Not just a matter of weight: A case report of ECMO treatment in a severely obese patient.

The ELSO Guidelines list a BMI ≥ 40 kg/m2 among the relative contraindications to give ECMO treatment in SARS - COV2 patients. We describe a case of a 52-year-old with BMI 50.21 kg/m2, admitted to the intensive care unit (ICU) with severe respiratory conditions and successfully treated with extracorporeal membrane oxygenation (ECMO). The application of veno-venous (VV) ECMO will evolve as far as we understand the pathophysiology of the COVID-19 disease and will probably have a determinant role in management of patient with refractory hypoxemia, whose ventilation management is difficult, even in case of severe obesity.

Impact of the pericapsular nerve group (PENG) block on postoperative analgesia and functional recovery following total hip arthroplasty: a randomised, observer-masked, controlled trial.

The pericapsular nerve group (PENG) block is a novel regional anaesthesia technique that aims to provide hip analgesia with preservation of motor function, although evidence is currently lacking. In this single-centre, observer-masked, randomised controlled trial, patients undergoing total hip arthroplasty received pericapsular nerve group block or no block (control group). Primary outcome measure was maximum pain scores (0-10 numeric rating scale) measured in the first 48 h after surgery. Secondary outcomes included postoperative opioid consumption; patient mobilisation assessments; and length of hospital stay. Sixty patients were randomly allocated equally between groups. The maximum pain score of patients receiving the pericapsular nerve group block was significantly lower than in the control group at all time-points, with a median (IQR [range]) of 2.5 (2.0-3.7 [0-7]) vs. 5.5 (5.0-7.0 [2-8]) at 12 h; 3 (2.0-4.0 [0-7]) vs. 6 (5.0-6.0 [2-8]) at 24 h; and 2.0 (2.0-4.0 [0-5]) vs. 3.0 (2.0-4.7 [0-6]) at 48 h; all p < 0.001. Moreover, the pericapsular nerve group showed a significant reduction in opioid consumption, better range of hip motion and shorter time to ambulation. Although no significant difference in hospital length of stay was detected, our results suggest improved postoperative functional recovery following total hip arthroplasty in patients who received pericapsular nerve group block.

"Minimum pruning", "minimal pruning" and "physiological pruning" as new techniques in grey mould agronomic eco-compatible (natural) control. Researches and considerations.

The aim of this work was to find agronomic eco-compatible ("natural") control solutions against grey mould of grapevine too. Our researches about "minimum pruning", "minimal pruning" and "physiological pruning" started in 1980, and in 1983 with specific relation to grey mould on vines of Merlot, Cabernet sauvignon and Chardonnay previously set in vegetative and productive growth balance. These researches were conducted to verify the affordability of innovative winter pruning techniques like "minimum pruning", "minimal pruning" and the so called 'physiological pruning", in the natural agronomic eco-compatible grey mould control. As a result we found that the new techniques contribute to limit the incidence of grey mould; especially "physiological pruning" followed by "minimal pruning" and 'minimum pruning". The best results were observed on Chardonnay, followed by Merlot and Cabernet sauvignon.

D.M.R. ("Double Reasoned Maturing"): innovative technique of agronomic ecologic control of grey mould on grapevine. trials and various considerations.

A study was carried out in order to identify agronomic ecologic solutions in the indirect grey mould control on grapevine. These specific trials started since 1990 and, after years of validation, now they are applied by the entrepreneur to the business practice in the different pedological and climatic area and on different cultivars and forms of growing. The technique of "Doppia Maturazione Ragionata" (D.M.R.) ("Doubles Reasoned Maturing") consists of far "completing" the maturing of the grape for wilting on the plant through the reasoned cut of the heads to fruit e/o of shoots. The application of D.M.R., besides determining valid and important technical and qualitative (organoleptic, economic and social quality) improvements on the product, is particularly effective in the indirect grey mould control on grapevine. Such technique, in fact, allows us to vintage the grape during the business demands and not when imposed by Botrytis cinerea; it has been possible, in some cases, to vintage in December and over, without problems of B. cinerea. The trials have shown the technical, economic, social sustainability of D.M.R. application. This paper reports all trials that have brought, by now from years, to apply in the practice DMR (Double Reasoned Maturing).

[Light-emitting diodes (LED) technology applied to the photopolymerization of resin composites]. / Tecnologia light-emitting diodes (LED) applicata alla fotopolimerizzazione delle resine composite.

An adequate polymerization of resin composites can significantly contribute to increase the longevity of a restoration. In this field, the choice of the operative technique and the characteristics of the lamp are very important. The aim of this review was to evaluate the effectiveness of cure of the light-emitting diodes (LED) lamps comparing them to the others currently available for resin composites photopolymerization. At present, halogen lamps are the most commonly used light sources, but this technology does not allow further developments; even plasma arc and laser lamps have some drawbacks. The innovative LED technology, based on semiconductors, opened new and interesting views in the field of photopolymerization; to the advantages of a soft-start polymerization they add the safety, efficiency, economy and long lifetime of LED light. A careful review of the literature revealed that, although their lower emission of light, these lamps are capable of a polymerization qualitatively comparable to other light sources. Physical and mechanical properties, degree of conversion, depth of cure and final hardness of the composites cured with a LED light are similar to the values achieved with the halogen lamp, whereas the temperature increase is significantly lower and does not pose a threat to the pulp tissue. Undoubtedly, more tests of the mechanical properties of composites processed with LED units need to be carried out but, as the technology improves, LED curing will become an interesting alternative to existing curing methods.

[Hemorrhoidectomy with ropivacaine (Naropin) local anesthesia. Preliminary experience]. / L'emorroidectomia in anestesia locale con ropivacaina (Naropina). Esperienza preliminare.

BACKGROUND: The use of local anesthesia in non-septic anal surgery is now well established. Tolerance to local injection, duration of local effect and the risk of local or systemic complications still represent unsolved issues. Ropivacaine, a new local anesthetic, seems particularly indicated for this kind of surgery because of its pharmacologic properties which reduce patient's discomfort during infiltration and provide good antalgic coverage in the first hours following the operation. METHODS: The first 20 consecutive cases operated with local anesthesia by ropivacaine have been prospectively studied. All patients have been given an 11-point box VAS scale which is used for subjective evaluation of pain. RESULTS: Mean pain score resulted 1.1, 1.6 and 1.4 at 1, 2 and 3 postoperative hours, respectively. Thirty percent of patients subsequently required pain medication up to the first bowel movement. No complications related to the use of ropivacaine has been observed. CONCLUSIONS: This new drug can be safely used in the outpatient or Day-Surgery treatment of hemorrhoids.

[A case of loco-regional recurrence of carcinoma of the male breast]. / Su di un caso di recidiva loco-regionale di carcinoma della mammella maschile.

The case of a 47-year-old man surgically treated with Halsted mastectomy for breast cancer and submitted to Tamoxifen therapy for more than four years is reported. A loco-regional recurrence following withdrawal of oestrogen antagonist therapy was observed and surgically treated by local excision. Normal karyotype analysis of peripheral leucocytes, normal male phenotype of the patient, his height and the lack of family history for breast cancer, as well as a possible dysfunction of the endocrine system were considered in the aetiopathogenesis of the disease.

[A case of anaplastic carcinoma of the thyroid. Clinico-pathological and therapeutic aspects and review of the literature]. / Un caso di carcinoma anaplastico della tiroide. Aspetti clinico-patologici, terapeutici e revisione della Letteratura.

A case of anaplastic carcinoma of the thyroid observed in a 72-year-old female patient, admitted with previous diagnosis of Riedel's thyroiditis, is reported. Clinicopathologic features and management of this rare neoplasm are discussed and Literature is reviewed. Anaplastic cancer is a locally and systemically aggressive histologic type, occurring more frequently in older patients and in those with a history of benign and/or malignant thyroid disease. Because long-term survival was seen most commonly in well-localized anaplastic tumors, a more aggressive approach to thyroid lesions, especially in the elderly, may be warranted to improve early diagnosis and effectiveness of therapy of this nearly always lethal neoplasm. Although patients can rarely be cured, efforts should be made to control the disease locally by combined treatment including surgery and radiochemotherapy, which is found to be, at times, a national palliative therapeutic approach despite patient's advanced age.

[Use of human fibrin glue (Tissucol) in the treatment of recurrent fistulas]. / Impiego della colla di fibrina umana (Tissucol) nel trattamento delle fistole recidive.

In this study, the treatment of either primitive or secondary abdominal relapsed fistulas with Human Fibrin Glue (Tissucol) is reported. Twelve patients with different types of fistulas were treated in day hospital with the above mentioned procedure. Apart from two patients, the good percentage of success obtained in a short period of time is stressed. Results show that such a technique may be favourably adopted, nevertheless a correct first surgical procedure is recommended.

[Tietze's syndrome in the elderly: description of a case and review of the literature]. / La sindrome di Tietze in età avanzata: descrizione di un caso e revisione della letteratura.

A case of Tietze's syndrome in a 62-year-old man and a critical up-to-date review of the literature are reported. Although the etiology of the disease is unknown, it has been suggested that recurrent microtrauma of the anterior chest wall may be implied in the development of characteristic degenerative changes involving single or multiple upper costochondral junction. The syndrome described by Tietze has been more commonly found in older people than previously reported and it seems to be no sex or side prevalence. Because of the benign nature of this disease and its excellent prognosis, the treatment is usually symptomatic. The accumulated data stress the importance of a thorough clinical investigation and the need to exclude severe and lifethreatening conditions in the elderly.

[The clinico-diagnostic and therapeutic considerations in carcinoma of the male breast]. / Considerazioni clinico-diagnostiche e terapeutiche nel carcinoma della mammella maschile.

Three cases of male breast cancer, observed during the last 10 years at the III Surgical Department of the University of Rome "La Sapienza", out of a total of 282 operations performed for mammary carcinoma are reported. In agreement to what reported in the literature the M/F ratio was 1:100. It is pointed out how male breast cancer compared to the female one, involves older subjects. Furthermore, since the disease in males reaches its most advanced stages quite rapidly a radical surgical treatment such as the traditional Halsted operation is mandatory. The prevalence of the histopathological form of invasive ductal carcinoma and the high frequency of intratumoral estradiol and progesterone receptors are confirmed. The latter in many cases allows for adjuvant hormonal therapy and represents, in association with polychemotherapy, a valid alternative to traditional endocrino-surgical therapy, both in terms of long term prognosis and quality of life.