160 research outputs found
Emergency Surgery in Obese Patients
No full textObesity is considered an important risk factor for the development of gastrointestinal
disorders [1], likely through alterations of gastrointestinal motility. Even though
gastroesophageal reflux disease is the condition mainly studied at present, the prevalence
of other upper gastrointestinal symptoms has also increased.
Upper gastrointestinal tract perforations occur as a result of various causes. The
majority of the perforations that we see today in the esophagus are iatrogenic (about
60%), but they could be spontaneous (Boerhaave’s syndrome), traumatic or due to
other causes. Perforation of a peptic, gastric or duodenal, ulcer is now less frequent
because of the availability of adequate medical therapy. Peptic ulcer disease represented
1% of the discharge diagnosis of patients with a body mass index
(BMI) > 25 kg/m2 admitted to the Surgical Unit of Christchurch Hospital, New
Zealand in a 26-month study period [2], and a surgical intervention for perforated
viscus accounted for 4.4% of patients with a BMI > 30 kg/m2 operated on at a US
community teaching hospital in 1 year [3].
They represent a surgical emergency and the timing of the intervention is very
important. Just one day of delay increases mortality significantly.
Since a detailed discussion of upper gastrointestinal perforations is beyond the
scope of this chapter, attention has been directed to examining the peculiar characteristics
of this topic in the obese population
Complete heterotopic pancreas
No full textA 43-year-old man presented to our hospital with acute abdominal pain and decreased bowel movements. Physical examination revealed a painful abdominal mass in mesogastrium. A small intestine contrast ultrasonography showed an ileal–ileal intussusception looked like a doughnut shape, with the telescoped part inside (“double cockade”, “bowel in the bowel”), created by the hyperechoic central core and mesentery surrounded by the hypoechoic outer oedematous bowel (Fig. 1, panel a), confirmed by MR-enterography (Fig. 1, panel b). Laparoscopy was performed and showed an intussusception of 10 cm length at about 80 cm from ileo-ciecal valve. A side-to-side anastomosis at ileal level was performed. Pathological examination revealed a polyp with a short peduncle (Fig. 2, panel a) diagnosed as complete heterotopic pancreas with both ductal–acinar and insular features. Antibodies to glucagon were used to identify alpha cells (Fig. 2, panel b). Postoperative course was uneventful
ATR-FTIR Spectroscopy, a New Non-Destructive Approach for the Quantitative Determination of Biogenic Silica in Marine Sediments
No full textBiogenic silica is the major component of the external skeleton of marine micro-organisms, such as diatoms, which, after the organisms death, settle down onto the seabed. These micro-organisms are involved in the CO2 cycle because they remove it from the atmosphere through photosynthesis. The biogenic silica content in marine sediments, therefore, is an indicator of primary productivity in present and past epochs, which is useful to study the CO2 trends. Quantification of biosilica in sediments is traditionally carried out by wet chemistry followed by spectrophotometry, a time-consuming analytical method that, besides being destructive, is affected by a strong risk of analytical biases owing to the dissolution of other silicatic components in the mineral matrix. In the present work, the biosilica content was directly evaluated in sediment samples, without chemically altering them, by attenuated total reflection Fourier transform infrared (ATR-FTIR) spectroscopy. Quantification was performed by combining the multivariate standard addition method (MSAM) with the net analyte signal (NAS) procedure to solve the strong matrix effect of sediment samples. Twenty-one sediment samples from a sediment core and one reference standard sample were analyzed, and the results (extrapolated concentrations) were found to be comparable to those obtained by the traditional wet method, thus demonstrating the feasibility of the ATR-FTIR-MSAM-NAS approach as an alternative method for the quantification of biosilica. Future developments will cover in depth investigation on biosilica from other biogenic sources, the extension of the method to sediments of other provenance, and the use higher resolution IR spectrometers
Cascade Stomach as a Risk Factor for Incomplete Resection of the Gastric Fundus in Laparoscopic Sleeve Gastrectomy: a Point of Technique
No full textIn 1941, Schaffner et al. reported a case of a patient suffering from cascade stomach (CS) who underwent surgical exploration, using these words: “the fundus of the stomach was very much larger than usual, somewhat thickened, but atonic and flaccid. The space above the pancreas and behind the fundus was deeper and larger than usual. The fundus was freed. Its superior attachments appeared elongated and lax. The entire fundus was resected laterally to below the level of the splenic artery, leaving only a strip on the lesser curvature side about one and one-half inches wide. This was converted into a tube not much larger than the esophagus itself”. This is very likely the first description of a sleeve gastrectomy (SG) ante littera
Corrigendum: Defining functional interactions during biogenesis of epithelial junctions
No full textThe original version of this Article (https://doi.org/10.1038/ncomms13542) contained an error in the spelling of the author Tommaso Poggioli, which was incorrectly given as Tommaso Pogglioli. This has now been corrected in both the PDF and HTML versions of the Article
Distributed data management for large scale applications
No full textImprovements in data storage and network technologies, the emergence of new highresolution scientific instruments, the widespread use of the Internet and the World Wide Web and even globalisation have contributed to the emergence of new large scale dataintensive applications. These applications require new systems that allow users to store, share and process data across computing centres around the world. Worldwide distributed data management is particularly important when there is a lot of data, more than can fit in a single computer or even in a single data centre. Designing systems to cope with the demanding requirements of these applications is the focus of the present work.This thesis presents four contributions. First, it introduces a set of design principles that can be used to create distributed data management systems for data-intensive applications. Second, it describes an architecture and implementation that follows the proposed design principles, and which results in a scalable, fault tolerant and secure system. Third, it presents the system evaluation, which occurred under real operational conditions using close to one hundred computing sites and with more than 14 petabytes of data. Fourth, it proposes novel algorithms to model the behaviour of file transfers on a wide-area network.This work also presents a detailed description of the problem of managing distributed data, ranging from the collection of requirements to the identification of the uncertainty that underlies a large distributed environment. This includes a critique of existing work and the identification of practical limits to the development of transfer algorithms on a shared distributed environment. The motivation for this work has been the ATLAS Experiment for the Large Hadron Collider (LHC) at CERN, where the author was responsible for the development of the data management middleware
Anorectal adenocarcinoma recurrence successfully treated with electrochemotherapy: a case report
No full textAnal canal adenocarcinoma is generally treated like rectal cancer. Surgery is the standard treatment in early stages and neoadjuvant chemoradiation in locally advanced tumors. Local recurrences treatment paradigm often depends on the previous therapies of either surgery or radiotherapy or systemic therapy. We present the case of a patient with tubulovillous adenocarcinoma of the anal canal which relapsed after chemoradiation. The patient refused salvage surgery and was treated with definitive electrochemotherapy under general anesthesia. Tumor electroporation performed with the insertion of three needles in the recurred site was preceded by an intravenous bolus of bleomycin. After the administered treatment, the patient showed a complete clinical response. A year after electrochemotherapy, the patient is free from local disease with excellent preservation of the sphincter function. Electrochemotherapy may be considered as an alternative to surgery in small lesion in the anorectal region when other approaches are excluded
Private Equity funds laws and regulations: tackling the main tax obstacles to cross-border investments
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Correction to: Ostomy closure rate during COVID-19 pandemic: an Italian multicentre observational study (Updates in Surgery, (2022), 74, 3, (1017-1025), 10.1007/s13304-022-01274-w)
No full textWhile typesetting the article the Collaborators were not included in the proofs. The collaborators names are provided below: DOC Collaborative Group: Laura Agostinelli, Ferdinando Agresta, Gabriele Anania, Laura Antolino, Pietro Anoldo, Emanuele Botteri, Umberto Bracale, Fabio Carbone, Massimo Carlini, Francesco Maria Carrano, Giorgia Casadei, Diego Coletta, Francesco Crafa, Nicola de’Angelis, Paolo Delrio, Giovanni Domenico De Palma, Marcello Di Martino, Ugo Elmore, Lorenzo Gozzini, Michele Grieco, Giovanni Battista Levi Sandri, Edelweiss Licitra, Andrea Lucchi, Marco Massani, Riccardo Memeo, Marco Milone, Dario Oppici, Monica Ortenzi, Alberto Patriti, Francesca Pecchini, Roberto Peltrini, Micaela Piccoli, Adolfo Pisanu, Mauro Podda, Gilberto Poggioli, Maria Chiara Ranucci, Daniela Rega, Riccardo Rosati, Francesco Roscio, Matteo Rottoli, Roberto Santoro, Alberto Sartori, Antonino Spinelli, Serafino Vanella, Giovanni Vennarecci, Nereo Vettoretto. The original article has been corrected
Partial splenic embolization preceding splenectomy, in a case of refractory immune thrombocytopenic purpura.
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