Z-entry technique reduces the risk of trocar-site hernias in obese patients

Open laparoscopy and techniques using a Veress needle permit entry into the peritoneal cavity, and are recommended. These approaches require fascial closure of 12mm trocar sites, thereby reducing the risk of trocar-site hernias in obese patients

Conceptualising business model innovation: evidence from the managers’ advice network

In recent years, there has been a growing consensus in management and organisation studies regarding the crucial role played by business model innovation in supporting firms’ competitiveness. However, the intra-organisational processes that aim to develop business model innovation and the antecedents for its conceptualisation remain underexplored. Organisational mechanisms for learning between managers lead to the establishment of intra-organisational advice networks, which facilitate the acquisition and diffusion of knowledge for innovation. Using social network analysis, this study investigates the elements associated with intra-organisational networking intended to innovate business models. We analyse a multiunit cooperative firm as a case study. Within this firm, the conceptualisation of the novel business model activated a collaborative system of advice exchange between managers. We found that networking is supported by active managers who spread advice within the firm and managers who go beyond the boundaries of their organisational role. We propose several managerial recommendations, including that managers can develop sub-groups constituting specific and unique knowledge structures, which represent the real generators of business model innovation.Peer reviewe

Overcoming hierarchy in business model innovation: an actor-oriented approach

Purpose Business model innovation is a key element for firms' competitiveness. Its development can be supported by the establishment of an actor-oriented scheme to overcome hierarchical structures. The actor-oriented scheme is characterized by intra-organizational networks of relationships that can be established and dissolved between individuals. However, we lack an empirical perspective about its establishment; therefore, the purpose of this research is to advance our understanding of intra-organizational networks for supporting business model innovation. Design/methodology/approach Individuals create and manage knowledge aimed to innovate the business model through cognitive search and experiential learning mechanisms. Knowledge is spread within organizations by using intra-organizational advice networks, whose patterns reflect the presence of an actor-oriented scheme. This work applies social network analysis to network data from a multi-unit organization specializing in personal care services. We use a Logistic Regression-Quadratic Assignment Procedure to analyze intra-organizational network data on managers' advice exchange related to the learning modes of cognitive search and experiential learning. Findings Our research empirically identifies the main elements of an actor-oriented scheme in a business model innovation process. We find that managers are able to self-organize, because they are not influenced by their organizational roles, and that commons for sharing resources and protocols, processes and infrastructures enable advice exchange, thus showing the presence of an actor-oriented scheme in business model innovation process. Research limitations/implications This research is based on a cross-sectional database. A longitudinal study would provide a better understanding of the network evolution characterizing the innovation process. Practical implications The results of our study support organizational decision-making for business model innovation. Originality/value This study provides empirical evidence of how an actor-oriented scheme emerges in a business model innovation process.Peer reviewe

Managers' brokerage for business model innovation : A case study

Business model innovation is recognized as a key process for strengthening firms' performance in situations of strong competitive pressure and environmental changes. This process is driven by intra-organizational advice networks between managers, which exchange different types of advice based on organizational learning mechanisms such as cognitive search (how to conceptualize and create a novel business model) and experiential learning (how to adapt and experiment a novel business model. Investigating what are the key figures emerging from such network is essential for an in-depth understanding of the business model innovation process. By focusing on a multi-unit firm operating in the personal care service industry, we use Social Network Analysis (SNA) to examine the brokerage role of managers when sharing different types of advice towards a novel business model. Our results show that middle-level managers connect different managerial groups in different networks; however, differences exist between groups of middle managers, confirming their peculiar nature within organizations.Peer reviewe

Il tempo nel cambiamento organizzativo

Il lavoro discute la rilevanza della variabile temporale nel cambiamento delle organizzazioni. Si approfondisce l'approccio metodologico di processo nello studio di casi e si evidenziano le implicazioni dell'estensione dell'indagine a periodi temporali prolungati per l'interpretazione dei fenomeni di cambiamento

A case of acute aortic dissection type b associated with cushing's syndrome

We report a case of a 63-year-old man, with a previous history of hypertension and glucose intolerance associated troncular obesity that was emergently admitted to our Institution for evaluation of a severe, constant posterior chest pain which radiated anteriorly and dyspnoea with a suspected diagnosis of acute aortic dissection. A CT scan of thorax and abdomen demonstrated a dissection starting just below left succlavian artery and extending downward to the left renal artery, involving the celiac tripod and superior mesenteric artery. The dissection was classified as Stanford B, De Bakey III. Moreover, CT scan of abdomen revealed incidentally a left adrenal tumor of 25 mm of diameter. An emergent prosthetic graft was placed just below the origin of the left succlavian artery up-to the diaphragmatic hiatus. Furthermore, a diagnostic evaluation of the mass revealed an increase of cortisol production, and a diagnosis of Cushing's syndrome was done and the patient underwent an adrenalectomy via laparotomic approach. We report an association of acute aortic dissection of acute aortic dissection type B associated to Cushing's syndrome. Cushing's syndrome; Adrenocortical adenoma; Aortic dissection type B

Epidermal inclusion cyst of the breast . A literature review

An epidermal inclusion cyst (EIC) of the breast is a rare, benign condition that may potentially be malignant. The present study conducted a systematic review of the literature in order to identify pathological hypotheses, clinical characteristics, and diagnostic and treatment options. A search for relevant studies was conducted through the Scopus, Embase and Medline databases during September 2014. The search term employed was ῾epidermal inclusion cyst breast᾽. Studies were selected if they contained adequate information regarding symptoms at presentation, diagnostic tools, pathology, characteristics, type of procedure performed and follow-up routines. A total of 35 papers describing 91 patients affected by EIC of the breast were identified. Following this, a total of 82 patients, including an additional case supplied from the present study, were selected for further analysis. EIC of the breast typically occurs during the fifth decade of life. A palpable mass of the breast was present in 65 (79%) patients. Ultrasonographic imaging was consistently utilized as a diagnostic tool in all the cases analyzed, whereas fine-needle aspiration cytology was used in 70% of the cases and mammography in 65%. No tumor recurrence was reported at a mean follow-up time of 53 months. The present study demonstrated that elliptical excision is the preferred treatment for EIC of the breast, with pathological analysis required to exclude malignancy

Successful retrograde recanalization of internal jugular vein passing from omolateral external jugular vein

Severe stenosis and/or thrombosis of the internal jugular vein could be managed through a novel technique herein reported. Recanalization can be achieved passing through the omolateral external jugular vein

Un insolito caso di reazione anafilattica da farmaco: cenni clinici e riflessioni medico-legali

We report a case of a cutaneous ulcer in a 49 years-old patient with diabetes and hypertension. Penicillin in pownder for local use was prescribed. A severe anaphylactic reaction was observed. This case leads to some considerations concerning the off-label prescribing, that is to say the prescription of a registered medicine for a use that is not included in the product information. Thus off-label prescribing in dermatology may sometimes be clinically appropriate, it may be associated with a number of clinical, safety and legal issues. Off-label prescribing is acceptable if there is no suitable alternative and an appropriate process for informed consent is needed. The practice of prescribing off-label drugs is common among dermatologists, many of whom had misperceptions about which are the approved indications of the drug and about the legal ramifications of off-label therapies. The authors suggest that understanding the principles of off-label prescribing in conjunction with the mechanisms of drug action in diseases may help clinicians in increasing the safety of their patients and in avoiding legal litigations