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Among the main causes of absence from work, with direct and indirect social costs, there are the low back pain that represent the most frequent complaint in health professionals. From 8 to 16% of the nursing staff and care is damaged skeletal muscle such as to limit the eligibility to work. In the Campania Region has introduced a structural adjustment program of the institutions which provide social and health care in order to improve the "practicality" and "usability" of space for guests and operators. The implementation of this program in the Azienda Sanitaria Locale Napoli 2 North, and especially in our district 39, has been the main targets of optimizing the organization of work and reducing the percentage of low back pain. The evaluation of this program has shown that compliance with ergonomic principles leads to the prevention of psychological and physical disorders related to a bad drawing of organized labor.

Aim: A retrospective analysis was made to evaluate our experience in the management of tracheobronchial foreign bodies (TFB) in children (age

An extremely rare case of type A esophageal atresia is reported. The baby girl patient born spontaneously after a 38-week pregnancy, was diagnosed prenatally with suspected type A esophageal atresia. Diagnosis was confirmed at birth by chest and abdominal X-ray. As per protocol, a naso-esophageal tube was positioned in aspiration and a Stamm gastrostomy made for nutritional purposes. Evaluation of the distance between blind pouches at one month of life showed they were overlapping. At intervention the pouches were found to be united by a fibrous bridge about 1.5 cm long. Anastomosis was carried out with ease. The postoperative course was trouble-free. On the X day the baby girl was being fed completely per os. Histolo-gical examination of the fibrous residue excluded the presence of a mucosa-lined lumen. X-ray examination of the esophageal-gastric passage, one month after the operation, showed the smooth transit of the contrast medium and an adequate anastomotic lumen. At follow-up, at the age of 9 months, the baby was growing normally and being fed per os with a diet appropriate for her age; no oesophageal dilatation was necessary. Type A oesophageal atresias are long-gap forms: they are treated with direct anastomosis after the blind pouches come together spontaneously in the first four months of life. Stress is laid on the rarity of the case. According to Kluth's classification of 1976, this form was described by Mason in 1855 and Jlott in 1905 on the basis of autopsy findings. A review of the literature did not show any similar clinical cases.

Aim: Macrogol 4,000 is one of the new generation's osmotic laxatives. It is constituted by a heavy molecular weight polymer without additional salts. In most of patients Macrogol 4,000 shows its efficacy in 48 hours from the beginning of treatment. Daily evacuations has been reported after first week therapy with an improvement in quality of life. The aim of this observational study was to demonstrate the efficacy of Macrogol 4,000 in the treatment of constipation in children., Methods: The effect of Macrogol 4,000 was assessed in 120 children affected by constipation treated with therapeutic doses of Macrogol 4,000. The study period ranged from September 2006 to March 2007. The data analysis was collected with the evaluations concerning clinical examination and the consultation of daily diaries assembled by parents, tracking stooling pattern; in case of loosing contacts with the patient, a telephonic survey has been carried out. The child with symptoms improvement, i.e. reduction of the pain during defecation, daily spontaneous evacuations and better stool consistence, were considered ''normal''., Results: Of the 120 patients, 89 returned to the clinical follow-up, while the remaining 31, who missed the follow-up, has been contacted by telephone. To the final analysis, 103 patients (85.8%) have had a normalization of the clinical symptoms, 9 patients (7.5%) have refused Macrogol 4,000 for the unpleasant flavour, 8 patients (6.7%) did not have any improvement from the treatment., Conclusion: The results of this observational study suggest that Macrogol 4,000 could be very useful to treat pediatric patients with constipation, also those affected by neuronal intestinal displasia (NID) type B.

A clinical series of 580 patents (318, F, 199 M) personally observed at the Emergency Surgery and First Aid Division of the Fatebenefratelli and Ophthalmic Hospital Board of Milan between 1975 and 1980, and suffering from acute inflammation of the bile ways (gall bladder empyemas, acute cholecystitis, gangrene of the gall bladder, haemobilia due to gall bladder puncture), has been examined. Of these patients, 558 were subjected to surgery between 12 hours and 6 days after admittance. Operated patients are subdivided into 4 groups on the basis of their anatomo-pathological form and the average time interval between admittance and intervention. Critical examination shows that their behaviour with respect to acute inflammatory forms of the gall bladder can be split up as follows: 1) immediate surgery (within 12 hours) for empyematous and/or punctured forms; 2) emergency surgery (within 2 days of admittance) for cases with certain diagnosis backed up by historical and X-ray data pointing to calculosis of the gall bladder; 3) early surgery (within 3 days) for cases with certain diagnosis but without prior X-ray documentation; 4) deferred surgical intervention (within 6 days) for patients without X-ray documentation and in whom immediate medical treatment leads to a rapid improvement in the clinical picture. The very good clinical results obtained and the observation of a low mortality and morbility index (comparable to those of surgery of choice) suggest that early surgery is certainly the therapy of choice when dealing with acute cholecystitis.

The authors exam 8 subfrenic abscesses cases observed in the last 5 years in Fatebenefratelli Hospital of Milano - Emergency Surgical Department. After considering etiologic, clinical and therapeutic aspects of their casuistry, they remark the importance of the basal illness, particularly in secondary subfrenic abscesses which are the most part in their series and in the literature ones. In this series of cases they always used trans-abdominal laparatomy which never gave technical problems, so they underline it may be preferable in comparison with other surgical methods.

On the basis of two cases of chronic duodenal stasis following Billroth I and Billroth II the Authors analyse this syndrome not very frequently described in literature. They disagree with those who state that chronic duodenal stasis after gastric-resection is to be considered solely as a complication of gastric surgery, but rather tend to think that is misunderstanding may be a cause of considerable therapeutic failures.

A group of 137 patients observed at the Emergency Surgery and First Aid Division of the Fatebenefratelli Hospital of Milan between 1971 and 1974 is examined. The patients all presented a clinical picture of occlusion and/or perforation of the colon and rectum due to carcinoma, requiring emergency surgery. The clinical material examined is analysed and the surgical treatment adopted and the results obtained reported. Post-operative mortality was 16.8% in cases of occlusion, 21.6% in cases of perforation, and 36.4% in mixed cases. 63 patients, i.e. 46%, were subjected to more or less extensive resection and the mortality in this group was 11.2%; in the remaining 74 patients, ax only palliative measures were possible and mortality was 28.3%. It is observed, finally, that among emergency colon operations, right colectomy carried out immediately offers encouraging results, while resection of the left colon, apart from certain special cases, should be preceded by decompressive colostomy.

Personal experience and conclusions are reported after a review of the literature on rupturing aneurysms of the abdominal aorta. After considering some clinical data, which are features of this pathology, particularly prolonged hypotension, anuria and infarction of mesentery as negative prognostic elements, the diagnoses calling for hospitalisation, the causes of death, the interval between onset of symptomatology, admittance and surgery are examined and pointers sought with a view to improving results.