Analisi di vulnerabilita' e miglioramento sismico del centro di socializzazione di Sant' Agata. Comune di Scarperia

Lo studio oggetto della Tesi è l' analisi di vulnerabilità del centro di socializzazione di Sant' Agata a Scarperia nel Mugello (FI). L' edificio è un fabbricato in muratura della prima metà del XX secolo e oggi è sede di un' associazione di volontariato per disabili. All' analisi di vulnerabilità segue una proposta di miglioramento sismico del fabbricato

Hepatic resection for hepatocellular carcinoma in patients with Child–Pugh's A cirrhosis: is clinical evidence of portal hypertension a contraindication?

AbstractBackgroundAccording to international guidelines [European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD)], portal hypertension (PHTN) is considered a contraindication for liver resection for hepatocellular carcinoma (HCC), and patients should be referred for other treatments. However, this statement remains controversial. The aim of this study was to elucidate surgical outcomes of minor hepatectomies in patients with PHTN (defined by the presence of esophageal varices or a platelet count of <100 000 in association with splenomegaly) and well‐compensated liver disease.MethodsBetween 1997 and 2012, a total of 223 cirrhotic patients [stage A according to the Barcelona Clinic Liver Cancer (BCLC) classification] were eligible for this analysis and were divided into two groups according to the presence (n = 63) or absence (n = 160) of PHTN. The demographic data were comparable in the two patient groups.ResultsOperative mortality was not different (only one patient died in the PHTN group). However, patients with PHTN had higher liver‐related morbidity (29% versus 14%; P = 0.009), without differences in hospital stay (8.8 versus 9.8 days, respectively). The PHTN group showed a worse survival rate only if biochemical signs of liver decompensation existed. Multivariate analysis identified albumin levels as an independent predictive factor for survival.ConclusionsPHTN should not be considered an absolute contraindication to a hepatectomy in cirrhotic patients. Patients with PHTN have short‐ and long‐term results similar to patients with normal portal pressure. A limited hepatic resection for early‐stage tumours is an option for Child–Pugh class A5 patients with PHTN

The spectrum of computed tomography findings in blunt trauma of the subclavian/axillary artery: a pictorial essay

Traumatic injuries of the subclavian and axillary arteries are uncommon but have high morbidity and mortality. In contrast to penetrating injuries, which are often lethal, blunt injuries present a wide and heterogeneous spectrum of imaging findings. If a vessel tear or transsection is a life-threatening circumstance, minor injuries might be overlooked in an emergency setting but could cause or aggravate the functional loss of a limb. The aim of this pictorial essay is to acquaint radiologists with the spectrum of imaging findings that could be encountered during the radiological evaluation of the subclavian/axillary artery (SAA) in trauma patients and offer tips and tricks to improve the diagnostic workup of patients with suspected blunt SAA injuries

An optimized infrastructure for deferred telemonitoring of home rehabilitation in chronic rheumatic patients

The interest towards telemedicine and its various branches is constantly growing, given the opportunities in terms of costs reduction, efficiency and capillarity in delivering health services. In particular, telerehabilitation aims at improving the quality of life of physically impaired patients, providing the support for home-managed rehabilitation sessions. Moving from an existing outpatient device for the quantitative evaluation of hand rehabilitation exercises, opportunely enhanced to be used in a telemonitoring scenario, in this paper the development of the remaining telerehabilitation infrastructure is presented and evaluated. It includes, beyond the rehabilitation kits, a remote server and a deferred monitoring software application. The kits, entrusted to the patients for rehabilitation in their home, are able to send to the remote server via a GSM/GPRS connection, quantitative measurements of the patients' performance. The physician's monitoring application, retrieving such data and providing an appropriate visualization, allows the evaluation of both the patients' compliance to the rehabilitation protocol and their progresses. The system has been evaluated by a small panel of rheumatologists in order to assess its acceptability in a clinical environment and is currently under test for experimental trials in Italy

A Device for Local or Remote Monitoring of Hand Rehabilitation Sessions for Rheumatic Patients

Current clinical practice suggests that recovering the hand functionality lost or reduced by injuries, interventions, and chronic diseases requires, beyond pharmacological treatments, a kinesiotherapic intervention. This form of rehabilitation consists of physical exercises adapted to the specific pathology. Its effectiveness is strongly dependent on the patient's adhesion to such a program. In this paper, we present a novel device with remote monitoring capabilities expressly conceived for the needs of rheumatic patients. It comprises several sensorized tools and can be used either in an outpatient clinic for hand functional evaluation, connected to a PC, or afforded to the patient for home kinesiotherapic sessions. In the latter case, the device guides the patient in the rehabilitation session, transmitting the relevant statistics about his performance to a TCP/IP server exploiting a GSM/GPRS connection for deferred analysis. An approved clinical trial has been set up in Italy, involving 10 patients with rheumatoid arthritis and 10 with systemic sclerosis, enrolled for 12 weeks in a home rehabilitation program with the proposed device. Their evaluation has been performed not only with traditional methods, but also with the proposed device. Subjective (hand algofunctional Dreiser's index) and objective (ROM, strength, and dexterity) parameters showed a sustained improvement throughout the follow-up. The obtained results proved that the device is an effective and safe tool for assessing hand disability and monitoring kinesiotherapy exercise, portending the potential exploitability of such a methodology in the clinical practice

An Integrated Portable Device for the Hand Functional Assessment in the Clinical Practice

The functionality of the human hand is of paramount importance for the daily life activity of a subject. Several chronic diseases can have localized lesions on the hands, causing disability, as for the Systemic Sclerosis and Rheumatoid Arthritis. In these cases the evaluation of the hand functionality is a necessary step for setting up the therapeutic and rehabilitation program. This research presents a novel device tackling this problem, allowing the evaluation of hand dexterity and strength on 4 simple rehabilitation exercises. Real-time controlled by a wirelessly connected PC where a C++ physician graphical interface enables a user-friendly management of the assessment, the device provides hitherto unavailable measurements. A first evaluation of the device in a real outpatient rheumatology clinic has been performed and the preliminary results reveal the potentialities of the approach

Telemedicine applied to kinesiotherapy for hand dysfunction in patients with systemic sclerosis and rheumatoid arthritis: recovery of movement and telemonitoring technology

Objective. To describe a feasibility study focused on a telemonitoring approach to self-managed kinesiotherapy sessions for the rehabilitation of hand function in patients with systemic sclerosis (SSc) and rheumatoid arthritis (RA). Methods. Ten patients with SSc and 10 with RA were enrolled in a 3-month controlled trial (approval no. 9751/2012 - Italian Department of Health) to perform a home kinesiotherapy protocol, consisting of strengthening and mobility exercises, using a newly developed telemedicine system (a portable device and the related telemonitoring infrastructure). A further 10 patients with SSc and 10 with RA were enrolled as controls to perform a similar home kinesiotherapy protocol with the aid of common daily-life objects. Both groups were evaluated at baseline and at followup, after 6 and 12 weeks. The primary outcome of the trial was hand function measured by Dreiser's index (Functional Index for Hand OA, FIHOA), Health Assessment Questionnaire (HAQ), and the Hand Mobility in Scleroderma (HAMIS) test (only for SSc). Results. Patients with SSc showed an improvement of FIHOA in both arms (p < 0.01) but the HAQ (p = 0.016) and the HAMIS test (right hand p = 0.016, left hand p = 0.075) improved significantly only in the experimental arm. Patients with RA showed a statistically significant improvement of FIHOA (p = 0.013) and HAQ (p = 0.015) in the experimental arm, while patients in the control arm did not significantly improve. However, no statistically significant differences in outcome measures between treatment methods were observed. Withdrawals were higher in control arms (SSc 20%; RA 30%) than in experimental arms (SSc 10%; RA 10%). Conclusion. Telemonitoring of self-administered kinesiotherapy programs is a promising approach to the rehabilitation of hand functions in patients with rheumatic disease

Home tele-rehabilitation for rheumatic patients: impact and satisfaction of care analysis

INTRODUCTION: In this paper, we evaluated patients' perspectives on the use of a system for home tele-rehabilitation, designed for subjects with low computer literacy suffering hand impairment due to rheumatic diseases. METHODS: After a clinical trial assessing device effectiveness, the Psychosocial Impact of Assistive Devices Scale (PIADS), Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) and Individually Prioritised Problem Assessment (IPPA) questionnaires were administered to evaluate the system's impact on each patient's life, and the results were correlated with clinical indices. Patients were asked to continue self-administered rehabilitation with common objects. One year later, a semi-structured telephone interview gathered data on their experience. RESULTS: The system received a positive QUEST score (4.5 ± 0.3) and a modest PIADS score (0.84 ± 0.8) due to the small impact on adaptability and self-esteem. The IPPA (3.7 ± 3.4) revealed improvement in the ability to perform tasks considered important, which was significantly correlated (r = 0.60; p &lt; 0.02) with the clinical Health Assessment Questionnaire (HAQ) index improvement. The interviews revealed a positive engagement effect, enhanced by the need to develop skills to be able to use the device (technological challenge) and by the perception of more attention by the medical staff. This may explain the significant dropout rate (80%) from the post-trial rehabilitation of the patients who used the device. DISCUSSION: The system was largely accepted by the patients. The results suggest that the need for information on their rehabilitation progress and the technological challenge deserves further study to make patients more autonomous in cases of continuous rehabilitation

Single-access transumbilical laparoscopic unroofing of a giant hepatic cyst using reusable instruments

Introduction: Single-access laparoscopy has garnered growing interest in recent years in an attempt to improve cosmesis, reduce postoperative pain, and minimize abdominal wall trauma. Case Description: A female patient suffering from a symptomatic giant biliary cyst of the liver segments 4-7-8 was admitted for transumbilical single-access laparoscopic cyst unroofing. The procedure was performed using a standard 11-mm reusable trocar for a 10-mm, 30°- angled, rigid scope and curved reusable instruments inserted transumbilically without trocars. Operative time was 90 minutes, and the final incision length was 14 mm. The use of minimal pain medication permitted discharge on the third postoperative day, and after 25 months, the patient remains asymptomatic with a no visible umbilical scar. Conclusions: Giant biliary cysts can be removed by single-access laparoscopy. Because of this technique, surgeons work in ergonomic positions, and the cost of the procedure remains similar to that of the multitrocar technique. The incision length and the use of pain medication are kept minimal as well. © 2012 by JSLS.SCOPUS: ar.jinfo:eu-repo/semantics/publishe