Triggering and recovery of earthquake accelerated landslides in Central Italy revealed by satellite radar observations.

Earthquake triggered landslides often pose a great threat to human life and property. Emerging research has been devoted to documenting coseismic landslides failed during or shortly after earthquakes, however, the long-term seismic effect that causes unstable landslides only to accelerate, moderately or acutely, without immediate failures is largely neglected. Here we show the activation and recovery of these earthquake accelerated landslides (EALs) in Central Italy, based on satellite radar observations. Unlike previous studies based on single or discrete landslides, we established a large inventory of 819 EALs and statistically quantified their spatial clustering features against a set of conditioning factors, thus finding that EALs did not rely on strong seismic shaking or hanging wall effects to occur and larger landslides were more likely to accelerate after earthquakes than smaller ones. We also discovered their accelerating-to-recovering sliding dynamics, and how they differed from the collapsed 759 coseismic landslides. These findings contribute to a more comprehensive understanding of the earthquake-triggering landslide mechanism and are of great significance for long-term landslide risk assessment in seismically active areas.

Is laparoscopic surgery really effective for the treatment of colon and rectal cancer in very elderly over 80 years old? A prospective multicentric case-control assessment.

BACKGROUND: To evaluate the effectiveness of laparoscopic surgery (LCS) for colon and rectal cancer in the very elderly over 80 years old. METHODS: We performed a prospective multicentric analysis comparing patients over 80 years (Group A) and patients between 60 and 69 years (Group B) undergoing LCS for cancer from January 2008 to December 2013. Colon and rectal cancers were analyzed separately. Comorbidity and complications were classified using the Charlson comorbidity index (CCI) and the Clavien-Dindo system, respectively. Oncological parameters included tumor-free margins, number of lymph nodes harvested and circumferential resection margin. RESULTS: Group A included 96 and 33 patients, and Group B 220 and 82 for colon and rectal cancers, respectively. Groups were similar except for ASA score and CCI, as expected. There was no significant difference in operative time [colon; rectum] (180[IQR 150-200] vs 180[150-210] min; NS-180[160-210] vs 180[165-240] min; NS), estimated blood loss (50[25-75] vs 50[25-120] mL; NS-50[0-150] vs 50[25-108.7] mL; NS) and conversion rate (2.1 vs 2.7 %; NS-3.0 vs 2.4 %; NS). Timing of first stool (3[2-3.25] vs 3[2-5] dd; NS-3[2-4] vs 3[2-5] dd; NS), length of stay (7[6-8] vs 7[6-8] dd; NS-8[8-9] vs 8[7-9] dd; NS) and readmission rate (1.0 vs 0.45 %; NS-6.1 vs 1.2 %; NS) were similar. Tumor-free margins were appropriate, and positivity of CRM is poor (6.1 vs 4.9; NS). We did not record significant differences in complications rate (47.9 vs 43.6 %; NS-63.6 vs 52.4 %; NS). CONCLUSIONS: Laparoscopic surgery is effective for the treatment of colorectal cancer even in the very elderly. Age is not a risk factor or a limitation for LCS.

Effectiveness of elective laparoscopic treatment for colonic diverticulitis.

BACKGROUND AND OBJECTIVES: To analyze the short- and long-term outcomes of laparoscopic sigmoid colectomy for the elective treatment of diverticular disease. METHODS: A consecutive unselected series of 94 patients undergoing elective laparoscopic sigmoid colectomy for diverticular disease from 2008 to 2012 was analyzed. We collected patients-, surgery- and hospital stay-related data, as well as the short- and long-term outcomes. Operative steps, instrumentation, and postoperative cares were standardized. Comorbidity was assessed by Charlson comorbidity index. Complications were classified using the Clavien-Dindo classification system. The qualitative long-term assessment was carried out by subjecting patients to the validated gastrointestinal quality of life index questionnaire before and after surgery. RESULTS: The mean age of our cohort was 61.3 ± 11.0 years with a Charlson comorbidity index of 1.2 ± 1.5. Mean operative time was 213.5 ± 60.8 minutes and estimated blood loss was 67.2 ± 94.3 mL. We had 3 cases (3.2%) of conversion to open laparotomy. The rates of postoperative complications were 35.1%, 6.3%, 2.1%, and 1.06%, respectively, for grades 1, 2, 3b, and 5 according to the Clavien-Dindo system. Length of hospital stay was 8.1 ± 1.9 days, and we have not recorded readmissions in patients discharged within 60 days after surgery. Median follow-up was of 9.6 ± 2.7 months. We observed no recurrence of diverticular disease, but there was evidence of 3 cases of incisional hernia (3.19%). The difference between preoperative and late gastrointestinal quality of life index score was statistically significant (97.1 ± 5.8 vs 129.6 ± 8.0). CONCLUSIONS: Elective laparoscopic treatment of colonic diverticular disease represents an effective option that produces adequate postoperative results and ensures a satisfactory functional outcome.

Borehole flowmeter logging for the accurate design and analysis of tracer tests.

Tracer tests often give ambiguous interpretations that may be due to the erroneous location of sampling points and/or the lack of flow rate measurements through the sampler. To obtain more reliable tracer test results, we propose a methodology that optimizes the design and analysis of tracer tests in a cross borehole mode by using vertical borehole flow rate measurements. Experiments using this approach, herein defined as the Bh-flow tracer test, have been performed by implementing three sequential steps: (1) single-hole flowmeter test, (2) cross-hole flowmeter test, and (3) tracer test. At the experimental site, core logging, pumping tests, and static water-level measurements were previously carried out to determine stratigraphy, fracture characteristics, and bulk hydraulic conductivity. Single-hole flowmeter testing makes it possible to detect the presence of vertical flows as well as inflow and outflow zones, whereas cross-hole flowmeter testing detects the presence of connections along sets of flow conduits or discontinuities intercepted by boreholes. Finally, the specific pathways and rates of groundwater flow through selected flowpaths are determined by tracer testing. We conclude that the combined use of single and cross-borehole flowmeter tests is fundamental to the formulation of the tracer test strategy and interpretation of the tracer test results.

Totally laparoscopic resection of the splenic flexure for tumor.

Colonic tumors located at the splenic flexure are rare and show a higher occlusive risk than other colorectal cancers. The totally laparoscopic segmental resection of splenic flexure represents a challenging procedure that requires adequate technical skills and for this reason it is still not widespread and validated. Between October 2010 and March 2012, a consecutive unselected series of eight (N = 8) patients underwent totally laparoscopic splenic flexure resection at our Institute. Data on patients' demographics, disease features, operative details and short-term follow-up were prospectively recorded in a specific database and retrospectively analyzed. All the operations were performed or supervised by the same surgeon (I.S.). We used a four-port medial-to-lateral standardized technique with intracorporeal anastomosis. A selective vascular ligation was performed in all cases and the specimens were extracted through a protected incision. Perioperative care plan and surgical instrumentations were standardized. Complications were classified using the Clavien-Dindo classification system. No conversion to open surgery was registered. All cases achieved an adequate number of lymph nodes harvested (22.9 ± 5.2) and an oncologically correct resection of the tumor (proximal margin 7.0 ± 2.4 cm, distal margin 7.1 ± 2.8 cm). The mean hospital stay was 6.1 ± 1.3 days. Postoperative complication rate according to the Clavien-Dindo system was 37.5 %, but all the complications reported were grade I. We did not observe any reoperation or readmission within 60 days after discharge. Totally laparoscopic splenic flexure resection is a feasible and reproducible technique. A correct surgical indication and a standardized technique allow to perform an oncologically safe and functionally effective treatment.

Totally laparoscopic versus laparoscopic assisted right colectomy for cancer.

INTRODUCTION: Colorectal cancer (CRC) is one of the leading causes of cancer death all over the world and right-sided colon cancer represents approximately 15% of all cases of CRC. Laparoscopic colectomies produce advantages in short-term outcome compared to open procedures and have recently benefited by a long term oncologic validation. This study was designed to compare the short- and medium-term surgical outcomes of totally laparoscopic (TLRC) and laparoscopic-assisted right colectomy (LARC) for neoplasia, hypothesizing they may be at least similar. METHODS: A consecutive unselected series of 72 patients undergone elective surgery for right-sided colon cancer from April 2006 to April 2011 was retrospectively evaluated. All patients were treated by laparoscopic medial-to-lateral right colectomy. In 42 patients a TLRC was performed, in 30 a LARC. Perioperative care plan, operative steps and surgical instrumentations were standardized. All the operations were performed or supervised by the same Surgeon (I.S.). Data on the patients' demographics, disease features, operative details and follow up were recorded and analyzed. Complications were classified using the Clavien-Dindo classification system. Continuous variables were expressed as mean ± standard deviation and analyzed with the Student t test. Categorical ones were expressed as percent value and analyzed with Fischer test or Chi-square test, where appropriate. P < 0.05 were considered statistically significant. RESULTS: There was no significant difference in term of age, sex, body mass index and American Society of Anesthesiology score between the two groups. Comorbidities, site of tumor and stage of disease were similar too. No conversion to laparotomy was registered. Median operative time (186.3 ± 40.1 min vs 176.5 ± 40.0 min; not significant (NS)) and estimated blood loss (43.3 ± 89.8 ml vs 31.2 ± 51.3 ml; NS) were statistically comparable in both groups. Timing of first defecation (3.4 ± 0.9 dd vs 2.9 ± 0.9; P = 0.023) and length of hospital stay (7.2 ± 1.3 dd vs 6.2 ± 1.1 dd; P < 0.001) were statistically lower in TLRC cohort. A significantly longer length of skin incision characterized LARC group compared with TLRC group (71.0 ± 13.5 mm vs 48.2 ± 10.2 mm; P < 0.001). Both groups achieved an adequate number of lymph nodes harvested (22.0 ± 8.2 vs 25.9 ± 9.0; P = 0.036) and oncological resection of the tumor (proximal margin 7.6 ± 7.7 vs 6.1 ± 3.8; NS - distal margin 13.3 ± 7.7 vs 13.6 ± 5.8; NS). Post-operative complications according to Clavien-Dindo classification were statistically comparable in both cohorts. No readmission within 60 days of discharge was observed. The mean follow-up recorded was 27.7 ± 16.6 months. Late complications consisted in 1 case of incisional hernia (3.8%) in LARC group. CONCLUSIONS: Although more appropriate indications must be set by future studies, we encourage the choice of a TLRC for the treatment of cancer of the right colon. TLRC is actually a feasible and safe technique, which has resulted in an encouraging short-term outcome, low incidence of major complications and preservation of oncologic principles, without affecting operative times.