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Il saggio intende migliorare la comprensione dei processi di creazione di spin-off accademici nel Mezzogiorno, approfondendo in particolare il ruolo che il framework istituzionale gioca nella costruzione e nello sviluppo del progetto di un'impresa accademica.

Introduction: The total mesorectal excision (TME) for rectal tumours was introduced in 1982 by Heald and coll. and has led both to a 5% decrease of local recurrences 5 and 10 years after the operation if confronted with the cases treated with conventional surgery and to the increase of survival up to five years estimated in 80% of the cases. In Italy, TME firstly introduced for distal rectal cancer about 20 years ago, this surgical technique has shown the same rate of local recurrences reported by Heald. The aim of our work is to highlight TME advantages and demonstrate how this more demanding and longer method, has an acceptable risk for the surgery of rectal tumours. Materials and method: We have confronted two groups of patients operated for rectal carcinoma; the first group (no TME, including 50 patients) was treated with the standard surgery technique, while the second group (TME, 44 patients) underwent the total mesorectal excision. 14 no TME patients belong to Dukes stage A, 20 to stage B, 12 to C and the remaining 4 had miscellaneous diagnosis; whereas in the TME group 12 patients belonged to Dukes stage A, 16 to B, 6 to C and the remaining 10 patients had miscellaneous diagnosis. The patients of both groups were undergone the exams of follow up (blood test, hepatic echography, abdominal TC, thorax RX), the follow up pattern expect periodic controls with check-up to three and six months, one and five years. Results: postoperative complications in the groups considered do not show important differences in rates, although, the second group (TME) had 9 cases with postoperative complications confronted with the 11 cases of the first group (no TME). The complications taken into consideration were: anastomotic bleeding (2 patients TME, 4% vs 3 patients no TME, 6%), intestinal obstruction (1 patient TME, 2% vs 1 patient no TME, 2%), paretal infection (3 patients TME, 7% vs 4 patients no TME, 8%), anastomotic fistulae (2 patients TME, 4% vs 2 patients no TME, 4%), retention of urine and vesicular disorder (1 patient TME, 2% vs 1 patient no TME, 2%). Tumours closer to the anus have shown more complications compared with higher ones. As a matter of fact, 10 cases of no TME and TME patients with low placed tumours have undergone complications compared with the 3 cases of no TME and TME patients with tumours being more distant from the anus. A lower rate of local recurrences was noticed in the TME group: 3 (7%) compared with the no TME group: 18 (36%) with P < 0,001. Other tardy complications taken into consideration were: hepatic metastasis (5 patients no TME, 10% vs 6 patients TME, 14%), pulmonary metastasis (5, 10% of the no TME vs 3, 7% of the TME), anastomotic stenosis (4, 8% of the no TME vs 3, 7% of the TME), impotence and orgasm sine materia (2, 4% of the no TME vs 3, 7% of the TME). We also noticed that most of the tardy complications in the TME group belonged to Dukes stage C. Conclusion: from our experience, we deduced that, in TME patients, complications are lower than in no TME patients with no important P; the seat of the tumour affects the appearance of complications which are more frequent in distal localizations. The important result is a minor incidence of recurrences (P < 0,001) which brings us to the conclusion that TME can be considered a valid method with an acceptable risk for the surgery of rectal tumours.

SUMMARY BACKGROUND: More and more people with severe hemophilia reach an old age thanks to an effective treatment. There is no information on the health status and quality of life of elderly people with hemophilia born at a time when replacement therapy was hardly available. METHODS: Italian patients with severe hemophilia, aged >or=65 years and hence born in 1942 or earlier, were compared with elderly men without bleeding disorders matched for age, sex, geography and social status. The following aspects were evaluated: concomitant illness, orthopedic status, physical functioning and cognitive status. Measurements of generic and disease-specific health-related quality of life were also obtained, together with the presence or absence of depression. RESULTS: Thirty-nine patients, aged 65-78 years, were investigated; 33 had hemophilia A. All patients had started regular treatment on demand only when they were already 25-30 years of age. Patients were compared with 43 men without hemophilia, aged 65-79 years. More patients with hemophilia had chronic hepatitis B and C, HIV infection and hypertension. On the other hand, their elderly peers without hemophilia were more frequently hypercholesterolemic and had more cardiovascular diseases. Most hemophiliacs had arthropathy and worse values for physical functioning, but their cognitive status was similar to that of elderly non-hemophiliacs. Hemophiliacs reported greater depression and lower health-related quality of life. CONCLUSIONS: Elderly patients with hemophilia have more co-morbidities and problems in daily living, but similar cognitive status as age-matched non-hemophilic peers. They have more chronic viral infections and hypertension but fewer cardiovascular diseases. These observations should help to optimize health care delivery in this increasing and neglected population of people with hemophilia.

BackgroundDespite depressive disorders being very common there has been little research to guide primary care physicians on the choice of treatment for patients with mild to moderate depression.AimsTo evaluate the efficacy of interpersonal counselling compared with selective serotonin reuptake inhibitors (SSRIs), in primary care attenders with major depression and to identify moderators of treatment outcome.MethodA randomised controlled trial in nine centres (DEPICS, Australian New Zealand Clinical Trials Registry number: ACTRN12608000479303). The primary outcome was remission of the depressive episode (defined as a Hamilton Rating Scale for Depression score 7 at 2 months). Daily functioning was assessed using the Work and Social Adjustment Scale. Logistic regression models were used to identify moderators of treatment outcome.ResultsThe percentage of patients who achieved remission at 2 months was significantly higher in the interpersonal counselling group compared with the SSRI group (58.7% v. 45.1%, P = 0.021). Five moderators of treatment outcome were found: depression severity, functional impairment, anxiety comorbidity, previous depressive episodes and smoking habit.ConclusionsWe identified some patient characteristics predicting a differential outcome with pharmacological and psychological interventions. Should our results be confirmed in future studies, these characteristics will help clinicians to define criteria for first-line treatment of depression targeted to patients' characteristics.

Malignancies, antiproliferative drug treatment, cancer-related conditions like immobilization, perioperative status and radiotherapy are risk factors for hypercoagulability. Setting aside mass or invasion-related venous thrombosis, the differential diagnosis regarding the etiopathogenesis (paraneoplastic syndrome or antiproliferative treatment) is usually problematic. The authors report a case of combined malignant hemangiopericytoma and recurrent deep venous thrombosis in the right inferior limb. Through a literature review, the following issues are discussed: 1) the criteria for cyto-histopathologic assessment; 2) the involvement of pericytes both in coagulation and platelet aggregation; 3) the importance of discriminating true paraneoplastic syndromes from other tumor-related clinical manifestations; 4) the response to external radiotherapy of malignant hemangiopericytoma as limited disease; 5) the poor results of doxorubicin-ifosfamide polychemotherapy and dacarbazine monochemotherapy in metastatic disease. Although doxorubicin-ifosfamide treatment was in progress in the reported case, the authors conclude that the recurrent deep venous thrombosis is likely to be paraneoplastic, even if such a diagnosis has not been previously reported in the literature.

Atti XXXV Convegno SIA, Napoli, (a cura di Mori M., Fagnano M.).

In this paper the modifications of the Plio-Pleistocene vertebrate assemblages of Sicily and Sardinia are examined. The extinction events, the effects of major climatic changes on this events, the snapshot extinctions, and the extinctions of highly endemic taxa that have survived for a very long time on the islands, are discussed.

The aim of the study was to evaluate effects of shoulder overuse in elite symptomatic or asymptomatic gymnasts.This was a university-based sport traumatology research, a cohort study, with a control group comparison. Patients included were: 21 elite male gymnasts performing in the Italian National team for at least 10 years and a control group of 10 patients (20 shoulders) of the same age and sex, randomly selected among a healthy non-athletic population who underwent shoulder MRI. Magnetic resonance imaging without contrast were performed to all participants and clinical findings were summarized. Two experienced musculoskeletal radiologists interpreted each MRI scan for multiple variables (rotator cuff tendons, labral signal, capsule), including type of measurements performed on soft tissues (muscles, tendons) to assess global modifications of the shoulders.Signal abnormalities were detected in 36/36 (100%) gymnasts' shoulders, and in 4/20 (20%) of the controls. Sixteen of 36 (44.4%) shoulders had findings consistent with SLAP tears, bilateral in four patients; anteroinferior labrum lesions were identified in 10/36 (27.7%) shoulders, as compared with none (0%) in the controls. Eight of 36 (22%) shoulders had findings consistent with partial- or full-thickness tears of the rotator cuff as compared with none (0%) of the controls. Increased thickness of rotator cuff tendons and hypertrophy of rotator cuff muscles and deltoid muscles were recorded: such reports were symmetrical between dominant and non dominant arms, and increased when compared to controls.Gymnasts' shoulders are significantly different from those of the general population. MRI findings, especially SLAP tears, and hypertrophy are symmetrical. SLAP tears seem to be responsible of most early retirement.