The Italian Unitary Society of Colon-proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of anal fissure.

INTRODUCTION: The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colon-Proctologia) on the diagnosis and management of anal fissure, with the purpose to guide every physician in the choice of the best treatment option, according with the available literature. METHODS: A panel of experts was designed and charged by the Board of the SIUCP to develop key-questions on the main topics covering the management of anal fissure and to performe an accurate search on each topic in different databanks, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in different rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to the PICO criteria, and the statements developed adopting the GRADE methodology. CONCLUSIONS: In patients with acute anal fissure the medical therapy with dietary and behavioral norms is indicated. In the chronic phase of disease, the conservative treatment with topical 0.3% nifedipine plus 1.5% lidocaine or nitrates may represent the first-line therapy, eventually associated with ointments with film-forming, anti-inflammatory and healing properties such as Propionibacterium extract gel. In case of first-line treatment failure, the surgical strategy (internal sphincterotomy or fissurectomy with flap), may be guided by the clinical findings, eventually supported by endoanal ultrasound and anal manometry.

Cosmogenic (7)Be and (22)Na in ground level air in Switzerland (1994-2011).

We report monthly averages of weekly (7)Be and (22)Na concentrations in aerosol samples collected with high volume aerosol filters at 5 sampling sites in Switzerland from 1994 to 2011 ((7)Be) and from 2000 to 2011 ((22)Na). Monthly average concentrations of the two cosmogenic isotopes varied between 2600 and 4600 µBq/m(3) for (7)Be and between 0.2 µBq/m(3) and 0.5 µBq/m(3) for (22)Na. The (22)Na concentration in ground level air strongly increased from March to May, while a corresponding (7)Be increase was seen from March until July. The observed variations of the (7)Be and (22)Na activities together with the changes in the (7)Be/(22)Na ratio indicate input of stratospheric air between March and May, increased mixing of upper tropospheric air from June to August, and less exchange between the upper and lower troposphere in autumn and winter. Additionally, the 11-year solar cycle is clearly seen in the annual averages of the (7)Be concentrations.

Ability of Preissmann slot scheme to simulate smooth pressurisation transient in sewers.

Urban drainage networks are generally designed to operate in a free-surface flow condition. However, as a consequence of heavy rainfall events or network malfunctions, the filling of sewers (pressurisation) and network overflow may occur. Several modelling software products are commonly used to simulate floods in drainage networks, and their results are usually thought to be reliable and robust. However, no specific studies have been carried out on the behaviour of these modelling products during the pressurisation transition. Mathematical models often use the Preissmann slot concept to handle pressurisation. In this paper, on the basis of laboratory pipe tests, the reliability of such a scheme is studied by means of a popular and open-source software product: SWMM (Storm Water Management Model). Many numerical tests were carried out with SWMM, varying the spatial and time steps and the Preissmann slot width, in order to examine the performance of the modelling software over intervals of these parameters even wider than what is usual in practical applications. The comparison between simulated and experimental surges allows one to draw interesting conclusions regarding the effectiveness of software products analogous to SWMM in simulating pressurisation, as well as the choice of the parameters themselves.

[The Mirizzi syndrome. Analysis of an unknown complication of the gallstones]. / La sindrome di Mirizzi. Analisi di una patologia spesso preoperatoriamente misconosciuta.

BACKGROUND: Mirizzi syndrome is one possible complication of the gallstones. The incidence in patients treated with cholecystectomy is 0.7-1.1%. MATERIALS AND METHODS: We have analyzed on 4123 colecistectomie conduct in Unit of General Surgery and Organ Transplantation of the University of Parma from January 1992 to October 2006, 46 cases of syndrome of Mirizzi (1.1%) with age comprised between 29-82 years (medium 67.8 years) were 28 women (60.9%) and 18 men (39.1%). We have considered the symptomatology, the diagnostic and therapeutic way, the comorbidity. RESULTS: In 19 cases (41.3%) there were the signs of acute cholecystitis; in 28 cases (60.9%) the clinical picture was characterized from repeated biliary pain. The jaundice was present in 29 cases (63%) with hyperpyrexia (>38 degrees) in 27 cases (58.7%). In 14 cases (30.4%) was a Mirizzi type I, in 32 cases (69.6%) a Mirizzi of type II. CONCLUSIONS: The Mirizzi syndrome is a diagnosis frequently conduct intraoperatively. The surgical therapy is characterized by the acknowledgment of the biliary structures, the complete removal of the stones, the surgical therapy of the leaks.

Preliminary experience in minimally invasive videoassisted thyroidectomy (MIVAT).

BACKGROUND: We report our initial experience in the treatment of thyroid disease with Minimally Invasive Videoassisted Technique (MIVAT) introduced by Miccoli. METHODS: We have treated from July to September 2005, 5 patients, with MIVAT. The procedure is carried out through an incision of 15-20 mm 2 cm on sternal notch and the thyroidectomy is performed by dedicated instruments. RESULTS: We have surgically treated 3 follicular hyperplasias, one Hurthle adenoma and one papillary carcinoma. The mean time of thyroidectomy was 98 +/- 14 minutes; four cases were discharged after 24 hours and one case after 48 hours for a postoperative hypertension. No hypocalcemia, no nerve palsy. Cosmetic result and postoperative pain were excellent. CONCLUSION: MIVAT is a safe, reproducible technique with an indication in a minority of patients candidates to thyroidectomy and is characterized by a better postoperative discomfort.

The utility of serum PTH assessment 24 hours after total thyroidectomy.

BACKGROUND: Hypocalcemia is the most frequent complication following total thyroidectomy. This prospective study examines the predictive value of parathyroid hormone (PTH) levels measured 24 hours after surgery. MATERIAL AND METHODS: A total of 1006 consecutive patients (mean age, 54.8 years; female/male ratio, 4/1) underwent total thyroidectomy for benign or malignant thyroid from January 1995 to November 2003. Serum calcium, phosphorus, and PTH were measured preoperatively and at 24 hours after surgery. All patients underwent preoperative examination to assess cord motility. RESULTS: A total of 253 (25.1%) patients presented with hypocalcemia demonstrated by clinical and laboratory findings. In 101 cases the hypocalcemic syndrome manifested after 24 to 36 hours whereas in 5 of 101 cases, symptom onset was between 48 and 72 hours. Serum calcium levels lower than 7.5 mg/dL were recorded in all the 101 cases. In 239 of 253 cases serum calcium returned to normal values within 7 days following surgery. PTH at 24 hours was below normal levels in 49 of the 101 patients but was within normal limits in 52 cases. The incidence of hypocalcemia was higher in patients undergoing surgery for malignant thyroid ( P < 0.05). CONCLUSIONS: We do not consider PTH levels at 24 hours postoperatively as predictive of hypocalcemia.

[Post-thyroidectomy hypocalcemia: clinical and laboratory findings]. / Ipocalcemia post-tiroidectomia: modificazioni cliniche e di laboratorio.

Hypocalcaemia is a possible sequela of thyroidectomy, the causes of which are not fully understood. Today, correct surgical technique is the most important factor in decreasing the incidence of hypocalcaemia. We analysed 1223 patients (930 total thyroidectomies, 293 hemi-thyroidectomies) treated in our institute from January 1995 to July 2003. Serum calcium, ionized calcium, parathyroid hormone and phosphoraemia were screened pre- and postoperatively. Hypocalcaemia, as defined by a serum calcium concentration below 8.5 mg/dL, occurred in 241 patients (25.1%). In 90.9% of these patients, serum calcium was normal 7 days after thyroidectomy. In three patients we registered permanent hypoparathyroidism 180 days after thyroidectomy. We found a statistically significant difference in the incidence of hypocalcaemia between patients treated for benign disease and those treated for malignant disease with a greater incidence in the latter group (P < 0.05). Several factors are important in determining the incidence of post-thyroidectomy hypocalcaemia but the inadvertent excision of the parathyroid gland, ischaemia and injury are the main causes of the lowering of serum calcium concentrations.

[Role of endoscopy in the treatment of non-variceal upper gastrointestinal hemorrhage]. / Ruolo dell'endoscopia nel trattamento delle emorragie digestive alte non varicose.

Over the past three decades important progress has been made in the diagnosis and treatment of non-variceal upper gastrointestinal bleeding. We discuss the endoscopic techniques available today in combination therapies. The data in the literature regarding endoscopic techniques are discordant and no single technique has proved statistically superior in the management of bleeding. We believe that the initial injection approach is still the procedure of choice, particularly when performed by less expert endoscopists.