Optimization of sub-relativistic co-propagating accelerating structures.

In this paper, novel optimization methodologies of sub-relativistic guided interaction structures for dielectric laser particle acceleration (DLA) are presented. In particular, we focus on co-propagating geometries based on slot waveguides in continuous wave (CW) operation, where the particle flow and the direction of propagation of the accelerating field are co-linear. Since the velocity of sub-relativistic particles varies along the acceleration path, proper tapering of the waveguide geometry is required to achieve an extended acceleration region, and, thus a large energy gain. The design of an optimal taper ensuring particle-wave synchronicity and maximum energy gain is pursued through a physics-based approach, and these results are compared, for validation, with the outcomes of a downhill simplex method searching algorithm. Additionally, the application of a simplified 2D model of the accelerating slot waveguide is investigated and profitably used to get qualitative results useful for fast structure optimization. Indeed, this approach can hold significant potential for the development of novel accelerating structures, as it enables a thorough and fast exploration of the design space.

Biological properties of Cakile maritima Scop. (Brassicaceae) extracts.

OBJECTIVE: Cakile maritima scop. (CKM) is a herbaceous plant (Brassicaceae) growing also in high salinity environment. It is an annual plant growing in clumps or mounds in the sand on beaches and bluffs. MATERIALS AND METHODS: Stems, seeds, leaves and flowers of CKM were used to obtain 70% of ethanol extracts. The phenolic content of the different extracts was evaluated by the Folin-Ciocalteu method. The separation of phytochemical compounds was based on ultra-performance liquid chromatography coupled to mass spectrometry. Radical scavenging activity was determined by 1,1-diphenyl-2-picrylhydrazyl assay. The qualitative assay for the inhibition of α-glucosidase was quantified spectrophotometrically and the anti-inflammatory activity was determined in the U937 cell line by using gene expression of pro-inflammatory cytokines. Cell viability assay was done in U937, MM1S, and U266 cells by using the 3-(4,5-Dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide assay. The antimicrobial activity was investigated by MIC determination, "double-triple combinations assay", and growth inhibition curves analysis, using the extracts individually or in various combination. Statistical analysis was performed by the Student's t-test and ANOVA. RESULTS: All parts of the plant exhibited a high antioxidant capacity as measured by DPPH assay. Furthermore, all extracts reduced (about 10 folds) the expression of inflammatory cytokines in macrophage following LPS treatment. As regards the antibacterial activity, only the seeds extract was able to inhibit both Gram-negative and Gram-positive bacteria when tested alone, whereas dual combinations of different extracts (leaves, flowers, stems and seeds) caused bacterial inhibition exhibiting a synergic action. Finally, we showed that the extracts did not exhibit cytotoxic effects in normal cells and that, surprisingly, it exhibited an anti-proliferative effect (inhibition ≈80%) in multiple myeloma U266 cells. CONCLUSIONS: Our study suggests that CKM possesses antioxidant, anti-inflammatory, antibacterial, anti-proliferative activities and such pleiotropic effects may be exploited under various pathological conditions.

Radiation-induced undifferentiated pleomorphic sarcoma of the breast: a rare but serious complication following breast-conserving therapy. A case report and literature review.

BACKGROUND: Undifferentiated pleomorphic sarcoma (UPS) of the breast is an extremely rare, but aggressive subtype of sarcoma that can develop in radiotherapy (RT)-treated breast cancer patients. Due to the low incidence, there are many uncertainties regarding the adequate management of these tumors. We present a rare case of radiation-induced UPS in a 63-year-old woman who had undergone breast conserving therapy for invasive ductal carcinoma of the left breast, six years prior to presentation. CASE PRESENTATION: A 63-year-old woman presented with a rapidly growing left breast mass. She had been diagnosed with invasive ductal carcinoma of the left breast for which she underwent a left upper outer quadrantectomy and ipsilateral axillary dissection followed by RT, six years previously. During her routine oncologic follow-up, the mammography revealed a dense, nodular opacity with microcalcifications. The breast ultrasound (US) confirmed the presence of the nodule. US-guided fine needle aspiration biopsy was performed and the diagnosis of UPS was made, the reason for which the patient underwent wide local excision of the left breast. CONCLUSION: The diagnosis of RT-induced UPS is challenging and often missed due to the low incidence, long latency period, unspecific imaging findings, and difficulties in clinical and histological detection of these lesions. These tumors should be considered in differential diagnoses of rapidly-growing breast masses in previously RT-treated breast cancer patients, as they can mimic the local recurrence of the primary tumor. Since the prevalence of breast-conserving surgery followed by RT has been increasing, the careful monitoring of at risk patients is of utmost importance, as UPSs are highly aggressive tumors associated with very poor outcomes.

Laparoscopic cholecystectomy in children with chronic hemolytic anemia. Is the outcome related to the timing of the procedure?

BACKGROUND: The aim of this study was to evaluate whether the outcome in children with chronic hemolytic anemia (CHA) and cholelithiasis undergoing laparoscopic cholecystectomy (LC) is related to the operation timing. METHODS: From June 1995 to December 2004, 46 children with CHA were referred to our division of surgery for cholelithiasis. All 46 children were asymptomatic at the time of the first visit, and an elective LC was proposed to all of them before the onset of symptoms. The operation was accepted in the period of study by 24 children and refused by 22. The patients were divided into three groups (group A, asymptomatic; group B, symptomatic; and group C, emergency admitted) depending on clinical presentation and operation timing, and the respective outcomes were compared. RESULTS: Elective LC in asymptomatic children (group A) is safe with no major complications reported. In children who refused surgery (groups B and C), we observed four sickle cell crises, four acute cholecystitis, and two choledocholithiasis, and all these complications were related to waiting. Two sickle cell crises occurred in symptomatic children waiting for surgery during biliary colic. The risk of emergency admission in children with cholelithiasis and CHA awaiting surgery was found to be high: 28% of the children admitted in emergency after a mean of 32 months (range, 22-36). Morbidity rate and postoperative stay increased when children with hemoglobinopathies underwent emergency LC. CONCLUSIONS: Elective LC should be the gold standard in children with CHA and asymptomatic cholelithiasis in order to prevent the potential complications of cholecystitis and choledocholithiasis, which lead to major risks, discomfort, and longer hospital stay.

[Endoscopy in non-neoplastic cholestasis]. / L'endoscopia nella colestasi non neoplastica.

The role of endoscopic treatment of cholestasis is well codified as an alternative or adjuvant therapy to surgery, particularly in those cases where non malignant cause has been identified. Non-neoplastic cholestasis therefore benefits very substantially from endoscopic treatment in a context where the traditional surgical approach presents limitations in terms of morbidity and mortality. It should be borne in mind, however, that the two approaches are strictly complementary for the correct management of these patients.

[Benign esophageal stenosis: role of endoscopic therapy]. / Le stenosi esofagee benigne: ruolo della terapia endoscopica.

The authors report on their experience over a period of three years with the endoscopic treatment of benign oesophageal stenosis utilising the endoscopic balloon dilatation (EBD) technique or Savary-Gilliard cylindrical-conical dilators. They evaluate the results of the therapy with clinical and endoscopic follow-up at six-monthly intervals. The treatment proved effective, with total remission of dysphagia symptoms in approximately 95% of patients and with a low risk of complications.

Pre and intra-operative methods of staging gastric cancer.

The aim of this paper was to examine the indications and limits of pre- and intra-operative instrumental diagnosis of gastric cancer. In order to achieve this effectively, the authors emphasized the importance of proper staging methods and obtained a detailed description of tumor diffusion. The most important diagnostic instruments considered were magnetic resonance, endosonography, intra-operative echography, pre- and intra-operative immunoscintography and a cytological examination of peritoneal lavage fluid. The authors concluded that pre- and intra-operative staging of gastric cancer is important for two major reasons: it results in the most accurate definition possible of disease evolution, enabling a proper therapeutic program; and it involves a combination of three complementary metasurgical treatments.

[Primary hyperparathyroidism]. / L'iperparatiroidismo primitivo.

Primary hyperparathyroidism is a hormonal disease that is more and more frequent and is often manifested exclusively by an increase in calcium levels in the serum. After examining the main anatomopathological and clinical characteristics of the disease, the authors present their experience in its diagnosis and surgical treatment. They suggest that cervical exploration with removal of the adenomas and hyperplastic glands in both asymptomatic and highly symptomatic patients is strongly advised. Since it is already possible to obtain an early diagnosis of the disease thanks to multicanal hematochemical equipment, the Authors conclude that in the near future, studies on cellular receptors for calcium will allow new therapeutic treatments to be applied.

[Primary hyperparathyroidism: follow-up of the surgically treated patient]. / Iperparatiroidismo primario: follow-up del paziente operato.

After several remarks on the etiopathogenesis of primary hyperparathyroidism the Authors emphasise the importance of follow-up in operated patients. The evaluation begins right after removal of the lesion in the intraoperative phase, in order to evaluate the validity of the intervention and continues with evaluation of mineral homeostasis, disease itself and function of target structures. In addition to possible hypocalcemic crises, special attention should be placed on possible disease recurrence, and the study of all involved parts such as bones, kidneys, pancreas, digestive apparatus as well as the psychological aspects. These are often involved in a significant manner and condition the quality and duration of the patient's life.

[Miles operation in rectal carcinoma: history and current status]. / L'intervento di Miles nella chirurgia del carcinoma del retto: la sua storia, il suo presente.

The Authors confirm how the advent of mechanical suture has directed the management of rectal carcinoma to an increasingly conservative attitude. In reporting their experience--which consists of about twenty years (222 patients) they specify how not only an increased incidence of recurrence has not appeared, but they have also observed a reduction of theirs (-5.2%). They then attempt to outline basic moments which have characterized the history of rectal carcinoma surgery and they state how today, 80 years since it was conceived, Miles' intervention maintains its validity, even if with more restrictive indications.

[The use of synthetic prosthesis in the treatment of hernia]. / L'impiego di protesi sintetiche nel trattamento dei laparoceli.

The authors report their experience on synthetic prosthesis used in 36 patients with abdominal hernias. Thirty six cases of incisional hernias have been analyzed by Institute of General Surgery of Messina University from 1992 to 1998. Among the 33 cases with median parietal defect, in 7 cases concerning great incisional hernias group a PTEF-e prosthesis, which was positioned in an intraperitoneal site, was employed. In 21 cases of medium size incisional hernias they used a polypropylene prosthesis, which was positioned in an intraparietal or preperitoneal site. In 5 cases of small size incisional hernias, polypropylene prosthesis was placed in a superfascial site. In the 3 cases of medium size lateral laparocele++, polypropylene prosthesis was positioned in a intraparietal site. There was no operative mortality. Among postoperative complications, 4 seromas, 1 parietal and 1 subcutaneous haematoma and 2 haematomas in retroperitoneal site appeared. Clinical-instrumental controls, which have continued until two or three years after the operation were performed which pointed out a recurrence in just one case where the prosthesis was positioned in a superfascial site. To conclude, we consider that nowadays the use of synthetic prosthesis lets us face and solve problems concerning surgical treatment of incisional hernias with confidence.

[Aorto-esophageal fistula caused by foreign body]. / La fistola aorto-esofagea da corpo estraneo.

Aortoesophageal fistula is a rare but fatal cause of upper gastrointestinal bleeding. AEF develop progressively from the esophageal perforation caused by foreign body. Clinically, there is a medial chest pain, followed by hematemesis and finally terminal exsanguination. Diagnosis must be achieved during the free intervals in this triad of often rapidly succeeding signs.

[Bilateral carcinoma of the breast]. / Il carcinoma bilaterale della mammella.

From 1990 to 1996, a total of 223 patients, with breast cancer, were treated. Out of these patients, 7 (3.04%) developed a second primary carcinoma in the controlateral breast. Two (28.5%) had a synchronous manifestation while the remaining 5 (71.5%) had a metachronous manifestation. The seven patients were followed up for periods between 4-8 years: 80% of the metachronous tumours occur within 5 years of follow-up. The 7-year actuarial survival was 100% in the two synchronous tumours and 60% in the five metachronous tumours (two patients died on account of intervening diseases). The prognosis does not depend on the length of the interval between the development of the two carcinomas but it is in relation with the anatomo-clinical state, to the adequate treatment of each primary tumour and to the rigorous clinical-instrumental follow-up, in which the mammography plays a fundamental role.

[Surgery of the thyroid in short-stay hospitalization]. / La chirurgia della tiroide in short stay surgery.

New trends and improvements in health care system allow to choose short hospital stay even on major surgical operations. Authors report their experience on 200 moderate or good operative risk patients who underwent operation for thyroid disease from 1993 to 1998. Short hospital stay program was achieved after 48-72 hours under observation in 193 patients (96%) who underwent subtotal, total and total with lymphadenectomy, thyroidectomy. All the patients, informed on detail were kept under close phone contact after discharge to be able to take part if need be.

[Subclavicular localization of Castleman's disease]. / La malattia di Castelman a localizzazione sottoclaveare.

Castelman disease is a rare disease of lymph nodes. There are 2 pathological types: hyalo-vascular asymptomatic form and plasmacytic symptomatic form. Authors report a case of Castelman disease of a subclavicular lymph nodes that underwent surgical operation. Ethiopathogenesis and treatment of the disease are reported.

[Day-surgery treatment of pilonidal sinus]. / Il trattamento in day-surgery del sinus pilonidalis.

Authors discuss ethiopathogenus of pilonidal disease after a historical background and support acquired-congenital theory. Open and closed treatment are reported on the acute and chronic phases, highlighting economical advantages of closed method. Carbon-dioxide laser on Authors experience was very useful to prevent complications and to shorten healing time in open method.

[US or CT-guided percutaneous drainage of pancreatic pseudocyst]. / Il drenaggio percutaneo Eco o T.C. guidato delle pseudocisti pancreatiche.

Authors, after illustrating the pathogenesis of Pancreatic Pseudocysts (PPC) and classifying them into secondary to acute pancreatitis and arising in course of chronic pancreatitis, underline that the use of Ultrasound (US), CT-scan, Magnetic Resonance, Endoscopic Retrograde CholangioPancreatography and, above all, percutaneous drainage of the cysts has modified the therapeutic approach to this pathology. They describe indications and technique of US or CT-guided percutaneous drainage, and report their experience about 12 cases of PPC secondary to acute pancreatitis and 4 of PPC arising during chronic pancreatitis. They analyze the limits of this technique (risk of infections, recurrences, fistulas), and conclude that Percutaneous Drainage of Pancreatic Pseudocysts is a useful therapeutic approach in the treatment of PPC secondary to acute pancreatitis, while its use is complementary to surgery in the treatment of PPC due to chronic pancreatitis.

[Medullary carcinoma of thyroid gland]. / Il carcinoma midollare della tiroide.

The authors present the characteristic features of medullary carcinoma of thyroid (CMT) and underline the necessity to identify RET proto-oncogene that is the cause of hereditary transmission of CMT. Physiology of C cells and clinical syndromes are reported and the importance of a genetic screening in population at risk is emphasized; this test has shown to be reliable and easy to apply. They report their experience on techniques of amplification and restriction for RET proto-oncogene identification in relatives of patients with MEN or familial CMT syndromes. This study has allowed to recognize a population bearing the oncogene responsible of the disease and to achieve a correct prophylactic therapeutic management.

[Nuclear risk and thyroid neoplasms in infancy]. / Rischio nucleare e carcinoma tiroideo nell'infanzia.

Thyroid carcinoma is a disease with low incidence in adult and rare in child. The authors give oncogenic risk factors of the disease and underline environment factors as iodine deficiency and radiation pollution that, as shown in certain world areas, has a strong effect in the epidemiology of this disease. Eventually radiation's are the most important oncogenic risk factors but and adequate iodine prophylactic program can be considered a valid shield to prevent this disease.

[Principles of rehabilitation of patients with ileostomy]. / Principi di riabilitazione nell'ileostomizzato.

Authors, believing that ileostomy is the cause of serious clinical, functional and psychological consequences, dwell upon principles of rehabilitation, which aim is the reinstatement of ileostomized patients into daily life. The most important aspect is to select the position of the stoma; it is necessary to consider some technical and functional aspects. The Authors examine local problems of the stoma, the unstable electrolytical balance, and report some therapeutical aspects. They expose early and late complications after surgical therapy and conclude underlining the advantages of a rapid social reinstatement of patients with an ileostomy.