Impact of ammonium nitrate and sodium nitrate on tadpoles of Alytes obstetricans.

The presence of pesticides, herbicides and fertilisers negatively affect aquatic communities in general, and particularly amphibians in their larval phase, even though sensitivity to pollutants is highly variable among species. The Llobregat Delta (Barcelona, Spain) has experienced a decline of amphibian populations, possibly related to the reduction in water quality due to the high levels of farming activity, but also to habitat loss and alteration. We studied the effects of increasing ammonium nitrate and sodium nitrate levels on the survival and growth rate of Alytes obstetricans tadpoles under experimental conditions. We exposed larvae to increasing concentrations of nitrate and ammonium for 14 days and then exposed them to water without pollutants for a further 14 days. Only the higher concentrations of ammonium (>33.75 mg/L) caused larval mortality. The growth rate of larvae was reduced at ≥22.5 mg/L NH4+, although individuals recovered and even increased their growth rate once exposure to the pollutant ended. The effect of nitrate on growth rate was detected at ≥80 mg/L concentrations, and the growth rate reduction in tadpoles was even observed during the post-exposure phase. The concentrations of ammonium with adverse effects on larvae are within the range levels found in the study area, while the nitrate concentrations with some adverse effect are close to the upper range limit of current concentrations in the study area. Therefore, only the presence of ammonium in the study area is likely to be considered of concern for the population of this species, even though the presence of nitrate could cause some sublethal effects. These negative effects could have an impact on population dynamics, which in this species is highly sensitive to larval mortality due to its small clutch size and prolonged larval period compared to other anuran amphibians.

Subkilohertz linewidth room-temperature mid-infrared quantum cascade laser using a molecular sub-Doppler reference.

We report on the narrowing of a room-temperature mid-IR quantum cascade laser by frequency locking it to a CO2 sub-Doppler transition obtained by polarization spectroscopy. A locking bandwidth of 250 kHz has been achieved. The laser linewidth is narrowed by more than two orders of magnitude below 1 kHz, and its absolute frequency is stabilized at the same level.

Why there is a need of an ethics committee in scientific medical societies.

Scientific associations involved in clinical activities are responsible to their members and to the medical community when using new drugs or technologies in clinical practice. Any new procedure or clinical use of new drugs represents a form of research and should adhere to guidelines defined by an ethics committee. It is therefore important that all medical scientific societies should establish an ethics committee. The ethics committee should be in direct contact with the scientific or research committee of the society to evaluate if a clinical trial is useful and not dangerous for patients. A group of expert members of this committee should advise the best method to avoid harm or discomfort to the patient. This gives the best guarantee and can evaluate the real progress of such a new procedure for the benefit of the patient.

Relationship between diet and helminths in Gallotia caesaris (Sauria: Lacertidae).

Diet and helminth fauna were analysed in Gallotia caesaris, a small lacertid lizard endemic to El Hierro (Canary Islands, Spain) in order to study the evolutionary and functional relationships between the two traits. This species is omnivorous but consumed a high proportion (82.13%) of plant matter including not only seeds but also leaves and other vegetative parts. Helminth fauna included many helminth species typical of herbivorous reptiles. Both herbivory and helminth presence were higher than expected for a lizard of its size. Comparison with other lacertids suggests that both traits result from an adaptation to insular conditions but that some "evolutionary time" to develop them is needed. Canarian Gallotia lizards, a separate lineage evolving for a long time in insularity, constitutes the most advanced lacertid group in this way. Nevertheless, results for G. caesaris indicate that helminth fauna also changes seasonally tracking variation in diet (and herbivory) throughout the year, which suggests a dynamic interaction between diet and helminth parasites.

The surgical treatment of fecal incontinence with artificial anal sphincter implant. Preliminary clinical report.

BACKGROUND/AIMS: Fecal incontinence has a serious impact upon patients' quality of life. Several treatment methods are possible according to the pathophysiology of the disease. METHODOLOGY: Between March 1999 and February 2002 eight artificial anal sphincters (American Medical System - AMS) were implanted in seven patients affected with severe fecal incontinence; in one case the device was positioned in a patient who had previously undergone a Miles' resection. All cases were carefully selected according to appropriate diagnostic evaluation. The follow-up varies between 3 and 40 months. RESULTS: The prosthesis had to be removed in two cases; in one patient infection of the implant area occurred, while in the other case persistent perianal pain due to the presence of the device could not be tolerated by the patient. In the six patients that could be successfully treated with the artificial anal sphincter implant, it dramatically improved their quality of life. CONCLUSIONS: The success of the procedure allows the consideration that the artificial anal sphincter implant is the best treatment for severe fecal incontinence that cannot be solved with conservative therapy.

Gallstones in elderly patients: impact of laparoscopic cholecystectomy.

The use of laparoscopic cholecystectomy (LC) in elderly patients may pose problems because of their poor general condition, especially of cardiopulmonary function. Moreover, these patients present with acute cholecystitis and associated common bile duct stones more often than their younger counterparts. From 1990 to 1999, the authors performed 943 LCs; 31 (3.2%) were attempted on elderly patients, 11 (35%) of which were on an emergency basis because of acute cholecystitis, cholangitis or acute biliary pancreatitis. Ten per cent of LCs needed to be converted to an open cholecystectomy, most often because of an increase in the partial pressure of carbon dioxide in the blood produced by excessive operative time. A gasless procedure was used in the last three years of the study on eight cases; the overall rate of conversion from LC to open cholecystectomy in this group was 0%. Associated gallbladder and common bile duct stones were found in five (16%) patients (four preoperative LC endoscopic sphincterotomy and one transcystic approach). The success rate in both of these cases was 100%, overall morbidity was 29% and there was no mortality. These results show that LC is a feasible and safe procedure for use in elderly patients. Gasless LC should be preferred in patients classified as American Society of Anesthesiologists' class III because an excessive duration of operation is the most common reason for converting to an open cholecystectomy.

[Hemorrhoidectomy with ropivacaine (Naropin) local anesthesia. Preliminary experience]. / L'emorroidectomia in anestesia locale con ropivacaina (Naropina). Esperienza preliminare.

BACKGROUND: The use of local anesthesia in non-septic anal surgery is now well established. Tolerance to local injection, duration of local effect and the risk of local or systemic complications still represent unsolved issues. Ropivacaine, a new local anesthetic, seems particularly indicated for this kind of surgery because of its pharmacologic properties which reduce patient's discomfort during infiltration and provide good antalgic coverage in the first hours following the operation. METHODS: The first 20 consecutive cases operated with local anesthesia by ropivacaine have been prospectively studied. All patients have been given an 11-point box VAS scale which is used for subjective evaluation of pain. RESULTS: Mean pain score resulted 1.1, 1.6 and 1.4 at 1, 2 and 3 postoperative hours, respectively. Thirty percent of patients subsequently required pain medication up to the first bowel movement. No complications related to the use of ropivacaine has been observed. CONCLUSIONS: This new drug can be safely used in the outpatient or Day-Surgery treatment of hemorrhoids.

Endoscopic and surgical integration in the approach to biliary tract disease.

Several techniques are available today to access the bile ducts, all equally safe and effective. Since 1990, we have studied three groups of patients treated with different methods: the sequential endoscopic sphincterotomy + laparoscopic cholecystectomy, the single-stage laparoscopic approach, and the single laparoscopic-endoscopic approach. The results obtained in 127 patients to date suggest that one single-stage treatment is more convenient for the patient, while the combination of endoscopic sphincterotomy with laparoscopic cholecystectomy is preferable in terms of efficacy and safety.

[Surgical rehabilitation of stomal disease]. / La riabilitazione chirurgica delle patologie stomali.

The Authors report their experience in the surgical rehabilitation of patients with complicated ileo- or colostomy. Mechanical and psychosocial implications as well as different rehabilitative methods are discussed. The results of a surgical protocol in the treatment of stomal diseases observed in 63 patients are herein reported. In 14 patients the surgical treatment was performed in general anaesthesia, while in 49 local anaesthesia was used. The latter was better tolerated by the patients. In conclusion, surgery should play a major role in this rehabilitation protocol, either in terms of prevention or definitive treatment.

[Results of the local excision of rectal cancer after high-dose radiotherapy associated or not to chemotherapy]. / Risultati dell'escissione locale del cancro del retto dopo radioterapia ad alte dosi associata o meno a chemioterapia.

Local excision of rectal cancer in low-risk patients is appealing but it provides limited control of the disease. Postoperative radiation therapy may improve results. The Authors report on their experience with preoperative high dose radiation therapy for rectal cancer patients; more recently, chemoradiation was used. Local excision is advised only for those patients with minimal or no residual disease. The results obtained in 34 cases are encouraging; moreover, a better control of the disease seems to be offered combining chemo- and radiotherapy.

[Gastric resection and subtotal gastrectomy. Principles and updated surgical technique]. / La resezione gastrica e la gastrectomia subtotale. Princìpi ed attualità di tecnica chirurgica.

The Authors describe their last 10 years experience in gastric surgery. They report the results obtained in 12 gastric resections performed for complications following gastric and/or duodenal peptic ulcers, in 33 cases of total gastrectomies (34%), and 48 cases of subtotal gastrectomies (49%) for early and advanced cancer. The results lead to interesting conclusions: first of all achieving a wide jejunojejunostomy between the afferent and the efferent loop the problems related to gastric resection (as postoperative sequelae, dumping syndrome, reflux esophagitis, alkaline gastritis, etc.) are avoided. Problems regarding lymphadenectomy in patients submitted to subtotal gastrectomy (D2-D3) are then reported. After a brief history of gastric reconstruction following gastric resection the evolution in surgical techniques and the results obtained during the last 10 years are described. The good long term results allow to conclude that our strategy in gastric surgery ensures a good quality of life of the patients as well as a radical operation in case of gastric cancer.

[Septic ascites: a rare post-operative complication]. / L'ascite settica: una rara complicanza post-operatoria.

Spontaneous bacterial peritonitis in patients with chronic hepatitis represents a very controversial matter in terms of frequency, pathology and treatment. This unusual complication mainly due to decreased immunological defences and ascitic fluid opsonic activity is not accepted by all the Authors as a rare event. However, there is agreement as far as management is concerned: cultural examination of the ascitic fluid and the relative antibiogram are the best tools in guiding the approach to an adequate antibiotic therapy.

[A novel diagnostic method to study the residual pelvic cavity after Miles abdomino-pelvic resection]. / Proposta di una metodica diagnostica originale per lo studio dello scavo pelvico residuo dopo RAP secondo miles.

Local pelvic perineal recurrence represents the most frequent site of failure following abdominoperineal resection (APR) for rectal cancer. Patients con be studied at this level by Computerized Tomography (CT) scan, Magnetic Resonance Imaging (MRI), suprapubic or, in women, endovaginal ultrasound (US). CT scan and MRI show sensitivity and specificity in excess, respectively, of 70 and 90%, but the high cost and the invasiveness of CT scan controindicate their frequent use. Suprapubic US has no value in terms of diagnostic accuracy, whereas endovaginal US shows a good specificity, but it is quite refused by the patients since the discomfort of the examination. 34 patients from the Rehabilitation Unit of Colostomy Patients at the University of Rome, "La Sapienza", have been blindly followed by transperineal US. The results have been compared with those obtained by CT scan or MRI. Specimens have been obtained of any suspicious mass by needle biopsy. The diagnostic accuracy of transperineal US has resulted comparable to CT scan and MRI. The authors also describe the morphology and US pattern of the pelvic hollow as demonstrated by transperineal US and the distinctive features of abnormality seen.

[Use of human fibrin glue (Tissucol) in the treatment of recurrent fistulas]. / Impiego della colla di fibrina umana (Tissucol) nel trattamento delle fistole recidive.

In this study, the treatment of either primitive or secondary abdominal relapsed fistulas with Human Fibrin Glue (Tissucol) is reported. Twelve patients with different types of fistulas were treated in day hospital with the above mentioned procedure. Apart from two patients, the good percentage of success obtained in a short period of time is stressed. Results show that such a technique may be favourably adopted, nevertheless a correct first surgical procedure is recommended.

Gall stone pulverisation strategy in patients treated with extracorporeal lithotripsy and follow up results of maintenance treatment with ursodeoxycholic acid.

Between November 1988 and July 1992 70 patients with radiolucent gall stones were treated with extracorporeal lithotripsy (ESL) and ursodeoxycholic acid (UDCA; mean (SD) dose 11.2 (1.9) mg/kg/day). Fifty three patients have been followed for one year. One week after lithotripsy, 30.6% had completely eliminated all stone fragments from the gall bladder and one year later 93.9% were free of stones. Three factors were considered important in achieving these results. 'Pulverisation' of the stone--that is, its fragmentation into echogenic dust (crystalline aggregates, some few hundred mu in size) or particles similar to grains of sand, smaller than 1 mm in diameter, or both, is required. Secondly, dust and particles were rapidly eliminated, strongly suggesting a mechanical elimination process by physiological gall bladder contractions. Thirdly, there must be chemical dissolution with biliary acids. This therapeutic approach gave excellent results without causing any clinically relevant side effects. The first 20 patients who became free of stones after ESL were given oral bile acid maintenance treatment--300 mg/day of UDCA at bedtime, for two years. All were asymptomatic and none had suffered a recurrence after two years. In four patients, crystalline aggregates, detected in gall bladder bile by ultrasound, were subsequently dissolved between one and three months after resuming a full dose regimen of UDCA.

[Anterograde laparoscopic cholecystectomy: when and why]. / La colecistectomia laparoscopica per via anterograda: quando e perché.

Today largely diffused is the concept that laparoscopic cholecystectomy (LC) represents the treatment of choice for symptomatic gallstones. Nonetheless some questions have been raised on the real safety of this new method in terms of procedure-related complications. On the basis of our experience with traditional open cholecystectomy, we have recently performed a prograde LC in those cases with difficulties in identifying the anatomical structures of the so called Calot's triangle. This alternative route can be easily performed laparoscopically and has been useful in reducing the time of the intervention in the most difficult setting and to increase the safety of the procedure. The technical details and the results are compared with those of the laparoscopic retrograde route.