Management of a traumatic anorectal full-thickness laceration: a case report

Fortuna Laura,Bottari Andrea,Somigli Riccardo,Giannessi Sandro 대한외상학회 2022 大韓外傷學會誌 Vol.35 No.3

The rectum is the least frequently injured organ in trauma, with an incidence of about 1% to 3% in trauma cases involving civilians. Most rectal injuries are caused by gunshot wounds, blunt force trauma, and stab wounds. A 46-year-old male patient was crushed between two vehicles while he was working. He was hemodynamically unstable, and the Focused Assessment with Sonography for Trauma showed hemoperitoneum and hemoretroperitoneum; therefore, damage control surgery with pelvic packing was performed. A subsequent whole-body computed tomography scan showed a displaced pelvic bone and sacrum fracture. There was evidence of an anorectal full-thickness laceration and urethral laceration. In second-look surgery performed 48 hours later, the pelvis was stabilized with external fixators, and it was decided to proceed with loop sigmoid colostomy. A tractioned rectal probe with an internal balloon was positioned in order to approach the flaps of the rectal wall laceration. On postoperative day 13, a radiological examination with endoluminal contrast injected from the stoma after removal of the balloon was performed and showed no evidence of extraluminal leak. Rectosigmoidoscopy, rectal manometry, anal sphincter electromyography, and trans-stomic transit examinations showed normal findings, indicating that it was appropriate to proceed with the closure of the colostomy. The postoperative course was uneventful. The optimal management for extraperitoneal penetrating rectal injuries continues to evolve. Primary repair with fecal diversion is the mainstay of treatment, and a conservative approach to rectal lacerations with an internal balloon in a rectal probe could provide a possibility for healing with a lower risk of complications.

Regionalism versus Globalism: A Southeast Asian Perspective

( Dewi Fortuna Anwar ) 한국국방연구원 1996 The Korean Journal of Defense Analysis Vol.8 No.2

A Journey of Change : Indonesia’s Foreign Policy

Dewi Fortuna Anwar 동아시아재단 2009 Global Asia Vol.4 No.3

Indonesia

Dewi Fortuna Anwar 동아시아재단 2013 Global Asia Vol.8 No.4

Pain in Patients with Dystrophic Epidermolysis Bullosa: Association with Anxiety and Depression

Giulio Fortuna,Massimo Aria,Rodrigo Cepeda-Valdes,Maria Guadalupe Moreno Trevino,Julio Cesar Salas-Alanís 대한신경정신의학회 2017 PSYCHIATRY INVESTIGATION Vol.14 No.6

Objective: We investigate the presence and the quality of pain in patients with dystrophic epidermolysis bullosa (DEB), and its correlation with the level of anxiety and depression. Methods: We collected data from 27 DEB patients and 26 healthy individuals. DEB patients and controls completed 1 scale for the quality of pain, and 1 scale for anxiety and depression. Pain was assessed with the short form of the McGill Pain Questionnaire, whereas anxiety and depression were assessed with the Hamilton rating scale for anxiety and depression. Results: DEB patients and healthy control individuals were homogeneous for age and gender (p>0.05). A statistically significant difference in the two groups was seen for sensory pain rating scale (p<0.001), affective pain rating scale (p=0.029), total pain rating scale (p<0.001), visual analogue scale (p=0.012) and present pain intensity (p=0.001), but not for anxiety (p=0.169) and depression (p=0.530). The characteristics of pain that showed a significant difference between DEB patients and healthy controls were shooting, splitting, tender and throbbing (p<0.05). In DEB patients pain was not correlated with anxiety or depression (p>0.05), whereas a slight correlation between pain and anxiety was found in healthy controls (p<0.05). No difference was found between quality of pain and anxiety-depression in DEB patients (p>0.05), but was between the DEB dominant and the recessive form of DEB (p=0.025). Conclusion: The perception of pain in DEB patients appears greater than in healthy individuals, with splitting and tender characteristics being the most significant ones, but was not associated with anxious and/or depressive symptoms.

Effect of Tocopherols, Tocotrienols, β-Carotene, and Chlorophyll on the Photo-oxidative Stability of Red Palm Oil

Dewi Fortuna Ayu,Nuri Andarwulan,Purwiyatno Hariyadi,Eko Hari Purnomo 한국식품과학회 2016 Food Science and Biotechnology Vol.25 No.2

Effect of tocols, β-carotene, and chlorophyll on photo-oxidative stability of red palm oil (RPO) were studied. Model systems of triacylglycerols+tocols, triacylglycerols+β-carotene, triacylglycerols +tocols+β-carotene, and triacylglycerols+tocols+β-carotene+chlorophyll were exposed to fluorescent light at intensities of 5,000, 10,000, and 15,000 lux for 7 h at 30±2oC. Changes in concentrations of tocopherols, tocotrienols, β-carotene, chlorophyll, and peroxide values were evaluated every hour. Light intensity accelerated degradation of tocols in the triacylglycerols+tocols system and β-carotene in the triacylglycerols+β-carotene system. Gamma-tocotrienol showed the highest degradation rate and β-carotene was the most sensitive compound to changes in light intensity, indicated by the lowest light intensity coefficient (zi) value. The presence of tocols and β-carotene together showed protective effects for the photo-oxidative stability of RPO. The presence of chlorophyll increased the rate of photo-oxidation at high light intensities. Interactions between tocols and β-carotene contributed to the photo-oxidative stability of RPO.

Making the Difference in Occupational Health: Three Original and Significant Cases Presented at ICOH Congresses in the 20^th Century

Iavicoli, Sergio,Valenti, Antonio,Barillari, Caterina,Fortuna, Grazia,Boccuni, Valeria,Carnevale, Francesco,Riva, Michele A.,Kang, Seong-Kyu,Tomassini, Luigi Occupational Safety and Health Research Institute 2020 Safety and health at work Vol.11 No.2

Background: The aim of this study is to illustrate the historical role of the International Commission on Occupational Health (ICOH) congresses as an arena where national and international occupational medicine can dialogue and as the first example of scientific transferability of the research and prevention results that have had such an impact on global public health. Methods: We used the ICOH Heritage Repository, in which ICOH congress proceedings (from the first congress in Milan in 1906 to the last congress, held in Dublin in 2018), are organised in an orderly way, updated and easily accessible according to open access logic. Results: We describe studies by three physicians who submitted significant scientific work to ICOH congresses, one on the battle against ancylostomiasis (Volante, 1906), the second (Quarelli, 1928) on carbon disulphide poisoning, and the third (Viola, 1969) on the carcinogenicity of vinyl chloride monomer. Priority is given to Italian cases, on account of the authors' obvious familiarity with the issues. Conclusion: The visibility offered in ICOH conferences and their published proceedings has boosted the international spread of their findings, contributing to the scientific transferability of the research results and influencing the development of policies and prevention interventions that have had a great impact on global public health.

Amorphous nasal powder advanced performance: in vitro/ex vivo studies and correlation with in vivo pharmacokinetics

Henriques Patrícia,Bicker Joana,Carona Andreia,Miranda Margarida,Vitorino Carla,Doktorovová Slavomíra,Fortuna Ana 한국약제학회 2023 Journal of Pharmaceutical Investigation Vol.53 No.5

Purpose Amorphous solid dispersions (ASD) for nasal delivery offer the opportunity to increase drug release performance, while using polymers with mucoadhesive properties. The aim of the present study was to apply this solubility enhancement technique to a poorly soluble drug for nasal delivery, while comparing two particle engineering strategies, namely spray dried microparticles and chimeral agglomerates, with the corresponding physical blends with crystalline drug. Methods Formulations of piroxicam were manufactured using varied polymer and particle engineering strategies and evaluated through in vitro drug release and ex vivo permeation studies, as well as nasal deposition and in vivo pharmacokinetic studies. Results ASD with hydroxypropyl methylcellulose (HPMC) showed enhanced drug release and permeation, compared to polyvinylpyrrolidone/vinyl acetate formulations and blends. Nasal deposition of HPMC chimeral agglomerates suggested off-target deposition. In vivo pharmacokinetic studies revealed that spray-dried HPMC-containing microparticles exhibited the highest maximum plasma concentration (Cmax) and the lowest time to attain it (tmax). In vitro release rate and in vivo absorption rate were correlated as well as tmax and in vitro performance. When excluding the formulation with least nasal targeted deposition, in vitro release and ex vivo permeation performance were also correlated with Cmax and area under the drug concentration-time curve (AUC) from 0 to 1 h, with R2 > 0.89. Conclusion ASD for nasal delivery provide fast drug absorption, which depends on the supersaturation ability of the polymer employed. In vitro-in vivo correlations suggested that in vitro release and ex vivo permeation studies are predictive tools regarding nasal absorption.