Axin1 Protects Colon Carcinogenesis by an Immune-Mediated Effect.

Background & Aims: Axin1 is a negative regulator of wingless-type MMTV integration site family, member 1 (Wnt)/β-catenin signaling with tumor-suppressor function. The Wnt pathway has a critical role in the intestine, both during homeostasis and cancer, but the role of Axin1 remains elusive.

Methods: We assessed the role of Axin1 in normal intestinal homeostasis, with control, epithelial-specific, Axin1-knockout mice (Axin1) and Axin2-knockout mice.

Arterial Stiffness: Effects of Anticancer Drugs Used for Breast Cancer Women.

It is well known that anticancer drugs used for treating breast cancer can cause cardiac toxicity, and less is known about vascular toxicity. The aim of this study was to assess subclinical vascular effects of anthracyclines and trastuzumab (TRZ) in women treated for breast cancer. We enrolled 133 female patients with breast cancer undergoing adjuvant treatment with anthracycline-containing chemotherapy (CT) followed by taxane (paclitaxel/docetaxel) + TRZ.

Occult hepatitis B virus infection predicts non-alcoholic steatohepatitis in severely obese individuals from Italy.

Background & Aims: Obesity is associated with non-alcoholic fatty liver (NAFL), which may progress towards non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma (HCC). Occult hepatitis B virus infection (OBI) may contribute to hepatic damage in patients with chronic liver disease of different aetiologies (eg HCV, alcohol). However, information on the prevalence and clinical impact of OBI in obese individuals is lacking.

Variability of Hypericins and Hyperforin in Hypericum Species from the Sicilian Flora.

Within Sicilian flora, the genus Hypericum (Guttiferae) includes 10 native species, the most popular of which is H. perforatum. Hypericum's most investigated active compounds belong to naphtodianthrones (hypericin, pseudohypericin) and phloroglucinols (hyperforin, adhyperforin), and the commercial value of the drug is graded according to its total hypericin content.

Phytochemical profiles, phototoxic and antioxidant properties of eleven Hypericum species - A comparative study.

Hypericum is one out of the nine genera belonging to the botanical family Clusiaceae Lindl (syn. Hypericaceae Juss.; APG III, 2009).

Does the margin width influence recurrence rate in liver surgery for hepatocellular carcinoma smaller than 5 cm?

Objective: Liver surgery is considered a curative treatment for hepatocellular carcinoma (HCC) but the importance of resection margin width remains controversial. The aim of this study is to clarify the role of 5-10 mm surgical margin width on post-operative recurrence and overall survival after resection.

Patients And Methods: We analyzed recurrence rate and overall survival rate of 72 patients who underwent curative hepatic resection for HCC smaller than 5 cm with 5-10 mm surgical margin width between January 2005 and December 2014.

Fever of unknown origin due to intrahepatic wooden toothpick.

Ingestion of foreign bodies is a common clinical problem, but intrahepatic migration is an exceptional occurrence. Clinical history is not helpful. Abdominal ultrasonography and CT are fundamental to exclude surgical causes of fever of unknown origin.

Arbuscular mycorrhizal fungi altered the hypericin, pseudohypericin, and hyperforin content in flowers of Hypericum perforatum grown under contrasting P availability in a highly organic substrate.

St. John's Wort (Hypericum perforatum) is a perennial herb able to produce water-soluble active ingredients (a.i.

Multi-port versus single-port cholecystectomy: results of a multi-centre, randomised controlled trial (MUSIC trial).

Background: Single-port laparoscopic surgery as an alternative to conventional laparoscopic cholecystectomy for benign disease has not yet been accepted as a standard procedure. The aim of the multi-port versus single-port cholecystectomy trial was to compare morbidity rates after single-access (SPC) and standard laparoscopy (MPC).

Methods: This non-inferiority phase 3 trial was conducted at 20 hospital surgical departments in six countries.

Evaluation of CTNNB1 and TP53 variability in patients with hepatocellular carcinoma and occult hepatitis B virus infection.

Hepatitis B virus (HBV) infection plays a major role in hepatocellular carcinoma (HCC) development. Much evidence suggests that HBV also maintains its pro-oncogenic properties in cases of occult HBV infection (OBI). Mutations of the beta-catenin and p53 genes (CTNNB1 and TP53, respectively) may be associated with HCC occurrence in patients with overt HBV infection, whereas such genetic mutations have not been investigated in HCC patients with OBI thus far.

Three-Dimensional Versus Two-Dimensional Laparoscopic Cholecystectomy: Is Surgeon Experience Relevant?

Background: A prospective randomized comparison of three-dimensional (3D) versus two-dimensional (2D) imaging during elective laparoscopic cholecystectomy (LC), both performed separately by an advanced laparoscopic surgeon and by a surgeon experienced in open surgical procedures but a novice at laparoscopic procedures, was designed to address the issue of whether 3D systems offer real operative time advantages to this laparoscopic procedure.

Patients And Methods: Eighty patients were randomized the day of surgery by random computer-generated allocation list to receive either a 3D or 2D high-definition imaging system LC by two surgeons with differing experience. After the insertion of the access ports the surgical procedure was divided in two component tasks.

The Aquamantys® system as alternative for parenchymal division and hemostasis in liver resection for hepatocellular carcinoma: a preliminary study.

Objective: To evaluate the clinical feasibility and safety of a new technique for liver resection using a new saline-coupled bipolar sealing device (Aquamantys®) that has shown high performance in the animal setting.

Patients And Methods: Twelve Child-Pugh A cirrhotic patients with hepatocellular carcinoma underwent partial hepatectomies using Aquamantys®. Our primary end-point was to observe occurrence of early specific surgical complications as bleeding, biliary leakage and abscess development.

Reversible bilio-pancreatic diversion with explorable excluded stomach-the Messina technique.

The authors propose a reversible bilio-pancreatic diversion with access to the bypassed stomach. In the Messina technique, bilio-pancreatic diversion is accomplished by transecting the stomach without gastric resection, as already described by Resa et al. In addition, a temporary gastrostomy is performed on the excluded stomach and allows direct postoperative exploration of the duodenum and the biliary tree.

Single-incision versus three-port conventional laparoscopic right hemicolectomy: is there any real need to go single?

Background: Preliminary results showed some benefits of single-incision laparoscopic surgery (SILS) over conventional laparoscopic colectomy, including better cosmesis, less postoperative pain, and faster recovery, but these results need further confirmation. In addition, the literature still lacks comparative studies between the two approaches to prove the above-mentioned advantages of SILS over conventional laparoscopy and, most importantly, its equivalent effectiveness in terms of initial oncological results.

Patients And Methods: Two consecutive series of 10 patients undergoing three-port conventional laparoscopic right hemicolectomy (3PCL-RH) and single-incision laparoscopic right hemicolectomy, respectively, were compared in their short-term surgical and oncological outcomes.

SILS and NOTES cholecystectomy: a tailored approach.

Background: Natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS) have been proposed as different solutions to further minimize the invasiveness of laparoscopy. In this article, we present our experience with NOTES and SILS over the last few years, trying to focus on identifying which technique should be offered to which patients at the beginning of 2010.

Patients And Methods: Between January 2009 and January 2010, 100 patients were diagnosed with symptomatic cholelithiasis at our department.

[Radio-guided parathyroidectomy].

The Authors, after a careful review of literature about the instrumental diagnostic techniques (with particular attention to the nuclear-medical ones) and the surgical therapy of parathyroid diseases, report their experience on the use of the radio-guided mininvasive surgery with MIBI and gamma-probe for intraoperative localization of pathological glands. Once exposed their experience, the Authors conclude asserting that this technique is fast, slightly invasive and expensive, and certainly useful for the detection of pathological or ectopic glands. It can be widely employed because, in comparison to its numerous advantages, such as the reduction of the operating time and of the hospital-stay, the greater radicality and the possibility to use mininvasive techniques, it does not present significant technical limitations and/or radio-protectionistic problems.

[Laparoscopy in traumatic abdominal emergencies].

Over the past few years the laparoscopic technique has changed most of the concepts of traditional surgery and is today the standard approach in elective surgery for many pathologies requiring surgery. Unfortunately the same cannot be said for emergency surgery, though much progress has been made in this field, too. The Authors examine the most important abdominal diseases that can be diagnosed and, possibly, treated by the laparoscopic approach in the emergency setting, concluding that laparoscopic management of such conditions is a feasible proposition in many cases.

[Role of ultrasonography in the non-operative management of liver traumas].

The technical progress in imaging methodology and intensive care over recent years has allowed a reduction in surgical operations for hepatic trauma. In the past, surgeons based their evaluations on clinical findings and patients in critical condition were submitted to surgery. The percentage of negative laparotomies was high (6% to 25%) due to non-haemorrhagic hepatic lesions at surgery.

Laparoscopic cholecystectomy in cirrhotic patients.

Background: This study aimed to evaluate the safety of laparoscopic cholecystectomy for patients with cirrhosis.

Methods: The records of 22 laparoscopic cholecystectomies performed in patients with cirrhosis Child-Pugh A and B, from January 1995 to July 2001 were retrospectively reviewed.

Results: No deaths occurred.

[Intraperitoneal neoplastic dissemination of incidental gallbladder carcinoma after laparoscopic surgery].

Background: Several laboratory and clinical studies have raised the concern that laparoscopic procedures might worsen the prognosis of patient with malignant disease due to premature intraperitoneal cancer cell dissemination. The aim of the study was to examine the risk of the dissemination in patients with unsuspected gallbladder cancer diagnosed after laparoscopic cholecystectomy (LC).

Methods: A retrospective clinicopathologic study was performed on 5 patients with unsuspected gallbladder cancer without preoperatively diagnosis among 1280 patients that underwent LC in the period 1993-2002.

[Intrabiliary rupture of hepatic hydatid cyst].

Spontaneous hepatic hydatid cyst rupture into the biliary tract is unusual. The authors describe a case of a 62-year-old man with a hepatic hydatid cyst, showing that it is possible to confirm rupture into the biliary system with cholangiography-MRI. Surgical treatment remains the best form of management.

[Diagnostic problems of choledochal cysts in the adult].

Choledochal cysts are rare malformations of the biliary tree, the precise pathogenesis of which remains unclear. The authors present the case of a 21-year-old man with a choledochal cyst and discuss the main issues regarding the diagnosis and treatment of this uncommon lesion. In particular, of all the diagnostic techniques available, magnetic resonance cholangiopancreatography (MRCP) could become the imaging technique of choice for defining the pancreatobiliary ductal anatomy with at least the same degree of accuracy as that of diagnostic ERCP, while avoiding the potential complications associated with the latter.

[Conservative treatment of hepatic trauma].

Liver trauma has increased over the past few years. In haemodynamically stable patients with hepatic injuries a conservative approach is possible, mainly as a result of the reliability of the diagnostic tools available which allow accurate monitoring of the patients. Computed tomography (CT) of the abdomen is extremely useful for documenting the extent of the damage.

[Endoscopy in non-neoplastic cholestasis].

The role of endoscopic treatment of cholestasis is well codified as an alternative or adjuvant therapy to surgery, particularly in those cases where non malignant cause has been identified. Non-neoplastic cholestasis therefore benefits very substantially from endoscopic treatment in a context where the traditional surgical approach presents limitations in terms of morbidity and mortality. It should be borne in mind, however, that the two approaches are strictly complementary for the correct management of these patients.