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High suspicion of scar endometriosis are painful no-dule in the abdominal scar. Wide surgical excision is the treatment of choice.Endometriosis has been described as the presence of endometrial tissue outside uterine cavity. Scar endometriosis (SE) is a rare disease reported in 0.03-1.08% of women following gynaecologic surgery. In our retrospective observational cohort study we studied anamnesis, symptoms, surgical procedures and outcomes linked to scar endometriosis in our medical experience from 2004 to 2018.We reviewed the medical records of 46 patients with a histopathological diagnosis of SE. All patients had a history of at least one previous caesarean section (n=46, 100%). Forty-two patients (91,3%) complained gradually growing nodular abdominal mass near or adjacent to caesarean incision scar, while only 4 patients (8,6%) complained aspecific abdominal pain. Ultrasound scan was performed in all patients (n=46, 100%) and mean size of the nodules at US was 26,8 ± 13,8 mm.All patients underwent surgery. Seven patients (15,2%) needed mesh implantation, while 39 patients (84,8%) underwent local resection with reconstruction of muscle fascia. Mean follow-up was 31,6 ± 14 months and no patients reported local recurrence of disease.

BACKGROUND: Abdominal compartment syndrome (ACS) is a clinical condition caused by an increase in intra-abdominal pressure. The incidence is variable, based on the type of patients taken into consideration, increasing exponentially in critical conditions, such as traumatized, burned patients in shock. The syndrome can also follow surgical procedures like transplantation of abdominal organs, for example configuring rare pictures such as RACS (post-transplant kidney syndrome). In most cases the symptoms are non-specific and varied according to the different etiology of the ACS, therefore the diagnosis may not be immediate. AIM: The aim of this work is to evaluate the best therapeutic approach based on the evidence in the literature. RESULTS: An early diagnosis, which can also identify the stages of intra-abdominal hypertension, is necessary to ensure the survival of the patient, implementing an integrated multidisciplinary treatment, expecially in the early stages of the development of the ACS. CONCLUSIONS: The definitive treatment is surgical and is based on the decompression of the abdomen.

Hyperparathyroidism is an alteration of the pathophysiological parathyroid hormone (PTH) secretion due or an independent and abnormal release (primary or tertiary hyperparathyroidism) by the parathyroid or an alteration of calcium homeostasis that stimulates the excessive production of parathyroid hormone (secondary hyperparathyroidism).There is not a standard, clinical or surgical, treatment for hyperparathyroidism. We review current diagnostic and therapeutic methods.In secondary hyperparathyroidism (2HPT) there is a progressive hyperplasia of the parathyroid glands and an increased production of parathyroid hormone. Several causes are proposed: chronic renal insufficiency, vitamin D deficiency, malabsorption syndrome. The tertiary hyperparathyroidism (3HPT) is considered a state of excessive autonomous secretion of PTH due to long-standing 2HPT and it's usually the result of a lack of suppression in the production of PTH. The pathophysiological implications are both skeletal and extraskeletal: it damages the cardiovascular system, nervous system, immune, hematopoietic and endocrine system. The introduction of new drugs has improved the survival of these patients, allowing the inhibition of the synthesis of PTH. Indication for surgical treatment is unresponsive medical therapy.There are no large prospective studies that comparing the medical and surgical treatment. The choice is not unique and we have to consider the singolar case and the clinical condition of the patient.

Background and aims A high prevalence of atherosclerotic lesions characterizes patients with chronic kidney disease, though there is little data on the relationship between kidney function and atherosclerotic changes in the healthy population or in people with no known renal impairment. The aim of our study was to analyze, in a comprehensive general population with no known kidney disease, the relationship between renal function and subclinical carotid atherosclerotic damage. Methods and results A general real-life population of 611 participants (233 males and 378 females; age ≥18 years) with no known kidney failure was selected for the study. The glomerular filtration rate (GFR) was estimated according to the CKD-EPI equation. Carotid intima-media thickness (c-IMT) and plaques were assessed by duplex Doppler ultrasonography of the carotid vessels. The main laboratory and metabolic parameters were evaluated in all participants. When we divided the overall study population into tertiles according to GFR values (I tertile 99 ml/min/1.73 m 2 ), the c-IMT mean values and the prevalence of carotid plaques decreased with the increasing tertile of GFR. On univariate analysis, c-IMT was significantly correlated with eGFR (r = −0.33; p 1 c). On multiple regression analysis, serum creatinine was associated with c-IMT (β = 0.069; p = 0.017), independent of other covariates. Conclusion Our study seems to suggest the importance of early identification of people with near normal or mildly decreased renal function due to its association with carotid atherosclerosis.

Patients who underwent primary inguinal hernia repair still report a high rate of postoperative pain after operation due to the effect of mesh fixation by suture.An alternative is the use of human fibrin glue. We compared the two techniques.468 patients randomly underwent primary inguinal hernia Lichtenstein repair fixing the mesh by suture or by human fibrin glue (HFG); in both cases the mesh was fixed to the posterior wall of the inguinal canal and to the inguinal ligament.No significant differences were recorded between the two groups in terms of complications, while the sutureless technique reduces the operative time and the postoperative pain.A widespread technique for the treatment of inguinal hernia is the application of a mesh using Lichtenstein procedure. The prosthesis can be fixed by traditional suture or using a new method of sutureless fixation with adhesive materials that shows an excellent local tolerability and lack of adverse effects and contraindications.

A well known problem in conventional cycling crank systems is the pedalling dead spot when the crank arms are in vertical position. The pedalling dead spot mitigates the power output during the propulsion phase of pedalling. The aim of this study was to verify the effects of a new design of crank system on aerobic parameters of performance in healthy non-cyclists. The mechanical concept of the new system is based on the theory that crank arms should never be perpendicularly aligned to the ground at dead spot.The maximal aerobic capacity (VO2 max) and different parameters of cycling efficiency were measured in 14 (mean±SD of age: 26±5) non-obese (body mass index: 26.0±3.0 kg/m2) healthy men in two different occasions at intervals of 2 days using alternately and in randomized order both the traditional crank system and the system without dead spot respectively.The workload performed was significantly higher with the new crank system as suggested by the higher exercise duration (12.89 ±2.36 vs. 13.33±2.30 min; P=0.032).The favourable results obtained in this study using the new chainring may be in consequence of a more efficient biomechanics of pedalling that does not reflect changes in O2 consumption and CO2 produced. However, it is not possible to exclude that involuntary motivational factors may have induced the difference in the time test since it was not possible to blind subjects about the two crank systems. Further investigations are necessary to confirm the results of this exploratory study and give a more exhaustive explanation about the mechanisms that allow the possible better performance with this new chainring system.

Subjects who are at increased risk of developing diabetes may have increased glycaemic variability associated with endothelial dysfunction and possibly subclinical atherosclerosis, which may lead to increased cardiovascular risk observed at the time of diabetes diagnosis. To investigate this hypothesis, we measured endothelial function, carotid intima-media thickness and glycaemic variability using 48-h continuous subcutaneous glucose monitoring in 3 groups of overweight or obese subjects--those without the metabolic syndrome, and those with the metabolic syndrome with or without newly diagnosed Type 2 diabetes.Consecutive subjects, aged 30-65 years with a body mass indexor= 25 kg/m(2) were recruited. Patients were classified as with or without the metabolic syndrome,or as metabolic syndrome with newly diagnosed Type 2 DM. Glycaemic variability was calculated in terms of the coefficient of variation. Endothelial function was measured using brachial artery flow-mediated dilation.We identified 75 subjects. Mean flow mediated dilation decreased (P0.001) and carotid intima-media thickness increased (P0.05) across groups. Flow mediated dilation predictors included mean 48-h continuous subcutaneous glucose monitoring values (beta = -0.022; P0.005) and the coefficient of variation (beta = -0.10; P = 0.01). Carotid intima-media thickness predictors included age (beta = 0.009; P0.001) and flow mediated dilation (beta = -0.014; P = 0.076). Patients re-stratified according to cut-offs for mean 48-h glycaemia and variability demonstrated that subjects with high mean glycaemia but low coefficient of variability had similar flow mediated dilation and carotid intima-media thickness to subjects with low mean glycaemia but high coefficient of variation.This study suggests that glycaemic variability influences endothelial function even in non-diabetic subjects. Such variability may explain the increased cardiovascular risk observed in patients prior to developing overt Type 2 diabetes.

A new series of fluorinated salts, iodides and trifluoromethanesulfonates, was synthesized from perfluoroalkylated 1,2,4-oxadiazolylpyridines. Their thermotropic properties were investigated by combined temperature resolved small angle and wide angle X-ray scattering, differential scanning calorimetry and polarised optical microscopy. The UV–visible and hotoluminescence properties were studied for all compounds. The results showed for two compounds the existence of an enantiotropic mesomorphic smectic liquid crystal phase. All iodides showed thermochromism phenomena suggesting prospective applications in optoelectronics.

The systematic use of video-fibro-endoscopy techniques has made it possible to precisely define an uncommon laryngeal pathology of traumatic origin: arytenoid subluxation. This pathology general arises after anesthesiological intubation and is characterized by a pathological anteromedial shift of one arytenoid resulting in cord immobility. The symptoms of this disorder are dysphonia similar to recurrent nerve palsy. Differential diagnosis is not always easy. The treatment of choice indicated in the literature is based on invasive approaches (reduction under direct laryngoscopy or, less frequently, even more aggressive surgery) while voice treatment plays a marginal role. The authors offer an overall picture of arytenoid subluxation in view of the anatomophysiological aspects of the crico-arytenoid articulation and describe a new approach to voice rehabilitation. While watching himself in the video-fibroscopy monitor (visual feedback), the patient performs a particular exercise enabling him to raise the larynx, lifting the arytenoids and causing hyperadduction and vibration of the arytenoid hood. After having learned the exercise the patient continues with regular speech therapy sessions and voice therapy at home. Periodically the patient undergoes video-endoscopy and phoniatric-speech therapy check-ups until vocal function and cord motility have been restored. This type of approach was applied in 4 patients, all of whom responded relatively quickly with reactivation of the articulation and recovery of the voice. The authors conclude that voice therapy can achieve full healing in patients with arytenoid subluxation and should be given priority over other forms of treatment. The excellent results are explained asserting that particular movement of the larynx can achieve a reduction in subluxation by rearranging the articulatory surface.

Even though autonomic diabetic neuropathy is highly prevalent and a noted risk factor for cardiovascular morbidity and mortality, very little is known about factors associated with it. We carried out standard autonomic nervous system function tests by means of a computerized portable system on 55 diabetic patients (22 with type 1 diabetes, 33 with type 2 diabetes) who had no signs or symptoms of autonomic diabetic neuropathy and on 10 age- and sex-matched healthy control subjects. Test results of patients with type 1 diabetes did not differ significantly from those with type 2 diabetes. Of the clinical, metabolic, and anthropometric variables considered, only the duration of diabetes was inversely and independently correlated to deep breathing test scores (E:I ratio value of deep breathing 1.38-0.009. years of diabetes; R2 = 0.25). The duration of diabetes was inversely correlated to variations in orthostatic systolic blood pressure (r = -0.37, p0.01). The prevalence of diabetic retinopathy (score: 1 = no; 2 = yes) was significantly higher in the diabetic group with lower deep breathing values (1.8 +/- 0.3 vs 1.0 +/- 0.0; p0.01). The prevalence of ischemic electrocardiographic alterations (score: 1 = no; 2 = yes) was significantly higher in the diabetic group with a poorer orthostatic systolic blood pressure response (1.4 +/- 0.1 vs 1.2 +/- 0.1; p0.01). This study suggests that 1) autonomic neuropathy is correlated to disease duration; 2) type of diabetes, present level of metabolic compensation, and anthropometric characteristics do not seem correlated to this complication; 3) diabetic retinopathy and ischemic cardiopathy may be correlated to autonomic neuropathy.

The aim of this study was to verify if there is a 1:2 correlation between subcutaneous adipose tissue thickness measured by ultrasonography and skinfold caliper and if this correlation varies in function of the degree of obesity, subcutaneous fat thickness, and the area evaluated. Forty women (age 27.9 +/- 11.7 years, body mass index 28.75 +/- 5.40 Kg/m2, waist to hip ratio 0.77 +/- 0.06) underwent ultrasonographic measurement of subcutaneous adipose tissue and skinfold caliper measurement at nine different sites (bicipital, tricipital, subscapular, suprailiac, epigastric umbilical, hypogastric, gluteal, and femoral). Data analysis confirmed a significant correlation between measurements made by ultrasonography and skinfold plicometry at all sites when the patients were not subdivided according to body mass index or skinfold thickness. When they were subdivided on the basis of body mass index, a significant correlation was found for subjects with a body mass index30; when the index was30, the correlation was observed at only the subscapular and suprailiac sites, and to a lesser degree at the tricipital and femoral sites. Moreover, a highly significant correlation was found only at sites at which ultrasonographic thickness was not20 mm (p0.001) with an r value decreasing progressively from 0.685 (thickness10 mm) to 0.248 (thickness40 mm). Given the great variability of this correlation, we suggest that ultrasonography is preferable to plicometry for the measurement of fat.

Rickettsia conorii is the etiologic agent of Boutonneuse fever, a rickettsiosis of the spotted fever group that is endemic in Southern Italy. Chloramphenicol or tetracyclines are still the treatment of choice for this disease, and recently quinolones have also been utilized with success. In 1994-95, 39 otherwise healthy patients were admitted to our unit for Boutonneuse fever. They were treated, in random order, with quinolones (10 subjects received ciprofloxacin, 500 mg/12 h per os; 8 subjects received intravenous pefloxacin, 200 mg/12 h), or tetracyclines (21 subjects received intravenous rolitetracycline, 275 mg/12 h). Outcome was favorable in all cases and no significant complications were observed. However, in a significant number of cases, increased blood concentrations of glutamic-oxalacetic (68.4%) and glutamic-pyruvic (60.5%) transaminases were found. Above normal blood creatinine values were observed in 29.7% of the cases, and urinanalysis disclosed blood in 35.9% and proteins in 56.4% of the cases. Both tetracyclines and quinolones were well tolerated and effective, with apyrexia achieved after 2.7 +/- 0.1 days (mean +/- SEM). All patients were discharged after an average of 7.1 +/- 0.4 days. Liver and kidney function derangements seem to occur to some extent in the acute phase of Boutonneuse fever. This finding might partially explain the increased mortality rate reported for subjects with simultaneous systemic or organ diseases or when the administration of an effective antibiotic is delayed. Together with chloramphenicol and tetracyclines, quinolones might be considered as first line antibiotics.

In order to assess to what extent familial factors play a role in thermogenesis of obese individuals, the 3 h response to a 100 g glucose oral load was measured in 11 obese subjects (6 m, 5 f) with a familial history of obesity and/or obesity-non-insulin dependent diabetes mellitus (NIDDM, group A); these were compared to 9 obese subjects (5 m, 4 f) without familial history of these disorders (group B). All subjects had normal glucose tolerance and the two groups were comparable with respect to anthropometric features. The glucose-induced thermogenesis of group A (7.9 +/- 1.2 per cent) above preload energy expenditure was significantly lower (P less than 0.01) than that observed in group B (13.5 +/- 0.5 per cent). The same conclusions were obtained when the results were expressed as a percentage of the glucose load ingested (4.4 +/- 0.67 and 7.8 +/- 0.80 in group A and group B respectively, P less than 0.01). Despite these differences the pattern of change in glycaemia, insulinaemia, C-peptidaemia and glucagonaemia in response to the glucose load was the same between the two groups. Total glucose oxidation as well as non-oxidative glucose disposal did not differ between the two groups. These results seem to support the hypothesis that genetic factors may contribute to the low thermogenic response observed in some individuals with a familial history of obesity and/or obesity-NIDDM.

We have constructed, tested, and calibrated a polarized He3 target system which facilitates p-He3 elastic scattering at proton energies as low as 2MeV. This system consists of a target cell placed in a uniform B field inside a scattering chamber and an external optical pumping station utilizing Rb spin exchange. Computer-controlled valves allow polarized He3 gas to be transferred quickly between the optical pumping station and the spherical Pyrex target cell, which has Kapton film covering apertures for the passing beam and the scattering particles. The magnetic field required to maintain He3 polarization in the target cell is created with a compact, shielded sine-theta coil. Target gas polarimetry is accomplished using nuclear magnetic resonance and calibrated using the known analyzing power of α-He3 scattering.

In 16 abdominal type obese males, in 16 gluteal-femoral type obese females and in 10 nonobese males and 9 nonobese females, as controls, the influence of body fat distribution on basal lipid oxidation was evaluated by indirect calorimetry. Basal lipid oxidation was significantly higher in the obese males (1.21 +/- 0.12 g/kg-FFM.die) than in the nonobese males (0.47 +/- 0.13 g/kg-FFM.die; p less than 0.001), but not significantly different between obese and nonobese females (0.98 +/- 0.16 and 0.89 +/- 0.13 g/kg-FFM.die; p ns). A significant correlation between basal lipid oxidation and percentage of body fat was found only in the male subjects (r = 0.51; p less than 0.01). These results suggest that basal lipid oxidation differs in the two sexes according to adipose tissue anatomic location.

In 7 obese subjects (3 males and 4 females), before (T0) and after (T60) weight loss, and in 10 nonobese subjects (4 males and 6 females) as controls, resting energy expenditure (REE) and body composition were evaluated. In obese subjects fat-free mass (FFM) and fat mass (FM) were significantly reduced after weight loss. REE, expressed in absolute value, was significantly higher in obese subjects at T0 with respect to controls (1683 +/- 77.3 vs. 1425 +/- 70.5 Kcal/day; p less than 0.05); in obese group REE was significantly lower at T60 (1563 +/- 63.5 Kcal/day) than at T0 (p less than 0.01). The decrease in REE observed in the obese group after weight loss was related only to the loss of FFM (r = 0.88; p less than 0.01). REE, expressed in relation to FFM, was not different between control and obese subjects at T0 (28.64 +/- 0.42 vs 26.40 +/- 1.08 Kcal/Kg-FFM/day; pns); however, this value was significantly lower in the obese group at T60 (25.99 +/- 1.07 Kcal/Kg-FFM/day) with respect to controls (p less than 0.05). It is concluded that a reduction in REE, due at least in part to the loss of FFM, may contribute to the difficulty in the maintenance of body weight often observed in obese subjects after a period on hypocaloric diet.

Introduction. The induction of pneumoperitoneum is the first and most critical phase of laparoscopy, due to the significant risk of serious vascular and visceral complications. The closed technique for the creation of pneumoperitoneum could lead to several surgical complications. The present study aimed to overcome the complications associated with the insertion of Veress needle, improving its use, and facilitating the rapid creation of pneumoperitoneum. Methods. Thirty large white female pigs were enrolled in our study. A common plunger was modified in order to allow the passage of a 15-cm long Veress needle. This method was applied to 26 laparoscopic procedures (26 pigs) of several specialist branches. Results. OneShot-M close laparoscopy pneumoperitoneum creation device allowed us to obtain pneumoperitoneum quickly in all attempts, without any intraoperative and postoperative complications related to the use of the Veress needle. Conclusion. The use of the proposed device showed an induction time as quick as the standard laparoscopic closed abdominal entry. The patented device is cheap and allows a safe abdominal entry. In addition, abdominal entry is much faster than the classic open technique.

Preference data are a particular type of ranking data where some subjects (voters, judges, ...) give their preferences over a set of alternatives (items). It happens, in most of the real cases, that some items receive the same preference by a judge, giving raise to a ranking with ties. The purpose of our paper is to investigate on the consensus between rankings with ties taking into account the importance of swapping elements belonging to the top (or to the bottom) of the ordering (position weights). Combining the structure of the Taux proposed by Emond and Mason and the class of weighted Kemeny-Snell distances, we propose a position weighted rank correlation coefficient to compare rankings with ties. The one-to-one correspondence between the weighted distance and the rank correlation coefficient holds, analytically speaking, using both equal and decreasing weights.

CONTEXT: Post-pancreatectomy hemorrhage is one of the most common complications after pancreaticoduodenectomy. OBJECTIVE: To evaluate the late post-pancreatectomy hemorrhage rate according to the International Study Group of Pancreatic Surgery criteria and to recognize factors related to its onset. METHODS: A prospective study of 113 patients who underwent pancreaticoduodenectomy was conducted. Late post-pancreatectomy hemorrhage was defined according to the criteria of the International Study Group of Pancreatic Surgery. Demographic, clinical, surgical and pathological data were considered and related to late post-pancreatectomy hemorrhage. RESULTS: Thirty-one (27.4%) patients had a post-pancreatectomy hemorrhage. Twenty-five (22.1%) patients developed late post-pancreatectomy hemorrhage: 19 (16.8%) grade B, 6 (5.3%) grade C. Surgical re-operation was performed in 2 out of the 25 cases with late post-pancreatectomy hemorrhage (8.0%) grade C associated with postoperative pancreatic fistula. At univariate analysis, the only factor significantly related to late post-pancreatectomy hemorrhage was postoperative pancreatic fistula (P

La radioterapia nel trattamento delle neoplasie della regione pelvica, a livello di utero, cervice, prostata, vescica e retto, è spesso associata all’insorgenza di proctite acuta e cronica. Mentre la proctite acuta tende a risolversi spontaneamente, la forma cronica è spesso difficile da trattare. Infatti la fibrosi e l’endoarterite obliterante, in alcuni pazienti, possono indurre fenomeni di telengectasia, stenosi e fistole. La complicanza più frequente è il sanguinamento da rottura di telengectasie, che pone spesso indicazione a trasfusioni croniche, a causa della cronica anemizzazione del paziente. Il trattamento medico della proctite post-attinica risulta spesso inefficace. Farmaci quali la sulfasalazina orale o l’applicazione locale di acido acetil-salicilico, di sucralfato o steroidi, non si sono rilevati idonei a indurre e a mantenere la remissione clinica. L’endoscopia è il trattamento di scelta del sanguinamento, attraverso l’utilizzo della termocoagulazione, l’applicazione di formalina e la coagulazione mediante l’utilizzo di laser ad argon o Nd:YAG laser. La comprovata efficacia del Nd:YAG laser nel controllo a lungo termine del sanguinamento ha favorito la sua diffusione e il suo utilizzo. In questo studio riportiamo la nostra esperienza su – pazienti, trattati dal 1997 al maggio 2008.

The hydrazinolysis reaction of 5-perfluoroalkyl-1,2,4-oxadiazoles with hydrazine or methylhydrazine as bidentate nucleophiles has been investigated. The reaction occurred through the addition of the bidentate nucleophile to the C(5)-N(4) double bond of the 1,2,4-oxadiazole followed by ring-opening and ring-closure (ANRORC) involving the second nucleophilic site of the reagent. This ring-closure step could involve either the original C(3) of the 1,2,4-oxadiazole (giving a five-to-five membered ring rearrangement) or an additional electrophilic center linked to it (exploiting a five-to-six membered ring rearrangement). An alternative initial nucleophilic attack may involve the additional electrophilic center linked at C(3), that is the carbonyl group, leading to the formation of the hydrazones which undergo the Boulton-Katritzky rearrangement (BKR). The chosen reaction path is a function of the used nucleophile and of the nature of the substituent at C(3). At variance with previous hypotheses, when methylhydrazine was used, the observed regiochemistry always showed the preferred initial attack by the less hindered NH(2) end of the nucleophile on C(5). Moreover, new spectroscopic evidence allowed the assignment of correct structures to the products formed by reaction of 5-perfluoroalkyl-3-phenyl-1,2,4-oxadiazoles with methylhydrazine.

Adrenal myelolipoma is a rare benign, non-functioning tumor consisting of fat and hematopoietic tissues. In January 2005 we had observed an adrenal myelolipoma in 70 year old man. During the follow-up for bladder urothelioma, an abdominal CT revaled a well delineated 4x4 cm homogeneous fatty mass in the right suprarenal area with negative attenuation values. The functional study of adrenal gland was normal. The patient underwent videolaparoscopic right adrenalectomy (Gagner technique). Postoperative course was uneventful. The istological diagnosis showed adrenal myelolipoma. We conclude that videolaparoscopic adrenalectomy should be considered the gold standard treatment for benign adrenal lesions.