Appendiceal abscess in a giant left-sided inguinoscrotal hernia: a rare case of Amyand hernia

The hernia of Amyand is an inguinal hernia containing the appendix in the sac. It is a rare pathology often diagnosed only intra-operatively. We report a case even more rare of a giant left-sided inguinoscrotal Amyand hernia with appendiceal abscess without clinical findings of incarceration/strangulation, occlusion, perforation, or acute scrotum and with the presence in the sac of the caecum and other anatomical structures (last ileal loops, bladder and omentum). The 68-years-old man patient successfully underwent surgical treatment only through the hernia sac (meshless repair according to Postempski technique)

Novel Modality of Endoluminal Anastomotic Integrity Assessment with Fluoroangiography After Left-sided Colorectal Resections

Background Several methods have been described for the intraoperative evaluation of colorectal anastomotic integrity. Technological evolution has allowed to progress from basic mechanical methods to the use of more sophisticated techniques. This study describes a novel endoluminal modality of colorectal anastomotic assessment through the use of a Disposable Rigid Scope Introducer (DRSI) also allowing for intraoperative endoluminal perfusion evaluation by indocyanine green (ICG) fluoroangiography in patients undergoing left-sided colorectal resection. Methods The DRSI consists of an endoluminal introducer device made up of an insertion tube and port connected to an insufflation bulb to manually insufflate the sigmoid and rectum and is compatible with any laparoscopic camera, also allowing for ICG fluoroangiography for perfusion purposes. Results The DRSI was successfully used to assess anastomotic integrity after left-sided colorectal resections performed in 16 consecutive patients. The DRSI allowed to visualize by fluoroangiography the quality of tissue perfusion at the anastomotic site in all cases, contributing to the decision of avoiding loop ileostomies in low rectal resections. In 2 cases, the DRSI showed the presence of significant anastomotic bleeding which was successfully controlled by laparoscopic suture placement. No adverse event resulted from the use of this device. Conclusions The DRSI combines direct endoluminal visualization of the anastomosis together with real-time evaluation of its blood flow. This device holds great potential for prompt intraoperative detection of anastomotic alterations, possibly reducing the risk of postoperative anastomotic bleeding or leaks related to mechanical construction/perfusion issues. Potential advantages of this device warrant larger cohort studies and prospective randomized trials

Rare chondrosarcoma of the breast treated with quadrantectomy instead of mastectomy. A case report

Breast chondrosarcoma is a rare sarcoma that mainly occurs in females >50 years old. To the best of our knowledge, only 16 cases were reported in the literature prior to 2013 and all patients were surgically treated by mastectomy, with or without lymphadenectomy, which was occasionally preceded by neoadjuvant chemotherapy. However, the literature does not report the benefit of mastectomy compared with a more conservative surgery. The present study reports a novel case of extraskeletal chondrosarcoma of the breast. A 63‑year‑old female patient presented with a neoplasm localized in the upper‑outer quadrant of the right breast. The palpable lesion with sharp margins was a firm parenchymatous mass, which was confirmed by ultrasonography and mammography. The patient underwent conservative quadrantectomy instead of mastectomy, followed by post‑surgical chemotherapy. A positron emission tomography scan performed five months subsequent to the surgery revealed no remnants of the disease. The patient underwent a strict clinical and instrumental follow‑up, and two and half years after surgery, there are no signs of recurrent disease. In conclusion, the present case is currently one of the two cases in which a more conservative quadrantectomy was performed, instead of mastectomy. This surgical approach did not lead to metastasis and resulted in a good follow‑up for the patient

Il contributo della geologia e della geotecnica nel ripristino dei terrazzamenti dell'area amalfitana

Il lavoro analizza le caratteristiche geomorfologiche, stratigrafiche e geotecniche dei versanti terrazzati nell’area di Amalfi-Ravello (23 km2) e le relative condizioni di stabilità, allo scopo di individuare le cause principali che determinano il collasso dei manufatti. In base ad una serie di sopralluoghi in campo finalizzati all’individuazione delle dimensioni delle opere murarie e di prove fisico-meccaniche in laboratorio sui terreni piroclastici sostenuti dalle macére, sono state condotte verifiche di stabilità, sia in condizioni statiche che dinamiche, valutando anche l’effetto della spinta aggiuntiva imputabile alla formazione di accumulo d’acqua temporaneo a tergo del muro. Lo studio ha evidenziato che, in presenza di eventi critici ed accumulo d’acqua a tergo del muro dovuto ad un cattivo funzionamento del sistema di smaltimento delle acque piovane, si verifica un’instabilità locale che può comportare il tranciamento o il ribaltamento del muro. Tali condizioni possono giustificare l’innesco di fenomeni di colata rapida che interessano frequentemente ampie porzioni di versante. Pertanto, ne deriva la necessità di prevedere: l’istallazione di sistemi di canalizzazione che allontanino le acque meteoriche impedendone l’infiltrazione a tergo del muro; un ‘ordinaria manutenzione dei sistemi di drenaggi del manufatto stesso. Tenuto conto dell’estensione dei terrazzamenti nell’area di studio (circa 163 km) e dell’abbandono delle antiche pratiche agronomiche in molte zone difficilmente raggiungibili, si ritiene che questi interventi possano migliorare, in molti casi, la stabilità globale di questi territori antropizzati ma fortemente vulnerabili

Elliptic flow of charged particles in Pb-Pb collisions at 2.76 TeV

We report the first measurement of charged particle elliptic flow in Pb-Pb collisions at 2.76 TeV with the ALICE detector at the CERN Large Hadron Collider. The measurement is performed in the central pseudorapidity region (|$\eta$|<0.8) and transverse momentum range 0.2< $p_{\rm T}$< 5.0 GeV/$c$. The elliptic flow signal v$_2$, measured using the 4-particle correlation method, averaged over transverse momentum and pseudorapidity is 0.087 $\pm$ 0.002 (stat) $\pm$ 0.004 (syst) in the 40-50% centrality class. The differential elliptic flow v$_2(p_{\rm T})$ reaches a maximum of 0.2 near $p_{\rm T}$ = 3 GeV/$c$. Compared to RHIC Au-Au collisions at 200 GeV, the elliptic flow increases by about 30%. Some hydrodynamic model predictions which include viscous corrections are in agreement with the observed increase.Comment: 10 pages, 4 captioned figures, published version, figures at http://aliceinfo.cern.ch/ArtSubmission/node/389

Dor Against Toupet Fundoplication After Heller Myotomy. Laparoscopic Technical Improvements and Endoscopic Support

[No abstract available