Radiofrequency (SECCA Procedure)

Many resource materials exist for the physician or surgeon evaluating and managing the patient with fecal incontinence. Much of the available information is embedded in the context of an overall textbook or compendium of colorectal surgery. There are a relatively limited amount of focused data for the practitioner who wishes to become familiar or updated with the latest relevant diagnostic and therapeutic information. Professor Mongardini is to be commended for having assembled in a cogent, succinct, and imminently readable textbook all of the abovementioned required details. He has selected 14 chapters each of which was authored by between one and fi ve experts. This book commences with a very surgeon-specifi c view of pelvic fl oor anatomy which I found readily comprehensible and clinically relevant. The second chapter which I also very much enjoyed reading is a description of physiology and physiopathology again written from the perspective of the practicing surgeon. Studying this chapter is an excellent prerequisite to digesting the subsequent four chapters each of which delves into a different but important facet of evaluation. Specifi cally, the chapters on endoanal ultrasound, magnetic resonance, anorectal manometry, and electromyography are all very up to date, highly descriptive, and again immediately useful in daily patient management. Reading these four chapters allows one a comprehensive overview of the optimal available current diagnostic tools. The remaining eight chapters describe virtually every currently available therapeutic modality by which the practitioner can try to assist the patient with fecal incontinence. The chapters include the gamut from pelvic fl oor rehabilitation and radiofrequency tissue remodeling to stomas and stem cells. In between these extremes are reviews of injectable and implantable agents, sacral neuromodulation, the artifi cial bowel sphincter and the more \u201cstandard\u201d surgical therapies of sphincter repair, post anal repair, and muscle transposition. The easy readability of the material in the textbook is further complimented by the high-quality illustrations and photographs. It is clear that each of the authors commands expertise in his or her respective chapter. It is also quite apparent that Professor Mongardini edited the material to allow for an easy narrative fl ow between chapters with minimal subject overlap but excellent subject juxtaposition and interplay. I am very grateful to Professor Mongardini for having invited me to author this Foreword. I highly commend this textbook to all physicians and surgeons who evaluate and/or manage patients with fecal incontinence. This book shall certainly occupy a prominent place in my personal library and will be enjoyed by all of my residents and fellows. Steven D. Wexner, MD, PhD (Hon), FACS, FRCS, FRCS (Ed) Chairman, Department of Colorectal Disease Director, Digestive Disease Center Cleveland Clinic Florida, US

A Cognitive Model for Emergency Management in Hospital: Proposal of a Triage Severity Index

The book tries to investigate the complexity of the risk management through some application examples. It contains original research and application chapters from different perspectives and covers different areas such as human aspects, emergency management, cognitive factors, software engineering and marketing

The medical point of view into a simulation project of management for safety and security in disasters and emergencies of industrial plants (Diem-Ssp Project)

Industrial mass casualty incidents are an unfortunate reality in the 21st century, but there are few situational training exercises to prepare and to cope with emergencies management. The Authors realized a project to carry out development of the activities devoted to face the complexities arising from emergencies in industrial plants. The DIEM-SSP is a simulation project working on two interoperable simulators, based on the IEEE 1516 High Level Architecture (HLA), used as test-bed on specific case studies. The project is aimed to study innovative emergency procedures and proper routing of critical patients with severe traumas toward the most suitable first aid facilities. The project takes into account the emergency procedures considering the human factor and the possibility of mistakes. It is aimed to test and validate these methodologies through a test-bed based on distributed and interoperable simulation. The Authors report the medical contribution in this project

Plume risk in videolaparoscopy and in endoscopic surgery

Approximately 90% of endoscopic and open surgical procedures generate some level of surgical smoke. (Ulmer B, 1998). Lasers and electrosurgery devices commonly used to cut, coagulate, vaporize, and ablate tissue are the \u201chot\u201d tools that cause targeted cells to heat to the point of rupturing the cellular membrane and spewing cellular contents into the air as surgical smoke. Through continuous exposure, the inhalation of surgical smoke can become harmful to the surgical team members. Plume can also be hazardous to patients during laparoscopy or other endoscopy procedures when the contaminants of surgical smoke are absorbed into the patient\u2019s vascular system. Research studies have repeatedly highlighted the hazards of surgical smoke during laser use so smoke evacuation has been accepted as a common practice. Unfortunately evacuation of smoke generated during electrosurgery has not been as widely accepted even though research has been definitive in proving inhalation hazards. One of the most interesting paper, by Tomita, demonstrated that using an electrosurgery device on one gram of tissue, inhaling the plume was equivalent to smoking 6 unfiltered cigarettes. This study demonstrated that plume generated during electrosurgical procedures has the potential to be twice as harmful as the smoke produced during laser surgeries. (Tomita et al., 1989) The bottom line is that all surgical smoke should be considered as harmful if not evacuated appropriately. Unfortunately many healthcare professionals are indifferent and do not feel the need to evacuate plume since they have been breathing it for years. The following toxic chemical byproducts have been identified in surgical smoke resulting from tissue pyrolysis: (Hoglan, 1995 and Ott, 1993) acrolein, acetonitrile acrylonitrile, methane phenol polycyclic aromatic hydrocarbons propene propylene pyridene pyrrole styrene toluene xylene, acetylene alkyl benzenes, benzene, butadiene, butane, carbon monoxide creosols, ethane, ethylene, formaldehyde, free radicals hydrogen, cyanide isobutene. Complete evacuation of surgical smoke is necessary because of these unwanted hazards and potential complications. Research has conclusively shown that surgical smoke is hazardous to the surgical team members who are exposed to it on a continual basis and hazardous to endoscopic patients when the plume is not evacuated. Also during endoscopic procedures the usage of electric tools to cut and coagulate is frequent, and this could represent a real problems for operators may be more than for the patients. At the present time it is not possible to find in literature papers about hazards of surgical smoke during endoscopic procedures even if they have to be considered definitely as surgical procedures. This implies the necessity of a deeper consciousness to the smokes risk and consequently a more care in operators and patients protection

Chirurgia : il filo di Arianna : casi clinici didattici per gli studenti del corso di laurea in Medicina e chirurgia

Il libro contiene casi clinici di chirurgia adatti allo sviluppo del senso clinico dello studente degli ultimi anni di medicina e chirurgi

LA TECNICA DI LICHTENSTEIN PER LA RIPARAZIONE DELL\u2019ERNIA INGUINALE MONOLATERALE PRIMITIVA

Premessa - L\u2019ernioplastica protesica in anestesia locale \ue8 attualmente considerata il gold standard nel trattamento delle ernie inguinali primitive monolaterali. Tuttavia ancora si discute sul tipo di tecnica e soprattutto sul recupero post-operatorio. Scopo del lavoro - Riportare 15 anni di esperienza nella riparazione dell\u2019ernia inguinale primitiva monolaterale con tecnica di Lichtenstein in 1.172 pazienti di sesso maschile con un follow-up minimo di 1 anno. Metodi - Dal marzo 1990 al dicembre 2005, sono stati sottoposti ad intervento chirurgico 1.172 pazienti di sesso maschile affetti da ernia inguinale monolaterale primitiva con un\u2019et\ue0 media di 59,4 anni (range: 16-97): 476 pazienti (40,6%) avevano pi\uf9 di 65 anni e 60 (5,1%) pi\uf9 di 80. La durata dei sintomi prima dell\u2019intervento chirurgico \ue8 stata in media di 3,7 anni (range: 0,1-4,9). In 31 casi (2,7%) l\u2019ernia era incarcerata e in 3 (0,3%) strozzata. In 539 pazienti (46%) erano presenti una o pi\uf9 comorbilit\ue0. Tutti i pazienti sono stati sottoposti in anestesia locale ad ernioplastica protesica anteriore con la tecnica di Lichtenstein. Gli interventi eseguiti da un chirurgo esperto sono stati 938, mentre i restanti sono stati eseguiti da specializzandi di qualunque anno di corso sotto la supervisione di un tutor specialista. Risultati - Nel periodo perioperatorio non vi sono state complicanze maggiori. Complicanze generali (18 episodi di reazione vaso-vagale, 3 ritenzioni urinarie acute e 1 iperpiressia di origine ignota) sono insorte in 22 pazienti (1,9%), mentre quelle locali (10 ematomi, 8 infezioni superficiali, 2 edemi scrotali e 1 sieroma) in 21 (1,8%). Dolore post-operatorio precoce significativo \ue8 stato registrato in 13 pazienti (1,1%) che hanno richiesto un supplemento di analgesici oppioidi, mentre non vi sono stati casi di dolore cronico o a lungo termine. La quasi totalit\ue0 dei pazienti \ue8 stata dimessa il giorno stess o il giorno successivo all\u2019intervento. Un prolungamento della degenza si \ue8 reso necessario in 27 casi per complicanze generali e/o locali o dolore. Al follow-up sono stati registrati 5 casi di recidiva erniaria (0,4%) la cui incidenza \ue8 risultata sovrapponibile per gli interventi eseguiti da un chirurgo esperto e da uno specializzando. Conclusioni - La rapida ripresa delle normali attivit\ue0, l\u2019assenza di complicanze maggiori sia generali sia addominali, la bassa incidenza di complicanze locali unitamente ai costi contenuti supportano la scelta di utilizzare la tecnica di Lichtenstein per il trattamento delle ernie inguinali primitive monolaterali

Proteolytic cleavage of band 3 protein in relation to anion transport in fish (Oncorhynchus mykiss) red blood cells

1. The effects of trypsin and chymotrypsin on HCO3−/Cl− exchange through red blood cell membranes of humans and trout were studied. 2. To measure the anion exchange we used a right-angle light-scattering technique by applying the Jacobs-Stewart cycle in ammonium solution and the osmotiration method at constant cell volume. 3. The Cl− flux in human red blood cells remained unaltered after treatment with external trypsin and chymotrypsin while in trout red blood cells the flux decreased. 4. This partial inhibition of anion transport in fish, ranging from 30 to 40%,suggest that one or several of the cleavage sites in band 3 protein, essential for anion transport function, are exposed in fish red blood cells. 5. In human red blood cells the fragments of band 3 which are affected by proteolytic digestion, retain their tertiary structure because there is no influence on anion transport