Inquietudine spettrale

Inquietudine spettrale. Gli uccelli nella concezione poetica di Jacob Grimm covers a peculiar aspect of Jacob Grimm’s poetry: in the framework of a nature pervaded with spirituality, whose hard-to-reach secrets inspire fascination, birds, as inhabitants of the air, are perceived as ghostly creatures, capable of infusing the observer with a sense of restlessness. The individual references to the theme found in essays, letters and works all confirm a strong interest in these animals, and constitute analysis material in the context of Grimm’s vast production. Particular recognition is given to the famous collection entitled Kinder- und Hausmärchen (in its first and mostly unknown version), the capital book of the Romantic current in Germany, where the liminal role of birds can be attributed to archaic myths and popular beliefs

Small aortic annulus: The hydrodynamic performances of 5 commercially available bileaflet mechanical valves

AbstractObjectiveHemodynamic performances of mechanical valve prostheses in patients with aortic valve stenosis and a small aortic annulus are crucial. We analyzed the in vitro hydrodynamics of 5 currently available bileaflet mechanical prostheses that fitted a 21-mm-diameter valve holder of a Sheffield pulse duplicator.MethodsThree samples of 5 high-performance production-quality prostheses, including the sewing ring cuffs, were tested in the aortic chamber of a Sheffield pulse duplicator. Sizes of the prostheses fitting the 21-mm valve holder were as follows: 18-mm ATS, 19-mm SJM Regent, 19-mm Sorin Bicarbon Slimline, 19-mm On-X, and 21-mm Carbomedics Top Hat. The tests were carried out at a fixed pulse rate (70 beats/min) and at increasing cardiac outputs of 2, 4, 5, and 7 L/min. Each valve was tested 10 times for each different cardiac output. This resulted in a total of 40 tests for each valve and 120 tests for each valve model. The aortic pressure was set at 120/80 mm Hg (mean pressure, 100 mm Hg) throughout the experiment for all cardiac outputs. Forward flow pressure decrease, total regurgitant volume, closing and leakage volumes, effective orifice area, and stroke work loss were recorded while the valve operated under each cardiac output.ResultsThe SJM Regent valve and the Sorin Bicarbon Slimline prosthesis showed the lowest mean and peak gradients at increasing cardiac outputs. The closure volume was higher for the SJM Regent and Sorin Bicarbon Slimline prostheses, unlike with the ATS prosthesis at 7 L/min of cardiac output. The ATS and SJM Regent prostheses showed the largest regurgitant volume, whereas the Sorin Bicarbon Slimline prosthesis showed the lowest regurgitant volume. The calculated effective orifice area and stroke work loss were significantly better with the SJM Regent and Sorin Bicarbon Slimline prostheses.ConclusionAssuming that the 21-mm valve holder in which all the tested prostheses were accommodated is comparable with a defined aortic valve size, this hydrodynamic evaluation model allowed us to compare the efficiency of currently available valve prostheses, and among these, the SJM Regent and the Sorin Bicarbon Slimline exhibited the best performances

Gli uccelli come figure liminari nella concezione poetica di Jacob Grimm = Die Vögel als Grenzfiguren in der Poesieauffassung Jacob Grimms

Da alcune affermazioni contenute negli scritti di Jacob Grimm sul ruolo delle diverse figure animali nei vari generi letterari, così come nelle antiche credenze religiose dei popoli, emerge una singolare caratterizzazione degli uccelli, concepiti come creature portatrici di “spettrale inquietudine”. Alla luce della presenza nella vasta produzione grimmiana di specifici saggi o capitoli di opere, relativi a contesti diversi e di datazione anche molto lontana fra loro, dedicati a questa specie animale, il lavoro indaga questo particolare interesse – finora inesplorato – dello studioso, nell’ambito della sua concezione poetica, della dicotomia “Natur- / Kunstpoesie” che la domina, della visione della natura in senso romantico, quale fonte di mistero e continua fascinazione. Uno studio approfondito è stato riservato alle numerose “Vogelfiguren” delle raccolte “Kinder- und Hausmärchen” e “Deutsche Sagen”, e alle loro connessioni con quei miti arcaici che presentano gli uccelli come esseri liminari, in diretto contatto con il mondo dei morti e degli dèi.In mehreren Schriften Jacob Grimms über die Rolle der Tierfiguren in den unterschiedlichen literarischen Gattungen sowie im alten Volksglauben, werden Vögel merkwürdigerweise als Träger einer „geisterhaften Unruhe“ beschrieben. Im Angesichts anderer Werke Grimms, die sich in ganz unterschiedlichen Kontexten immer wieder mit den besonderen Eigenschaften dieser Tierart auseinandersetzen, obwohl sie in großem zeitlichen Abstand voneinander entstanden sind, hat die Arbeit dieses bemerkenswerte – und bis jetzt unerforschte – Interesse des Gelehrten untersucht, und zwar unter Rücksichtnahme seiner poetologischen Konzeption, der für Grimm so wichtigen Dichotomie zwischen Natur- und Kunstpoesie, einer Weltanschauung, die die Natur auf typisch romantische Weise als unerschöpfliche Geheimnis- und Faszinationsquelle auffasst. Die ausführliche Analyse wurde anhand der zahlreichen Vogelfiguren in den „Kinder- und Hausmärchen“ und „Deutschen Sagen“ durchgeführt, unter Berücksichtigung ihrer Bezüge zu den alten Mythen, die die Vögel als Wesen in Verbindung mit der Toten- und Götterwelt darstellen

A Case-Control Comparison of Surgical and Functional Outcomes of Robotic-Assisted Spleen-Preserving Left Side Pancreatectomy versus Pure Laparoscopy

Aim During left-sided spleen-preserving pancreatectomy (SPLP), limitations of laparoscopy may require spleen sacrifice or conversion to maintain patient safety. The objective of our study is to compare surgical and functional outcomes of robot-assisted and pure laparoscopic SPLP in patients with benign or borderline lesions of the body/tail of the pancreas. Patients and methods This was a case-matched study: fifteen patients who had robotic SPLP (R-SPLP) were matched with 15 comparable patients who had pure laparoscopic SPLP (L-SPLP). The peri-operative variables (conversion rate, amount of bleeding, operation time, length of hospital stay, complications, mortality and readmission) as well as the spleen preservation rate were compared between the two groups, The European Organisation for Research and Treatment of Cancer QLQ-C30 (EORTC QLQ-C30) specific questionnaires were used in each arm after at least 1 year of follow up in order to evaluate quality of life (QoL). Results No R-SPLP was converted to conventional laparoscopy, hand-assisted laparoscopy, or open surgery whereas L-SPLP had a conversion rate of 13.3% (p=n.s.); also fistula formation (20% vs. 46%; p=n.s.) was higher in the laparoscopic group although not statistically significant. Mean operative time (220 vs. 279 min; p=0.027) was shorter and the spleen-preserving rate (fail/ success, 0/15 vs. 4/11; p=0.03) of R-SPLP was significantly better compared to L-SPLP. Moreover, length of hospital stay was significantly shorter in the R-SPLP group compared to the L-SPLP group (6.5 vs. 8.8 days; p=0.04). Post-operative high grade surgical complications occurred only in one L-SPLP patient (0% vs. 6.6%; p=n.s.). Quality of life scores were not significantly different between the two groups. Conclusions R-SPLP could provide an increased chance for spleen preservation and faster surgical procedure. Furthermore, fistula formation and conversion rate seem to be lower, reducing the length of the hospital stay. Our case matched study confirmed the potential peri-operative benefits of robotic assistance in this setting, however these benefits did not translate into a better quality of life at least one year post-operatively

Linear Time-History Analysis for EC8 design of CBF structures

Increased availability of strong motions, improved computational capabilities and availability of open-source software for Eurocode 8-compliant record selection make Linear Time History Analysis (LTHA) a potential more rigorous analysis approach for the design of structures. This methodology is not explicitly codified in the Eurocode and it requires some "code-friendly" recommendations for its implementation in practice. Herein, LTHA is employed for the first time as design method for a five-storey archetype high ductility class concentric brace frame (CBF). A new-optimized design method for braces is presented for the smooth implementation of both Response Spectrum Analysis (RSA) and LTHA. In fact, the tension-only design approach for CBF in Eurocode 8 has some criticalities arising even when a routine RSA is employed. The design process is rather smooth only in the case of linear static approach classically implemented for regular, mid-rise structures. Results of this study provide insights for validation of LTHA as design method for CBFs, and for its code implementation as routine design method in EC8, valuable in near source conditions or for irregular structural configurations

Sexual and urinary functions after robot-assisted versus pure laparoscopic total mesorectal excision for rectal cancer

Background Laparoscopic total mesorectal excision (LapTME) is a validated technique for the treatment of rectal cancer. However, the ergonomic limitations of pure laparoscopy could lead to high conversion rates and a high rate of autonomic disorders. For these reasons the robot-assisted TME (RobTME) has been proposed to overcome the limitations of LapTME. The aim of this study is to compare surgical outcomes, medium-term oncologic results, and postoperative autonomic function of LapTME versus RobTME, in a single surgeon experience. Patients and Methods The first 26 LapTME were compared with the first 26 RobTME performed by a single surgeon between January 2009 and May 2013. Perioperative outcomes were prospectively collected and compared. The impact of minimally invasive TME on autonomic function and quality of life (QOL) was analyzed with the ICIQ-FLUTS and the ICIQ-MLUTS (International Consultation on Incontinence–Male/Female Lower Urinary Tract Symptoms) and IIEF (International Index of Erectile Function)/FSFI (Female Sexual Function Index) questionnaires. Pathological aspects and oncological outcomes were also collected. Results Of the 26 LapTME, 22 were anterior resections (ARR), 2 intersphincteric resections (ISR), and 2 abdominoperineal resections (APR), while of the 26 RobTME, 17 were ARR, 5 ISR, and 4 APR. Mean operative time was significantly higher (p<0.001) while conversion rate to hand-assisted or open surgery was significantly lower in the robTME group (p<0.05). There were no significant differences in sexual and urinary scores between the two groups before surgery and at 1 year after surgery. There were no differences in 3 year overall survival, disease free survival, and recurrence rate as well as the other parameters analysed. Conclusion RobTME is a safe and effective technique and the results compare favourably to the results obtained with laparoscopic procedures. It seems a promising alternative to preserve autonomic function and results in a low conversion rate even when used for more high risk procedures such as ISR or APR

Hand-assisted hybrid laparoscopic–robotic total proctocolectomy with ileal pouch–anal anastomosis

PURPOSE: Few studies have reported minimally invasive total proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) and familial adenomatous polyposis (FAP). We herein report a novel hand-assisted hybrid laparoscopic-robotic technique for patients with FAP and UC. METHODS: Between February 2010 and March 2014, six patients underwent hand-assisted hybrid laparoscopic-robotic total proctocolectomy with IPAA. The abdominal colectomy was performed laparoscopically with hand assistance through a transverse suprapubic incision, also used to fashion the ileal pouch. The proctectomy was carried out with the da Vinci Surgical System. The IPAA was hand-sewn through a trans-anal approach. The procedure was complemented by a temporary diverting loop ileostomy. RESULTS: The mean hand-assisted laparoscopic surgery (HALS) time was 154.6 (±12.8) min whereas the mean robotic time was 93.6 (±8.1) min. In all cases, a nerve-sparing proctectomy was performed, and no conversion to traditional laparotomy was required. The mean postoperative hospital stay was 13.2 (±7.4) days. No anastomotic leakage was observed. To date, no autonomic neurological disorders have been observed with a mean of 5.8 (±1.3) bowel movements per day. CONCLUSIONS: The hand-assisted hybrid laparoscopic-robotic approach to total proctocolectomy with IPAA has not been previously described. Our report shows the feasibility of this hybrid approach, which surpasses most of the limitations of pure laparoscopic and robotic techniques. Further experience is necessary to refine the technique and fully assess its potential advantages

Short-term clinical outcomes of robot-assisted intersphincteric resection and low rectal resection with double-stapling technique for cancer: a case-matched study

Background: Intersphincteric resection (ISR) with total mesorectal excision (TME) is an accepted technique for the surgical treatment of very low rectal cancer. Historically it is associated with a higher functional complication rate than the Double Stapling (DS) technique when performed with open or laparoscopic approach. The aim of this study was to compare the surgical, short-term oncologic and functional outcomes of robotic ISR TME (R-ISR-TME) with those of robotic low anterior resection TME with a double stapling technique (R-DS-TME). Methods: Between April 2010 and December 2013, 42 patients underwent robot-assisted rectal resection with TME at our General Surgery Unit, including 10 R-ISR-TME. The outcomes of the R-ISR-TME group were compared with a R-DS-TME group selected using a case-matched methodology. We evaluated the operative, pathological, short-term oncologic results and postoperative sexual, urinary and defecation functions using specific questionnaires. Results: The analyses of the data showed similar results for R-ISR-TME and R-DS-TME regarding the operative, pathological and oncologic results. Focusing on urinary and sexual function, no score values were significantly different at any time between the two groups. The daily frequency of defecation 1 year after surgery was 1.9±0.9 for RISR-TME and 1.8±0.3 for RDS-TME indicating no difference between the two groups. Moreover, there were no significant differences between the two groups in other defecation functions. The mean Wexner score 1 year after surgery was 3.0±1.1 in R-ISR-TME and 2.2±1.0 in R-DS-TME group (p=0.2) and defecation-related quality of life for R-ISR-TME and R-DS-TME was not significantly different (modified fecal incontinence quality of life score: 30.3±19.1 vs 27.5±14.5, respectively; p=0.2). Conclusions: These clinical and functional results suggest that R-ISR-TME could be a good sphincter-preserving surgery for patients with very low rectal cancer. Robotic assistance may overcome some intrinsic limitations of the ISR technique flattening the difference with the DS-TME procedure

Pancreatoduodenectomy without vascular resection in patients with primary resectable adenocarcinoma and unilateral venous contact:A matched case study

Purpose. To investigate the oncological outcome and survival of patients following a conservative approach on the portal- mesenteric axis, in an intraoperative ultrasound-selected group of pancreatoduodenectomy (PD), performed on patients with primary resectable with vascular contact (prVC) pancreatic ductal adenocarcinoma (PDAC). Methods. A consecutive series of patients who underwent PD for PDAC at our tertiary care center, between 2008 and 2017, were reviewed. A total of 156 PDs and 88 total pancreatectomies were performed during the study period, including 35 vascular resections. We identified a group of 40 (25.6%) patients with prVC-PDAC in whom after checking the feasibility with intraoperative ultrasound, we were able to perform PD by separation of the tumor from the portomesenteric axis avoiding vascular resection, without residual macroscopic disease (no vascular resection, nvrPD), and compared this group, using case-matched methodology, with the standard PD (sPD) group of primary resectable without vascular contact- (prwVC-) PDAC. Results. The median follow-up was 28.5 ± 23.2 months in the sPD group and 23.8 ± 20.8 months in the nvrPD group (p = 0 35). Isolated local recurrence rate was 2/40 (5%) in both groups. Additionally, there were no statistical differences in the systemic progression of the disease (42.5% sPD vs. 45% nvrPD, p = 0 82) or local plus synchronous systemic disease rates (2.5% sPD vs. 7.5% nvrPD, p = 0 30). The median survival was 22 months for the sPD group and 23 months for the nvrPD group, p = 0 86. The overall survival was similar in the two groups (1 y: 76.3% sPD vs. 70.0% nvrPD; 3 y: 35.6% vs. 31.6%; and 5 y: 28.5% vs. 25.3%; p = 0 80). Conclusions. PD without vascular resection can be considered safe and oncologically acceptable in selected patients with preoperative diagnosis of prVC-PDAC. The poor prognosis of PDAC is related to the aggressive biology and systemic spread of the tumor, rather than the local control of the disease