Does the nasogastric tube has a role in elective colo-rectal surgery?

Introduction. Routine use of nasogastric tubes (NGT) after abdominal operations is intended to hasten the return of bowel function, diminish the risk of anastomotic leakage and prevent pulmonary complications. The aim of our study was to prospectively assess the tolerability and the safety of the non use of NGT after elective colorectal open operations. Patients and methods. Between March 2009 and December 2010, 110 consecutive patients underwent colo-rectal elective open surgery for neoplasm without nasogastric decompression. We analyzed the incidence of nausea and vomiting, the pulmonary complications, the return of bowel function the deep wound breakdown (fascial dehiscence) and the anastomotic leakage. Results. Only 15 patients (13,6%) reported nausea without vomiting immediately after surgery and 9 cases of vomiting were observed (8%), requiring the insertion of the NGT (nasogastric tube) in 5 (4,5%). A total of 105 patients (96,3%) were NGT free. No deep wound dehiscence was observed and only one real pneumonia occurred. Anastomotic dehiscence occured in 4 patients (3,6%) and a second surgical procedure was needed in three cases. The return of bowel function, except in the last four patients, occurred in 3,8 days average (range 2-7 days). Conclusion. We confirm the uselessness of the NGT in the framework of fast track program adopted in elective open colo-rectal surgery.

Surgical strategy for the treatment of sporadic medullary thyroid carcinoma: our experience

Background. Medullary thyroid carcinoma (MTC) is a rare disease which accounts for approximately 5-9% of all thyroid cancers and originates from the calcitonin-secerning parafollicular C cells. MTC can be divided into two subgroups: sporadic (75%) or inherited (25%). The majority of patients with invasive MTC have metastasis to regional lymph nodes at the time of diagnosis, as evidenced by the frequent finding of persistently elevated calcitonin levels after thyroidectomy and the high rates of recurrence in the cervical lymph nodes reported in retrospective studies. Objectives. The purpose of the study is to review our single institution's experience with MTC since 1998 and to evaluate surgical strategy, patterns of lymph node metastases and calcitonin response to compartment-oriented lymphadenectomy in patients with primary or recurrent sporadic medullary thyroid carcinoma. Methods. A retrospective review of 26 patients treated for MTC at the “Antonio Cardarelli” Hospital referral center, in Naples, between 1998 and 2012. There were 18 female and 8 male patients, median age at presentation was 55 years, and median follow-up for survivors was 5 years. Total thyroidectomy was performed in all 26 patients; central compartment (CC) node dissection (level VI) in 12 (46%) patients; central plus lateral compartment (LC) node dissection (levels II, III, and IV) in 7 (27%) patients. 4 patients (15%) underwent reoperation for loco-regional recurrent/persistent MTC. Results. After a median post-surgical follow-up of 5 years (range 1-10 years), 63 % of patients were living disease-free, 15% were living with disease and/or persistently elevated calcitonin levels after surgery, 11% were deceased due to MTC and 11 % were lost to follow-up. Conclusions. We agree with most authors advocating for a total thyroidectomy and prophylactic central neck dissection in the setting of clinically detected MTC. Lateral neck dissection may be best reserved for patients with positive preoperative imaging. Nevertheless MTC has a high rate of lymph node metastases that are sub optimally detected preoperatively in the central compartment by neck ultrasound or intra-operatively by the surgeon, and reoperation is associated with a higher rate of surgical complications. In our limited experience, patients with thyroid confined nodular pathology, without nodal disease and unknown preoperative diagnosis of MTC, underwent only total thyroidectomy with a good prognosis.

Proposta per un maglev urbano. Lineamenti di un progetto di ricerca industriale per lo sviluppo di un sistema di trasporto innovativo

L'oggetto della proposta è un sistema di trasporto guidato di media potenzialità destinato alle aree metropolitane, basato sulla tecnologia della levitazione magnetica. Utilizza magneti permanenti ad alta energia per la sostentazione; un motore lineare sincrono per la propulsione; un dispositivo meccanico, o elettromagnetico, per stabilizzare la guida assicurata dagli stessi magneti della sostentazione. Il contenuto innovativo dell'oggetto non si limita alla parte non convenzionale (levitazione), ma investe tutto il sistema, poiché l'offerta industriale di un sistema destinato alle aree metropolitane è vincente solo se riferita ad un sistema completo (infrastruttura, veicoli, alimentazione, sistema di sicurezza, modello di esercizio, gestione, manutenzione, …). Si descrive inoltre la particolare soluzione inedita con abitacolo sospeso al di sotto dell'involucro tecnologico (comprendente magneti di sostentamento, motore lineare, sistema di guida, sospensione secondaria).

An Unusual Complication of Transthoracic Lung Biopsy

Objectives: We report a case of a frail older adult affected by Chilaiditi syndrome complicating transthoracic lung biopsy, which has never been presented before in the literature. Materials and methods: After illustration of our case, we review the available literature about Chilaiditi syndrome. Results: Chilaiditi syndrome is a rare disease characterised by the interposition of colonic segments between the liver and diaphragm associated with mild to severe clinical symptoms. Conclusion: Although it is uncommon, Chilaiditi syndrome is a clinical condition that should be recognized early and differentiated from other diseases since it may significantly impair a patient’s prognosis.