17 research outputs found
Clinical Usefulness of the Valsalva Manoeuvre to Improve Hemostasis during Thyroidectomy
No full textBleeding after total thyroidectomy remains a rare event that affects early postoperative morbidity, occurring in 0.3% to 4.2% of cases. Intraoperative bleeding is an unpleasant complication, and it is often easily manageable, although postoperative bleeding may represent a life-threatening condition for the patient. The purpose of our study was to clarify the role of the Valsalva manoeuvre to reduce postoperative bleeding. Between January 2019 to February 2022, 250 consecutive patients were listed for thyroid surgery at our surgical department. The study cohort consisted of 178 patients, divided into two groups based on the execution of the Valsalva manoeuvre. There was no difference in the duration of surgery between groups. Group B had fewer reinterventions for bleeding. Group A had a significantly greater volume of drainage output than Group B. Cervical haematoma can compromise a patient’s life, so bleeding control is crucial. Our results show that using a simple and safe Valsalva manoeuvre can improve the postoperative course with a significant reduction in drainage output, but does not prevent the risk of reoperation for hemorrhage
Metastatic melanoma causing small bowel perforation: A case report
No full textIntroduction and importance: Metastatic localization of melanoma often affects the gastrointestinal tract, with reference to the small intestine. Case presentation: In this work we present the clinical course of a patient affected by a surgically treated mela-noma of the right conjunctiva, suddenly manifesting abdominal symptomatology. The abdominal computed tomography scan (CT scan) show evidence of free air into the peritoneal cavity, cholecystitis and brain lesions highly suspicious for metastases. Patient underwent emergency surgery, consisting of ileo-cecal resection, cho-lecystectomy, with the construction of an ileostomy. The histological examination diagnosed multiple ileal and gallbladder localizations of pigmented epithelial melanoma, and localization. Clinical discussion: The treatment of conjunctival melanoma consists in surgical removal. Distant metastases frequently affect the gastrointestinal tract, leading to the necessity to assess patients with abdominal symptoms, in order to avoid emergency scenarios such as the one reported in our study. Conclusions: Intra-abdominal metastases from melanoma are an event that should not be underestimated, because if detected in time, they can be treated with surgery resulting in a clear improvement in the prognosis. Late diagnosis of intestinal metastases can cause an acute abdomen scenario frequently caused by intestinal obstruction or gastrointestinal bleeding
Is Emergency Surgery Back to Pre-Covid-19 Era? Our Cohort Study
No full textIntroduction: The aim of this study is to analyze the progress of hospitalizations and how the emergency operations in our Department of Medical and Surgical Sciences of the Foggia Hospital have changed qualitatively and quantitatively from pre-Covid-19 to today.Methods: Our cohort-study was conducted by analyzing four groups of patients admitted in emergency to our department from 2019 to 2022.Results: We observed a total of 150 patients for the group 1, 25 patients for the group 2, 71 patients for the group 3 and 110 for the group 4, of these 20 were emergency admission during 2019, 16 during 2020, 31 during 2021 and 10 during 2020 (p <0.05); 130 were elective admission during 2019, 9 during 2020, 40 during 2021 and 100 during 2022 (p <0.05). Of the emergency admissions 11 were operated during the no covid period in 2019, 14 during 2020, 29 during 2021, 6 during 2022.Conclusions: The contraction of hospitalizations for urgent and emergency conditions during the first lockdown has been accompanied by positive implications. The measures employed in hospitals to contain the infection determined a reduction in COVID cases, allowing the nearly complete resumption of the surgical activity provided in the pre-COVID era
Bariatric surgery: to bleed or not to bleed? This is the question
No full textBACKGROUND: Bariatric surgery procedures are the most successful and durable treatment for morbid obesity. Hemorrhage represents a life-threatening complication, occurring in 1.3–1.7% of bariatric surgeries. MATERIALS AND METHODS: We examined patients undergoing Bariatric Surgery from July 2017 to June 2020 (Group A) and those operated from July 2020 to June 2022 (Group B) in our Department. Starting from July 2020 we have implemented intraoperative measures to prevent postoperative bleeding, increasing mean arterial pressure (MAP) by 30% compared to preoperative and reducing the pneumoperitoneal pressure of CO(2) to 8 mmHg in the last 15 min of the operation. RESULTS: The study gathered 200 patients divided into the two described groups. The mean age of Group A is 44 ± 8.49 and 43.73 ± 9.28. The mean preoperative BMI is 45.6 kg/m(2) ± 6.71 for Group A and 48.9 ± 7.15 kg/m(2) for Group B. Group A recorded a mean MAP of 83.06 ± 18.58 mmHg and group B a value of 111.88 ± 12.46 mmHg (p value < 0.05 and z-score is 4.15226 and the value of U is 13,900). We observed 9 cases of bleeding in group A, most of them being treated with medical therapy and transfusions; only 1 hemodynamically unstable patient underwent re-laparoscopy. We reported only 2 cases of bleeding in group B, one of which required blood transfusions. CONCLUSION: From our study we can conclude that increasing mean arterial pressure (MAP) by 30% compared to preoperative and reducing the pneumoperitoneum pressure of CO(2) to 8 mmHg in the last 15 min of the operation led to a decrease in bleeding cases in group B and, most importantly, all the bleedings were easily controllable with medical therapy and/or transfusions. These measures allowed us to reduce postoperative bleeding
Can robotic gastric bypass be considered a valid alternative to laparoscopy? Our early experience and literature review
No full textBackground: Robotic bariatric surgery serves as an alternative to laparoscopy. The technology provides the surgeon with an accurate three-dimensional view, allowing complex maneuvers while maintaining full control of the operating room. Hypothesis: We report our experience with this innovative surgery compared with laparoscopy during Roux-en-Y gastric bypass to demonstrate its safety and feasibility. The aim of this study is to evaluate potential differences between the robotic and laparoscopic techniques. Materials and methods: Our study retrospectively identified 153 consecutive obese patients who underwent either laparoscopic or robotic gastric bypass (RGB) procedures over a 2-year period at the Department of Medical and Surgical Sciences, University of Foggia. Data on demographics, operative time, conversion rate, length of hospital stay, and mortality were collected and compared between two groups of patients: 82 patients who underwent laparoscopic procedures and 71 who underwent robotic procedures. Results: We analyzed 153 patients who underwent gastric bypass with a mean age of 42.58 years, of whom 74 were female; 71 were treated with a robotic approach and 82 with a laparoscopic approach. The mean operative time was 224.75 +/- 10.4 min for RGB (including docking time) and 101.22 min for laparoscopic gastric bypass (LGB) (p < 0.05), which is statistically significant. The median length of stay was 4.1 days for the RGB group and 3.9 days for the LGB group (p = 0.89). There is only one conversion to laparoscopy in the RGB group. We observed only one case of postoperative complications, specifically one episode of endoluminal bleeding in the laparoscopic group, which was successfully managed with medical treatment. No mortality was observed in either group. Conclusion: The statistical analysis shows to support the robotic approach that had a lower incidence of complications but a longer operative duration. Based on our experience, the laparoscopic approach remains a technique with more haptic feedback than the robotic approach, making surgeons feel more confident
Reply to a letter to the editor regarding the published article: “YouTube™ as a source of information on bladder pain syndrome: A contemporary analysis”
No full textas a source of information on bladder pain syndrome: A contemporary analysis
No full textAim: To evaluate the quality of YouTubeTM videos on bladder pain syndrome (BPS) and to investigate whether they can be used as a reliable source of information.
Methods: The search term "bladder pain syndrome" was used on YouTubeTM platform. The first 100 videos were selected. Patient Education Materials Assessment Tool for audio-visual content (PEMAT A/V), Global Quality Score (GQS), Misinformation tool, and DISCERN score were used to assess videos' quality content. Pearson's test was used to assess potential correlations between variables.
Results: Seventy-nine videos were suitable for the analyses. The median PEMAT A/V Understandability score and PEMAT A/V Actionability score were 66.7% (interquartile range [IQR]: 46.2-100.0) and 75.0% (IQR: 37.5-100.0), respectively. According to GQS, 26 (32.9%), 32 (40.5%), 3 (3.8%), 15 (19.0%), and 3 (3.8%) videos were excellent, good, moderate, generally poor, and poor, respectively. According to Misinformation tool, of all videos, 81% (n = 64), 6.3% (n = 5), 5.1% (n = 4), 5.1% (n = 4), 2.5% (n = 2) had respectively no, very little, moderate, high, and extreme misinformation. The overall median DISCERN score ranged from 5.0 (IQR: 2.0-5.0) to 5.0 (IQR: 5.0-5.0). A positive statistically significant correlation was found between video length and PEMAT A/V Understandability (r = 0.27, p = 0.01), video length and PEMAT A/V Actionability (r = .26, p = 0.02), and video length and DISCERN Question 16 (r = 0.28, p = 0.01).
Conclusions: Nowaday, the overall quality of YouTubeTM videos on BPS have been evaluated good according to PEMAT A/V, GQS, Misinformation tool, and DISCERN score. It is possible to assume that YouTubeTM may be considered as a reliable source of information on BPS
Il rischio di periferizzazione nelle aree urbane e metropolitane. Una proposta metodologica per l'analisi e la mitigazione
No full text2019 - 2020As cities and poverty continue to grow worldwide, both ‘spatial’ and ‘a-spatial’ peripheralization processes expose entire urban and metropolitan areas at risk of degradation, not just traditional peripheries. The spatial sense refers to peri-urban areas, in particular to the phenomena of sprawl and, in general, to land take; the non-spatial sense goes beyond the localization with respect to a center and it is associated with the multidimensional concept of urban poverty or deprivation.
These processes, which go beyond municipal limits, are associated with a widespread unsustainability, against which urban planning can play a key role, as stated in the New Urban Agenda.
Furthermore, according to the European Commission, the fight against degradation in the most deprived areas, through urban regeneration programs, can discourage the increasing land consumption.
Some European countries make use of composite indices to identify areas of intervention, as proposed in the scientific international literature about urban poverty/deprivation, even if a general agreement on the most suitable indicators set is not recognizable, as well as on the threshold values for their classification.
In Italy, where national legislation for urban regeneration is still lacking, there are generally no scientific criteria for the identification of areas in need of intervention, which is usually left to the municipal authorities, on the occasion of sporadic calls for public funding. As a result, interventions translate into operations mainly driven by convenience in real estate transformations, regardless of city planning, while less and less importance is given to territorial strategic planning, which is crucial considering the inter-municipal nature of such processes.
The main aim of this work is to propose a methodology for peripheralization risk assessment, according to the theory of territorial risk, in order to spatially identify and map priority areas, those most at risk, where mitigation actions should be envisaged through urban and territorial planning, starting from a large scale. In this framework, a further objective is to provide a decision support model for the evaluation of the effectiveness of urban regeneration interventions in such areas, in terms of risk mitigation at urban scale.
Such an approach constitutes the novelty of the work. So, peripheralization risk is defined for the first time, as the product of Overall Vulnerability and Exposure. In order to construct the composite index of Overall Vulnerability in the Italian geographical context, a set of Vulnerability Indicators is defined on the basis of a literature review, and structured in four dimensions: Social, Building, Urban and Environmental Vulnerability.
However, the estimation of the composite indices of Social, Building and Urban Vulnerability is more subjective than the Environmental Vulnerability evaluation, due to the lack of aggregation techniques and well-established threshold values in the relevant literature, therefore it requires a different modelling: an aggregation method based on fuzzy logic is used, in order to overcome the greater uncertainty of this process. In this way, two different risk scenarios are delineated: the first considers the three social, building and urban domains; the second all the four peripheralization dimensions identified.
Finally, the work defines a set of mitigation indicators, with reference to vulnerability indicators selected for the identification of priority areas, and a model for the assessment of the most effective urban regeneration alternative, on the basis of analytic hierarchy process (AHP) algorithms.
The methodology for large-scale risk assessment is applied to a conurbation of sixteen municipalities in the Campania region (Italy), known as Caserta conurbation. The obtained results showed that, in all scenarios, areas most at risk can be both peripheral and central neighborhoods, but also entire municipalities, demonstrating how mitigation actions are needed at different planning levels.
Then, the proposed model for urban-scale risk mitigation is tested with reference to an area within the conurbation, belonging to Marcianise Municipality (CE) and found as a priority from the previous risk mapping. This application demonstrates that design alternatives apparently similar in number and type of interventions may have different effectiveness in relation to the reduction of pre-existing vulnerability levels.
Since the necessary input data are ordinarily available in planning processes, the entire proposed methodology can be transferred to other geographical contexts. [edited by Author]XXXIII cicl
Rede Salesiana de Escolas (RSE): desafios da educação histórica
No full textA presente pesquisa analisa sobre as apropriações e representações referentes à utilização do material didático da coleção de livros didáticos de História do Ensino Médio, da Rede Salesiana de Escolas (RSE), por parte dos professores no estado do Rio Grande do Sul. As instituições de ensino integrantes dessa Rede no estado gaúcho são: o Colégio Dom Bosco de Santa Rosa, o Colégio Nossa Senhora Auxiliadora de Bagé, o Colégio Dom Bosco de Porto Alegre, o Instituto Laura Vicunã de Uruguaiana e o Colégio Liceu Salesiano Leão XIII em Rio Grande, apenas esse último foram pesquisados os estudantes do terceiro ano, que concluíram o Ensino Médio no ano de 2013 e que também eram alunos da professora e também autora dessa pesquisa. Os livros didáticos utilizados nessas instituições de ensino foram produzidos por equipes da própria Rede Salesiana de Escolas e também eram todos impressos pela Editora Salesiana. Especificamente foram pesquisadas as apropriações referentes ao trabalho do professor e o sentido atribuído aos 32 estudantes do 3º Ano do Colégio Liceu Salesiano Leão XIII e também pelos próprios autores dos referidos livros didáticos. Em termos metodológicos foi utilizado a História Oral Temática e Análise de Conteúdo. Esse trabalho também fez uma análise comparativa com o trabalho desenvolvido pela professora pesquisadora Geane Kantovitz, que estudou as mesmas temáticas só com relação ao estado de Santa Catarina. As apropriações e o desenvolvimento da Consciência Histórica e os sentidos atribuídos a Historia com o uso dos livros didáticos da Rede Salesiana de Escolas(RSE), foram analisados com base nos conceitos de Consciência Histórica e Aprendizagem Histórica de acordo com Jorn Rüsen. Enfim, a proposta pedagógica da RSE referenda a utilização do livro didático como principal instrumento de trabalho do professor, buscando a formação de determinada cultura escolar. Todavia, a pesquisa evidencia que as instituições escolares da RSE, apesar de orientados a seguir os mesmos princípios, criam dinâmicas próprias. Assim, muito embora o livro didático seja importante aliado no desenvolvimento do pensamento histórico, é a mediação do professor que direcionará o processo escolar na compreensão da História e na formação da Consciência Histórica.This research analyzes on the appropriations and representations regarding the use of teaching materials from the collection of textbooks in high school History, Schools Salesian Network (CSR), by teachers in the state of Rio Grande do Sul. The institutions teaching members of this network in Rio Grande do Sul state are: the Don Bosco College of Santa Rosa, the college Our Lady Help of Bage, the Don Bosco College in Porto Alegre, the Laura Vicuña Institute of Uruguaiana and the College Lyceum Salesian Leo XIII in Rio Grande, only the latter were surveyed students of the third year, who have completed high school in 2013 and who were also students of the teacher and also the author of this research. The textbooks used in these educational institutions were produced by teams of their own Salesian Network of Schools and also were all printed by the Salesian Publisher. Specifically they were surveyed appropriations for the teacher's work and the meaning attributed to the 32 students of the 3rd year of the College Lyceum Salesian Leo XIII and also by the authors of these textbooks. In terms of methodology was used to Oral History and Thematic Content Analysis. This work also made a comparative analysis with the work of the teacher researcher Geane Kantovitz, who studied the same issues only concerning the state of Santa Catarina. Appropriations and the development of Historical Consciousness and the meanings attributed to history with the use of textbooks from the Salesian Schools Network (RSE) were analyzed based on the concepts of Historical and Historical Learning Consciousness according to Jorn Rüsen. Finally, the pedagogical approach of CSR endorses the use of the textbook as a primary teacher working tool, seeking the formation of a certain school culture. However, research shows that the educational institutions of CSR, although instructed to follow the same principles, create their own dynamics. Thus, while the textbook is important ally in the development of historical thinking is the mediation of the teacher who directs the school process in the understanding of history and the formation of Historical Consciousness
La componente archeologica nelle metodologie di valutazione ambientale dei piani
No full text2009 - 2010The evaluation component of archaeological in urban planning finds its legal basis in European and specific national legislation of environmental assessments. The planning maps often contain the archaeological map in the themes of environmental knowledge. Generally this tool is limited at the mapping and reporting of findings in the literature, without adding information on the predicted scale. To obtain a predicted level, that can provide more accurate information to avoid impacts with the existing it is proposed the drawing up of maps of archaeological potential. These tools would be able to provide information both on the level of anthropic attending of land, also to identify "archaeologically empty" areas. Fundamental tool for the preparation of these maps are the techniques of spatial analysis conducted through the tools offered by information technology. It is the environmental assessment, measuring among others, pressure of the urban plan on the ground and the landscape, is characterized as the main tool for the evaluation of the archaeological component in the strategic development of the territory. To obtain the purpose of the research project it was required to use high analytical tools. To do it, the research has seen before the interaction and then a synthesis between the various disciplines interested, in different way, to the landscape and its history: urban planning, geography, geomorphology, ecology and archeology. A basical characteristic of the approach to landscape in fact, is an interdisciplinary approach, or rather would say transdisciplinarity: the "place" where the boundaries of different disciplines involved are broken and disciplines influence each other. For this reason it is conducted before a "semantic" job, a knowledge work towards acquiring experiences and methods typical of the various "disciplines of the landscape". The second step of the work was characterized by the synthesis of a common lexicon. It was to establish a sort of ontology is able to combine different types of knowledge in a structure containing all the relevant entities and their relationships. [edited by Author]IX n.s
