To analyze the dynamics of systolic blood pressure (SBP) and the results of various types of carotid endarterectomy (CEE) in patients with resistant arterial hypertension (RAH).

The study included 1577 patients with hemodynamically significant stenosis of the internal carotid artery (ICA) and RAH for more than 3 years. Patients were enrolled from January 2014 to December 2020. Depending on the implemented revascularization strategy, 5 groups were formed group 1 (

=289 (18.3%)) with classical CEE with plasty of the reconstruction zone with a patch, group 2 (

=472 (29.9%)) with eversional CEE with cut-off of carotid glomus (CG); group 3 (

=109 (6.9%)) with the formation of a new bifurcation; group 4 (

=117 (7.4%)) with autoarterial reconstruction; group 5 (

=590 (37.4%)) with glomus-saving CEE.

In the postoperative period, no significant differences were obtained in the frequency of deaths (0.34% for group 1; 0.63% for group 2; 0% for groups 3, 4 and 5), myocardial infarction (0.34%, 0.84%, 1.83, 0.8 and a high risk of hemorrhagic transformation in the brain. Thus, the most effective and safe types of CEE in the presence of RAH are classical CEE with plasty of the reconstruction zone with a patch and glomus-sparing CEE.

To compare clinical and functional features of the essential tremor (ET) and Parkinson’s disease (PD) with- or without rapid eye movement (REM) sleep behavior disorder (RBD).

Sixty patients with PD and 52 patients with ET were examined. Cognitive functions, anxiety, asthenia and depression, autonomic disorders and sleep disorders were assessed with scales and questionnaires. All patients underwent polysomnography (PSG). Based on the results of PSG, patients were divided by the presence or absence of parasomnia, known as REM sleep behavior disorder.

Patients with PD and ET suffering from RBD were more likely to be overweight, more likely to develop cognitive impairment, obstructive sleep apnea, and emotional disorders. In addition, presence of RBD has adverse effects on the sleep structure. The profile of memory, attention, psychoemotional and sleep disorders in patients with PD and ET had common features, which suggests that it is RPBDH that affects the change in the clinical picture.

Presence of RBD aggravates non-motor manifestations of such extrapyramidal diseases as PD and ET. On the one hand it helps to predict the course of the disease, on the other hand let us suspect RBD when we see non-motor symptoms worsening.

Presence of RBD aggravates non-motor manifestations of such extrapyramidal diseases as PD and ET. On the one hand it helps to predict the course of the disease, on the other hand let us suspect RBD when we see non-motor symptoms worsening.

To define psychopathological and phenomenological characteristics of the apocalyptic variant of end-world delusion with religious content (EWDRC) in schizophrenia, to identify features of clinical dynamics of delusional disorders and their interaction with delusional behavior of patients.

A total of 28 patients with schizophrenia (F20.01, F20.02 according to ICD-10) and EWDRC were examined. Clinical-psychopathological and follow-up methods were used.

The development of the end-world delusional ideas occurred in unstructured affective-delusional disorder with acute sensual delusion. Two types of EWDRC were differentiated with predominance of perception delusion or picturesque delusion. These types differed by acuity and massiveness of psychotic symptomatology, the mono- or polythematic character of delusional disorders, affect type, as well as by the duration and intensity of the development of delusional stages, and in their phenomenological specifics.

Delusional ideas of the end of the world in schizophrenic patients develop in the structure of the syndrome of acute sensory delusions with a predominance of delusions of perception (type I) or visual-figurative delusions of the imagination (type II), which have different duration, degree of dominance and depth of psychopathological disorders.

Delusional ideas of the end of the world in schizophrenic patients develop in the structure of the syndrome of acute sensory delusions with a predominance of delusions of perception (type I) or visual-figurative delusions of the imagination (type II), which have different duration, degree of dominance and depth of psychopathological disorders.

The aim of this systematic review was to report and to analyze if there is and what is the impact of telemedicine in the surgical practice during COVID-19 pandemic. Many authors have posited that the pandemic urged a high implementation of the telemedicine service even in surgical specialties, however, the impact of this change of the clinical practice has been variably reported and its utilization in general surgery is uncertain.

All articles from any country written in English, Italian, Spanish, or French, about the use of telemedicine for indication to surgical treatment or for 30-day postoperative follow-up in general surgery during the COVID 19 outbreak, from the March 1, 2020, to December 1, 2020, were included.

Two hundred nine articles were fully analyzed, and 207 further articles were excluded. Finally, 2 articles, both published in October 2020, were included in the present systematic review.

In conclusion, the rapid spread of SARS-CoV-2 pandemic has forced to review the traditional methods to deliver surgical assistance and urged surgeons to find alternative methods to continue their practice. The literature about this topic is yet scarce and many questions regarding its efficacy in improving patients’ health, cost-effectiveness and user satisfaction remain unsolved.

In conclusion, the rapid spread of SARS-CoV-2 pandemic has forced to review the traditional methods to deliver surgical assistance and urged surgeons to find alternative methods to continue their practice. The literature about this topic is yet scarce and many questions regarding its efficacy in improving patients’ health, cost-effectiveness and user satisfaction remain unsolved.

Postoperative Pancreatic Fistula (POPF) is a common and serious complication after Distal Pancreatectomy (DP). An effective and accepted score to predict the occurrence of Clinically Relevant (CR-) POPF does not exist.

Data regarding 103 consecutive patients undergoing DP from 2015 to 2019 were collected. A multivariate logistic regression was performed, in order to build a simplified score. The accuracy in predicting a categorical outcome was evaluated using the Receiver Operating Characteristic (ROC) curves. Youden’s J test was performed to evaluate the performance of a positive score on the POPF occurrence.

33 patients developed a CR-POPF. Based on multivariate analysis results, a 4 points score was created by assigning 1 point if operation time was >4 hours, amylase levels on drains’ fluid >500 UI on POD 3, pancreatic thickness >10mm and if the BMI was > 30. The discriminating ability was tested on the ROC curve, showing an area under the curve of 0.83 (CI 95%=0.75 – 0.92). The score threshold was determined at 2 points/4, the highest value according to the Youden index (0.53). The sensitivity is calculated at 82% (CI95% 69-95) and the specificity at 71 (CI95% 61 – 82). A threshold of 3 points/4 allows to reach a specificity of 99% (CI95% 99 – 100).

An easy to use post-operative score based on operation time, obesity, amylase level on drains on POD3 and pancreatic thickness on preoperative CT seems to predict the risk of developing CR-POPF.

An easy to use post-operative score based on operation time, obesity, amylase level on drains on POD3 and pancreatic thickness on preoperative CT seems to predict the risk of developing CR-POPF.

The treatment of achalasia has undergone continuous evolution with the advancement of technology. Since the beginning of the new millennium, the employment of robotics has led to technical facilitation with the execution of the myotomy and consequently to improvement of outcomes and decrease perioperative morbidity.

We provide a detailed description of the surgical procedure and the perioperative management together with a literature search of Electronic PubMed/Medline database and Cochrane Library. English written studies on robotic assisted myotomy (case reports, reviews, single arm and comparative studies) were included.

Between 2001 and 2020, 10 case reports, 13 single arm studies, 10 comparative studies, 2 meta-analysis, 11 reviews and 2 technical notes on robotic assisted esophagomyotomy for achalasia were published.

As reported by the studies available in the literature and evaluated in this manuscript, robotic assisted cardiomyotomy seems not only feasible but also a safer operation compared with traditional laparoscopic Heller myotomy, due to a significant lower incidence of intraoperative esophageal perforation. Also if large and randomized controlled studies are advocated, robotic assisted esophagocardiomyotomy might be considered superior to laparoscopic Heller myotomy that, until now, is mostly considered the gold standard in the surgical treatment of achalasia.

As reported by the studies available in the literature and evaluated in this manuscript, robotic assisted cardiomyotomy seems not only feasible but also a safer operation compared with traditional laparoscopic Heller myotomy, due to a significant lower incidence of intraoperative esophageal perforation. Also if large and randomized controlled studies are advocated, robotic assisted esophagocardiomyotomy might be considered superior to laparoscopic Heller myotomy that, until now, is mostly considered the gold standard in the surgical treatment of achalasia.

Breast cancer is the second leading cause of death in women. The most recent and successful advancement in implant-assisted breast reconstruction after mastectomy is the prepectoral approach using an acellular dermal matrix (ADM). Patients with ptotic breasts and macromastia were initially excluded from this type of immediate reconstruction remaining a difficult group to treat. The aim of this paper is to present our experience in performing skin-reducing mastectomy with pre-pectoral implant and complete ADM coverage as a single-stage procedure in patients with large ptotic breasts, evaluating the benefits and complications resulting from the use of this technique.

A retrospective analysis of skin-reducing mastectomies and pre-pectoral breast reconstructions using Braxon porcine-derived ADM performed between January 2019 and February 2021 at our Breast Unit.

We treated 20 patients and performed a total of 24 skin-reducing mastectomies with pre-pectoral reconstruction. We observed 2 cases of partial NAC necrosis (8,3%) and one case of total NAC necrosis (4,2%). The incidence of skin flap necrosis was 8,3% (n=2) healed by secondary intention. No case of prosthesis removal, infection or seroma was reported. Patients scored very good level of satisfaction with breast based on the results of the BREAST- Q questionnaire.

Skin-reducing mastectomy and pre-pectoral breast reconstruction can be offered to patients with large and ptotic breasts with good aesthetic and functional results. New prospective observational studies would be desirable to provide an opportunity to evaluate the long-term capabilities and complications of this technique.

Skin-reducing mastectomy and pre-pectoral breast reconstruction can be offered to patients with large and ptotic breasts with good aesthetic and functional results. New prospective observational studies would be desirable to provide an opportunity to evaluate the long-term capabilities and complications of this technique.