APS--controversies in diagnosis and management, critical overview of current guidelines.

Because the diagnosis of antiphospholipid syndrome is based on laboratory data, performance and interpretation of such tests is essential. Positivity in a single test among Lupus Anticoagulant (LA), anti cardiolipin (aCL) and anti β2-glycoprotein I (aβ2GPI) antibodies calls APS diagnosis into question. Conversely, triple positivity is strongly associated to thrombosis and pregnancy morbidity.

Caustic ingestion and oesophageal cancer: intra- and peri-tumoral fibrosis is associated with a better prognosis.

Objective: Oesophageal carcinoma is a well-known late complication of caustic ingestion, occurring in up to 7% of cases. We report a large series of patients with oesophageal scar cancer (SC), investigating the association between fibrosis and survival.

Methods: A total of 25 patients with a history of oesophageal SC (1979-2005) were retrospectively studied.

Lower versus standard intensity oral anticoagulant therapy (OAT) in elderly warfarin-experienced patients with non-valvular atrial fibrillation.

It has been observed that elderly patients with nonvalvular atrial fibrillation (NVAF) benefit from standard [an international normalised ratio (INR) goal of 2.0-3.0] oral anticoagulant treatment (OAT).

Standardized low-molecular-weight heparin bridging regimen in outpatients on oral anticoagulants undergoing invasive procedure or surgery: an inception cohort management study.

Background: Bridging therapy with low-molecular-weight heparin is usually recommended in patients who must stop oral anticoagulants before surgical or invasive procedures. To date, there is no universally accepted bridging regimen tailored to the patient's thromboembolic risk. This prospective inception cohort management study was designed to assess the efficacy and safety of an individualized bridging protocol applied to outpatients.

Trends in management and prognosis for esophageal cancer surgery: twenty-five years of experience at a single institution.

Objective: To investigate trends in results of esophagectomies to treat esophageal cancer at a single high-volume institution during the past 25 years.

Design And Setting: Retrospective cohort study in a university tertiary referral center.

Patients And Methods: Patients with cancer of the thoracic esophagus or esophagogastric junction seen from 1980 through 2004 were included (N = 3493).

Prediction of lymph node status in superficial esophageal carcinoma.

Background: Esophageal carcinoma is among the cancers with the worst prognosis. Real chances for cure depend on both early recognition and early treatment. The ability to predict lymph node involvement allows early curative treatment with less invasive approaches.

Adenocarcinoma of the proximal esophagus: report of 9 patients and review of the literature.

Background: Adenocarcinoma of the proximal esophagus is a rare clinical entity, with only 28 cases described in the literature. We report our experience with 9 patients and a review of the literature on this topic.

Methods: Between 1980 and 2004, 1010 patients with esophageal or gastroesophageal junction adenocarcinoma (from a total of 4655 cancers, 3510 squamous and 1145 adeno) presenting at our department were retrospectively evaluated.

Long-term outcome of operated and unoperated epiphrenic diverticula.

Introduction: The natural history of esophageal epiphrenic diverticula (ED) is not entirely clear; the decision whether to operate or not is often based on the personal preference of the physician and patient. The aim of this study was to evaluate the long-term fate of operated and unoperated patients with ED.

Materials And Methods: Clinical, radiological, and motility findings, and operative morbidity and long-term outcome of 41 patients with ED (January 1993 to December 2005) were analyzed.

Effectiveness and safety of a management protocol to correct over-anticoagulation with oral vitamin K: a retrospective study of 1,043 cases.

Background: Timely reversal of excessive anticoagulation is important in preventing bleeding complications. The use of vitamin K in correcting over-anticoagulation is widely accepted to be superior to discontinuation of therapy but its effectiveness and safety in large scale cohort studies has not been assessed.

Methods: According to our protocol, 2 mg of oral vitamin K in addition to omitting the day's dose of warfarin, were administered to all patients presenting INR levels >or=5.

Endoscopic ultrasound: accuracy in staging superficial carcinomas of the esophagus.

Background: Endoscopic procedures may represent an alternative to esophagectomy for superficial neoplasms of the esophagus (T1m/T1sm), but they are considered curative only in case of no lymph node involvement. Endoscopic ultrasound (EUS) is the most accurate method to define both T and N staging of esophageal carcinoma. Aims of the study were to assess the staging accuracy of EUS in superficial lesions (T1m and T1sm) of patients who were candidates for esophagectomy or local endoscopic resection and to establish which variables (site of neoplasm, histologic type, macroscopic appearance) can affect the accuracy of EUS in distinguishing between T1m and T1sm lesions.

Co-infection with Mycoplasma pneumoniae and human herpesvirus 6 (HHV-6) in an immunocompetent child with meningoencephalitis: a random association?

Encephalitis can represent a complication of both Mycoplasma and Human Herpesvirus type 6 infections and, although uncommon, is associated with significant morbidity and mortality. We describe a 13-year-old girl with fever, headache and mental changes with a pattern of concomitant Mycoplasma and Human Herpesvirus-6 infection. The hypothetical relationship between this dual infection and the central nervous system disease is discussed.

Esophageal GIST: case report of surgical enucleation and update on current diagnostic and therapeutic options.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, but they have been rarely reported in the esophagus. The authors present the case of an esophageal GIST and discuss the diagnostic course and therapeutic options, as currently reported in the literature.

A rare surgical case of metachronous double carcinoma of the biliary tract.

We report on a rare case of metachronous double carcinoma of the biliary tract, occurring in a 65-year-old male. The patient was admitted to the hospital with jaundice in March 2004. Ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) scans of the abdomen showed a minimally dilated intrahepatic biliary tree with normal-appearing choledocus.

Objective follow-up after laparoscopic repair of large type III hiatal hernia. Assessment of safety and durability.

Background: Symptomatic results of laparoscopic repair of large type III hiatal hernias, with/without prosthetic mesh, are often excellent; however, a high recurrence rate is detected when objective radiological/endoscopic follow-up is performed. The use of mesh may reduce the incidence of postoperative hernia recurrence or wrap migration in the chest.

Methods: We retrospectively studied 54 patients (10 men, 44 women; median: age 64.

Effects of neoadjuvant therapy on perioperative morbidity in elderly patients undergoing esophagectomy for esophageal cancer.

Background: The use of cytoreductive therapy followed by surgery is preferred by many centers dealing with locally advanced esophageal cancer. However, the potential for increase in mortality and morbidity rates has raised concerns on the use of chemoradiation therapy, especially in elderly patients. The aim of this study was to assess the effects of induction therapy on postoperative mortality and morbidity in elderly patients undergoing esophagectomy for locally advanced esophageal cancer at a single institution.

Management of esophageal cancer in patients aged over 80 years.

Background: Important advances in the management of cancer of the esophagus and esophagogastric junction have occurred in the last decades, making treatment possible even in elderly patients. Unfortunately there is little information on management of esophageal cancer in octogenarian patients. The aim of this study was to evaluate the treatment results of esophageal and esophagogastric junction cancer in a single institution over a 14-year period in patients>or=80 years of age.

Long-term results (6-10 years) of laparoscopic fundoplication.

Most papers report excellent results of laparoscopic fundoplication but with relatively short follow-up. Only few studies have a follow-up longer than 5 years. We prospectively collected data of 399 consecutive patients with gastroesophageal reflux disease (GERD) or large paraesophageal/mixed hiatal hernia who underwent laparoscopic fundoplication between January 1992 and June 2005.

Results of esophagectomy for esophageal cancer in elderly patients: age has little influence on outcome and survival.

Objective: The aging of the population and a longer life expectancy have led to an increased number of elderly patients with esophageal cancer being referred for surgical treatment. The aim of this study was to assess the effects of age on the outcome of surgery for esophageal cancer at a single institution.

Methods: Perioperative outcome and long-term survival of patients at least 70 years old undergoing esophagectomy between 1992 and 2005 for cancer of the esophagus or esophagogastric junction were compared with findings in younger patients.

Heart transplantation in pediatric age.

Heart transplantation, formerly the final option for terminally ill children, has now become the treatment of choice for a number of serious acquired or congenital cardiac conditions, which cannot be treated conservatively. Nevertheless, several problems remain unsolved. First of all the shortage of donors, mainly in the first months and years of life, which has become more and more significant with time, regardless of the country, religious belief or culture of the people.

Antiphospholipid antibody ELISAs: survey on the performance of clinical laboratories assessed by using lyophilized affinity-purified IgG with anticardiolipin and anti-beta2-Glycoprotein I activity.

Lupus anticoagulant (LA) and anticardiolipin (aCL) antibodies are the classical tests used to diagnose the antiphospholipid syndrome (APS). Unfortunately, since these are nonspecific and standardization is lacking, the results of laboratory work-ups upon which diagnosis are made are often misleading. The performance of clinical laboratories in detecting LA using lyophilised affinity purified immunoglobulin has been previously reported.

Circulating progenitor cells are reduced in patients with severe lung disease.

Patients with chronic severe lung disease are prone to develop pulmonary vascular remodeling, possibly through pulmonary endothelial dysfunction. Circulating endothelial progenitor cells (EPCs) are involved in maintenance of endothelial homeostasis. The aim of this study was to assess whether obstructive and restrictive lung diseases are associated with modification of EPC number in peripheral blood.

Long-term outcome of laparoscopic Heller-Dor surgery for esophageal achalasia: possible detrimental role of previous endoscopic treatment.

Laparoscopic Heller myotomy has recently emerged as the treatment of choice for esophageal achalasia. Previous unsuccessful treatments (pneumatic dilations or botulinum toxin [BT] injections) can make surgery more difficult, causing a higher risk of mucosal perforation and jeopardizing the outcome. The study goal was to evaluate the effects of prior endoscopic treatments on laparoscopic Heller myotomy.

Barrett's epithelium after antireflux surgery.

Barrett's epithelium (BE), defined as endoscopically visible, histologically proved intestinal-type epithelium in the esophagus, is considered the ultimate consequence of long-standing gastro(duodeno)esophageal reflux disease (GERD). Recent reports suggest that effective antireflux therapy may promote the regression of this metaplastic process. This study aimed to establish whether antireflux surgery (laparoscopic fundoplication) can induce any endoscopic and/or histologic changes in BE.