Surgical mistake causing an high recto-vaginal fistula. A case report with combined surgical and endoscopic approach: therapeutic considerations

BACKGROUND: Rectovaginal fistulas (RVFs) have multiple causes, size and location on which the surgical treatment depends. DESCRIPTION: The Authors consider different approaches to RVFs and describe a clinical case of recurrent high RVF. CONCLUSIONS: Most RVFs can be successfully repaired, although many interventions may be necessary. A colostomy with delayed repair may improve RVFs outcome. Moreover, several authors indicate Mucosal Advancement Flap and Babcock-Bacon technique as the treatments of choice respectively for low and high RVFs (complex and recurrent) and emphasize the placement of endoscopic prothesis in cases of difficult healing of the anastomosis

Abdominal Wall Reconstruction Utilizing the Combination of Absorbable and Permanent Mesh in a Retromuscular Position: A Multicenter Prospective Study.

Background Optimal mesh reinforcement for abdominal wall reconstruction (AWR) in complex hernias remains questionable. Use of biologic, absorbable and synthetic meshes has been described. The idea of using an absorbable mesh (AM) under a permanent mesh (PM) in a retromuscular position may help in these challenging situations. Methods Between 2011 and 2016, consecutive patients undergoing open AWR utilizing an AM as posterior layer reinforcement and configuration of a large PM were identified in a multicenter prospectively maintained database in four hospitals. Main outcomes included demographics, ventral hernia classifications, perioperative data, complications and recurrences. Results A total of 169 complex incisional hernias were analyzed. Mean age was 60.9, with mean body mass index 30.7 (range: 20–46). Location of incisional hernias (IH) was: 80 midline, 59 lateral and 30 midline and lateral. 78% were grade I and II in Ventral Hernia Working Group classification. 52% of patients were discharged with no complication. There were 19% seromas, 13% hematomas, 12% surgical-site infection and 10% skin dehiscence. Only partial mesh removal was necessary in one patient. After a mean follow-up of 26 months (range 15–59), there were five (3.2%) recurrences. Reoperations on patients showed a band of fibrosis separating the peritoneum from the PM. Conclusion The combination of AM with very large PM in the same retromuscular position in AWR seems to be safe. The efficacy with recurrence rates below 4% in complex midline and lateral IH may be explained by the use of larger PMs that are extended and configured with the support of AMs. Reoperations on patients have confirmed the previous experimental reports on the use of the AM.pre-print1351 K

Negrar di Valpolicella (VR). Indagini archeologiche e paleoambientali nel sito delle Colombare di Villa.

This paper presents the first results of research conducted in the prehistoric settlement of Colombare di Negrar di Valpolicella (VR) as of 2019. The site is located about 650 m above sea level, on a steep slope facing south, towards the Veronese plain and the lower Garda area. It was discovered and partially explored in the early 1950s by Francesco Zorzi and is characterized by a long continuity of occupation, certainly with solutions that apparently began in the recent Neolithic and ended at the threshold of the Iron Age. The fieldwork included surface reconnaissance and actual surveys aimed, on the one hand, at defining the spatial extent of prehistoric and protohistoric anthropization and, on the other hand, at verifying the stratigraphic sequences and their content in structural, cultural, paleoecological and paleoeconomic terms. The radiocarbon dates available to date relate to the early settlement phases of the recent and Late Neolithic and are inscribed in a chronological interval between about 4300 and 3500 BC in calibrated history. New data are expected for the subsequent exploitation phases of the Copper and Bronze Ages, which are well documented by the rich material culture. From the point of view of settlement strategy, the Colombare di Negrar site documents the occupation of sensitive areas from the point of view of territorial control and traffic. This occupation seems to have been aimed at the exploitation of the glassy flint characteristic of the Lessini, valued not only in northern Italy but also in the areas north of the Alpine watershed. The site was to be a center where the quality of the flints supplied from outside was tested in order to produce semi finished products for regional and national distribution. The large number of fragmented dagger blades seems to suggest that their production was common at the site. A wide range of pollen and carpological analyses, as well as studies on faecal biomarkers contained in the sediments, open up important palaeoenvironmental and palaeoeconomic perspectives. The embryonic forms of feeding and care of wild grapevines are in this sense among the most significant data to emerge from the research. Public archaeology, communication and educational activities are programmatically linked to the research project

Estimation of the incubation period and generation time of SARS-CoV-2 Alpha and Delta variants from contact tracing data

: Quantitative information on epidemiological quantities such as the incubation period and generation time of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants is scarce. We analysed a dataset collected during contact tracing activities in the province of Reggio Emilia, Italy, throughout 2021. We determined the distributions of the incubation period for the Alpha and Delta variants using information on negative polymerase chain reaction tests and the date of last exposure from 282 symptomatic cases. We estimated the distributions of the intrinsic generation time using a Bayesian inference approach applied to 9724 SARS-CoV-2 cases clustered in 3545 households where at least one secondary case was recorded. We estimated a mean incubation period of 4.9 days (95% credible intervals, CrI, 4.4-5.4) for Alpha and 4.5 days (95% CrI 4.0-5.0) for Delta. The intrinsic generation time was estimated to have a mean of 7.12 days (95% CrI 6.27-8.44) for Alpha and of 6.52 days (95% CrI 5.54-8.43) for Delta. The household serial interval was 2.43 days (95% CrI 2.29-2.58) for Alpha and 2.74 days (95% CrI 2.62-2.88) for Delta, and the estimated proportion of pre-symptomatic transmission was 48-51% for both variants. These results indicate limited differences in the incubation period and intrinsic generation time of SARS-CoV-2 variants Alpha and Delta compared to ancestral lineages

Competenze interculturali nel lavoro di accoglienza con rifugiati e richiedenti asilo”

L’articolo presenta l’esperienza di un percorso di ricerca-formazione che ha coinvolto 40 operatori che a vario titolo lavorano nei servizi per rifugiati e richiedenti asilo. Il focus della ricerca è stato progettato sulla declinazione delle competenze interculturali di secondo livello – ridurre i pregiudizi, interpretare le culture, trovare orizzonti condivisi – elaborate dal Centro di Ricerca sulle Relazioni interculturali del-l’Università Cattolica di Milano (Reggio, Santerini, 2014). Attraverso l’approccio metodologico dell’argomentazione di competenza, si è la-vorato con i partecipanti sulle competenze interculturali agite nell’am-bito degli interventi a favore di richiedenti asilo e rifugiati politici, a partire dalla rivisitazione riflessiva delle proprie pratiche professionali. Al termine del percorso di ricerca-formazione le tre competenze in-terculturali complesse sono state declinate nei contesti di intervento con rifugiati e richiedenti asilo.The article presents the experience of a research-training process which involved 40 social workers employed in services for refugees and asylum seekers. The focus of research was designed on the adaptation and the validation of the “second level intercultural skills” – reducing prejudices, interpreting cultures, building shared horizons – developed by the Research Center on Intercultural Relations of the Catholic University of Milan (Reggio, Santerini, 2014). Through the methodological approach of the argumentation of competence, the participants worked on the intercultural competences used in the context of interventions in favor of asylum seekers and political refugees, starting from the reflective review of their own professional practices. At the end of the research-training process, the three complex intercultural skills were adjusted to the contexts of intervention with refugees and asylum seekers

Evaluation of predictive factors for i-CLARAS (intraoperative complications in laparoscopic renal and adrenal surgery): a multicentre international retrospective cohort study

The laparoscopic approach represents the standard of treatment for renal and adrenal diseases, and its use is increasing even outside referral centres. Although most procedures are routinely performed, intraoperative complications do not occur, and the rate and predictive factors of these complications have not been established. The aim of this study was to evaluate the incidence and type of intraoperative complications and to identify predictive factors in patients undergoing laparoscopic renal and adrenal surgery. This was a cohort, multicentre, international retrospective study. Patients who underwent laparoscopic renal and adrenal surgeries between April 2017 and March 2022 were included in the study. Bivariate analysis was performed using contingency tables and the χ2 test for independent samples to compare qualitative variables and the T test and Mood test for continuous variables. Multivariate analysis was performed using a logistic regression model to obtain adjusted odds ratios. A total of 2374 patients were included in the study. Intraoperative complications were reported for 8.09% of patients who underwent renal surgery, with the most common complications reported being hollow viscus and vascular complications, and for 6.75% of patients who underwent adrenal surgery, with the most common complication reported being parenchymatous viscous complications. Multivariate analysis revealed that both adrenal and renal surgery radiological preoperative factors, such as invasive features during adrenalectomy and the RENAL score during nephrectomy, are predictive factors of intraoperative complications. In contrast to existing data, surgeon experience was not associated with a reduction in the incidence of perioperative complications