Fast track in colo-rectal surgery. Preliminary experience in a rural hospital.

BACKGROUND: "Fast Track surgery" is a therapeutic program of large application, despite some doubts about its applicability and real validity. Literature review shows that this approach to colo-rectal surgery, particularly video-assisted, can allow a rapid recovery, better performance and a faster postoperative functional autonomy of the work, which can be discharged without cause additional welfare costs; in addition it can be reproducible in different health reality. PURPOSE: To analyze the possibility to apply the Fast Truck protocol in patients undergoing colorectal surgery in a rural hospital and non specialistic Unit of Surgery. PATIENTS AND METHODS: We have conducted a prospective, randomized study on 80 patients subjected to colorectal surgery in the last year. RESULTS: The protocol was observed in 95% of cases, compliance with the Fast Track was high and general morbidity was limited (7.8%). CONCLUSION: This "aggressive" approach, which has fundamentally altered the usual surgical behavior, seems to allow a mean length of stay significantly lower than in controls (p < 0.05) with positive implications for patients and containment of health care costs, even after discharge (no need for home care in 92% of cases, no early re-admittance to the hospital). Homogeneous protocols are desirable, as well as an increased enrollment, to consolidate these rehabilitation programs in order to provide a reference for all hospitals.

A RICH detector for hadron identification at JLab.

The "standard" Hall A apparatus at Jefferson Lab (TOF and aerogel threshold Cherenkov detectors) does not provide complete identification for proton, kaon and pion. To this aim, a proximity focusing C(6)F(14)/CsI RICH (Ring Image CHerenkov) detector has been designed, built, tested and operated to separate kaons from pions with a pion contamination of a few percent up to 2.4GeV/c. Two quite different experimental investigations have benefitted of the RICH identification: on one side, the high-resolution hypernuclear spectroscopy series of experiments on carbon, beryllium and oxygen, devoted to the study of the lambda-nucleon potential. On the other side, the measurements of the single spin asymmetries of pion and kaon on a transversely polarized (3)He target are of utmost interest in understanding QCD dynamics in the nucleon. We present the technical features of such a RICH detector and comment on the presently achieved performance in hadron identification.

Nucleon form factor studies at JLab.

The ratio of the electromagnetic proton elastic form factors, G(p)(E)/G(p)(M), has been measured at Jefferson Lab up to Q(2) approximately 9(GeV/c)(2), by using the CEBAF 6GeV electron beam, and revealing an unexpected and challenging physical behaviour. The 2014 scheduled 12GeV upgrade will allow the measurement of G(p)(E)/G(p)(M) up to Q(2) approximately 15(GeV/c)(2), by taking advantage of the new large-acceptance forward spectrometer Super BigBite (SBS) in Hall A. Measurements of neutron form factors in the region around 10(GeV/c)(2), where quark confinement plays an important role, are expected to show the behaviour already observed in the proton case.

Limits on light-speed anisotropies from Compton scattering of high-energy electrons.

The possibility of anisotropies in the speed of light relative to the limiting speed of electrons is considered. The absence of sidereal variations in the energy of Compton-edge photons at the European Synchrotron Radiation Facility's GRAAL facility constrains such anisotropies representing the first nonthreshold collision-kinematics study of Lorentz violation. When interpreted within the minimal standard-model extension, this result yields the two-sided limit of 1.6×10(-14) at 95% confidence level on a combination of the parity-violating photon and electron coefficients (κ(o+))(YZ), (κ(o+))(ZX), c(TX), and c(TY). This new constraint provides an improvement over previous bounds by 1 order of magnitude.

[Common bile duct injuries during videolaparocholecystectomy]. / Le lesioni della via biliare principale in corso di videolaparocolecistectomia.

In the years an increase of last biliary injuries during laparoscopic cholecystectomy was observed. At present this occurrence rate is 0.1-3.4% of laparoscopic procedures. Probably this is to be related to less contraindications to cholecystectomy by laparoscopic procedures, with increase of more difficult operations. The intraoperative biliary injuries are due to anatomical anomalies of the local structures, mistakes of technique, flogosis of the cholecisto-choledocal region. Factors preventing iatrogenic injuries are accurate and standardized operative technique, adoption of modern instruments, intraoperative cholangiography. The Authors have reviewed their experience based on 1236 laparoscopic cholecysectomies performed in six years (1992-1998) in their own structure. Four lesions of the biliary tract (0.3%) have occurred: three Bismuth I-II and one Bismuth IV. They have always performed intraoperative cholangiography, without false negative, in contrast with present literature. They conclude underlining the need of the routine contrastrographic study of the biliary tract in all cholecysectomies as well as of an adequate training in radiological imagines interpretation.