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Background: Despite cardiac rehabilitation for elder people already showed its usefulness, to date it is still not clear the impact of gender and of psychological constructs in influencing the rehabilitation outcomes., Aim: This study aimed at exploring the gender differences of great elders (over 75 years old) in cardiac rehabilitation, with particular attention to the impact of physical and psychological conditions, as depressive symptoms, on long-term post-discharge outcomes., Design: A cohort study design was used and a secondary analysis was conducted., Setting: Cardiac rehabilitation unit of a postacute rehabilitation Institute., Population: Elderly patients over 75 years old admitted to the cardiac rehabilitation program., Methods: Psychological and functional variables, such as Barthel Index, BMI, quality of life, and depression measured at admission and discharge from CR were matched with mortality information up to 4 years, used as long-term outcomes., Results: A total of 523 patients, 228 females and 295 males, with a mean age of 76.27 years±3.46 were progressively enrolled. Barthel index at admission and discharge was higher for males than females, 74.10±17.31 vs. 68.90 SD±16.81 (P<0.001), and 95.45±10.64 vs. 92.95±13.03 (p=0.021), respectively, while the relative change from admission to discharge Δ% of Barthel was higher for females 0.25±0.18 than for males 0.21±0.17 (P<0.05). Compared to males, either at admission or discharge females presented more severe depressive symptoms (5.21±3.46 vs. 3.86±2.79, P<0.001; 4.15±3.21 vs. 2.93±2.45, P<0.001) and a worse quality of life (10.58±2.15 vs. 9.55±2.24, P<0.001; 7.5±1.63 vs. 7.02±1.08, P=0.018). Cox proportional analysis revealed that female gender, depression at discharge, Barthel, and Comorbidity Index were associated with higher hazard and shorter survival time. On the other hand, higher BMI was associated with lower hazard and longer survival time., Conclusions: Elderly women following a CR program present more disability, depression, and a worse QoL than men. Obviously, these characteristics influence the length of hospitalization but with significant improvement. Despite the frail-gender paradox regarding survival, after CR program women have a higher risk of mortality than men. Depression has a significant negative impact on elderly psychophysical health., Clinical Rehabilitation Impact: Gender-specific and individualized rehabilitation programs should be implemented by considering the discussed physical and psychological risk factors. Further insight about gender differences among over 75 elderlies in CR is provided, this knowledge may be useful for clinicians scheduling recovery plans to promote elderlies' psychological and physical health. Psychological interventions should be implemented to relieve the depressive symptoms among elders.

Background: Elderlies in cardiac rehabilitation show a particular frailty due to specific aging issues, thus specific professional psychophysical care is required., Aim: This study aimed at evaluating the effect of a cardiac rehabilitation program enhanced with psychological support on the psychophysical health of elderly subjects aged ≥75. Moreover, the association of psychophysical conditions with the long-term post-discharge course of medical events was examined., Design: This retrospective cohort study was conducted on elderly patients aged ≥75 admitted from 2015 to 2019 to a cardiac rehabilitation program including psychological support., Setting: The cardiac ward and the psychology unit of a post-acute clinical rehabilitation Institute., Population: A total of 523 elderly inpatients (44% females), aged ≥75 years (mean 79.7±3.46 years), admitted to a cardiac rehabilitation ward due to heart disease., Methods: Psychological and functional variables such as depression, quality of life, and Barthel Index were measured at hospitalization and at discharge. The medical events after discharge such as emergency department accesses and rehospitalizations were registered., Results: Cardiac rehabilitation showed significant improvements both in elderlies' psychological and physical health. Higher depression levels predicted a worse post-discharge course. Patients who received psychological intervention accessed emergency department and were re-hospitalized significantly later than the others., Conclusions: Cardiac comprehensive rehabilitation can significantly improve the psycho-physical health of elderly subjects aged ≥75 who benefit of psychological support. Psychological support can enhance the psychophysical health of great elder inpatients in cardiac rehabilitation., Clinical Rehabilitation Impact: Given the associations with short and long-term outcomes, health professionals should take care of the psychological conditions of elderlies (e.g., depression) by integrating psychological interventions in cardiac rehabilitation in order to promote the elderlies' psychophysical conditions, quality of life, as well as more favorable medical outcomes.

Background: In recent years the "tension-free" techniques have been progressively replacing conventional hernioplasty by Bassini and Shouldice. Personal experience in the application of various techniques using a prosthesis to make the back wall of the inguinal canal stronger is described., Methods: From January 1995 to February 1996, 119 non-selected patients were examined; they were operated by Trabucco's (100 cases), Lichtenstein's (16 cases), Gilbert's (13 cases) and Rives's (1 case) techniques, using polypropylene prostheses. Patients were followed for ten months (range 4-18) after surgery with Day-hospital checks at 1 month, 4 months, 1 year and 18 months., Results: Mortality was not observed. Morbility presented in 12 cases: 2 suppurating wounds, 3 seromas, 2 hematomas, 2 temporary neuralgias of the genito-femoral nerve and 2 scrotal edemas. There was a recurrence (0.8%)., Conclusions: The cases presented confirm the validity of the "tension-free" techniques, both for reduced incidence of complications and recurrences, and for a better compliance of the patient, compared with conventional techniques.

The authors present their experience (136 cases) in the treatment of cholelithiasis with coelioscopic cholecystecomy. After a comparison of this modern technique with the traditional laparotomic approach, they underline the several advantages of coelioscopy (short hospitalization and early return to patient's work, reduced post-operative abdominal pain, avoidance of laparocele, better aesthetic results). Then the authors describe the present treatment of combined cholecysto-choledochic lithiasis with the help fo ERCP (their hope is for further improvement in surgical instruments to allow a single laparoscopic solutions.

The authors describe three cases of gastric leiomyosarcoma that required surgical treatment in emergency. Myogenic gastric tumors are extremely rare (1-3% of primitive gastric neoplasias) and little is known about their biological evolution, even if they seem to have scarce power of spreading and of local invasion. Echoendoscopy appears to be the best screening method for the evaluation of staging and DT (doubling time). In the authors' opinion, when neoplasms have a diameter less than 5 cm, subtotal or total gastrectomies don't offer better results in the follow-up than simple minimal excision of the gastric tumor.

The authors describe a case of acute abdomen operated in emergency for obstruction in a patient with eosinophilic gastritis. This is very unusual pathology characterized by eosinophilic infiltration of the gastric antral wall combined with peripheric eosinophilia. This particular case was operated for a small bowel obstruction but in those rare cases, when we can reach a diagnosis with endoscopic biopsy, a prudential attitude becomes inevitable as this pathology is very responsive to medical treatment with corticosteroids.

The authors describe their experience in the surgical treatment of splenic lesions, mostly traumatic. In recent years a resolutely conservative attitude has been turned to splenic salvage, thanks to late findings on its immunological and haematological functions. Against 59 splenectomies for III-V degree lesions, the authors report a case of splenic trauma (II degree) without surgical treatment, monitored with clinical, haematological and instrumental (echography) test.

The authors describe an acute intestinal occlusion due to a rare case of strangulated intra-abdominal hernia of the retrocaecal peritoneal recess. They underline the rarity of this pathology which is often treated in emergency without any possibility of preoperative diagnosis. Therefore, in order to carry out surgical therapy with good results, a correct knowledge of the anatomical features of these hernias is necessary.