M. Frascio

Mini abstractWe tested usability, safety, and ability to manage elective surgery flow of a multidisciplinary pathway adopting the SWALIS-2020 model in an interhospital setting during the COVID-19 pandemic. This pilot included 295 adults. The pathway prioritized, monitored and scheduled surgery in an 840.000-inhabitants area. Using the COVID-19-GOA-Sur-MDT-SWALIS-2020 model may be warranted.Structured abstractThe COVID-19 outbreak burdens non-COVID elective surgery patients with figures similar to the SARS-Cov-2, by creating an overwhelming demand, increasing waiting times and costs. New tools are urgently needed to manage elective access. The study assesses the “SWALIS-2020” model’s ability to prioritize and optimize access to surgery during the pandemic.A 2020 March - May feasibility-pilot study, tested a software-aided, inter-hospital, multidisciplinary pathway. All specialties patients in the Genoa Departments referred for urgent elective surgery were included in a multidisciplin...

Twenty-one subjects suffering daily from fecal incontinence were treated with biofeedback training as a rehabilitative trial. Fifteen of these patients had incontinence following surgical interventions; the other six had senile incontinence. A device was employed to record the pressure existing at the level of the anal canal and to stimulate the rectal ampulla to control the performance of the external anal sphincter and the sensibility of the rectum. Of the 31 treated patients, eighteen (86%) presented good results with satisfactory recovery of anal incontinence, and three subjects (14%) showed unsatisfactory results (more than one episode of incontinence monthly). Although both groups of patients showed improvement in external anal sphincter contraction, the sensibility of the rectum to endoluminal distention improved more in good responders. The employment of biofeedback training to obtain improvement of the threshold of rectal sensibility (minimal volume of endoluminal distentio...

The development of reconstructive venous surgery has been hampered by the lack of suitable graft materials. Fourteen carbon fibre grafts (phi: 8 mm), 30 glutaraldehyde treated ovine collagen grafts and 29 polytetrafluoroethylene (PTFE) grafts were used to replace a 35 mm segment of infrarenal inferior vena cava in pigs. Prostheses were removed 1 hour and 7, 14, 28, 56 and 112 days after implantation. All specimens were examined by light and scanning electron microscopy. The 112 day patency rate was 67% for ovine collagen grafts, while all carbon and PTFE grafts thrombosed. The difference was statistically significant (p less than 0.01). During the first hour after implantation, a thick (800-900 microns) thrombotic layer deposited on the inner surface of carbon grafts. This layer possibly caused the subsequent complete occlusion of the tubular segments. A thin neointima (less than 200 microns) developed on the flow surface of ovine collagen prostheses. This favoured complete endothel...

: A survey was made in 13 Italian centers with a questionnaire concerning the (a) indications, (b) postoperative complications, (c) functional results and (d) diagnostic imaging modalities related to the making of an ileal or colonic (neo) rectum. Ulcerative colitis (100%), familial polyposis (61.5%) and Crohn's disease (15.3%) were the most common indications for an ileal pouch; rectal cancer (7.96%), chronic inflammatory diseases (15.3%), diverticulosis, rectal prolapse, redundant colon and imperforate anus (7.6% each) were the most common indications for a colonic pouch. Postoperative complications included pelvic abscess (14%), sinus tract/dehiscence (10%) and bowel obstruction (9%). When compared with the S and W variants, the J-shaped ileoanal pouch proved superior because urgency and fecal retention rates were lower (18.4% vs. 44.4% and 23% vs. 28.6%, p < 0.01 and p < 0.05, respectively), despite slightly more frequent staining episodes (15.8% vs. 11.1%; p < 0.05). As for colonic ampullae, fecal retention and provoked evacuation were more frequent in the J pouch and after gracileplasty; urgency and incontinence in the straight colo-anal anastomosis (33.3% vs. 22.2% and 41.6% vs. 33.3%, respectively). The functional outcome was assessed by anal endosonography (available in 4/13 centers), defecography and anorectal manometry. Abnormal findings included: (a) reduced capacity, barium leakage, anal gaping, sphincter damage (urgency and incontinence); (b) barium retention, pouch dilatation, split evacuation, knobs and strictures (fecal retention).

The ageing process of general population implies new socio-sanitary problems. Indications for surgical intervention have been modified and enhanced. As far as elective surgery is concerned, the results in elderly subjects do not seem alarming, whereas less satisfactory results have been registered in the patients who underwent an emergency surgical intervention, where nowadays morbidity and mortality still turn out to be high. The Authors have reported their experience of emergency surgery in the geriatric patient. From 1982 to 2002, 718 pts (361 males, 50.3% and 357 females, 49.7%; average age 50 yrs, range 5-92) underwent emergency surgical interventions for abdominal lesions. The pts were subdivided in two groups: group A (> 65 years; 190 pts, 87 males and 103 females; average age 72 yrs, range 66-92); control group B (<65 years; 528 pts, 274 males and 254 females; average age 43 yrs, range 5-65). The results were assessed in terms of morbidity and of the operative and post...

Industrial mass casualty incidents are an unfortunate reality in the 21st century, but there are few situational training exercises to prepare and to cope with emergencies management. The Authors realized a project to carry out development of the activities devoted to face the complexities arising from emergencies in industrial plants. The DIEM-SSP is a simulation project working on two interoperable simulators, based on the IEEE 1516 High Level Architecture (HLA), used as test-bed on specific case studies. The project is aimed to study innovative emergency procedures and proper routing of critical patients with severe traumas toward the most suitable first aid facilities. The project takes into account the emergency procedures considering the human factor and the possibility of mistakes. It is aimed to test and validate these methodologies through a test-bed based on distributed and interoperable simulation. The Authors report the medical contribution in this project.

BACKGROUND The observation that in more than 90% of Crohn's disease patients the postoperative recurrences are located in the pre-anastomotic tract leads us to suppose that the anastomosis would play a role in the appearance of recurrences. AIM AND METHODS To focus the role of different anastomotic configurations in the incidence of recurrences, the Authors have conducted a review of the literature of the last two decades and have revised critically their experience. RESULTS The rate of recurrences seem to be lower in patients in whom the anastomotic configuration is such as to present a wide lumen; it seems that they are lower after stapled side-to-side anastomosis. The Kono-S anastomosis, recently introduced technique, seems to offer better results. CONCLUSIONS The role of the various types of anastomosis remains uncertain. Further large-scale controlled trials with long term follow-up are needed. KEY WORDS Anastomosis, Crohn's disease, Postoperative Recurrences.

Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. The hypothesis is that a significant reduction in the number of emergent appendectomies was observed during the pandemic, restricted to complex cases. The study aimed to analyse emergent surgical appendectomies during pandemic on a national basis and compare it to the same period of the previous year. This is a multicentre, retrospective, observational study investigating the outcomes of patients undergoing emergent appendectomy in March–April 2019 vs March–April 2020. The primary outcome was the number of appendectomies performed, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs open) and the complication rates. One thousand five hundred forty one patients with acute appendicitis underwent surgery during the two study per...

Abstract This work aims to explore innovative joining processes for additively manufactured components, and, in particular, to assess the feasibility of hybrid weld-bonded joints by comparing their performance with the baseline bonded and welded joint configurations. The novelty of the proposed solution lies in the fact that welding is achieved using a 3D printed material with conductive filaments, a solution derived from the use of embedded 3D printed circuits (direct printing) in the AM components. Direct printing can be used to obtain an accurate local control of the thermal cycle and to overcome geometrical limitations inherent to the process, as for example the need of access for the welding tools. The feasibility of the hybrid weld-bonded joint was assessed and, while for adhesive bonding the use of dedicated surface treatments was found to be necessary to improve the joint performance, the welding process was determined to be the most promising joining process, especially when directly integrated into a multi material additive manufacturing (MMAM) process.

Aims and background Carcinoids of the appendix continue to be of interest, despite their low incidence. There is still considerable controversy surrounding these tumors, especially with regard to the role of right hemicolectomy in the surgical management. The aim of this work was to explicate the current therapeutic knowledge and to review the criteria for the indications of appendectomy or hemicolectomy. Methods The records of patients who underwent appendectomies from 1990 to 2000 were analyzed. Seven patients were included in the study. The clinical data were reviewed for demographic details, tumor size, localization in the appendix, histological patterns and surgical procedures. All patients underwent appendectomy including removal of the mesenteriolum, and in one of them a right hemicolectomy was performed 3 weeks later. The mean follow-up was 7 years (range, 4–14). Follow-up data included symptoms, urinary 5-hydroxyin-doleacetic acid, ultrasound examination, computerized tomog...

The objective of this study was to evaluate outcomes of mesh versus primary suture procedures for repair of anterior abdominal wall midline hernias. Between 1995 and 2005, 98 patients (46 males) underwent repair of umbilical (69 cases) or epigastric (29 cases) hernias. Primary suture of the defect was performed in 34 cases (group 1). A polypropylene mesh was positioned in 64 cases (group 2). Overall, mean aponeurotic defect diameter was 2.5 cm (range 0.5 +/- 10 cm). Procedures were carried out under local anesthesia in 76 instances (71% group 1 vs. 81% group 2). Complications occurring in group 2 comprised three seromas, one hematoma and one prosthetic infection. Follow up was scheduled yearly up to the fifth postoperative year. Recurrence rate in group 1 was 14.7% compared to 3.1% in group 2 (logrank test p 0.0475). Anterior preperitoneal mesh repair of abdominal wall midline hernias under local anesthesia seems to be a safe and effective technique that can be performed as a day su...

Crohn's disease is associated with high rates of postoperative recurrence. By 10 years postoperatively a high percentage of patients suffer clinical relapses (as many as 75% and above) and many of these (up to 45%) require re-intervention. The aim of the study was to identify, among the various potentially predictive factors, those which today can be considered real risk factors for postoperative recurrence. A review of the literature of the last two decades was carried out. Factors related to the patient, disease, type of surgery and pharmacological treatment were analysed. The relapse rate we recorded was 41.17% (28 of 62 patients operated on in the last 20 years and included in an average 6-year follow-up (range: 1-19 years). Significant predictive factors, in adition to duration of the follow-up and smoking, are also the location of the disease in the colon, extent more than 100 cm and the absence of postoperative pharmacological prophylaxis. The high incidence of postoperat...

The aim of the present study was to evaluate the gastro-duodenal motility coordination, both during the interdigestive phase and after antroduodenal volumetric stimulus. It has been proved that it is possible to evoke the peristaltic gastric activity by stretching the gastric walls. Thus, the Authors simulated the mechanical conditions of the meal by inflating air into the antrum. They studied 5 healthy volunteers, whose age averaged 43 +/- 22.85 years. A 120 cm probe provided with two balloons at 7 and 21 cm from the distal end, and with 7 open-tips for manometric recording, was positioned by endoscopic way. The Authors were able to evaluate the Motor Antral Threshold (i.e. minimum air volume able to evoke an antral motor reflex), obtained by means of the antral inflatable balloon. The average values of this threshold showed to be 35 +/- 5 ml of air. While keeping the duodenal balloon inflated, the repetition of volumetric antral stimulus did not show any Motor Antral Threshold. Th...

A retrospective study is reported carried out on a group of 166 patients affected by dyspeptic syndrome who presented at least 3 of the 9 symptoms which characterise this pathology. One hundred and twenty-eight patients underwent prokinetic drug therapy and 38 received placebo. Clinical parameters were evaluated following one month of therapy all patients in order to compare them to basal values. The results obtained confirm a satisfactory efficacy of the prokinetic treatment in improving dyspeptic symptoms. Although administered to a smaller number of patients, placebo was also found to play an important role in the multifactorial etiopathogenesis of the dyspeptic syndrome on a functional basis.

New technologies have improved the ability of electronically storing, transferring and sharing medical data; they also create serious questions about who has access to this cross-media content and how it is protected and distributed. Doc@Hand provides a consistent level of ...

Approximately 90% of endoscopic and open surgical procedures generate some level of surgical smoke. (Ulmer B, 1998). Lasers and electrosurgery devices commonly used to cut, coagulate, vaporize, and ablate tissue are the \u201chot\u201d tools that cause targeted cells to heat to the point of rupturing the cellular membrane and spewing cellular contents into the air as surgical smoke. Through continuous exposure, the inhalation of surgical smoke can become harmful to the surgical team members. Plume can also be hazardous to patients during laparoscopy or other endoscopy procedures when the contaminants of surgical smoke are absorbed into the patient\u2019s vascular system. Research studies have repeatedly highlighted the hazards of surgical smoke during laser use so smoke evacuation has been accepted as a common practice. Unfortunately evacuation of smoke generated during electrosurgery has not been as widely accepted even though research has been definitive in proving inhalation hazards. One of the most interesting paper, by Tomita, demonstrated that using an electrosurgery device on one gram of tissue, inhaling the plume was equivalent to smoking 6 unfiltered cigarettes. This study demonstrated that plume generated during electrosurgical procedures has the potential to be twice as harmful as the smoke produced during laser surgeries. (Tomita et al., 1989) The bottom line is that all surgical smoke should be considered as harmful if not evacuated appropriately. Unfortunately many healthcare professionals are indifferent and do not feel the need to evacuate plume since they have been breathing it for years. The following toxic chemical byproducts have been identified in surgical smoke resulting from tissue pyrolysis: (Hoglan, 1995 and Ott, 1993) acrolein, acetonitrile acrylonitrile, methane phenol polycyclic aromatic hydrocarbons propene propylene pyridene pyrrole styrene toluene xylene, acetylene alkyl benzenes, benzene, butadiene, butane, carbon monoxide creosols, ethane, ethylene, formaldehyde, free radicals hydrogen, cyanide isobutene. Complete evacuation of surgical smoke is necessary because of these unwanted hazards and potential complications. Research has conclusively shown that surgical smoke is hazardous to the surgical team members who are exposed to it on a continual basis and hazardous to endoscopic patients when the plume is not evacuated. Also during endoscopic procedures the usage of electric tools to cut and coagulate is frequent, and this could represent a real problems for operators may be more than for the patients. At the present time it is not possible to find in literature papers about hazards of surgical smoke during endoscopic procedures even if they have to be considered definitely as surgical procedures. This implies the necessity of a deeper consciousness to the smokes risk and consequently a more care in operators and patients protection

... l'esperienza in due fasi.Nella prima fase, con l'ADE frontale, le lezioni sono state tenute in dieciincontri da 3 ore utilizzando materiale didattico proiettato a video.La modalità web è stata organizzata in modo che gli studenti potessero fruire del materiale didattico online dove le ...

To present the University of Genoa Advanced Simulation Center (SimAv) and the project of a trainer (eLap4D) that would achieve the equivalent goals of the fundamentals of laparoscopic surgery trainer at an economical cost. The validation process is going to be shown too. METHODS. The laparoscopic trainer is a physical low-cost laparoscopic training platform that reproduces the tactile feedback (eLaparo4d) integrated with a software for virtual anatomical realistic scenarios (Unity3D V 4.1). A sample of 20 students was selected, divided into 2 homogeneous groups with respect to the level of confidence with the use of video games, consoles, smartphones (this has been possible thanks to the use of a questionnaire, administered before the practical phase of training). The groups participated in a training program based on 5 basic laparoscopic skills (laparoscopic focusing and navigation, hand – eye – coordination and grasp coordination). So, a second and a third study sample was chosen,...

The patients with Crohn's disease (CD) have a greater risk of gastrointestinal and hemopoietic cancers compared with background population. Identify groups of people affected by CD with exposition to factors that play a role in the development of cancer could be useful to plan correct diagnostic and therapeutic methods. A reaserch on "pubmed" with "Risk factors for cancer in patients with Crohn's disease", "Cancer and Crohn's disease" Crohn's disease and cancer risk" as key-words was conducted. We identified 35 studies and analized also references reported inside each single work. Patients with CD have a higher risk of colorectal cancer (CRC). The risk of colon cancer alone was found to be increased, with no significant increase in the risk of rectal cancer. Factors that play a role in the development of CRC are: diagnosis of CD before 25-years-old, duration of disease, severity of inflammation, habit to cigarette's smoke, a fam...

Postoperative thromboembolic complications do present an underestimated problem whenever their detection simply relies upon individual clinical judgement. Major abdominal operations are at increased risk of pulmonary embolism (PE) and deep vein thrombosis (DVT), mostly in advanced age, overweight subject, and in patients with cardiac or malignant diseases, or with previous venous diseases. Such patients may benefit from a peri- and postoperative prophylaxis with chemical or mechanical procedures, as a recent meta-analysis seems to suggest. In our experience, a randomized, multicentric clinical trial with defibrotide (DF) versus calcium-heparin (CH) was realized with the aim of evaluating their effectiveness and side effects in the prophylaxis of PE and DVT after major abdominal surgery; 1296 patients were randomly assigned to i.v. DF (400 mg.) or subcutaneous CH (0.2 ml. = 5000 U.I.) given one hour prior to operation and twice daily for seven days postoperatively. Definitive evaluat...

Short bowel syndrome is a complex clinical picture, characterized by signs and symptoms of malabsorption and subsequent malnutrition, which often occurs after extensive bowel resections. Short bowel syndrome's treatment must begin together with the planning of the first surgery, especially for disease that may need multiple interventions. Patients with short bowel should be individually managed because they all are different in diagnosis, length of the remaining bowel and in psychosocial characteristics. For all these reasons, a multidisciplinary approach between the various specialists is therefore needed.