Application Of Safety And Security Principles To Flood Event Management In Highly Populated Urban Areas

This paper refers to non-structural actions which are to be carried out on the Arno river basin (Italy). In particular the town of Florence is considered where 56 catastrophic flood events have been recorded in the last 1000 years, the latter in 1966 with damages estimated at 10,000 billion euros. A huge system of structural works is presently being carried out planned to the 200-year return period event in the next ten years. To manage the present and future residual risk, specific safety plans have been provided at the scale of single buildings in order to give residents an effective instrument to prevent and protect them from the major flooding risk. This paper illustrates how safety and security principles can be applied to the management of a flood event at the scale of several thousands of square kilometres. A specific Security Plan and, if needed, a Recovery Plan is linked to each building which is potentially subject to flooding. Based on analytical hazard assessment and mapping, techniques to improve or increase the safety-level as well as appropriated information are described. These local scale plans are interfaced with civil protection and disaster management plans at the regional scale by suitable procedures. Keywords: risk assessment, flood event, security plan, recovery plan, signs, procedures, building. 1 Introduction A study for a plan in order to provide the residents of the area of the Arno River basin (and in future perspective all the residents) with one useful instrument t

ESMO management and treatment adapted recommendations in the COVID-19 era: gynaecological malignancies

The rapid spread of severe acute respiratory syndrome coronavirus 2 infection and its related disease (COVID-19) has required an immediate and coordinate healthcare response to face the worldwide emergency and define strategies to maintain the continuum of care for the non-COVID-19 diseases while protecting patients and healthcare providers. The dimension of the COVID-19 pandemic poses an unprecedented risk especially for the more vulnerable populations. To manage patients with cancer adequately, maintaining the highest quality of care, a definition of value-based priorities is necessary to define which interventions can be safely postponed without affecting patients' outcome. The European Society for Medical Oncology (ESMO) has endorsed a tiered approach across three different levels of priority (high, medium, low) incorporating information on the value-based prioritisation and clinical cogency of the interventions that can be applied for different disease sites. Patients with gynaecological cancer are at particular risk of COVID-19 complications because of their age and prevalence of comorbidities. The definition of priority level should be based on tumour stage and histology, cancer-related symptoms or complications, aim (curative vs palliative) and magnitude of benefit of the oncological intervention, patients' general condition and preferences. The decision-making process always needs to consider the disease-specific national and international guidelines and the local healthcare system and social resources, and a changing situation in relation to COVID-19 infection. These recommendations aim to provide guidance for the definition of deferrable and undeferrable interventions during the COVID-19 pandemic for ovarian, endometrial and cervical cancers within the context of the ESMO Clinical Practice Guidelines

Reconstruction of nasal skin cancer defects with local flaps.

Reconstruction of nasal defects must preserve the integrity of complex facial functions and expressions, as well as facial symmetry and a pleasing aesthetic outcome. The reconstructive modality of choice will depend largely on the location, size, and depth of the surgical defect. Individualized therapy is the best course, and numerous flaps have been designed to provide coverage of a variety of nasal-specific defects. We describe our experience in the aesthetic reconstruction of nasal skin defects following oncological surgery. The use of different local flaps for nasal skin cancer defects is reported in 286 patients. Complications in this series were one partial flap dehiscence that healed by secondary intention, two forehead flaps, and one bilobed flap with minimal rim necrosis that resulted in an irregular scar requiring revision. Aesthetic results were deemed satisfactory by all patients and the operating surgeons. The color and texture matches were aesthetically good, and the nasal contour was distinct in all patients. All scars were inconspicuous and symmetrical. No patient had tenting or a flat nose

ESMO management and treatment adapted recommendations in the COVID-19 era: gynaecological malignancies

The rapid spread of severe acute respiratory syndrome coronavirus 2 infection and its related disease (COVID-19) has required an immediate and coordinate healthcare response to face the worldwide emergency and define strategies to maintain the continuum of care for the non-COVID-19 diseases while protecting patients and healthcare providers. The dimension of the COVID-19 pandemic poses an unprecedented risk especially for the more vulnerable populations. To manage patients with cancer adequately, maintaining the highest quality of care, a definition of value-based priorities is necessary to define which interventions can be safely postponed without affecting patients’ outcome. The European Society for Medical Oncology (ESMO) has endorsed a tiered approach across three different levels of priority (high, medium, low) incorporating information on the value-based prioritisation and clinical cogency of the interventions that can be applied for different disease sites. Patients with gynaecological cancer are at particular risk of COVID-19 complications because of their age and prevalence of comorbidities. The definition of priority level should be based on tumour stage and histology, cancer-related symptoms or complications, aim (curative vs palliative) and magnitude of benefit of the oncological intervention, patients’ general condition and preferences. The decision-making process always needs to consider the disease-specific national and international guidelines and the local healthcare system and social resources, and a changing situation in relation to COVID-19 infection. These recommendations aim to provide guidance for the definition of deferrable and undeferrable interventions during the COVID-19 pandemic for ovarian, endometrial and cervical cancers within the context of the ESMO Clinical Practice Guidelines

Management of bladder endometriosis with combined transurethral and laparoscopic approach. Follow-up of pain control, quality of life, and sexual function at 12 months after surgery

To describe the pre-surgical and post-surgical outcomes at one year in terms of recurrence of lower urinary tract symptoms, quality of life, and sexual function of a transurethral and laparoscopic combined approach in the treatment of bladder endometriosis. The authors performed a prospective observational study of 16 women affected by symptomatic bladder endometriosis at the University Hospitals of Cagliari, Padua, and Foggia. In all patients bladder nodule was excised with a transurethral and laparoscopic combined approach technique. Intensity of lower urinary tract symptoms (VAS score) were assessed pre- and post-operatively at one, six, and 12 months after surgery; quality of life (SF-36) and sexual functions (FSFI) were collected preoperatively and one year postoperatively. Operative time was 120.18 ± 15.77 minutes and mean blood loss was 65.12 ± 44.74. No intraoperative and postoperative complications and conversion laparotomy occurred. Intensity of lower urinary tract symptoms evaluated with VA S score were significantly lower after one, six, and 12 months postsurgery vs. presurgery (p < 0.001). The authors observed a significantly improvement in the quality of life and sexual functions in all patients at one year after surgery. This surgical approach is safe and simple in the treatment of bladder en-dometriosis, with low risks and optimal resolution of symptoms, and improvement of quality of life and sexual function

Surgical morbidity of total laparoscopic hysterectomy for benign disease: Predictors of major postoperative complications

Objective: To estimate rate of perioperative complications and to define risk factors of 30-day major (Clavien-Dindo &gt; 2) postoperative complications of total laparoscopic hysterectomy (TLH) for benign disease. Study design: An uncontrolled single-center single-arm retrospective study. Data of consecutive patients who have undergone TLH for pathologically confirmed benign disease between January 2000 and December 2019 have been analyzed. Perioperative surgical outcomes, occurrence of postoperative complications, readmissions, and reoperations within 30 days from surgery were registered. Univariate and multivariable analyses were performed to determine the factors associated with major (Clavien-Dindo &gt; 2) postoperative complications. Results: Over the study period 3090 patients were included in the study. Conversion to open surgery occurred in 54 (1.7%) cases. Mean operative time for TLH was 87.7 (+/- 1.7) minutes while mean estimated blood loss was 119.5 (+7.4) mL. Overall, postoperative complications were registered in 430 (13.9%) patients, and major events were observed in 208 (6.7%) of the cases. Same-hospital readmissions and reoperations within 30-day from surgery occurred in 78 (2.5%) and 28 (0.9%) patients, respectively. At multivariable analysis, endometriosis (odds ratio: 3.51, 95%CI:1.54-8.30, p = 0.02), the need for conversion to open surgery (odds ratio: 1.26, 98%CI:1.03-12.64, p &lt; 0.001), and the occurrence of any intraoperative complication (odds ratio: 3.10, 95%CI: 1.45-21.61, p &lt; 0.001) were found as independent risk factors for major postoperative complications. Conclusions: Total hysterectomy performed via laparoscopy is associated with acceptable major postoperative complications rate. A huge effort should be made to minimize the occurrence of intraoperative complications and the need for conversion to open surgery. Patients undergoing TLH for endometriosis should be counselled about the increased risk of major postoperative events. (c) 2021 Elsevier B.V. All rights reserved

The implant-prosthetic rahabilitation in free vascularized bone flaps.A clinical study.

Objectives. Oromaxillo mandibular reconstruction using free bone flaps is nowadays a safe technique with a satisfying rate of success (95%) due to the self flap vascularization. Materials. Between April 1996 and May 2006, 153 patients underwent oncological surgery and immediate reconstruction using bone free flaps. Among those patients, we present only 11 patients (7,2%), because they received reconstruction with bone free flaps and dental rehabilitation using osteointegrated implants. Results and conclusions. We analyze them under the aesthetic and functional point of view, using particular tests to evaluate deglutition, mastication, speech, self-esteem, and implant success. The use of free flaps after oncologic surgical demolition is indicated in case of soft tissue and/or bone defects. Maxillo-mandibular reconstruction is more complete if the patient receives dental prosthetic rehabilitation using osseointegrated implants and, for this reason, bone free flap is the best solution

Surgical morbidity of total laparoscopic hysterectomy for benign disease: Predictors of major postoperative complications

Objective: To estimate rate of perioperative complications and to define risk factors of 30-day major (Clavien-Dindo ≥ 2) postoperative complications of total laparoscopic hysterectomy (TLH) for benign disease. Study design: An uncontrolled single-center single-arm retrospective study. Data of consecutive patients who have undergone TLH for pathologically confirmed benign disease between January 2000 and December 2019 have been analyzed. Perioperative surgical outcomes, occurrence of postoperative complications, readmissions, and reoperations within 30 days from surgery were registered. Univariate and multivariable analyses were performed to determine the factors associated with major (Clavien-Dindo ≥ 2) postoperative complications. Results: Over the study period 3090 patients were included in the study. Conversion to open surgery occurred in 54 (1.7%) cases. Mean operative time for TLH was 87.7 (±1.7) minutes while mean estimated blood loss was 119.5 (+7.4) mL. Overall, postoperative complications were registered in 430 (13.9%) patients, and major events were observed in 208 (6.7%) of the cases. Same-hospital readmissions and reoperations within 30-day from surgery occurred in 78 (2.5%) and 28 (0.9%) patients, respectively. At multivariable analysis, endometriosis (odds ratio: 3.51, 95%CI:1.54–8.30, p = 0.02), the need for conversion to open surgery (odds ratio: 1.26, 98%CI:1.03–12.64, p &lt; 0.001), and the occurrence of any intraoperative complication (odds ratio: 3.10, 95%CI: 1.45–21.61, p &lt; 0.001) were found as independent risk factors for major postoperative complications. Conclusions: Total hysterectomy performed via laparoscopy is associated with acceptable major postoperative complications rate. A huge effort should be made to minimize the occurrence of intraoperative complications and the need for conversion to open surgery. Patients undergoing TLH for endometriosis should be counselled about the increased risk of major postoperative events