90 research outputs found
Definizione dell'eta' scheletrica dall'entita' dell'obliterazione delle suture mascellari.
No full textLife expectancy in the districts of Taranto
No full textThe "Taranto case" has aroused the scientific interest of demographers, statisticians, epidemiologists and doctors, to understand what is happening today to the health of citizens, finding excesses of mortality and morbidity in certain pathologies strictly connected to pollution, in particular in the Ionian capital and in some neighboring municipalities. We have developed abbreviated mortality tables, using a methodology essentially different from that of Istat due to the fact that we do not rework the probabilities of death at all, which remain real. This solution is valid as Taranto is a large municipality, with almost 200,000 inhabitants
Isolating the Role of Bone Lacunar Morphology on Static and Fatigue Fracture Progression through Numerical Simulations
No full textCurrently, the onset of bone damage and the interaction of cracks with the surrounding micro-architecture are still black boxes. With the motivation to address this issue, our research targets isolating lacunar morphological and densitometric effects on crack advancement under both static and cyclic loading conditions by implementing static extended finite element models (XFEM) and fatigue analyses. The effect of lacunar pathological alterations on damage initiation and progression is evaluated; the results indicate that high lacunar density considerably reduces the mechanical strength of the specimens, resulting as the most influencing parameter among the studied ones. Lacunar size has a lower effect on mechanical strength, reducing it by 2%. Additionally, specific lacunar alignments play a key role in deviating the crack path, eventually slowing its progression. This could shed some light on evaluating the effects of lacunar alterations on fracture evolution in the presence of pathologies
RIGHT SIDED DIVERTICULITIS IN EMERGENCY AND ELECTIVE SETTINGS: A SINGLE CENTRE EXPERIENCE
No full textIntroduzione
Right sided colonic diverticulitis is a rare condition in Western countries while is common in Asian ones. In most cases, right colonic diverticulitis mimicks an acute appendicitis and it is often diagnosed when explorative laparoscopy excludes the presence of appendicits. We report our experience in the treatment of right-side diverticulitis.
Pazienti e metodi
From September 2011 to May 2015 170 patients underwent surgical intervention for diverticular disease in our unit, both in emergency or elective setting. Pre- intra- and postoperative data of patients were prospectively registered. Uni and multivariate analysis was performed both for factors associated with postoperative morbidity and conversion to laparotomy. Statistical analysys was performed with SPSS v. 13.0. Significance was considered for p value < 0.05.
Risultati
17 patients (10%) was affected by right colonic diverticulitis and only 3 of them (17.6%) came from Asian countries. Male/female ratio was 1:1 with mean age of 5115 years, statistically lower respect to our cohort of patients with left side diverticulitis (6714 years; P<0.001). In 16 cases (94,1%) a surgical exploration was performed due to clinical and laboratoristic diagnosis of acute appendicitis. Only one patient underwent elective surgery for recurrent episodes of acute diverticulitis that required two hospital admissions. In 9 cases (52.9%) the disease was localized in the ascending colon while in the other 8 patients there was a caecal diverticulitis. 12 patients (70.6%) had Hinchey 1-2, in one case there were a generalized purulent peritonitis and in one case we found hemoperitoneum from diverticular bleeding. 13 patients (76.5%) underwent colonic resection with anastomosis while in the other 4 cases a diverticulectomy was performed with no postoperative events. Surgical interventions were performed with mini-invasive approach in 13 patients (76.5%) with a conversion rate of 29.4% (5 patients). Mean postoperative stay was 9 11 days. Overall postoperative morbidity rate was 12.6% (3 patients) according Calvien Dindo Classification. There was no postoperative in-hospital mortality. We also performed multivariate analysis to identify factors predicting overall, surgical ad medical complications but we did not find any significant factor. Also the logistic regression to identify factor predicting conversion from laparoscopic to open approach failed to find an independent variable.
Conclusioni
In our experience, right side colonic diverticulitis is a rare but not irrelevant condition also in Caucasian young individuals. Clinical and laboratoristic features of right diverticulitis can mimick other pathological contidion as acute appendicitis and often is misdiagnosed. Patients with acute right colonic diverticulitis can be treated safely with colonic resection and anastomosis. In selected cases isolated diverticulectomy can be an adequate approach
Short term outcomes in surgery for complicated acute diverticulitis
No full textAim: To identify prognostc factor for postoperative complications in patients who
underwent surgery for complicated acute diverticulitis (CAD).
Method: From September 2011 to March 2016 we operated 136 patients for
CAD. Multivariate analysis with logistic regression was performed for postoperative
morbidity and mortality.
Results: Mean age was 68 15 years. In 17 cases (12.5%) the disease was localised
at right colon. Postoperative morbidity was 53.7%. According Clavien-Dindo classi-
fication, 12.5% of patients had grade III-IV complications with mortality at 15.4%.
At multivariate analysis, age 80, chronic renal failure and diffuse peritonitis were
independent factors for mortality (respectively; OR 2.8, 95% CI 1.00–8.2;
P = 0.005, OR 5.4, 95% CI 1.6–18.3; P = 0.007, OR 2.4, 95% CI 1.2–4.9;
P = 0.014). For postoperative morbidity, the only independent factor was left side
disease (OR 4.2, 95% CI 1.1–16.0; P = 0.033), while chronic renal failure did not
reach significance (OR 3.8, 95% CI 0.9–15.9; P = 0.062).
Conclusion: Surgery for CAD has high rate of postoperative adverse events. Partic-
ular care must be taken in patients’ 80 years, with renal impairment and with
Hinchey III-IV disease. Right colonic CAD seems to have a milder postoperative
course
Inkjet Printing of Cobalt Ferrite for Hard Ferromagnetic Thick Films Manufacturing
No full textInkjet printing is a versatile and cheap technique for the fabrication of films, offering unique advantages in terms of scalability, precision, and customization. In recent years, there has been a growing interest in utilizing inkjet printing technology for the deposition of magnetic films with tailored properties. Cobalt ferrite (CoFe2O4) stands out due to its exceptional magnetic properties, including high coercivity, saturation magnetization, and excellent chemical stability. This paper presents a comprehensive study on the inkjet printing of cobalt ferrite magnetic films, focusing on the manufacturing process, especially on the different factors that could lead to stable multilayer depositions to achieve high thicknesses: ink solid loading, drop spacing, substrate temperature, and interlayers drying. Finally, the microstructure of the samples is investigated to identify the occurring defects after sintering between 800 and 1000 °C. The magnetic properties of the films are determined, revealing a maximum coercivity of 1.98 kOe and a magnetic saturation of 78.25 emu cm^−3
SHORT TERM RESULTS OF ELECTIVE COLON RESECTIONS FOR UNCOMPLICATED DIVERTICULAR DISEASE
No full textIntroduzione
Indications for elective surgery in diverticular disease are sill debated and recent findings suggest a conservative approach since most patients present complicated diverticulitis as the first manifestation of diverticular disease. In our study we analyze the result in term of postoperative morbidity and mortality in patiets who underwent elective surgery for diverticular disease.
Pazienti e metodi
From September 2011 to May 2015 we perfomerd 170 surgical interventions for diverticular disease in our unit. Of these, 51 resection were performed in elective setting. Pre-, intra- and postoperative findings were collected in a prospective database. Multivariate analysis with logistic regression was performed to find out independent predictive factors for postoperative events. Statistical analysis was made with SPSS v.13.0 and significance was considered with p value < 0.05.
Risultati
Male:Female ratio was 1:1 with mean age of 5914 years. 44 patients was younger than 75 years. 54.9% of patients had one or more comorbidities and 12 patients (23.5%) had ASA score >2. Most patients had only one previous hospital admission (28 patients, 54.9&) while 9 patients reported two or more admissions. 2 patient underwent surgery for the development of colo-vescical or colovaginal fistula and 2 patient for paracolic or pelvic abscess refractory to medical therapy. In 70.6% (36 patients) of cases a laparoscopic approach was performed with a conversion rate of 16.7%. No postoperative in-hospital mortality was recorded. Postoperative complication rate was 31.4% (16 patients) according Clavien-Dindo Classification. Anyway 14 patients had grade I or II complication with mild clinical impairment. Multivariate analysis did not find any independent predictive factor for overall and surgical complications. On the other hand presence of diabetes mellitus (DM) and ASA score > 2 was associated with increased risk of medical complication (OR 16.7; 95%CI 1.1-259.9 P=0.044 and OR 8.5; 95%CI 1.1-62.6 P=0.036 respectively). A T-test was performed to compare mean of postoperative stay within the two variables. Patients with ASA score > 2 were found to have longer postoperative stay respect to those with ASA score 1-2 (13,5 vs 8,4 P=0.008). No significant difference was found in patients with or without DM (9.0 vs 9.6 P=0.818).
Conclusioni
In our experience, elective surgery for diverticular disease can be performed safely and often with mini-invasive approach, with accetable rate of significant postoperative event. Anyway we need powerful studies providing strong evidence to identify patients who could really take advantage of elective surgical intervention
Small bowel obstruction due to metastasis of cutaneous melanoma: 7-years after primary diagnosis.
No full textAim of study: Metastatic involvement of the small bowel by melanoma is rare. The average time from the excision of the primary cutaneous melanoma to the occurrence of intestinal metastases tends to be between 3 and 5 years; one case of recurrence after 15 years is described.
The most common kind of lesion is polypoid: this can cause intussusception and intestinal occlusion. We report a case of intestinal occlusion by an ileal metastasis of a melanoma occurred 7 years earlier.
Materials and Methods: Case Report: The patient was a 57-year-old female who was admitted to our hospital for persistent abdominal pain and sub-occlusion. The patient's past medical history included cutaneous malignant melanoma 7 years before and lobular breast adenocarcinoma 10 years before. During the previous three months, she had intermittent abdominal pain and a weight loss of about 7 kg. Abdominal-US, EGDS and colonoscopy were all negative for pathologic findings. During the hospital stay, a CT enterography revealed lower intestinal intussusception, and enlarged lymph nodes both in the abdominal cavity and in the retroperitoneum. Intraoperatively we found an ileal invagination due to a polypoid mass of the ileal tract. Segmental ileal resection was performed; wide mesenteric lymph node dissection was not possible because of large and extended retroperitoneal lymphadenopathies. Histological examination showed epithelioid and spindle tumor cells with obvious cytoplasmic melanin deposition. Immunohistochemical staining revealed that tumor cells were positive for S-100, HMB-45 and vimentin, confirming the diagnosis of melanoma.
Main results and conclusions: Appearance of GI metastases is reported up to 15 years after the inital diagnosis of melanoma. Reported clinical signs and symptoms generally include chronic abdominal pain, occult or gross bleeding and, as in this case, weight loss. Aspecificity of symptoms may impede early diagnosis and treatment of the disease. As in this case, where curative surgery is impossible because of the extent of disease, metastatic tumor resection or GI tract bypass surgery is recommended to relieve symptoms or avoid future complications. Early diagnosis of metastases requires adequate imaging (CT) and prolonged follow up
FACTORS PREDICTING MORBIDITY AND MORTALITY AFTER SURGERY FOR COMPLICATED ACUTE DIVERTICULITIS: A SINGLE CENTER EXPERIENCE
No full textIntroduzione
Complicated acute diverticulitis (CAD) occurs in approximately 10 to 25 percent of patients affected by diverticular disease and a surgical treatment is often necessary. Postoperative morbidity and mortality are still high, up to 40% of cases in patients with generalized peritonitis. The purpose of this study is to identify predictive prognostc factor for postoperative morbidity and mortality in patients requiring surgical intervention for CAD.
Pazienti e metodi
From September 2011 to May 2015 170 patients underwent surgical intervention for diverticular disease in our unit. Of these, 119 patients required urgent surgery for complicated acute diverticulitis (CAD). Pre-, intra- and postoperative findings were collected in a prospective database. Multivariate analysis with logistic regression was performed to find out independent predictive factors for postoperative morbidity and mortality. Statistical analysis was made with SPSS v.13.0 and significance was considered with p value < 0.05.
Risultati
There were 56 males and 63 females with mean age of 68 ± 15 years. 100 patients (84.0%) were at first hospital admission for diverticular disease and in 16 cases (13.4%) the disease was localized at right colon or ceacum. A stomy was required in 84 patients (70.6%) and postoperative morbidity rate was 52,9% according Clavien–Dindo Classification. Anyway only 10.9% of patients were affected by grade III or IV complication with a mortality rate of 16.8%. At multivariate analysis the presence of a postoperative medical complication was the only predictive factor for mortality (OR 10.3; 95%CI 2.1-51.3 p=0.004) while the presence of COPD and purulent or fecal peritonitis were not statistically significant (OR 3.3; 95%CI 0.9-12.2 p=0.073 and OR 3.1 95%CI 0.8-11.6 p=0.099 respectively). For postoperative morbidity the logistic regression showed that patients ≥75 years and with ASA score > 2 were independently associated with postoperative morbidity (OR 2.8; 95%CI 1.1-7.2 p=0.028 and OR 5.3 95%CI 2.0-13.9 p=0.001 respectively). The same factors were independent prognostic factor associated with medical complication with OR 3.0; 95%CI 1.1-7.8 p=0.028 and OR 6.5 95%CI 2.0-21.3 p=0.002 respectively. Multivariate analysis of factor predicting surgical morbidity showed that age ≥75 was the only predictive factor for postoperative surgical morbidity (OR 3.1; 95%CI 1.1-8.8 P=0.027).
Conclusioni
In our experience the majority of patients who require surgery for CAD are at the first episode of acute diverticulitis. Medical complication after surgery for CAD is the only factor associated with mortality while surgical complications do not seem to have the same weight. Age≥75 years and ASA score >2 are independent predictive factors for postoperative medical complications while only age seems to have a significant effect on surgical morbidity
Assessment of the uncertainty in human exposure to vibration: an experimental study
No full textThe purpose of this work is to analyze and to quantify the contributions of measurement uncertainty in the human exposure to vibrations. Typically, the high-level vibrations exposure in workplace can cause the onset of pathologies affecting musculoskeletal, vascular and neurological systems. Regulations and Standards lay down the assessment of the health risks arising from vibrations by using specific instruments and a proper measurement procedure. This paper proposes a methodology for the uncertainty evaluation of exposure to hand-arm and whole-body vibrations; as a main contribution, the uncertainty analysis of daily exposure hand-arm vibrations and whole-body vibrations is provided in order to estimate the exposition vibrations and to reduce the risks of the worker. This activity was developed in collaboration with Military Navy Arsenal in Taranto (South Italy), which is active all along in the protection of health and the safety in the workplac
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