Innovative technique for large septal perforation repair and radiological evaluation.

PERFORATION OF THE NASAL SEPTUM MAY HAVE MULTIPLE CAUSES: traumatic, iatrogenic, infectious, degenerative, overuse of vasoconstrictors, abuse of cocaine and more recently chemotherapy agents. Perforations are also classified according to their size and type of cartilaginous or osteocartilaginous deficit, as well as location (front, middle and rear). Many surgical techniques have been proposed to repair the perforation, although the results are often unsatisfactory for perforations of small and medium size; in large perforations permanent obliteration of the defect cannot always be ensured. It is often necessary to use tissues from inside the nasal turbinates or cartilage from other donor sites such as the ear or rib, and various techniques are discussed in light of the recent literature. The perforations observed in the last eight years and surgical approaches performed in open or closed approaches are taken into account. The authors propose a new technique that has been used with success in many types of septal perforation regardless of aetiology, and in particular large perforations, which allows for the use of the osteocartilaginous donor site as a hump. It is also useful in reductive rhinoseptoplasty, which targets selection to easily obtain mucopericondral flaps with an extramucosal technique and to obtain also an aesthetic improvement.

Influence of primary sedimentation on pre-denitrification system performances.

The effects of suppressing primary sedimentation on nitrogen removal efficiency of a pre-denitrification system have been evaluated for a large municipal wastewater treatment plant. Simulations have been carried out using the STOAT model. For both the process schemes with and without primary sedimentation, nitrification efficiencies are calculated for increasing influent loads of COD, total N and suspended solids. The sensitivity analysis shows that for the usual carbon to nitrogen ratios in the raw influent both the process schemes allow the requested removal efficiencies, whereas for significantly high C/N ratios the scheme with primary sedimentation is preferable.

[Critical evaluation of the reconstruction of the intestinal continuity after total gastrectomy by the Moricca technique]. / Valutazione critica della ricostruzione della continuità intestinale dopo gastrectomia totale secondo Moricca.

The authors analyze a series of 48 total gastrectomies for gastric carcinomas performed between 1987 and 1994. Seven out of these 48 gastrectomies were performed adopting the double circuit esophagojejunoduodenal plasty according the procedure described in 1976 by Francesco Moricca. The double jejunal loop represents a sort of "digestive reservior" allowing to avoid the sensation of epigastric fullness after eating. Moreover, this technique permits a better absorption of the liquids and the partial mixing of the bolus with the bilio-pancreatic secretion stimulates the duodenal secretin and cholecystochinin release. The possibility of a "dumping syndrome" is diminished by the presence of the double possibility of diversion of the alimentary bolus. On the contrary the segment of jejunum transposed between the esophagus and duodenum is antiperistaltic and this fact can cause sometimes an esophagitis at the lower third of the esophagus due to the prolonged alkaline reflux. This study is aimed at verifying the entity and frequency of the esophagitic complication in patients who underwent a total gastrectomy and at analyzing the procedures adopted to cure this severe complication that seriously affects the wellness and the nutritional status of the gastrectomized patients.