La colecistectomia videolaparoscopica elettiva: i limiti di un sogno ormai realtà

La tecnica laparoscopica per la colecistectomia elettiva è il capolinea di un’evoluzione volta a ridurre ai minimi termini la via d’accesso. Abbiamo analizzato dal 1° gennaio 2004 al 31 dicembre 2006 un totale di 5515 interventi di colecistectomia, di cui 4877 laparoscopici e 635 in tecnica tradizionale. Le complicanze e le diagnosi aggiuntive sono state codificate ricercandole nel database delle SDO della Regione Lombardia. La morbilità è stata di 82 casi (12.9%) con la tecnica tradizionale e da 109 casi (2.23%) con la tecnica laparoscopica; la mortalità è stata di 11 casi (1.73%) con la tecnica tradizionale e di 1 caso (0.02%) con la tecnica laparoscopia. Le giornate di degenza media sono state 14.40 con la tecnica tradizionale e 4.75 con la tecnica laparoscopia La morbilità nella tecnica open è sei volte superiore rispetto alla tecnica laparoscopica. Questo divario tra le due tecniche è presente in tutte le casistiche mondiali ed è il risultato della mini-invasività della laparoscopia rispetto all’incisione laparotomica, condizione che spiega e giustifica anche la differenza per quanto riguarda i giorni di degenza media in favore ovviamente della tecnica laparoscopia. La mortalità così alta nella tecnica tradizionale rispetto alla laparoscopia è da attribuirsi ai casi selezionati La prima importante osservazione è che nei nostri ospedali, come in tutti i migliori del mondo, la colecistectomia laparoscopica è diventata il gold standard di trattamento della colelitiasi e la seconda è che sempre di più la tecnica open è riservata alla patologia complicata della litiasi della colecisti e questo quindi ne giustifica l’importante divario, rispetto alla tecnica laparoscopica, per quanto concerne le giornate di degenza, la morbilità e la mortalità

Simultaneous idiopathic segmental infarction of the great omentum and acute appendicitis: a rare association

Idiopathic segmental infarction of the greater omentum is an uncommon cause of acute abdomen. The etiology is still unclear and the symptoms mimic acute appendicitis. Its presentation simultaneously with acute appendicitis is still more infrequent. We present a case of a 47-year old woman without significant previous medical history, admitted with an acute abdomen, in which the clinical diagnosis was acute appendicitis and in whom an infarcted segment of right side of the greater omentum was also found at laparotomy. As the etiology is unknown, we highlighted some of the possible theories, and emphasize the importance of omental infarction even in the presence of acute appendicitis as a coincident intraperitoneal pathological condition

Different biological and prognostic breast cancer populations identified by FDG-PET in sentinel node-positive patients: Results and clinical implications after eight-years follow-up

Abstract Background Sentinel node (SN) biopsy is the standard method to evaluate axillary node involvement in breast cancer (BC). Positron emission tomography with 2-(fluorine-18)-fluoro-2-deoxy-D-glucose (FDG-PET) provides a non-invasive tool to evaluate regional nodes in BC in a metabolic-dependent, biomolecular-related way. In 1999, we initiated a prospective non-randomized study to compare these two methods and to test the hypothesis that FDG-PET results reflect biomolecular characteristics of the primary tumor, thereby yielding valuable prognostic information. Patients and methods A total of 145 cT1N0 BC patients, aged 24–70 years, underwent FDG-PET and lymphoscintigraphy before surgery. SN biopsy was followed in all cases by complete axillary dissection. Pathologic evaluation in tissue sections for involvement of the SN and other non-SN nodes served as the basis of the comparison between FDG-PET imaging and SN biopsy. Results FDG-PET and SN biopsy sensitivity was 72.6% and 88.7%, respectively, and negative predictive values were 80.5% and 92.2%, respectively. A subgroup of more aggressive tumors (ER-GIII, Her2+) was found mainly in the FDG-PET true-positive (FDG-PET+) patients, whereas LuminalA, Mib1 low-rate BCs were significantly undetected ( p = 0.009) in FDG-PET false-negative (FDG-PET−) patients. Kaplan–Meier survival estimates after a median follow-up of more than 8 years showed significantly worse overall survival for FDG-PET+ patients in node-positive (N+) patients ( p = 0.035) as compared to N+/FDG-PET− patients, which overlapped with survival curves of N− and FDG-PET+ or − patients. Conclusions Our findings suggest that FDG-PET results reflect intrinsic biologic features of primary BC tumors and have prognostic value with respect to nodal metastases. FDG-PET false negative cases appear to identify less aggressive indolent metastases. The possibility to identify a subgroup of N+ BC patients with an outcome comparable with N− BC patients could reduce the surgical and adjuvant therapeutic intervention

Participatory development of ICT entrepreneurship in an informal settlement in South Africa

A unique Participatory Entrepreneurship Development (PED) project was implemented in an informal settlement (Zandspruit) in South Africa. The purpose of the project was to stimulate, among local members of the community, the establishment of innovative, needs-based ICT-related businesses. Training was offered in participatory methods, the process of business development (including needs assessment, business idea generation, business modelling, feasibility analysis, and business plan writing), and sensitization to possible ICT solutions as inspiration for innovation. Participants were expected to propose ICT business solutions for the community, by the community. Results were mixed, with perhaps the most important insight that lack of in-depth ICT knowledge might be the crucial inhibiting factor for community-driven pro-poor ICT-related entrepreneurship.

Small bowel occlusion due to giant perineal hernia: abdominal approach with plastic perineal reconstruction

A perineal hernia is defined as a protrusion of peritoneal or extraperitoneal content through a pelvic floor defect. A 64-year-old woman with a bowel occlusions due to a giant postoperative perineal hernia was admitted to our hospital. We describe abdominal approach with plastic perineal reconstruction

Delayed and occult splenic rupture: a diagnostic puzzle

Splenic rupture is a common complaint encountered in emergency surgery. Trauma is the most common cause of splenic rupture, while non-traumatic or occult splenic rupture (OSR) is a rare condition. The differential diagnosis weighs on treatment that ranges between close monitoring, splenorrhaphy, splenic conservation and splenectomy. We report a case of an 63-year-old man presenting with acute atraumatic left upper quadrant pain. Preliminary diagnosis was subsequently determined to be a hematoma secondary to OSR. More accurate detailed history revealed a previous trauma, which occurred more than one year before and mimicked an OSR. Delayed and occult splenic rupture are as different diagnosis as different treatment. Even in emergency surgery, the key for a target therapeutic strategy should consider an accurate diagnostic time

Quaderni Ircres numero 2/2019

- Il pubblico della musica classica: innovare l’offerta per ampliare il consumo dei giovani #5- La VoSL, “Value of Statistical Life”. Il caso italiano relativo al rischio sismico #21- Socioeconomic analysis of breast cancer between countries, 2012-2018 period #39- Solvibilità vs. liquidità nelle crisi d’impresa #49- Alle origini dell’emigrazione africana: la letteratura francofona racconta il mancato superamento del colonialismo #85- Pour les héritiers. Penser une praxis pour combattre la faim #97letteratura francofona racconta il mancato superamento del colonialismo #85- Pour les héritiers. Penser une praxis pour combattre la faim #9

Étude 'Innovation et recherche dans la mode et le luxe'- Institut Carnot-CARATS avec le soutien du DÉFI

Restitution des ateliers de conception innovante organisés entre professionnels de la filière industrielle mode & luxe et scientifiques sur les enjeux contemporains du secteu