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During the last recent years, in Quinis, a small village sited in the Alta Val Tagliamento valley (Friuli Venezia Giulia Region, NE Italy), the inhabitants faced with instability phenomena related to the presence of soluble rocks in the subsurface. The evaporite bedrock is mainly mantled, in fact, by high thickness deposit. This paper explains the methodological approach that we used to identify the instabilities in a very complex geo-structural environment where the urbanization limits the applicability of several investigation techniques. Different methods were used to define the bedrock morphology, to characterize the mantling deposits and to identify the processes behind. What emerged from the study is a mandatory multidisciplinary approach to characterize the subsoil, because each technique is not able individually to take to a unique result. The data collected allowed to draft a geo–hydrogeological conceptual model of the Quinis village. The lessons learned, even if with some site-specific dependency, demonstrate the importance of broad-spectrum investigations, which are essential to understand the subsurface characteristics avoiding relevant socio-economic impact and supporting an adequate future territorial planning.

Aim Rectal prolapse is a distressing condition affecting mostly elderly patients and females. Delorme's procedure is frequently performed since it offers good results and is burdened by a particularly low morbidity. Faecal Incontinence is associated with prolapse in a large percentage of patients, due to the sphincter damage caused by the prolapsed rectum through the anal canal. Prolapse resection is often ineffective in treating incontinence, and further specific procedures are frequently required. At present, no data are available on combined Delorme's procedure with the implant of Bulking Agents for the simultaneous treatment of rectal prolapse and faecal incontinence. Method Three patients affected by complete external rectal prolapse underwent simultaneous Delorme's procedure with application of six polyacrylonitrile prosthetic cylinders in the inter-sphinteric space (Gate Keeper™, THD, Correggio Italy). Follow up was at 3,6 and 12 months. Results Gate Keeper procedure required a short operative time; no morbidity or complications were experienced. Prolapse was successfully treated in all patients and the mean Vaizey's incontinence score value dropped from pre-operative 19.3 to 9.3 after 3 months. All patients experienced a reduction of incontinence episodes and an improvement in daily activities and lifestyle. Conclusion Gate Keeper implant is feasible and safe when associated to surgical procedures like Delorme's prolapse resection. Preliminary results are positive even if a study with a larger numbers of patients is needed to confirm the efficacy. A simultaneous treatment of faecal incontinence should be always considered when performing surgery for rectal prolapse. Short statement The present manuscript describes a simultaneous combination of two surgical techniques to treat rectal prolapse and faecal incontinence. To date, there are no published data on a similar approach. The paper underlies the importance of treating faecal incontinence when performing surgery for rectal prolapse.

In the phantom illumination illusion, luminance ramps ranging from black to white induce a brightness enhancement on an otherwise homogeneous dark background. The strength of the illusion was tested with regard to the extension of the brightness inducing perimeter, surrounding the target area by manipulating the number of inducers (exp. 1) and the size of the inducers (exp. 2). Participants' task was to rate the difference in brightness between the target area and the background. Results show that the illusion occurs only when the target area is not completely segregated from the background by luminance ramps; vice versa, when the target area is delimited by a continuous gradient, it appears darker than the background. These findings suggest a major role of figure-ground organization in the appearance of the illusion. This hypothesis was tested in a rating task experiment with three types of target area shapes circumscribed by four types of edges: luminance contours, illusory contours, no contours, and ambiguous contours. Illusory contours, just as luminance contours, hinder the illusion and produce a darkening of the target area. A control experiment measured the brightness of the previous stimuli without luminance ramps: all configurations resulted in a darkening of the target area. Results from all experiments suggest that figure-ground segmentation plays a major role in the determination of both illumination and lightness in stimuli with luminance gradients. © 2008 Elsevier B.V. All rights reserved.

Aims To compare physical morbidity and health-related quality of life (HRQOL) in breast cancer patients who received standard axillary dissection (ALND) or sentinel lymph node biopsy (SLNB), followed by axillary dissection only in the case of sentinel-node positivity, within a randomised clinical trial. Patients and methods Patients with early breast cancer ≤ 3 cm and clinically negative axilla were randomly allocated to ALND or SLNB. All patients underwent physical examination every 6 months in order to assess any arm-related symptoms. A subset of patients completed the SF-36 quality of life questionnaire and the Psychological General Well Being Index (PGWBI) before randomisation, at 6 and 12 months after surgery and yearly thereafter. Results of the first 24 months are reported. Results Six-hundred and seventy-seven patients were available for analysis: 341 patients randomised to the ALND group and 336 to the SLNB group. Six months after surgery, the SLNB group had significantly less lymph-oedema, movement restrictions, pain and numbness with respect to the ALND group. Lymph-oedema was also significantly reduced at 12 months and numbness remained significantly less frequent in the SLNB arm at all time points. Three-hundred and ten patients participated in the HRQOL assessment. The mean scores of the PGWB questionnaire general index and anxiety domain were significantly better in the SLNB group than in the ALND group but the difference ceased to be significant at 24 months. Conclusions The SLNB is associated with reduced arm morbidity without evidence of a negative impact on psychological well being. While waiting for long-term results of ongoing randomised clinical trials, the SLNB may be proposed for early stage breast cancer patients after adequate information on the expected advantages and the possible risks.

Axillary lymph node dissection (ALND) in patients with ductal carcinoma in situ with microinvasion (DCISM) of the breast was controversial, because of the relevant morbidity incurred by the procedure and the low incidence of axillary involvement. The introduction of the sentinel lymph node (SLN) biopsy as a minimally invasive procedure for axillary staging has prompted new interest in this issue. However, as DCISM is a rare type of cancer, data on the incidence of SLN metastasis are scarce. The aim of the present paper was therefore to assess the prevalence of SLN metastasis in a multi-institutional series of DCISM patients, in order to ascertain whether SLN biopsy might be justified as a standard procedure in the presence of microinvasive cancer. Between 1999 and 2004, 43 patients with a diagnosis of DCISM underwent SLN biopsy. Microinvasion was defined as one or more foci of invasion beyond the basal membrane, none exceeding 1mm. SLNs were examined following haematoxylin-eosin and immunohistochemical staining. SLN metastases were found in four out of 43 cases (9.3%). In one patient, SLN contained only micrometastasis. All four patients with positive SLN underwent complete ALND and in all these cases further metastatic axillary nodes were found. In conclusion, given the relevant incidence of nodal metastases and the low morbidity of the procedure, we believe that SLN biopsy should be considered in all patients with a diagnosis of DCISM. In cases of SLN involvement, even if micrometastatic, our policy is to perform a complete ALND.

Aim To report the pattern of lymphatic mapping following intrasubdermal injections of radiocolloid and of blue dye in different sites of the breast. Methods Prior to surgery 137 breast cancer patients underwent intrasubdermal injection of 30–50 MBq 99m Tc-colloidal albumin over the tumour site (ISI group). Ten minutes before surgery, 2 ml patent blue was injected in the subareolar area (SAI group) in 117/137 patients, while 20 patients received intrasubdermal blue-dye in the quadrant opposite the tumour site (OQI group). The different injection routes were considered concordant when the hottest sLN was also blue. Results In 134/137 patients radiocolloid drained to one or more axillary nodes, while blue nodes were found in 98/117 SAI patients and in 17/20 OQI patients. Multiple hot nodes were found in 63/134 cases and multiple blue nodes in 35/115. In patients in whom both tracers reached the axilla, the hottest node was also blue in 108/115 cases (93/98 SAI and 15/17 OQI patients). In the seven discordant cases, the hottest node was not blue, but in two cases the blue node was also radioactive. Conclusions Superficial lymphatic drainage from the breast most frequently merges to a single axillary lymph node, irrespective of the site of tracer injection. In a few cases different injection sites identify different, often closely interconnected sLNs.

The distribution of the main prognostic factors in different age groups was evaluated in 1226 patients operated on for primary breast cancer, in order to identify those influenced by age and/or menopausal status. Patients were divided into the following groups: 1) 40 years of age and under; 2) premenopausal over 40 years of age; 3) postmenopausal under 75 years of age and 4) 75 years of age and over. Our findings showed that the youngest patients had the worst prognostic pattern, which improves as age increases and is the best in patients over 75 years of age. Some of the parameters investigated (tumour size, histologic and nuclear grade, tumour infiltrating lymphocytes, p53 and Ki 67) were found to be influenced by age, some (necrosis and oestrogen receptors) were influenced by menopausal status and/or age, some (vascular invasion, ploidy, S-phase and progesterone receptors) showed significant differences in different age groups but there was no consistent relation with patient age or menopausal status, and others (node status, ErbB2/Neu and Cathepsin D) were not influenced by age or menopause.

The aim of this study was to discuss the role of preoperative ultrasound (US) scanning and sentinel node biopsy (SNB) in melanoma patients. 100 patients underwent SNB following preoperative US scan and lymphoscintigraphy; patent blue dye (PBD) was injected before biopsy. Intra-operative lymphoscintigraphy (IL) was performed in 51 basins. All nodes were examined with histology and immunohistochemistry. Sensitivity and specificity of US scanning was 33% and 100%, respectively; 7% were true positives. The low sensitivity was mainly due to the resolution power of the US scanner (2 mm) which was unable to identify all the patients with microdeposits. PBD associated with IL identified SNs in all cases. In all patients with Breslow >1.5 mm and in all cases with two metastatic SNs, further positive additional nodes were found. The mean counts per 10 s (CP10S) ratio for SN and non-SN values was 5.62 (1.29–23.51) and 3.09 (1.03–10.99) in the intra-operative and extra-operative phases, respectively. US scanning and preoperative lymphoscintigraphy associated with PBD allows preoperative patient selection and accurate SN(s) identification. Breslow thickness and the number of metastatic SN(s), but not their type, are correlated with disease spread; CP10S contributed to the differentiation amongst the nodes and the determining of procedure's completion.

Vimentin and proliferating cell nuclear antigen (PCNA) immunohistochemical staining was performed in a series of 92 node-negative breast carcinomas and expression compared with tumour size, histological grade, nuclear grade, necrosis, lymphocytic infiltrate, oestrogen and progesterone receptors, and relapse rate. Vimentin was expressed in 13% of tumours and all positive cases were invasive ductal carcinomas. A strong relationship was noted between vimentin positivity, and both histological ( P = 0.01) and nuclear grade ( P = 0.02). The percentage of PCNA positive cells (PCNA index) varied from 0.2 to 70% (mean 27.45, median 28). PCNA index showed a significant correlation with histological ( P = 0.001) and nuclear grade ( P = 0.004). Furthermore vimentin positivity was significantly associated with high PCNA index ( P = 0.002). With univariate analysis vimentin positivity and high PCNA index (> 28) were both significantly correlated with shorter disease free survival ( P = 0.003 and P = 0.002 respectively) (median follow-up 84 months), while no other parameter reached significance. Using multivariate analysis PCNA index was statistically related to disease-free survival ( P = 0.05), whereas vimentin lost its significance. Our results suggest that PCNA may be useful in identifying node-negative breast cancer patients at risk of recurrence.

Department of Oncological and Surgical Sciences, University of Padua Medical School, Padua, Italy Nuclear Medicine Service, ‘S. Maria della Misericordia’ Hospital, Viale Tre Martiri 140, 45100 Rovigo, Italy General Surgery Unit, Verona Hospital, Verona, Italy Second Nuclear Medicine Service, Padua University Hospital, Padua, Italy Radiotherapy Unit, Department of Oncology, ‘S. Maria della Misericordia’ Hospital, Rovigo, Italy Regional Center of Nuclear Medicine, University of Pisa Medical School, Pisa, Italy