Face-to-face versus distance learning in a seaside area: the teacher's point of view.

The total or partial replacement of face-to-face teaching with distance teaching brings a number of problems for teachers, children and families. Recently, in our province in Southern Italy, in a seaside area, we conducted a survey to assess the experiences of high school teachers faced with distance learning during the COVID-19 pandemic, with the purpose of examining the real impact of these dramatic changes, both from social and health perspectives. From the preliminary aspects of this survey it emerges that it is difficult to univocally consider the effectiveness of distance learning in such a complex territory, especially in a seaside area. This experience will serve us to reflect in the future on a school tailored to the individual student by a permanent integration of face-to-face forms with distance learning.

Robotic nephropexy in case of symptomatic nephroptosis.

We found only a recent report of robotic-assisted nephropexy, in a young female with associated dismembered pyeloplasty. Herein we present the first case of isolated robotic nephropexy. A 34-year old female was referred to our Urological Division history of right flank pain and evidence at intravenous urography of a 5-6 cm descent of right kidney moving from supine to erect position. The robotic nephropexy was performed with a transperitoneal approach and 4 trocars. The kidney was wrapped up with a Parietex Composite (PCO) mesh (Tyco Healthcare), previously precut in an hockey stick shape to obtain a "spoon effect" to push up the lower pole of kidney. Despite the laparoscopic or retroperitoneoscopic procedures, the robotic-assisted nephropexy appears easier, with the particular advantages of the intracorporeal suturing and a better intraoperative view. The use of mesh, in our opinion, is preferable respect the decapsulation of the kidney, to avoid unnecessary blood loss and possible scarring.

Carotid endarterectomy with intermediate cervical plexus block.

During carotid endarterectomy, the use of locoregional anesthesia to achieve a combined superficial and deep cervical plexus block can cause cardiovascular, respiratory, and neurologic complications. Seeking to reduce risk and find an easier procedure, we applied locoregional anesthesia and an intermediate cervical plexus block in a series of patients who underwent carotid endarterectomy. From 2006 through 2007, 183 patients underwent primary carotid endarterectomy at our hospital. Mean age was 75.9 +/- 9.9 yr; mean body mass index, 27.3 +/- 6.7 kg/m(2); and median American Society of Anesthesiologists physical status classification, P3 (range, P2-P4). All procedures combined an intermediate cervical plexus block with subcutaneous infiltration of the incision line. We inserted a 15-mm, 25G needle to its full length, perpendicular to the skin along the posterior border of the sternocleidomastoid muscle, midway between the mastoid process and the clavicle. We injected 10 mL of 0.75% ropivacaine solution for 3 to 5 minutes. This block was systematically combined with subcutaneous infiltration of the incision line with the ropivacaine (0.75%, 10 mL), and sometimes also with 2% topical lidocaine intraoperatively. If necessary, intraoperative sedation, analgesia, or both were given to patients to improve their compliance. Intraoperative topical lidocaine was required in 59 patients (32.2%), and intravenous midazolam, fentanyl, or both were required in 29 patients (15.8%). Two procedures were converted to general anesthesia (1.1%). No perioperative deaths or complications occurred. Postoperatively, 2 patients experienced strokes and 1 sustained a myocardial infarction (total rate, 1.6%). We found the intermediate cervical plexus block to be feasible, effective, and safe, with low perioperative and postoperative complication rates. Herein, we report our findings.

A singular case of iatrogenic axillofemoral bypass disruption: a dramatic event treated by a lucky combined approach.

Proximal disruption of an axillofemoral bypass is a catastrophic event rarely caused by a posttraumatic anterior dislocation of the shoulder. Herein, we present a 74-year-old man with a painful dislocation of the right shoulder that was successfully reduced. Three hours later he had hemodynamic shock with an expanding and pulsating hematoma at the level of the right shoulder, pectoral and infraclavicular region. Surgical exposure of the right brachial artery was carried out, and intraoperative angiography revealed a proximal anastomotic leakage. The distal ballooning improved the hemodynamic status, and by a redo infraclavicular incision the hematoma was drained. The arterial leak was repaired by an 8 mm polytetrafluoroethylene interposed graft between the axillary artery and existing graft. The utility of a combined approach (endovascular + open surgical) is discussed.

Asymptomatic chronic urachal abscess mimicking a bladder tumor.

A 72-year-old man was admitted with a lower abdominal mass, occasionally detected during a previous laparoscopy. The cystoscopy revealed a bulging mass 5 cm in diameter at the vesical dome. The computed tomography (CT) scan showed an extravescical extension in close relationship with the posterior abdominal wall. Two consecutive endoscopic biopsies and a CT-guided percutaneous biopsy were not helpful. At surgery, a mass about 10 cm in diameter was found at the vesical dome and removed "en-block". The microscopic examination showed a chronic urachal abscess. To our knowledge, this is the second case of asymptomatic urachal abcess mimicking a bladder neoplasm. The reasons of a surgical approach are discussed.

Robotic-assisted laparoscopic prostatectomy in Italy: perioperative data on the first 150 patients.

BACKGROUND: In 2004 we performed the first robot-assisted laparoscopic prostatectomy (RALP) at Aosta, Italy. METHODS: Data about our first 150 RALPs are presented. RESULTS: Mean patient age was 65.2 (range 51-75) years; mean preoperative PSA level 7.9 (range 1.8-25.0) ng/ml. Nerve sparing was performed in 109 cases (72.7%) with lymph nodes dissection in 27 (18.0%). Operative time: patients 1-50, mean 213.3 (range 185-290) min; patients 51-100, 207.3 (range 185-335) min; patients 101-150, 171.7 (range 123-270) min. Two procedures were converted to open. Mean blood loss was 235 (range 20-1000) ml with two blood transfusions. One patient was reoperated for anastomotic leakage. Four patients were treated by colostomy and rectal suture for rectal injury (n = 3) or recto-urethral fistula (n = 1). The overall complication incidence was 13.3% (20 events), while mortality was nil. CONCLUSIONS: The incidence of complications is slightly higher than in major pilot centres but it is comparable, hence RALP also appears feasible in our italian peripheral centre.