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INTRODUCTION: The clinical management of chronic cough patients is challenging, and their response to proton pump inhibitors (PPIs) is considered as unsatisfactory. Few data concerning the association between impedance-pH variables and PPI response in these patients are available. Mean nocturnal baseline impedance (MNBI) and postreflux swallow-induced peristaltic wave (PSPW) index increase the diagnostic yield of impedance-pH in gastroesophageal reflux disease. METHODS: Demographic, clinical, and endoscopy findings; impedance-pH; and high-resolution manometry tracings from consecutive patients assessed for cough were evaluated. Univariable and multivariable regression models were generated to evaluate the association between impedance-pH and high-resolution manometry findings, endoscopic and clinical characteristics, and PPI response. RESULTS: A total of 178 patients were included. Eighty-four of 178 cough patients (47.2%) displayed grade C-D erosive esophagitis or were characterized by a pathological acid exposure time (AET) and/or positive symptom association probability/symptom index. When also considering MNBI and PSPW, 135 of 178 patients (75.8%) were characterized by the evidence of reflux disease (P < 0.001). Eighty patients (44.9%) had cough responding to PPIs, whereas 98 (55.1%) were nonresponders (P = 0.071). At the receiver operating characteristic analysis, both PSPW index and MNBI were associated to PPI responsiveness. MNBI and PSPW index showed higher sensitivity in predicting PPI response compared with AET and symptom association probability/symptom index. The area under the curves of MNBI and PSPW index were significantly higher than that of AET (P < 0.01 for both comparisons). When patients were stratified according to AET and excluding those with erosive esophagitis, pathological MNBI or PSPW index, hiatal hernia, and hypomotility features were associated to PPI response in all groups. DISCUSSION: Our results demonstrate the usefulness of an up-front esophageal testing in discriminating reflux-related cough patients and predicting PPI response.

Angioleiomyoma (ALM) is a rare benign, vascular smooth muscle tumor originating from the tunica media of the vessel wall. It typically arises in the cutaneous, subcutaneous tissue of the lower extremities in middle-aged women and is less than 2 cm in diameter. We report an ALM of the thigh in a 69-year-old woman with intermittent pain. US was performed with a high-resolution, broad-band (5 MHz-18 MHz) linear transducer for the superficial nodule. To the best of our knowledge, there has been no report of high-resolution ultrasound image features, including grayscale US, color Doppler US and Real-Time Tissue Elastography (RTE) for an ALM. ALM should be considered as one of the painful and vascularized subcutaneous mass, a superficial location that can be seen on high-resolution US. The feature of adjacent blood flow signal on color Doppler US could be strongly suggested to be ALM.

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During the Covid-19 health emergency, telemedicine was an essential asset through which health systems strengthened their response during the critical phase of the pandemic. According to the post-pandemic economic reform plans of many countries, telemedicine will not be limited to a tool for responding to an emergency condition but it will become a structural resource that will contribute to the reorganization of Healthcare Systems and enable the transfer of part of health care from the hospital to the home-based care. However, scientific evidences have shown that health care delivered through telemedicine can be burdened by numerous ethical and legal issues. Although there is an emerging discussion on patient safety issues related to the use of telemedicine, there is a lack of reseraches specifically designed to investigate patient safety. On the contrary, it would be necessary to determine standards and specific application rules in order to ensure safety. This paper examines the telemedicine-risk profiles and proposes a position statement for clinical risk management to support continuous improvement in the safety of health care delivered through telemedicine.

Aim: This study proposed the robot-assisted laparoscopic simple prostatectomy (RASP) as safe and reliable surgical option for the treatment of men with prostate size > 80 mL. It was aimed to evaluate preoperative and postoperative results in RASP using a surgical variation to the standard technique: the temporary bilateral internal iliac arteries clamping. Methods: This study analyzed 18 patients underwent RASP with temporary clamping of bilateral internal iliac arteries. Procedures were performed by two surgeons in two different hospitals using the same surgical technique. Preoperative and postoperative data were collected and statistically analyzed. Results: The temporary clamping duration was less than 12 min during each adenoma's enucleation. Despite the vascular control, the median operating time was similar to RASP performed without iliac clamping. The results showed minimal blood loss, a median catheter duration of 5 days, a median duration of postoperative continuous catheter irrigation of 41 h, and short hospitalization (3.2 days). A significant corellation was observed between the estimated blood loss and the duration of irrigation. Conclusion: RASP performed with bilateral vascular control, combined with the known benefits of minimally invasive surgery resulted in bleeding reduction. The minimal blood loss further reduces catheter duration, decreases continuous catheter irrigation and patient's hospitalization duration. Key words:Benign prostatic hyperplasia, clamping, prostatectomy, robotic ABSTRACTArticle history:

Introduction: Small gallbladder polyps (GBP) are usually asymptomatic and benign and are monitored with regular ultrasonography (US) surveillance. Although most centers repeat imaging within a year, there remains no consensus regarding appropriate scan intervals.Aims: To investigate the size stability of GBP and to review the need for close surveillance.Methods: All abdominal ultrasound scans performed in our hospital over 3-month period were reviewed. Patients with sonographic evidence of GBP and with subsequent surveillance were included. The demographics of patients, characteristics of polyps, and subsequent scans over the following five years were reviewed. Histological reports were obtained for patients who underwent cholecystectomy.Results: 96 patients were included in the study. Median age was 51 (range, 24-89) years with a male predominance (67.7%). Main indications for US were hepatitis follow-up (41.7%) and abdominal pain (20.8%). Most patients had multiple polyps (62.5%) and the median diameter of the largest polyp was 4 (range, 3-10) mm. An average of 4.5 scans were performed over five years following detection and most polyps remained stable in size, rarely growing beyond 10mm -only two patients had polyps beyond 10mm. No gallbladder carcinoma was detected during the follow-up period. Conclusion:GBP usually remain stable in size, seldom grow beyond 10mm, and are rarely malignant. Surveillance scans for polyps smaller than 10mm should not be performed at intervals less than a year.