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Context. Period variations have been detected in a number of eclipsing close compact binary subdwarf B stars (sdBs) and these have often been interpreted as being caused by circumbinary massive planets or brown dwarfs. According to canonical binary models, the majority of sdB systems are produced from low mass stars with degenerate cores where helium is ignited in flashes. Various evolutionary scenarios have been proposed for these stars, but a definite mechanism remains to be established. Equally puzzling is the formation of these putative circumbinary objects which must have formed from the remaining post-common envelope circumbinary disk or survived its evolution. Aims. In this paper we review the eclipse time variations (ETVs) exhibited by seven such systems (EC 10246-2707, HS 0705+6700, HS 2231+2441, J08205+0008, NSVS 07826147, NSVS 14256825, and NY Vir) and explore whether there is conclusive evidence that the ETVs observed over the last two decades can reliably predict the presence of one or more circumbinary bodies. Methods. We report 246 new observations of the seven sdB systems made between 2013 September and 2017 July using a worldwide network of telescopes. We combined our new data with previously published measurements to analyse the ETVs of these systems. Results. Our data show that period variations cannot be modelled simply on the basis of circumbinary objects. This implies that more complex processes may be taking place in these systems. These diffculties are compounded by the secondary star not being spectroscopically visible. From ETVs, it has historically been suggested that five of the seven binary systems reported here had circumbinary objects. Based on our recent observations and analysis, only three systems remain serious contenders.We find agreement with other observers that at least a decade of observations is required to establish reliable ephemerides. With longer observational baselines it is quite conceivable that the data will support the circumbinary object hypothesis of these binary systems. Also, we generally agree with other observers that higher values of (O,C) residuals are found with secondary companions of spectral type M5/6 (or possibly earlier as a result of an Applegate type mechanism). [ABSTRACT FROM AUTHOR]

The article reviews the transit time variations (TTVs) exhibited by HS0705 eclipsing binary system, over the last thirteen years as of 2015 and explore whether there is conclusive evidence that these TTVs can predict the presence of a third body. Topics include the HS0705 identified as an subdwarf (sdB) star and their subsequent analyses since 2001, 25 new measurements taken between late 2013 and early 2014 using Sierra Stars and iTelescope robotic telescope.

TW Coronae Borealis (TW CrB) is a binary system likely to be active, showing evidence of starspots and a hotspot. We calculated a new ephemeris based on all available timings from 1946 and find the period to be 0.58887492(2) days. We have revised the average rate of change of period down from 1.54(16)×10-7 days/yr to 6.66(14)×10-8 days/yr. Based on lightcurve simulation analysis we conclude that the two stars are close to filling their Roche lobes, or possibly that one of the stars' Roche lobe has been filled. The modelling also led to a hotspot and two starspots being identified. Conservative mass transfer is one of a number of possible mechanisms considered that could explain the change in period, but the mass transfer rate would be significantly lower than previous estimates. We found evidence that suggests the period was changing in a cyclical manner, but we do not have sufficient data to make a judgement on the mechanism causing this variation. The existence of a hotspot suggests mass transfer with a corresponding increase in the amplitude in the B band as compared with the R and V bands. The chromospheric activity implied by the starspots makes this binary system a very likely X-ray source. [ABSTRACT FROM AUTHOR]

Background: Postoperative perineal hernia (PH) is an uncommon complication after abdominoperineal resection (APR). Different techniques have been described in literature and there is no consensus regarding the optimal repair approach. In the present study, we reported a case of a laparoscopic combined repair of a perineal hernia and abdominal parastomal hernia (PSH) with mesh. Studies have shown that the prosthetic PSH and PH repair can be performed at the same time by laparoscopy with the same trocars positioning, adding the advantages of minimally invasive surgery and avoiding large laparotomy., Methods: A literature search in Pubmed was performed. All articles in English describe laparoscopic repair of combined perineal and parastomal hernias. A case presentation of an 83-year-old woman with combined parastomal and perineal hernias after abdominoperineal resection (APR) shown in a video vignette is provided., Results: Three single patient case reports published between 2016 and 2023 were found in literature. Two patients with rectal cancer underwent APR procedure, while the third patient underwent an anterior pelvic exenteration (APE) for carcinoma of the urinary bladder (CUB). The laparoscopic procedures did not require conversion and all procedures successfully closed the defect using a mesh. In our case, the operative time was 3 h with the major time spent for PH repair. The intraoperative blood loss was non-significant and the postoperative course was regular. The patient has been discharged on the fourth postoperative day. At 1 year follow-up, the patient noticed a great improvement in her daily-life due to the absence of the previous discomforts and there was no evidence of early recurrence or other postoperative complications., Conclusion: Combined laparoscopic transabdominal PH and PSH repair with the use of synthetic mesh was shown to be a safe and effective repair for this rare disorder. To accurately compare techniques, we require prospective studies with longer follow up durations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Brucchi, Limongi, Masci, De Stefano, Pelfini, Cassini, Clarizia, Franzini and Faillace.)

Purpose: This study aimed to evaluate the feasibility, safety, and efficacy of laparoscopic transabdominal preperitoneal hernia repair (TAPP) for inguinal hernias in emergency settings, providing insights from a long-term follow-up., Methods: We retrospectively analyzed all patients who underwent emergency TAPP repair in ASST Nord Milano from January 2005 to December 2023. A prospectively collected database of 54 consecutive TAPP hernia repairs was reviewed. The study evaluated the feasibility and safety of TAPP through operative time and the conversion rate. Effectiveness was gauged by recurrence and complication rates as well as acute and chronic pain using the Visual Analog Scale (VAS). Long-term follow-up included assessing recovery to normal activity., Results: Overall, data from 54 consecutive patients were analyzed. Median age was 72 (IQR = 11), with 21 men and 33 women (38.8% vs. 61.2%). The primary diagnosis was a primary hernia (61.1%), while a recurrent type was identified in 21 patients (38.9%). Femoral hernia was identified in 36 cases (48%). The median operative time was 100 min (IQR = 53 min) with 6 cases of conversion (11.1%). One recurrence (1.85%) was noted and the complication rate was 5.55 %. At a median follow-up of 38 months, there was a low grade of chronic pain (VAS 3) in a patient (1.85%) and one recurrence (1.85%)., Conclusion: TAPP is a safe, feasible, and effective option for emergency inguinal hernia repair, exhibiting low complication and recurrence rates on long-term follow-up when performed by surgeons with minimally invasive surgery experience and in selected patients., (© 2024 The Author(s). World Journal of Surgery published by John Wiley & Sons Ltd on behalf of International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)

Background: The routine use of abdominal drainage (AD) after laparoscopic cholecystectomy (LC) is still controversial. The aim of this expertise-based study is to evaluate the efficacy of prophylactic AD in terms of postoperative complications and analyze the factors linked to AD placement., Methods: This case-control retrospective study included patients with cholelithiasis who underwent LC with AD (AD group) and LC without drainage (no-AD group) in two Italian centers. Allocation to groups was non-randomized and based on surgeons' decisions. Patient's characteristics, operative results, postoperative outcomes, surgeon's expertise related data were compared between the two groups with univariate and multivariate analysis., Results: Patients in the two groups were comparable for age, sex ratio, and morbidity. Length of postoperative hospital stay (LOS) in the no-AD group was shorter than the AD group. Patients in the AD group had a higher rate of wound infection. No difference in postoperative pain measured 7 days after the surgery was found. Our results show an association between the first operator's expertise and age and the decision of placing the AD. The operative time seems to be the principal factor impacting the decision whether to place or not the AD., Conclusions: Our results indicate that it is feasible not to insert routine AD after elective LC for cholelithiasis. The use of AD seems to cause more cases of postoperative wound infections, prolongs the LOS and the operative time. The drain placement choice seems to change in relation to the surgeon's expertise.

Aim: The study aimed to evaluate and compare the short and long-term outcomes of doppler-guided (DG) hemorrhoidal artery ligation and rectoanal repair (HAL-RAR) using a wireless-doppler-guided probe and stapled hemorrhoidopexy (SH) for treatment of II-III hemorrhoids., Methods: This cohort study included patients who underwent HAL-RAR (n = 89) or SH (n = 174) for grade II-III hemorrhoids between January 2020 and December 2021. After propensity score matching at a 1:1 ratio, 76 patients for each group were analyzed. Short and long-term outcomes were collected. Pain was measured using a Visual Analogue Scale (VAS) at POD1, POD 10, 1 month, and 6 months after surgery. The enrolled patients completed the Hemorrhoidal Disease Symptom Score and Short Health ScaleHD quality of life (HDSS/SHS QoL) questionnaire preoperatively and during a regular follow-up visit at 24 months after surgery., Results: Groups exhibited comparable overall postoperative complication rates (23% HAL-RAR/ 21% SH; p = 0.295). Postoperative pain via VAS showed median scores of 4, 3, 1, 1 for HAL-RAR and 6, 4, 2, 1 for SH at POD1, POD10, 1 month, and 6 months, respectively (p =  < 0.001, 0.004, 0.025, 0.019). At a median follow-up of 12 months, the recurrence rate was 10.5% in the HAL-RAR group and 9.2% in the SH group (p = 0.785), respectively. At 24 months, 15.7% of HAL-RAR patients and 19.7% of SH patients remained symptomatic (p = 0.223). Median post-op QoL index was 1 (HAL-RAR) and 0.92 (SH), p = 0.036., Conclusions: HAL-RAR is a safe and feasible technique in treating grade II-III hemorrhoids showing better outcomes in terms of postoperative pain and QoL., Significance: This paper adds a new perspective in comparing the HAL-RAR and SH, focusing the attention on the patients and not surgical techniques. A long and difficult follow-up was completed to fully understand the long-term results and the impact on the QoL of the patients who underwent these procedures., (© 2024. The Author(s).)

Aim: We aimed to investigate the short and the long-term outcomes and 2-year Quality of Life (QoL) of patients with right-sided colonic diverticulitis (RCD) surgically managed., Method: We conducted an ambidirectional cohort study of patients with RCD undergoing surgery between 2012/2022. A colonoscopy was performed at 1-year post surgery. The enrolled patients completed the EuroQoL (EQ-5D-3L) during a regular follow-up visit at 12 and 24 months after surgery., Results: Three hundred nineteen patients with RCD were selected: 223 (70%) patients were treated by non-operative management (NOM) while 33 underwent surgery. Acute diverticulitis occurred in 30 patients: 9 (27.2%) were classified by CT as uncomplicated and 21 (63.6%) as complicated diverticulitis. Additionally, chronic diverticulitis occurred in 3 cases (9.2%). Specifically, 27 patients were classified by CT as 1a (81.8%) and 6 patients as 3 (18.2%). Right hemicolectomy was performed in 30 patients (90.8%), and ileo-caecectomy in 3 (9.2%). Nine (27.27%) experienced postoperative complications: 7 (77.7%) were classified according to the Clavien-Dindo as grade I-II, and 2 (22.2%) as grade III. No disease recurrence or colorectal cancer (CRC) was detected on colonoscopy. Thirty (90.8%) patients completed the 24-month follow-up. A statistically significant difference between preoperative and 24-month QoL index values (median 0.72; IQR = 0.57-0.8 vs. median 0.9; IQR = 0.82-1; p = 0.0003) was observed., Conclusions: The study results demonstrate satisfactory surgical outcomes and a better QoL after surgery. No disease recurrence or CRC was observed at colonoscopy 1 year after surgery., (© 2024 The Authors. World Journal of Surgery published by John Wiley & Sons Ltd on behalf of International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)

Laparoscopic ventral hernia repair (LVHR) is a widely practiced treatment for primary (PH) and incisional (IH) hernias, with acceptable outcomes. Prevention of recurrence is crucial and still highly debated. Purpose of this study was to evaluate predictive factors of recurrence following LVHR with intraperitoneal onlay mesh with a single type of mesh for both PH and IH. A retrospective, multicentre study of data collected from patients who underwent LVHR for PH and IH with an intraperitoneal monofilament polypropylene mesh from January 2014 to December 2018 at 8 referral centers was conducted, and statistical analysis for risk factors of recurrence and post-operative outcomes was performed. A total of 1018 patients were collected, with 665 cases of IH (65.3%) and 353 of PH (34.7%). IH patients were older (p < 0.001), less frequently obese (p = 0.031), at higher ASA class (p < 0.001) and presented more frequently with large, swiss cheese type and border site defects (p < 0.001), compared to PH patients. Operative time and hospital stay were longer for IH (p < 0.001), but intraoperative and early post-operative complications and reinterventions were comparable. IH group presented at major risk of recurrence than PH (6.7% vs 0.9%, p < 0.001) and application of absorbable tacks resulted a significative predictive factor for recurrence increasing the risk by 2.94 (95% CI 1.18-7.31). LVHR with a light-weight polypropylene mesh has low intra- and post-operative complications and is appropriate for both IH and PH. Non absorbable tacks and mixed fixation system seem to be preferable to absorbable tacks alone., (© 2022. The Author(s).)

Objective: Laparoscopic cholecystectomy is the first-choice treatment for symptomatic cholelithiasis. Though generally safe, this procedure is not without complications, with bleeding the most frequent cause of conversion to open cholecystectomy. Oxidized regenerated cellulose (ORC) added to conventional hemostatic strategies, is widely used to control bleeding during surgery despite limited evidence supporting its use. This retrospective study analyzed patients undergoing laparoscopic cholecystectomy in an Italian center over a 16-month period, between October 2014 and February 2016, who experienced uncontrollable bleeding despite the use of conventional hemostatic strategies, requiring the addition of ORC gauze (Emosist ® )., Results: Of the 530 patients who underwent laparoscopic cholecystectomy, 24 (4.5%) had uncontrollable bleeding from the liver bed. Of these, 62.5% had acute cholecystitis and 33.3% chronic cholecystitis; 1 patient was diagnosed with gallbladder carcinoma, postoperatively. Most patients had comorbidities, 16.7% had liver cirrhosis, and 37.5% used oral anticoagulants. The application of ORC rapidly controlled bleeding in all patients. Patients were discharged after a mean duration of 2.2 days. ORC was easy to use and well tolerated. Bleeding complications remain a relevant issue in laparoscopic cholecystectomy. ORC was able to promptly stop bleeding not adequately controlled by conventional methods and appears, therefore, to be a useful hemostat.

Background & Aims: Some Parkinson's disease patients may develop morbid obesity, on account of the reduction in exercise and/or of the appearance of compulsive food intake in the first years after diagnosis. The prescription of central appetite suppressants is actually not recommended in Parkinson's disease patients. To the best of our knowledge, no cases of morbidly obese Parkinson's disease patients submitted to bariatric surgery procedures have been reported in literature before., Methods: We here describe for the first time the outcome of a sleeve gastrectomy intervention in a morbidly obese Parkinson's disease patient, resistant to several non-surgical weight-loss treatments., Results: The outcome of the sleeve gastrectomy intervention was satisfactory in terms of body weight-loss, long term weight stabilization and improvement of cardioprotective circulating factors, including adiponectin. Furthermore, the antiparkinson therapy (levodopa) was reduced by 25%., Conclusions: These observations suggest that morbidly obese Parkinson's disease patients, who are resistant to other dietary treatments, might be candidated for sleeve gastrectomy., (Copyright © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Appendicitis is one of the most common causes of acute abdomen in adults and appendectomy is the most common emergency abdominal procedure. Laparoscopic appendectomy has gained popularity only in recent years and the optimal approach for the treatment of acute appendicitis is still under debate. This retrospective study aimed at examining the current indications for laparoscopic appendectomy. 1024 patients undergoing laparoscopic appendectomy between February 1992 and December 2007 were retrospectively reviewed. 39.9% of patients (n=408) underwent emergency surgery. In 616 cases (60.1%) conservative management was performed in vain and these patients underwent an elective operation. In the 36 patients with an intraoperative normal appendix, other pathological findings were laparoscopically detected and treated. Conversion to an open procedure was required for 13 (1.3%) cases. The mean operative time was 38 min and the average length of postoperative hospitalization was 2.5 days. The overall morbidity rate was 2.6%. Laparoscopic appendectomy should be considered a procedure of choice for the treatment of non-complicated appendicitis. We stress the possibility to laparoscopically treat even complicated appendicitis in the surgical setting with substantial experience in minimally invasive surgery.

Objective: The aim of this study was to compare the morbidity of fixation of prosthetic meshes using Tissucol fibrin glue versus staples in laparoscopic transabdominal preperitoneal (TAPP) repair of inguinal and femoral hernias., Summary Background Data: In patients undergoing laparoscopic hernia repair, fixation of mesh prostheses with staples may affect inguinocrural nerves causing early postoperative neuralgia and chronic neuralgia., Methods: Between June 2003 and February 2005, 197 patients with inguinal or femoral hernia were enrolled in this prospective, randomized study, to assess morbidity following hernia repair with staples (n = 98) or Tissucol (n = 99). The primary outcomes were early postoperative and late neuralgia recorded using a visual analog scale (VAS). The effects of neuralgia on functional status were evaluated using the modified SF-36 questionnaire. Secondary outcomes included complications such as nonspecific pain and recurrence., Results: Assessments took place at 1, 3, 6, and 12 months, with all patients completing each follow-up visit. Mean VAS scores were significantly lower in the Tissucol group versus the staples group (MANOVA, P < 0.05). Higher scores for the modified SF-36 questionnaire at 1 month were demonstrated in the Tissucol group compared with the staples group (23.2 and 22.6, respectively; P < 0.05). The mean recovery time for normal physical activity was significantly shorter in the Tissucol group compared with the staples group (7.9 vs. 9.1 day, respectively; P < 0.001). One recurrence was seen in the fibrin glue group, which was attributable to a technical error in fixation of the mesh., Conclusions: The use of Tissucol provides distinct advantages in laparoscopic treatment of inguinal/femoral hernias compared with conventional TAPP, including a lower incidence of postoperative neuralgia and an earlier resumption of physical and social activities.

The jejunal free flap is a standard technique in the reconstruction of hypopharyngeal and cervical esophageal defects. Conventional harvesting of the jejunal segment is performed with midline open laparotomy, which is associated with complications including prolonged ileus, abdominal pain, wound infection or dehiscence. Laparoscopic resection of the small intestine is a well documented surgical technique. Two different methods of laparoscopic harvest of a jejunal autografts for their cervical implantation have been already described. In both cases, low complication rate and better postoperative course have been observed in the patients treated. During the last 10 years, we have performed 43 circumferential pharyngoesophageal resection for advanced hypo-pharyngeal cancer followed by reconstruction with a free flap of jejunum. All but one the jejunal segments have been harvested with conventional open laparotomy. In the last patient of this group, laparoscopic harvest of the jejunal segment has been successfully performed. In this paper, we describe the laparoscopic technique used and we compare the postoperative course of this patient with those of the patients treated with conventional technique.

A rare case of primary malignant melanoma of the oral cavity is reported and a literature review of etiopathogenesis, biological bases and prognosis is made. The hypotheses to explain the very severe prognosis of malignant melanoma of the oral cavity with respect to that of skin are discussed. The therapeutic approaches are described as well as the frequent difficulty to perform them in relation to the anatomical region and the wide extension of the tumoral lesion.

Oral and maxillo-facial mesenchymal malignant neoplasms are rare. They involve nosologic, diagnostic and therapeutic problems. Clinical cases of soft and bone tissue are reported. They share difficulties in clinical, roentgenographic and histopathological diagnosis and often the disagreement between the clinical evidence and the histopathological report. The rule of the immunohistochemistry for a correct characterization of mesenchymal malignant neoplasms and the necessity for correct and early diagnostic definition in order to plain the treatment are emphasized.

The synthesis of 3-exo-dialkylamino-(Z)-camphoroximes 7 starting from a mixture of 3-endo- and 3-exo-bromocamphornitrimine, hydroxylamine hydrochloride and excess secondary amine (dimethylamine, pyrrolidine, piperidine or morpholine) is described. Compounds 7 gave a series of omega-dialkylaminoalkyl ethers 9, 10 and 11 by reaction of 7 as sodium salts with omega-chloroalkyldialkylamines in DMF solution. Some of compounds 9, 10, 11 showed an appreciable antiarrhythmic and local anesthetic activity in rats and mice, respectively.