic referral center.
EID was used as first-line treatment for the management of leaks, fistulae, and collections. Leaks and fistulae were treated with double pigtail stent (DPS) deployment in order to guarantee internal drainage and second intention cavity obliteration. Collections were treated with endoscropic ultrasound (EUS)-guided deployment of DPS or lumen apposing metal stents.
A total of 617 patients (83.3% female; mean age, 43.1 yr) were enrolled in the study for leak (n = 300, 48.6%), fistula (n = 285, 46.2%), and collection (n = 32, 5.2%). Median follow-up was 19.5 months. Overall clinical success was 84.7% whereas 15.3% of cases required revisional surgery after EID failure. Clinical success according to type of AE was 89.5%, 78.5%, and 90% for leak, fistula, and collection, respectively. A total of 10 of 547 (1.8%) presented a recurrence during follow-up. A total of 28 (4.5%) AE related to the endoscopic treatment occurred. At univariate logistic regression predictors of failure were: fistula (OR 2.012), combined endoscopic approach (OR 2.319), need for emergency surgery (OR 1.755), and previous endoscopic treatment (OR 4.818).
Early EID for the management of leak, fistula, and post-operative collection after SG seems a safe and effective first-line approach with good long-term results.
Inflammatory myoglandular polyp (IMGP) is a rare non-neoplastic polyp of the large bowel, commonly with a distal localization (rectosigmoid), obscure in its pathogenesis. Up till now, 60 cases of ...IMGP have been described in the literature, but none located in the cecum.
We report a case of a 53-year-old man who was admitted to our hospital for further evaluation of positive fecal occult blood test associated to anemia. A colonoscopy identified a red, sessile, lobulated polyp of the cecum, 4.2 cm in diameter, partially ulcerated. The histological examination of the biopsy revealed the presence of inflammatory granulation tissue with lymphocytic and eosinophil infiltration associated to a fibrous stroma: it was diagnosed as inflammatory fibroid polyp. Considering the polyp's features (absence of a peduncle and size) that could increase the risk of a polypectomy, a surgical resection was performed. Histological examination of the specimen revealed inflammatory granulation tissue in the lamina propria, hyperplastic glands with cystic dilatations, proliferation of smooth muscle and multiple erosions on the polyp surface: this polyp was finally diagnosed as IMGP. There was also another little polyp next to the ileocecal valve, not revealed at the colonoscopy, 0.8 cm in diameter, diagnosed as tubulovillous adenoma with low grade dysplasia.
This is the first case of IMGP of the cecum. It is a benign lesion of unknown pathogenesis and must be considered different from other non-neoplastic polyps of the large bowel such as inflammatory cap polyps (ICP), inflammatory cloacogenic polyps, juvenile polyps (JP), inflammatory fibroid polyps (IFP), polyps secondary to mucosal prolapse syndrome (MPS), polypoid prolapsing mucosal folds of diverticular disease. When symptomatic, IMGP should be removed endoscopically, whereas surgical resection is reserved only in selected patients as in our case.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The elevated serum and peritoneal cytokine concentrations responsible for the systemic response syndrome (SIRS) and multiorgan failure in patients with severe acute pancreatitis lead to high ...morbidity and mortality rates. Prompted by reports underlining the importance of reducing circulating inflammatory mediators in severe acute pancreatitis, we designed this study to evaluate the efficiency of laparotomy followed by continuous perioperative peritoneal lavage combined with postoperative continuous venovenous diahemofiltration (CVVDH) in managing critically ill patients refractory to intensive care therapy. As the major clinical outcome variables we measured morbidity, mortality and changes in the Acute Physiology and Chronic Health Evaluation (APACHE II) score and cytokine concentrations in serum and peritoneal lavage fluid over time.
From a consecutive group of 23 patients hospitalized for acute pancreatitis, we studied 6 patients all with Apache II scores >/=19, who underwent emergency surgery for acute complications (5 for an abdominal compartment syndrome and 1 for septic shock) followed by continuous perioperative peritoneal lavage and postoperative CVVDH. CVVDH was started within 12 hours after surgery and maintained for at least 72 hours, until the multiorgan dysfunction syndrome improved. Samples were collected from serum, peritoneal lavage fluid and CVVDH dialysate for cytokine assay. Apache II scores were measured daily and their association with cytokine levels was assessed.
All six patients tolerated CVVDH well, and the procedure lasted a mean 6 days (range, 3-12). Five patients survived and one died of Acinetobacter infection after surgery (mortality rate 16.6%). The mean APACHE II score was >/= 19 (range 19-22) before laparotomy and decreased significantly during peritoneal lavage and postoperative CVVDH (P = 0.013 by matched-pairs Students t-test). The decrease in cytokine concentrations in serum and lavage fluid was associated with the decrease in APACHE II scores and high interleukin 6 (IL-6) and tumor necrosis factor (TNF) concentrations in the hemofiltrate.
In critically ill patients with abdominal compartment syndrome, septic shock or high APACHE II scores related to severe acute pancreatitis, combining emergency laparotomy with continuous perioperative peritoneal lavage followed by postoperative CVVHD effectively reduces the local and systemic cytokines responsible for multiorgan dysfunction syndrome thus improving patients' outcome.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
A non cirrhotic patient with esophageal varices and portal vein thrombosis had recurrent variceal bleeding unsuccessfully controlled by endoscopy and esophageal transection. Emergency transhepatic ...portography confirmed the thrombosed right branch of the portal vein, while the left branch appeared angulated, shifted and stenotic. A stent was successfully implanted into the left branch and the collateral vessels along the epatoduodenal ligament disappeared. In patients with esophageal variceal hemorrhage and portal thrombosis if endoscopy fails, emergency esophageal transection or nonselective portocaval shunting are indicated. The rare patients with only partial portal thrombosis can be treated directly with stenting through an angioradiologic approach.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Objectives
To report the results of a multicenter retrospective evaluation of the clinical outcomes of thermal ablation (TA) in a large series of autonomously functioning thyroid nodules (AFTN) with ...a follow-up protracted up to 3 years.
Methods
Patients treated with single TA for an AFTN in Italy were included. Changes in nodule volume, TSH values, and ongoing anti-thyroid therapy were assessed at the 2-, 6-, 12-, 24-, and 36-month follow-up controls. Complications and need of any additional therapy after TA were also registered.
Results
A total of 361 patients (244 females, 117 males, median age 58 years, IQR 46–70 years) were included. Nodule volume was significantly reduced at all time points (
p
< 0.001) (median volume reduction 58% at 6-month and 60% at 12-month). Serum TSH values increased significantly at all time points. After TA, anti-thyroid therapy was withdrawn in 32.5% of patients at 2 months, in 38.9% at 6 months, and in 41.3% at 12 months. A significant difference in the rate of patients who withdrawn medical therapy at 12 months was registered between small (< 10 mL) (74%), medium (49%), or large (> 30 mL) nodules (19%). A single major complication occurred (0.25%). Additional treatments were needed in 34/361 (9.4%) of cases including 4 (1.1%) surgical treatment.
Conclusions
Image-guided thermal ablation offers a further safe and effective therapeutic option in patients with AFTN. Clinical outcomes are significantly more favorable in small than in large size AFTN.
Key Points
• Thermal ablations (TA) can be safely and effectively used in patients with autonomously functioning thyroid nodules (AFTN).
• TA results in a clinically significant nodule volume reduction that is paralleled by TSH level normalization and anti-thyroid drug therapy discontinuation (after TA anti-thyroid therapy was withdrawn in 41.3% at 12 months).
• Clinical outcomes after TA are more favorable in small nodules, and when a large amount of thyroid nodule tissue is ablated.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
The recovery of wastewater will be a fundamental action in the coming years to facilitate the sustainable development of the world's economies. A large portion of recoverable wastewater comes from ...petrochemical activities such as oil extraction and its subsequent refining processes. The most important characteristic of this water is its heavy contamination by soluble and insoluble hydrocarbons (as emulsioned hydrocarbons) and inorganic and heavy metal ions. Furthermore, the presence of refineries is directly linked to possible groundwater contamination that must be then remediated. In this context, adsorption technologies appear to be very promising for the remediation and recovery of “petrochemical” water. In this paper, we present a review of applied adsorption technologies and examine both the use of two different microporous materials, a natural zeolite called clinoptilolite and a polymeric chelating resin named Purolite® Resin S910, for the removal of dissolved heavy metals, and the use of a mesoporous siliceous material for the uptake of hydrocarbons from wastewater. Batch experiments on the kinetics and equilibrium of adsorption were carried out on all the materials by using Pb2+, Cd2+ and Ni2+ as target heavy metals and benzene and toluene as target organic pollutants. The effect of ionic strength was also investigated.
The batch tests indicated a good adsorption rate and a percentage of heavy metal and hydrocarbon removal that was always greater than 90%. A new adsorption model was also developed to better describe the adsorption mechanism of heavy metals, while a model with a two-step mechanism was chosen for hydrocarbons. Increasing ionic strength appeared to decrease the adsorption performance of the microporous material and the presence of organic interfering contaminants. However, both materials seemed to maintain good adsorption capabilities.
•Heavy metal and hydrocarbon adsorption of synthetic and natural material was studied.•Ionic strength seems to depress the adsorption of heavy metals.•A cooperation mechanism of Pb2+ and benzene seems to occur during the adsorption.•A new model for heavy metals uptake by clinoptilolite and S910 resin was developed.•The mesoporous materials seems to be a promising material for hydrocarbons removal.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
A membraneless microbial electrolysis cell (MEC) has been developed for perchloroethylene (PCE) removal through the reductive dechlorination reaction. The MEC consists of a tubular reactor of 8.24 L ...equipped with a graphite-granule working electrode which stimulates dechlorinating microorganisms while a graphite-granule cylindrical envelopment contained in a plastic mesh constituted the counter electrode of the MEC. Synthetic PCE-contaminated groundwater has been used as the feeding solution to test the nitrate and sulfate reduction reactions on the MEC performance at different hydraulic retention times (HRTs) (4.1, 1.8, and 1.2) and different cathodic potentials −350, −450, and −650 mV vs standard hydrogen electrode (SHE). The HRT decrease from 4.1 to 1.8 d promoted a considerable increase in sulfate removal from 38 ± 11 to 113 ± 26 mg/Ld with a consequent current increase, while a shorter HRT of 1.2 d caused a partial inhibition of sulfate reduction with a consequent current decrease from −99 ± 3 to −52 ± 6 mA. Similarly, the cathodic potential investigation showed a direct correlation of current generation and sulfate removal in which the utilization of a cathodic potential of −350 mV versus SHE allowed for an 80% decrease in the sulfate removal rate with a consequent current decrease from −163 ± 7 to 41 ± 5 mA. The study showed the possibility to mitigate the energy consumption of the process by avoiding side reactions and current generation, through the selection of an appropriate HRT and applied cathodic potential.
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IJS, KILJ, NUK, PNG, UL, UM, UPUK
High-latitude ionospheric plasma constitutes a very complex environment, which is characterized by turbulent dynamics in the presence of different ion species. The turbulent plasma motion produces ...statistical features of both electromagnetic and velocity fields, which have been broadly studied over the years. In this work, we use electric field high-resolution observations provided by the China-Seismo Electromagnetic Satellite-01 in order to investigate the properties of plasma turbulence within the Earth’s polar cap. We adopt a model of turbulence in which the fluctuations of the electric field are assimilated to a stochastic process evolving throughout the scales, and we show that such a process (i) satisfies the Markov condition (ii) can be modeled as a continuous diffusion process. These observations enable us to use a Fokker–Planck equation to model the changes in the statistics of turbulent fluctuations throughout the scales. In this context, we discuss the advantages and limitations of the proposed approach in modeling plasma electric field fluctuations.
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