437 research outputs found
A narrative review about difficult laparoscopic cholecystectomy: technical tips
No full textBackground: Laparoscopic cholecystectomy (LC) is the most practiced procedure in general surgery worldwide. It is nowadays the optimum surgical procedure for symptomatic gallbladder lithiasis. Nevertheless, it should not be underestimated since vascular and biliary duct injuries are not uncommon, with devastating consequences. This study aimed to advise the best surgical technical approach for LC according to the intraoperative situation to avoid accidental anatomical structures injuries. Methods: A traditional narrative literature search for articles published up to December 2021 was performed using the most common search engines (PubMed, Web of Science, Google Scholar). The search strategy utilized in all databases included the combination of the keywords: "laparoscopic cholecystectomy", "difficult cholecystectomy", "acute cholecystitis", "prevention bile duct injuries", "safe cholecystectomy". No restrictions were applied to the language of the publication if an English version of the article was available. Key Content and Findings: Difficult laparoscopic cholecystectomy (DLC) is a distressing condition. Its definition is not well established and may vary according to the surgeon's experience. Several techniques have been proposed to minimize the bile duct or hepatic injury risk during the challenging cholecystectomy. Conclusions: Although LC is nowadays the optimum surgical procedure for symptomatic gallbladder lithiasis, it should not be underestimated since vascular and biliary duct injuries are very morbid, significantly increase care costs, and often lead to litigations
Sedimentology, Petrografy and Provenance of the triassic Verrucano Group, Monte Argentario (Tuscany Italy)
No full textDeposition of the Verrucano Group (max. thickness 700 m) took place in a series of N-Strending grabens after rifting of the Hercynian basement. The presence of violet-gray mudrocks, caliche nodules and crusts, and the abundance of iron oxides in the sandstones and siltstones suggest that the Verrucano was deposited when the climate was semiarid.The scarcity of conglomerates and presence of upward-fining cycles suggest that the upper part was deposited by low-sinuosity mcandcring streams. T'he abundance ofconglomerate andabsenceo f sequencest ypic:rl of point bars indicate that the rest of the Verrucano was deposited chiefly by high-gradient braidcd streams. Low-grade metamorphism, which occurred duringthe Alpine orogcny, resulted in the recrystallization of argillaceous rock fragments and clay rip-up clasts, but did not clestroy primary sedimentary structures or recrystallize detrital quartz. Based on modal analyses, the sandstone composition in percents is quartz, ; microcrystalline quartz in rock fragments, quartz-mica rock fragments, mica rock fragments, iron oxides, Feldspars:The conglomerates are composed chiefly of quartz, showing various degrees of strain,and metachert .metasandstones, micas chist
Gli amministratori indipendenti: alcuni spunti per un possibile miglioramento
No full textIl presente lavoro contribuisce all’approfondimento di uno dei temi centrali del dibattito in materia di corporate governance – i.e., il ruolo degli amministratori indipendenti all’interno del sistema dei controlli aziendali – adottando una prospettiva sia giuridica, sia economico-aziendale.
Dopo il necessario inquadramento normativo, infatti, il tema viene esaminato, in primis, alla luce della letteratura e delle best practice in materia di controllo e, successivamente, alla luce delle evidenze empiriche riscontrate nel panorama delle società quotate alla Borsa Valori di Milano, fornendo – in conclusione – alcuni spunti di riflessione sulla definizione di indipendenza e sul ruolo degli amministratori indipendenti all’interno dei Consigli di Amministrazione e nel più ampio sistema dei controlli aziendali
Enforcing Cooperative Storytelling: First Studies
No full textIn this paper, we describe the first prototype of a system called StoryTable, aimed at supporting a group of children in the activity of storytelling. The system is based on a special multi-user touchable device (the MERL DiamondTouch) and it was designed with the purpose of enforcing collaboration between children. The paper discusses how the main design choices were influenced by the paradigm of cooperative learning and presents two observational studies to assess the effects of the different design choices on the storytelling activit
Laparoscopic splenectomy with radiofrequency
No full textO b j e c t i v e : Intraoperative bleeding is the maincomplication and cause of conversion during laparoscopicsplenectomy (LS). We present the advantages of the useof the Ligasure Vessel Sealing System added to a lateralapproach for achieving safe vascular control.Method: Ligasure applies a precise amount of bipolar en-ergy and pressure to the tissue, achieving a permanentseal. We have performed 55 LS by using a technique with4 trocars, a right semi-lateral position, and dissection ofthe spleen and vessels sealing with 10mm LigaSure Atlas.The indications were thrombocytopenic idiopathic pur-pura (20), spherocytosis (12), b thalassemia (6), lym-phoma (15), hemolytic anemia (1), and splenic cyst (1).Results: LS was completed in 51 patients with 4 (7.2 %)conversions because of hilar bleeding due to accidental injury (1), difficult splenic hilar dissection (1), diffuseperitoneal adhesions (1), and massive splenomegaly (1).The average splenic weight was 485 g, with an averagediameter of 15.2 cm. In all but 4 patients, the intraopera-tive blood loss was less than 100 mL. The average opera-tive time was 121.6 minutes, including 15 patients whounderwent the following combined operations: cholecys-tectomy (9), hepatic biopsy and hilar lymphadenectomy(3), adhesion dissection (3). No mortality and 3 (5.4%)postoperative complications occurred, ie, thrombosis ofthe spleno-portal axis (1); hemoperitoneum due to a pan-creatic tail bleed, laparoscopically treated (1); and pleuraleffusion (1). The average postoperative hospital stay was4.2 days.Conclusion: The use of LigaSure associated with the se-milateral position results in a gain of time and safety.Furthermore, the average intraoperative bleeding is verylow
Dome Down Laparoscopic Cholecystectomy: Our Experience and the State of Art
No full textIntroduction: Laparoscopic Cholecystectomy is nowadays the gold standard technique for
benign gallbladder disease both in elective and emergency surgery. But it is even true that in very
acute cholecystitis when the tissues are inflamed and the anatomy can be difficult to recognize, the
classic laparoscopic approach can lead to biliary and vascular injuries. Dome down laparoscopic
approach can be used to avoid conversion to open surgery and decrease surgical complications.
Methods: A retrospective record of all Cholecystectomy carried out in our unit by experienced
surgeons from January 2013 to August 2017 was examined. Cases were divided by surgical
technique: Classical laparoscopic technique, Open cholecystectomy, Laparoscopic converted to
open cholecystectomy, Dome down laparoscopic Cholecystectomy (DDLC). A systematic literature
search was performed using PubMedz and Embase databases. The search was limited to studies
on humans and to those reported in the English language between January 2009 and December
2016.
Results and discussion: 194 cholecystectomy were performed, among these 163 with
laparoscopic technique and 3% of all laparoscopic approached cholecystectomy were performed
as DDLC. The mean hospital stay was 5 days (2-11). 1 out of 5 patients needed postoperatory
ERCP and endobiliary stent was positioned removed in 30 days with no other complications.
Other 4 patients were evaluated after 1 week from dismission with no evidence of postoperative
complications.
Conclusion: Dome down cholecystectomy is a feasible and safe procedure; it avoids biliary
and vascular injuries in difficult cholecystectomy. It can still be improved by the combination
with ultrasonic devices or with new surgical techniques such as Single-incision Laparoscopic
cholecistectomy
Cap.6 - I fattori di crisi dei controlli nelle aziende di credito
No full textIl lavoro ha l’obiettivo di evidenziare i risultati di una ricerca avente ad oggetto i sistemi di controllo nelle banche, con segnato riferimento alle casistiche del suo fallimento e alle possibili cause ad esso relative, anche alla luce dell’evoluzione dell’operatività degli intermediari e delle variazioni nella struttura dei sistemi finanziari. In particolare, si delineano le attività di controllo tipiche del settore del credito declinando un modello di sistema di controlli per le banche e riportando, contestualmente, le evidenze emerse nell’esperienza di vigilanza e nella letteratura sul tema della crisi dei controlli nel settore oggetto di indagine. Sono poi presentate le risultanze della somministrazione di un questionario ad alcuni componenti di organi di controllo e gli elementi qualificanti emersi in alcune interviste di taglio qualitativo condotte ad attori chiave del controllo nelle banche italiane. L’analisi dei questionari somministrati e delle interviste condotte risulta utile per fornire spunti circa i punti di forza e di debolezza e le possibili azioni di miglioramento dei sistemi di controllo in concreto implementati dalle banche italiane
Laparoscopic splenectomy with radiofrequency. SLS annual meeting – 14th international congress and endoexpo, S.Diego (USA) 14-17 settembre 2005
No full textO b j e c t i v e : Intraoperative bleeding is the main
complication and cause of conversion during laparoscopic
splenectomy (LS). We present the advantages of the use
of the Ligasure Vessel Sealing System added to a lateral
approach for achieving safe vascular control.
Method: Ligasure applies a precise amount of bipolar en-
ergy and pressure to the tissue, achieving a permanent
seal. We have performed 55 LS by using a technique with
4 trocars, a right semi-lateral position, and dissection of
the spleen and vessels sealing with 10mm LigaSure Atlas.
The indications were thrombocytopenic idiopathic pur-
pura (20), spherocytosis (12), b thalassemia (6), lym-
phoma (15), hemolytic anemia (1), and splenic cyst (1).
Results: LS was completed in 51 patients with 4 (7.2 %)
conversions because of hilar bleeding due to accidental injury (1), difficult splenic hilar dissection (1), diffuse
peritoneal adhesions (1), and massive splenomegaly (1).
The average splenic weight was 485 g, with an average
diameter of 15.2 cm. In all but 4 patients, the intraopera-
tive blood loss was less than 100 mL. The average opera-
tive time was 121.6 minutes, including 15 patients who
underwent the following combined operations: cholecys-
tectomy (9), hepatic biopsy and hilar lymphadenectomy
(3), adhesion dissection (3). No mortality and 3 (5.4%)
postoperative complications occurred, ie, thrombosis of
the spleno-portal axis (1); hemoperitoneum due to a pan-
creatic tail bleed, laparoscopically treated (1); and pleural
effusion (1). The average postoperative hospital stay was
4.2 days.
Conclusion: The use of LigaSure associated with the se-
milateral position results in a gain of time and safety.
Furthermore, the average intraoperative bleeding is very
low
Disciplinary homogeneity in university departments following the Gelmini law: an exploratory analysis through social networks
No full textThe aim of this work is to evaluate the implementation of the Gelmini law; a law that has reorganized the universities into departments in order to create homogeneous scientific centres in the various fields of research. The methodology used to analyse the change in the structure of departments following the new regulation considers the social networks that unify the subject areas according to their current position. With the help of these social networks, we try to understand whether the new departments are really homogeneous research centres or instead are modelled on the previous faculties. The present work has been carried out in relation to the universities of the Abruzzo region and the sectors interconnected with Area 13 on the list of italian university disciplinary sector see Appendix (which contains the fields of economics and statistics), and we can extend the results to other Italian universities. We highlight: (1) the interactions between the scientific discipline sectors and the departments; (2) the definition of a cosector data matrix (binary and weighted ties); and (3) the hierarchical analysis of the cliques of the scientific discipline sectors. We discuss and compare the results to find out the reasons why the universities have still not become homogenous research centres. © 2018, Springer Nature B.V
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