An extraperitoneal approach for complex flank, iliac, and lumbar hernia.

PURPOSE: The aim of this paper is to propose our four-step technique, an open extraperitoneal approach for complex flank, lumbar, and iliac hernias. METHODS: A big polypropylene mesh is placed, covering and reinforcing all the lateral abdominal wall in an extraperitoneal space. Its borders are retroxiphoid fatty triangle and the costal arch cranially and the retropubic space caudally, psoas muscle, and paravertebral region posteriorly and contralateral rectus muscle medially. Mesh dimensions do not depend from the defect size, but prosthesis has to cover all the lateral abdominal wall. RESULTS: No major complications have been reported. The mean length of stay is 4.8 days (range 3-11). Mean follow-up is 44.8 months (range 5-92). One recurrence (4.5%) has been reported at the 1-year clinical evaluation. CONCLUSION: In conclusion, we believe that regardless size and location of the defect, every complex lateral hernia requires the same extensive repair because of the critical anatomy of the region with a big medium-heavyweight polypropylene mesh placed in an extraperitoneal plane, the only one that allows adequate covering of the visceral sac. Our technique is a safe, feasible, and reproducible treatment for this challenging surgical problem.

Breast cancer and thyroid diseases: analysis of 867 consecutive cases.

INTRODUCTION: The aim of this study was to evaluate the association of breast cancer with thyroid diseases. Many authors have already studied the possible relationship between these two diseases, but the results are nowadays conflicting. MATERIALS AND METHODS: Our study examining 867 patients with breast cancer (862 women and 5 men, average age = 61 years old) of whom 141 also had thyroid disease evaluated the recurrence of thyroid diseases and their association with different types of breast cancer. Statistical analyses were performed using SPSS software for Windows; we used nonparametric tests (Chi-square and Mann-Whitney), and the level of significance was set at p < 0.05. RESULTS: We found a significant association between breast cancer diagnosed after menopause and thyroid disease (p < 0.003). Moreover, we analyzed the role of thyroid autoimmunity identifying an association between chronic autoimmune thyroiditis and breast cancer diagnosed before menopause (p < 0.05). Regarding receptor profile of breast carcinoma, we have found an increased expression of estrogen receptors in patients with autoimmune thyroiditis compared to patients with any other thyroid diseases (p < 0.03). Contrariwise, we do not have found any difference between the group with every thyroid disease and the group without thyroid disease (p < 1.00). We did not find other statistically significant associations with breast cancer's parameters like family history, tumor size, lymph node metastasis, distant metastasis, cancer clinical and pathological stage, differentiation grade and expression of Ki67, p53 and Her2 in the two main groups with or without thyroid disease. Likewise, we did not found other statistically significant association between hypothyroidism or hyperthyroidism and breast cancer.

A field study on thermal comfort in an Italian hospital considering differences in gender and age.

The hospital is a thermal environment where comfort must be calibrated by taking into account two different groups of people, that is, patients and medical staff. The study involves 30 patients and 19 medical staff with a view to verifying if Predicted Mean Vote (PMV) index can accurately predict thermal sensations of both groups also taking into account any potential effects of age and gender. The methodology adopted is based on the comparison between PMV values (calculated according to ISO 7730 after having collected environmental data and estimated personal parameters) and perceptual judgments (Actual Mean Vote, AMV), expressed by the subjects interviewed. Different statistical analyses show that PMV model finds his best correlation with AMV values in a sample of male medical staff under 65 years of age. It has been observed that gender and age are factors that must be taken into account in the assessment of thermal comfort in the hospital due to very weak correlation between AMV and PMV values.

[A particular anthropometric method for the study of accessibility of a workstation]. / Un particolare approccio antropometrico per lo studio della raggiungibilità di una postazione cassa.

One of the main factors which can involve musculo-skeletal disorders is the assumption of awkward postures. These lasts can be caused, in some cases, by a no-suitable collocation of some devices which are indispensable for the work. It is possible to evaluate if the chosen collocation is adequate or not by studying the accessibility of the workstation with a special regard for the accessibility of the devices placed inside the workstation. EN ISO 14738:2002 is a specific standard which has been adopted in Italy as UNI EN ISO 14738:2004. This standard gives some useful requirements, in terms of accessibility, to design a workstation at no-mobile machinery. In this study, the authors have analyzed a check out workstation by following the requirements described in UNI EN ISO 14738:2004. Critical aspects, related to the organization both of the work activities either of the workstation, have been highlighted taking into account standard criteria. Finally the authors make a new design of the check out workstation trying to optimize device collocation in order to reduce awkward postures. The new configuration has been investigated by applying the criteria mentioned in the standard.

[Function analysis of employees at cash desks in the retailing sector by means of the study of the movements of the upper limbs]. / Analisi della mansione dell'addetto alle casse nella grande distribuzione mediante lo studio del movimento degli arti superiori.

Supermarket checkouts are different in term of dimensions and arrangement of the essential devices for cashier's work. It means that a different layout can involve different tasks, so it is necessary to evaluate every single system in order to define the entity of required commitment for the worker. A supermarket checkout was considered in order to evaluate its workstation and to analyze the different tasks of two cashiers with similar anthropometric measurements. In particular one of them is affected by a widespread osteoarthritis, verified by instrumental tests and clinical examination. Several geometrical measures of the workstation were carried out while the cashiers were observed and filmed by videotapes during their activities. The study has been carried out by drawing the "preferred" and "maximal" working areas, as UNI EN ISO 14738:2004 suggests. Some tasks seem to be particularly critical especially for the cashier affected by osteoarthritis, who adopts compensatory postural mechanisms in order to use some devices which are not easy to reach inside the workstation, and which can induce pain to her. Finally the authors make some considerations about the opportunity of making a new layout of the workstation in order to find a more suitable arrangement of the devices.