La responsabilità di amministratori e soci nelle società a partecipazione pubblica

Oggetto del lavoro di tesi è la responsabilità di amministratori e soci nelle società a partecipazione pubblica soprattutto alla luce dei problemi di giurisdizione rilevati dalla Corte di Cassazione. Si è esaminato dapprima il tema della responsabilità amministrativa indicandone l’evoluzione nell’ordinamento e le difficoltà relative alla configurabilità come istituto di diritto privato o di diritto pubblico ed i mutamenti avvenuti nell’ordinamento relativamente ad una crescente commistione tra pubblico/privato ed un’ elevata diffusione di società a partecipazione pubblica: a livello centrale soprattutto come risultante delle privatizzazioni di enti ed imprese pubbliche e a livello locale come modalità di gestione dei servizi pubblici locali (I capitolo). Successivamente (II capitolo) si sono analizzati quegli elementi e requisiti fondanti la responsabilità amministrativa indagati dal giudice contabile: attraverso l’esame di ciascun aspetto si potranno meglio evidenziare gli orientamenti giurisprudenziali della Corte di Cassazione e gli sviluppi successivi (III capitolo). Nonostante la numerosa presenza delle società a partecipazione pubblica, il legislatore non ha provveduto a risolvere in maniera univoca e definitiva la questione cosicché permane il dubbio relativo alla giurisdizione operante nei confronti di amministratori e soci di tali organismi. Si devono ritenere operanti e cogenti i principi propri del codice civile in materia di responsabilità, al pari delle società private oppure applicare i principi della disciplina contabilistica dettata per i dipendenti e funzionari pubblici? A quali criteri ci si deve attenere per operare una disciplina anziché un’altra? Obiettivo di questo lavoro di tesi è analizzare come la Suprema Corte sia intervenuta ed abbia cercato di risolvere tali problematiche sviluppando criteri via via diversi, volti a colmare il vuoto normativo dovuto alla mancanza di una previsione univoca. Si sono pertanto analizzati gli orientamenti della Corte soprattutto alla luce della sentenza n. 26806/2009 che ha modificato il precedente orientamento. Da questo consegue la rilevanza della posizione di soci ed amministratori all’interno della compagine societaria e non più il requisito del rapporto di servizio esistente tra Pa e società stessa. A tutt’oggi tale orientamento si rileva condiviso nella giurisprudenza successiva ed ulteriormente puntualizzato attraverso l’identificazione due regole riguardanti le figure soggettive private e le società a totale partecipazione pubblica

The Management of Ruptured Abdominal Aortic Aneurysms: An Ongoing Challenge

Background: despite improvements in the diagnosis and treatment of elective AAAs, ruptured abdominal aortic aneurysms (RAAAs) continue to cause a substantial number of deaths. The choice between an open or endovascular approach remains a challenge, as does postoperative complications in survivors. The aim of this manuscript is to offer an overview of the contemporary management of RAAA patients, with a focus on preoperative and intraoperative factors that could help surgeons provide more appropriate treatment. Methods: we performed a search on MEDLINE, Embase, and Scopus from 1 January 1985 to 1 May 2023 and reviewed SVS and ESVS guidelines. A total of 278 articles were screened, but only those with data available on ruptured aneurysms' incidence and prevalence, preoperative scores, and mortality rates after emergency endovascular or open repair for ruptured AAA were included in the narrative synthesis. Articles were not restricted due to the designs of the studies. Results: the centralization of RAAAs has improved outcomes after both surgical and endovascular repair. Preoperative mortality risk scores and knowledge of intraoperative factors influencing mortality could help surgeons with decision-making, although there is still no consensus about the best treatment. Complications continue to be an issue in patients surviving intervention. Conclusions: RAAA still represents a life-threatening condition, with high mortality rates. Effective screening and centralization matched with adequate preoperative risk-benefit assessment may improve outcomes

Emergent management of diabetic foot problems in the modern era: Improving outcomes

Limb amputation is a consequence, and the leading complication, of diabetic foot ulcers. Prevention depends on prompt diagnosis and management. Patients should be managed by multidisciplinary teams and efforts should be focused on limb salvage (“time is tissue”). The diabetic foot service should be organized in a way to meet the patient's clinical needs, with the diabetic foot centers at the highest level of this structure. Surgical management should be multimodal and include not only revascularization, but also surgical and biological debridement, minor amputations, and advanced wound therapy. Medical treatment, including an adequate antimicrobial therapy, has a key role in the eradication of infection and should be guided by microbiologists and infection disease physicians with special interest in bone infection. Input from diabetologists, radiologists, orthopedic teams (foot and ankle), orthotists, podiatrists, physiotherapists, and prosthetics, as well as psychological counseling, is required to make the service comprehensive. After the acute phase, a well-structured, pragmatic follow-up program is necessary to adequately manage the patients with the aim to detect earlier potential failures of the revascularization or antimicrobial therapy. Considering the cost and societal impact of diabetic foot problems, health care providers should provide resources to manage the burden of diabetic foot problems in the modern er

A technical review of bail-out procedures to place Najuta stent-graft into the ascending aorta

BackgroundThe Najuta stent-graft (Kawasumi Laboratories Inc., Tokyo, Japan) is usually easily advanced to the correct deployment position in the ascending aorta thanks to the pre-curved delivery J-sheath with all fenestrations automatically oriented towards the supra-aortic vessels. Aortic arch anatomy and delivery system stiffness could however represent limitations for proper endograft advancement, especially when the aortic arch bends sharply. The aim of this technical note is to report a series of bail-out procedures that could be useful to overcome the difficulties encountered during the Najuta stent-graft advancement up to the ascending aorta.Main bodyThe insertion, positioning and deployment of a Najuta stent-graft requires a through-and-through guidewire technique using a .035 '' 400 cm hydrophilic nitinol guidewire (Radifocus (TM) Guidewire M Non-Vascular, Terumo Corporation, Tokyo, Japan) with right brachial and both femoral accesses. When standard maneuver to put the endograft tip into the aortic arch, some bail-out procedures can be applied to obtain proper positioning. Five techniques are described into the text: positioning of a coaxial extra-stiff guidewire; positioning of a long introducer sheath down to the aortic root from the right brachial access; inflation of a balloon inside the ostia of the supra-aortic vessels; inflation of a balloon inside the aortic arch (coaxial to the device); and transapical access technique. This is a troubleshooting guide for allowing physicians to overcome various difficulties with the Najuta endograft as well as for other similar devices.Short conclusionTechnical issues in advancing the delivery system of Najuta stent-graft could occur. Therefore, the rescue procedures described in this technical note could be useful to guarantee the correct positioning and deployment of the stent-graft

[18F]-Fludeoxyglucose Positron Emission Tomography/Computed Tomography with Radiomics Analysis in Patients Undergoing Aortic In-Situ Reconstruction with Cryopreserved Allografts

The aim of this study was to evaluate the effectiveness of positron emission tomography/computed tomography with [18F]-fludeoxyglucose (FDG-PET/CT) and radiomics analysis in detecting differences between the native aorta and the abdominal aortic allograft after the total eradication of infection in patients undergoing infected graft removal and in situ reconstruction with cryopreserved allografts

Insight from an Italian Delphi Consensus on EVAR feasibility outside the instruction for use: the SAFE EVAR Study

BACKGROUND: The SAfety and FEasibility of standard EVAR outside the instruction for use (SAFE-EVAR) Study was designed to define the attitude of Italian vascular surgeons towards the use of standard endovascular repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA) outside the instruction for use (IFU) through a Delphi consensus endorsed by the Italian Society of Vascular and Endovascular Surgery (Societa Italiana di Chirurgia Vascolare ed Endovascolare - SICVE). METHODS: A questionnaire consisting of 26 statements was developed, validated by an 18 -member Advisory Board, and then sent to 600 Italian vascular surgeons. The Delphi process was structured in three subsequent rounds which took place between April and June 2023. In the first two rounds, respondents could indicate one of the following five degrees of agreement: 1) strongly agree; 2) partially agree; 3) neither agree nor disagree; 4) partially disagree; 5) strongly disagree; while in the third round only three different choices were proposed: 1) agree; 2) neither agree nor disagree; 3) disagree. We considered the consensus reached when >70% of respondents agreed on one of the options. After the conclusion of each round, a report describing the percentage distribution of the answers was sent to all the participants. RESULTS: Two -hundred -forty-four (40.6%) Italian Vascular Surgeons agreed to participate the first round of the Delphi Consensus; the second and the third rounds of the Delphi collected 230 responders (94.3% of the first -round responders). Four statements (15.4%) reached a consensus in the first rounds. Among the 22 remaining statements, one more consensus (3.8%) was achieved in the second round. Finally, seven more statements (26.9%) reached a consensus in the simplified last round. Globally, a consensus was reached for almost half of the proposed statements (46.1%). CONCLUSIONS: The relatively low consensus rate obtained in this Delphi seems to confirm the discrepancy between Guideline recommendations and daily clinical practice. The data collected could represent the source for a possible guidelines' revision and the proposal of specific Good Practice Points in all those aspects with only little evidence available

Memorabilia : nel paese delle ultime cose

Memorabilia : nel paese delle ultime cose raccoglie gli atti dell’omonimo convegno che si è tenuto presso l’Accademia di architettura, Università della Svizzera italiana nel maggio del 2015. L’incontro è stato il terzo appuntamento della serie “Ricicli immateriali” organizzata dal gruppo di curatori della sezione “Teorie del Re-cycle” del progetto di ricerca Re-cycle Italy. Memorabilia è impostato sulla scelta di un “oggetto” da portare nel futuro e sul senso e sulla struttura di un possibile archivio

Endoscopy Biopsy Forceps as Tool for Iliac Covered Stent Removal

Endoscopy biopsy forceps is mostly used in the gastrointestinal tract but here it was used to remove a covered iliac self-expandable stent. A 57-year old male previously treated with bilateral iliac covered stenting and double barrel technique on the right iliac side was admitted for acute ischaemia of the right lower limb. Computed tomography showed thrombosis of covered stents on the right side [aorta/common iliac Viabahn 8 × 100 mm; external iliac artery (EIA) Viabahn 7 × 50 mm; internal iliac artery (IIA) 6 × 50 mm; W.L. Gore Medical, Flagstaff, AZ]. A left percutaneous femoral approach and surgical exposure of the right femoral arteries was performed. After distal clamping, an arteriotomy of the common femoral artery allowed the insertion of a large introducer sheath (Flexor 20F; Cook Medical, Bloomington, IN) via a stiff 0.035" guidewire after recanalization of the thrombosed iliac axis. Via this sheath a coaxial endoscopy biopsy forceps (reusable Fenestrated Rat Tooth Alligator Jaw, working length 230cm; Olympus, Center Valley, PA) was inserted to catch the distal edge of the covered self-expandable stent previously deployed in the EIA ([Fig.]), allowing removal of that covered stent. Next, a balloon was inserted and inflated on the left side, and an over-the-wire thrombectomy using a Fogarty 5F arterial embolectomy catheter (Edwards Lifesciences, Irvine, CA). was performed. A larger covered stent (Viabahn 8 × 100 mm) was used to reline the iliac axis. The ostium of IIA was occluded. In conclusion, endoscopy biopsy forceps could be used in “ultima ratio” as a vascular tool for removing covered self-expandable stents via a surgical femoral approach

Hepatosplenic Candidiasis Detected by 18F-FDG-PET/CT

Hepatosplenic candidiasis is a fungal infection, which mostly affects patientswith hematologic malignancies such as leukemia. The pathogenesis of thisinfection is not clear yet, and the liver is the most commonly affected organ.Diagnosis of hepatosplenic candidiasis can be only established via biopsy,since computed tomography (CT) scan, ultrasonography, and magneticresonance imaging (MRI) yield non-specific results. The role of fluorine-18fluorodeoxyglucose positron emission tomography /computed tomography(18F-FDG PET/CT) in diagnosis of hepatosplenic candidiasis remainsundetermined, considering a few evidences in the literature. In this casereport, we present the case of a 47-year-old patient, affected by acute myeloidleukemia, which was treated with three cycles of chemotherapy, resulting inthe development of neutropenia and fever following the last cycle. The 18F-FDGPET/CT scan showed some foci of intense FDG uptake in the liver and spleen.The subsequent diagnostic investigations (i.e., abdominal CT scan and biopsy)were suggestive of hepatosplenic candidiasis. The patient was started onantifungal treatment with fluconazole. After one month, the clinical conditionswere resolved, and the subsequent abdominal CT scan was negative