Quantum statistics in Network Geometry with Fractional Flavor

(23 pages, 6 figures)(23 pages, 6 figures

Il trattamento del carcinoma del retto basso nel paziente anziano fragile. Contributo casistico

Il carcinoma del retto è di frequente riscontro nella popolazione anziana, nell’ambito della quale morbilità e mortalità correlate alla terapia chirurgica sono spesso aggravate da patologie concomitanti. Tuttavia, previo un accurato studio preoperatorio e la rigida selezione dei pazienti in categorie di rischio, è possibile l’attuazione di procedure chirurgiche sicure ed efficaci. Nel nostro studio abbiamo incluso 149 pazienti affetti da carcinoma del retto distale, suddivisi tra soggetti con più di 75 anni e con meno di 75 anni. Gli interventi eseguiti sono stati: resezione curativa in 94 casi, interventi palliativi in 19, escissione locale in 31; anche tra i pazienti di età superiore a 75 anni abbiamo ottenuto buoni risultati per quanto riguarda le complicanze e la mortalità postoperatorie. Possiamo dunque concludere che le procedure chirurgiche da noi eseguite garantiscono, anche in pazienti anziani selezionati, buoni risultati in termini di controllo sia del rischio perioperatorio sia della malattia neoplastic

La trombosi venosa profonda in gravidanza: caso clinico

Sulle base di un caso clinico di recente giunto alla nostra osservazione abbiamo ritenuto di esporre le linee guida più attuali per la prevenzione e il trattamento delle TVP in gravidanza. Il tromboembolismo venoso in gravidanza e nel puerperio rimane la maggior causa di mortalità e morbilità. La gravidanza, infatti, rappresenta di per sé una predisposizione alla TVP. Fattori di rischio specifici possono essere identificati prima o durante la gravidanza ed il parto. Grazie all’introduzione di nuove strategie diagnostiche tipo l’EcoColor-Doppler ed il dosaggio del D-dimero plasmatico è possibile prevenire la trombosi venosa profonda ed evitare le complicanze tromboemboliche. L’elasto-compressione degli arti inferiori e il trattamento farmacologico con EBPM rappresentano nei soggetti a rischio un buon protocollo di prevenzion

Perspectives from Italy during the COVID-19 pandemic: nationwide survey-based focus on minimally invasive HPB surgery

The safety of minimally invasive procedures during COVID pandemic remains hotly debated, especially in a country, like Italy, where minimally invasive techniques have progressively and pervasively entered clinical practice, in both the hepatobiliary and pancreatic community. A nationwide snapshot of the management of HPB minimally invasive surgery activity during COVID-19 pandemic is provided: a survey was developed and conducted within AICEP (Italian Association of HepatoBilioPancreatic Surgeons) with the final aim of conveying the experience, knowledge, and opinions into a unitary report enabling more efficient crisis management. Results from the survey (81 respondents) show that, in Italian hospitals, minimally invasive surgery maintains its role despite the COVID-19 pandemic, with the registered reduction of cases being proportional to the overall reduction of the HPB surgical activity. Respondents agree that the switch from minimally invasive to open technique can be considered as a valid option for cases with a high technical complexity. Several issues merit specific attention: screening for virus positivity should be universally performed; only expert surgical teams should operate on positive patients and specific technical measures to lower the biological risk of contamination during surgery must be followed. Future studies specifically designed to establish the true risks in minimally invasive surgery are suggested. Furthermore, a standard and univocal process of prioritization of patients from Regional Healthcare Systems is advisable

Perspectives from Italy during the COVID-19 pandemic: nationwide survey-based focus on minimally invasive HPB surgery

The safety of minimally invasive procedures during COVID pandemic remains hotly debated, especially in a country, like Italy, where minimally invasive techniques have progressively and pervasively entered clinical practice, in both the hepatobiliary and pancreatic community. A nationwide snapshot of the management of HPB minimally invasive surgery activity during COVID-19 pandemic is provided: a survey was developed and conducted within AICEP (Italian Association of HepatoBilioPancreatic Surgeons) with the final aim of conveying the experience, knowledge, and opinions into a unitary report enabling more efficient crisis management. Results from the survey (81 respondents) show that, in Italian hospitals, minimally invasive surgery maintains its role despite the COVID-19 pandemic, with the registered reduction of cases being proportional to the overall reduction of the HPB surgical activity. Respondents agree that the switch from minimally invasive to open technique can be considered as a valid option for cases with a high technical complexity. Several issues merit specific attention: screening for virus positivity should be universally performed; only expert surgical teams should operate on positive patients and specific technical measures to lower the biological risk of contamination during surgery must be followed. Future studies specifically designed to establish the true risks in minimally invasive surgery are suggested. Furthermore, a standard and univocal process of prioritization of patients from Regional Healthcare Systems is advisable

Current status of liver surgery for non-colorectal non-neuroendocrine liver metastases: the NON.LI.MET. Italian Society for Endoscopic Surgery and New Technologies (SICE) and Association of Italian Surgeons in Europe (ACIE) collaborative international survey

Despite the increasing trend in liver resections for non-colorectal non-neuroendocrine liver metastases (NCNNLM), the role of surgery for these liver malignancies is still debated. Registries are an essential, reliable tool for assessing epidemiology, diagnosis, and therapeutic approach in a single hub, especially when data are dispersive and inconclusive, as in our case. The dissemination of this preliminary survey would allow us to understand if the creation of an International Registry is a viable option, while still offering a snapshot on this issue, investigating clinical practices worldwide. The steering committee designed an online questionnaire with Google Forms, which consisted of 37 questions, and was open from October 5th, 2022, to November 30th, 2022. It was disseminated using social media and mailing lists of the Italian Society of Endoscopic Surgery and New Technologies (SICE), the Association of Italian Surgeons in Europe (ACIE), and the Spanish Chapter of the American College of Surgeons (ACS). Overall, 141 surgeons (approximately 18% of the total invitations sent) from 27 countries on four continents participated in the survey. Most respondents worked in general surgery units (62%), performing less than 50 liver resections/year (57%). A multidisciplinary discussion was currently performed to validate surgical indications for NCNNLM in 96% of respondents. The most commonly adopted selection criteria were liver resectability, RECIST criteria, and absence of extrahepatic disease. Primary tumors were generally of gastrointestinal (42%), breast (31%), and pancreaticobiliary origin (13%). The most common interventions were parenchymal-sparing resections (51% of respondents) of metachronous metastases with an open approach. Major post-operative complications (Clavien-Dindo > 2) occurred in up to 20% of the procedures, according to 44% of respondents. A subset analysis of data from high-volume centers (> 100 cases/year) showed lower post-operative complications and better survival. The present survey shows that NCNNLM patients are frequently treated by surgeons in low-volume hospitals for liver surgery. Selection criteria are usually based on common sense. Liver resections are performed mainly with an open approach, possibly carrying a high burden of major post-operative complications. International guidelines and a specific consensus on this field are desirable, as well as strategies for collaboration between high-volume and low-volume centers. The present study can guide the elaboration of a multi-institutional document on the optimal pathway in the management of patients with NCNNLM