Hydatid disease of the liver: thirty years of surgical experience.

Hydatid disease of the liver is a relatively frequent disease. Although the natural history is almost completely known, several complications may occur. The aim of this study was to show that radical surgical resection of the hepatic hydatid cyst is a safe and very effective technique, based on our results after 30-year experience. A review of most significant studies was carried out. We retrospectively evaluated our surgical cases. From January 1973 to December 2003 we treated 216 patients, 98 males and 118 females. Survival was compared with the Kaplan-Meier test, using log-rank analysis to compare data. Differences with a p value less than 0.05 were considered significant. A total of 279 cysts were excised. We performed pericystectomy in 122 cases, 73 of which closed. We also performed 19 atypical resections, 10 segmentectomies, 20 lobectomies and 2 percutaneous treatments. In more than 90% of cases, preoperative data collection was completed by preoperative ultrasound. The cumulative morbidity was 13%. The recurrence rate amounted to 4.3% at 5 years and 7% at 10 years: of these, 6 occurred after non-radical surgery and 2 after total pericystectomy or liver resection (p < 0.001). Technical advances and accumulated experience permit safe treatment of hepatic hydatid cysts by radical resection, with an almost zero recurrence rate, making it the treatment of choice over partial resection. The utility of percutaneous treatment remains confined to limited indications, such as laparoscopy

Gender-dependent characteristics of the hypothalamo-corticotrope axis function in glucocorticoid-replete and glucocorticoid-depleted rats

The aim of the present study was to determine the role of the endogenous sex steroid environment in the hypothalamo-corticotrope (HC) function in both sham-operated (SHAM) and bilaterally adrenalectomized (ADX) rats. For this purpose adult rats of both sexes were used 3 and 6 weeks after either SHAM or ADX. The results indicate that: a) in SHAM animals, basal plasma ACTH levels were significantly higher in females than in males, and this sexual dimorphism was overridden by ADX, regardless of the time post-surgery; b) although basal anterior pituitary (AP) ACTH content was similar in SHAM animals of both sexes, 3- and 6-week ADX induced higher AP ACTH in males than in females; c) at 3- and 6-weeks, ADX rats of hoth sexes had an AVP: CRH ratio (r), in the median eminence (ME) and medial basal hypothalamus (MBH), increased several fold over the respective SHAM-value and, although no sexual dimorphism was found at week 3 post-ADX, by 6-weeks post ADX, these ratios were significantly higher in both brain tissues of females than in those of males; and d) the in vitro ME CRH and AVP output in response to high potassium concentrations (hK+; 28 and 56 mmol/l), was concentration-related, regardless of sex and surgery, and was characterized by enhanced secretion of neuropeptides by MEs from ADX in comparison to SHAM rats of both sexes, and a sexual dimorphism was found in this parameter, consisting in general, in greater neuropeptide output from tissues of female than of male animals. Our results indicate that: 1) there is a gender-dependent characteristic of the HC axis function in glucocorticoid-replete rats and 2) the absence of the glucocorticoid negative feedback mechanism is responsible for either the expression or for the override of the sexual dimorphism in different parameters, a phenomenon which dependent on the time elapsed after ADX.Instituto Multidisciplinario de Biología CelularFacultad de Ciencias Exacta

The relationship of sex and sexual orientation to self-esteem, body shape satisfaction, and eating disorder symptomatology

There is increasing interest in understanding what role, if any, sex and sexual orientation play in body dissatisfaction, its correlates to distress, and its relationship to disordered eating. The goals of the present study were to examine: (a) differences in sex and sexual orientation in internalization of societal pressure to modify physical appearance, components of body image dissatisfaction, self-esteem, and eating disorder symptomatology and (b) whether the internalization-eating disorder symptomatology was mediated by the different components of body image dissatisfaction and low self-esteem. The present data support several key trends in the literature: men generally reported less body dissatisfaction, internalization of socio-cultural standards of beauty, drive for thinness, and disordered eating, but a greater drive for muscularity than women; results also indicated that different components of body image dissatisfaction and low self-esteem partially mediated the relationship between internalization and eating disorder symptomatology. Gay men reported significantly more body dissatisfaction, internalization, eating disorder symptomatology, drive for thinness, and drive for muscularity than heterosexual men. Compared to heterosexual women, lesbians reported increased drive for muscularity, lower self-esteem, and lower internalization; however, they did not significantly differ on body dissatisfaction, drive for thinness or disordered eating. Correlation coefficients between body shape dissatisfaction and several aspects of mental distress were significantly larger for gay men than heterosexual men; the same coefficients did not differ between lesbian women and heterosexual women. Results of path analyses indicated that the relationship between internalization and disordered eating differs for gay and heterosexual men but not for lesbian and heterosexual women. These results call attention to lesbians as a generally understudied population

Italian immunization calendar implementation: Time to optimize number of vaccination appointments?

In the Italian vaccination schedule, at least six vaccination appointments are scheduled in the first year of life. This implies more discomfort for both the patient and the parents. This was particularly evident during the COVID-19 pandemic, during which several appointments were missed. A UK experience with three injectable vaccines and an oral one co-administered at the same appointment (4-in-1) at 2 and 4 months of age showed interesting results. The vaccination coverage was high, consistent with previous practice, and no relevant increase in adverse events was reported. Translating the UK experience into the Italian context would not be immediate, due to several organizational and social issues. Nevertheless, this option warrants some further considerations, which are discussed in this manuscript

Thermal analysis of a cold room

The purpose of this research was to study the storage of fresh raw horticultural material processed and frozen in an industrial plant in southern Italy. A simulation technique (validated by experimental tests) was used giving the chance to evaluate the effect of bins location on the cooling capacity of the cold room avoiding expensive experimental tests. An external cooling system and an intermediate fluid ensure the cooling of the products. The air is distributed inside the cold room by two blowers that provide the forced convection of the air itself. First of all, experimental tests were carried out to validate the preliminary results obtained from the previous experiment, and then the authors carried out a computational fluid dynamic (CFD) analysis in order to verify where a good arrangement of the storage bins is achieved inside the room. The tests were carried out in summer (July) on zucchini and peppers. The important deviations in the temperature of the product are mainly due to the different position occupied by the bins in the room. In fact, they are positioned at different distances and heights from the forced convection fans. Both simulation and experimental results show that the raw material cooled in the shortest possible time was the one placed to the shortest distance from the wall and at the lowest height of the room because of the low heat transfer through the floor. By increasing the distance from the access door through which the most significant heat transfer takes place, there is a small variation due to the optimal position of the storage bins inside the room, which still allows a good distribution of air

Thermo-fluid-dynamic characteristics of confluent jets for distribution of treated air in small environment

The diffusion of the air through nozzles and/or diffusers has been studied extensively thanks to the numerous examples of environmental conditioning systems and in general of systems in which the flow of matter escapes from particular openings. In this paper, we studied closed and small environments requiring thermo-hygrometric and ventilation control. Air jets are used to mix the treated air within the environment. The widespread diffusion of this technology, mainly conceived for large environments, justifies the characterization of a particular type of system realized by the authors. The first results of experimental tests carried out with a particular air conditioning system are showed in the present work. The particularity of the system consists in a low construction cost, possibility of modifications and operation according to the characteristics and needs to different agricultural species. This initial phase of the research related to the isothermal regime, allowed by the conditioning system, aimed to characterize the fluid-dynamic behaviour of the air diffusion systems realized with perforated surfaces. First tests were carried out in a specifically designed climatic room whose climate conditions are strictly controlled by a suitable control system under isothermal conditions. Moreover, an ad-hoc designed experimental device was used. It consists of a pantograph kinematic structure carrying the probes around in the fluid dynamic field. It allows measuring air velocity in different points in stationary or slowing enough transient conditions. The experimental data was used to validate the computational fluid dynamics (CFD) model to predict the internal airflow velocity distribution

Bilateral adrenal enucleation-induced changes in adenohypophyseal pro-opiomelanocortin (POMC)-related peptides synthesis and secretion: A comparative study with adrenalectomized rats

The aim of the present study was to elucidate the modulatory effect of transient changes in endogenous glucocorticoids, occurring after bilateral adrenal enucleation (ENUC), on anterior pituitary (AP) proopiomelanocortin (POMC)-derived peptides synthesis and output in rats. For this purpose, adult female rats were either bilaterally ENUC, adrenalelectomized (ADX), or sham-operated (SHAM) and killed by decapitation 2, 7, 14, and 21 days after surgery. Trunk blood was collected for measurements of ACTH, β-endorphin (β-END) and corticosterone (B) concentrations; APs were quickly dissected for the determination of ACTH, β-endorphin (β-END)-like (β-END-LI) and γ3-MSH contents and adrenal glands were removed and submitted to histological study. The results indicate that ENUC and ADX increased AP POMC-related peptides synthesis and release in association with changes in the AP processing of peptides belonging to the N-terminal (γ3-MSH), mid (ACTH) and C-terminal (β-LPH/ENDs) portions of POMC. While ADX abolished plasma B levels, ENUC induced a transient (day 2) decrease in plasma B concentrations which returned to SHAM levels at 7 days after surgery. These data tallied with the histological observations carried out, indicating a time-dependent regenerative process of the adrenal which was completed by three weeks after ENUC. There was a different pattern in plasma ACTH and β-END levels between ENUC and ADX; maximal plasma peptide levels were found 7–14 days after ENUC, then falling down to SHAM values at 21 days post ENUC. Conversely, there was a constant increment in plasma peptide levels up to 21 days after ADX. At 2 days after both ENUC and ADX all peptides measured in the AP were lower than SHAM values, thus reflecting a rapid corticotrope secretion. Thereafter, 7 or more days after surgery, AP peptide content in ADX rats increased, in a time-related fashion, up to 21 days after surgery. Only β-END-LI showed a similar AP content to that of the SHAM group, thereafter indicating a preferential cleavage of POMC to β-END long after ADX (21 days). ENUC rats showed increased AP POMC peptides content throughout the whole time, and it was significantly different from SHAM and ADX values 14 days post-surgery. Interestingly, we found an increment in AP γ3-MSH, a peptide which is preferentially synthesized in the intermediate lobe of the rat pituitary, in both ENUC and ADX situations. Our results further indicate that: 1) glucocorticoids, from regenerating adrenal origin, induce a fast negative feedback mechanism on AP secretion, and 2) there might be a delayed inhibitory action of newly synthesized corticosteroids on higher levels of the central nervous system. The lack of glucocorticoids (ADX) clearly corroborates a persistent enhancement of AP POMC-related peptides synthesis and secretion. The differences in AP processing of POMC between ENUC and ADX might be due to qualitative/quantitative changes in hypotalamic ACTH secretagogues output.Facultad de Ciencias Médica

Cardiac Rehabilitation After Mitral Valve Intervention: Tailored Assessment, Management, and Exercise Training

Cardiac rehabilitation should be suggested after mitral valve intervention. Physical exercise is associated with improved cardiorespiratory fitness and clinical outcome and reduced rehospitalization and mortality in patients after heart valve surgery. Tailored assessment is the first step before starting a cardiac rehabilitation program. Physical examination, electrocardiogram, echocardiography, and peak exercise capacity stratify the risk of these patients when prescribing appropriate supervised aerobic and resistance exercise training. Cardiac rehabilitation participation impacts physical capacity, psychosocial function, and prognosis in patients after mitral valve surgery and transcatheter edge-to-edge repair. However, further evidence is needed on the efficacy and safety of cardiac rehabilitation programs, as well as standardization. In this review, we provide a contemporary and comprehensive update on the role of cardiac rehabilitation in patients after mitral valve intervention, after both mitral valve surgery and transcatheter mitral valve implantation. Specifically, we focus our review on the tailored assessment and management of these patients from post-operative to cardiac rehabilitation