Search

Objectives The traditional surgical approach to the treatment of the superficial venous insufficiency requires at least 12 h of post-operative monitoring and this often means the necessity of an overnight hospitalization. The introduction of new, less invasive techniques (i.e endovenous laser ablation) reduces the hospitalization stay in a Day Surgery setting. However, the increasing skills of the operators and the patient's selection, allows to propose endovenous laser ablation in an Outpatient setting. The aim of this study is to evaluate the activity of a single high-volume center. Method We enrolled 112 consecutive patients with great sapehous vein insufficiency and indication to endothermal laser ablation, 57 operations (51%) were performed in Day Surgery setting and 55 (49%) in Outpatient setting according to endovascular laser ablation's criteria. Past medical history, CEAP classification, VCSS score, type of symptoms and intervention's data were collected. Post-operative results (success and complications rates, patient's functional and aesthetic satisfaction) were evaluated at 7 and 30 days after intervention. A QoL questionnaire (CIVIQ) was submitted to the patients 30 days after surgery. Results We did not observe a statistically significant difference between the two groups concerning treatment results and complications onset. The QoL assessment did not differed significantly, except for over 65-year old patients undergoing outpatient treatment that showed a better QoL compared to those undergoing the same treatment in Day Surgery (p 0.05). Conclusions The endothermal laser ablation technique allows a safe, comfortable and faster management of the venous disease in Outpatient setting. This would further reduce the costs of the treatment while preserving the functional and aesthetic results and the low complication rate of the Day Surgery setting.

Gianfranco Varetto,1 Caterina Guiot,2 Matteo Destro,1 Claudio Castagno,1 Luigi Contessa,1 Stefano Zan,1 Paolo Garneri,1 Pietro Rispoli11Division of Vascular Surgery, Department of Surgical Sciences, 2Department of Neuroscience, University of Turin, Turin, ItalyBackground: Endovenous laser ablation is a minimally invasive procedure in the treatment of great saphenous vein insufficiency. Procedural criteria (energy delivered according to the selected fluence) could affect outcome after treatment, potentially improving the success rate and reducing complications. However, the optimal values of the required energy per unit volume are not known, but on the basis of clinical experience, a range of optimal speed of retraction of the laser fiber catheter should exist and strictly depend on the actual vein dimensions.Methods: The study population included 21 patients. The equipment was a Diomed 30W® laser, wavelength 810 nm. Before treatment, three segments of the great saphenous vein were mapped and their diameter measured and recorded. The energy delivered to each segment was recorded as well as its relationship with vein diameter being evaluated for each vein segment.Results: A 100% success rate was observed at 12-month follow-up assessment, the discomfort complaint 1 week after endovenous laser ablation by 19% of patients was always low (2 or 3 on a scale of pain of 10). On the basis of the actual result, which greatly improves our previous clinical experience, a range of effective values of speed of retraction of the laser fiber catheter (and of the energy per unit volume) is assessed, which strictly depends on the diameter of each segment of the vein.Conclusion: The speed of retraction of the laser fiber catheter should be properly tailored, in order to deliver the right energy dose depending on the actual vein diameter. A real-time procedure can be easily performed using a simple mathematical nomogram.Keywords: EVLA, great saphenous vein, fluence

Gianfranco Varetto, Paolo Garneri, Claudio Castagno, Valentina Molinaro, Simone Quaglino, Matteo Ripepi, Emilio Benintende, Lorenzo Gibello, Stefano Zan, Luigi Contessa, Ugo Bertoldo, Pietro Rispoli Vascular Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy Abstract: Venous ultrasonography is an indispensable tool in minimally invasive surgery for the treatment of varicose veins. However, the criteria for defining preoperative imaging parameters, outcome monitoring, and follow up are not well characterized. In this retrospective study, we reviewed the ultrasound periprocedural parameters and the outcomes in 274 patients (280 limbs) after endoluminal laser treatment, at early (

In this work, long period gratings coated with polymeric high refractive index (HRI) thin layers are proposed as high sensitive opto-chemical sensors with tailored sensitivity profile. The deposition of thin coatings with high refractive index (compared to the cladding one) induces strong changes in the field distribution related to the cladding modes. The main effect is a significant change in the sensitivity characteristic to surrounding refractive index (SRI) and to overlay refractive index. Differently from the standard LPG, where the sensitivity to SRI exhibits an exponential form, in HRI coated LPG the sensitivity shows a resonant-like profile. Since the resonant-peak can be centered around the selected SRI by acting on the overlay features (refractive index and thickness), this effect can be efficiently used to realize high performance opto-chemical sensors. In order to investigate the sensor performances the SRI sensitivity of attenuation bands related to different cladding modes have been experimentally tested. Here &form Syndiotactic Polystyrene (sPS) was selected as nanoscale HRI polymeric layer.

In this work, the numerical and experimental investigation of the cladding modes re-organization in high refractive index (HRI) coated Long Period Gratings (LPGs) is reported. Moreover, the effects of the cladding modes re-organization on the sensitivity to the surrounding medium refractive index (SRI) have been outlined. When azimuthally symmetric nano-scale HRI coatings are deposited along LPGs devices, a significant modification of the cladding modes distribution occurs, depending on the layer features (refractive index and thickness) and on the SRI. In particular, if layer parameters are properly chosen, the transition of the lowest order cladding mode into an overlay mode occurs. As a consequence, a cladding modes re-organization can be observed leading to relevant improvements in the SRI sensitivity in terms of wavelength shift and amplitude variations of the LPGs attenuation bands.

In this work, a novel fiber optic sensor able to measure the concentration of organic analytes, in aqueous environment is presented. Long period gratings were selected as high sensitive refractive index transducers and syndiotactic polystyrene in the nanoporous crystalline form was used as sensitive polymeric layer due to its high sorption properties towards chlorinated and aromatic compounds. In particular, a thin semi-crystalline syndiotactic polystyrene film with crystalline nanoporous form was deposited along the sensing element by using dip-coating technique. Chemical detection has been carried out by measuring the wavelength shift and the amplitude change in the attenuation bands of the long period grating due to analytes sorption. Experimental results demonstrate the capability of the proposed sensor to detect very low concentrations (in the range of few ppm) of chloroform in water.

In this work, the use of fiber long-period gratings (LPGs)—coated with nanoscale overlays of Syndiotactic Polystyrene (sPS) in the nanoporous crystalline δ form as specific and highly sensitive chemical sensors for in water monitoring—is proposed. The approach presented here, combines the excellent sorption properties of δ form sPS as a chemosensitive layer with the excellent refractive index sensitivity of LPG-based sensors as ideal transducers. In particular, when overlays with a high refractive index compared with the cladding one are deposited along the grating region, as in this case, the refraction-reflection regime at the cladding-overlay interface occurs. As result of this mechanism, the attenuation bands of coated LPGs would respond to the optical changes induced in the sensitive overlay due to chemical sorption by a significant modification of the peak central wavelength and intensity. The sensitivity depends strongly on the overlay thickness and the grating coupled cladding mode. Here, sensor probes were prepared by using a dip coating technique and a proprietary procedure to obtain the δ form sPS. An experimental demonstration of the sensor capability to perform sub-ppm detection of chloroform in water at room temperature is reported here. Also, the effects of the overlay thickness and the cladding mode order on sensor sensitivity and response time have been numerically and experimentally investigated.

In this work, we theoretically and experimentally investigated the cladding modes re-organization in high refractive index coated long period gratings (LPGs), focusing the attention on the influence on the refractive index sensitivity. When azimuthally symmetric nano-scale HRI coatings are deposited along LPGs devices, a significant modification of the cladding modes distribution occurs, depending on the layer features (refractive index and thickness) and on the surrounding refractive index. In particular, if these parameters are properly chosen, the transition between cladding modes and overlay modes occurs. Here, numerical and experimental results on the effect of the modes transition surrounding refractive index (SRI) sensitivity are presented.

In this work, a novel fiber optic sensor able to measure the concentration of organic analytes, in aqueous environment is presented. The proposed structure relies on the use of long period gratings (LPGs), as high sensitivity refractive index transducers, coated with thin films of syndiotactic polystyrene (sPS) in the nanoporous crystalline /spl delta/ form, as sensitive polymeric layer. The combination of the intrinsic and high refractive index sensitivity of the LPGs with the high sorption properties towards chlorinated and aromatic compounds of sPS /spl delta/ form allows detecting very low concentrations (in the range of few ppm) of analytes in water. Chemical detection is carried out by measuring the wavelength shift and the amplitude changes in the attenuation bands of the LPG due to analyte sorption.

In this work, a long period grating (LPG) is coated with a thin film of syndiotactic polystyrene (sPS) in the nanoporous crystalline /spl delta/ form in order to obtain a species-specific chemical sensor. The combination of the intrinsic and high refractive index sensitivity of the LPGs with the high sorption properties toward chlorinated and aromatic compounds of sPS /spl delta/ form allows detecting very low concentrations (in the range of few parts per million) of chloroform in water. Chemical detection is carried out by measuring the wavelength shift and the amplitude changes in the attenuation band of the LPG due to analyte sorption.

In this work, the numerical and experimental analysis of coated Long Period Gratings (LPGs) as high sensitivity optochemical sensor is presented. The proposed structure relies on LPGs coated with nanoscale high refractive index (HRI) overlays. When azimuthally symmetric nano-scale HRI coatings are deposited along LPGs devices, a significant modification of the cladding modes distribution occurs, depending on the layer features (refractive index and thickness) and on the external refractive index. If these parameters are properly chosen, a strong field enhancement within the overlay occurs, leading to an excellent sensitivity to the coating properties. Here, the effects of the overlay thickness and the cladding mode order on sensor sensitivity and response time have been numerically and experimentally investigated. In order to provide a high sensitivity and species specific opto-chemical sensor, the LPGs were coated with nanoscale overlays of Syndiotactic Polystyrene (sPS) in the nanoporous crystalline δ form. The sensitive material was chosen in light of its selectivity and high sorption properties towards chlorinated and aromatic compounds. Sensor probes were prepared by using dip coating technique and a proprietary procedure to obtain the form sPS. Experimental demonstration of the sensor capability to perform sub ppm detection of chloroform in water at room temperature is also reported.

Personal experience concerning the treatment of 8 patients with infrarenal aortic aneurysms associated with extravascular non-neoplastic abdominal diseases is presented.In all 7 cases which underwent combined surgical procedures (aneury-smectomy + cholecystectomy in 4 patients and aneurysmectomy + groin hernia repair in 3 patients) early and late postoperative complications were not recorded.The main therapeutic guidelines concerning the pathologic association of infrarenal aortic aneurysms associated with extravascular non-neoplastic abdominal diseases are discussed on the basis of a literature review and of personal experience.

Self-transfusion represents a method used for the restoration of haematic losses that, in recent years, has been employed more and more widely in the surgical ambit. The utilisation of this method has become increasingly frequent because of the high diffusion of blood transmitted diseases and of the incidence, not negligible, of complications relative to the transfusions of homologous blood. The techniques that are currently used are: self-donation with predeposit; inter-surgery recovery; hemodilution normal blood volume. The authors report their experience relative to the use of self-transfusion, as self-donation with predeposit and as inter-surgery recovery, employed in the treatment of haemorrhagic complications, from 1990 until now in the Department of I Surgical Clinic of University of Turin, in a series of 48 patients in which were performed infrarenal abdominal aortic repair. In practice this technique did not present any complications.

During a 5-year period, from 1990 to 1994, 61 patients underwent prosthetic reconstruction of aorto-iliac district for aneurysmal (53 cases) or obstructive (8 cases) disease. There was no postoperative mortality; 3 cases of early perianastomotic thrombosis, 2 cases of left colon necrosis, 4 cases of femoral pseudoaneurysm and 5 cases of sexual disfunction were recorded. If accurately performed, the surgery of this arterial district offers very good early and late results.

A case of splenic abscess in a diabetic, cardiopathic and arteriopathic 49-year-old man is reported. The abscess developed on a previous splenic infarction caused by an embolus coming from an intraventricular thrombus. The angiographic procedure was the source of bacterial contamination (Staphylococcus aureus). The patient was successfully treated with splenectomy.

The authors report their experience relative to 8 patients who underwent IMA revascularization during infrarenal AAA repair. The Carrel patch technique was employed in all cases operated. With this procedure no ischemic intestinal complication occurred. Two cases of ischemic colitis were observed in a second group of 40 patients operated for AAA in whom the IMA wasn't reimplanted into the aortic graft. The overall incidence of acute intestinal ischemia was 4%.

The authors report their experience of two cases of popliteal artery aneurysm. Both patients were treated with aneurysm resection and inverse saphenous vein bypass. Early surgical intervention is the only effective therapeutic tool to avoid serious complications of this pathology.

The authors report their experience relative to 102 patients evaluated with carotid duplex-scanner. Ultrasonographic data of atherosclerotic carotid changes have been correlated with the outcome of the tested series. In fact, echographic images of vascular changes with high thromboembolic risk (ulcerated plaque) have been associated with cerebrovascular injuries in 25% of the cases. Furthermore, the duplex-scanner showed the need for surgical treatment (TEA) in 32 patients with asymptomatic carotid stenosis. Therefore, this noninvasive diagnostic tool seems to play an essential role in the prevention of cerebrovascular ischemia.

The authors present their experience relative to 5 patients with multiple carcinomas (synchronous and metachronous) of the large bowel. They underline that full examination of the colon before operation in all patients with primary colorectal cancer is necessary, and they propose a lifelong follow-up program after resection for early detection of multiple carcinomas.

The paper reports a case of mesenteric fibromatosis with familial polyposis, an association which was diagnosed as Gardner's syndrome, and highlights the complications connected to mesenterial desmoid tumours. In addition, the importance of radical surgical therapy of these neoplasias is underlined. Lastly, it is hypothesised that full screening of patients affected by familial polyposis might show a greater incidence of association between widespread polyposis and pathological changes attributable to Gardner's syndrome.