[Endothoracic goitre: anatomoclinical and therapeutic considerations]. / Gozzo endotoracico: considerazioni anatomocliniche e terapeutiche.

Substernal goitre is a clinical condition in which the masin bulk of the enlarged gland is firmly located in the chest. The incidence of this pathology ranges in literature from 1.7% and 30%. This study examines 230 cases of substernal goitre out of a total 5.362 operations performed from 1965 to 2000, for thyroid gland pathologies (4.36%). According to their experience the Authors propose a classification based on the anatomical location of the goitre: right, left, anterior and posterior goitre are therefore identified. The surgical procedures performed include 136 subtotal thyroidectomies (59.1%), 59 emithyroidectomies (25.7%) and 23 total thyroidectomies (10%). In 12 cases the operation was confined to removal of the mediastinal mass (5.2%). The cervical approach was the only surgical access route used in all the patients, regardless of the different anatomical variants. Appreciable venous stasis, due to the mediastinal mechanical obstruction exerted by the goitre, was always evident at the operation. In order to limit the risk of bleeding during operation, careful hemostasis of the major vascular pedicles must be performed. Any attempt to legate the smallest vessel, should be avoided since it is a difficult, useless and time-consuming procedure. Minor bleeds promptly stop as soon as the pathological mass is removed. Ligation of the vascular pedicles can be easily achieved; in this way, the goitre is freed from its anatomical connections and the surgeon can safely manage the substernal portion of the mass. The mortality reported in this study was 0.43% (one patient died 30 days postoperatively due to respiratory complications), whereas the morbidity rate was 2.6%.

Student-faculty joint authorship: ethical and legal concerns.

Although faculty mentoring through joint authorship with students offers benefits to both, the claim of joint authorship of students' works by faculty members may raise ethical and legal concerns. Whether based on institutional policies, faculty members' mandates or suggestions, or even students' invitations, such claims may violate principles of autonomy, fidelity, veracity, and justice. Moreover, such claims may be contrary to basic requirements of copyright law relating to joint authorship and derivative works. Unjustified claims to authorship may have adverse effects on the student-faculty relationship, give rise to professional embarrassment for the individual faculty and the institution, or lead to legal liability. The responsibility to address ethical and legal concerns inherent in such joint authorship rests with the administration and faculty of the individual nursing education department.

Toward interactive scheduling systems for managing medical resources.

Managers of medico-hospital facilities are facing two general problems when allocating resources to activities: (1) to find an agreement between several and contrasting requirements; (2) to manage dynamic and uncertain situations when constraints suddenly change over time due to medical needs. This paper describes the results of a research aimed at applying constraint-based scheduling techniques to the management of medical resources. A mixed-initiative problem solving approach is adopted in which a user and a decision support system interact to incrementally achieve a satisfactory solution to the problem. A running prototype is described called Interactive Scheduler which offers a set of functionalities for a mixed-initiative interaction to cope with the medical resource management. Interactive Scheduler is endowed with a representation schema used for describing the medical environment, a set of algorithms that address the specific problems of the domain, and an innovative interaction module that offers functionalities for the dialogue between the support system and its user. A particular contribution of this work is the explicit representation of constraint violations, and the definition of scheduling algorithms that aim at minimizing the amount of constraint violations in a solution.

[Aneurysm of the hepatic artery. Case report and review of the literature]. / L'aneurisma dell'arteria epatica. Case report e revisione della letteratura.

Hepatic artery aneurysms (HAAs) are considered rare even though their reports in the literature are becoming more and more frequent. The great improvement in the diagnosis of vascular diseases and the increasing incidence of atherosclerosis have resulted in a wider recognition of these pathologies. Differently from other splanchnic locations HAAs have a high risk of rupture (up to 80%) so that an aggressive treatment is required. Different therapeutic options are currently available: simple ligation of the artery, aneurysm excision and vascular reconstruction, transcatheter embolization. However, the therapeutic choice must be evaluated in each single case, depending on the size, aspect and locations of the aneurysm, and requiring an accurate study of the collateral vascular supply. Finally, since additional aneurysms in other sites are frequent, a dose follow up of these patients is recommended.

[Cystadenocarcinoma of the pancreas. Case report and review of the literature]. / II cistoadenocarcinoma del pancreas. Caso clinico e revisione della Letteratura.

Pancreatic cystadenocarcinoma is a quite rare neoplasm. Due to the low incidence and recent nosographic arrangement, the natural evolution and the clinical development of this type of neoplasm are not well known. The Authors report their experience and a review of the Literature trying to establish the criteria for the classification, diagnosis and therapy of pancreatic cystadenocarcinoma.

[Gastrointestinal carcinoids and carcinoid syndrome: classification, diagnosis and therapy]. / I carcinoidi gastrointestinali e la sindrome da carcinoide: inquadramento, diagnosi e terapia.

Historically, carcinoids have long been known as a morphologically distinct class of rare intestinal tumors which behave less aggressively than the more common intestinal adenocarcinomas. In recent decades refined methods in pathology improved our knowledge on the diffuse neuroendocrine system, leading to some confusion in classification and nomenclature of carcinoids. The World Health Organization (WHO) classification of endocrine tumors has cleared the definition of carcinoids. The Authors report on 7 cases of midgut carcinoid tumors and 1 case of carcinoid syndrome focusing on the newer approaches to the diagnosis, localization, and role of surgery and peptide therapy.

[Blind-ending branch of bifid ureter: apropos of a case]. / L'uretere bifido a branca cieca: a proposito di un caso.

The Authors report on a case of blind-ending ureter. A young woman (29 years old) underwent surgery because of recurrent urinary tract infections and left loin pain. The operation consisted in a radical resection of the blind branch together with Coen's operation for the coexistence of vesicoureteral reflux. Authors' goal was to review the international Literature on this rare pathology pointing out their opinion on the existing terminology which is still far from being clear and definite.

[The intraoperative visualization of the bile ducts by the use of fluorescent substances. A feasibility study]. / Visualizzazione intraoperatoria delle vie biliari mediante impiego di sostanze fluorescenti. Studio di fattibilità.

Iatrogenic bile duct injury during cholecystectomy is the most serious complication of this surgical procedure. Initial reports suggest that this complication is particularly problematic during laparoscopic cholecystectomy. Proper identification of biliary anatomy in the subhepatic region is the only way to avoid this severe complication. The potential benefit from a simple, reliable method for intraoperative delineation of biliary anatomy is self-evident. In this experimental work the Authors-study the possibility and the feasibility of intraoperative biliary tree imaging with two fluorescent molecules (rolitetracyclin and fluorescin).

Intraoperative biliary tree imaging with cholyl-lysyl-fluorescein: an experimental study in the rabbit.

Iatrogenic bile duct injury during cholecystectomy is the most serious complication of this surgical procedure. Initial reports suggest that this complication is particularly troublesome during laparoscopic cholecystectomy. Proper identification of the biliary anatomy in the subhepatic region is the only way to avoid this catastrophe. The potential benefits of a simple, reliable method for intraoperative delineation of biliary anatomy are self-evident. In this experimental study on rabbits, we show how the simple i.v. injection of a fluorescent bile salt, cholyl-lysyl-fluorescein, enables the surgeon to visualize the entire biliary tree in anatomic detail.

[An unusual case of spontaneous idiopathic hemothorax]. / Un caso eccezionale di emotorace spontaneo idiopatico.

Spontaneous haemothorax is an extremely rare pathology. Up to date, only 3 cases have been described in literature. The authors report the fourth case personally observed.

The value of endoluminal ultrasonography and computed tomography in the staging of rectal cancer: a preliminary study.

A prospective study was carried out in 14 patients with rectal cancer. Tumors were staged preoperatively by endoluminal ultrasonography (EU) and computed tomography (CT). Patients were followed postoperatively for 2 years by the same modalities. Extramural spread was 100% (9/9), accurately assessed by EU and 77.8% (7/9) with CT. Lymph node sensitivity was 87.5% for EU and 37.5 for CT (P less than 0.05). Overall accuracy of lymph node metastases was 85.7% for EU and 57.1% for CT (P less than 0.1). In conclusion, the study shows EU to be statistically more accurate for nodal metastases than CT; therefore, its routine use can be recommended in the preoperative staging of rectal carcinoma in those patients for whom a sphincter-saving procedure is considered.

In vitro enhancement of human platelet aggregation by somatostatin.

Very low concentrations of somatostatin (S-14) strongly potentiate the in vitro aggregation induced by collagen, ristocetin and arachidonic acid, but not that induced by ADP or epinephrine, in both human platelet rich plasmas and gel-filtered platelet preparations. Desensitization phenomena may be induced either by repeated addition of S-14 or long lasting contact between S-14 and platelets.

[Advantages of the systematic combined use of endoscopy, monitored pH measurement and aimed biopsy in the study of gastroesophageal reflux]. / Vantaggi dell'impiego associato sistematico della endoscopia, della pHmetria monitorata e della biopsia mirata nello studio del reflusso gastroesofageo.

The Authors refer their experience using endoscopy, biopsy and 24 hours pHmetry associated in 62 patients with symptomatology of reflux. In 21 cases it was shown different grades of esophagitis, in 12 cases reflux potentially pathological. The Authors refer that this association in studying reflux is very comfortable for every Department.