Venture capital-backed firms, trade sales e tutela dell’imprenditore tra shareholder value maximization e equa valorizzazione

Questo elaborato si focalizza sull’operazione – la trade sale – tramite cui si perviene al trasferimento del controllo totalitario degli assets della venture capital-backed firm ad un partner strategico; e che, a seconda del contesto in cui essa si realizza, può assumere forme diverse: negli Stati Uniti, essa si realizza tramite una fusione con integrale conguaglio in denaro; in Italia, invece, tramite la co-vendita da trascinamento. Può schematicamente dirsi che il presente elaborato si prefigga tre obiettivi. Il primo e basilare obiettivo è quello di conseguire una più granulare conoscenza della struttura economica del rapporto tra venture capitalist e imprenditore al fine di (i) comprenderne appieno la logica di fondo; (ii) delineare con sufficiente precisione le prerogative dell’uno e dell’altro; e, quindi, (iii) far luce sulle dinamiche osservabili in occasione della trade sale. Il secondo obiettivo è quello di delineare la disciplina che governa la trade sale negli Stati Uniti e in Italia, al fine di comprendere come il diritto vigente in tali due giurisdizioni sia, in effetti, in grado di servire le esigenze di venture capitalist e imprenditori. Tale operazione sarà svolta muovendo da un approccio funzionale che consenta quindi di comparare operazioni formalmente diverse ma funzionalmente equivalenti: la cash-for-stock merger e la co-vendita da trascinamento. Il terzo e ultimo obiettivo è quello di analizzare la risposta regolatoria negli Stati Uniti e in Italia, evidenziandone gli eventuali limiti e sforzandosi, pur senza offrire soluzioni definitive, di porre in rilievo taluni elementi in considerazione dei quali sarebbe forse possibile elaborare percorsi argomentativi utili a migliorarla, come pure di segnalare possibili soluzioni pur esse non perfette ma quantomeno medio tempore utili, forse, a superare i limiti della disciplina cui attualmente la trade sale è soggetta nell’uno come nell’altro ordinamento.Questo elaborato si focalizza sull’operazione – la trade sale – tramite cui si perviene al trasferimento del controllo totalitario degli assets della venture capital-backed firm ad un partner strategico; e che, a seconda del contesto in cui essa si realizza, può assumere forme diverse: negli Stati Uniti, essa si realizza tramite una fusione con integrale conguaglio in denaro; in Italia, invece, tramite la co-vendita da trascinamento. Può schematicamente dirsi che il presente elaborato si prefigga tre obiettivi. Il primo e basilare obiettivo è quello di conseguire una più granulare conoscenza della struttura economica del rapporto tra venture capitalist e imprenditore al fine di (i) comprenderne appieno la logica di fondo; (ii) delineare con sufficiente precisione le prerogative dell’uno e dell’altro; e, quindi, (iii) far luce sulle dinamiche osservabili in occasione della trade sale. Il secondo obiettivo è quello di delineare la disciplina che governa la trade sale negli Stati Uniti e in Italia, al fine di comprendere come il diritto vigente in tali due giurisdizioni sia, in effetti, in grado di servire le esigenze di venture capitalist e imprenditori. Tale operazione sarà svolta muovendo da un approccio funzionale che consenta quindi di comparare operazioni formalmente diverse ma funzionalmente equivalenti: la cash-for-stock merger e la co-vendita da trascinamento. Il terzo e ultimo obiettivo è quello di analizzare la risposta regolatoria negli Stati Uniti e in Italia, evidenziandone gli eventuali limiti e sforzandosi, pur senza offrire soluzioni definitive, di porre in rilievo taluni elementi in considerazione dei quali sarebbe forse possibile elaborare percorsi argomentativi utili a migliorarla, come pure di segnalare possibili soluzioni pur esse non perfette ma quantomeno medio tempore utili, forse, a superare i limiti della disciplina cui attualmente la trade sale è soggetta nell’uno come nell’altro ordinamento.LUISS PhD Thesi

The impact of intraoperative “Nerve Monitoring” in a tertiary referral center for thyroid and parathyroid surgery

The most fearsome complication in thyroid surgery is the temporary or definitive recurrent laryngeal nerve (RLN) injury. The aim of our study was to evaluate the impact of intraoperative neuromonitoring (IONM) on postoperative outcomes after thyroid and parathyroid surgery. From October 2014 to February 2016, a total of 80 consecutive patients, with high risk of RLN injuries, underwent thyroid and parathyroid surgery. They were divided in two groups (IONM group and control group), depending on whether neuromonitoring was used or not. We used the Nerve Integrity Monitoring System (NIM)-Response 3.0 (R) (Medtronic Xomed (R)). The operation time (p=0.014). and the length of hospital stay (LOS) (p=0.14) were shorter in the IONM group. Overall mean follow-up was 96.7 +/- 14.3 months. The rate of transient RLN palsy was 2.6% in IONM group and 2.5% in the control group (p=not significant). Only one case of definitive RLN injury was reported in control group. No differences were reported between the two groups in terms of temporary or definitive RLN injury. Routine use of IOMN increases the surgery cost, but overall, it leads to long-term cost savings thanks to the reduction of both operating times (106.3 +/- 38.7 vs 128.1 +/- 39.3, p: 0.01) and LOS (3.2 +/- 1.5 vs 3.7 +/- 1.5 days, p=0.14). Anatomical visualization of RLN remains the gold standard in thyroid and parathyroid surgery. Nevertheless, IONM is proved to be a valid help without the ambition to replace surgeon's experience

Dermoid cyst of the pancreas: presentation and management

<p>Abstract</p> <p>Background</p> <p>Dermoid cyst of the pancreas is a benign, well-differentiated, extremely rare germ cell neoplasm. Published data indicate that differential diagnosis of cystic lesions of the pancreas is challenging and although ultrasonography, computed tomography and magnetic resonance may be useful, radiological findings are often inconclusive and the diagnosis is intraoperative. We report a case of a dermoid cyst of the tail of the pancreas intraoperatively diagnosed and successfully treated with left pancreatectomy. Further, characteristics, preoperative detection and differential diagnosis of this rare pathology are also discussed.</p> <p>Case presentation</p> <p>This report documents the findings of a 64-year-old male presenting with a well defined echogenic pancreatic mass on ultrasonography. Computerized Tomography (CT) showed a 5 cm cystic tumor arising from pancreatic tail and Magnetic Resonance Imaging (MRI) suggested a tumor extension to the middle side of the stomach without defined margins. A left pancreatectomy was performed. On surgical specimen, histological evaluation revealed a dermoid cyst of the tail of the pancreas measuring 8.5 × 3.0 cm.</p> <p>Conclusion</p> <p>Given the benign nature of the dermoid cyst, surgical resection most likely represents the definitive treatment and cure. In addition, resection is indicated in consideration of the difficulty in diagnosing dermoid cyst preoperatively. However, endoscopic ultrasound and fine needle aspiration cytology have recently been shown to be effective, safe, reliable and cost-saving preoperative diagnostic tools. Therefore, until more cases of dermoid cyst are identified to further elucidate its natural history and improve the reliability of the preoperative diagnostic tools, surgical resection should be considered the standard therapy in order to exclude malignancy.</p

Robotic Versus Laparoscopic Adrenalectomy: Pluriannual Experience in a High-Volume Center Evaluating Indications and Results

Background: Robotic adrenalectomy offers several clinical benefits if compared with laparoscopic adrenalectomy; however, its superiority is still under debate. The aim of this study was the investigation of differences between the two techniques, and a comparison when approaching right or left side adrenal lesions was further conducted. Materials and Methods: All patients undergoing laparoscopic and robotic unilateral adrenalectomy at our institution from January 2006 to December 2019 were collected and retrospectively analyzed. Statistical analysis was conducted; differences between the two cohorts were reported. Results: A total of 160 cases were included (84 patients in laparoscopic adrenalectomy-group [LA-g] 76 cases in robotic adrenalectomy-group [RA-g]). The groups were homogeneous for demographic data. No intraoperative complications were reported; mean amount of intraoperative blood loss was comparable. No cases of conversion to open surgery were required. RA-g presented a longer operative time than LA-g for right adrenalectomy (P = .05), no differences were noted for left side (P = .187). Overall morbidity was 21% for LA-g and 10.5% for RA-g (P = .087), with an inferior rate of surgical complications for RA-g (P = .024), and for robotic left adrenalectomy than robotic right procedure (P = .03). Length of hospital stay was shorter for RA-g (P = .005). Conclusions: Robotic adrenalectomy presents similar outcomes as laparoscopic approach with some benefits for selected cases. Left adrenal lesions seem to receive greater advantages from robotic technique. Large randomized controlled trials are required to determine the role of robotic adrenal surgery and if the indication can be standardized based on the laterality of adrenal procedure

Evaluation of clinical, laboratory and morphologic prognostic factors in colon cancer

<p>Abstract</p> <p>Background</p> <p>The long-term prognosis of patients with colon cancer is dependent on many factors. To investigate the influence of a series of clinical, laboratory and morphological variables on prognosis of colon carcinoma we conducted a retrospective analysis of our data.</p> <p>Methods</p> <p>Ninety-two patients with colon cancer, who underwent surgical resection between January 1999 and December 2001, were analyzed. On survival analysis, demographics, clinical, laboratory and pathomorphological parameters were tested for their potential prognostic value. Furthermore, univariate and multivariate analysis of the above mentioned data were performed considering the depth of tumour invasion into the bowel wall as independent variable.</p> <p>Results</p> <p>On survival analysis we found that depth of tumour invasion (P < 0.001; F-ratio 2.11), type of operation (P < 0.001; F-ratio 3.51) and CT scanning (P < 0.001; F-ratio 5.21) were predictors of survival. Considering the degree of mural invasion as independent variable, on univariate analysis, we observed that mucorrhea, anismus, hematocrit, WBC count, fibrinogen value and CT scanning were significantly related to the degree of mural invasion of the cancer. On the multivariate analysis, fibrinogen value was the most statistically significant variable (P < 0.001) with the highest F-ratio (F-ratio 5.86). Finally, in the present study, the tumour site was significantly related neither to the survival nor to the mural invasion of the tumour.</p> <p>Conclusion</p> <p>The various clinical, laboratory and patho-morphological parameters showed different prognostic value for colon carcinoma. In the future, preoperative prognostic markers will probably gain relevance in order to make a proper choice between surgery, chemotherapy and radiotherapy. Nevertheless, current data do not provide sufficient evidence for preoperative stratification of high and low risk patients. Further assessments in prospective large studies are warranted.</p

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

La regolamentazione degli hedge funds negli Usa: dal quasi-collasso di Long-Term Capital Management al Dodd- Frank Act

SOMMARIO: 1. Introduzione. — 2. Inquadramento del fenomeno regolando. — 3. Gli hedge funds nella prima legislazione statunitense. — 4. Il dibattito per una nuova regolamentazione degli hedge funds: il quasi-collasso di Long-Term Capital Management ed il modello di regolamentazione indiretta. — 5. Segue: La crescita dell’industria, la retailization ed il modello di regolamentazione semi-diretta. — 6. Segue: La crisi finanziaria globale ed il modello di regolamentazione diretta. — 7.1. Il DoddFrank Act: uno sguardo d’assieme — 7.2. Segue: La regolamentazione degli hedge funds nel Dodd-Frank Act: la vigilanza sul fund manager. — 7.3. Segue: la regolamentazione prudenziale degli hedge funds di rilevanza sistemica. — 7.4. Segue: la regolamentazione del rapporto banche-hedge funds e del rapporto di prime brokerage nella c.d. Volcker Rule. — 7.5. Segue: le norme a protezione degli investitori. — 8. Analisi critica della nuova regolamentazione degli hedge funds. — 9. Alcune proposte ed alcuni spunti per la ricerca futura. — 10. Conclusioni