Sialoadenectomy for sialolithiasis is necessary when the stone cannot be removed through the salivary duct. In addition, extracorporeal. shock-wave lithotripsy has recently become available for this purpose. The safety and efficacy of this method was assessed in 52 outpatients bearing stones with an average diameter of 6.76 mm in the submandibular or parotid gland. Anesthetics, sedatives, and analgesics were not required. Twenty-four of the 36 patients with submandibular gland calculi and all 16 with parotid sialolithiasis had complete stone disintegration or fragmentation of the calculi, with possible spontaneous clearance. Untoward effects were observed in 15 patients, namely localized skin petecchiae, transitory swelling of the gland, and self-limiting bleeding from the duct. No persistent damage of the salivary glands or adjacent structures was noted during a mean follow-up period of 10 months.

BackgroundScreening significantly reduces mortality from colorectal cancer (CRC). Screen detected (SD) tumors associate with better prognosis, even at later stage, compared to non-screen detected (NSD) tumors. We aimed to evaluate the association between diagnostic modality (SD vs. NSD) and short- and long-term outcomes of patients undergoing surgery for CRC.Materials and MethodsThis retrospective cohort study involved patients aged 50–69 years, residing in Veneto, Italy, who underwent curative-intent surgery for CRC between 2006 and 2018. The clinical multi-institutional dataset was linked with the screening dataset in order to define diagnostic modality (SD vs. NSD). Short- and long-term outcomes were compared between the two groups.ResultsOf 1,360 patients included, 464 were SD (34.1%) and 896 NSD (65.9%). Patients with a SD CRC were more likely to have less comorbidities (p = 0.013), lower ASA score (p = 0.001), tumors located in the proximal colon (p = 0.0018) and earlier stage at diagnosis (p < 0.0001). NSD patients were found to have more aggressive disease at diagnosis, higher complication rate and higher readmission rate due to surgical complications (all p < 0.05). NSD patients had a significantly lower Disease Free Survival and Overall Survival (all p < 0.0001), even after adjusting by demographic, clinic-pathological, tumor, and treatment characteristics.ConclusionsSD tumors were associated with better long-term outcomes, even after multiple adjustments. Our results confirm the advantages for the target population to participate in the screening programs and comply with their therapeutic pathways.

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Introduction: Crohn's disease (CD) is a chronic inflammatory disease of the gastrointestinal tract. The diversion through a colostomy or an ileostomy is sometimes required for disease control. In these patients, common stoma-related complications sum up with CD-related complications and often require revisional surgery. Methods: The aim of the study was to assess stoma morbidity after surgery for CD and to identify the burden of CD-related complications. Details of past medical history, surgery and follow up of 54 consecutive patients operated on for CD with any sort of stoma were retrieved from the stoma therapist prospectively maintained database. Results: In our series, 23 patients had a colostomy, and 31 an ileostomy. CD-related complications arose in 8 patients (including pyoderma gangrenosus in 3 patients, peristomal fistulae in 2, granulomas in 2, and peristomal abscess in 1). Patients with CD-related complications had shorter disease duration (p=0.07) and, more frequently end-stoma (p=0.006). In this cohort, 11 cases had to be surgically treated for peristomal fistulae or abscess, parastomal hernia, prolapse, pyoderma gangrenosus and recurrent CD. Discussion/conclusions: In patients with CD, stoma creation is burdened by a high rate of postoperative complication and a relevant rate is specifically related to CD. Often these patients required to be re-operated on to re-do the stoma. Moreover, end stoma configuration and aggressive CD phenotype are associated to a higher rate of complications.

Diffuse idiopathic skeletal hyperostosis (also known as Forestier's disease) is a systemic condition with a wide spectrum of clinical manifestations. Patients with diffuse idiopathic skeletal hyperostosis often experience pain, stiffness, loss of range of motion, and even difficulty breathing or swallowing. As a consequence, the presence of such disabling symptoms may interfere with activities of daily living and significantly reduce perceived quality of life. Moreover, the ankylosed spine in patients with diffuse idiopathic skeletal hyperostosis is prone to unstable fractures, thus exposing patients to a considerable risk of secondary spinal cord injury. This study found an exceptionally high prevalence of diffuse idiopathic skeletal hyperostosis among patients with congestive heart failure who were undergoing cardiac rehabilitation, particularly in obese and older individuals. Given the risk of spinal fractures, even after low impact trauma, and of severe disability, the presence of diffuse idiopathic skeletal hyperostosis should always be investigated in patients with congestive heart failure who report stiffness of the spine or chronic back pain, especially in those undergoing exercise-based activities. Objective: To assess the prevalence of diffuse idiopathic skeletal hyperostosis and its relationship with vascular risk factors among patients with congestive heart failure. Design: Population-based cross-sectional study. Participants: A total of 584 consecutive patients admitted to a Rehabilitative Cardiology Unit. Methods: Chi-square Automatic Interaction Detector (CHAID) decision tree analysis was used to build a predictive model. Results: The mean age (standard deviation) of the study population was 68.1 years (standard deviation 12.3), and 77.7% of the subjects were men. The overall prevalence of diffuse idiopathic skeletal hyperostosis in the cohort was 49.8%. Logistic regression analysis showed that age was a predictor of diffuse idiopathic skeletal hyperostosis (odds ratio 1.034; 95% confidence interval: 1.021-1.047, p < 0.001), with increasing odds ratios for increasing age tertiles. The CHAID prediction model identified 2 age "buckets": ≤ 69 and > 69 years. Patients > 69 years had a diffuse idiopathic skeletal hyperostosis prevalence of 60.1%, compared with 39.2% among those ≤ 69 years. Notably, body mass index was a predictor of diffuse idiopathic skeletal hyperostosis in this younger subset of patients (p = 0.028), with 2 body mass index buckets, ≤ 23.3 and > 23.3 kg/m 2 , the latter showing more than twice the prevalence of diffuse idiopathic skeletal hyperostosis (43.2% vs 20%). Conclusion: Diffuse idiopathic skeletal hyperostosis is extremely frequent among patients with congestive heart failure, with age and body mass index being the strongest predictors.