Godine 2020. je pronađen ulaz u potpuno nepoznatu pećinu na području kvarnerskog zaleđa u blizini mjesta Veli Brgud. Pećina je speleološki istraživana 2021. godine te se tada na površini uočilo ...ulomke keramičke posude, koja tipokronološkim specifičnostima sigurno datira u brončano doba, tj vrlo moguće u srednje brončano doba. Pošto je riječ o potpuno novom speleoarheološkom nalazištu, ova objava obogaćuje širu arheološku topografiju kvarnerskog područja, kao i područja s kojima postoje tipokronološke paralele, ali s druge strane, i uža topografska slika je zanimljiva u vidu odnosa ovog nalazišta i obližnjeg toponima Gradina koji uobičajeno aludira na prapovijesna visinska utvrđena naselja. Pošto o toponimu Gradina također nema nikakvog spomena u literaturi, a niti ni u usmenoj predaji, potencijalna kronološka povezanost ovog prostora sa špiljom ostaje u sferi nagađanja i hipotezi.
Jama Strmac kod Lipe, nedaleko Rijeke na Kvarneru prvi put je istraživana od strane Speleološke Udruge Estavela i Speleološkog Društva Istra u nekoliko navrata tijekom kolovoza 2013. godine. Špilja ...je čini se odavno poznata lokalnom stanovništvu što možemo zaključiti prema brojnim predmetima nađenim na dnu šahta kao što su puške, eksplozivi i kosti. Jama se nalazi na brdu Strmac otprilike kilometar od sela Lipa. Svojom dužinom od 428 metara i dubinom od 69 metara, jedan je od najdužih speleoloških objekata u širem području zaleđa Rijeke. Tri manja objekta također se nalaze u njezinom susjedstvu: Pećina pul donje šterne, Jama za breg i Jama do Strmca. U jami Strmac kod Lipe šaht je dubok 49 m. Na dnu se dvorana grana na dva manja i dva veća prolaza. Dijelovi špilje sadrže iznimnu količinu sigastih i kalcitnih tvorevina. Nema mogućnosti daljnjeg istraživanja speleološkog objekta, no manjak biospeleoloških podataka ukazuju na potrebu za istraživanjem.
U radu su prikazane dvije gradine prepoznate prilikom
topografskog pregleda nekadašnjeg graničnog prostora, između
Republike Venecije i Kuće Austrije, na području Ćićarije.
Gradina na Vrhu od Šterne, ...nalazi se istočno od Dana, dok
je druga na vrhu Kosmačić, nad graničnim prijelazom Jelovice.
Jama Upad kod Breze ima relativno dugu povijest speleoloških istraživanja i spada među zanimljivije speleološke objekte kastavskog zaleđa. Istraživana je kroz tri faze, u razdoblju od druge polovice ...20. st. do 2024. godine. Premda svaka faza istraživanja predstavlja zasebnu priču, svaka je obilježena svojim dostignićima, a međusobno kombinirani rezultati i podaci iz svih istraživačkih faza se nadopunjuju te u konačnici, s jedne strane daju nove uvide, a s druge strane, otvaraju neka nova pitanja. Na primjer, pogleda li se prvi nacrt objekta iz 1960. godine, na kojem su prikazani te godine istraženi dijelovi jame i usporedi li se s nacrtima iz druge faze, može se zaključiti, da taj nacrt izgleda skromno i nepotpuno, budući da su tijekom druge faze otkriveni brojni "novi metri", koji su do tada speleolozima bili potpuno nepoznati te koji su radikalno promijenili percepciju značaja jame Upad. S jedne strane, druga faza istraživanja, tijekom sasvim druge "speleo-tehnološke" ere, na prijelazu milenija, rezultirala je novim otkrićima u jami, no s druge strane, upravo ta "manjkavost" pionirskoga nacrta iz prve faze, biti će zanimljiv i važan podatak, pri konačnoj analizi nekih antropoloških konteksta u jami. Tijekom druge faze, koja je definitivno bila najprogresivnija i najproduktivnija po pitanju otkrivanja do tada nepoznatih dijelova jame, dogodio se nesretan propust prilikom topografskog snimanja, radi čega ta istraživanja nisu rezultirala cjelovitim speleološkim nacrtom. U drugoj fazi su otkriveni baš svi danas poznati dijelovi jame te se, zahvaljjuući tadašnjim istraživačima, sačuvalo vrijedne informacije i podatke, koji su bili od značaja za jednostavnu realizaciju treće faze istraživanja, prilikom koje je valjalo samo ponoviti nacrt svih do tada poznatih dijelova. Osim toga, podaci iz druge faze biti će od iznimne važnosti za sintetiziranje priče oko antropoloških tragova nađenih u jami, o čemu će više riječi biti u posljednjem dijelu članka. Osim speleološkog aspekta (podataka o položaju, povijesti istraživanja te opisa jame), opisani i predstavljeni su zanimljivi drveni nalazi, pronađeni dublje u jami, , koji upućuju na ljudsku aktivnost prije prvih speleoloških istraživanja. Ovu jamu danas uobičajeno nazivamo Upad, ali nosi i sljedeće sinonime: Voragine di Bresa, Jama Vrh Pišćina, Jama na Pešćine i Velika Pišćina.
Već na prvi (speleološki) pogled, ističu se posebnosti jame Upad u lokalnom kontekstu. Dimenzijom ulaza i razvijenom morfologijom, definitivno se ističe među speleološkim objektima šireg kastavskog zaleđa, a konkretno jezero na samom dnu, čini ovu jamu jedinstvenom na ovom području. S dubinom od -75 m i duljinom od 338 m, svojom morfologijom, dimenzijama prostora i jamskog inventara, jamu Upad može se svrstati u kategoriju značajnijih i većih speleoloških objekata ovoga kraja, uz bok sa Šparožnom jamom, jamom na Puharevom kod Permana i jamom Strmac kraj Lipe.
U dubljem dijelu jame su otkriveni drveni nalazi, čiji kontekst i položaj, kao i njihove karakteristike (tragovi obrade – sječenja i urezivanja, dimenzije), ukazuju da su na to mjesto dospjeli ljudskom rukom te da su imali neku uporabnu funkciju – moguće kao sjedišta. U ovom trenutku je nemoguće datirati te predmete bez dodatnih istraživanja i analizi, a cijeli kontekst, osim kronoloških, otvara još i niz drugih pitanja poput svrhe tih predmeta te na kraju krajeva, i samog načina svladavanja ulazne vertikale u pred-speleološkoj eri. Dakle, ne zna se ni tko ni kada ni kako ni zašto, samo se zna, da je netko, prije svih speleologa, upao u Upad.
Global experience with splenic flexure cancer is limited because of its low incidence. Both limited (segmental) and extended resections are performed, because agreement on which is the adequate ...procedure has not been reached.
The purpose of this study was to investigate whether segmental resection is as safe and effective as extended resection.
This nationwide retrospective cohort study included all consecutive resections of splenic flecure cancer between January 2006 and December 2016 using data from the National Colorectal Cancer Network of the Italian Society of Surgical Oncology following the guidelines set out in the STROBE statement.
Data were obtained for 31 Italian Referral Centers for Colorectal Surgery.
A total of 1304 patients were submitted to resection of the splenic flexure (n = 791, 60.7%) or extended procedures (extended right and left colectomies; n = 513, 39.3%).
We evaluated Clavien-Dindo ≥3 postoperative complications and oncological (number of lymph nodes removed, length of free proximal and distal margins, rate of R0 resections) and survival outcomes.
The 2 arms were well balanced in regard to sex, BMI, ASA and Eastern Cooperative Oncology Group scores, and disease stage. Limited resection was performed more frequently using a minimally invasive approach (62.1% vs 50.9%, p < 0.001) and with shorter operation times than extended procedures (165 vs 189 minutes, p < 0.001), but the same Clavien-Dindo ≥3 postoperative complications (6.44% vs 6.43%, p = 0.99), 30-day mortality (0.63% vs 0.38%), oncological outcomes, and survival rates (5-year overall survival 0.84 vs 0.83, 5-year progression-free survival 0.85 vs 0.84).
There are limitations inherent to the retrospective nature of the study and a potential lack of consistency in treatment across centers over time. Indications as to why a specific operation was chosen were based mostly on surgeons' beliefs.
Segmental resection is a safe and effective treatment option for cancer of the splenic flexure. See Video Abstract at http://links.lww.com/DCR/B307. LA RESECCIÓN DE COLON SEGMENTARIA ES UNA OPCIÓN DE TRATAMIENTO SEGURA Y EFICAZ PARA EL CÁNCER DE COLON DE LA FLEXIÓN ESPLÉNICA: UN ESTUDIO RETROSPECTIVO A NIVEL NACIONAL DE LA SOCIEDAD ITALIANA DE ONCOLOGÍA QUIRÚRGICA - GRUPO COLABORATIVO RED DE CÁNCER COLORRECTAL: La experiencia global con el cáncer de flexión esplénica es limitada debido a su baja incidencia. Se realizan resecciones limitadas (segmentarias) y extendidas, ya que no se ha llegado a un acuerdo sobre cuál es el procedimiento adecuado.El propósito de este estudio fue investigar si la resección segmentaria es tan segura y efectiva como la resección extendida.Este estudio de cohorte retrospectivo a nivel nacional incluyó todas las resecciones consecutivas de cáncer de flecura esplénica entre enero de 2006 y diciembre de 2016 utilizando datos de la Red Nacional de Cáncer Colorrectal de la Sociedad Italiana de Oncología Quirúrgica siguiendo las pautas establecidas en la declaración STROBE.Se obtuvieron datos para 31 centros de referencia italianos para cirugía colorrectal.Un total de 1304 pacientes fueron sometidos a resección de la flexión esplénica (n = 791, 60.7%) o procedimientos extendidos (colectomías extendidas derecha e izquierda; n = 513, 39.3%).Evaluamos Clavien-Dindo ≥3 complicaciones postoperatorias y oncológicas (número de ganglios linfáticos extirpados, longitud de márgenes proximales y distales libres, tasa de resecciones R0) y resultados de supervivencia.Los dos brazos estaban bien equilibrados en cuanto a sexo, IMC, ASA y puntajes ECOG, y etapa de la enfermedad. La resección limitada se realizó con mayor frecuencia utilizando un enfoque mínimamente invasivo (62.1% versus 50,9%, p < 0.001) y con tiempos de operación más cortos que los procedimientos extendidos (165 min versus 189 min, p <0.001), pero el mismo Clavien-Dindo ≥3 complicaciones postoperatorias (6,44% versus 6,43%, p = 0.99), mortalidad a los 30 días (0,63% versus 0,38%), resultados oncológicos y tasas de supervivencia (5-y OS 0,84 versus 0,83, 5-PFS 0,85 versus 0,84).Existen limitaciones inherentes a la naturaleza retrospectiva del estudio y una posible falta de consistencia en el tratamiento entre centros a lo largo del tiempo. Las indicaciones de por qué se eligió una operación específica se basaron principalmente en crieterios de los cirujanos.La resección segmentaria es una opción de tratamiento segura y efectiva para el cáncer de la flexión esplénica. Consulte Video Resumen en http://links.lww.com/DCR/B307. (Traducción-Dr. Adrian Ortega).
This Italian multicentric retrospective study aimed to investigate the possible changes in outcomes of patients undergoing surgery for gastrointestinal cancers during the COVID-19 pandemic.
Our ...primary endpoint was to determine whether the pandemic scenario increased the rate of patients with colorectal, gastroesophageal, and pancreatic cancers resected at an advanced stage in 2020 compared to 2019. Considering different cancer staging systems, we divided tumors into early stages and advanced stages, using pathological outcomes. Furthermore, to assess the impact of the COVID-19 pandemic on surgical outcomes, perioperative data of both 2020 and 2019 were also examined.
Overall, a total of 8250 patients, 4370 (53%) and 3880 (47%) were surgically treated during 2019 and 2020 respectively, in 62 Italian surgical Units. In 2020, the rate of patients treated with an advanced pathological stage was not different compared to 2019 (P = 0.25). Nevertheless, the analysis of quarters revealed that in the second half of 2020 the rate of advanced cancer resected, tented to be higher compared with the same months of 2019 (P = 0.05). During the pandemic year ‘Charlson Comorbidity Index score of cancer patients (5.38 ± 2.08 vs 5.28 ± 2.22, P = 0.036), neoadjuvant treatments (23.9% vs. 19.5%, P < 0.001), rate of urgent diagnosis (24.2% vs 20.3%, P < 0.001), colorectal cancer urgent resection (9.4% vs. 7.37, P < 0.001), and the rate of positive nodes on the total nodes resected per surgery increased significantly (7 vs 9% - 2.02 ± 4.21 vs 2.39 ± 5.23, P < 0.001).
Although the SARS-CoV-2 pandemic did not influence the pathological stage of colorectal, gastroesophageal, and pancreatic cancers at the time of surgery, our study revealed that the pandemic scenario negatively impacted on several perioperative and post-operative outcomes.
•This multicentric Italian cohort study, including 8250 patients, demonstrated that the COVID-19 pandemic did not influence the stage of gastrointestinal cancer during the 2020.However, it showed an increased rate of cancer diagnosis following an urgent admission, of neoadjuvant treatment and of the mean number of positive lymph nodes during the 2020.
A preliminary analysis from the COVID-Advanced Gastrointestinal Cancer Surgical Treatment (AGICT) study showed that the rate of minimally invasive surgery (MIS) for elective and urgent procedures did ...not decrease during the pandemic year. In this article, we aimed to perform a subgroup analysis using data from the COVID-AGICT study to evaluate the trend of MIS during the COVID-19 pandemic period in Italy.
This study was conducted collecting data of MIS patients from the COVID-AGICT database. The primary endpoint was to demonstrate whether the SARS-CoV-2 pandemic scenario reduced MIS for elective treatment of gastrointestinal cancer (GIC) in Italy in 2020. The secondary endpoint was to evaluate the impact of the pandemic period on perioperative outcomes in the MIS group.
In the pandemic year, 62% of patients underwent surgery with a minimally invasive approach, compared to 63% in 2019 (
= .23). In 2020, the proportion of patients undergoing elective MIS decreased compared to the previous year (80% versus 82%,
= .04), and the rate of urgent MIS did not differ between the 2 years (31% and 33% in 2019 and 2020 -
= .66). Colorectal cancer was less likely to be treated with MIS approach during 2020 (78% versus 75%,
< .001). Conversely, the rate of MIS pancreatic resection was higher in 2020 (28% versus 22%,
< .002). Conversion to an open approach was lower in 2020 (7.2% versus 9.2% -
= .01). Major postoperative complications were similar in both years (11% versus 11%,
= .9).
In conclusion, although MIS for elective treatment of GIC in Italy was reduced during the COVID-19 pandemic period, our study revealed that the overall proportion of MIS (elective and urgent) and postoperative outcomes were comparable to the prepandemic period. ClinicalTrial.gov (NCT04686747).
Approximately 20% of locally advanced rectal cancers treated with neoadjuvant therapy achieve a pathologic complete response, but approximately 10% of them present residual nodal metastases (ypT0N+). ...We aimed this research to compare the survival rates of ypT0/ypTisN+ and stage 3a rectal cancer patients. A large multicenter study recently investigated ypT0/ypTis rectal cancers treated between 2005 and 2015 in Italy and Spain. ypT0/ypTisN+ were selected and compared with stage 3a rectal cancers treated at the same institutions with upfront surgery (ySICO group). Additionally, the SEER database was searched for patients with stage 3a rectal cancers treated with surgery in the same years. Overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) were analyzed using Kaplan-Meier curves and random survival forest analysis (RSF). The ySICO study population consisted of 19 ypT0/2ypTisN+ (mean follow-up 41.8 months) and 72 Stage 3a patients (mean follow-up 56.9 months). These subgroups were comparable, but stage 3a patients were treated more frequently with adjuvant therapy (90.5% vs 61.9%, p 0.0001). No significant differences were reported between the ySICO subgroups for the OS, DFS, and DSS curves. When the 1213 SEER patients were added to Stage 3a, the RFS model failed to differentiate OS between groups that presented identical survival. Root analysis showed that adjuvant therapy was the only variable differentiating OS and DSS in the ySICO population. These findings suggest that ypT0/ypTisN+ and stage 3a rectal cancers could be ranked together based on their similar outcomes and pathologic assessment, and they stress the importance of adjuvant therapy in patients presenting with residual nodal metastases.
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•We compared the survival of ypT0/ypTisN+ rectal cancers with that of patients with minimal rectal wall disease and nodal metastases (Stage 3a) to test the hypothesis that these subgroups could be ranked together.•Data were extracted from a large multicenter study, and from SEER database.•The analyses were conducted using a machine learning approach. These findings are consistent with the research hypothesis.
In this article we aimed to perform a subgroup analysis using data from the COVID-AGICT study, to investigate the perioperative outcomes of patients undergoing surgery for pancreatic cancers (PC) ...during the COVID-19 pandemic.
The primary endpoint of the study was to find out any difference in the tumoral stage of surgically treated PC patients between 2019 and 2020. Surgical and oncological outcomes of the entire cohort of patients were also appraised dividing the entire peri-pandemic period into six three-month timeframes to balance out the comparison between 2019 and 2020.
Overall, a total of 1815 patients were surgically treated during 2019 and 2020 in 14 Italian surgical Units. In 2020, the rate of patients treated with an advanced pathological stage was not different compared to 2019 (p = 0.846). During the pandemic, neoadjuvant chemotherapy (NCT) has dropped significantly (6.2% vs 21.4%, p < 0.001) and, for patients who didn't undergo NCT, the latency between diagnosis and surgery was shortened (49.58 ± 37 days vs 77.40 ± 83 days, p < 0.001). During 2020 there was a significant increase in minimally invasive procedures (p < 0.001). The rate of postoperative complication was the same in the two years but during 2020 there was an increase of the medical ones (19% vs 16.1%, p = 0.001).
The post-pandemic dramatic modifications in healthcare provision, in Italy, did not significantly impair the clinical history of PC patients receiving surgical resection. The present study is one of the largest reports available on the argument and may provide the basis for long-term analyses.
•In 2020, the rate of pancreatic cancer patients treated with an advanced pathological stage was not different compared to 2019.•During the pandemic, neoadjuvant chemotherapy has dropped significantly.•During 2020 there was a significant increase in minimally invasive procedures.•The rate of postoperative complication was the same in the two years but during 2020 the medical ones increased.
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