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Background: Patients with anorectal malformation (ARM) need long-term follow-up, in order to evaluate fecal continence; the main predictors of longer-term success are the type of ARM, associated anomalies and sacral integrity. Three-Dimensional High Resolution Anorectal Manometry (3D-HRAM) gives detailed information on pressure on the anal complex profile. Our objective was to analyze anal sphincter activity in ARM patients with 3D-HRAM establishing the correlation between manometric and clinical data. Methods: Forty ARM patients were submitted to 3D-HRAM: manometric, anatomical and clinical scores were correlated with each other and with the bowel management response (BM). Results: A positive correlation between all scores and types of ARM was found: in high ARM and in patients with spinal anomalies (regardless to ARM type) lower scores were reported and even after BM they did not achieve good continence. Conclusions: 3D-HRAM gives detailed data on the functional activity of the anal sphincter complex. Our study revealed a correlation between manometric parameters and clinical outcomes, confirming spinal malformations and ARM type as the most important prognostic risk factors for a bad outcome. Specific sphincteric defects can also be explored with manometry, allowing for tailored bowel management strategies.

The neuroendocrine carcinoma is defined as a high-grade malignant neuroendocrine neoplasm arising from enterochromaffin cells, usually disposed in the mucosa of gastric and respiratory tracts. The localization in the gallbladder is rare. Knowledge of these gallbladder tumors is limited and based on isolated case reports. We describe a case of an incidental finding of small cell neuroendocrine carcinoma of the gallbladder, observed after cholecystectomy for cholelithiasis, in a 55-year-old female, who already underwent quadrantectomy and sentinel lymph-node biopsy for breast cancer. The patient underwent radiotherapy for breast cancer and six cycles of chemotherapy with cisplatin and etoposide. Eighteen months after surgery, the patient was free from disease. Small cell neuroendocrine carcinoma of the gallbladder has poor prognosis. Because of the rarity of the reported cases, specific prognostic factors have not been identified. The coexistence of small cell neuroendocrine carcinoma of the gallbladder with another malignancy has been reported only once. The contemporary presence of the two neoplasms could reflect that bioactive agents secreted by carcinoid can promote phenotypic changes in susceptible cells and induce neoplastic transformation.

Il cambiamento climatico è stato riconosciuto come il problema globale, i cui effetti nel corso di questo secolo, potrebbero avere impatti catastrofici sul benessere e la salute umana. Le città subiscono gli effetti del climatico ma concorrono anche a determinarlo a causa degli eccessivi consumi energetici e di stili di vita poco sostenibili. Esse sono quindi chiamate ad affrontare la nuova sfida e a svolgere un ruolo significativo nell individuazione di politiche e strategie innovative che assicurino la sostenibilità e il ripensamento alla gestione e alla pianificazione urbana, al fine di aumentare la loro capacità di adattarsi ai cambiamenti in corso. Nuovi assetti urbani e territoriali, edifici e infrastrutture a basso consumo di energia, infrastrutture verdi e l adozione di tecnologie avanzate, favoriscono l adattamento al cambiamento climatico. La tesi indaga sul ruolo degli spazi verdi e la loro messa in rete, nel raggiungimento della qualità ambientale alla scala urbana, in particolare esplora le dinamiche connesse alla relazione tra le Infrastrutture Verdi e il comfort climatico all interno delle città, cercando di favorirne il riconoscimento e ruolo di componente essenziale, nel processo di pianificazione, nelle politiche di mitigazione e adattamento ai cambiamenti climatici e nei piani di investimento della città. Dall esame dei casi più rappresentativi, di applicazione di Infrastrutture Verdi nel mondo e dall esplorazione delle opportunità alla scala locale, si propongono azioni e strategie mirate ad incrementare l utilizzo delle nuove tecnologie verdi, nella lotta ai cambiamenti ambientali in atto, non trascurando quando ancora utilizzabile dei saperi verdi tradizionali che in passato hanno garantito stili di vita e confort ambientali tuttora validi.

Purpose An accurate diagnosis of acute appendicitis is important to avoid severe outcome or unnecessary surgery but management is controversial. The aim of study was to evaluate, in younger and older children, the efficacy of conservative management for uncomplicated appendicitis and the outcome of complicated forms underwent early surgery. Methods Children with acute appendicitis were investigated by clinical, laboratory variables and abdominal ultrasound and divided in two groups: complicated and uncomplicated. Complicated appendicitis underwent early surgery; uncomplicated appendicitis started conservative treatment with antibiotic. If in the next 24–48 h it was worsening, the conservative approach failed and patients underwent late surgery. Results A total of 362 pediatric patients were included. One hundred sixty-five underwent early appendectomy; 197 patients were at first treated conservatively: of these, 82 were operated within 24–48 h for failure. The total percentage of operated patients was 68.2%. An elevated association was found between surgery and ultrasound. Conclusions Conservative treatment for uncomplicated appendicitis had high percentage of success (58%). Complications in operated patients were infrequent. Our protocol was effective in order to decide which patients treat early surgically and which conservatively; specific red flags (age and onset) can identified patients at most risk of complications or conservative failure. Type of study: treatment study. Level of evidence II.