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To better understand the movement of water and solutes in soils, and the risk of groundwater contamination, we need water and solute flux observations distributed in space and time. We designed a new variable-suction multicompartment percolation sampler that can be buried below an undisturbed soil volume in the field. The instrument collects percolate from 100 cells within a 32.5- by 32.5-cm area. Drop counters record the number of drops falling into the sample collectors of all cells. The cells are covered by a porous material to which suction is applied in accordance with nearby tensiometer readings. The collected water can be repeatedly extracted in situ, allowing the breakthrough curve of each cell to be measured. This temporal and spatial resolution greatly helps to quantify heterogeneous flow at scales between that of the individual sampling cell and the entire sampler. Three prototypes were tested in different laboratory (under a soil monolith) and field experiments (buried in situ) in Australia and the Netherlands. One sampler was covered with a nylon mesh, another with sintered porous stainless steel plates, and a third with a polyamide membrane. Water was uniformly applied at the soil surface by irrigation (laboratory) or natural rainfall (field). Suction could be controlled once the covers were saturated, blocking the inflow of air. The instruments operated continuously for several months. The membrane and metal covers worked best. The wealth of data obtained from a single experiment provides considerable insight in water and solute transport processes in undisturbed soils. [ABSTRACT FROM AUTHOR]

Abstract: Little attention has been paid to the possibility that soil water repellency could enhance non-equilibrium water flow and solute transport through macropores present in structured clay soils. In this study, we measured infiltration and solute transport in a clay soil under near-saturated conditions in both the field using tension infiltrometers and in the laboratory on undisturbed soil columns. Measurements were made on adjacent plots under grass and continuous arable cultivation. Steady-state field infiltration rates measured using water and ethanol as the infiltrating fluids demonstrated that the soil macroporosity under grass was better developed, but that much of the structural pore system was inactive due to water repellency. No water repellency was detected on the arable plot disturbed by tillage. Dye tracing showed that the conducting macroporosity was largely comprised of earthworm channels in the grassed plot and inter-aggregate voids resulting from ploughing in the arable plot. Tracer breakthrough curves measured on field-dry soil indicated rapid macropore transport in columns taken from both plots, although the degree of non-equilibrium transport appeared somewhat stronger under grass. This result, which was attributed to water repellency, was also consistent with the larger flow-weighted mean pore size found in the field infiltration experiments. It is concluded that water repellency in undisturbed structured clay soils can have significant effects on the occurrence of non-equilibrium water and solute transport in macropores. [Copyright &y& Elsevier]

Abstract: This study describes the use of landscape transition analysis as a means for effective basin management. Land cover transitions from 1995 to 2002 were analyzed using a cross-tabulation matrix for an important economic zone in south-west Victoria, Australia. Specifically, the matrix was used to determine whether the transitions were random or systematic. Random landscape transitions occur when a land cover replaces other land covers in proportion to their availability. Systematic landscape transitions occur when there are deviations from random patterns, and land use types ‘target’ other land use types for replacement. The analysis was conducted with 11 land cover categories and showed that dryland pastures have been systematically losing area to dryland crops and blue gum (Eucalyptus globulus) plantations. Dryland crops have systematically expanded in the north-east of the catchment, an area where increasing in-stream salinization has occurred concurrently with this transition. The systematic expansion of the blue gum plantations has been predominantly in the south-west of the catchment and has the potential to reduce stream flows and groundwater recharge in an already water-stressed region, as blue gums use more water than the dryland pastures they are replacing. All other transitions were largely random. These findings have implications for land use planning in the study area for regional water balance and revegetation strategies. Landscape transition analysis is a cost-effective means of contributing to the management of water resources at a regional scale, and is highly recommended for future basin planning. [Copyright &y& Elsevier]

This study presents an environmental-friendly and cost effective method for the extraction of arsenic from contaminated soils. Laboratory experiments using inorganic salts, potassium phosphate (KH2PO4), potassium chloride (KCl), potassium nitrate (KNO3), potassium sulfate (K2SO4), and sodium perchlorate (NaClO4) were evaluated as arsenic extractants. An Andosol soil was artificially contaminated with arsenite [As(III)] and arsenate [As(V)]. The soil was washed in a batch process with different salt solutions in the pH range 3–11 for 24 hours at 20°C. Among the various potassium and sodium salts tested, KH2PO4 was found to be highly effective in extracting arsenic from As(III)-soil attaining more than 80% and 40% from As(V)-soil in neutral pH range. Other salts were particularly ineffective in extraction of arsenic from both soils. More arsenic was extracted more from the As(III)-soil than the As(V)-soil. [ABSTRACT FROM AUTHOR]

Abstract: A nonlinear model for single-phase fluid flow in slightly compressible porous media is presented and solved approximately. The model assumes state equations for density, porosity, viscosity and permeability that are exponential functions of the fluid (either gas or liquid) pressure. The governing equation is transformed into a nonlinear diffusion equation. It is solved for a semi-infinite domain for either constant pressure or constant flux boundary conditions at the surface. The solutions obtained, although approximate, are extremely accurate as demonstrated by comparisons with numerical results. Predictions for the surface pressure resulting from a constant flux into a porous medium are compared with published experimental data. [Copyright &y& Elsevier]

Abstract: Water repellent soils are difficult to irrigate and susceptible to preferential flow, which enhances the potential for accelerated leaching to groundwater of hazardous substances. Over 5Mha of Australian soil is water repellent, while treated municipal sewage is increasingly used for irrigation. Only if a critical water content is exceeded will repellent soils become wettable. To avoid excessive loss of water from the root zone via preferential flow paths, irrigation schemes should therefore aim to keep the soil wet enough to maintain soil wettability. Our objective was to monitor the near-surface water content and water repellency in a blue gum (Eucalyptus globulus) plantation irrigated with treated sewage. The plantation''s sandy soil surface was strongly water repellent when dry. For 4 months, three rows of 15 blue gum trees each received no irrigation, three other rows received 50% of the estimated potential water use minus rainfall, and three more rows received 100%. During this period, 162 soil samples were obtained in three sampling rounds, and their water content (% dry mass) and degree of water repellency determined. Both high and low irrigation effectively wetted up the soil and eliminated water repellency after 2 (high) or 4 (low) months. A single-peaked distribution of water contents was observed in the soil samples, but the water repellency distribution was dichotomous, with 44% extremely water-repellent and 36% wettable. This is consistent with a threshold water content at which a soil sample changes from water repellent to wettable, with spatial variability of this threshold creating a much wider transition zone at the field scale. We characterized this transition zone by expressing the fraction of wettable samples as a function of water content, and demonstrated a way to estimate from this the wettable portion of a field from a number of water content measurements. To keep the plantation soil wettable, the water content must be maintained at a level at which a significant downward flux is likely, with the associated enhanced leaching. At water contents with negligible downward flux, the field is water repellent, and leaching through preferential flow paths is likely. Careful management is needed to resolve these conflicting requirements. [Copyright &y& Elsevier]

Abstract: Applications of the axisymmetric Boussinesq equation to groundwater hydrology and reservoir engineering have long been recognised. An archetypal example is invasion by drilling fluid into a permeable bed where there is initially no such fluid present, a circumstance of some importance in the oil industry. It is well known that the governing Boussinesq model can be reduced to a nonlinear ordinary differential equation using a similarity variable, a transformation that is valid for a certain time-dependent flux at the origin. Here, a new analytical approximation is obtained for this case. The new solution,, which has a simple form, is demonstrated to be highly accurate. [Copyright &y& Elsevier]

Gallstone ileus is a rare disorder in emergency surgical practice with diagnosis usually difficult and only achieved at surgery. The current approaches are: enterolithotomy, cholecystectomy and fistula repair (one-stage surgery), enterolithotomy with cholecystectomy performed later (two-stage surgery) and only enterolithotomy (most reported surgical procedure)., Methods: The clinical, operative and follow-up data on 14 consecutive patients treated in our clinic for gallstone ileus was retrospectively reviewed., Results: Gallstone ileus was recorded in 0.06% of all operations for biliary lithiasis and 1% of all enteric occlusions. There were 11 women and one men, with a mean age of 77.3 (range 67-100) years. There was a mean delay of 3.16 days for onset of symptoms to admission. Urgent laparotomy confirmed gallstone obstruction and a cholecysto-duodenal fistula (13 cases) or cholecysto-colonic fistula (1 case). We performed one stage surgery in 4 cases, enterolithotomy alone in 8 cases (one case operated initially in another surgical service), Hartman procedure, cholecystectomy and fistula repair in one case and a spontaneous evacuation of the gallstone with cholecystectomy and fistula repair later in another case. We recorded 2 deaths in patients with multiple comorbidities in which only enterolithotomy was performed and with 1 and 2 reinterventions, respectively. Postoperative stay was 9.4 days for cases with simple enterolithotomy and 18.6 days for cases with radical treatment. We did not record any recurrence., Conclusions: Although rarely encountered in surgical practice, gallstones ileus should be noted in the differential diagnosis of intestinal obstruction in patients with a past history of biliary disease, occlusive syndrome, pneumobilia and possibly ectopic gallstone. The one-stage procedure should be the offered to stabilized patients, but in cases with associated comorbidities, only enterolithotomy represent a best option., Key Words: Gallstone ileus, Cholecystoduodenal fistula, Intestinal Obstruction.

Spontaneous biliary-enteric fistula (SBEF) is an abnormal communication between the biliary tree and the gastrointestinal tract which develops as a result of biliary or gastrointestinal disease. Iatrogenic fistulas, due to surgery or instrumental exploration, are not included in this definition. R. Colombo, in 1559, was the first to describe SBEF as an occasional finding during an autopsy. In almost 90% of cases the cause of SBEF is chronic recurrent cholelithiasis. Less common causes are penetrating peptic ulcers and neoplastic infiltration from the biliary or gastrointestinal tract. The most common type of SBEF is cholecystoduodenal fistula and the least common is choledochoduodenal fistula. There are various complications associated with SBEF but often these are not promptly recognized by patients or physicians and diagnosis and treatment may be delayed for years. The most important complication, which can be considered pathognomonic for SBEF, is gallstone ileus which manifests clinically as acute or chronic mechanical intestinal obstruction. Gallstone ileus, a rather rare complication of a rather common pathology, biliary lithiasis, is found in 0.000015% of hospitalized patients but in 0.0003% of surgical patients. It is mainly found in women over the age of 65, with a male to-female ratio of 1:5. There are various forms of occlusion, related to the sites of gallstone impaction, with various clinical characteristics and degrees of severity. These include Bouveret syndrome ( 10% of cases) with impaction in duodenum or pylorus, and the more common Barnard's syndrome (5-75% of cases) in which the site of impaction is in the terminal ileum right before Bauhin's valve. For diagnosis, the radiological signs which make up Riglerâ??s triad or tetrad, are essential, and are best visible on magnetic resonance. The the gold standard is contrast-enhanced computed tomography scan. Regarding the surgical management, one-stage simple enterolithotomy is reserved for the oldest patients and the most severe cases. Nowadays, is performed more and more frequently by laparoscopy. In more favorable cases radical treatment of the occlusion, the biliary lithiasis and the SBEF is recommended, either as a one-stage procedure or in two stages with the second procedure performed after few weeks., (Celsius.)

There is no doubt that postgraduate education and all "professional development activity" is in crisis, not only in our country but in all of Europe. The crisis is on one hand due to a lack of resources which has been evident for more than a decade, and on the other hand due to factors such as organization, culture, and education. Many of the chief medical disciplines such as internal medicine or general surgery, have been literally crushed and replaced by a myriad of subspecialties that have undermined the original unified character of the main disciplines 1. The teaching regulations in recent years have significantly limited students' opportunities to have direct, practical experience with surgery, which would allow them to develop their abilities and a true vocation , both crucial for a profession such as surgery which requires specific qualities and skills. Moreover the new regulations regarding admission to residency programs do not require candidates to make a definitive decision up front about what they want to specialize in, but rather leads them to accept any position among those still available after the candidates who are higher on the national rank-order list, get first pick of all specialties. General surgery is not among the specialties that are most popular in Italy and this appears to be true all over the world. It is therefore one of the few specialties that candidates with a low ranking are allowed to enter, even if they have no natural affinity for this discipline and no special desire to become a general surgeon. This is detrimental not only for healthcare as a whole and patients in particular, but for those doctors who would have selected surgery as their first choice , but cannot because they are too far down on the rank-order list. As a result a significant number of surgeons in training will leave during the five-year training period or after obtaining their diploma or will dedicate themselves to parasurgical activities or specific subspecialties, losing in a short time the broader skills of general surgery and emergency surgery. At the same time the universities has neither the organizational capacity, nor the resources to ensure that all these new subspecialties have the same degree of status and funding. Consequently, the training offered in each subspecialty is currently dependent not on an organic strategy but on factors such as problems with funding and administration, support from the medical industry, or, or even temporary appeal The crisis of training in emergency surgery is paradigmatic probably due to all of the above factors. The lack of foresight of the European institutions in charge has unfortunately had an completely negative influence on this discipline. While general surgery was imploding, the increase in the average age, the evolution of mechanization, the logistics of both work and pleasure, and the explosion of home automation, has dramatically increased the number of both trauma and non-trauma emergencies, increasing the need for professionals with specific cultural and technical skills. Coping with of surgical emergencies accounts for up to 50% of all surgical activity , but in Europe training in Emergency surgery, the only surgical discipline that still maintains the scientific, clinical, technical, and organizational knowledge and skills of general surgery, has been reduced to a bare minimum This affects morbidity and mortality rates, leading to a considerable increase in hospital costs 2. Our English colleagues put a spotlight on this problem some time ago, highlighting the professional and existential problems of surgeons who do not feel able to adequately manage any type of surgical emergency. They therefore demand on the one hand more effective technical training and on the other hand that emergency surgery be reserved only for specialists in the sector. But who will train them if residency programs in emergency surgery have been eliminated and have not been replaced, as they have, by training courses such as "Acute Care Surgery" Thanks to the attitude of national and continental institutions, the number and quality of training opportunities continues to decline Recently, the European Working Time Directive(EWTD) has been introduced, reducing by 50% the time that both tutors and residents could devote to professional activities (3), As a result, for some time now, public and private institutions, cultural and professional associations, trade union representatives, specialty organizations, scientific societies and whatever else, have been proposing and organizing events of all kinds: theoretical and practical courses, Masters programs, single-theme seminars, continuing medical education events, distance learning courses, Technical training live or on the simulator, Cadaver labs and so on, many of which have increased the financial burden on the individual doctor. The Royal College of Surgeons, calculated that the cost of completing the post-university requirements in surgery is today on average about £ 3360 (with a range of $2735 - 20780) compared to £2815 for internal medicine and £ 2215 for anesthesiology .This contributes significantly in increasing young doctors' loss of interest in this specialty. In particular, this applies to emergency surgery because of the poor quality of life , wage limitations, increased responsibilities, and legal disputes associated with this discipline4 . We feel that scientific societies must attempt to compensate for the deficits of institutional education by producing and supplying qualified products at a low price. In recent years various, chiefly Anglo-Saxon societies have proposed live courses on trauma surgery such as the ATOM and DSCT and practical theoretical courses on the first approach to patients requiring emergency care. AEMS has planned theoretical courses in emergency surgery aimed in particular at the acquisition of a European certificate of professional competence and qualification in emergency surgery and ESTES has done the same with regard to professional development in specific diagnostic and therapeutic emergency procedures 5. The Italian Society of Emergency Surgery and Trauma (SICUT), after having validated and proposed in Italy the best English-speaking products and having directly imported the DSCT, began its own production of residential events and dedicated education proposals addressed in particular to the young surgeons. The current symposium consists of a series of short presentations of the various training initiatives for the professional development of emergency surgical care staff that the SICUT has organized in the last few years . This is a series of educational and training events of different kinds, many of which are produced in partnership with other organizations, dedicated to surgeons willing to implement or renew their knowledge and technical skills.

Although emergency surgery accounts for 50% of the surgery cases in hospitals in Italy, in 57% of the hospitals emergency surgery is not performed by a dedicated team. In Europe, numerous surveys have shown that 50% of the young surgeons desire a more complete training in emergency general surgery (EGS). A survey conducted by the Association of Surgeons in training in the UK has shown that trainees want greater competence in EGS (92.4%) through the adoption of specific programs and training protocols. The Italian Society of Emergency Surgery and Trauma (SICUT)) has decided to try to make up for this lack of training by organizing specific courses that can serve as a training pathway in EGS. KEY WORDS: Emergency Surgery, Training.

Background: A wide variety of hemostats are available as adjunctive measures to improve hemostasis during surgical procedures if residual bleeding persists despite correct application of conventional methods for hemorrhage control. Some are considered active agents, since they contain fibrinogen and thrombin and actively participate at the end of the coagulation cascade to form a fibrin clot, whereas others to be effective require an intact coagulation system. The aim of this study is to provide an evidence-based approach to correctly select the available agents to help physicians to use the most appropriate hemostat according to the clinical setting, surgical problem and patient's coagulation status., Methods: The literature from 2000 to 2016 was systematically screened according to PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses] protocol. Sixty-six articles were reviewed by a panel of experts to assign grade of recommendation (GoR) and level of evidence (LoE) using the GRADE [Grading of Recommendations Assessment, Development and Evaluation] system, and a national meeting was held., Results: Fibrin adhesives, in liquid form (fibrin glues) or with stiff collagen fleece (fibrin patch) are effective in the presence of spontaneous or drug-induced coagulation disorders. Mechanical hemostats should be preferred in patients who have an intact coagulation system. Sealants are effective, irrespective of patient's coagulation status, to improve control of residual oozing. Hemostatic dressings represent a valuable option in case of external hemorrhage at junctional sites or when tourniquets are impractical or ineffective., Conclusions: Local hemostatic agents are dissimilar products with different indications. A knowledge of the properties of each single agent should be in the armamentarium of acute care surgeons in order to select the appropriate product in different clinical conditions.

Background: Intestinal obstructions/pseudo-obstruction of the small/large bowel are frequent conditions but their management could be challenging. Moreover, a general agreement in this field is currently lacking, thus SICUT Society designed a consensus study aimed to define their optimal workout., Methods: The Delphi methodology was used to reach consensus among 47 Italian surgical experts in two study rounds. Consensus was defined as an agreement of 75.0% or greater. Four main topic areas included nosology, diagnosis, management and treatment., Results: A bowel obstruction was defined as an obstacle to the progression of intestinal contents and fluids generally beginning with a sudden onset. The panel identified four major criteria of diagnosis including absence of flatus, presence of >3.5 cm ileal levels or >6 cm colon dilatation and abdominal distension. Panel also recommended a surgical admission, a multidisciplinary approach, and a gastrografin swallow for patients presenting occlusions. Criteria for immediate surgery included: presence of strangulated hernia, a >10 cm cecal dilatation, signs of vascular pedicles obstructions and persistence of metabolic acidosis. Moreover, rules for non-operative management (to be conducted for maximum 72 hours) included a naso-gastric drainage placement and clinical and laboratory controls each 12 hours. Non-operative treatment should be suspended if any suspects of intra-abdominal complications, high level of lactates, leukocytosis (>18.000/mm3 or Neutrophils >85%) or a doubling of creatinine level comparing admission. Conversely, consensus was not reached regarding the exact timing of CT scan and the appropriateness of colonic stenting., Conclusions: This consensus is in line with current international strategies and guidelines, and it could be a useful tool in the safe basic daily management of these common and peculiar diseases., Key Words: Delphi study, Intestinal obstruction, Large bowel obstruction, Pseudo-obstruction, Small bowel.

Aim: We performed a prospective study to evaluate the effect of antibiotic prophylaxis (AP) on the incidence of infection in elective laparoscopic cholecystectomy (LC)., Material of Study: All patients were at low-medium anesthetic and infectious risk and underwent LC for benign disease. At induction of anesthesia 41 patients received ampicillin-sulbactam 3g, 40 patients received ciprofloxacin 400mg intravenously, and 53 patients received no AP., Results: Postoperative infection was observed in 11 patients (8.2%) in the entire study group. All ob served infections were superficial surgical site infections (SSIs), always located at the umbilical incision. Infection occurred in 3 patients (7.3%) in ampicillin-sulbactam group, in 3 patients (7.5%) in ciprofloxacin group and in 5 patients (9.4%) in nonantibiotic group (p=0.916). Univariate analysis showed that duration of operation, placement of a drain and postoperative hospital stay were significantly associated with the development of SSIs. At multivariate analysis, only duration of operation was statistically significant in predicting SSIs., Discussion: The present study did not show any advantage in the use of AP, although in case of difficult surgery the risk of SSIs is increased, in particular in the umbilical incision. In all patients, the bile culture was sterile, then the infection of the umbilical site is not due to bacterial infection from the gallbladder., Conclusions: AP in elective LC should not be routinely performed. A particular attention to the preoperative cleaning and topical antibiotic therapy of the umbilical area is advised.

Surgical wounds dehiscence is a serious post-operatory complication, with an incidence between 0.4% and 3.5%. Mortality is more than 45%. Complex wounds treatment may require a multidisciplinary management. VAC Therapy could be an alternative treatment regarding complex wound. VAC therapy has been recently introduced on skin's graft tissue management reducing skin graft rejection. The use of biological prosthesis has been tested in a contaminated field, better than synthetic meshes, which often need to be removed. The Permacol is more resistant to degradation by proteases due to its cross-links. Surgery is still considered the best treatment for digestive fistula. A 58 years old obese woman come to our attention, she was operated for an abdominal hernia. She had a post-operatory entero-cutaneous fistula. She was submitted to bowel resection, the anastomosis has been tailored and the hernia of the abdominal wall has been repaired with biological mesh for managing such condition. She had a wound dehiscence with loss of substance and the exposure of the biological prosthesis, nearly 20 cm diameter. She was treated first with antibiotic therapy and simple medications. In addiction, antibiotic therapy was necessary late associated to 7 months with advanced medications allowed a small reduction's defect. Because of its, treatment went on for two more months using VAC therapy. Antibiotic's therapy was finally suspended. The VAC therapy allowed the reduction of the gap, between skin and subcutaneous tissue, and the defect's size preparing a suitable ground for the skin graft. The graft, managed with the vac therapy, was necessary to complete the healing process.

Objective: The aim of this study was to evaluate the clinical usefulness of computed tomography colonography (CTC) in the preoperative staging in patients with abdominal pain for occlusive colorectal cancer (CRC) and to compare the results of CTC with the surgical ones., Patients and Methods: 127 patients with abdominal pain, iron deficiency anemia and occlusive CRC underwent a CTC examination in prone position without intravenous contrast agent and in prone position after administration of intravenous contrast medium. All the patients underwent surgery after CTC. Two radiologists with different experience analyzed the images first independently and then by consensus. They evaluated the location of the lesion, the depth of the invasion of the colon-rectal wall (T stage), lymph node involvement (N stage) and the presence or absence of distant metastasis (M stage). CTC findings were correlated with surgical outcomes., Results: The overall accuracy values for tumour localization according to consensus reading of CTC examinations in comparison to surgical results were 100% (K = 1, p = 0.0001). The overall accuracy values of agreement for T staging of reader 1, reader 2 and consensus reading of CTC examinations in comparison to surgical results were respectively 95.5% (K = 0.876, p = 0.0035), 93.3% (K = 0.858, p = 0.0037) and 97.7% (K = 0.926, p = 0.0014) for ≤ T2; 91.3% (K = 0.839, p = 0.0027), 88.3% (K = 0.817, p = 0.0031), and 92.9% (K = 0.894, p = 0.0025) for T3; 89.6% (K = 0.825, p = 0.0037), 86.2% (K = 0.837, p = 0.0032) and 89.6% (K = 0.821, p = 0.0023) for T4. The overall accuracy values for N staging for reader 1, reader 2 and consensus reading was 90.2% (K = 0.865, p = 0.0029). The overall accuracy values for M staging of reader 1, reader 2 and consensus reading was 92% (K = 0.875, p = 0.0019)., Conclusions: CTC with is a very useful tool for accurate pre-treatment staging and localization of occlusive CRC.

Malignant melanoma is characterized by metastases also to the gastrointestinal tract, especially in the small bowel. The diagnosis is often delayed because unspecific clinical presentation (frequently as chronic iron deficiency anemia, rectal bleeding or intestinal obstruction). We present a case of melanoma of unknown primary site, with clinical presentation of intestinal obstruction. A segmental resection of the ileum was performed including mesentery with lymph nodes. Histology revealed metastatic melanoma from unknown primary. PET and MRI confirmed disseminated disease without brain metastasis.

The biliodigestive fistula is not a rare affection in the context of acute pathology of the gastrointestinal tract. It often affects patients between 63 and 85 years old , particularly the female sex, and the most common cause is acute or chronic cholecystolithiasis. Open issues are the delayed in the pre-operative diagnosis, and controversies exist regarding the best surgical approach. The choice of treatment options is influenced by the age of the patients and their clinical conditions and also by the presence of comorbidities and of a delayed right diagnosis. In the 1 to 3% of cases, the biliodigestive fistula presents a gallstone ileus as complication, whose diagnosis is particularly difficult for the lack of specific signs and symptoms. The contrast-enhanced CT is considered the gold standard for a specific pre-operative diagnosis, as it directly shows the fistula. Surgical treatments include one-stage procedure or two-stage procedure. Many studies seem to favor a deferred definitive procedure. The Authors describe 4 cases: in 3 cases, women between 70 and 80 years old presenting an history of recurrent cholecystitis, in 2 cases, and in 1 case presenting a bowel obstruction; in 1 case a 50-years-old man, with no significant past medical history, presenting a bowel obstruction. The Authors have performed in the 2 cases of gallstone ileus an enterolithotomy with cholecysto-duodenal fistula repair and cholecystectomy, in one-stage, and this has been possible because of the good clinical conditions of the patients and their low operative risk. In the case of fistula without the complication of gallstone ileus, the treatment approach has been cholecysto-gastric fistula closure with a gastroplastic using separate stitches and cholecystectomy, in one-stage. We are in agreement with data in the literature regarding the delay into the diagnosis of biliodigestive fistula and with the importance to suspect it or gallstone ileus presence, although the clinical presentation is extremely non-specific. In our experience, cholangiopancreatography-CT and CECT have made easier the pre-operative diagnosis and so reducing the delay of the treatment.

Fresh water scarcity is an increasing problem worldwide. Strategies to alleviate water scarcity include the use of low-quality water for irrigation. The risk of groundwater contamination by pollutants in this water is affected by soil heterogeneity and preferential flow. These risk factors can be assessed by measuring the spatio-temporal redistribution of uniformly applied water and solutes. We placed a soil monolith (height 29 cm) from an Australian vineyard on a 100-cell multi-compartment sampler (MCS). At this vineyard, treated wastewater is used in response to the severe shortage of water in the summer. We studied the leaching risk associated with heterogeneous or preferential flow by irrigating the soil column with 24 applications to simulate one year. We applied simulated rainfall as well as wastewater (which contained chloride) during summer while relying on rainfall only in winter. We compared the chloride leaching with the leaching of bromide, which was applied during one of the applications as a pulse. During the entire simulated year, leaching of solutes from the monolith was measured. The results indicate that the assumption of uniform flow would underestimate the risk for the fresh groundwater reserves: 25% of the solutes are transported though 6% of the soil's cross-section. The spatial distribution of drainage and solute leaching varied little during the experiment. Consequently, the mass flux density pattern of the bromide pulse was comparable to that of the repeatedly applied chloride. However, the MCS data suggested lateral 'escape' from chloride to non-mobile areas, which means in the long run, considerable quantities of these solutes can build up in areas that do not receive irrigation water.

Aim: To demonstrate the surgical treatment validity and the post-operative complication decrease., Material of Study: Seventythree women who underwent P.O.P.S. + S.T.A.R.R. treatment, follow-up one year., Results: We observed an important reduction or a completely disappearance about pre-operative signs and symptoms., Discussion: We are aware that the proposed technique, if taken into account by urogynecologists, will raise several arguments and will raise many doubts and perplexities. For this reason we wanted develop a follow-up sufficiently long and many case studies with data to support our claims., Conclusions: We believe that the procedure proposed by us, given the results, was excellent in patients with multiorgan pelvic prolapse, especially with the vagina walls elongated and that retain a good trophism.

Several studies have demonstrated the clinical and technical benefits of the laparoscopic surgery for complicated and uncomplicated appendicitis. Our retrospective study included 12 patient who underwent SILS appendectomy (SILS-A), 14 who received conventional laparoscopic surgery (VL-A), and 12 who received laparotomic appendectomy (OA); performed in all cases by the same surgeon (C.F.). The aim of this study was the comparison between this three different surgical techniques on same features: post operative leukocytosis, post operative pain, need abdominal drainage, esthetic viewpoint, incidence of complication, hospital stay. The results showed no significant differences between SILS-A and VLS-A, while an evident improvement shows versus O-A, even though not statistically significative. SILS was more effective in decreasing the risk of postoperative wound infection.