Tiroidectomia totale con impiego del dissettore ad ultrasuoni: risultati di uno studio prospettico randomizzato

In the last years, the introduction and employment in surgery of the dissectors of last generation (ultrasounds, radiofrequency, etc.) have contributed to a remarkable improvement and simplification of the performances and the surgical techniques. The present study has the aim to verify, on the basis of the experience made in the last two years and through a careful comparisons with operations performed in the usual way, the advantages of employment of ultrasonic dissector in thyroid surgery and if besides such advantages it is possible to obtain real and substantial reductions of the complications. To such aim a randomized perspective study has been lead, confronting two groups of 60 patients, submitted to total thyroidectomy in Chair of General Surgery and Surgical Physiopathology of the University of Palermo - Complex Operating Unit of General Surgery. In all patients have been considered age, sex, histological diagnosis, length of the incision, time (from the incision until suture of skin), entity of the bleeding, hospital stay, post-operative consequences and total costs of thyroidectomy. The elaboration of the obtained data shows the advantages following to the use of the dissectors of last generation: reduction of the times, reduction of the complications, better tolerance of the operation by patients, better rationalization of the resources

Eight-point Compass Rose Underlay Technique in 72 Consecutive Elderly Patients with Large Incisional Hernia

SummaryBackgroundRepair of incisional hernia (IH) in the elderly is a challenge for the surgeon. Primary closure is preferable but is not always possible because of high recurrence rates of IH repaired without a prosthesis and/or possible respiratory and cardiovascular complications due to extreme tension of the margins. We report our experience with underlay mesh placement in elderly patients with large IH.MethodsA total of 72 patients from January 2003 to December 2009 underwent IH repair involving placement of an intraperitoneal Gore® DualMesh® prosthesis. The prosthesis was first anchored at eight points in a compass rose pattern using a Gore® suture passer and then firmly secured to the abdominal wall with a 360° internal crown running suture.ResultsTwo intraoperative intestinal tears occurred during debridement and were immediately sutured. Postoperative complications included seven seromas, four hematomas, and two infections, one of which was resolved with conservative treatment while one required prosthesis removal.ConclusionThis surgical procedure, like laparoscopic treatment, allows the surgeon to avoid dissection of the abdominal layer and improves prosthesis adhesion with reinforcement of the incisional area near the abdominal defect. The reduction in operation time is remarkable. Despite good results in terms of safety and minimal recurrence for laparoscopy in the management of IH, the use of minimally invasive techniques for large incisional wall defects, especially in elderly patients, is still controversial and practiced by few surgeons. This open technique avoids cardiopulmonary complications arising from pneumoperitoneum in the elderly

Valutazione della vulnerabilità sismica della chiesa di sant’Agostino ad Amatrice tramite analisi multitemporali

La chiesa di Sant’Agostino ad Amatrice è divenuta il simbolo dei tanti beni architettonici gravemente danneggiati dalla lunga sequenza sismica del 2016- 2017, che progressivamente l’ha portata ad un crollo quasi totale. La ricerca multidisciplinare ha avuto la finalità di interpretare il danneggiamento della chiesa, prima in forma di gravi lesioni e poi definitivamente di collasso, correlando in modo interdisciplinare un insieme di dati eterogenei. I modelli digitali derivati dai rilievi 3D realizzati seguendo i progressivi danneggiamenti, gli studi storici delle lesioni emerse in seguito ad altri importanti eventi sismici del passato, lo studio e l’analisi critica dei precedenti lavori di consolidamento, i risultati della microzonazione sismica per la definizione della risposta sismica locale dell’edificio, i risultati delle prove diagnostiche eseguite in situ sulle strutture murarie e la modellazione agli elementi finiti del comportamento dinamico dell’edificio sono discussi in forma integrata

Rilievo 3D e monitoraggio dinamico della Torre degli Smeducci e del campanile del Duomo vecchio a San Severino Marche

Le attività della task force del Politecnico nell’Italia Centrale, nelle fasi post sisma del 2016, sono state indirizzate non solo alle aree epicentrali, ma si sono estese anche ad aree del cratere sismico che hanno subito danneggiamenti meno importanti. In queste aree le attività sono state rivolte alla analisi di beni monumentali ad alta vulnerabilità che hanno subito danneggiamenti limitati. In questo contesto si inquadrano le indagini condotte su due torri storiche di San Severino Marche, la Torre del Duomo Vecchio e la Torre degli Smeducci. Tali attività fanno parte di un piano di cooperazione strategica tra il Comune di San Severino Marche, il Politecnico di Torino e di Nagoya City University (Giappone)

A complex case of fatal calciphylaxis in a female patient with hyperparathyroidism secondary to end stage renal disease of graft and coexistence of haemolytic uremic syndrome

Background. Calciphylaxis is a potentially fatal complication of persistent secondary hyperparathyroidism; its cause is still not clear. Unfortunately there is no close relation in severity of clinical picture, serological and pathological alteration. For this reason the prognosis is difficult to establish. Administration of sodium thiosulphate may reduce the precipitation of calcium crystals and improve the general clinical conditions before surgical parathyroidectomy, which seems the only therapeutic approach able to reduce the mortality risk in these patients. Methods and Results. A 60 year old female patient suffering from End Renal Stage Disease, on haemodialysis from 2001 due to the onset of haemolytic uremic syndrome, underwent a kidney transplant in April 2008. After transplantation there was a recurrence of the haemolytic uremic syndrome, with temporary worsening of the graft. Six months later there was a definite loss of graft and return to dialysis treatment. On April 2010 a severe systemic calciphylaxis related to secondary hyperparathyroidism was diagnosed. The patient underwent parathyroidectomy but, because of the unimproved clinical picture, treatment with sodium thiosulphate was initiated. There was only improvement in cutaneous lesions. The worsening general clinical condition of the patient caused death due to general septic complications. Conclusions. The coexistence of haemolytic uremic syndrome and secondary hyperpathyroidism makes the prognosis poor and, in this case, therapy, which counteracts calcium crystals precipitation, has no effect. Preventive parathyroidectomy can be considered as the only possible treatment

A misunderstood intestinal perforation believed acute pancreatitis: a case report

Acute pancreatitis represents one, possible but rare, of the several complications of laparoscopic cholecystectomy. In the case reported, a 31-year-old female patient complained of abdominal pain after laparoscopic cholecystectomy. The clinical picture, the high values of serum amylase, lipase and white blood cell count and the subsequent abdominal computed tomography (CT) led to diagnose an acute biliary pancreatitis. This was pharmacologically treated, but the patient worsened in a few days. A contrastenhanced CT showed the presence of free air and effusion into the peritoneal cavity. The patient was submitted to another intervention, which revealed a 1-cm jejunal perforation. The injured loop was then repaired and the patient discharged after three days. The cause remains obscure but it was likely due to umbilical trocar insertion. An upper quadrant abdominal pain with elevated amylase and lipase serum concentration, not always indicate the presence of an acute pancreatitis but could be associated to a difficult case of intestinal perforation

Ileus nakon spontanog intramuralnog hematoma jejunuma: prikaz slučaja i pregled literature

Anticoagulant therapy may cause the onset of a spontaneous intramural hematoma of the small bowel, in the jejunum, ileum or duodenum. A 53-year-old woman on therapy with heparin for previous pulmonary embolism was admitted for abdominal pain and vomit. Computed tomography scan visualized an intramural hematoma of the jejunum causing subtotal obstruction of the intestinal lumen. The patient underwent resection of a part of the jejunum, securing intestinal continuity by a mechanical side-to-side anastomosis. The postoperative course was regular, but the initial anticoagulant therapy was reduced to prevent recurrence. In conclusion, spontaneous hematoma of small bowel can occur as a complication of anticoagulant therapy. The clinical picture and rapid diagnosis indicate medical or surgical therapy.Antikoagulantna terapija može uzrokovati spontanu pojavu intraparijetalnog hematoma tankog crijeva na razini jejunuma, ileuma ili duodenuma. Prikazuje se klinički slučaj 53-godišnje žene na terapiji heparinom zbog ranije plućne embolije, koja je zadržana na bolničkom liječenju zbog bolova u trbuhu i mučnine. Tomografija abdomena potvrdila je prisutnost intraparijetalnog hematoma jejunuma koji je uzrokovao gotovo potpuno zakrčenje crijevnog lumena. Izvedena je resekcija zahvaćenog dijela jejunuma i rekonstrukcija crijevnog nastavka posredstvom “mehaničke latero-lateralne anastomoze”. Poslijeoperacijski tijek je bio uredan, ali je smanjena početna antikoagulantna terapija kako bi se izbjegao recidiv bolesti. U zaključku, spontani intraparijetalni hematom tankog crijeva može biti rezultat komplikacija antikoagulantne terapije. Klinička slika i brzo postavljanje dijagnoze upućuju na medicinsku ili kiruršku terapiju

Eight-point compass rose underlay technique in 72 consecutive elderly patients with large incisional hernia

Background: Repair of incisional hernia (IH) in the elderly is a challenge for the surgeon. Primary closure is preferable but is not always possible because of high recurrence rates of IH repaired without a prosthesis and/or possible respiratory and cardiovascular complications due to extreme tension of the margins. We report our experience with underlay mesh placement in elderly patients with large IH. Methods: A total of 72 patients from January 2003 to December 2009 underwent IH repair involving placement of an intraperitoneal Gore® DualMesh® prosthesis. The prosthesis was first anchored at eight points in a compass rose pattern using a Gore® suture passer and then firmly secured to the abdominal wall with a 360° internal crown running suture. Results: Two intraoperative intestinal tears occurred during debridement and were immediately sutured. Postoperative complications included seven seromas, four hematomas, and two infections, one of which was resolved with conservative treatment while one required prosthesis removal. Conclusion: This surgical procedure, like laparoscopic treatment, allows the surgeon to avoid dissection of the abdominal layer and improves prosthesis adhesion with reinforcement of the incisional area near the abdominal defect. The reduction in operation time is remarkable. Despite good results in terms of safety and minimal recurrence for laparoscopy in the management of IH, the use of minimally invasive techniques for large incisional wall defects, especially in elderly patients, is still controversial and practiced by few surgeons. This open technique avoids cardiopulmonary complications arising from pneumoperitoneum in the elderly

Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance

Il Vice Presidente dell’Associazione Italo-Nipponica ringrazia il rettore di Ca’ Foscari per l'interessamento ai corsi di lingu giapponese dell'Associazione (Venezia, 6 maggio 1944)

Il vice presidente dell'Associazione italo-nipponica, Antonino Sammartano, ringrazia Alfonso de Pietri-Tonelli per l’interessamento al corso di lingua giapponese, con riferimento alla lettera del 26 aprile in cui gli dava comunicazione di averne diffuso notizia tramite l'affissione di un manifesto..Lettera dattiloscritta su carta intestata del Vice Presidente delegato dell’Associazione Italo-Nipponica con firma autografa (Antonino Sammartano). Nota manoscritta relativa al protocollo di uscita n. 61. Protocollo di entrata n. 426 dell'8/5/1944