European diabetes research and its funding, 2002-2013.

AIM: This study examined the outputs of research papers in diabetes from 31 European countries between 2002 and 2013, and their funding. METHODS: Diabetes research papers in the Web of Science were identified by means of a filter based on journals and title words. For 2009-2013 papers, the funders were coded to show their sector and nationality. RESULTS: Europe published 40 547 diabetes papers in the 12 years between 2002 and 2013. Denmark, Sweden and Finland published the most relative to their wealth, but the UK published the most absolutely despite an apparently low burden (as measured by disability-adjusted life years). The largest source of funding was government (30%), followed by the non-profit sector (18%) and industry (13%). The European Commission supported 2.7% of papers, but more in Latvia (33%) and Estonia (16%). Based on an estimated cost per paper of €260 000, the annual research expenditure in Europe was approximately €986 million in 2013. CONCLUSIONS: The European diabetes burden in disability-adjusted life years increased by one third between 2002 and 2012, but its output of research papers has decreased from 44% to 36% of the world total. This decrease needs to be reviewed in the context of European non-communicable disease research policy.

[The post-cholecystectomy syndrome. Evaluation of symptomatology using Tc-99m-HIDA sequential hepatic scintigraphy (cholescintigraphy)]. / La sindrome post-colecistectomia. Valutazione della sintomatologia mediante scintigrafia epatica sequenziale (colescintigrafia) HIDA 99mTc.

The authors comment the data from research on 70 patients with post cholecystectomy syndrome, using cholescintigraphy HIDA 99mTc to evaluate the relation ship between symptomatology (see classific.) and duodenogastric reflux entity. Cholescintigraphy seems to be a valid clinical means, especially for a correct indication to endoscopy.

[Brucellosis with osteo-muscular localization. A case report of a not rare pathological condition]. / Brucellosi a localizzazione osteo-muscolare. Un caso come condizione patologica non infrequente.

Brucellosis may show itself only through its bone and muscle complications, especially in the lumbar region, such as vertebral colliquation or psoas abscess. The authors describe a case of brucellosis (56 year old male, butcher) with lumbar bone and muscle involvement. The first symptom was a persistent pain of the right lumbar region, with irradiation to the homolateral leg. At admission the patient showed a lumbar cutaneous fistula with pus-like secretion. Quick diagnosis and therapy can prevent irreparable damage, even when the symptoms are silent.

[Surgical treatment of extrahepatic biliary lithiasis and Kehr's tube. Indications]. / Terapia chirurgica della litiasi biliare extraepatica e tubo di Kehr. Indicazioni.

The paper outlines the indications for the use of Kehr's tube in the surgical management of extra-hepatic biliary lithiasis by reporting the authors' personal experience relating to the period 1988-1992. In line with data reported in the literature the paper emphasizes the value of Kehr's tube not only in those cases where it is necessary to prevent choledochotomy and radiological control, but above all were the postoperative possibility of removing any residual calculi using litholytic, endoscopic or lithotripsic methods, is of prime importance.

[Video laparoscopic cholecystectomy. An analysis of our initial experience]. / La colecistectomia videolaparoscopica. Analisi della nostra esperienza iniziale.

The paper analyses the authors' initial experience of video laparoscopic cholecystectomy, outing the difficulties and incidence of morbidity in the preliminary group of 38 patients. The details of complications and their pathogenesis are also reported.

[Recurrent inguinal hernia. The surgical procedure and technic]. / L'ernia inguinale recidiva. Tattica e tecnica chirurgica.

The authors describe two years and six months of personal experience in the treatment of recurrent inguinal hernia with polypropylene mesh. There was a follow-up with controls every 6 months with excellent results. From the data of the operation we programmed a further control 1'after 5 and 10 years. Considering the limited number of cases and the fact that the follow-up is not yet at completion, the information is provided as preliminary.

[Inguinal hernia repair with marlex mesh in a preperitoneal site using the classical inguinal access]. / La riparazione delle ernie inguinali con rete di marlex in sede preperitoneale mediante accesso inguinale classico.

Following a brief review of the main method of prosthetic repair used for inguinal hernia: Lichtenstein, Stoppa, Rives, etc, the authors propose an original technique consisting in the placement of a marlex patch below the trasversalis fascia, in a pre-peritoneal site, using a classical inguinal access route. The prosthesis is fitted round the spermatic funicle and fixed with a single stitch to the pubis and with a few others, in resorbable material, to the posterior face of the trasversalis fascia. Above it, plastic surgery is performed to bring the triple stratum closer to the reflexio of the inguinal ligament. The prosthesis is kept in place by positive abdominal pressure. The method outlined here has been used in 71 cases of primary or recurrent inguinal hernia. Follow-up lasted for 1-24 months and showed the low morbidity (4.5%) due to sepsis of the surgical wound, which did not require reoperation, and only 1 case of recurrent hernia which was probably caused by the incorrect positioning of the prosthesis.

[Non-palpable lesions of the breast. Analysis of 111 cases]. / Lesioni non palpabili della mammella. Analisi di 111 casi.

The authors report a series of 111 cases of non-palpable breast tumours. Radiological examinations showed the following mammographic patterns: microcalcification (63%); irregular opacity and/or denseness (26%); opacity and low density microcalcifications (12%), to which 3 progressive risk rates were assigned (high, medium, low). Histological controls of the tumours showed a positive predictive value of 73% for mammographic patterns defined as "high-risk". Localisation using a metal probe proved to be a simple and efficacious method which was well tolerated by patients.

[Two cases of adrenal myelolipoma]. / A proposito di due casi di mielolipoma del surrene.

The paper reports two rare cases of adrenal myelolipoma which were referred to the authors' attention. This is a functionally inactive benign tumour made up of fatty tissue and foci of hemopoietic cells. It is often diagnosed due to the compression disorders caused to adjacent structures, whereas at other times it is identified by chance during the course of diagnostic tests carried out for other pathologies.

[The surgical treatment of biliary lithiasis in the patient of an advanced age]. / Il trattamento chirurgico della litiasi biliare nel paziente in età avanzata.

The paper reports the authors' experience in the treatment of biliary lithiasis in elderly patients. The indications for surgery are examined taking into account the possibilities offered by the introduction of new technologies, and in particular preoperative EPST.

[Diagnostic and therapeutic strategy in extrahepatic biliary lithiasis. Our experience]. / Strategia diagnostica e terapeutica nella litiasi biliare extraepatica. La nostra esperienza.

The paper describes the Authors' personal experience in the diagnosis and treatment of extrahepatic biliary lithiasis in 166 patients admitted to the Surgical Division of the International Evangelical Hospital. The basic tests for a correct diagnostic strategy are echotomography and ERCP in cases of jaundice and/or dilatation of the biliary tract with negative echographic results for lithiasis of the choledochus. The indications for surgery are also discussed and the new possibilities of pre- and post-operative PSTE are also taken into account.

[Our experience with recurrent biliary calculosis after cholecystectomy]. / La nostra esperienza sulla calcolosi biliare ricorrente dopo colecistectomia.

Recurrent calculi of the main bile way may be recurrent or residual. Recurrent stones are yellow-brown, crumbly and earthy and contain high quantities of calcium palmitate; residual stones, on the other hand, are firmer, round or berry-like, usually faceted and contain cholesterol, bilirubinate and carbonate of calcium (aragonite, vaterite, etc.) but never palmitate. Residual stones at times also present a peripheral "shell" presenting palmitate and this shows that a new component determined by bile changes is added to the cholesterol stone, which represents the central core, because of stasis and biliary infection. The distinction of calculi into residual and recurrent is also made on the basis of the classic morphologic and clinical criteria described in the literature, also and above all on the basis of specific, objective scientific criteria deriving from in-depth clinical study of the patient, the chemical study of the bile, morphological, mineralogical and structural study of the stone. The following are considered in particular: instrumental examinations made during hospitalisation and operation; pH, enzymatic activity (phospholipase, trypsin and amylase) and examination of bile cultures; morphological, microscopic examination (electronic scan microscopy) and mineralogical examination (X-ray diffractometry and infrared spectroscopy) of the calculus. A personal series of recurrent calculosis of the main biliary way is considered, special attention being paid to a case that was particularly interesting in relation to the fact lithiasic recurrence occurred just 10 months after the previous operation and the fact that biliary stasis was not determined by stenosis of the papilla which proved fully patent.

[Our experience concerning acute phase proteins (A.P.P.) in the monitoring of surgical patients at risk of infection]. / Nostra esperienza in tema di proteine di fase acuta (A.P.P.) nel monitoraggio del paziente chirurgico a rischio settico.

Continuing researches on the monitoring of acute phase proteins (A.P.P.) as markers of septic risk in the surgery patient, a series of 50 patients suffering from pathological processes classifiable as follows has been examined: 1) acute biliary pancreatitis 18 cases; 2) acute hepatobiliary pathology without pancreatic impairment 26 cases; 3) burn 2 cases; 4) particularly serious sepsis in immunodepressed subjects 4 cases. The constant finding of increased values of PCR, fibrin, cerul, alpha 1-Trip in the surgery patient at septic risk and their normalisation after treatment is, in single cases, particularly significant and perfectly consistent with the clinical entity of the infectious process. In immunodepressed surgery patients showing deficiency in nitrogen balance and suffering from endotoxin shock a marked, persistent decrease in alpha 2-Macro, Tranfs, Albu and Prealbu parameters was noted. The reduction in these four A.P.P. can, in the Authors' experience, be considered a diagnostic indicator of sepsis of extreme gravity and an unfavourable prognosis finding regarding the course of the disease process.

[On lymph node excision in malignant neoplasms of the splenocolic fold]. / Considerazioni in tema di linfectomia nelle neoplasie maligne della flessura splenocolica.

The latest findings on lymphatic draining of the splenocolic flexure are recalled in a discussion of lymphadenectomy in the surgical treatment of cancer of the left corner of the colon. The main features of the lymphatic down flow ways of this colon segment justify extended exeresis operations as described by Madden and Welti: they also mention colon resection, removal in one block of the spleen and the caudal corporal portion of the pancreas with the lymph node stations of the pancreatico-lienal group invaded by cancer. Some observations are made regarding experience of twenty-five years at various Hospital Surgeries and twenty operated patients: stress is laid on the importance of intraoperative biopsy of the pancreatico-lineal lymph nodes for the purposes of correct staging and for programming extended surgical exeresis.

[Clinical use of ceftriaxone in short-term prophylaxis in general surgery. A case load contribution]. / Impiego clinico del ceftriaxone in corso di profilassi "short-term" in chirurgia generale. Contributo casistico.

The results obtained after short-term surgical prophylaxis with ceftriaxone in 443 patients of whom 361 operated of choice are reported. In all, only 3 failures were encountered. The drug also proved to be well tolerated and there were no noteworthy side-effects in the treated patients. The effectiveness of prophylactic treatment is attributed to the long half-life of the molecule (about 8 hours) guaranteeing efficient antibacterial cover with just one administration for the whole period that is critical for surgical infections, during and after operation.

[Neurilemmoma of the stomach. Presentation of a case]. / Il neurilemmoma dello stomaco. Presentazione di un caso.

The paper describes a recent case of neurilemmoma of the stomach. Following a review of the literature, the Authors focus their attention on the diagnostic difficulties and the choice of therapy. Tomography, arteriography and gastroscopy with multiple biopsies may at times be misleading depending on the development of the tumour. Most Authors agree that local resection or, when possible, enucleation are the most appropriate forms of therapy.

[Early treatment of acute necrotico-hemorrhagic pancreatitis: percutaneous peritoneal dialysis. Preliminary data]. / Il trattamento precoce della pancreatite acuta necrotico-emorragica: la dialisi peritoneale per via percutanea. Dati preliminari.

Early peritoneal dialysis is proposed for the early treatment of acute necrotic haemorrhagic pancreatitis on the basis of experimental and clinical studies. The results obtained in 53 cases so treated in the past 8 years are reported.

[Acute phase proteins as markers of septic risk in surgical patients]. / Le proteine di fase acuta (APP) quali markers di rischio settico nel paziente chirurgico.

A heterogeneous group of surgery patients at septic risk was studied through monitoring of acute phase proteins (APP). Plasma levels of 8 acute phase proteins (C-reactive, alpha-1 antitrypsin, fibrinogen, ceruloplasmin, transferrin, albumin, prealbumin, alpha-2 macroglobulin) were measured in the pre- and postoperative period of septic surgery patients suffering from disease processes in various sites and with different aetiopathogenesis. The experiment is related to some interesting research proposed by authors in the Shock Physiopathology Study Centre of the Catholic University of Rome and their results. The constant finding of increased values of PCR, fibrin, cerul, alpha-1 Tryp in the septic risk surgery patient and their normalisation following treatment is particularly significant. In these same cases, a depression or, depending on circumstances, normal findings of Transf, alpha-2 Macro, Albu and Prealbu were observed. The results point to the practical utility an high reliability of APP changes as markers of septic risk.

[Cancer of the stomach, the choice of surgery based on correct staging: total or subtotal gastrectomy?]. / Il cancro dello stomaco, da una corretta stadiazione la scelta dell'intervento: gastrectomia totale o gastrectomia subtotale?

On the basis of the literature and of personal experience, the problem of the extent of demolition time, total gastrectomy or subtotal gastrectomy for patients suffering from stomach cancer is analysed. It is considered that total gastrectomy does not always lead to longer survival by comparison with subtotal gastrectomy and that in certain cases the latter, after careful consideration of a series of variables, may be the operation of choice.

[Acute unrestrainable digestive hemorrhage caused by primary neurogenic tumor of the duodenum]. / Emorragia acuta digestiva irrefrenabile da tumore neurogeno primitivo del duodeno.

An extremely rare case of primary benign neurogenic tumour of the duodenum that determined a picture of severe digestive haemorrhage is reported.