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PURPOSE: The anal fissure and spasm represent possible complications and causes of postoperative anal pain in patients that have undergone stapled trans-anal rectal resection (STARR). The etiology of these complications is still questioned such as the treatment modality. This study was designed to evaluate the effectiveness of topical glyceryl trinitrate (GTN) 0.4 % in determining decrease of incidence of postoperative anal spams and fissure and reduction of early postoperative pain. METHODS: From a total of 243 patients referred for obstructed defecation syndrome (ODS) 104 (42.7 %) underwent STARR and were randomized to receive (Group 1) or not (Group 2) topical 0.4 % GTN ointment every 12 h for four postoperative weeks. Postoperative evaluation was made at 1, 6, and 12 months. RESULTS: At 1 month follow-up, the incidence of anal spasm in Groups 1 and 2 was, respectively, 0 and 14.6 % (6/41) (p = 0.010; Fisher's exact test). The incidence of anal fissure was 4/41 (9.7 %) in Group 2 and 0/44 (0 %) in Group 1 (p = 0.05; Fisher's exact test). Significant differences in median visual analogue scale score between groups were found at 1 week and 1 month follow-up (1; 0-5 vs. 2; 0-7: p = 0.0104; Mann-Whitney U test). CONCLUSION: Anal spasm and fissure may represent a cause of early postoperative anal pain in patients that have undergone STARR procedure for ODS. The use of topical GTN 0.4 % ointment in the early postoperative course seems to reduce the incidence of anal spasm and fissure and to improve the associated early postoperative pain.
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Canal Anal/cirugía , Enfermedades del Ano/tratamiento farmacológico , Defecación , Procedimientos Quirúrgicos del Sistema Digestivo , Nitroglicerina/uso terapéutico , Recto/cirugía , Grapado Quirúrgico , Adulto , Enfermedades del Ano/fisiopatología , Enfermedades del Ano/cirugía , Defecografía , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Humanos , Manometría , Persona de Mediana Edad , Pomadas , Dimensión del Dolor , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , SíndromeRESUMEN
OBJECTIVE: The aim of the study was to assess the safety, efficacy and feasibility of stapled transanal procedures performed by a new dedicated device, TST STARR Plus, for tailored transanal stapled surgery. METHODS: All the consecutive patients admitted to eight referral centres affected by prolapses with III-IV degrees haemorrhoids or obstructed defecation syndrome (ODS) with rectocele and/or rectal intussusception that underwent stapled transanal resection with TST STARR plus were included in the present study. Haemostatic stitches for bleeding of the suture line, specimen volume, operative time, hospital stay and perioperative complications were recorded. RESULTS: From 1 November 2012 to 31 March 2013, 160 consecutive patients (96 females) were enrolled in the study. In 94 patients, the prolapse was over the half of the circular anal dilator (CAD). The mean duration of the procedure was 25 min. The mean resected volume of the specimen was 13.3 cm(3), the mean hospital stay was 2.2 days. In 88 patients (55%), additional stitches on the suture line were needed (mean 2.1). Suture line dehiscence was reported in four cases, with intraoperative reinforcement. Bleeding was reported in seven patients (5%). Urgency after 30 days was reported in one patient. No major complication occurred. CONCLUSIONS: The new device seems to be safe and effective for a tailored approach to anorectal prolapse due to haemorrhoids or obstructed defecation.
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Estreñimiento/cirugía , Hemorroides/cirugía , Obstrucción Intestinal/cirugía , Enfermedades del Recto/cirugía , Grapado Quirúrgico/instrumentación , Canal Anal/cirugía , Defecación , Estudios de Factibilidad , Femenino , Técnicas Hemostáticas , Humanos , Tiempo de Internación , Masculino , Tempo Operativo , Dolor/etiología , Satisfacción del Paciente , Prolapso , Grapado Quirúrgico/efectos adversos , SíndromeRESUMEN
BACKGROUND AND AIM: The literature continues to emphasize the advantages of treating patients in "high volume" units by "expert" surgeons, but there is no agreed definition of what is meant by either term. In September 2012, a Consensus Conference on Clinical Competence was organized in Rome as part of the meeting of the National Congress of Italian Surgery (I Congresso Nazionale della Chirurgia Italiana: Unità e valore della chirurgia italiana). The aims were to provide a definition of "expert surgeon" and "high-volume facility" in rectal cancer surgery and to assess their influence on patient outcome. METHOD: An Organizing Committee (OC), a Scientific Committee (SC), a Group of Experts (E) and a Panel/Jury (P) were set up for the conduct of the Consensus Conference. Review of the literature focused on three main questions including training, "measuring" of quality and to what extent hospital and surgeon volume affects sphincter-preserving procedures, local recurrence, 30-day morbidity and mortality, survival, function, choice of laparoscopic approach and the choice of transanal endoscopic microsurgery (TEM). RESULTS AND CONCLUSION: The difficulties encountered in defining competence in rectal surgery arise from the great heterogeneity of the parameters described in the literature to quantify it. Acquisition of data is difficult as many articles were published many years ago. Even with a focus on surgeon and hospital volume, it is difficult to define their role owing to the variability and the quality of the relevant studies.
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Competencia Clínica , Hospitales de Alto Volumen/normas , Neoplasias del Recto/cirugía , Canal Anal/cirugía , Humanos , Laparoscopía , Microcirugia , Recurrencia Local de Neoplasia , Neoplasias del Recto/mortalidad , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Common bean cultivation has historically been a typical component of rural economies in Italy, particularly in mountainous and hilly zones along the Apennine ridge of the central and southern regions, where the production is focused on local landraces cultivated by small-scale farmers using low-input production systems. Such landraces are at risk of genetic erosion because of the recent socioeconomic changes in rural communities. One hundred fourteen accessions belonging to 66 landraces still being grown in the Lazio region were characterized using a multidisciplinary approach. This approach included morphological (seed traits), biochemical (phaseolin and phytohemagglutinin patterns), and molecular (microsatellite loci) analyses to investigate their genetic variation, structure, and distinctiveness, which will be essential for the implementation of adequate ex situ and in situ conservation strategies. Another objective of this study was to determine the original gene pool (Andean and Mesoamerican) of the investigated landraces and to evaluate the cross-hybridization events between the two ancestral gene pools in the P. vulgaris germplasm in the Lazio region. Molecular analyses on 456 samples (four for each of the 114 accessions) revealed that the P. vulgaris germplasm in the Lazio region exhibited a high level of genetic diversity (He = 0.622) and that the Mesoamerican and Andean gene pools were clearly differentiated, with the Andean gene pool prevailing (77%) and 12% of landraces representing putative hybrids between the two gene pools. A model-based cluster analysis based on the molecular markers highlighted three main groups in agreement with the phaseolin patterns and growth habit of landraces. The combined utilisation of morphological, biochemical, and molecular data allowed for the differentiation of all landraces and the resolution of certain instances of homonymy and synonymy. Furthermore, although a high level of homozygosity was found across all landraces, 32 of the 66 examined (49%) exhibited genetic variability, indicating that the analysis based on a single or few plants per landrace, as usually carried out, may provide incomplete information.
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BACKGROUND: The treatment of ventral hernias is still a subject of debate. The affixing of a prosthesis and the subsequent introduction of laparoscopic treatment have reduced complications and recurrences. The high incidence of seromas and high costs remain open problems. METHODS: At our Department between January 2008 and December 2011, 87 patients (43 over 65 years), out of a total of 132, with defects of wall whose major axis was less than 10 cm, or minor and multiple defects (Swiss-cheese defect) on an axis not exceeding 12 cm underwent laparoscopic ventral hernia repair (LVHR) with primary and transparietal closure of the hernial defect. Through small incisions in the skin we proceeded to close the parietal defect with sutures tied outside. Then the mesh was fixed as usual with double row of stitches and an overlap of 3-5 cm. RESULTS: In all patients, 43 of them elderly, surgery was successfully conducted. The juxtaposition of the edges of the hernial defect has not been time consuming and has not developed new complications. The postoperative course was uneventful, with discharge on the third day, except in 5 patients. Were observed only small gaps and not the formation of large seromas. There were no infections wall. We do not have relapses, but some small and asymptomatic solutions continuously up to 2 cm at the sonographic study. In elderly patients the absence of dead space and the feeling of greater stability of the wall, early mobilization and pain control have facilitated the post-operative course. CONCLUSIONS: The positioning of sutures transcutaneous is simple and effective, the reduced incidence of seromas and the greater stability of the wall suggest to adopt this procedure fully.The possibility to close the margins of the defect may allow to change the size and setting of the mesh, since the absence of dead space allows to download physiologically tensions of the wall.
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Hernia Ventral/cirugía , Herniorrafia/métodos , Laparoscopía/métodos , Técnicas de Sutura , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Seguimiento , Herniorrafia/instrumentación , Humanos , Persona de Mediana Edad , Mallas Quirúrgicas , Resultado del TratamientoRESUMEN
Italy is a recognized secondary center of diversification for cultivated tomato (Solanum lycopersicum L.). The study of phenotypic and genetic diversity in landrace collections is important for germplasm conservation and valorization. Here, we set up to study the tomato germplasm collected in the region of Lazio in Central Italy, with a focus on the distinctiveness among landraces and the attribution of membership to unnamed accessions. Our regional collection included 32 accessions belonging to eight different locally recognized landraces and 19 unnamed accessions. All accessions were gathered from local farmers and are preserved in the collection held at the Regional Agency for the Development and the Innovation of Lazio Agriculture (ARSIAL) and at the University of Tuscia. We included 13 control genotypes comprising nine landraces from neighbor regions and four reference cultivars. The collection showed wide phenotypic variability for several qualitative and quantitative traits, such as leaf border and shape, inflorescence type, fruit shape, green shoulder, fruit weight (range 14-277 g), locule number (2-12), shape index (0.54-2.65), yield (0.24-3.08 kg/plant), and soluble solids (3.4-7.5°B). A few landraces showed uncommon phenotypes, such as potato leaf, colorless fruit epidermis, or delayed ripening. Multivariate analysis of 25 cardinal phenotypic variables separated the accessions into two distinct groups; accessions showing a flattened-ribbed fruit were distinguished from those with round to elongate fruits with smooth structure. Genotyping analysis of 7,720 SNPs was performed using the tomato array platform SolCAP, to point out the genetic relationship among the studied accessions. A neighbor-joining tree analysis allowed to confirm or deny phenotypic data and to assign some of the unnamed accessions to recognized groups. Allelic status at marker loci linked to resistance genes commonly used in breeding identified accessions putatively derived from modern material or commercial hybrids, thus not classifiable as landraces. Overall, this study provided the information useful to preserve, valorize, and juridically protect tomato local landraces from the Lazio region and will in addition be helpful to their improvement by breeding.
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Neuroaesthetics, the science studying the biological underpinnings of aesthetic experience, recently extended its area of investigation to literary art; this was the humus where neurocognitive poetics blossomed. Divina Commedia represents one of the most important, famous and studied poems worldwide. Poetry stimuli are characterized by elements (meter and rhyme) promoting the processing fluency, a core aspect of neuroaesthetics theories. In addition, given the evidence of different neurophysiological reactions between experts and non-experts in response to artistic stimuli, the aim of the present study was to investigate, in poetry, a different neurophysiological cognitive and emotional reaction between Literature (L) and Non-Literature (NL) students. A further aim was to investigate whether neurophysiological underpinnings would support explanation of behavioral data. Investigation methods employed: self-report assessments (recognition, appreciation, content recall) and neurophysiological indexes (approach/withdrawal (AW), cerebral effort (CE) and galvanic skin response (GSR)). The main behavioral results, according to fluency theories in aesthetics, suggested in the NL but not in the L group that the appreciation/liking went hand by hand with the self-declared recognition and with the content recall. The main neurophysiological results were: (i) higher galvanic skin response in NL, whilst higher CE values in L; (ii) a positive correlation between AW and CE indexes in both groups. The present results extended previous evidence relative to figurative art also to auditory poetry stimuli, suggesting an emotional attenuation "expertise-specific" showed by experts, but increased cognitive processing in response to the stimuli.
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BACKGROUND AND AIM OF THE WORK: subcutaneous Achilles tendon lesions are common degenerative tendon tears, often related to sport activities, multiple pharmacotherapies and internal medical comorbidities. Neglect an Achilles tendon lesion can affect walk ability, while neglect a bilateral lesion could really lead to a serious limitation of self-sufficiency in daily living. We report a case of chronic bilateral Achilles tendon lesion successful treated with LARS augmentation, along with some clinical considerations concerning the clinical outcome. METHODS: we report a case of a chronic bilateral Achilles tendon lesion in an elderly man with multiple comorbidities, successful treated with LARS reconstruction, along with some considerations concerning possible intraoperative issues and the clinical outcome. RESULTS: good functional result was obtained as documented with pre and postoperative American Orthopedic Foot And Ankle Society Scale and the "Foot And Ankle Disability Index", without complications. CONCLUSIONS: a bilateral Achilles tendon rupture is a very disabling pathology, that needs prompt diagnosis and treatment to prevent further complications. LARS reconstruction could be an effective method in selected patients to avoid some intraoperative issues related to patient comorbidities and ability to follow complex postoperative rehabilitation protocols. (www.actabiomedica.it).
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Tendón Calcáneo/lesiones , Tendón Calcáneo/cirugía , Traumatismos de los Tendones/cirugía , Anciano , Enfermedad Crónica , Estudios de Seguimiento , Humanos , Masculino , Procedimientos Ortopédicos/métodosRESUMEN
In the context of global warming, the general trend towards earlier flowering dates of many temperate tree species is likely to result in an increased risk of damage from exposure to frost. To test this hypothesis, a phenological model of apple flowering was applied to a temperature series from two locations in an important area for apple production in Europe (Trentino, Italy). Two simulated 50-year climatic projections (A2 and B2 of the Intergovernmental Panel on Climate Change--Special Report on Emission Scenarios) from the HadCM3 general circulation model were statistically downscaled to the two sites. Hourly temperature records over a 40-year period were used as the reference for past climate. In the phenological model, the heat requirement (degree hours) for flowering was parameterized using two approaches; static (constant over time) and dynamic (climate dependent). Parameterisation took into account the trees' adaptation to changing temperatures based on either past instrumental records or the downscaled outputs from the climatic simulations. Flowering dates for the past 40 years and simulated flowering dates for the next 50 years were used in the model. A significant trend towards earlier flowering was clearly detected in the past. This negative trend was also apparent in the simulated data. However, the significance was less apparent when the "dynamic" setting for the degree hours requirement was used in the model. The number of frost episodes and flowering dates, on an annual basis, were graphed to assess the risk of spring frost. Risk analysis confirmed a lower risk of exposure to frost at present than in the past, and probably either constant or a slightly lower risk in future, especially given that physiological processes are expected to acclimate to higher temperatures.
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Aclimatación/fisiología , Clima , Flores/crecimiento & desarrollo , Frutas/crecimiento & desarrollo , Modelos Biológicos , Estaciones del Año , Tiempo (Meteorología) , Simulación por Computador , Predicción/métodos , Medición de Riesgo , Factores de RiesgoRESUMEN
BACKGROUND/AIMS: Laparoscopic cholecystectomy is characterized by a higher incidence of iatrogenic biliary lesions. The Authors evaluate the role of hepaticojejunostomy in the treatment of iatrogenic biliary lesions following laparoscopic cholecystectomy in 51 patients observed in the Campania region, Italy from 1991 to 2003. METHODOLOGY: The Authors report the data of a retrospective multicentric study of 51 patients -39 women (76.47%), 12 men (13.53%)-reoperated on for major biliary lesions following laparoscopic cholecystectomy. Hepaticojejunostomy in 20 cases (39.21%) and T-Tube plasty in 20 cases (39.21%) were performed. RESULTS: The mean follow-up was 25.01 months. The mean hospital stay was 25.7 days. 1/51 patients (1.9%) died from intraoperative incontrollable hemorrhage while cumulative postoperative mortality was 9.8% (5/51 patients). Therapeutic success rate of hepaticojejunostomy was 70% with a T-Tube plasty success rate of 65%. 9/51 patients (17.64%) were reoperated while in 4/51 (7.84%) a biliary stent was positioned. In 1/51 patients (1.9%) a biliary cirrhosis and in 3/51 (5.7%) a bioumoral cholestasis was observed. CONCLUSIONS: Laparoscopic cholecystectomy causes a higher incidence of iatrogenic biliary lesions. Hepaticojejunostomy gives better long-term results and lower morbidity compared to T-Tube plasty. Management of septic complications in patients with iatrogenic biliary lesions represents the first therapeutic step.
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Conductos Biliares/lesiones , Colecistectomía Laparoscópica/efectos adversos , Complicaciones Intraoperatorias/cirugía , Yeyunostomía , Adolescente , Adulto , Anciano , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
An higher incidence rate of iatrogenic bile duct injuries is reported in cholecystectomy performed with the laparoscopy than with the laparotomy approach. The aim of this study was to provide a multicentre report on surgical treatment and the outcome of biliary complications during and following laparoscopic cholecystectomy. A questionnaire was mailed to all surgeons with experience in laparoscopic cholecystectomy in the Campania region. Data were collected from January 1991 to December 2003. Each patient was requested to indicate age, gender, associated diseases, site and type of lesion, surgical experience, diagnosis, treatment and complications. Twenty-six surgeons answered the questionnaire. Fifty-one patients (36 F/15 M; mean age: 42.5 +/- 11.9, range 13-91 years) with bile duct injuries following laparoscopic cholecystectomy were reported. The most frequent lesions were main bile duct partial or total transection. The intraoperative mortality rate was 1/51 (1.9%) due to a complex biliary and vascular injury. The postoperative mortality rate of revision surgery was 5/50 (10%). T-tube positioning (n = 20) and Roux-en-Y hepato-jejunostomy (n = 20) were the procedures most frequently performed. The complication rate in patients treated with the T-tube was significantly higher than in those treated with hepatico-jejunostomy. Surgical treatment of biliary injuries following laparoscopic cholecystectomy was characterized by unusually high mortality and morbidity for a non-neoplastic disease. Roux-en-Y hepato-jejunostomy remains the procedure of choice for these injuries.
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Conductos Biliares/lesiones , Conductos Biliares/cirugía , Colecistectomía Laparoscópica/efectos adversos , Enfermedad Iatrogénica , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anastomosis en-Y de Roux , Colecistectomía Laparoscópica/mortalidad , Drenaje , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reoperación , Estudios Retrospectivos , Encuestas y Cuestionarios , Análisis de SupervivenciaRESUMEN
Six phenological series were available for 'Golden Delicious' apple blooming at six sites in Trentino, an alpine fruit-growing region. Several models were tested to predict flowering dates, all involving a "chilling and forcing" approach. In many cases, application of the models to different climatic conditions results in low accuracy of prediction of flowering date. The aim of this work is to develop a model with more general validity, starting from the six available series, and to test it against five other phenological series outside the original area of model development. A modified version of the "Utah" model was the approach that performed best. In fact, an algorithm using "chill units" for rest completion and a thermal sum for growing-degree-hours (GDH), whose efficiency changes over time depending on the fraction of forcing attained, yielded a very good prediction of flowering. Results were good even if hourly temperatures were reconstructed from daily minimum and maximum values. Errors resulting from prediction of flowering data were relatively small, and root mean square errors were in the range of 1-6 days, being <2 days for the longest phenological series. In the most general form of the model, the summation of GDH required for flowering is not a fixed value, but a function of topoclimatic variables for a particular site: slope, aspect and spring mean temperature. This approach allows extension of application of the model to sites with different climatic features outside the test area.