Assessment of the cardiovascular regulation during robotic assisted locomotion in normal subjects: autoregressive spectral analysis vs empirical mode decomposition.

Robotic assisted locomotion systems are recently gaining appreciation as methods to rehabilitate individuals with lost sensory motor function. In the present study we compare autoregressive power spectral analysis and empirical mode decomposition (EMD) applied to the analysis of short-term heart period variability regarding their ability to typify autonomic response during a robotic assisted locomotion session consisting in the following phases: 1) sitting position; 2) standing position; 3) suspension during subject instrumentation; 4) robotic assisted treadmill locomotion with partial body weight support; 5) standing recovery after exercise. Results showed a significant tachycardia during the suspension phase, but no significant changes of spectral indexes. On the contrary, when spectral indexes were derived according to EMD, changes were evidenced during the suspension and walking phases. The EMD method is more powerful than autoregressive spectral analysis in detecting variations of parasympathetic and sympathetic modulations elicited by a robotic-assisted locomotion protocol.

Cardiac response to robotic assisted locomotion in normal subjects: a preliminary study.

Robotic assisted locomotion systems are recently gaining appreciation and diffusion as useful methods to rehabilitate individuals with lost sensorimotor function. Our aim was to evaluate potential changes in the autonomic nervous system activity (by ECG and spectral analysis), due to the experimental protocol, which include suspension of the subject to be instrumented on the system. A group of 10 normal subjects was studied during the rehabilitation protocol. Results showed a significant tachycardia and a reduced variance, during orthostatic stress induced by the suspension phase in comparison with sitting baseline condition but no significant increase of LF normalized power as it would be expected during a sympathetic activation.

[Bleeding gastric lymphoma: report of two cases]. / Linfoma gastrico sanguinante: descrizione di due casi clinici.

We report two cases of bleeding gastric lymphoma. The stomach is the most common site of primary extranodal Non-Hodgkins Lymphomas. The best treatment for primary gastric lymphoma has not yet been defined. For many years the treatment of choice has been the gastric resection. Helicobacter pylori (H. pylori) has been associated with many gastric pathologies, including gastric lymphoma. Eradication of H. pylori is now considered essential for the treatment of this pathology, and usually consists of antibiotic therapy, combined with acid suppression by a proton pump inhibitor. This simple treatment in patients with low grade histology and tumor confined to the stomach can often obviate the need for surgical intervention. Surgery is a necessary treatment, independently of the grading and the staging of lymphoma, in the bleeding complication as the cases we showed.

[Retroperitoneal leiomyosarcoma: a case report]. / Il leiomiosarcoma del retroperitoneo: descrizione di un caso clinico.

The Authors report a rare case of retroperitoneal leiomyosarcoma in a 80 years woman with respiratory symptoms and right abdominal pain. A large neoplasm occupied the right abdomen, looking asymmetric. Upper abdominal CT showed a retroperitoneal neoplasm close to right kidney, liver, aponeurosis of right oblique muscles, producing a left-side dislocation of the intraabdominal organs. A surgical "en bloc" resection of the neoplasm was performed; neoplasm was plurilobed and capsulated. The histologic examination confirmed the diagnosis of leiomyosarcoma. The best treatment of these neoplasms is surgery, that in the last years has drawn advantage from more sensible and specific diagnostic procedures, which show a more radical surgical option. Though metastases are occasional, local recurrences can be taken into consideration and, after a careful tumoral re-staging, they can be resected once more. Therefore, a careful follow-up is necessary on the basis of neoplastic grading, extension and involvement of the closer structures.

[Metachronous carcinoma of the colon: report of a clinical case]. / Carcinoma 'meta-metacrono' del colon: descrizione di un caso clinico.

The Authors deal with a rare case of 'meta-metachronous' carcinoma of the colon. A seventy years old man was admitted to ward after being diagnosed an adenocarcinoma of the transverse colon. The anamnestic data pointed out that the patient had already been operated twice for the colon carcinoma, which had been diagnosed in the left colon and in the cecum respectively seven and two years before. A colonoscopy performed sixteen months before did not show any lesion of the residual colon. It is likely that tiny lesions, which were still in the adenoma phase, were not diagnosed by the endoscopy; it is also possible that the adenoma-carcinoma sequence was extremely fast. On the basis of this experience the Authors recommend that patients with metachronus carcinoma undergo either frequent controls or a preventive subtotal colectomy.

[The use of drainage in the "per primam" treatment of recurrent pilonidal cysts]. / L'uso del drenaggio nel trattamento "per primam" delle cisti pilonidali recidive.

Recurrent pilonidal sinus treatment is still controversial, as more and more frequently methods used determine unpleasant discomforts to the patients ("open" method) or increase recurrences rate. According to this consideration, the Authors have made a review of their cases (27 patients with recurrences), selected by standardized criteria and treated by "en bloc" excision of all pathologic tissue and following closure "per primam" of the wound, previously placing an aspirative drainage, then removed after 2 or 3 days. Ordinary use of the drainage, antibiotic prophylaxis extended to postoperative sixth or seventh day and daily careful disinfection of the wound and surrounding skin until suture removal got them excellent results.

[Gastric lymphomas: surgical indications]. / I linfomi gastrici: indicazioni all'intervento chirurgico.

Primary gastric lymphoma (PGL) are lymphomas with an exclusive gastric localization. Histologically they are B-like non-Hodgkin lymphomas. Aim of Authors' study is to define the role of surgery in the treatment of PGL, on the basis of their series casistics and a review of the more recent literature data. The Authors observed 41 patients (23 F and 18 M) in a period of 10 years: 35 patients underwent to surgical operation associated in 18 of them to chemotherapic treatment; in 6 cases medical eradication of Helicobacter Pylori (H.P.) was performed as unique treatment. Antibiothic treatment allows the eradication of H.P. in 97% of the patients and a histologic decreasing of MALT lymphoma in 70% of the patients in about 6 months. That represents the first therapeutic choice for the low grade of malignancy MALT PGL at I and II stages. In the cases of partial decreasing or progression of PGL, the Authors consider opportune surgical operation. In the majority of the cases the surgical option represents, according to our advise, the best choice for the high percentage of definitive recoveries, allowing a 10 or more years of surviving of the 90%, if it is done in the first stages of the disease. The results of the association with neoadjuvant or aduvant chemotherapy are still controversial. On the basis of their experience total gastrectomy can be considered the elective choice operation, with IID level lymphadenectomy and possible splenectomy.

[Surgical treatment of hemorrhoids in day-surgery]. / Il trattamento chirurgico delle emorroidi in day-surgery.

The Authors report their own experience with day-surgery treatment of haemorrhoids and underline the advantages in terms of patients' compliance and reduction of the sanitary management in order to the cost that this way suggests. The serie here reported includes 72 patients treated, by two years, with day-surgery haemorrhoidectomy. Here are indicated criteria of selection of the patients, related to the state of the illness, association of other pathologies and social factors. All the patients, moreover, have been treated according to a scheme that generally includes: a careful preoperatory valuation, local anaesthesia, standardized surgical method (Milligan-Morgan intervention), dimission few hours after the operation, control of the patients at their own home. The results obtained, careful examinted through an objective valuation (complications, relapses, time or reability) and subjective one (index of satisfaction of the patients), can be considered extremely positive.

[Day-hospital treatment of inguinal hernia]. / Il trattamento delle ernie inguinali in regime di day-hospital.

Aim of the Authors' research was to evaluate advantages of day-surgery treatment for inguinal hernias. The study has been performed on a series of 138 patients, operated because of unrelapsed and uncomplicated monolateral inguinal hernia. Up-to-date therapeutic behaviour relating to hernia is the result of brilliant intuitions: technical order (tension-free repair), technological progresses (using new prosthetic materials), and refinement of anaesthesiological procedures (local and loco-regional anaesthesia). As regards surgical and anaesthesiological methods, general principles have been accepted by now from the most of the Authors. The new frontier of hernias' treatment is the possibility of operate in a day-hospital way: that means real advantages, both as regards patients' compliance and, in consideration of the high incidence of such pathology, as regards the high economic savings and more reasonable management of hospital stays. The significative increase of day-hospital hernioplastic operations in last years is due to standardization of restrictiveless criteria of choice for patients who can be treated with such modality.

[Recurrence after hernioplasty according to Lichtenstein: analysis of the cause]. / Le recidive dopo ernioplastica secondo Lichtenstein: analisi delle cause.

The performance of surgical interventions of tension-free hernia repair has certainly reduced the recurrence rate in comparison with the previous techniques; notwithstanding this it is not uncommon to observe some recurrences also after a Lichtenstein hernia repair. The aim of this study is that to analyse the causes. In the last 2 years, 42 patients (mean age of 68 years) with recurrent hernia have been operated by Lichtenstein technique; 11 of the 42 patients had been treated before with an useful mesh hernia repair. In 8 of these patients the recurrence was produced by an insufficient medial extension of the mesh; in the other 3 patients the cause was the presence of an unrecognized indirect hernia in patients operated for a direct inguinal hernia. All the patients treated have been submitted to a 18 months time of follow-up.

Recurrent hernia of Petit's triangle: a case report.

The Authors describe a case of recurrent hernia of Petit's triangle in a 43-year-old man. The most salient feature of lumbar hernias is the difficulty of their treatment. Numerous, more or less complex techniques have been proposed for the repair of lumbar hernias. The classic procedure is that of Dowd (1907). Repair in this case consists of a flap of fascia and aponeurosis from the gluteus medius muscle which is elevated and rotated to cover the defect. Many modifications of this technique have been proposed. The modern prosthetics mesh materials allow a tension-free repair of lumbar hernias without distortion of the normal anatomy. Correct placement of a prosthetic mesh is relatively simple. Recurrences are due not to the material used, but to patches which are too small or too tight.

[Tension-free hernioplasty in the aged. A report of 94 cases]. / Ernioplastica secondo Lichtenstein nell'anziano. Contributo clinico.

BACKGROUND: Tension free inguinal hernioplasty has become the procedure of choice in the elderly. The operation of originally popularized by Lichtenstein and Shulman gives the best early result with low complication rates. METHODS: Between January 1991 and December 1996, 94 subjects over 70 with inguinal hernia were submitted to hernioplasty. The tension-free technique was adopted utilizing a polypropylene mesh. Peridural anesthesia was the method used in 67 procedures, local anesthesia in 27 procedures. RESULTS: The mean hospital stay was 48 hours (short stay surgery). Noteworthy general complications were not observed. Superficial wound infection occurred in 2 patients; superficial skin hematoma in 4 patients. No recurrences were observed (mean follow-up 60 months). The primary inguinal hernias in the aged is due to a progressive deterioration of the inguinal floor (collagenolylis, overpowers net collagen synthesis and deposition in the floor of the inguinal canal). CONCLUSIONS: Tension-free inguinal hernioplasty, originally popularized by Lichtenstein and Shulman, is simple to perform and gives excellent results with low complication rates. Current evidence suggests it as operation of choice in the elderly.

[Acute cholecystitis in patients over 80 years of age: indication for immediate surgical treatment]. / La colecistite acuta nei pazienti ultraottantenni: un'indicazione al trattamento chirurgico immediato.

The Authors analyse the results of very early surgical treatment in 43 patients over 80 years of age. The severity of morphological changes in the gallbladder and complicated course of the disease are the main factors causing an unfavorable effect on the results of a later treatment. Echography allows, in a high percentage of cases, to confirm the clinical doubt of acute cholecystitis. Cholecystectomy was carried out in all the patients within the first 6 hours (very early surgery-VES). The overall mortality rate was 7%; the morbility rate was 18%.

[Use of PTF prosthesis in hernia in the elderly]. / L'impiego di protesi in PTF e nei laparoceli dell'anziano.

The paper reports the author's experience of the use intraperitoneal of Gore-Tex Dual Mesh Biomaterial in large incisional hernia operations in patients over seventy. From January 1999 to December 1999 we operated on 24 patients for treatment of abdominal wall defect. In all patients we used a Dual Mesh Plus Biomaterial. Overall mortality was 0. Morbility was 9.5%. Follow-up is too short for definitive considerations about the incidence of recurrences but our initial experience with this material encourages us to use it again for replacement of abdominal wall defects in the age.

[Sarcoidosis with a prevalent splenic localization: surgical option (presentation of a case]. / Sarcoidosi a prevalente localizzazione splenica: opzione chirurgica (presentazione di un caso).

Sarcoidosis is a granulomatosis disease of unknown origin with a variable clinical presentation. The reported frequency of splenomegaly in sarcoidosis ranges from 1% to 40%. Splenomegaly has been associated with clinical evidence of more extensive thoracic and extrathoracic sarcoidosis. We describe an interesting case of sarcoidosis with giant splenomegaly and abdominal pain but no evidence of systemic involvement. Sarcoidosis must be considered in the differential diagnosis of splenomegaly. The main indication for splenectomy is splenomegaly with resulting discomfort and/or haematological abnormalities. Though the natural history of sarcoidosis is generally unchanged after splenectomy, in our patient the operation resolved the abdominal pain completely with no need for further therapy.

Estradiol in the striatum: effects on behavior and dopamine receptors but no evidence for membrane steroid receptors.

Estradiol was applied directly to the striatum of ovariectomized female rats by a unilateral intracerebral cannula for three hr or four days. Following four days of estradiol treatment, rats increased the number of rotations in the direction away from the side of the hormone treatment. Cholesterol-treated animals did not change their rotational behavior. Dopamine receptors were assayed in the same animals by autoradiography; D2 receptors increased on the hormone-treated side relative to the untreated side after four days of treatment, only in the lateral striatum. D1 dopamine receptors did not change. The D2:D1 receptor ratio was related to the direction of rotation. Measurements of membrane fluidity with a fluorescent probe revealed no effect of estradiol on striatal membrane fluidity. Membrane proteins were labeled with estrogen agonist and antagonist affinity labels and analyzed by gel electrophoresis, but no saturable membrane binding sites were detected. The results indicate that estradiol acts directly in the striatum to affect behavior and dopamine receptors, but the neurochemical mechanisms remain to be determined.