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Introduction. Intersigmoid hernia is a hernia of the small bowel into the intersigmoid fossa. It is well known to be a rare condition. Recent reports reveal that the preoperative differentiation of intersigmoid hernias is difficult and the diagnosis is often confirmed during the laparotomic exploration. Due to the vague clinical manifestation in most cases, the surgical treatment is frequently delayed. Materials and Methods. In this study, we systematically reviewed the literature up to 2019 covering 114 studies and 124 patients with an intersigmoid hernia. The purpose of this work is to improve the understanding of the anatomical aspects, clinical presentation, diagnosis, and treatment of intersigmoid hernia so as to assist the preoperative differentiation of these hernias when presented as acute abdomen in the emergency department. Results. The diameter of the intersigmoid recess was reported with mean 2.65 cm (range 1–10 cm, SD 1.15 cm) and the length of the incarcerated small intestine was between 3 cm (min) and 150 cm (max): mean 25.25 cm, SD 35.04 cm. The diameter of the sigmoid recess was greater in patients who underwent resection due to strangulation (mean 3.31 cm, SD 1.53 cm) compared to those who underwent only reduction of the hernia (mean 2.35 cm, SD 0.74 cm). The time from onset to operation was less in patients undergoing resection surgery due to throttling (mean 3.03 days, SD 3.01 days) compared to those who underwent only a reduction of hernia incarceration (mean 8.49 days, SD 6.83 days). Conclusion. Intersigmoid hernia is often a forgotten diagnosis and a clinical challange due to its anatomical characteristics.

[cat] Aquesta tesi es proposa analitzar com un projecte de lectura compartida i dialogada amb la participació d'infants i de les seves famílies pot afavorir el procés d’interpretació del text i l’aprenentatge de la lectura en contextos plurilingües i interculturals. Per aconseguir-ho hem dissenyat el projecte anomenat “Contes en família” i l’hem dut a terme en el context d’una escola de la ciutat de Barcelona amb infants de llengües i cultures diverses. Partint de la concepció de la lectura com a pràctica social i afectiva, arrelada a un context històric i cultural específic, hem volgut observar de quina manera la presència costant de les llengües familiars durant l’experiència lectora, així com l’obertura a les pràctiques familiars dels participants, poden facilitar la interpretació dels textos i nodrir l’interès per llegir. Així, a partir dels conceptes de literacitats situades i plurals, ens hem preguntat com les literacitats familiars poden esdevenir “instruments” que contribueixin a la construcció d’un tercer espai; espai que veiem en costant construcció i que es situa entre l’espai oficial de l’escola i els espais no oficials dels alumnes. Amb un enfocament metodològic qualitatiu, etnogràfic i d’estudi de casos -de tres alumnes i les seves famílies- hem desenvolupat directament les sessions del projecte “Contes en família”, hem realitzat entrevistes amb els familiars i els mestres dels infants participants, les hem enregistrat, després transcrit, i finalment a través de l’anàlisi del discurs hem interpretat les dades per donar resposta a les preguntes plantejades. Els resultats obtinguts ens porten a remarcar la importància de l’aprenentatge de la lectura com a procés mediat cognitivament, afectivament i lingüísticament. Seguint la proposta de lectura transaccional i interactiva elaborada per Terwagne, Vanhulle, i Lafontaine (2003), hem pogut comprovar la importància de la presència d’un dinamitzador que exemplifica les estratègies d’interpretació i d’interacció, per tal que els alumnes les interioritzin gradualment i les facin servir en les discussions amb els seus companys. Els resultats també mostren que la presència i col·laboració dels pares en el procés de lectura suporten la motivació a la lectura per part dels nens; en particular, hem pogut observar com la proximitat física, la mirada atenta i el diàleg constant, sobretot amb els propis familiars, proporcionen un suport emocional a la perezhivanie (Vygotsky) dels infants que sosté el procés lector. Des del punt de vista lingüístic, hem observat que l’ús del llenguatge híbrid fa que hi hagi un accés permanent als recursos lingüístics, culturals i cognitius dels altres. D’aquesta manera l’ús de les llengües, i en general de totes les literacitats locals dels alumnes, es revelen com a instruments de mediació per a la construcció del coneixement, alhora que faciliten l’apropiació del discurs de l’escola que és necessari per al progrés escolar. Així, l’experiència de lectura compartida i dialogada amb la participació de la família promou la pràctica de la mediació i de la hibridació que, al seu torn, afavoreixen el procés lector. Els resultats també mostren de quina manera el fet d’ampliar el model convencional de relacions entre escola i família, com ara oferint un espai de lectura compartida, pot incidir en part sobre la participació dels pares a l’escola. Es fa evident la necessitat per part del pares de comprendre el funcionament d’un sistema escolar que no els és familiar; i per part de l’escola la necessitat d’obertura a les famílies per comprendre i incloure les seves literacitats., [eng] The aim of this work is to analyse how a shared reading project with the participation of children and their families can favour learning to read in multilingual and intercultural contexts. To achieve this purpose, we have designed the project "Contes en família" and we have carried it out in the context of a school in Barcelona with children of different languages and cultures. Starting from the conception of reading as a social and emotional practice, rooted in a specific historical and cultural context, we wanted to observe how the constant presence of family literacies during the reading experience can facilitate the interpretation of the texts and nurture the interest to read. Thus, from the concepts of situated and plural family literacies, we have asked ourselves how family literacies can become "instruments" that contribute to the construction of a third space; a space that we see as in constant construction and that is situated between the official space of the school and the unofficial spaces (environments) of the students. Under a qualitative, ethnographic methodological and case study approach -three students and their families- we have directly developed the sessions of the "Contes en família" project; interviewing the relatives and teachers of the participating children, recording the sessions and transcribing them, and lastly answering the questions posed through discourse analysis and interpretation of the data. The results obtained emphasize the importance of learning to read as a cognitive, emotional and linguistically mediated process. We have been able to verify the importance of the presence of a facilitator who exemplifies the strategies of interpretation and interaction. The results also show that the presence and collaboration of parents in the reading process provide an emotional support to children that sustains the reading process. From a linguistic point of view, we have observed that the use of hybrid language (and the local literacies of the students in general), is an important instruments of mediation for the construction of knowledge; at the same time it facilitates the appropriation of the school’s discourse which is necessary for the school progress. The results also show how broadening the conventional model of school-family relationships, such as offering a shared reading space, may have an impact on parental involvement in school.

Gastric cancer constitutes a major health problem. Robotic surgery has been progressively developed in this field. Although the feasibility of robotic procedures has been demonstrated, there are unresolved aspects being debated, including the reproducibility of intracorporeal in place of extracorporeal anastomosis. Difficulties of traditional laparoscopy have been described and there are well-known advantages of robotic systems, but few articles in literature describe a full robotic execution of the reconstructive phase while others do not give a thorough explanation how this phase was run. A new reconstructive approach, not yet described in literature, was recently adopted at our Center. Robotic total gastrectomy with D2 lymphadenectomy and a so-called “double-loop” reconstruction method with intracorporeal robot-sewn anastomosis (Parisi's technique) was performed in all reported cases. Preoperative, intraoperative, and postoperative data were collected and a technical note was documented. All tumors were located at the upper third of the stomach, and no conversions or intraoperative complications occurred. Histopathological analysis showed R0 resection obtained in all specimens. Hospital stay was regular in all patients and discharge was recommended starting from the 4th postoperative day. No major postoperative complications or reoperations occurred. Reconstruction of the digestive tract after total gastrectomy is one of the main areas of surgical research in the treatment of gastric cancer and in the field of minimally invasive surgery. The double-loop method is a valid simplification of the traditional technique of construction of the Roux-limb that could increase the feasibility and safety in performing a full hand-sewn intracorporeal reconstruction and it appears to fit the characteristics of the robotic system thus obtaining excellent postoperative clinical outcomes.

Introduction: The goal of non-operative management (NOM) for blunt splenic trauma (BST) is to preserve the spleen. The advantages of NOM for minor splenic trauma have been extensively reported, whereas its value for the more severe splenic injuries is still debated. The aim of this systematic review was to evaluate the available published evidence on NOM in patients with splenic trauma and to compare it with the operative management (OM) in terms of mortality, morbidity and duration of hospital stay. Methods: For this systematic review we followed the “Preferred Reporting Items for Systematic Reviews and Meta-analyses” statement. A systematic search was performed on PubMed for studies published from January 2000 to December 2011, without language restrictions, which compared NOM vs. OM for splenic trauma injuries and which at least 10 patients with BST. Results: We identified 21 non randomized studies: 1 Clinical Controlled Trial and 20 retrospective cohort studies analyzing a total of 16,940 patients with BST. NOM represents the gold standard treatment for minor splenic trauma and is associated with decreased mortality in severe splenic trauma (4.78% vs. 13.5% in NOM and OM, respectively), according to the literature. Of note, in BST treated operatively, concurrent injuries accounted for the higher mortality. In addition, it was not possible to determine post-treatment morbidity in major splenic trauma. The definition of hemodynamic stability varied greatly in the literature depending on the surgeon and the trauma team, representing a further bias. Moreover, data on the remaining analyzed outcomes (hospital stay, number of blood transfusions, abdominal abscesses, overwhelming post-splenectomy infection) were not reported in all included studies or were not comparable, precluding the possibility to perform a meaningful cumulative analysis and comparison. Conclusions: NOM of BST, preserving the spleen, is the treatment of choice for the American Association for the Surgery of Trauma grades I and II. Conclusions are more difficult to outline for higher grades of splenic injury, because of the substantial heterogeneity of expertise among different hospitals, and potentially inappropriate comparison groups.

Enterovesical fistula is a rare disease. The standard treatment of colovesical fistula is removal of the fistula, suture of the bladder wall, and colic resection with or without temporary colostomy. The usual approach is open because the laparoscopic one has high conversion rates and morbidity. We report the first laparoscopic conservative treatment of colovesical fistula in our knowledge and its long-term results. A 69-year-old man was affected by colovesical fistula due to endoscopic exeresis of a 2 cm adenomatous polyp in the sigmoid diverticulum. We performed a laparoscopic conservative treatment of the fistula without colic resection. Operative time was 210 min and estimated blood loss was 300 ml. The catheter was removed after 10 days. Time to first flatus was 2 days and the hospital stay was 8 days. No peri- or post-operative complications occurred. At 48-month follow-up fistula did not recur. Laparoscopic conservative surgery for colovesical fistula is safe and feasible. It could be a therapeutic option in selected cases, especially if diverticular disease and inflammation are slight.