Chron's Disease is a chronic inflammatory intestinal disease, first described at the beginning of the last century. The disease is characterized by the alternation of periods of flares and remissions ...influenced by a complex pathogenesis in which inflammation plays a key role. Crohn's disease evolution is mediated by a complex alteration of the inflammatory response which is characterized by alterations of the innate immunity of the intestinal mucosa barrier together with a remodeling of the extracellular matrix through the expression of metalloproteins and increased adhesion molecules expression, such as MAcCAM-1. This reshaped microenvironment enhances leucocytes migration in the sites of inflammation, promoting a T
1 response, through the production of cytokines such as IL-12 and TNF-α. IL-12 itself and IL-23 have been targeted for the medical treatment of CD. Giving the limited success of medical therapies, the treatment of the disease is invariably surgical. This review will highlight the role of inflammation in CD and describe the surgical approaches for the prevention of the almost inevitable recurrence.
Purpose
In Italy, colorectal surgery has been strongly affected with the vast majority (90%) of operations treating benign diseases, with an estimated overall 12-week cancellation rate of 72%. Little ...is known on how to best manage patients with benign diseases and the consequences this interruption of care will have in post-pandemic times. Proctologic diseases have social, psychological, and healthcare repercussions for their high incidence and great impact on the quality of life.
Methods
We decided to treated 10 urgent cases affected from III- and IV-degree hemorrhoids with 3% polidocanol foam in attempt to reduce hemorrhoidal symptoms while waiting for surgery so called “bridge treatment”.
Results
During the follow-up no complications were occurred, and all patients had resolution of bleeding and pruritus with a mean VAS of 1 (range, 0-1).
Conclusions
This treatment could reduce the bleeding that is the main symptom from which patients suffer and for which they underwent proctological evaluation and surgery. According to our preliminary experience in the impossibility of accessing the surgery during the COVID-19 pandemic, ST could be considered as the treatment of choice in those patients who are suffering from grade III- and IV-degree hemorrhoids while waiting for surgery.
Abstract
Gravitational-wave observations can be used to accurately measure the Hubble constant
H
0
and could help understand the present discrepancy between constraints from Type Ia supernovae and ...the cosmic microwave background. Neutron star mergers are primarily used for this purpose as their electromagnetic emission can be used to greatly reduce measurement uncertainties. Here we quantify the implied
H
0
using the recently observed black hole merger GW190521 and its candidate electromagnetic counterpart found by ZTF using a highly eccentric explanation of the properties of GW190521. As the electromagnetic association is currently uncertain, our main goal here is to determine the effect of eccentricity on the estimated
H
0
. We obtain
km s
−1
Mpc
−1
. Our results indicate that future
H
0
computations using black hole mergers will need to account for possible eccentricity. For extreme cases, the orbital velocity of binaries in active galactic nucleus disks can represent a significant systematic uncertainty.
Aim
A new artificial anal sphincter placed into the intersphincteric space, SphinKeeper™, has recently been proposed to improve outcomes in the treatment of faecal incontinence (FI). We report our ...preliminary results with short‐term follow‐up, comparing preoperative and postoperative data after implant of SphinKeeper™ in patients suffering from FI.
Methods
All patients older than 18 years were included with FI of at least 6 months, incontinence episodes occurring more than once a week and resistance to other conservative treatments. Anorectal manometry, endoanal ultrasound, Cleveland Clinic FI Score, FI Quality of Life score and total number of episodes of FI per week were recorded preoperatively and at the end of the 6‐month follow‐up period.
Results
Thirteen consecutive patients were treated with SphinKeeper™. No intra‐operative nor postoperative complications were reported. Two cases of prosthesis extrusion occurred, and in one case an anterior dislocation was detected. Maximum resting pressure, total number of episodes of FI per week and Cleveland Clinic FI Score were improved after 6 months (P < 0.05).
Conclusions
SphinKeeper™ could be a minimally invasive procedure for FI with good postoperative outcomes. If these results are confirmed by studies with more patients and longer follow‐up, it could be a first‐line approach in FI.
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