Search

Based on a comprehensive literature analysis, a review on factors that control water cycle and water use in Mediterranean forest ecosystems is presented, including environmental variables and silvicultural treatments. This important issue is considered in the perspective of sustainable forest management of Mediterranean forests, with special regard to crucial environmental hazards such as forest fires and desertification risks related to climate change.

The postoperative hypoparathyroidism is a not rare complication after total thyroidectomy and/or total parathyroidectomy. Attempts to transplant parathyroid tissue began in 1975 with the work of Wells, but still today results are disappointing. However, with the development of tissue engineering techniques, some experimental approaches to build artificial parathyroid are been made. Bioengineered device, actively secreting PTH, for transplant in patients with iatrogenic hypoparathyroidism is unavailable.Parathyroid cells were obtained from three chronic uremic patients in hemodialysis, operated for secondary hyperparathyroidism. Cell cultures in RPMI medium were subsequently seeded on collagen scaffold (three-dimensional matrix with slow biodegradation). Collagen is the major component of the extracellular matrix and thus is a good substrate for cell adhesion and growth. Culture media, with a low calcium concentration, were optimised to physiologically stimulate parathyroid hormone secretion. Cell cultures were morphologically observed in optical and electron (ESEM) microscopy and metabolically assayed by MTT method until the tenth week. Besides, concentration of parathyroid hormone in the culture medium has been measured for several weeks.After 24 hours of culture in RPMI, cells extracted from human parathyroid glands were nearly all adherent and organised in clusters to resemble the glandular organization. The cellular population consisted predominantly of parathyroid cells (90-95%). On collagen scaffolds, cells maintains an epithelial-like morphology also after 10 weeks, colonizing the scaffold surface and keeping a good proliferative rate with a discrete production of parathyroid hormone.The use of parathyroid cells extracted from patients with secondary hyperparathyroidism was certainly an appropriate choice that enabled us to achieve these results, that albeit partial bode well for the experimental in vivo animal model. The bioengineered scaffolds when implanted in the subcutaneous can avoid the dispersion of parathyroid cells, assuring also the possibility to easily remove the implant in case of complications. Our research was aimed primarily to the optimisation of PTH secreting human parathyroid cells cultures and then to the in vitro engineering of human parathyroid glands in three-dimensional collagen scaffolds.

Axillary lymphadenectomy remains an integral part of breast cancer treatment, yet seroma formation occurs in 15-85% of cases. Among the methods employed to reduce seroma magnitude and duration, fibrin glue has been proposed in numerous studies with controversialSixty patients underwent quadrantectomy or mastectomy with level I/II axillary lymphadenectomy; a suction drain was fitted in all patients. Fibrin glue spray was applied to the axillary fossa in 30 patients; the other 30 patients were treated conventionally. Suction drainage was removed between postoperative days III and IV. Seroma magnitude and duration were significantly reduced (P=0.004 and 0.02, respectively), and there were fewer evacuative punctures, in patients receiving fibrin glue compared with the conventional treatment group. The authors conclude that the use of fibrin glue does not always prevent seroma formation, but does reduce seroma magnitude, duration and necessary evacuative punctures.

21ST NATIONAL CONGRESS SICO ITALIAN SOCIETY OF SURGICAL ONCOLOGY. SAN FELICE CIRCEO (LT), ITALY JUNE 26-28 1997. JOURNAL OF EXPERIMENTAL & CLINICAL RESEARCH,16.2.1997

Knowledge of axillary lymph node status is a key aid to staging and prognosis and it represents a guideline for adjuvant therapy in breast cancer. Despite the morbidity it causes, complete axillary dissection was long the mainstay of treatment. Sentinel lymph node biopsy has proved so reliable in the evaluation of node involvement that axillary node dissection is now generally performed when sentinel node biopsy tests negative.In this 3-phase study, 50 patients were enrolled to evaluate the learning curve of sentinel node biopsy (phase 1, September 1997-January 1998); 256 patients (age range 27-81 years) with infiltrative breast cancer (T3 cm, clinical N0) underwent level 1 lymph node dissection when the sentinel node tested negative at histopathology (phase 2, February 1998-March 2001); 221 patients with T3 cm underwent dissection of the sentinel node when it tested negative for metastasis (phase 3, April 2001-March 2005).The sentinel node was preoperatively detected in 98.6% of cases after peritumoral and intradermic injection of the radionuclide tracer and intraoperatively in 99% (90% with radio-guided surgery, 10% with vital staining). The sentinel node was positive in 15% of patients with T1 and metastatic in 65%.Our results are in line with the published data; therefore, the study will go forward to examine the role of the micrometastasis in the sentinel node and of in-transit tumoral cells.

The Authors report their experience about 127 ductal carcinoma in situ (DCIS) of the breast. Guidelines for surgical treatment are: radiological or clinical diagnosis, tumor's extension, histological classification, grading and margin status. At the present the Authors prefer breast conserving surgery with tumor margin's study. They report their experience in the last seven years about sentinel node biopsy. Radiotherapy and endocrine therapy are indicated for selected patients; local recurrence after DCIS therapy is 8,1% on a 6,1 years follow-up.

Breast-conserving surgery is the treatment of choice for the breast cancer T3 cm. The local recurrence is a problem of diagnosis and consequent treatment. We enrolled, from 1987 to 2004, 1504 breast cancer. In 803 (53.4%) tumor with T3 cm we performed conserving surgery. The sentinel lymph node (SN) technique induce to limit the axillary dissection in patients T1a-b to the SN only if non metastatic and located to the first level, the dissection of the 1st level of the axilla in patients T1c-T23 cm and SN negative, complete axillary dissection in patients with metastatic SN or located to the 2nd level. Our percentage of local recurrence in the follow-up was 3.5% at 5 years and 6% at 10 years.

New models of care are proposed to reduce the costs of traditional hospitalization and to improve the utilization of resources in surgery. Day surgery is widely employed in breast surgery. In this study we report the conversion rate and causes in ordinary hospitalization and we identify some contraindications related to breast surgery in day surgery.A cohort study was performed on 306 patients operated on between July 1999 and December 2001 for breast lesions with uncertain interpretation at the clinical and/or instrumental examination. Those patients who lived at a distance of less than 50 km from the hospital, had a telephone, a suitable house, direct family support and, if necessary, could benefit from home health care in addition to hospitalization, were considered as eligible to day surgery. The kind of anesthesia and hospital admission were established after clinical, psycho-emotional, and socio-familiar evaluation of the patients by the surgeon and the anesthetist.A total of 250 excisional biopsies and 56 biopsies with a Mammotome were performed. Surgery was performed under local anesthesia in 278 patients and general anesthesia in 28 subjects. Observation exceeding 24 hours was only necessary in 10 patients reporting hypotension syndrome and anxiety. The conversion rate in ordinary hospitalization was 0.3%. Postoperative morbidity was 1%.Day surgery is an effective model of care in breast surgery for diagnostic and therapeutic purposes without axillary dissection. A good selection of patients, perfect interdisciplinary collaboration, and an efficient structural organization are necessary to control the complication and conversion rates of traditional hospitalization.

Large teratomas with gastric mucosa are rare. We report a case of mature cystic teratoma in an ovary of a young woman. Tumor growth was large and rapid enough to displace abdominal organs. The cyst was aspirated (removing 101 of mucinoid liquid) and excised by medial hypogastric laparotomy. The histological examination revealed differentiated gastric fundal mucosa with no other tissue involvement.

A recent case of pleural plaques fibrosis in a worker exposed since 20 years to asbestos induced us to report our experience. A 52-year-old man was seen because of chest multiple opaques of soft tissue density without any symptoms. The CT-scan of thorax with i.v. contrast showed multiple lesions of diameter 0.5-4 cm on the posterolateral pleura bilaterally. FNAB of one lesion CT guided was not diagnostic. The pleural biopsy obtained at surgical exploration showed hyaline tissue, avascular, almost acellular, with calcifications and inflammation of low grade. The pleural plaques are generally multifocal and bilateral. They usually affect the parietal pleura. The connection between asbestos and plaques is firmly established. The pathogenesis is not well known. The pleural plaques fibrosis is a benign disease and a very common manifestation of asbestos exposure; it is not related to mesothelioma and it does not need any treatment. Because of the lack of symptoms it must be searched for in high risk subjects.

A recent book on the forests of southern Italy is presented. The book treats many ecological and silvicultural aspects of forests across southern Italy and major islands, including forest typologies, as well as practices to be applied for management of these peculiar environments. Written in Italian.

The engineering approach in the design of fire prevention allows the engineer to study fire pre-vention solutions that do not meet the requirements of the Rules provided that they ensure the same level of fire safety. To design interventions appropriate to ensure the fire resistance of structures, and in particular for the steel structures, the performance approach of the Rules requires the adoption of prede-fined solutions as a function only of the structural material and the required fire resistance. The performance approach of the Norms, therefore, does not take into account the loads acting on the structural element and the critical temperature, which is the temperature at which the load that can be worn in hot equals the exercise load. Often, during the design phase, some of the requirements of rules are difficult, if not impossible to meet. A practical example is that of a restoration project of a historic building, for which interventions are required non-invasive, reversible and compatible. In this paper it is presented a study that enables you to design interventions appropriate to en-sure the fire resistance of structural elements with an analytical method and, therefore, with an engineering approach. In particular, according to the fire scenario adopted, the analytical method proposed allows to determine the critical temperature of the structural element under study, depending on the working load, the resistant section and solicitation of project. Subsequently, depending on the critical temperature and the required fire resistance, it is possible to design the appropriate fire-fighting interventions.

Le metastasi epatiche rappresentano circa il 36% di tutti i tumori e nel 50% dei casi sono secondarie a neoplasie dell’area portale. Il cancro colo- rettale e il tumore primitivo che pin frequentemente da metastasi epatiche. Ogni anno in Italia si veriticano circa 33.000 nuovi casi di neoplasie colo- rettali ed il 40-60% di essi sviluppano metastasi epatiche. In assenza di trattamento, la sopravvivenza dei pazienti con metastasi epatiche é nulla. La chemioterapia non ha dato, a tutt’oggi, risultati molto incoraggianti in termini di sopravvivenza. La chirurgia rappresenta, laddove e possibile effettuarla con radicalita oncologica, la terapia pin efiicace con possibilita di sopravvivenza a 5 anni fino al 30-40% dei casi "’. Purtroppo, la terapia chirurgica é possibile solo nel 15% dei casi, in quanto la malattia e spesso estesa a piu segmenti 0 settori epatici difiicili da resecare, o é localizzata anche in sede extraepatica"’. Pertanto, sono stati proposti vari trattamenti miniinvasivi per distruggere le lesioni epatiche in modo da controllare la progressione epatica della malattia.