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Assessing historical changes in marine biodiversity at regional or local scales is often challenging due to insufficient long-term data for most marine organisms. Yet, these assessments are crucial to understanding potential long-term variation in the species pool in response to complex and interacting local and global environmental changes. Here, we performed a comprehensive review of scientific and grey literature, archival records and floristic data spanning over the last two centuries to reconstruct an updated and revised taxonomic dataset of macroalgae in the Gulf of Trieste (Northern Adriatic Sea), one of the most exposed to human-driven pressures and climatically vulnerable regions in the Mediterranean Sea. The subset of data from 1960 to present, encompassing nearly all available records, was used to assess the contribution of species replacement and gain/loss to temporal β-diversity and to test for changes in the taxonomic distinctness of the species pool over the past six decades. We identified 68 species that have never been recorded again since 1990, indicating their likely local extinction. The major change, however, was due to species replacement and to a reduction in the taxonomic breadth of macroalgal diversity, as highlighted by a significant decrease in the Average Taxonomic Distinctness of the species pool, especially along the Italian coast. The loss of species has mainly affected habitat-formers (e.g., Cystoseira sensu lato) and species with Atlantic/Circumboreal and Mediterranean affinities, which were replaced by turf-formers and species with Pantropical/Cosmopolitan/IndoPacific affinities. While multiple human impacts (e.g., coastal artificialisation, unbalanced N/P ratios) might have contributed to the ongoing change in macroalgal diversity, the observed decline of cold-affinity species in favour of warm-affinity species pointed out a critical role of exacerbating climatic changes. Our study demonstrated that historical reconstructions of species records coupled with effective indicators for the analysis of presence/absence data can help quantify long-term biodiversity changes and provide valuable insights into their possible causes., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Annalisa Falace reports financial support was provided by University of Trieste. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: To describe the treatment of patients with great saphenous vein (GSV) incompetence and varicose veins (VVs), utilizing an Automated Microfoam Preparation System (AMPS, Varixio ® , VB Devices, Barcelona, Spain)., Methods: Adults between January and June 2021 were included. The AMPS system was used for foam preparation. Sclerotherapy treatment followed international recommendations. The primary endpoint was GSV closure rate after 36 months., Results: 164 patients were enrolled. During the 7-day follow-up period, all GSVs showed complete closure, which was maintained at the 1-year mark. No major complications were reported. A cumulative complete GSV recanalization rate of 6.1% and a partial recanalization rate of 26.8% after 36 months were noted. Some patients (9.7%) required additional treatment. A higher BMI was associated with complete recanalization., Conclusion: The AMPS offers an easy-to-use and standardized procedure, potentially enhancing treatment outcomes if compared with manual preparation. Caution is advised when treating obese patients., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Marine environmental monitoring is essential to ensure that heavy-metal (HM) concentrations remain within safe limits. Most seawater analyses currently consider sediment or water samples, but this approach does not apply to rocky substrates, where water samples can only indicate immediate contamination. We used two common Mediterranean algae species, Cystoseira compressa and Ericaria mediterranea , as bioindicators living in the intertidal zone on rocky substrates along the seacoast. HM concentrations were assessed over a one-year period in the perennial base crust and in the seasonal frond, considering marine sites characterised by different contamination risks. Both algae showed that HMs accumulate mainly in the perennial base rather than in the seasonal frond. Furthermore, the algae species always showed a different order of bioaccumulation factors: Cd > Ni > Pb > Cr > Cu > Mn > Zn for the frond and Pb > Cr > Ni > Cd > Mn > Cu > Zn for the base. Our study shows that C. compressa and E. mediterranea accumulate HM consistently with the types of sites analysed and differentially with respect to the part of the thallus. These results demonstrate that these algae can be effectively used as reliable bioindicators to assess the presence of HM in marine environments with rocky substrates, providing both short- and long-term monitoring.

Fucales (Phaeophyceae) are ecosystem engineers and forest-forming macroalgae whose populations are declining dramatically. In the Mediterranean Sea, Cystoseira sensu lato (s.l.) -encompassing the genera Cystoseira sensu stricto , Ericaria , and Gongolaria -is the most diverse group, and many species have been shown to be locally extinct in many areas, resulting in a shift toward structurally less complex habitats with the consequent loss of ecosystem functions and services. In this study, we report on the extensive occurrence of healthy and dense marine forests formed by Fucales in the Santa Maria di Castellabate Marine Protected Area in Cilento, Italy (Tyrrhenian Sea, Mediterranean). On a total area of 129.45 ha, 10 Cystoseira s.l. taxa were detected using a combined morphological and molecular approach, with an average cover of more than 70%. One of these taxa has been sequenced for the first time. These findings underline the high ecological value of this area as a hotspot of benthic biodiversity and highlight the importance of marine protected area management and regional monitoring programs to ensure the conservation of these valuable yet fragile coastal ecosystems.

The coralligenous habitat represents one of the most important hotspots of Mediterranean biodiversity. However, along the Ionian coast of Sicily (Italy) the coralligenous macroalgal assemblages have always been poorly studied. The present study was carried out in the coralligenous habitat of the Marine Protected Area (MPA) Isole Ciclopi, located along the central-eastern coast of Sicily. Previously, only a few floristic studies, including some data on the coralligenous flora, were conducted within this MPA in the 1970s and 2001. Therefore, the present study aimed to gain an updated knowledge on the coralligenous flora and to compare the current data with data derived from the previous floristic studies, to observe if in the last 50 years environmental changes occurred and to monitor the effectiveness of the MPA in protecting this habitat. In particular, the coralligenous flora of the MPA was analyzed through remotely operated vehicles (ROV) surveys and destructive samples. ROV surveys allow us to observe that the coralligenous assemblages of the MPA are well-structured, especially regarding the encrusting Rhodophyta, which showed the highest percent cover among the main morphological groups/taxa. Through the sample analysis in the laboratory, a total of 92 taxa has been recorded. Comparing the floristic lists of the present research and the past studies, an increase of local biodiversity was highlighted. Nevertheless, an increment of Non-Indigenous Species (NIS), warm-water species, and Rhodophyta with wide ecological valence was also noted. The main causes of these variations in the coralligenous flora have been traced back to reduced water transparency, maybe due to sedimentation, and a rise in the seawater temperature. Therefore, although the coralligenous assemblages of the MPA Isole Ciclopi appear to be well-structured, future studies will be necessary to continue monitoring this habitat to evaluate whether the MPA is effective in safeguarding this hotspot of biodiversity.

Rational: Infective endocarditis (IE) is defined as an infection of the endocardial surface of the heart, which may include one or more heart valves, the mural endocardium., Patient Concerns: A 53-years-old man with a history of alcohol abuse was admitted in hospital for fever, paroxysmal atrial fibrillation cardioverted by Amiodarone and pulmonary infection., Diagnosis: A case of recurrent severe endocarditis, with neurological complications both ischemic and hemorrhagic and heart failure caused by Streptococcus agalactiae in healthy man we reported., Interventions: Surgery was performed 2 weeks after admission., Outcomes: The onset of intracranial hemorrhage delayed second cardiac surgery and the patient died because of end-stage heart failure., Conclusions: Infective endocarditis caused by S. agalactiae is very rare, particularly in patients without underlying structural heart disease. This study showed that IE due to S. Agalactiae is a disease with high mortality when associated with neurological complication, heart failure but especially when it is recurrent and hits valve prosthesis.

Clinical management of breakthrough cancer pain (BTcP) is still not satisfactory despite the availability of effective pharmacological agents. This is in part linked to the lack of clarity regarding certain essential aspects of BTcP, including terminology, definition, epidemiology and assessment. Other barriers to effective management include a widespread prejudice among doctors and patients concerning the use of opioids, and inadequate assessment of pain severity, resulting in the prescription of ineffective drugs or doses. This review presents an overview of the appropriate and inappropriate actions to take in the diagnosis and treatment of BTcP, as determined by a panel of experts in the field. The ultimate aim is to provide a practical contribution to the unresolved issues in the management of BTcP. Five 'things to do' and five 'things not to do' in the diagnosis and treatment of BTcP are proposed, and evidence supporting said recommendations are described. It is the duty of all healthcare workers involved in managing cancer patients to be mindful of the possibility of BTcP occurrence and not to underestimate its severity. It is vital that all the necessary steps are carried out to establish an accurate and timely diagnosis, principally by establishing effective communication with the patient, the main information source. It is crucial that BTcP is treated with an effective pharmacological regimen and drug(s), dose and administration route prescribed are designed to suit the particular type of pain and importantly the individual needs of the patient.

Objective: To incrementally improve the use of beryllium lymphocyte proliferation test (LPT) results., Methods: Beryllium BioBank data were analyzed for 532 subjects in three groups: beryllium-exposed, sensitized, or chronic beryllium disease. Predictor variables were LPT stimulation index (SI) at the date of the earliest available data and at the study entry date., Results: Cross-sectionally, LPT SI magnitude does not distinguish among the three groups. The likelihood of progression from sensitization to disease is associated with the absolute value of SI, but LPT SI interpreted by traditional cut point criteria was not predictive., Conclusions: Updating the criteria for interpreting beryllium LPT data should be considered. Prediction of progression to chronic beryllium disease may be improved by changing the cut point for interpretation or by using the SI as a continuous variable.

Objective: To assess the importance of occupational history for beryllium-exposed workers., Methods: Beryllium BioBank data were analyzed for 532 subjects in the following three groups: beryllium-exposed, beryllium-sensitized, and chronic beryllium disease. Predictor variables were several questionnaire-derived exposure indices., Results: Cumulative exposure estimated from a standardized interview contributes to differentiating beryllium-exposed from chronic beryllium disease. The likelihood of progression from sensitization to disease was associated with peak-level weighted exposure hours., Conclusions: Selecting workers for extensive diagnostic testing should consider each worker's duration and characteristics of exposure. The intensity and total hours of exposure should be evaluated rather than relying on only the total years.

Occupational health nurses have diverse backgrounds and their practices require the ability to perform unique professional tasks. This study empirically evaluated their activities and skills using a web-based log system to describe activities at 15 specific sampled times. A national sample of 128 occupational health nurses provided 1,893 activity logs revealing occupational health nurses use both clinical and management skills on a regular basis; indirect client care is as common as direct "hands-on" client care. Most occupational health nurses are directly paid by their employer and activities serve to benefit both individual workers and their employers. Occupational health nurses have specific knowledge and skills in addition to general nursing competencies. Understanding the actual work of occupational health nurses is necessary to align training, certification, and competency maintenance systems such as continuing education with the unique skills used in actual practice activities., (Copyright 2014, SLACK Incorporated.)

Objective: This study addresses methods for training respirator users, particularly when occupational health professionals are not immediately available., Methods: A randomized trial compared three training methods-printed brochure, video, and computer-based training-for two respirator types (filtering facepiece and a dual-cartridge half facemask). Quantitative fit testing (PortaCount) measured the effectiveness of training. The study included 226 subjects., Results: For both respirator types, video was significantly superior to either print or computer-based training methods. Conclusions were consistent, whether determined by average fit factor (analysis of variance), log-transformed fit factors, or the number of users in the lowest quartile of achieved fit., Conclusions: Video training for proper respirator use can be effective when direct training from an occupational health professional is unavailable. These methods are particularly relevant to "rapid rollout" situations, such as natural disasters, epidemics, or bioterrorism concerns.

Contemporary surgical options to remove the thymus gland include median sternotomy with extended resection or minimally invasive techniques. Transcervical thymectomy has been criticized as potentially giving a "lesser" thymectomy. We describe the trans cervical approach with telescope enhancement using a standard VATS camera. This report describes the method emphasising the excellent visualization, and discuss the pro and cons over the classic trans-cervical approach or thymectomies performed by VATS or sternotomy.

Background: It has been reported a slow progression of hepatitis B in patients undergoing maintenance dialysis, and a role of dialysis session per se has been suggested. The aim of the present study is to evaluate the kinetics of the hepatitis B viral load (HBV DNA) in serum during haemodialysis sessions using a highly sensitive technique; the role of interferon-α in lowering HBV viral load in such patients was also investigated., Methods: HBV DNA was determined in 24 HBsAg positive patients on maintenance hemodialysis immediately before and after a 4-hour hemodialysis session, the same measurements were repeated 48 and 72 hours later. HBV DNA quantitation was performed by a novel RealTime PCR assay. Serum IFN-α levels were tested in parallel in a subset of HD sessions (n=40) by ELISA., Results: 20 (83%) HBsAg positive patients had detectable HBV DNA in serum. Positive status for HBV DNA in serum was not predicted by demographic, clinical or biochemical parameters. HBV load decreased in many patients after hemodialysis sessions 5.92 log10 IU/mL (95% CI, 5.34 to 6.28 log10 IU/mL) vs. 4.79 log10 IU/mL (95% CI, 4.23 to 6.15 log10 IU/mL) (P=0.02). A significant relationship between mean HBV DNA levels before dialysis and percentage reduction of HBV DNA during HD sessions occurred [F-test=5.41, rho (least squares)=0.307]. Increase of serum IFN-α levels was found in a minority (3/40=7%) of HD sessions., Conclusions: Hemodialysis procedure gives reduction of HBV load in HBsAg chronic carriers; no relationship with IFN-α activity during HD sessions was found. The kinetics of HBV viremia in HD procedures could explain the low viral load which is typically observed in these patients. Further studies to identify the mechanisms responsible for reduction of HBV viremia during HD procedures are under way., (© 2013 S. Karger AG, Basel.)

Respirators must be properly used to be effective. In an experimental protocol, 145 subjects were trained and then observed donning and doffing respirators. Filtering facepiece and dual cartridge half face mask types were studied. Subjects were then tested for knowledge and for proper performance using video recording analysis. Knowledge tests showed adequate learning, but performance was often poor. Inspection, strap tension (half mask), seal checking, and avoiding mask contact during doffing were particularly problematic. Mask positioning was generally well done. Correlation between knowledge and performance for specific items was generally poor, although there was a weak correlation between overall knowledge and overall performance (rho = 0.32) for the half mask users. Actual unprompted performance as well as knowledge and fit-testing should be assessed for user certification. Respirator design approval should consider users' ability to learn proper technique.

The Authors discuss on a laparoscopic-assisted approach for excision of a sessile villous adenomatous polyp of the cecum, unresectable by endoscopy. Because of the large implant of the polyp, endoscopic polypectomy was considered at high risk and a surgical laparoscopic procedure was scheduled for removal of the lesion. After right colon mobilization, an intraoperative endoscopy confirmed the location of th polyp in the posterior wall of the cecum, closed to the ileo-cecal valve. A small 10 cm laparotomy, through which the cecum was pulled out the abdominal cavity, was performed. Then, a minimal colotomy along the intestinal taenia was carried out to allow a safe and complete excision of the polyp. This laparoscopic approach differs from the other laparoscopic-assisted methods reported in the Literature since it provides at the same time the postoperative advantages associated with minimal access surgery and a safe oncological removal of the polyp with low risks of complications.

Mucinous adenocarcinoma of the small bowel is very rare, and only few cases have been described in the literature. Association of this tumor with celiac disease has never been published. The authors report a unique case of jejunal mucinous adenocarcinoma in which a concomitant celiac disease has been histologically recognized. The difficult diagnosis, the role of laparoscopic surgery and the relationship between small bowel tumors and celiac disease are discussed. A 49-year-old man presented with recurrent melena, nausea, vomiting and anemia. A stenosis of the jejunum was documented by means of CT scan and video capsule enteroscopy. A laparoscopy was scheduled. A tumor, found in the first jejunal loop, was removed by laparoscopic surgery. Histopathology revealed a rare mucinous adenocarcinoma associated with epithelial changes secondary to celiac disease. Although small bowel tumors are rare entity, in patients with celiac disease complaining of symptoms related to altered intestinal transit or occult bleeding, an appropriate work-up should be planned for diagnosis. Mucinous type intestinal adenocarcinoma, even if never published before, could be observed. Laparoscopic surgery is often essential for the diagnosis and treatment.

Venous thromboembolism (VTE) is a frequent complication in patients undergoing major surgery, with the possibility of long-term disability or fatal outcome. The rationale of the thromboprophylaxis in all patients can be summarized in three points: 1) the VTE is common in some types of surgery; 2) the VTE can be fatal; 3) thromboprophylaxis is highly effective and safe and, besides these clinical benefits, leads to lower total costs of treatment without further diagnostic and a new shelter for treating venous thrombosis. The surgical patients may present at admission one or more risk factors for VTE, The effect of this risk is cumulative, it is important to stratify the risk and to established an adequate prophylactic strategy. Today there is a unanimous consensus that the low molecular weight heparins are both effective and safe in preventing VTE in surgical patients. Unanimously approved guidelines can help surgeons in making decisions regarding VTE prophylaxis.

Laparoscopic colo-rectal surgery has been increasingly accepted and performed in several surgical centres. However, there are still concerns about the intra-operative risks and therefore on the safety of the procedure especially during the learning curve. As a matter of fact, in approximately one third of laparoscopic colo-rectal procedures, an intra-operative complication, mainly bleeding or iatrogenic injuries, may occur. In this paper, according to our experience, we analyse step by step the surgical technique of the laparoscopic left colectomy and evaluate the technical difficulties and complications in order to avoid them.

The control of the spread of hepatitis B virus (HBV) infection within dialysis units has been an important goal in the management of patients on regular dialysis but infected patients continue to enter the dialysis system. It is evident that HBV viraemia in hepatitis B surface antigen (HBsAg)-positive patients on dialysis is low but it remains unclear whether haemodialysis per se can contribute to viral load reduction in such patients. HBV DNA was determined in 40 HBsAg-positive patients on maintenance haemodialysis immediately before and at the end of a 4-h haemodialysis session. The same measurements were repeated 48 and 72 h later. Twenty (50%) of 40 HBsAg-positive patients had detectable HBV DNA in serum. Detectable HBV DNA in serum was not predicted by demographic, clinical or biochemical parameters. HBV load decreased in the majority of patients after haemodialysis, although the difference was not significant (29 390 +/- 48 820 vs 23 862.8 +/- 4 350 copies/mL, NS). There was a strong relationship between mean HBV DNA levels before dialysis and absolute reduction of HBV DNA during haemodialysis sessions (r = 0.75, P = 0.0001). No difference occurred in the magnitude of change in HBV DNA titre when comparing cellulosic to synthetic membranes. Haemodialysis per se leads to a reduction in HBV load in HBsAg-chronic carriers on maintenance dialysis. This phenomenon could explain the low viral loads in these patients. Prospective studies are in progress to identify the mechanisms responsible for reduction in HBV load during haemodialysis.

Adrenal myelolipoma is a rare benign, non-functioning tumor consisting of fat and hematopoietic tissues. In January 2005 we had observed an adrenal myelolipoma in 70 year old man. During the follow-up for bladder urothelioma, an abdominal CT revaled a well delineated 4x4 cm homogeneous fatty mass in the right suprarenal area with negative attenuation values. The functional study of adrenal gland was normal. The patient underwent videolaparoscopic right adrenalectomy (Gagner technique). Postoperative course was uneventful. The istological diagnosis showed adrenal myelolipoma. We conclude that videolaparoscopic adrenalectomy should be considered the gold standard treatment for benign adrenal lesions.

Treatment of liver hydatid cyst is still controversial. Besides medical treatment, interventional radiologic techniques and traditional surgery, recently the laparoscopic approach has been proposed. Laparoscopic treatment of liver hydatid cyst, however, has not been well defined so far and seems to be associated with a recurrence rate from 0 to 9%, in a 3-49 months follow-up. Disadvantages of the laparoscopic approach are difficult control of spillage, peritoneal dissemination of parasites and incomplete aspiration of high density fluid contents of the cyst. The authors have reviewed the literature and describe a personal technique to avoid this disadvantage and to reduce postoperative recurrence rate.

Background: The control of the spread of hepatitis B virus (HBV) infection within dialysis units has been one of the major advances in the management of patients with end-stage renal disease (ESRD). However, clinical and biochemical expression of HBV in dialysis patients have not been adequately addressed. Elevated values of serum aminotransferase activity are a sensitive measure of hepatocellular injury, but the role of HBV infection in the development of liver disease among dialysis patients has not been adequately analysed. Also, the clinical impact related to the virological characteristics of HBV in dialysis has not been evaluated., Methods: Demographic, biochemical and virological data from 727 patients undergoing chronic dialysis in seven dialysis units in northern Italy were collected in order to assess the biochemical consequences related to the presence of HBV infection in this population. We have measured by RT-PCR technology the titers of HBV viremia in HBsAg positive patients receiving dialysis., Results: Univariate analysis showed that AST and ALT values were significantly higher in HBsAg positive/HBV DNA positive than HBsAg negative patients on dialysis; AST, 22.86+/-31.34 vs. 14.19+/-9.7 IU/L (P=0.00001); and ALT, 25.07+/-41.59 vs. 13.9+/-41.59 IU/L (P=0.00001). In the subgroup of HBsAg positive patients, the frequency of detectable HBeAg in serum was 14.9% (7/47). The median value of HBV DNA in patients with detectable HBV DNA in serum was 2.160 x 10(3) copies/mL (range, 2.5 x 10(2)-4 x 10(6) copies/mL). HBsAg positive/HCV positive patients had higher aminotransferase activity than other subgroups (P=0.0001). Multivariate analysis showed a significant and independent association between detectable HBsAg/HBV DNA in serum and AST (P=0.00001) and ALT (P=0.0001) activity AST and ALT levels were lower in dialysis than healthy individuals--this finding persisted in age- and gender-matched comparisons., Conclusions: The HBV viral load in HBsAg positive patients receiving maintenance dialysis is not high. HBsAg positivity with detectable HBV DNA in serum is a strong and independent predictor of raised aminotransferase activity among dialysis patients. HBsAg positive patients had greater aminotransferase activity than HBsAg negative individuals even if both the groups had mean aminotransferase levels within the normal range considered for healthy population. Clinical trials aimed at identifying the best cut-off value to enhance the diagnostic yield of AST/ALT for detecting HBV in dialysis population are under way.

Background: Control of the spread of hepatitis B virus (HBV) infection in dialysis units has been one of major advances in the management of end-stage renal disease. However, the natural history of HBV in dialysis patients remains unclear. The aim of this study is to measure monthly HBV viral load (HBV DNA) in a large cohort (n = 29) of hepatitis B surface antigen (HBsAg)-positive chronic dialysis patients during 12 months., Methods: HBV DNA was measured using the Amplicor HBV Monitor Test (Roche Diagnostics, Branchburg, NJ), an in vitro assay using polymerase chain reaction nucleic acid amplification and DNA hybridization for the quantitative measurement of HBV DNA in serum., Results: We observed three HBV DNA patterns: (1) patients persistently positive by Amplicor HBV Monitor Test (persistent HBV DNA; 7 of 29 patients; 24.1%), (2) individuals with alternatively positive and negative results (intermittent HBV DNA; 18 of 29 patients; 62.1%), and (3) patients persistently negative by Amplicor HBV Monitor Test (4 of 29 patients; 13.8%). HBV viral load was greater in patients with persistent compared with intermittent HBV DNA (persistently HBV DNA positive; 2.686 x 10(4) copies/mL; 95% confidence interval [CI], 5.2499 x 10(4) to 1.8158 x 10(4)copies/mL) versus intermittently HBV DNA positive (1.071 x 10(3) copies/mL; 95% CI, 8.524 x 10(3) to 4.09 x 10(2) copies/mL; P = 0.0001). In the entire group, HBV load at study entry was low and did not change versus the end of follow-up., Conclusion: Three patterns of HBV viremia in dialysis patients over time were assessed; HBV load was not high and was relatively stable. HBsAg-positive patients who were intermittently HBV DNA positive had less HBV viral load than persistently HBV DNA-positive patients. Periodic testing for HBV DNA to assess the virological status of HBsAg-positive dialysis patients is recommended.

Background: In this open prospective study the correlation between bleeding patterns and endometrial histology has been evaluated in 101 postmenopausal women after 2 years of continuous sequential hormone replacement therapy (HRT)., Methods: All patients received continuous transdermal 17-b-estradiol supplementation, 0.05 mg/daily, with cyclic progestogen for 12 days every month. The progestogen was: dydrogesterone 10 mg/daily (56 cases); nomegestrol 5 mg/daily (15 cases); MAP 10 mg/daily (15 cases); norethisterone 0.25 mg/daily (15 cases). The changes in the characteristics of bleeding pattern and endometrial biopsy were performed in 90 of 101 patients, at the 10-12th of progestogen therapy., Results: The endometrial pattern was secretory in 60 cases, proliferative in 5 and atrophic in 22. In 3 cases the endometrial histology showed a simple hyperplasia. The bleeding generally starts 2 days after the end of progestogen therapy (13th +/- 2.9 day), with a mean duration of 4 days (4 +/- 2.8); in 21 patients (~20%) the bleeding is reduced. The endometrial histological characteristics haven't any influence on the bleeding pattern., Conclusions: In this study there was a low incidence of simple hyperplasia (3%), but the characteristics of bleeding don't permit to suspect this hyperplasia.

Background: Control of spread of HBV infection in dialysis units in developed countries has been one of the major advances in managing end-stage renal disease (ESRD). Patients with chronic HBV, however, continue to enter the population pool of dialysis patients and transplant candidates. The clinical significance related to the presence of HBsAg in serum of dialysis patients has not been completely understood., Aim and Methods: We collected demographic, biochemical and virological data from a large (n=464) population of patients on maintenance dialysis. This was done to assess the influence of virological and host factors on hepatocellular damage, as shown by serum aminotransferase activity., Results: The frequency of HBsAg positivity in our dialysis population was 8.2 % (38/464); the rate of HBsAg positive patients showing HBe antigen was 20.6% (7/34). Twenty-two (84.6%) of 26 HBsAg positive patients showed detectable HBV DNA in serum by Amplicor HBV MonitorTM Test. HBsAg positive patients had serum aminotransferase activity significantly higher than HBsAg negative individuals; GOT (AST) 25.1+/-29.9 vs. 16+/-21.5 UI/L (p=0.001), and GPT (ALT) 31.3+/-52.5 vs. 17.7+/-21.9 UIL (p=0.034). In the subset of HBsAg positive dialysis patients, those in the replicative phase HBeAg positive) had aminotransferase activity higher than HBeAg negative individuals, AST, 42.3+/-43.6 vs. 22.4+/-27.3 UI/L (p=0.097) and ALT, 49.41+/-54.7 vs. 29.17+/-55.76 UI/L (NS) respectively. We did a multivariate analysis by standard least square model on the entire patient group and we found independent and significant association between detectable HBsAg in serum and AST (p=0.0089)and ALT (p=0.0159) values. There was an independent and significant relationship between age and ALT (p=0.01)., Conclusions: In our study group, HBsAg positive patients on dialysis had serum aminotransferase activity significantly higher than that measured in HBsAg negative individuals. However, mean transaminase levels in HBsAg positive patients on dialysis were below the upper limit of normal for the reference range of healthy controls. HBsAg positive dialysis patients with active viral replication showed the greatest liver damage. Studies are in progress to understand further HBV-related liver disease in dialysis population.

The occurrence of post-operative pain, although less severe and frequent than in open surgery, may affect length of hospital stay and early return to normal activity in some patients operated on with laparoscopic surgery. Although several pathogenetic factors have been indicated in the literature, the mechanism responsible for post-operative pain after laparoscopy; still remains unclear. In this study the Authors evaluated post-operative pain in 90 patients submitted to laparoscopic cholecystectomy and correlated it to the length of operation, endoabdominal CO2 pressure maintained during surgery, and use of local anesthesia instilled din the liver bed and in the sites of introduction of trocars. Measuring post-operative pain by means of a modified Scott-Huskisson Visual Analogue Scale, no difference in the severity of the pain was noted in the two subgroups of patients with a length of operation inferior or superior to 60 minutes, respectively. Conversely, a statistical significant difference (p = 0.04 and p = 0.049 according to Fisher exact test and Pearson test, respectively) was observed evaluating the use of local anesthesia and the level of CO2 endoabdominal pressure, with less pain in patients whose pressure was maintained under 10 mmHg and in patients treated with instillation of local anesthetic drugs in the liver bed and in the sites of introduction of trocars.

The authors report a rare case of stenotic sigmoid endometriosis which presented with constipation and dysmenorrhea in a 48-year-old woman without past gynecological history. There were no typical radiological and endoscopic findings and only pathological examination revealed endometriosis. The patient did well after sigmoid resection and bilateral salpingo-oophorectomy and has had no further complaints. The authors stress the rare location of the disease and review the literature about etiopathogenetic hypotheses and pathological features. The diagnostic value of clinical examination, barium enema and colonoscopy is low as endometriosis rarely involves the mucosa. This case led the authors to discuss about diagnostic difficulties, differential diagnosis and therapeutic options.

The Authors describe the evolution of their anesthesiological techniques in the surgical repair of inguinal hernia. In this study they compare indications, complications, costs, hospital stay, length of surgery, postoperative pain and return to work after operations performed under local, spinal and general anesthesia. In their experience inguinal hernia treatment with local anesthesia and a tension-free technique is the preferred method of surgical repair.

Local anesthesia is the most common technique used in the surgical treatment of inguinal hernia. The introduction of synthetic prosthesis, which are resistant to infection, has to the development of surgical techniques used in local anesthesia, in a day hospital setting. These techniques permit a lowering of hospital costs and a reduction of the incidence of complications and recurrences. Over the last few years the authors have been performing a modified Lichtenstein repair or the Rives technique in local anesthesia. In this study they present their data on 52 patients surgically treated in the period 1997-1998, and discuss the advantages of their technique.

The authors report a rare case of mesenteric cyst in a 36 years old woman. These cysts have a pathogenesis that primarily may be ectopic lymphatic tissue and their most common site is in the small bowel mesentery, especially of the ileum. In the case reported the cyst was located in the right mesocolon. Mesenteric cysts can appear as chronic abdominal pain, a painless abdominal mass, or acute abdomen. Diagnostic aids include abdominal computed tomography and sonography, that usually make diagnosis of mesenteric cyst. Treatment of choice is enucleation; resection of the adjacent bowel may occasionally be necessary.

In order to assess the effects and acceptability of transdermal estradiol on the prevention of the loss of bone mass, the Authors administered transdermal estradiol (ETTS 50 mcgr/day) for 3 weeks and, cyclically, medroxyprogesterone 10/mg/day from day 10 to day 21 of each cycle for 12 months, to 20 operated patients for bilateral ovariectomy. Primary markers of the bone turnover (hydroxyproline urinary, osteocalcin, PTH) were estimated before therapy and after 3, 6, 9, 12 months. The BMD was evaluated before therapy and after 6 and 12 months. Our study clearly shows that the transdermal administration of estradiol prevents the postmenopausal bone loss, also in postmenopausal women at higher risk of developing osteoporosis as those evaluated in our study.

The most important factor responsible for osteoporosis postmenopausal is the loss of the oestrogen. For this reason we have estimated the modifications of the bone turnover in the operated patients for bilateral ovariectomy in fertile age by study of the BMD (bone mineral density) and of the various biohumoral parameters that are involved in the process of bone remodelling urinary hydroxyproline, osteocalcin). Our research consists of two phases. I phase: we have conducted a transverse study on a group of 43 patients subdivided in 3 subgroups on the basis of the years elapsed since they were operated. II phase: it is a longitudinal study. We have observed 6 women. We have estimated the turnover before the operation (T0) at (T1), at 30 (T2), at 90 (T3) and at 180 (T4) days from the operation. The results show that the sudden and rapid decrease of the oestrogenic rate determines a sudden increase of the bone turnover. The activity of the osteoblastic line is faster, the activity of osteoblastic line is slower. The beginning of the loss of the bone mass is about the 7% already at six months (longitudinal study), the loss of bone mass reaches the maximum within the first 2-3 years (about 16%) from the operation (transverse study).

Two patients with retroperitoneal liposarcoma are presented to determine the accuracy of diagnostic methods and the role of surgical treatment. In both the patients the large retroperitoneal liposarcoma recurred locally after surgery. Histological features, clinical presentation, diagnostic procedures, extent of surgical resection and adjuvant treatment are reviewed. These data suggest that an aggressive surgical approach followed by adjuvant postoperative irradiation is the treatment of choice in primary and recurrent neoplasms.

After a wide analysis of peptic gastroduodenal ulcer medical therapy, before and after the era of cimetidine, the Authors, after a brief account of the Anatomy and Physiology of the stomach, examine surgical therapy, from the end of the last century till now. After giving the results of the surgical cases of one of them (A. Vinci), including 500 operations, from 1955 till now, almost all with gastric resection, without vagotomy, the Authors point out that today, in the era of cimetidine, surgical therapy has considerably diminished and is reserved only for the complications of pathological cases (perforation, hemorrhage, closed duodenum stenosis), and for those cases which don't respond to antisecretory pharmacological therapy. They also emphasize, that nowadays, in spite of the cooperation among gastroenterologists, gastroscopists and surgeons, the etiopathogenesis of peptic ulcer isn't clear yet, and they conclude by saying that our lack of knowledge of its origin and natural evolution, doesn't guarantee a definitive cure, although the therapy with cimetidine and similar medicines, according to the Authors' personal experiences and opinion, must be continued for the patient's entire life.

One case of small bowel obstruction due to phytobezoar is reported. The various aetiological factors are discussed. The clinical features are not typical and small bowel obstruction can be initially recurrent until a complete intestinal occlusion. The diagnosis is not easy, and is nearly always made during urgent laparotomy. Surgical treatment consists of phytobezoar removal by enterotomy. The recognition of high-risk patients and their education to prevent phytobezoar are emphasized.

The authors, showing a case of breast retroareolar leiomyoma, study the literature thereabout, and emphasize the rareness of such disease, the impossibility of a correct preoperative diagnosis and the features of absolute benignity of this lesion.

On the basis of a study of the most recent clinico-statistical contributions on diverticula of the duodenum and personal experience, based on observation of 72 cases, the Authors set out a modern review of the subject. After emphasizing that diverticula of the duodenum are responsible for clinically evident and uncharacteristics sympatoms in only about 10-20% of cases, the Authors discuss the most modern procedures for diagnosis of diverticula of the duodenum. Lastly there is a full discussion of the indications for operation and the different surgical possibilities for treatment of the disease.

The authors submitted 24 patients affected by polycystic ovary syndrome to an oral glucose tolerance test (OGTT) and determined glucose, insulin and C Peptide levels. Patients were divided in four groups according to the degree of obesity and androgenic blood levels. Eight non hirsute women with normal ovulatory function, matched for height and weight, served as controls. The authors pointed out that insulin levels were greater in the obese and hyperandrogenic PCO women than in only the obese PCO women or only the hyperandrogenic PCO women. Obese patients with PCO had higher insulin levels than obese control group. Patients with PCO nonobese and nonhyperandrogenic had higher insulin levels than nonobese control group. Insulin levels did not differ in obese PCO and hyperandrogenic PCO women. These findings suggest that at least a component of insulin resistance which is found in PCO women is independent from body weight.

The authors report a case they had the opportunity to observe, surgically treated (thoraco-phrenotomy, removal of the herniated mass, repair of the diaphragmatic breach). They illustrate the genesis of such abnormality, its incidence and symptomatology. The Authors, moreover, dwell upon the diagnostic problems caused by Bochdalek's hernia with retroperitoneal contents, and upon the advantages shown by the thoracic way of aggression in the light of their own experience.