354 research outputs found
Use of biological mesh in trans-anal treatment for recurrent recto-urethral fistula
No full textDear Author, I read with interest the letter by Deepak Batura about our paper entitled Use of biological mesh in trans-anal treatment for recurrent recto-urethral fistula. I thank the colleague for his accurate comments. I take this opportunity to clarify the following points: 1.All 7 patients reported in the original article underwent double diversion at least 2 months before the author's procedure. In this situation, no enteric preparation is necessary with a surgical field clean and ideal to use a mesh in a potential infected site. The biological mesh has a great capacity to progressively integrate itself; 2.All 7 patients we described underwent extensive clinical investigations during serial follow-up visits that excluded urethral stricture, signs of infections or urethral sequelae. That's way the patients did not undergo extra exams (endoscopic or bacteriological) once the stoma was closed; I hope this additional information will help to clarify up your querie
Freehand Liver Volumetry by Using an Electromagnetic Pen Tablet: Accuracy, Precision, and Rapidity
No full textThe purpose of this study is to assess the accuracy, precision, and rapidity of liver volumes calculated by using a freehand electromagnetic pen tablet contourtracing method as compared with the volumes calculated by using the standard optical mouse contourtracing method. The imaging data used as input for accuracy and precision testing were computed by software developed in our institution. This computer software can generate models of solid organs and allows both standard mouse-based and electromagnetic pen-driven segmentation (number of data sets, n = 70). The images used as input for rapidity testing was partly computed by modeling software (n = 70) and partly selected from contrast-enhanced computed tomography (CT) examinations (n = 12). Mean volumes and time required to perform the segmentation, along with standard deviation and range values with both techniques, were calculated. Student's t test was used to assess significance regarding mean volumes and time calculated by using both segmentation techniques on phantom and CT data sets. P value was also calculated. The mean volume difference was significantly lower with the use of the freehand electromagnetic pen as compared with the optical mouse (0.2% vs. 1.8%; P < .001). The mean segmentation time per patient was significantly shorter with the use of the freehand electromagnetic pen contourtracing method (354.5 vs. 499.1 s on phantoms; 457.4 vs. 610.0 s on CT images; P < .001). Freehand electromagnetic pen-based volumetric technique represents a technologic advancement over manual mouse-based contourtracing because of the superior statistical accuracy and sensibly shorter time required. Further studies focused on intra- and interobserver variability of the technique need to be performed before its introduction in clinical application
Relations between Fault and Fracture Network Affecting the Lastoni di Formin Carbonate Platform (Italian Dolomites) and Its Deformation History
No full textIn this study, we analyze the fault and fracture network of the Middle Triassic carbonate platform of the Lastoni di Formin (Italian Dolomites, Italy). The reconstruction of the deformation history is of primary importance for a full comprehension of the present structural setting of this carbonate platform. The huge dimensions of the carbonate body and superb exposure of its vertical cliffs and gently dipping top plateau make the Lastoni di Formin platform an ideal outcrop to integrate traditional fieldwork with Digital Outcrop Modelling analysis. The results of the structural studies partially confirm that the present-day fracture pattern is the result of differential compaction-induced deformation that generated WNW-ESE-trending extensional fractures and normal faults, perpendicular to the direction of progradation of the platform. Successively, extensional tectonics, likely related to the Jurassic rifting phase, led to the formation of NNW-SSE striking fractures and westward-dipping normal faults. A Neogene compressional tectonic event, characterized by N-S to NW-SE crustal shortening, deformed the platform, essentially with strike-slip structures
Use of biological mesh in trans-anal treatment for recurrent recto-urethral fistula
No full textPurpose: To report the author's experience on a miniinvasive technique using bioprosthetic plug and a rectal wall flap advancement in the treatment of recurrent rectourethral fistula. Materials and methods: Between 2013 and 2015, seven patients with recurrent recto-urethral fistula were referred to the Pederzoli Hospital, Peschiera del Garda, Verona,Italy. Intraoperatively all patients were found to have a rectal wall lesion and were treated with urinary and fecal diversion. For the persistence of the fistula, all the patients underwent a mini-invasive treatment consisting on placement of a bioprosthetic plug in the fistula covered by an endorectal advancement flap through a trans-anal and transurethral combined technique. Results: Median operative time was 48 min with a median blood loss of 30 ml. Median hospital stay was 3 days (IQR 1-3). No case of fistula recurrence or plug migration was described. None of the patients experienced fecal or urinary incontinence. All patients obtained complete fistula healing. Conclusions: Recurrent recto-urethral fistula is a challenging postsurgical complication for surgeons and urologists
Microvolt T-wave alternans for risk stratification in athletes with ventricular arrhythmias : correlation with programmed ventricular stimulation
No full textBackground: Aim of our study is to evaluate the role of T-wave alternans (TWA) to stratify the risk of sudden cardiac death in athletes (Ath) with complex ventricular arrhythmias (VA), and to document a possible correlation between TWA and electrophysiological testing (EPS) results.
Methods: We studied 85 Ath with VA (61 M, mean age 32 +/- 11 years). In all cases a cardiological evaluation was performed, including TWA and EPS. The patients were evaluated during a follow-up of 30 +/- 21 months. The end point was the occurrence of sudden death (SD) or malignant ventricular tachyarrhythmias (VT).
Results: TWAwas negative in 57 Ath (68%), positive in 15 (18%) and indeterminate in 13 (14%). All subjects with negative TWA did not show induction of VT at EPS, with significant correlation between negative TWA and negative EPS (P < 0.001). All Ath with positive TWA also had VT induced by a EPS, with significant correlation (P < 0.001). By contrast, our data did not show significant correlation between indeterminate TWA and positive or negative EPS. However, there was significant correlation between abnormal TWA test (positive + indeterminate) and inducibility of VT at EPS (P < 0.001). During follow-up we observed a significant difference in end point occurrence (VT or SD) between Ath with negative or abnormal TWA and between Ath with negative or positive EPS.
Conclusion: TWA confirm its role as a simple and noninvasive test, and it seems useful for prognostic stratification of Ath with VA
Cognitive load in 3d and 2d minimally invasive colorectal surgery
No full textBackground: Three-dimensional (3d) laparoscopy has been introduced to enhance depth perception and facilitate surgical operations. The aim of this study was to compare cognitive load during 3d and 2d laparoscopic procedures. Methods: Two subjective questionnaires (the Simulator Sickness Questionnaire and the NASA task load index) were used to prospectively collect data regarding cognitive load in surgeons performing 2d and 3d laparoscopic colorectal resections. Moreover, the perioperative results of 3d and 2d laparoscopic operations were analyzed. Results: A total of 313 patients were included: 82 in the 2d group and 231 in the 3d group. The NASA TLX results did not reveal significantly major cognitive load differences in the 3d group compared with the 2d group; the SSQ results were better in the 3d group than in the 2d group in terms of general discomfort, whereas difficulty concentrating, difficulty focusing, and fatigue were more frequent in 3d operations than in 2d operations (p = 0.001–0.038). The results of age, sex, and ASA score were comparable between the two groups (p = 0.299–0.374). The median operative time showed no statistically significant difference between the 3d and 2d groups (median, IQR, 2d 150 min [120–180]—3d 160 min [130–190] p = 0.611). There was no statistically significant difference in the risk of severe complications between patients in the 3d group and in the 2d group (2d 7 [8.54%] vs 3d 21 [9.1%], p = 0.271). The median hospitalization time and the reoperation rate showed no difference between the 2d and 3d operations (p = 0.417–0.843). Conclusion: The NASA TLX did not reveal a significant difference in cognitive load between the 2d and 3d groups, whereas data reported by the SSQ showed a mild risk of cognitive load in the 3d group. Furthermore, 3d laparoscopic surgery revealed the same postoperative results as 2d standard laparoscopy
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