The shared environment. Environmental Ethics and common goods

Il lavoro si propone di affrontare un problema urgente e non rimandabile: la condizione di emergenza ambientale del pianeta terra. Il fenomeno viene ricostruito storicamente, focalizzando l’attenzione sugli aspetti filosoficamente rilevanti – come, per esempio, il rapporto tra scienza e tecnica – e dimostrando la necessità di un cambiamento di rotta, soprattutto in riferimento al fenomeno del surriscaldamento climatico. A questo riguardo viene passata in rassegna una tassonomia delle etiche ambientali, dividendole tra antropocentriche e anti-antropocentriche e considerando la rilevante eccezione a questo schema rappresentata da Hans Jonas. Vengono sottolineati i problemi che incontra l’etica nell’affrontare un compito complesso, globale, a responsabilità diffusa e per il quale è difficile individuare basi motivazionali come quello della difesa dell’ambiente. Per compensare queste mancanze viene preso in analisi il concetto di beni comuni, sulla scia della sua diffusione avvenuta negli ultimi anni. Questo è analizzato nel suo sviluppo a livello di storia delle idee. Sono presi in considerazione in modo critico i contributi di Garret Hardin, di Elinor Ostrom e dei diversi rappresentati dei fronti italiani, divisi in tre approcci: quello dei benecomunisti, quello giuridico e quello dell’etica della cura. Inoltre tale concetto viene posto in relazione dialogica con quelli di bene comune, democrazia e diritti e viene proposta una tassonomia dei suoi usi che si divide in quattro modalità: economica, giuridica, etica e sociale. Infine, viene valutato in modo critico l’effettivo contributo dei diversi fronti dei beni comuni e di un loro possibile approccio integrato possono fornire a livello etico e normativo per contribuire ala difesa dell’ambiente. L’attenzione viene posta anche sul rapporto tra crisi e opportunità e sull’etica animale. In conclusione, l’approccio dei beni comuni sembra essere insufficiente perché manca di una prospettiva globale per affrontare un problema che invece la richiede come quello ambientale. Vengono, quindi, proposte alcune possibili integrazioni.This work wants to face an urgent and not postponable issue: the environmental emergency on Planet Earth. The topic is explored from an historical point of view, focusing on some philosophically considerable issues – as, for example, the connection between science and technology – and showing how a change of human behaviour is needed, especially regarding global warming. A taxonomy of the environmental ethics is described, dividing them in anthropocentric and anti-anthropocentric and considering the exception of Hans Jonas. Ethic has problems to face such a complex, global, and with widespread responsibility task which does not offer a sound ground for motivation as environmental protection. In order to exceed these limits, the attention is focused on the notion of common goods, which has encountered a large use over the last few years. This topic is firstly described under the perspective of the history of ideas. Then some proposals are critically examined as the one of Garret Hardin, Elinor Ostrom and some among the different line-ups of the Italian debate as the “benecomunisti”, the juridical and the ethic of care approach. Moreover the notion of commons is related in a dialogic way to other concepts such as common good, democracy and rights and a taxonomy of its uses is proposed diving them into: economical, juridical, ethical and social uses. Finally the different proposals of the commons and the one of their integrated approach are critically analysed regarding the help they can offer from an ethical and normative point of view to the task of environmental protection. Also the crisis/opportunity dialectic and topics from animal ethics are described. In conclusion, the common goods approach is considered not sufficient to face a global issue as environmental emergency because of its lack of a global perspective. Therefore some possible integrations are offered

Prevalence and characteristics of diffuse idiopathic skeletal hyperostosis (DISH) in Italy

Purpose Diffuse idiopathic skeletal hyperostosis (DISH) is a benign condition characterized by ossification of the spine and prominent enthesopathies. Highly heterogeneous epidemiological figures have been reported in the literature, while in Italy the largest study has been conducted in 1992. The aim of our research is to contribute updated information about prevalence of DISH in Italy and to describe the clinical and radiographic characteristics associated with the disorder. Material and methods A retrospective review of lumbosacral spine, thoracic spine and pelvis radiographs was performed. Consecutive patients visiting the emergency department of our Institution over 3 years were enrolled. Presence of DISH was evaluated applying the Resnick and Niwayama criteria. Clinical and radiological features were also assessed. Results We included 1012 individuals (60.6% women), and DISH was present in 130 cases. The overall prevalence of DISH was 12.8% (95% CI 10.8-15.1), with higher figures in the male sample (16.8%) than in females (10.3%). In binary logistic regression adjusted for age, BMI (OR 1.50, p < 0.001) diabetes (OR 1.85, p = 0.003), hypertension (OR 2.04, p = 0.007) ischiopubic enthesopathy (OR 7.08, p < 0.001), iliac crest enthesopathy (OR 4.63, p < 0.001) and greater trochanter enthesopathy (OR 3.51, p < 0.001), were significantly associated with the condition. Conclusion The prevalence of DISH observed in our study is consistent with previous literature, and we confirm that the disorder is more frequently retrieved in men and that it is associated with the presence of metabolic disorders and pelvic enthesopathy. Knowledge about the epidemiology and characteristics of DISH is needed to properly identify the condition

Treatment of chronic osteomyelitis with antibiotic-loaded bone void filler systems: an experience with hydroxyapatites calcium-sulfate biomaterials

 This is a retrospective study that aims to quantify the problem of chronic osteomyelitis in one of the largest Italian orthopedic centers. Furthermore this study is focused on evaluation of efficacy of bone void filler systems with particular attention to a subgroup of patients treated with PerOssal®. Ninety-seven patients were included in this study between 2008 and 2013 with a minimum follow up of 24 months. A subgroup of 52 patients was treated with curettage plus PerOssal®, another group was treated with curettage only or curettage with other bone void filler systems.Overall we obtained a cure rate of 80,4%, whereas 19,6% had recurrent infection. Looking at the subgroup treated with PerOssal® we found a healing rate of 86,5%, which was significantly higher compared to the other groups. Of the patients with recurrence of infection, those treated with PerOssal® recurred 106 days later than the other patients

Surgical treatment of metastatic pheochromocytomas of the spine: a systematic review

Metastatic pheochromocytoma of the spine (MPS) represents an extremely rare and challenging entity. While retrospective studies and case series make the body of the current literature and case reports, no systematic reviews have been conducted so far. This systematic review aims to perform a systematic review of the literature on this topic to clarify the status of the art regarding the surgical management of MPS. A systematic review according to PRISMA criteria has been performed, including all studies written in English and involving human participants. 15 papers for a total of 44 patients were finally included in the analysis. The median follow-up was 26.6 months. The most common localization was the thoracic spine (54%). In 30 out of 44 patients (68%), preoperative medications were administered. Open surgery was performed as the first step in 37 cases (84%). Neoadjuvant treatments, including preoperative embolization were reported in 18 (41%) cases, while adjuvant treatments were administered in 23 (52%) patients. Among those patients who underwent primary aggressive tumor removal and instrumentation, 16 out of 25 patients (64%) showed stable disease with no progression at the final follow-up. However, the outcome was not reported in 14 patients. Gross total resection of the tumor and spinal reconstruction appear to offer good long-term outcomes in selected patients. Preoperative alpha-blockers and embolization appear to be useful to enhance hemodynamic stability, avoiding potential detrimental complications

To drill or not to drill, that is the question: nonsurgical treatment of chronic subdural hematoma in the elderly. A systematic review

OBJECTIVE: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical pathologies, typically affecting the elderly. Its incidence is expected to grow along with the aging population. Surgical drainage represents the treatment of choice; however, postoperative complications and the rate of recurrence are not negligible. For this reason, nonsurgical alternatives (such as middle meningeal artery embolization, steroids, or tranexamic acid administration) are gaining popularity worldwide and need to be carefully evaluated, especially in the elderly population.METHODS: The authors performed a systematic review according to PRISMA criteria of the studies analyzing the nonsurgical strategies for CSDHs. They collected all papers in the English language published between 1990 and 2019 by searching different medical databases. The chosen keywords were "chronic subdural hematoma," "conservative treatment/management," "pharmacological treatment," "non-surgical," "tranexamic acid," "dexamethasone," "corticosteroid," "glucocorticoid," "middle meningeal artery," "endovascular treatment," and "embolization."RESULTS: The authors ultimately collected 15 articles regarding the pharmacological management of CSDHs matching the criteria, and 14 papers included the endovascular treatment.CONCLUSIONS: The results showed that surgery still represents the mainstay in cases of symptomatic patients with large CSDHs; however, adjuvant and alternative therapies can be effective and safe in a carefully selected population. Their inclusion in new guidelines is advisable

Functional outcome of patients with unstable single- level/ two- level lumbar stenosis treated with decompression plus divergent screws (cortical bone trajectory) or percutaneous convergent pedicle screws

The aim of this prospective comparative study is to assess the functional outcome in two groups of patients suffering from spinal lumbar instability and treated by decompression and stabilization with posterior lumbar interbody fusion using percutaneous pedicle screws (PCT) or a novel technique of divergent pedicle screws insertion using a cortical bone divergent trajectory (CBT). Functional outcome after surgery has been evaluated using Numeric Rating Scale (NRS), Modified Rankin Scale (MRS), Smiley-Webster Scale, and Oswestry Disability Index (ODI)

Anterior Dural Tear in Thoracic and Lumbar Spinal Fractures: Single-Center Experience with Coating Technique and Literature Review of the Available Strategies

Differently from the posterior, the anterior dural tears associated with spinal fractures are rarely reported and debated. We document our experience with a coating technique for repairing ventral dural lacerations, providing an associated literature review on the available strategies to seal off such dural defects. A PubMed search on watertight repair techniques of anterior dural lacerations focused on their association with spinal fractures was performed. Studies on animal or cadaveric models, on cervical spine, or based on seal/gelfoam or “not suturing” strategies were excluded. 10 studies were finally selected and our experience of three patients with thoracic/lumbar spinal fractures with associated ventral dural tear was integrated into the analysis of the surgical techniques. Among the described repair techniques for ventral dural lacerations a preference for primary suturing, mostly trans-dural, was noted (n = 6/10 papers). Other documented strategies were the plugging of the dural opening with a fat graft sutured to its margins, or stitched to the dura adjacent to the defect, and the closure of the dural tear with two patches, both trans-dural and epidural. Our coating techniques of the whole dural sac with the heterologous patch were revealed as safe and effective alternatives strategies, even when patch flaps wrapping nerve roots have to be cut and a fat graft has to be stitched in the patch respectively for sealing off antero-lateral and wide anterior dural tears. Compared to all the documented strategies for obtaining a watertight closure of an anterior dural laceration, the coating techniques revealed advantages of preserving neural structures, being adaptable to anterior and antero-lateral dural tears of any size

A brain hidden in Ferrara cathedral: a novel interpretation of a Renaissance masterpiece

The aim of present report was to briefly review the history of the anatomical studies during the Italian Renaissance and to outline their relationship to the figurative arts, focusing, in particular, on neuroanatomical studies that have been at the center of the medical and philosophical debate from the 14th to 16th centuries. Therefore, we have presented the interpretation of different Renaissance masterpieces for which some references to brain anatomy have been previously reported. We propose a new interpretation, in neuroanatomical key, of the fresco of the universal judgment in the vault of San Giorgio's Cathedral in Ferrara, Italy, painted around the end of the 16th century

To drill or not to drill, that is the question: nonsurgical treatment of chronic subdural hematoma in the elderly. A systematic review

OBJECTIVE: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical pathologies, typically affecting the elderly. Its incidence is expected to grow along with the aging population. Surgical drainage represents the treatment of choice; however, postoperative complications and the rate of recurrence are not negligible. For this reason, nonsurgical alternatives (such as middle meningeal artery embolization, steroids, or tranexamic acid administration) are gaining popularity worldwide and need to be carefully evaluated, especially in the elderly population.METHODS: The authors performed a systematic review according to PRISMA criteria of the studies analyzing the nonsurgical strategies for CSDHs. They collected all papers in the English language published between 1990 and 2019 by searching different medical databases. The chosen keywords were "chronic subdural hematoma," "conservative treatment/management," "pharmacological treatment," "non-surgical," "tranexamic acid," "dexamethasone," "corticosteroid," "glucocorticoid," "middle meningeal artery," "endovascular treatment," and "embolization."RESULTS: The authors ultimately collected 15 articles regarding the pharmacological management of CSDHs matching the criteria, and 14 papers included the endovascular treatment.CONCLUSIONS: The results showed that surgery still represents the mainstay in cases of symptomatic patients with large CSDHs; however, adjuvant and alternative therapies can be effective and safe in a carefully selected population. Their inclusion in new guidelines is advisable

Chylothorax in spine fractures: A rarely reported complication? Literature review with an example case

Post-traumatic chylothorax may occur after blunt or penetrating trauma. We describe a case of chylothorax following a B3 fracture of the T12 vertebra, integrating our single-case experience into a focused literature review of this complication when it is directly associated with spine fractures.A PubMed search was performed by using the terms "chylothorax", "chyle leakage", "chylous leakage", "thoracic duct injury" combined with "spine", "fracture", "spine fracture", "spinal fracture", "vertebral fracture", "spine trauma", "spinal trauma", "spine injury" and "spinal injury". Nontraumatic chylothorax, iatrogenic chyle leakage, technical notes, purely descriptive papers, chylothorax as a consequence of chest and/or abdominal trauma, or studies on multiple thoracic and/or abdominal injuries were excluded. In addition to the 20 articles yielded by this search strategy, an example case of type B3 spine fracture, which caused a chylothorax, was discussed.The vast majority of chylothoraxes regarded spinal injuries from T9 to L1. A prevalence of type C fractures was noted. Pulmonary dysfunction usually developed 3-7 days after trauma, always requiring urgent thoracic drainage. Total parenteral nutrition and restrictive diet revealed insufficient with chyle leakage exceeding 1.5 litres/day, with prolonged drainage over 1 litre/day and with persisting chest tube outflow for more than 2 weeks or with deterioration in clinical status. Two dynamics of thoracic duct injury could be hypothesized: indirect lesion from an abrupt hyperextension of the spine overstressing the stretchability of the duct itself; and direct lesion likely depending from the thoracic duct overstretching and its concomitant impact against sharpened fracture margins or acuminated fracture fragments. Compared to vascular injuries sometimes complicating severely fragmented or dislocated spine fractures, chylothorax appears relatively underreported considering the greater anatomical fragility of the thoracic duct than an arterial vessel. LEVEL OF EVIDENCE: therapeutic