Single center experience with laparoscopic adrenalectomy on a large clinical series

BACKGROUND: Laparoscopic adrenalectomy is considered the gold standard technique for the treatment of benign small and medium size adrenal masses (<6 cm), due to low morbidity rate, short hospitalization and patient rapid recovery. The aim of our study is to analyse the feasibility and efficiency of this surgical approach in a broad spectrum of adrenal gland pathologies. METHODS: Pre-operative, intra-operative and post-operative data from 126 patients undergone laparoscopic adrenalectomy between January 2003 and December 2015 were retrospectively collected and reviewed. Diagnosis was obtained on the basis of clinical examination, laboratory values and imaging techniques. Doxazosin was preoperatively administered in case of pheochromocytoma while spironolactone and potassium were employed to treat Conn's disease. Laparoscopic adrenalectomies were all performed by the same surgeon (CG). First 30 procedures were considered as learning curve adrenalectomies. RESULTS: One hundred twenty-six patients were included in the study. Functioning tumors were diagnosed in 84 patients, 27 patients were affected by pheochromocytomas, 29 by Conn's disease, 28 by Cushing disease. Surgery mean operative time was 137.33 min (range 100-180) during the learning curve adrenalectomies and 96.5 min (range 75-110) in subsequent procedures. Mean blood loss was respectively 160.2 ml (range 60-280) and 90.5 ml (range 50-200) in the first 30 procedures and the subsequent ones. Only one conversion to open surgery occurred. No post-operative major complications were observed, while minor complications occurred in 8 patients (0,79%). In 83 out of 84 functioning neoplasms, laparoscopic adrenalectomy was effective in normalization of endocrine profile. CONCLUSIONS: Laparoscopic adrenalectomy is a safe and feasible procedure, even for functioning masses and pheochromocytomas. A multidisciplinary team including endocrinologists, endocrine surgeons and anaesthesiologists, is recommended in the management of adrenal pathology, and adrenal surgery should be performed in referral high volume centers. A thirty-procedures learning curve is recommended to improve surgical outcomes

Role of prophylactic central compartment lymph node dissection in clinically N0 differentiated thyroid cancer patients: Analysis of risk factors and review of modern trends

In the last years, especially thanks to a large diffusion of ultrasound-guided FNBs, a surprising increased incidence of differentiated thyroid cancer (DTC), "small" tumors and microcarcinomas have been reported in the international series. This led endocrinologists and surgeons to search for "tailored" and "less aggressive" therapeutic protocols avoiding risky morbidity and useless "overtreatment". Considering the most recent guidelines of referral endocrine societies, we analyzed the role of routine or so-called prophylactic central compartment lymph node dissection (RCLD), also considering its benefits and risks. Literature data showed that the debate is still open and the surgeons are divided between proponents and opponents of its use. Even if lymph node metastases are commonly observed, and in up to 90 % of DTC cases micrometastases are reported, the impact of lymphatic involvement on long-term survival is subject to intensive research and the best indications of lymph node dissection are still controversial. Identification of prognostic factors for central compartment metastases could assist surgeons in determining whether to perform RLCD. Considering available evidence, a general agreement to definitely reserve RCLD to "high-risk" cases was observed. More clinical researches, in order to identify risk factors of meaningful predictive power and prospective long-term randomized trials, should be useful to validate this selective approach

Additive Manufactured Scaffolds for Bone Tissue Engineering: Physical Characterization of Thermoplastic Composites with Functional Fillers

Thermoplastic polymer–filler composites are excellent materials for bone tissue engineering (TE) scaffolds, combining the functionality of fillers with suitable load-bearing ability, biodegradability, and additive manufacturing (AM) compatibility of the polymer. Two key determinants of their utility are their rheological behavior in the molten state, determining AM processability and their mechanical load-bearing properties. We report here the characterization of both these physical properties for four bone TE relevant composite formulations with poly(ethylene oxide terephthalate)/poly(butylene terephthalate (PEOT/PBT) as a base polymer, which is often used to fabricate TE scaffolds. The fillers used were reduced graphene oxide (rGO), hydroxyapatite (HA), gentamicin intercalated in zirconium phosphate (ZrP-GTM) and ciprofloxacin intercalated in MgAl layered double hydroxide (MgAl-CFX). The rheological assessment showed that generally the viscous behavior dominated the elastic behavior (G″ > G′) for the studied composites, at empirically determined extrusion temperatures. Coupled rheological–thermal characterization of ZrP-GTM and HA composites showed that the fillers increased the solidification temperatures of the polymer melts during cooling. Both these findings have implications for the required extrusion temperatures and bonding between layers. Mechanical tests showed that the fillers generally not only made the polymer stiffer but more brittle in proportion to the filler fractions. Furthermore, the elastic moduli of scaffolds did not directly correlate with the corresponding bulk material properties, implying composite-specific AM processing effects on the mechanical properties. Finally, we show computational models to predict multimaterial scaffold elastic moduli using measured single material scaffold and bulk moduli. The reported characterizations are essential for assessing the AM processability and ultimately the suitability of the manufactured scaffolds for the envisioned bone regeneration application.The work was supported by a Horizon 2020 Research and Innovation Programme grant from the European Union, called the FAST project (grant no. 685825, project website: http:// project-fast.eu). The authors acknowledge the support of the FAST project consortium for the various aspects of this wor

Self-Assembled Nanometer-Scale Magnetic Networks on Surfaces: Fundamental Interactions and Functional Properties

Nanomagnets of controlled size, organized into regular patterns open new perspectives in the fields of nanoelectronics, spintronics, and quantum computation. Self-assembling processes on various types of substrates allow designing fine-structured architectures and tuning of their magnetic properties. Here, starting from a description of fundamental magnetic interactions at the nanoscale, we review recent experimental approaches to fabricate zero-, one-, and two-dimensional magnetic particle arrays with dimensions reduced to the atomic limit and unprecedented areal density. We describe systems composed of individual magnetic atoms, metal-organic networks, metal wires, and bimetallic particles, as well as strategies to control their magnetic moment, anisotropy, and temperature-dependent magnetic behavior. The investigation of self-assembled subnanometer magnetic particles leads to significant progress in the design of fundamental and functional aspects, mutual interactions among the magnetic units, and their coupling with the environment

Il turismo nella legislazione italiana - problemi e prospettive della principale risorsa economica del paese

NOTA: La presente edizione si avvale di una struttura innovativa caratterizzata da box e schemi sinottici oltre che di richiami agli orientamenti giurisprudenziali, consentendo in tal modo un’agile e rapido apprendimento. Il libro sottolinea la necessità di un ordine per lo svolgimento delle attività economiche, costituito dalle regole giuridiche che garantiscono il corretto funzionamento del mercato. Anche il turismo è un mercato e come tale è stato nel tempo disciplinato, ma in modo sporadico e settoriale. Dalle origini del Grand Tour settecentesco a Trip Advisor su internet, passando perle associazioni di turisti della fine dell’ ottocento. Nell’ultimo scorcio del secondo millennio, il mondo ha vissuto una stagione nuova del turismo. Da quando, soprattutto dalla fine della seconda guerra mondiale, quello che potremmo definire come homo pellegrinus, ha rifatto la sua comparsa, tutte le rotte del pianeta sono state nuovamente battute ed altre se ne sono aperte, varcando perfino i confini dello spazio. La storia del turismo si intreccia con la storia dell'uomo e del suo desiderio di conoscenza. Oggi il turismo in Italia è una delle attività più redditizie del Paese (12% del PIL totale), grazie alle sue bellezze artistiche, storiche, archeologiche, naturalistiche e paesaggistiche. Il paese era, nel 2007 il quinto più visitato nel mondo con 43,2 milioni di turisti in arrivo, una cifra in linea con gli anni precedenti e si raffronta con una realtà economica dinamica nell’ambito di uno scenario internazionale. In questo senso gli interventi legislativi frammentari che si sono susseguiti nel corso del tempo, in particolar modo dopo la Riforma del Titolo V della Costituzione nel 2001, hanno indebolito la posizione del nostro Paese. La legislazione turistica ha il prioritario scopo di regolare e coordinare le scelte di politica turistica e di tutelare gli interessi individuali e collettivi. La normativa di diritto pubblico sia Statale che Regionale si presenta, nonostante le riforme in via di attuazione, frammentaria e settoriale. Gli interventi di carattere amministrativo hanno dimostrato di essere una risposta solo burocratica ai bisogni del settore senza incidere in maniera decisa sulle scelte di sviluppo turistico. Punto di partenza invalicabile per ogni intervento statale è rappresentato dall’art. 117 della Costituzione, che ha attribuito alle Regioni in maniera esclusiva, attraverso il principio della residualità, la competenza in materia turistica. Conclude l’indagine l’analisi delle condizioni attuali in cui versa la normativa turistica e la sua effettiva applicazione anche in relazione alle aree del Sud Italia. Considerate quindi le condizioni attuali il cui futuro non può che dipendere essenzialmente da tre azioni importanti: la pianificazione razionale del territorio e delle infrastrutture; la riqualificazione del patrimonio ambientale ed artistico; la promozione e la comunicazione multimediale delle bellezze del Sud in tutto il mondo

Automatic recording of direct current singularity amplitudes in Josephson junctions

We have designed and tested an electronic circuit to record the amplitude of any current singularity in the current‐voltage characteristic of a Josephson tunnel junction. The detection of the peak current occurs only when the junction voltage is within a range that can be centered and narrowed conveniently. We describe the circuit in detail and illustrate its operation in the recording of some typical dc singularities

Relationship between autonomic neuropathy, 24-h blood pressure profile, and nephropathy in normotensive IDDM patients

OBJECTIVE - To evaluate the relationship between autonomic neuropathy, nephropathy, and 24-h blood pressure (BP) pattern in insulin-dependent diabetes mellitus (IDDM). RESEARCH DESIGN AND METHODS - We studied 30 normotensive IDDM patients without overt nephropathy, divided into two groups and matched for age, duration of diabetes, and HbA(1), according to the presence of cardiovascular autonomic neuropathy. We simultaneously measured 24-h BP and urinary albumin excretion rate (UAE) on urine collections timed overnight and at 2-h intervals during the day. RESULTS - Mean day and night systolic and diastolic BP values did not significantly differ between the groups. Mean night albuminuria was significantly higher in patients with autonomic neuropathy than in those without (61.4 +/- 104.6 [mean +/- SD] vs. 16 +/- 25.2 mu g/min, P < 0.04). The percentages day-night changes in systolic BP, diastolic BP, and UAE were significantly lower in neuropathic patients (systolic BP: 2.4 +/- 7.7 vs. 9.6 +/- 4.2%, P < 0.001; diastolic BP: 8.4 +/- 6.9 vs. 15.5 +/- 5.4%, P < 0.002; UAE: -8 +/- 99.4 vs. 49.3 +/- 29.4%, P < 0.02) and were inversely related to autonomic score, index of autonomic neuropathy degree (r = - 0.54, P < 0.002; r = -0.58, P < 0.001; and r = -0.53, P < 0.005, respectively). In patients with autonomic neuropathy, 2-h day periods and day and night UAE were more strongly related, respectively, to mean 2-h day periods (r = 0.58, P < 0.0001), day systolic BP (r = 0.67, P < 0.04), and night systolic BP (r = 0.69, P < 0.04) than in patients without autonomic neuropathy (2-h day periods: r = 0.32, P < 0.001; day: r = 0.37, NS; night: r = 0.35, NS). CONCLUSIONS - Autonomic neuropathy in IDDM patients is associated with reduced nocturnal falls in BP and UAE and with a stronger relationship of UAE to systolic BP. We suggest a pathogenetic role of autonomic neuropathy in the development of diabetic nephropathy through changes in nocturnal glomerular function and by enhanced kidney vulnerability to hemodynamic effects of BP