Development of a dedicated instrumentation for electrical and thermal characterization of chemiresistive gas sensors.

This work presents the design and validation of a measuring instrumentation for an easy, complete, and tunable characterization of chemiresistive gas sensors based on metal-oxide semiconductors. The equipment, described in depth both as hardware and as software, was designed to monitor the electrical behavior of gas sensors in controlled thermodynamic conditions. The main goal of this setup is to synchronize the electrical characterization with different measuring conditions, i.e., operating temperature, relative humidity, and gas target concentration. This operation allows us to automate various measurement protocols, otherwise impossible to obtain manually. In particular, this instrumentation permits to correlate the response of a chemiresistive gas sensor to the applied voltage, to its working temperature, and to the gas concentration, automating the acquisition of the current-voltage characteristic and the current-temperature characteristic (Arrhenius plot) of sensing films. The experimental setup was validated by reporting the electrical characterization of a standard metal-oxide-based gas sensing material, such as SnO2, working under different thermodynamic conditions.

A systematic review of the psychometric properties of the Jebsen-Taylor Hand Function Test (JTHFT).

This systematic review of the literature aimed to identify studies examining the psychometric properties of the Jebsen-Taylor Hand Function Test (JTHFT) in various international populations on. The search was conducted in MEDLINE, SCOPUS, CINAHL and Web Of Science, with no restrictions on publication period, the country in which the study was conducted, or the age of the patients. Eligible studies were selected on the basis of inclusion criteria and data were extracted. Study quality and the risk of bias were assessed using the COnsensus-based Standards to select the health Measurement Instruments (COSMIN) checklist. 805 articles were identified; after removing duplicates, there were 361 single studies. 338 articles did not concern the psychometric properties of JTHFT. The remaining 23 studies were selected for full text review, and all were included. They comprised 8 languages and 9 pathologies. These findings suggest the JTHFT is a useful test of manual dexterity in activities of daily living. This study provides specific information on the instrument's psychometric properties in different populations and supports clinicians in making informed decisions when choosing instruments for upper-limb evaluations.

Surgical technique and haemodynamic changes in adrenalectomy for secreting neoplasia. Personal experience and review of the literature.

BACKGROUND: Laparoscopic adrenalectomy is now used worlwide and is a great advance in laparoscopic technology. The reported benefits of this approach include decreased blood loss, better intraoperative haemodynamic control and shorter hospital stay, however some doubts on its indication for adrenal secreting tumors are still present. The aim of this retrospective study is to compare the physiologic alterations on blood pressure during laparoscopic and laparotomic adrenalectomy in patients with adrenal secreting adenoma, the intraoperative blood loss and mean hospital stay in the 2 groups of patients. A review of the literature is included. METHODS: Laparoscopic adrenalectomy was performed in 13 patients (Conn's syndrome with adrenal adenoma in 10, pheochromocytoma in 3). Laparotomy was used for adrenalectomy in 9 patients: 4 with pheochromocytoma and 5 with Conn's adenoma. All the selected patients in the 2 groups had benign adenoma with tumor size less than 6 cm. During surgery the following data were determined: blood pressure before inducing anaesthesia, pressure peaks, episodes of hypertension and of hypotension, blood loss and operating times. The mean hospital stay was also recorded. RESULTS: No differences were found in the blood-pressure values of the 2 groups of patients. The blood loss was minimal in all but 2 patients. The mean hospital stay was significantly longer in those patients who underwent laparotomy. No significant differences were recorded in the mean operating time. CONCLUSIONS: The 2 techniques seem to have the same physiological consequences in the cardiovascular system, and the operating times for laparoscopic and laparotomic adrenalectomy are not so different. Laparoscopic adrenalectomy is a safe technique to treat small benign adrenal secreting adenomas.

[Transperitoneal anterior access in video-laparoscopic adrenalectomy]. / Accesso anteriore transperitoneale nella surrenalectomia videolaparoscopica.

BACKGROUND: The more wide spread laparoscopic technique to operate on the adrenal gland is transabdominal approach with a lateral flank adrenalectomy. However, the transabdominal anterior approach can be a sure and safe alternative in selected patients. METHODS: From 1997 to 1999, 18 selected patients underwent laparoscopic anterior adrenalectomy. Mean age was 43 years (range 25-63) with a male/female ratio of 1:1. Indications were Conn's adenoma in 10 patients, pheochromocytoma in 3 cases, Cushing syndrome in 1 and incidentaloma in 4. All the procedures were carried out laparoscopically and only one patient required conversion to an open adrenalectomy for clear signs of malignancy. The mean time for adrenalectomy was 140 minutes and the shorter times were recorded in the right-sided procedures (mean time 84 minute). Estimated blood loss was minimal and no transfusion was done. There were no postoperative complications related to the surgical technique and the hospital stay was 4 days in average. RESULTS: Our data confirm, according with other authors, that this method is feasible in selected patients. Longer times recorded for the left-sided lesions were due to the more difficult dissection required to gain the left adrenal gland. CONCLUSIONS: Transabdominal adrenalectomy with patient in the supine position is feasible, but its use is restricted to the cases with suspect bilateral or multifocal pheochromocytoma, to patients with concomitant abdominal pathologies that can be operated on laparoscopically, to surgeons who prefer to have a frontal view of the operative field.

A case of "silent" pheochromocytoma presenting as spontaneous retroperitoneal hematoma.

Pheochromocytoma of the adrenal gland can be the cause of massive and lethal retroperitoneal haemorrhage presenting as acute abdomen. Here we report a case of retroperitoneal hematoma, with concomitant peritoneal spillage, due to the spontaneous rupture of a silent pheochromocytoma. The main clinical findings of this disease will be described. Therapy and prognosis will be also discussed.

[The role of laparoscopy in the identification of peritoneal carcinosis from abdominal neoplasms. Analysis of our initial experience]. / Ruolo della laparoscopia nella identificazione della carcinosi peritoneale da neoplasie addominali. Analisi della nostra esperienza iniziale.

BACKGROUND: The authors reviewed the experience on the use of laparoscopy performed since January 1997 in malignant neoplasms at their institution. The aim of the study was to evaluate the real effectiveness of this procedure in the staging of abdominal neoplasms which were considered resectable at preoperative examinations and in particular in the detection of peritoneal metastases not evidenced with traditional imaging techniques. METHODS: Twenty-eight patients with malignant neoplasms: colo-rectum (15), stomach (5), pancreas (4), gallbladder (2), cardias (1), liver (1), were studied. All the patients were preoperatively examined with abdominal computed tomography (CT). In the 2 patients with gallbladder neoplasm a MR cholangiography was also performed. An explorative laparoscopy with peritoneal washing was then performed in all the patients. The diagnostic and therapeutic choices were subsequently done on the basis of laparoscopy results. RESULTS: Therapeutic approach was modified in 21% of cases, as a result of the detection of peritoneal metastases which were not evidenced with imaging examinations. On the contrary, peritoneal washing was not responsible of any preoperative evaluation. CONCLUSIONS: Laparoscopy performed in patients with abdominal neoplasms allows the detection of peritoneal micrometastases not previously evidenced through preoperative CT, thus modifying the therapeutic approach.

[Perioperative changes in the plasma levels of fibrinogen and D-dimer during laparoscopic cholecystectomy: the preliminary results of a prospective randomized clinical study]. / Modificazioni perioperatorie dei tassi plasmatici di fibrinogeno e D-dimero in corso di colecistectomia laparoscopica: risultati preliminari di uno studio clinico prospettico randomizzato.

AIM: Considering that laparoscopic procedure is associated with increased resistance to lower-limb venous return and subsequent stasis, with possible implications in terms of thromboembolic complications, the aim of our study was to investigate prospectively the coagulative-fibrinolytic profile, in laparoscopic and open cholecystectomy, in patients randomly alloted to receive or not preoperative heparin. METHODS: We prospectively analyzed 36 patients (20 laparoscopic and 16 open) and we randomly divided the patients in two groups: Group-A (28 patients--16 laparoscopic and 12 open) didn't take any preoperative thromboprophylaxis, Group-B (8 patients--4 laparoscopic and 4 open) took preoperative subcutaneous heparin. We took blood venous samples before surgery, at time 0 and + 30 min., at the end and 1 and 24 hours postoperatively. The following parameters were assessed: prothrombin time, partial thromboplastin time, fibrinogen and D-dimer. We statistically analyzed the differences by ANOVA test. RESULTS: In Group A, fibrinogen and D-dimer were significantly higher (p < 0.0001 and p = 0.0266) in open group as compared with laparoscopic one and we observed significant time-depending changes of fibrinogen's concentration (p = 0.0168). In Group B we obtained a higher fibrinogen's value in laparoscopic group than in conventional one, with a significant difference (p = 0.0283); also, the sampling-time affected the result in a very significant meaning (p = 0.0041). Comparing fibrinogen levels between Groups A and B, we observed lower values in heparin-treated group than in the other one (p < 0.0001), while in laparoscopic surgery there was not a significant difference between two groups of treatment. CONCLUSIONS: Our preliminary data suggest that, perioperatively (besides a smaller laparoscopic acute-phase response) the coagulative-fibrinolytic changes are lower in laparoscopic cholecystectomy than in open one and heparin treatment significantly reduces these changes in open surgery but doesn't seem to affect laparoscopic group. Our results seem to show another possible advantage of the laparoscopic surgical procedures over the traditional ones.

[Choledochojejunostomy using a mechanical stapler]. / La coledoco-digiunostomia con suturatrice meccanica.

Authors performed the mechanical termino-lateral bilio-digestive anastomosis, adopting a circular 21 mm stapler device. The patient was affected by non neoplastic papillary stenosis producing a common biliary tract dilatation so large to allow the stapler's head introduction. A 12 month follow-up was performed using ultrasonography and MRI cholangiopancreatography, that obtained a good demonstration of both biliary tract and bilio-digestive anastomosis.

Adenocarcinoma arising from a recurrent fistula-in-ano.

Anal fistulas are frequent events which often recur after an inadequate surgical treatment. Nevertheless their evolution into malignant diseases is infrequently observed. The authors report one case of mucinous adenocarcinoma arising out of a recurrent, long-lasting fistula-in-ano. As reported, abdomino-perineal resection combined with radiotherapy can be the choice treatment. The difficulty is to obtain a reliable differential diagnosis. No imaging technique nor histologic examination can establish a definitive reliable diagnosis; nevertheless, as the risk of adenocarcinoma developing from a long-lasting recurrent fistula-in-ano, although small, is real, authors believe that operative exploration and biopsy of recurrent abscesses and fistulas should be recommended.

[Perihepatic packing combined with wrapping in the treatment of major bi-lobar hepatic trauma]. / Il packing periepatico associato a wrapping nel trattamento dei grandi traumi epatici bilobari.

After the spleen the liver is the most exposed organ to injury in abdominal blunt trauma. The improvement in imaging techniques and in anesthesia and intensive care have contributed to a fallen in mortality rate and an enhanced possibility in non-operative management. In unstable patients the packing may be used to defer the definitive operation. The Authors report a case of liver injury of two lobes where the packing was followed by liver wrapping with an absorbable mesh. The patient, a female aged 67, resulted to have a bilobar liver injury of IV degree in the injury severity score. The delay of reoperation was 15 days. The procedure was complicated by a subphrenic abscess, successfully managed with non-operative procedures. Wrapping after liver packing may be considered a good option in unstable patient affected, by severe liver injuries after blunt abdominal traumas.

Effect of levamisole on binding of immune complex to mouse peritoneal macrophages.

Levamisole at the concentrations of 240 and 500 micrograms/ml increased DNA-anti-DNA immune complex (IC) binding to thioglycollate-stimulated mouse (CBA) peritoneal macrophages. Reduced IC binding by macrophages of (NZB/NZW)F1 a mouse model for systemic lupus erythematosus occurs as a consequence of disease and was partially corrected after inclusion of levamisole into the reaction mixture in vitro. However, in vivo administration of 2.5 mg/kg of levamisole, the therapeutic dose, did not alter IC binding to CBA macrophages.