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Cancer screening guidelines recommend annual screening with low-dose Computed Tomography (CT) for high-risk groups to reduce lung cancer mortality. Unfortunately, lung CT effectiveness can be strongly impacted by the considered reconstruction kernel. This selection is (almost) final, implying that it is no longer possible to change the used reconstruction kernel once applied, unless a sinogram for the conversion is available. The aim of this paper was to introduce a new sinogram-free kernel conversion in the contest of lung CT imaging. In particular, we wanted to define a procedure able to deal with different acquisition protocols, able to be used in an unpaired images scenario. To this aim, we leveraged a CycleGAN, considering the CT kernel conversion task as a style transfer problem. Results show that the CT kernel conversion can be effectively addressed as a style transfer problem.

Il notevole sviluppo, negli ultimi anni, del traffico motorizzato in tutti i centri urbani italiani ed europei non ha visto un corrispondente incremento della sensibilità di tecnici e progettisti nel tener conto delle loro specifiche esigenze nelle fasi di scelta degli interventi di manutenzione, di studio della segnaletica e di dimensionamento degli interventi di ingegneria della sicurezza. Inoltre negli ultimi anni sono cambiati gli stili di vita ed i modelli di mobilità in ambito urbano: sempre di più i viaggi aventi una unica destinazione (single-purpose journeys) sono stati sostituiti da spostamenti ed itinerari multi-scopo (multi-purpose) e/o multi-destinazione (multi-destination). L'analisi sistematica delle cause dell'incidentalità stradale testimoniano come la causa sia quasi sempre da ricercarsi nell'errore umano o più specificamente in debolezze dell'interazione fra guidatore e strada e/o guidatore e veicolo. Questa debolezza è tanto più evidente nella considerazione che negli ultimi decenni i progressi sulla sicurezza sono stati notevoli sul versante ingegneristico dei veicoli e della progettazione stradale, mentre il fattore umano giocoforza è rimasto il medesimo. Scopo del presente contributo è quindi quello di proporre dei primi strumenti operativi che consentano ai progettisti di integrare sempre più l'ingegneria della progettazione veicolare e stradale con la psicologia e le scienze cognitive che si occupano dello studio della mente e del comportamento. All'interno delle scienze cognitive l'ergonomia e lo studio dei fattori umani si occupano specificamente dell'analisi degli errori umani e dell'ottimizzazione della progettazione al fine di rendere l'interazione uomo-macchina la più funzionale e sicura possibile. Il compito non è facile per la variabilità e la complessità del processo di guida che coinvolge attori con caratteristiche psico-fisiche estremamente diversificate e per la grande variabilità degli ambienti e delle condizioni che è possibile riscontrare in ambito urbano. Questa complessità va colta, tuttavia, come una sfida e non come un ostacolo. Lo studio del comportamento di guida diviene una possibilità per meglio comprendere il funzionamento della mente e guadagnare conoscenza in campo psicologico. Nel contesto specifico questo contributo si occupa del ruolo dell'ergonomia e dei fattori umani nella regolazione dell'attenzione alla guida e nella regolazione della velocità con particolare riferimento alla mobilità stradale in ambito urbano.

È noto che le zone di transizione tra ambito extraurbano e urbano costituiscono dei punti critici della rete viaria. È necessario, pertanto, progettarle in sicurezza tenendo conto non solo dell’aspetto funzionale, ma anche della dinamica comportamentale dei conducenti, i cui meccanismi di comprensione, riconoscimento e decisione incidono pesantemente sul rischio di incidente. È possibile, infatti, influenzando la percezione dell’ambiente stradale degli utenti, modificarne la condotta di guida rendendola più sicura. A tal fine uno degli interventi più diffusi è la realizzazione di "porte di accesso" costituite da un restringimento della carreggiata associato a un'opportuna segnaletica verticale e orizzontale. Nella presente memoria, nell'ambito di una convenzione di ricerca tra la Provincia di Bologna e il dipartimento DICAM - Strade dell'Università di Bologna, se ne riporta un esempio realizzato sulla SP 610 “Selice-Montanara”, corredato dalla relativa valutazione dell'efficacia in termini di sicurezza di circolazione.

OBJECTIVE: The purpose of our study is to understand the compression, by subcutaneous fat in obese patients, who present a chronic increase in abdominal pressure, and on the sapheno-femoral cross. Such increase would result in a chronic venous insufficiency (CVI) of lower limbs and, if possible, it will be quantified also according to the posture. MATERIAL AND METHODS: We studied two different groups of patients with CVI: obese and non-obese. The severity of CVI was classified with the CEAP classification or by the standards of recent classifications. Abdominal pressure, by means of Kron's method, and anterior-sagittal diameter were measured in some of the non-obese patients (4 males and 4 females) and in all the obese patients. The diameter of the femoral vein of both groups of patients in supine, sitting and standing positions was also measured. RESULTS: We found a higher incidence of CEAP 5-6 classes in the obese group than in the non-obese one; we also saw a higher incidence of classes 1-2 in the non-obese group than in the obese one. Moreover, Kron's method showed a significant difference in abdominal pressure in relation to the BMI and the increase in the femoral vein diameter appears to be related to the weight and to the position. DISCUSSION: It was clear that the clinical manifestations of CVI are more severe in obese than in non-obese patients. Obesity in our study clearly acts with a continuous compressive action on the veins of the abdomen and thereby on the femoral vein, further contributing to a retrograde flow. So we tried to quantify an entity that until now could only be assumed.

OBJECTIVE: To test the usefulness of silver dressings in patients with skin ulcers in the healing phase after debridement. MATERIALS AND METHODS: After randomly selected a group of 30 patients and divided them into three groups (A, B and C) according to the type and severity of the ulcer, we used respectively for each group antiseptics-free dressings, hydrofiber dressings with a low or a high content of silver. Then we performed samples by aspiration from the bottom of the wound three times (zero time, after two weeks, after a month) to prepare bacterial cultures. RESULTS: In group A, 5 ulcers showed signs of critical colonization after two weeks and 2 of these showed evidence of infection without progression to healing after a month. In groups B and C, no ulcer showed signs of infection with negative cultures. In these two groups, wounds evolved towards healing. CONCLUSIONS: Silver dressings seem to be the best option for the prevention of reinfection of skin ulcers; silver concentration should vary according to the degree of ulcer contamination. Dressings with hydrofibers avoid the accumulation of secretions for bacterial growth which would compromise tissue repair.

È ormai noto che le zone di transizione tra ambito extraurbano ed urbano costituiscono un punto nero della rete viaria. Risulta pertanto necessario progettarle in sicurezza tenendo conto non solo dell’aspetto trasportistico, ma anche della dinamica comportamentale dei conducenti, i cui meccanismi di comprensione, riconoscimento e decisione incidono pesantemente sul rischio di incidente. È possibile, infatti, influenzando la percezione dell’ambiente stradale degli utenti, modificarne la condotta di guida rendendola più sicura. A tal fine uno degli interventi oggi più diffusi è la realizzazione di "porte di accesso" costituite da un restringimento della carreggiata associato a un'opportuna segnaletica verticale e orizzontale. Nella presente memoria, nell'ambito di una convenzione di ricerca tra la Provincia di Bologna e il dipartimento DICAM - Strade dell'Università di Bologna, se ne riporta un esempio realizzato sulla SP 610 “Selice-Montanara”, corredato dalla relativa valutazione dell'efficacia e dell'effettiva sicurezza.

INTRODUCTION: Laparoscopic adrenalectomy is a gold standard for the treatment of pheochromocytomas less than 6 cm in diameter. Given the difficulty in dissecting the adrenal glands, the presumed increase in the risk of malignancy, and capsular disruption there is controversy regarding minimally invasive surgery for neoplasms greater than 6 cm. The aim of this study was to report laparoscopic adrenalectomy results in 44 patients with pheochromocytomas either larger or smaller than 6 cm. METHODS: The retrospective clinical study was conducted on 44 patients who underwent surgery in the Campania region in Italy, between January 1998 and January 2008. In 30 cases the lesion measured ≤ 6 cm (group A) in diameter and in 15 > 6 cm (group B). The authors compared cardiovascular instability, operative time, conversion rate, incidence of intra and postoperative complications, length of hospital stay, and medium long term follow-up results in the two groups of patients. RESULTS: By comparing group A vs group B no significant differences were observed in operative time, incidence of intra and postoperative complications lenght of hospital stay or medium long term follow-up results. In patients with pheochromocytomas > 6 cm a higher conversion rate, although not statistically significant, was observed. The same occurred with cardiovascular instability shown by intraoperative sudden bouts of hypertension. One patient underwent "open" reoperation for residual retrocaval glandular tissue, not removed during laparoscopic treatment. CONCLUSIONS: Laparoscopic adrenalectomy for pheochromocytoma by experienced laparoscopic surgeon is safe and probably preferable also in selected cases larger than 6 cm. These patients may have a longer operative time, a greater intraoperative blood loss, a higher conversion rate, more intraoperative hypertensive crises than other patients. Adequate preoperative pharmacological therapy and careful anaesthesia monitoring make possible optimal management of cardiovascular instability.

Breast surgery is classified among the procedures performed in clean surgery and is associated with a low incidence of wound infection (3-15%). The objective of this study was to evaluate the advantages antibiotic prophylaxis in patients undergoing breast surgery. A multicenter randomized controlled study was performed between January 2008 and November 2008. One thousand four hundred patients were enrolled in prospective randomized study; surgical wound infection was found in 41 patients (2.93%). In our RCT we have shown that in breast surgery antibiotic prophylaxis does not present significant advantages in patients with potential risk of infection (17 patients, 2.42%, subjected to antibiotic prophylaxis vs 24 patients, 3.43%, without antibiotic prophylaxis) (P = 0.27). In patients with drainage there is a significant minor incidence of wound infections in patients receiving antibiotic prophylaxis (5 patients, 0.92%, subjected to antibiotic prophylaxis vs 14 patients, 3.09%, without antibiotic prophylaxis) (P = 0.02). CONCLUSION: This study is only a preliminary RCT to be followed by a study which should be enrolled more patients in order to get the results as statistically significant.

BACKGROUND: Intra Operative Nerve Monitoring (IONM) has been used in head and neck surgery since the 1970s. Its utilization for monitoring and protecting the recurrent laryngeal nerve, however, is a controversial subject. This paper details the use, value, and cost of this technology within a single institution. METHODS: We conducted a retrospective chart review, analysis of surgery time with and without IONM, analysis of postoperative vocal cord function, and review of the literature RESULTS: IONM did not reduce the operative time during total thyroidectomies in our experience. Use of IONM increased the cost of each surgery by € 450. IONM did not decrease the number of injured nerves (postoperative paresis). CONCLUSIONS: IONM has proven to be highly useful in certain circumstances but has not been definitively proven to protect the nerve any more effectively than the gold standard of nerve visualization. In our study, the use of IONM did not reduce the time of thyroid surgery and did increase the cost. While IONM may, in special clinical circumstances such as revision and malignant thyroid surgery, increase the value of the operation, its use for every thyroid surgery does not appear to be cost effective or valuable to the patient.

Direct laparoscopic visualization can be combined with intraoperative laparoscopic ultrasonography (LUS), which has shown a positive predictive value of resectability of 91%. Laparoscopic pancreatoduodenectomy (LPD) shows a high rate of complications and should be performed by very well-trained surgeons. Laparoscopic distal pancreatectomy (LDP) with an "en bloc" splenectomy and spleen preservation should be performed.

Background: The widespread use of surgical lasers has found place in dermatologic and aesthetic surgery largely because they are well tolerated with a reduced incidence of postoperative haemorrhage and oedema, few associated adverse events and a high rate of patient satisfaction. Patients and methods: A retrospective analysis of 1232 consecutive patients was performed on patients undergoing a range of laser treatments between January 2005 and January 2010. A mixed variety of indications for laser use included dermatologic surgeries for the removal of fibromas, angiomas and naevi, aesthetic surgeries for acne, superficial vascular conditions, facial rejuvenations and remodelling and tattoo removals as well as many miscellaneous conditions. A range of lasers were employed including CO2, Erbium: Yttrium Aluminum Garnet (Er:YAG), diodes, Alexandrite, Ruby and Neodymium:Yttrium Aluminum Garnet (Nd:YAG) lasers with variable use for different indications in combination with a selective protocol of topical anaesthesia and local cooling systems. Results: Patient satisfaction was high overall (92.4%) with most reported failures amongst those treated for general surgical conditions where there were the highest recorded complication rates. The main failures occurred in those with small cutaneous telangiectases (36.2% incomplete treatment response and 31.9% dissatisfaction rate). In those patients where lasers were used for aesthetic reasons,(most notably in those undergoing tattoo or scar removal and in those with hypertrichosis and dermatofolliculitis), incomplete results occurred in 7.2% with an 11.8% dissatisfaction rate and rare complications (0.9%). In this group, the highest reported incomplete results occurred in patients undergoing tattoo removal (13.9%), followed by scar removal (12.5%) and then by those undergoing treatment for hypertrichosis and dermatofolliculitis (8.8%). Conclusions: Laser use in general surgery is associated with a high success rate for a wide variety of conditions with high patient satisfaction and a low incidence of adverse events in experienced hands. The advantages and disadvantages as well as the specific recommendations for different laser types are presented with clinical advances resulting from the development of non-ablative laser systems designed for dermal remodeling. Key words: Cross-disciplinary, General surgery, Laser, Outpatient.

Usually, left colon cancer metastasis concerns liver, abdominal lymph nodes and lungs. Other localizations are quite rare occurrences. In spite of this, some uncommon metastasis sites are reported in literature, such as: peritoneum, ovaries, uterus, kidney testis, bones, thyroid, oral cavity and central nervous system. We report two cases of unusual localizations of left colon cancer metastasis localization, one into the retroperitoneal space and the other at the left axillary lynphnodes and between liver and pancreas. In the first reported case the diffusion pathway may have been the lymphatic mesocolic vessels, partially left in place from the previous surgery. In the second case the alleged metastatic lane may have been through the periumbilical lymph nodes to the parasternal lymph nodes and then to the internal mammary ones, finally reaching the axillary limph nodes.

Introduction.We carried out a retrospective analysis of our experience in the management of Differentiated Thyroid Carcinoma (DTC), in order to better define prognostic factors (age, gender, histological type, stage) and outline a standard procedure, where it’s possible, for surgical treatment. Patients and methods. Patient population consisted of 432 cases, operated from 1978 to 2003. We carried out 285 operations of total thyroidectomy of which 39 associated to some kind of lymphadenectomy, 66 totalization (21 pts had been operated in other institutes), 60 subtotal thyroidectomies and 21 lobo-isthmectomies. Survival and mortality curves for age, sex, histological type, grading and staging have been calculated. Kaplan-Meyer statistical elaboration for diseasefree interval and Mann-Withney test for the comparison of different clinical and pathological data have been employed. Results. The statistical analysis puts in evidence that on 432 cases examined, with a follow-up from 1 to 25 ys (median = 6.33 ys) and with a drop-out of 60 cases (13.8 %), total mortality for cancer has been of 24 cases (6,4%), with a median interval free by disease of 4.2 ys (range 5 months to 25 ys), and a probability to stay free by disease at 12 and 24 months respectively of 95.1% and 91.6%. The median survival is resulted of 5.8 ys (range 1 to 25 ys) with a probability of survival at 24 and 48 months respectively of 97.5% and 94.3%. The multivariate analysis evidences the most important variables, i.e. age > 45 ys, tumor of intermediate malignancy, with size 1.5 cm, operative M+, significantly condition the prognosis, noticeably getting worse it, indipendently by the kind of carried out operation. Conclusion. Our present therapeutic choises are: 1. total thyroidectomy in the treatment of the apparently benign pathology when bi- INTRODUCTION: We carried out a retrospective analysis of our experience in the management of Differentiated Thyroid Carcinoma (DTC), in order to better define prognostic factors (age, gender, histological type, stage) and outline a standard procedure, where it's possible, for surgical treatment. PATIENTS AND METHODS: Patient population consisted of 432 cases, operated from 1978 to 2003. We carried out 285 operations of total thyroidectomy of which 39 associated to some kind of lymphadenectomy, 66 totalization (21 pts had been operated in other institutes), 60 subtotal thyroidectomies and 21 lobo-isthmectomies. Survival and mortality curves for age, sex, histological type, grading and staging have been calculated. Kaplan-Meyer statistical elaboration for disease-free interval and Mann-Whitney test for the comparison of different clinical and pathological data have been employed. RESULTS: The statistical analysis puts in evidence that on 432 cases examined, with a follow-up from 1 to 25 ys (median = 6.33 ys) and with a drop-out of 60 cases (13.8 %), total mortality for cancer has been of 24 cases (6,4%), with a median interval free by disease of 4.2 ys (range 5 months to 25 ys), and a probability to stay free by disease at 12 and 24 months respectively of 95.1% and 91.6%. The median survival is resulted of 5.8 ys (range 1 to 25 ys) with a probability of survival at 24 and 48 months respectively of 97.5% and 94.3%. The multivariate analysis evidences the most important variables, i.e. age > 45 ys, tumor of intermediate malignancy, with size 1.5 cm, operative M+, significantly condition the prognosis, noticeably getting worse it, independently by the kind of carried out operation. CONCLUSION: Our present therapeutic choices are: 1. total thyroidectomy in the treatment of the apparently benign pathology when bilaterally with spread; the checking at the final histological exam of a cancer makes however think adequate the carried out operation; 2. lobo-isthmectomy in the treatment of unilateral benign pathology or with suspect FNAB for follicular neoplasm; the histological checking of a cancer makes think the operation adequate only in presence of favourable prognostic parameters, but in presence even of just one unfavourable variable, we consider necessary the totalization; 3. total thyroidectomy in presence of a certain or strongly suspected preoperative diagnosis of cancer.

Breast cancer in elderly patients occurs frequently and is often inadequately managed. Furthermore, for organizational and social reasons, the incidence of locally advanced neoplasms is higher in this age group than in the younger population. The aim of the study was to assess our experience in this specific pathology and review the international literature on this topic. From 2001 to 2005 116 cases of breast cancer in elderly women (70-95 years old) were observed by our surgical units. Of these, 38 were at a locally advanced stage (10--26.3%--stage IIIA, 28--73.7%--stage IIIB). Comorbidity (two or more diseases) existed in 32 patients. A Madden modified radical mastectomy was carried out in all cases. Resection was extended to the chest-wall tissues in cases of local infiltration. Surgical mortality was 10% (4 cases). Eight of the 34 patients discharged died within 24 months (2 of disease progression). Adjuvant chemotherapy was never offered. On the other hand, all patients received hormone therapy (tamoxifen). 10 of the 26 patients (38.4%) surviving over 2 years underwent redo surgery for local relapse of disease. Our conclusions are: 1) breast cancer in elderly patients is often underestimated and undertreated; 2) disease management cannot be standardized, but must be tailored to the single patient; 3) short- and medium-term results are satisfactory; 4) comorbidity must be carefully assessed. Breast cancer in elderly patients occurs frequently and is often inadequately managed. Furthermore, for organizational and social reasons, the incidence of locally advanced neoplasms is higher in this age group than in the younger population. The aim of the study was to assess our experience in this specific pathology and review the international literature on this topic. From 2001 to 2005 116 cases of breast cancer in elderly women (70-95 years old) were observed by our surgical units. Of these, 38 were at a locally advanced stage (10--26.3%--stage IIIA, 28--73.7%--stage IIIB). Comorbidity (two or more diseases) existed in 32 patients. A Madden modified radical mastectomy was carried out in all cases. Resection was extended to the chest-wall tissues in cases of local infiltration. Surgical mortality was 10% (4 cases). Eight of the 34 patients discharged died within 24 months (2 of disease progression). Adjuvant chemotherapy was never offered. On the other hand, all patients received hormone therapy (tamoxifen). 10 of the 26 patients (38.4%) surviving over 2 years underwent redo surgery for local relapse of disease. Our conclusions are: 1) breast cancer in elderly patients is often underestimated and undertreated; 2) disease management cannot be standardized, but must be tailored to the single patient; 3) short- and medium-term results are satisfactory; 4) comorbidity must be carefully assessed.

Interstitial lasertherapy (ILT) is one of the percutaneous thermal procedures allowing the ablation of primary or secondary hepatic lesions. This technique can be performed without general anaesthesia, since the patient is completely painless, in spite of the high temperatures reached, because there are no sensitive fibers around the lesion. This study includes patients with small hepatocarcinomas (< 2 cm) non peripherically sited, far from the gallbladder and the hepatic hilum. Twenty patients suffering from 24 cirrhotic hepatocarcinomas (two patients showed two nodules) have been enrolled for the present study. Mean diameter of lesions was 1.8 cm (1.3-2 cm). One or more 21 G (length 20 cm) Chiba's needles were inserted under sonographic view into the lesions. The laser energy was switched on at 4 Watts for 4-6 minutes, until an amount of energy of 900-1800 Joule was reached. All the patients were discharged 48 hours after the procedure. Triphasic CT-scan with contrast were performed 7 to 14 days after ILT, in order to check its efficacy. CT-scan showed complete necrosis in all the nodules ranging from 1.5 to 3 cm. All the patients received only one IL T session, whose longest duration was 20 minutes. No major complications occurred. ILT of small hepatocarcinomas is a safe, efficient procedure, also feasible without anaesthesia. Differently from percutaneous radiofrequency, in fact, it shows the advantage of less pain, that can avoid the need for general anaesthesia. Interstitial lasertherapy (ILT) is one of the percutaneous thermal procedures allowing the ablation of primary or secondary hepatic lesions. This technique can be performed without general anaesthesia, since the patient is completely painless, in spite of the high temperatures reached, because there are no sensitive fibers around the lesion. This study includes patients with small hepatocarcinomas (< 2 cm) non peripherically sited, far from the gallbladder and the hepatic hilum. Twenty patients suffering from 24 cirrhotic hepatocarcinomas (two patients showed two nodules) have been enrolled for the present study. Mean diameter of lesions was 1.8 cm (1.3-2 cm). One or more 21 G (length 20 cm) Chiba's needles were inserted under sonographic view into the lesions. The laser energy was switched on at 4 Watts for 4-6 minutes, until an amount of energy of 900-1800 Joule was reached. All the patients were discharged 48 hours after the procedure. Triphasic CT-scan with contrast were performed 7 to 14 days after ILT, in order to check its efficacy. CT-scan showed complete necrosis in all the nodules ranging from 1.5 to 3 cm. All the patients received only one IL T session, whose longest duration was 20 minutes. No major complications occurred. ILT of small hepatocarcinomas is a safe, efficient procedure, also feasible without anaesthesia. Differently from percutaneous radiofrequency, in fact, it shows the advantage of less pain, that can avoid the need for general anaesthesia.

It has been shown that magnetic resonance cholangiopancreatography (MRCP) has a diagnostic accuracy comparable to that of ERCP. The aim of this study was to compare the diagnostic accuracy of MRCP in patients with suspected choledocholithiasis, but with negative ultrasonography findings. Among 404 patients undergoing videolaparocholecystectomy for cholelithiasis, 48 with risk factors for coledocholithiasis were evaluated. All the patients with risk factors underwent preoperative hepatobiliary ultrasonography and MRCP. Patients were assigned to one of 2 main groups: A) patients with common bile duct stones at ultrasonography (15/48: 31%) and B) patients without evidence of common bile duct stones on ultrasonography (33/48: 69%), with B comprising two subgroups: B1) MRCP-positive for stones (7/33:21%) and B2) negative US and MRCP (26/33:79%). MRCP showed 100% sensitivity and 100% specificity. The high sensitivity of MRCP allows us to recommend a greater use of the procedure with avoidance of unnecessary ERCP, which should be reserved for therapeutic purposes only.

Laparoscopic cholecystectomy (LC) is associated with an higher incidence of bile duct injury than open cholecystectomy. There has been concern and the reason why bile leakages are more frequent with LC is yet unclear. Bile collections can occurr because of major about (75%) or minor (about 25%) injuries. Anyway, external biliary decompression is a key factor in the treatment, in order to avoid an emergency intervention. The Authors report their experience concerning 3 cases of bile leakages among a series of 458 LC. Only in one of the three cases the subhepatic space was not drained and an emergency laparotomy was performed. The Authors, on the basis of their own experience and of the data reported in literature, suggest the routinary intraoperative placement of a drainage into the subhepatic space, to be removed, if no complications occur, one day after surgery. Laparoscopic cholecystectomy (LC) is associated with an higher incidence of bile duct injury than open cholecystectomy. There has been concern and the reason why bile leakages are more frequent with LC is yet unclear. Bile collections can occurr because of major about (75%) or minor (about 25%) injuries. Anyway, external biliary decompression is a key factor in the treatment, in order to avoid an emergency intervention. The Authors report their experience concerning 3 cases of bile leakages among a series of 458 LC. Only in one of the three cases the subhepatic space was not drained and an emergency laparotomy was performed. The Authors, on the basis of their own experience and of the data reported in literature, suggest the routinary intraoperative placement of a drainage into the subhepatic space, to be removed, if no complications occur, one day after surgery.

Hypocalcemia is one of the most frequent complications after total extracapsular thyroidectomy (TET). In most of cases it is a transient phenomenon. The aim of this study is to evaluate if and how the oral administration of calcium or calcium combined with D-vitamin could effectively prevent post-thyroidectomy hypocalcemia. A randomized prospective study was performed, recruiting 120 patients who underwent total thyroidectomy. The patients in our series were randomly assigned to one of two groups: group A--patients who received calcium lactogluconate/calcium carbonate (mg 300 per day); group B--patients who received calcium carbonate/cholecalciferol therapy (calcium carbonate: 1500 mg per day; cholecalciferol 400 UI per day). The groups were well matched for age, sex and pathologies. Patients of both A and B groups were divided in two subgroups: those operated on for benign thyroid diseases (A1 and B1) and those operated on for malignancy (A2, B2). Serum calcium assays, performed 24, 48 and 72 hours after surgery, showed mean values of calcemia higher in patients of the B1 and B2 group. Statistical analysis was performed using a Student's t test. Mean serum calcium concentrations on post-operative day one, two and three were higher in patients of the group B (p<

Aim: In the present study the Authors assess the advantages of new technologies in thyroid surgery: to prevent nerve injury by using an intra-operative continuous nerve-monitoring techniques and to compare the real advantages of advanced coagulation devices. Materials and methods: Among a series of 440 thyroidectomies (jan 2004-feb 2006) the Authors reviewed charts from two groups: 1) 240 total thyroidectomies performed using the traditional monopolar electrocautery, non-absorbable stitches for the principal vascular pedicles. 2) 140 total thyroidectomies performed using dedicated small bipolar electro thermal coagulator (Ligasure-Precise®). 3) Since 2006 in a double blind group selection of 70, we've performed Sutureless Thyroidectomy with continuous intraoperative nerve monitoring using dedicated endotracheal tube. Mean operative time, post-operative bleeding, post-operative stay, incidence of transient or definitive laryngeal nerve lesions, incidence of permanent or transient hypocalcaemia, costs of the procedures were analyzed. Results: Major complications in the first two groups compared with the data of the literature are absolutely over-imposable, except a reduction of incidence of transient hypocalcaemia in the Precise group, but if we compare data of the 3rd group (NIM), we find a significative reduction of transient and permanent laryngeal nerve palsy incidence. Discussion and conclusion: This new technology offers several advantages: (1) atraumatic; (2) easy to use; (3) continuous monitoring and audio feedback to the surgeon (4) works outside the operation field (5) high sensitiveness. Costanalysis confirm that NIM + Ligasure have same or less cost and time and probably less complications than traditional Total Thyroidectomy.

Introduction: Our preliminary study examined the development of an advanced innovative technology with the objectives of: - developing methodologies and algorithms for a Artificial Neural Network (ANN) system, improving mammography and ultra-sonography images interpretation; - creating autonomous software as a diagnostic tool for the physicians, allowing the possibility for the advanced application of databases using Artificial Intelligence (Expert System). Materials And Methods: Since 2004 550 F patients over 40 yrs old were divided in two groups: 1) 310 pts underwent echo every 6 months and mammography every year by expert radiologists. 2) 240 pts had the same screening program and were also examined by our diagnosis software, developed with ANNES technology by the Engineering Aircraft Research Project team. The information was continually updated and returned to the Expert System, defining the principal rules of automatic diagnosis. Results: In the second group we selected: Expert radiologist decision; ANN-ES decision; Expert radiologists with ANNES decision. The second group had significantly better diagnosis for cancer and better specificity for breast lesions risk as well as the highest percentage account when the radiologist's decision was helped by the ANN software. The ANNES group was able to select, by anamnestic, diagnostic and genetic means, 8 patients for prophylactic surgery, finding 4 cancers in a very early stage. Discussion And Conclusion: Although it is only a preliminary study,this innovative diagnostic tool seems to provide better positive and negative predictive value in cancer diagnosis as well as in breast risk lesion identification.