El principio del buen funcionamiento: desde el metajurídico a la lógica del resultado en el sentido jurídico

Contiene: 1. El principio del buen funcionamiento: de la relevancia organizativa a la acepción relacional. — 2. El buen funcionamiento como principio de leal cooperación. — 3. El buen funcionamiento como principio de carácter funcional. — 4. La reciente evolución de la jurisprudencia administrativa en el ámbito del buen funcionamiento. — 5. El buen funcionamiento, la lógica del resultado y las recientes leyes de reforma.Publicado en la sección Derecho AdministrativoInstituto de Cultura Jurídic

Flap reconstruction of the hypopharynx: a defect orientated approach

The present retrospective analysis evaluated the outcomes of different flap reconstructions for several hypopharyngeal defects in 136 patients who underwent hypopharyngeal reconstruction with a free or pedicled flap after excision of pharyngeal or laryngeal carcinoma.Functional and oncological outcome were the main measures. Nine patients had a type I-a hypopharyngeal defect (partial with larynx preserved), 33 type I-b (partial without larynx preserved), 85 type II (circumferential), 5 type III (extensive superior) and 4 vertical hemipharyngolaryngectomy. The flaps used to reconstruct these defects were pectoralis major (n = 34), free radial forearm (n = 25), jejunum (n = 72), pedicled latissimus dorsi (n = 2), sternocleidomastoid (n = 1), lateral thigh (n = 1) and deltopectoral (n = 1). Twelve defects (9%) needed a secondary flap reconstruction. Surgical and medical complications were seen in 29% and 8% of patients, respectively; 18% of patients developed a fistula. No difference in complication rate or admission days was found for pre-operative versus no previous radiotherapy, type of defect or free versus pedicled flap. After 12 months follow-up, 38% of patients had a tracheo-oesophageal voice prosthesis, in 82% a fully oral diet was obtained and the average body weight gain was 0.9 kg. Five-year overall and disease-specific survival rates were 35% and 49%, respectively, while local and regional control rates were 65% and 91%, respectively. Considering these results, a defect orientated approach may be helpful for deciding which flap should be used for reconstruction of the hypopharynx. An algorithm is proposed with similar functional and oncological outcomes for the different groups. The choice of flap should be based on expected morbidity and functional outcome

Early thromboelastography in acute traumatic coagulopathy: an observational study focusing on pre-hospital trauma care

Background: Major brain injury and uncontrolled blood loss remain the primary causes of early trauma-related mortality. One-quarter to one-third of trauma patients exhibit trauma-induced coagulopathy (TIC). Thromboelastometry (ROTEM) and thrombelastography (TEG) are valuable alternatives to standard coagulation testing, providing a more comprehensive overview of the coagulation process. Purpose: Evaluating thromboelastographic profile, the incidence of fibrinolysis (defined as Ly30 > 3%) in severe trauma patients, and factors influencing pathological coagulation pattern. Methods: Prospective observational 2\ua0years cohort study on severe trauma patients assisted by Helicopter Emergency Medical System (HEMS) and Level 1 Trauma Center, in a tertiary referral University Hospital. Results: Eighty three patients were enrolled, mean NISS (new injury severity score) 36 (\ub1 13). Mean R value decreased from 7.25 (\ub1 2.6) to 6.19 (\ub1 2.5) min (p 40 groups, changes in R value increased their significance (p = 0.04 and p < 0.03, respectively). Pathological TEG was found in 71 (88.8%) patients at T0 and 74 (92.5%) at T1. Hypercoagulation was present in 57 (71.3%) patients at T0, and in 66(82.5%) at T1. 9 (11.3%) patients had hyperfibrinolysis at T0, 7 (8.8%) patients at T1. Prevalence of StO2 < 75% at T0 was greater in patients whose TEG worsened (7 patients, 46.7%) against whose TEG remained stable or improved (8 patients, 17.4%) from T0 to T1 (p = 0.02). 48 (57.8%) patients received < 1000\ua0mL of fluids, while 35 (42.2%) received 65 1000\ua0mL. The first group had fewer patients with hypercoagulation (20, 41.6%) than the second (6, 17.6%) at T1 (p < 0.03). No differences were found for same TEG pattern at T0, nor other TEG pattern. Conclusion: Our population is representative of a non-hemorrhagic severe injury subgroup. Almost all of our trauma population had coagulation abnormalities immediately after the trauma; pro-coagulant changes were the most represented regardless of the severity of injury. NISS appears to affect only R parameter on TEG. Hyperfibrinolysis has been found in a low percentage of patients. Hypoperfusion parameters do not help to identify patients with ongoing coagulation impairment. Small volume resuscitation and mild hypotermia does not affect coagulation, at least in the early post-traumatic phase

Italian patients with hemoglobinopathies exhibit a 5-fold increase in age-standardized lethality due to SARS-CoV-2 infection.

Since the beginning of the COVID-19 pandemic, concerns have been expressed worldwide for patients with hemoglobinopathies and their vulnerability to SARS-CoV-2 infection. Data from Lebanon confirmed a role of underlying comorbidities on COVID-19 severity, but no deaths among a cohort of thalassemia patients.1 Patients with sickle cell disease (SCD) displayed a broad range of severity after SARS-CoV-2 infection, spanning from a favorable outcome unless pre-existing comorbidities (UK cohort)2 to high case mortality in US.3 History of pain, heart, lung, and renal comorbidities was identified as risk factors of worse COVID-19 outcomes by the US SECURE-SCD Registry.4 While Italy experienced a death rate in the general population among the highest in the world, preliminary data from the first wave of the pandemic showed a lower than expected number of infected thalassemia patients (updated up to April 10, 2020), likely due to earlier and more vigilant self-isolation compared to the general population.

Riflessioni in tema di centralizzazione della committenza negli appalti pubblici

Il contributo analizza come la c.d. “cultura del sospetto” ostacoli l’attività contrattuale della pubblica amministrazione. La “cultura del sospetto” consiste nella percezione che ogni procedura negoziale sia foriera di reati e/o di “cattiva amministrazione”. Gli effetti di questa c.d. “cultura del sospetto” consistono in immobilismo e inerzia, dal momento che inibiscono il pieno ricorso ad azioni discrezionali ed efficienti, facendo sì che i funzionari evitino scelte rischiose, in termini di responsabilità penale, civile ed erariale. In tale contesto il tema della centralizzazione della committenza può acquisire un rilievo decisivo. Questo perché l’attribuzione ad un unico soggetto della competenza ad acquistare beni e servizi sul mercato, oltre a conseguire positive “economie di scala”, è in grado di accrescere le professionalità dei funzionari, che operano all’interno della centrale di committenza, e favorire la trasparenza delle procedure di gara. Il contributo si sofferma altresì su un’analisi critica dell’odierna disciplina normativa, nazionale ed europea, in tema di centrali di committenza e a vagliarne e proporre necessarie riforme e miglioramenti