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Nel passato, le metodologie utilizzate per lo smaltimento dei rifiuti, quali l’utilizzo della discarica, l’incenerimento senza recupero di energia e lo sversamento in mare aperto, non hanno valorizzato i rifiuti come risorsa. Le Direttive successive, invece, si focalizzano sulla prevenzione dei rifiuti dove possibile o, alternativa-mente, sulla minimizzazione dei danni che i rifiuti provocano all’ambiente. In questo Paper, viene analizzata la progressiva modificazione del trattamento dei rifiuti urbani, facendo riferimento ad una Società che opera da ol-tre 15 anni nell’area della pianura lombarda, nel settore dei ser-vizi di pubblica utilità, quali servizi ambientali ed energetici ed eroga il servizio di igiene ambientale a 17 Comuni, servendo una popolazione complessiva di circa 110.000 abitanti., Vol 8, No 1 (2017): Issue 1/2017

Within an ampler strategy of optimization of the cycle of the refusal and in line with the recommendations of the European Union within the sustainable development, the enhancement of the present resources present in the end life products a crucial point. In this context, the processes of reorganization of the service of removing of urban waste is framed, aim at differentiating of the fractions according to their composition. The regulations of the European Union identified some best practices that, contextualized to the local reality, allow the exploitation of the limitations and the potentialities in the reorganization of the service in Pavia area. Strategic objectives, however, can be achieved only through a process of sensitization of the community. Through a careful examination of the picked fractions, the economic, environmental and energetic values are underlined in order to share them with the citizens, to enhance their awareness about this topic., Vol 7, No 4 (2016): Issue 4/2016

The purpose of this work is to examine the economic and environmental sustainability of a laboratory that carries out the necessary analyses for biogas production from biomass. The results emerging from the Business Plan were related to the state of facilities existing in the Lombardia region. The limits and potentiality of the sector were identified by means of the BEP Model (Break Even Point) in the geographic area of reference. The most interesting final results have revealed both the undeniable potential of the sector and its strategic role within the framework of the sustainable energy objectives of Europe 20-20-20. The network of laboratories, in fact, constitutes a guarantee and an element of security for the effective reduction of greenhouse gases., Economia Aziendale Online, Vol 6, No 2 (2015): Issue 2/2015

Background: “Windswept” deformity (WSD) consists of a non-frequent condition in which the patient presents a valgus deformity in one knee and a varus deformity in the other. We performed a review of the available literature to aggregate the accessible data on the outcomes of bilateral knee arthroplasty in patients with WSD and to discuss the surgical challenges that this condition might pose. Methods: A systematic review of the literature following the PRISMA guidelines was conducted. The relevant studies between 1979 and 2021 were identified. Four studies with a total of 68 patients were included for analysis. The mean follow-up for varus knees was 3.3 years, 3.1 years for valgus knees. The quality and rigor of the included studies was assessed using the Methodological index for non-randomized studies (MINORS). Results: All the studies reported improvement in knee function following knee replacement surgery, and a reduction in axial deviation of both knees, with similar results in valgus and varus knees in terms of patient satisfaction. The most relevant data were that unicompartmental knee arthroplasty (UKA) allowed for limited axial correction with slightly inferior functional results. Kinematic alignment (KA) allowed for similar results in both knees. Conclusion: The present review shows how satisfactory results can be achieved in both knees in patients with WSD and osteoarthrosis (OA). However, the operating surgeon should be aware of the importance of the implant choice in terms of functional outcomes. In the absence of extra-articular deformities, calipered KA total knee arthroplasty (TKA) can be performed on both knees with good axial correction and functional outcome. Level of evidence: II —Systematic review of cohort studies.

PURPOSE: A deficiency of posterolateral structures significantly increases the varus load on the ACL, while a chronic ACL lesion, the increased tibial rotation and the repetitive non-physiological knee motion, could affect and damage the integrity of the popliteus tendon. Therefore, the aim of the present study was to report the very long clinical outcomes of a combined single-bundle BPTB ACL reconstruction and popliteus plasty according to Bousquets technique, for the treatment of combined chronic anterior and posterolateral laxities. METHODS: Fifteen patients that underwent combined ACL reconstruction and popliteal plasty according to Bousquets technique were available at mean 26.8 ± 1.0 years (range 25.4-28.0 years). All the patients were evaluated clinically and 13 by means of KT-1000 Arthrometer as well. Subjective evaluation was performed with the subjective IKDC, WOMAC and a 0-10 VAS for pain scales. RESULTS: At clinical evaluation, 10 patients (67 %) presented a negative anterior drawer test; Lachman test was negative in nine patients (60 %); the varus stress test was negative in eight (53 %); and the dial test was negative in all but one patient (93 %). Only two patients (15 %) presented a side-to-side difference >5 mm at the instrumented laxity evaluation. CONCLUSION: The combined single-bundle BPTB ACL reconstruction and popliteal plasty according to Bousquets technique were able to produce very good long-term results, in terms of knee stability, subjective outcomes, functional results and return to sport activity, in case of chronic anterior and posterolateral laxities. LEVEL OF EVIDENCE: Retrospective case series, Level IV.

To evaluate mid-term clinical and radiographic outcomes after an original medial patellotibial ligament reconstruction in patients with patellar dislocation. METHODS: Twenty-nine knees (27 patients, 8 males and 19 females) treated for patellar dislocation with medialization of the patellar tendon medial third combined with medial and lateral release were evaluated clinically and radiographically at a mean follow-up of 6.1±2.5 years. Trochleoplasty was performed in case of severe flat trochlea (6 knees, 21%). Aetiology of patellofemoral instability was traumatic in 6 (21%) and atraumatic in 23 (79%) knees. The mean age at first dislocation was 19.2±10.1 years. WOMAC, subjective and objective IKDC, Kujala, VAS for pain, Tegner activity and EQ-5D scores were used. Anteroposterior, lateral and 30° axial views were performed for radiographic monitoring. RESULTS: There was a significant improvement of all clinical scores and significant reduction in knee pain. Twenty-four knees (83%) were normal or nearly normal by objective IKDC score at final follow-up. Radiographs showed a higher incidence of patella alta and flat trochlea in the atraumatic group. Severe signs of patellar osteoarthritis were found in 1 knee (3%). A higher body mass index (BMI) was correlated with worse pre-operative scores. Four knees (14%) were considered failures (2 further dislocations, 2 revision surgeries). The overall survival rate at 6 years was 0.811. CONCLUSIONS: The presented techniques produced good clinical and radiographic results at mean 6.1 years follow-up, with 14 % failures. Signs of patellofemoral dysplasia were found in patients with atraumatic patellar dislocation. BMI was related to worse pre-operative clinical status. LEVEL OF EVIDENCE: Retrospective study, Level IV.

1997/1998 XI Ciclo 1967 Versione digitalizzata della tesi di dottorato cartacea.