Guido Zanghì

Localized and systemic bacterial infections in necrotizing pancreatitis submitted to surgical necrosectomy or percutaneous drainage of necrotic secretions

BackgroundInfectious complications are observed in 40-70% of all patients with severe acute pancreatitis. Infections are associated with a significant increase in mortality rates.MethodsWe evaluated the prevalence and characteristics of pancreatic and systemic infections in 46 patients with necrotizing pancreatitis submitted to surgical procedures during their hospital stay as well as the impact of such infectious complications on patient clinical outcome. Samples for microbiological cultures were taken at hospital admission from blood and bile and 2 days after invasive procedure from blood, drainage fluid, bile and necrotic tissues.Results74% patients with necrotizing pancreatitis had a localized or systemic infection. At admission, 15% of subjects had positive blood cultures whereas 13% had evidence of bacterial growth from bile cultures. Two days after the invasive procedures for removal of necrotic materials and fluids, blood cultures became positive in 30% of patients in spite of antibiotic prophylaxis and bile cultures resulted positive in 22% of cases. Furthermore, bacterial growth from drainage fluids was found in 30% and from homogenized necrotic material in 44% of cases. As refers to bacterial isolates, all patients had a monomicrobial infection. Carbapenems were the drugs with the best sensitivity profile.Mortality rate was significantly (p < 0.05) higher among patients with infection (17%) than subjects without infection (8%). Within the infected group, those subjects with evidence of systemic infection (positive blood cultures) developed more complications and demonstrated a higher (p < 0.05) mortality rate (28%) than those who had only a localized infection (10%).ConclusionsInfectious complications significantly increase mortality in patients with necrotizing pancreatitis. In addition, subjects with systemic infections developed more complications and demonstrated a higher mortality rate in comparison with those having a localized infection. In our study, the sensitivity pattern of the isolated microorganisms suggests to consider carbapenems as the best option for empirical treatment in patients with necrotizing pancreatitis who develop a clear-cut evidence of systemic or localized bacterial infection.

PAHs in seafood from the Mediterranean Sea: An exposure risk assessment

Seafood represent an important food source for human, and seafood quality is associated with marine environment quality. PAHs are one of the main organic environmental contaminants and they can be introduced into the body through different way (ingestion, inhalation, dermal absorption). We present data on bioaccumulation of the sixteen PAHs, defined priority by the U.S.- EPA, in Sardina pilchardus, Solea solea and Donax trunculus, three species caught in the Catania Gulf and highly consumed by the local population. The risk to develop chronic systemic and carcinogenic effects due to the consumption of these target species was evaluated through the EDI, THQ and CR. EDI derived from D. trunculus ingestion falls within the range calculated by the EFSA. The THQ is less than 1, and the CR calculated for the Benzo(a)Pyrene is at the limit of the ARL (1✕10-5). EDI derived from S. pilchardus and S. solea ingestion are below the range calculated by the EFSA. The THQ is less than 1, and the CR is below the acceptable risk level. The contamination level found in local seafood determines a low risk to develop chronic systemic effects, but the cancer risk could be of health concern especially for high-frequency molluscs consumers.

Nicotine Receptors as a Possible Marker for Smoking-related Sperm Damage

BACKGROUND Several studies demonstrate that cigarette smoking has a negative effect on the reproductive health of both genders. The mechanisms by which it alters male gonadic function are not entirely clear. The combustion of cigarette produces a lot of chemical compounds that may be responsible for the negative impact of cigarette smoke on sperm parameters. In particular, the effects on semen of nicotine, a substance present in the tobacco plant and the main constituent of cigarette smoke, have been studied, showing that this alkaloid alters sperm parameters. Recently we investigated the mechanism by which nicotine damages sperm through the evaluation of the expression of nicotinic receptors subunits in human spermatozoa. CONCLUSION 8 nAChR subunits found to date in mammals are expressed in human spermatozoa but, in non-smokers subjects, only α7 subunit is translated. Cigarette smoking may stimulate the expression of some subunits, not translated in non-smokers. Therefore, the presence in sperm of other nAChR subunits than α7 could represent a marker for smoking-related sperm damage.

Continuous and intermitted nerve monitoring in thyroid surgery: two complementary devices

Intraoperative neural monitoring (IONM) is a constitutive procedure in the management of the recurrent laryngeal nerve (RLN) in thyroid surgery. Progress in IONM currently includes devices that intermittently (I-IONM) evaluate RLN functionality and accessories that continuously assess the entire RLN route by permanent vagal nerve stimulation, i.e., continuous intraoperative nerve monitoring (C-IONM) (1). I-IONM is achievable through a monopolar or bipolar hand probe stimulator.

Evidence-based medicine measures for neural monitoring in thyroid surgery

Intraoperative neural monitoring (IONM) in thyroid and parathyroid surgery is not based on class I evidence. IONM in thyroid surgery is currently limited to class II and III studies (1-7).

Case Report: Spontaneous cholecystocutaneous fistula, a rare cholethiasis complication

One of the most unusual complications in cholethiasis is spontaneous cholecystocutaneous fistula, which has only been reported a few times in the literature. We report the case of a 76 year old man who presented with a right hypochondrium subcutaneous abscess, with pain evoked through palpation. No comorbidity in the patient’s medical history were noted. Confirmation of cholecystocutaneous fistula was made using the proper diagnostic process, which is computed tomography with contrast media, followed by hepatobiliary MRI. This confirmed the presence of a fistulous pathway between the gallbladder and the skin. The patient underwent cholecystectomy surgery and open laparotomy with en block aponeurotic muscle, skin and fistula orifice excision.