Ruolo della timectomia nel trattamento della miastenia gravis: considerazioni e casistica personale

L’effetto terapeutico della timectomia sul decorso clinico della miastemia gravis è ancora quanto mai controverso. Infatti, mentre la chirurgia è ormai universalmente accettata per i timomi, il suo ruolo è ancora discutibile in pazienti con miastenia gravis. La via chirurgica di elezione per la timectomia totale è rappre - sentata dalla sternotomia mediana. Altre metodologie chirurgiche includono l’accesso cervicale e la sternotomia parziale. Queste tecni - che, seppure con alterne fortune, hanno mostrato risultati eccellenti nella exeresi del timo. Più recentemente la timectomia toracoscopica video-assistita è stata proposta come una tecnica meno invasiva e parimenti efficace per l’asportazione di quest’organo ed il trattamento della miastenia gravis. Scopo del presente lavoro è quello di riferire l’esperienza degli Autori in tema di timectomia, analizzando i dati riportati dalla lette - ratura internazionale sulla mortalità operatoria, le eventuali compli - canze e i risultati estetici delle diverse tipologie di accesso chirurgico

Incidentally discovered enteric duplication cyst: a case report

Enteric duplications are rare congenital diseases with heterogeneous clinical pictures ranging from an asymptomatic course to life-threatening consequences, most commonly arising at the ileal and ileocecal region. The antenatal discovery is possible when it concerns a voluminous cystic form enabling an early management. The radiologic examinations are nonspecific and no diagnostic tools can allow a certain diagnosis on its own. Sometimes, the diagnosis of intestinal duplication is only made during the surgical exploration and confirmed after a histopathological examination. We report a 4 years old girl with antenatal diagnosed ovarian cystic mass of about 4 mm. She was admitted to our unit for abdominal pain and constipation. Abdominal ultrasonography showed a cystic mass in the right iliac fossa. MRI revealed a well-defined cystic mass (6 x 4.2 x 5.4 cm) in the right mid abdomen displacing the bowel to the left, likely to be strongly adherent to the last part of the ileum. 99mtc pertechnetate scan was negative for ectopic gastric mucosa. A laparoscopic approach was eventually necessary and the diagnosis of duplication cyst was confirmed. Children with antenatal diagnosis of abdominal mass need a close follow up and enteric duplication should be considered as potential diagnosis. The laparoscopic approach has an important role in differential diagnosis between intestinal duplications and other mass

Giant endobronchial hamartoma resected by fiberoptic bronchoscopy electrosurgical snaring

Less than 1% of lung neoplasms are represented by benign tumors. Among these, hamartomas are the most common with an incidence between 0.025% and 0.32%. In relation to the localization, hamartomas are divided into intraparenchymal and endobronchial

Influence of LV Neutral Grounding on Global Earthing Systems

International Standards define a Global Earthing System as an earthing net created interconnecting local Earthing Systems (generally through the shield of MV cables and/or bare buried conductors). In Italy, the regulatory authority for electricity and gas requires distributors to guarantee the electrical continuity of LV neutral conductor. This requirement has led to the standard practice of realizing “reinforcement groundings” along the LV neutral conductor path and at users' delivery cabinet. Moreover, in urban high-load scenarios (prime candidates to be part of a Global Earthing System), it is common that LV distribution scheme creates, through neutral conductors, an effective connection between grounding systems of MV/LV substations, modifying Global Earthing System consistency. The aim of this paper is to evaluate the effect, in terms of electrical safety, of the aforementioned LV neutral distribution scheme when an MV-side fault to ground occurs. For this purpose, simulations are carried out on a realistic urban test case and suitable evaluation indexes are proposed

Influence of LV Neutral Grounding on Global Earthing Systems

International Standards define a Global Earthing System as an earthing net created interconnecting local Earthing Systems (generally through the shield of MV cables and/or bare buried conductors). In Italy the Regulatory Authority for Electricity and Gas requires Distributors to guarantee the electrical continuity of LV neutral conductor. This requirement has led to the standard practice of realizing “reinforcement groundings” along the LV neutral conductor path and at users’ delivery cabinet. Moreover, in urban high load scenarios (prime candidates to be part of a Global Earthing System), it is common that LV distribution scheme creates, trough neutral conductors, an effective connection between grounding systems of MV/LV substations, modifying Global Earthing System consistency. Aim of this paper is to evaluate the effect, in terms of electrical safety, of the above mentioned LV neutral distribution scheme when an MV-side fault to ground occurs. At this purpose simulations are carried out on a realistic urban test case and suitable evaluation indexes are proposed

A Practical Method to Test the Safety of HV/MV Substation Grounding System

The adequacy of a Grounding System (GS) to the safety conditions has to be periodically tested by measurements. The test methods and techniques used to verify the electrical characteristics of the GS include the measurements of step and touch voltages. The goal of the test is to verify that touch voltage and step voltage remain below a safe value in all the zones of the installation. The measurements can present some operational difficulties. The purpose of this paper is to present the procedure, step-by-step, of a practical method of measuring touch/step voltages in grounding systems located in urban or industrial areas with reduced accessibility. The suggested method uses auxiliary current electrodes located at short distances. This paper demonstrates by test measurements done in a real case that the method provides conservative results

PARP-14 Promotes Survival of Mammalian α but Not β Pancreatic Cells Following Cytokine Treatment

PARP-14 (poly-ADP Ribose Polymerase-14), a member of the PARP family, belongs to the group of Bal proteins (B Aggressive Lymphoma). PARP-14 has recently appeared to be involved in the transduction pathway mediated by JNKs (c Jun N terminal Kinases), among which JNK2 promotes cancer cell survival. Several pharmacological PARP inhibitors are currently used as antitumor agents, even though they have also proved to be effective in many inflammatory diseases. Cytokine release from immune system cells characterizes many autoimmune inflammatory disorders, including type I diabetes, in which the inflammatory state causes β cell loss. Nevertheless, growing evidence supports a concomitant implication of glucagon secreting α cells in type I diabetes progression. Here, we provide evidence on the activation of a survival pathway, mediated by PARP-14, in pancreatic α cells, following treatment of αTC1.6 glucagonoma and βTC1 insulinoma cell lines with a cytokine cocktail: interleukin 1 beta (IL-1β), interferon gamma (IFN-γ) and tumor necrosis factor alpha (TNF-α). Through qPCR, western blot and confocal analysis, we demonstrated higher expression levels of PARP-14 in αTC1.6 cells with respect to βTC1 cells under inflammatory stimuli. By cytofluorimetric and caspase-3 assays, we showed the higher resistance of α cells compared to β cells to apoptosis induced by cytokines. Furthermore, the ability of PJ-34 to modulate the expression of the proteins involved in the survival pathway suggests a protective role of PARP-14. These data shed light on a poorly characterized function of PARP-14 in αTC1.6 cells in inflammatory contexts, widening the potential pharmacological applications of PARP inhibitors

TAO Conceptual Design Report: A Precision Measurement of the Reactor Antineutrino Spectrum with Sub-percent Energy Resolution

The Taishan Antineutrino Observatory (TAO, also known as JUNO-TAO) is a satellite experiment of the Jiangmen Underground Neutrino Observatory (JUNO). A ton-level liquid scintillator detector will be placed at about 30 m from a core of the Taishan Nuclear Power Plant. The reactor antineutrino spectrum will be measured with sub-percent energy resolution, to provide a reference spectrum for future reactor neutrino experiments, and to provide a benchmark measurement to test nuclear databases. A spherical acrylic vessel containing 2.8 ton gadolinium-doped liquid scintillator will be viewed by 10 m^2 Silicon Photomultipliers (SiPMs) of >50% photon detection efficiency with almost full coverage. The photoelectron yield is about 4500 per MeV, an order higher than any existing large-scale liquid scintillator detectors. The detector operates at -50 degree C to lower the dark noise of SiPMs to an acceptable level. The detector will measure about 2000 reactor antineutrinos per day, and is designed to be well shielded from cosmogenic backgrounds and ambient radioactivities to have about 10% background-to-signal ratio. The experiment is expected to start operation in 2022

Thoracoscopic resection of a paraaortic bronchogenic cyst

Bronchogenic mediastinal cysts (BMC) represent 18% of primitive mediastinal tumors and the most frequent cystic lesions in this area. Nowadays, BMC are usually treated by VATS. However, the presence of major adhesions to vital structures is often considered as an unfavourable condition for thoracoscopic treatment. The authors report the thoracoscopic treatment of a BMC having dense adhesions to the aortic arch. Diagnosis and surgical treatment is described. Review of the literature and surgical options on this topic are discussed

Surgical management of pulmonary inflammatory pseudotumors: A single center experience

<p>Abstract</p> <p>Background</p> <p>The pulmonary inflammatory pseudotumor (PIP) is a rare disease. It is still debated whether it represents an inflammatory lesion characterized by uncontrolled cell growth or a true neoplasm. PIP is characterized by a cellular polymorphism.</p> <p>Methods</p> <p>We retrospectively analyzed 8 patients with PIP treated by surgery between 2001 and 2009. Preoperative thoracic computed tomography (CT) scan was performed in all cases. All patients underwent preoperative bronchoscopy with washing and brushing and/or transbronchial biopsy and preoperative cytology examination</p> <p>Results</p> <p>There were 5 men and 3 women, aged between 38 and 69 years (mean of 58 years). 3 patients (37%) were asymptomatic. The others had symptoms characterized by chest pain, shortness of breath and persistent cough or hemoptysis. 5 patients had neutrophilic leucocytosis. CT scan demonstrated solitary nodules (maximum diameter <3 cm) in 5 patients (62%) and lung masses (maximum diameter >3 cm) in 3 patients (37%). In 2 patients there were signs of pleural infiltration. Distant lesions were excluded in all cases. A preoperative histology examination failed to reach a definitive diagnosis in all patients. At surgery, we performed two lobectomies, one segmentectomy and five wedge resections, these being performed with videothoracoscopy (VATS), except for one patient where open surgery was used. Complete tumor resection was obtained in all patients. According to the Matsubara classification, there were 2 cases of organizing pneumonia, 5 cases of fibrous histiocytoma and one case of lymphoplasmacytoma. All patients were discharged alive from hospital between 4 and 7 days after surgery. At follow-up CT scan performed annually (range 11 to 112 months) (mean 58 months), there were no residual lesions, neither local nor distant recurrences.</p> <p>Conclusions</p> <p>PIP is a rare disease. Many synonyms have been used for this disease, usually in relation to the most represented cell type. The true incidence is unclear. Preoperative diagnosis is difficult to reach, despite performing a bronchoscopy or a transparietal needle aspiration. Different classifications have been proposed for PIP. Either medical, radiation or surgical therapy has been used for PIP. Whenever possible, surgery should be considered the standard treatment. Complete surgical resection is advocated to prevent recurrence.</p