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Purpose The initial hypothesis of the exploratory paper lies in the fact that there exists a demand for healthier wines due to the higher presence of natural compound which potentially bring benefits to the consumer’s health. To satisfy this hypothesis, the research questions that paper tried to answer are the following: Do there exist a demand for naturally resveratrol-enhanced wine? What variables do influence the preference of consumers toward a naturally resveratrol-enhanced wine? As a consequence, the purpose of this paper is to explore what variables naturally influence resveratrol-enhanced wine consumption. Design/methodology/approach A structured questionnaire was administered through face-to-face interviews to a sample of 250 regular wine consumers which were randomly selected to achieve balanced socio-demographic characteristics. Subsequently, an econometric analysis was performed to estimate the effects that selected attributes, extrapolated from the literature, have on resveratrol-enriched wine consumption. With this aim, a logistic regression model was developed through the assessment of willingness to consume naturally resveratrol-enhanced wine. Findings The findings of this paper suggest that respondents consider wine as source of beneficial and healthy properties and they are willing to consume enriched-resveratrol wine. The study found a direct correlation between resveratrol and wine extrinsic attributes (organic label, brand) as well as any intrinsic attributes (tannins content). In addition, solely female consumers expressed to consider label information in their preference for resveratrol-enhanced wine. Among socio-demographic factors, only age and gender have an interaction effect on the consumption of these wines. Research limitations/implications Since this study has some limitations due to the limited number of observations and to the specific regional geographical context, the findings should be generalized in theoretical terms with a certain caution. Before to extend the results to all Italian consumers, future research should test the robustness of the findings by assessing the effect of the attributes that the authors have examined in this study in other environmental contexts, e.g. in other wine regions. Practical implications The results have important implications for wine producers, since the adoption of production practices explicitly related to the higher natural content of resveratrol can lead to a value augmentation and enhance business income of companies. Moreover, there exists implication also for wine managers, given the knowledge of factors affecting consumers’ attitudes toward naturally resveratrol-enhanced wines can lead to an increase in wine demand that should allow to reach a focused differentiation strategy in specified market segments. This suggests the need to indicate on the label the content of resveratrol as a distinctive signal of the “additional health information” of a wine. Originality/value While a substantial body of research has analyzed the healthy attributes that affect purchasing process of wine, no other known study has examined the effects of attributes on consumers’ willingness to purchase naturally resveratrol-enhanced wine. The study is the first that explores the consumers’ willingness to buy wine naturally enriched with resveratrol. Previous works took into account only resveratrol-enriched wines. The authors believe that in the eye of consumers there are significant differences between a natural enhancement and a simply technological enrichment, since the concepts and the technological aspects behind the two processes are strongly different. To fill this gap, the authors explored for the first time what variables can influence the preference of a naturally resveratrol-enhanced wine.

This study researches a novel advanced joining technique, utilizing metal additive manufacturing, named μPinning. μPins are small pin-like structures manufactured on a metal substrate and used to penetrate and be consolidated inside a fibre-reinforced polymer (FRP) laminate as through-the-thickness reinforcement during curing (Ucsnik et al. in Composite to composite joint with lightweight metal reinforcement for enhanced damage tolerance. ECCM16—16th European Conference on Composite Materials, Seville, Spain, 2014, Parkes et al. in Compos Struct 118:250–256, 2014). Prior studies have shown a significant increase in the load bearing capabilities of the joint [1, 2], as well as greater performance in dynamic and fatigue loads (Graham et al. in Compos Part A 64:11–24, 2014, Chang et al. in Compos Sci Technol 66(13):2163–2176, 2006, Ko et al. in Compos Struct 119:59–66, 2015]. The main objective of this research is to use numerical optimization tool to optimize the shape of a μPin, as studies have shown that the shape of the μPin exhibits a significant role in the mechanical response [1, 2, 5, 7]. After the numerical optimization, experimental testing was performed to validate the assumption of the importance of the μPin shape in the joint loading response. Finally, this study aims to lead to future research on the design of metal inserts in sandwich structures and struts for use in space applications.

The studies on gender differences in food consumption have experienced a deep and remarkable development from several perspectives. Many studies have been addressed to highlight whether differences exist among males and females in purchasing behaviors or consumption for specific food products but no study pizza consumption segmented by gender has been carried out. This study evaluates gender differences in the consumption of traditional Italian pizza. For this purpose, a quantitative study was conducted on a representative sample of Sicilian pizza consumers. Our findings showed that there exist any gender differences in pizza consumption that appear to be strongly related to preferences for sensory attributes such as "smell", "appearance", "crunchiness" as well for "price". Our findings show that gender differences can significantly influence the buying process of this traditional Italian food, and they have important implications for the food industry since gender differences should be taken into account in new formulation and characterization of pizza.

Pizza is eaten all over the world because of its simplicity and taste. Given its importance in the Italian diet, this paper provides a qualitative insight into fresh pizza consumption for the first time. This study deals with the perception of pizza attributes in Italy focusing on the main drivers of consumer acceptance of the traditional Margherita pizza, and analyzing in addition consumers’ preferences for novel types of pizza in the marketplace, such as those made with organic, low calorie or frozen ingredients. The results show how respondents firstly prefer to eat traditional pizza and mainly prefer organic ingredients leading Italian consumers to perceive them more positively than conventional ones. Furthermore, despite the frozen pizza market being fairly well-established in many countries, the study finds a strong propensity to buying fresh pizza in the traditional market. The role of low calorie pizzas appears to be limited despite consumers being quite interested in this type of product. The novelty of this paper is to fill the knowledge gap about new typologies of pizza available in the marketplace, by exploring consumer preferences for and perceptions of a traditionally made product in a traditional producer country. The study will also offer managerial-oriented implications to help pizza producers develop new strategies for better identifying the ongoing demand of pizza consumers both for traditional and new typologies.

The atmospheric re‐entry domain is a cornerstone of a wide range of space applications, ranging from reusable launcher stages developments, robotic planetary exploration, human space flight, to innovative applications such as reusable research platforms for in orbit validation of multiple space applications technologies. The Intermediate experimental Vehicle (IXV) is an advanced demonstrator which has performed in-flight experimentation of atmospheric re-entry enabling systems and technologies aspects, with significant advancements on Europe's previous flight experiences, consolidating Europe's autonomous position in the strategic field of atmospheric re-entry. The IXV mission objectives were the design, development, manufacturing, assembling and on-ground to in-flight verification of an autonomous European lifting and aerodynamically controlled reentry system, integrating critical re-entry technologies at system level. Among such critical technologies of interest, special attention was paid to aerodynamic and aerothermodynamics experimentation, including advanced instrumentation for aerothermodynamics phenomena investigations, thermal protections and hot-structures, guidance, navigation and flight control through combined jets and aerodynamic surfaces (i.e. flaps), in particular focusing on the technologies integration at system level for flight, successfully performed on February 11th, 2015.

Aim Lateral internal sphincterotomy is considered the surgical treatment of choice for chronic anal fissure after failure of medical therapy but it risks continence. The aim of the study was to evaluate fissurectomy with advancement flap for anterior chronic anal fissure (CAAF) resistant to medical therapy. Method Sixteen women with CAAF without hypertonia of the internal anal sphincter, unresponsive to previous medical treatment, were included in the study. Absence of hypertonia was defined as a maximum anal resting pressure (MRP) of less than 85 mmHg. All patients underwent fissurectomy with an advancement skin flap. Results Complete healing occurred in all patients within 30 days. The intensity and the duration of pain after defecation reduced from the first postoperative defecation. MRP before surgery and at 6 months showed no significant difference. At 1 month, four patients experienced a continence disturbance, two of whom had it preoperatively. At 12 months, two (12.5%) patients continued to experience a continence disturbance. Conclusion Fissurectomy with skin advancement flap resulted in complete healing and full relief of symptoms in all patients. There was a low incidence of continence disturbance.

Background Thrombosed external haemorrhoids are one of the most frequent anorectal emergencies. They are associated with swelling and intense pain. Internal sphincter hypertonicity plays a role in the aetiology of the pain. This study evaluated the efficacy and safety of an intrasphincteric injection of botulinum toxin for pain relief in patients with thrombosed external haemorrhoids. Methods Thirty patients with thrombosed external haemorrhoids who refused surgical operation were randomized into two groups. Patients received an intrasphincteric injection of either 0·6 ml saline or 0·6 ml of a solution containing 30 units botulinum toxin. Anorectal manometry was performed before treatment and 5 days afterwards. Results After 5 days of treatment, the maximum resting pressure fell in both groups, but was significantly lower in the botulinum toxin group (P = 0·004). Pain intensity was significantly reduced within 24 h of botulinum toxin treatment (P < 0·001), but only after 1 week in the placebo group (P = 0·019). Conclusion A single injection of botulinum toxin into the anal sphincter seems to be effective in rapidly controlling the pain associated with thrombosed external haemorrhoids, and could represent an effective conservative treatment for this condition. Registration number: NCT00717782 (http://www.clinicaltrials.gov).

Over the past decade, hernia surgery has undergone a considerable transformation with the use of prosthetic materials. The most used polypropylene meshes induce a rapid acute inflammatory response followed by chronic foreign body reaction. Many factors influence this response such as density, size, physical characteristics, different texture and porosity of each biomaterial. The aim of this study is to assess whether the implant of monofilament or multifilament meshes, in the inguinal hernioplasty, determine a different inflammatory response. Thirty-two male patients were included in the study and were randomly divided into two groups. In the first group (MO) inguinal hernioplasty was performed using monofilament polypropylene mesh, while in the second one (MU) multifilament prosthesis was used. Peripheral venous blood samples were collected 24 hours before surgery and then 6,24,48 and 168 hours posto-peratively. Modifications in leukocyte count, C-reactive protein (CRP), alpha-1 antitrypsin (α1-AT), interleukin (IL)-1, IL-6, IL-1 ra and IL-10 serum levels were recorded at all sampling times. We present evidence that serum levels of CRP, (α1-AT), leukocytes and cytokines were significantly increased post-operatively in both groups, returning to basal values 168 hours afterwards. In particular, the production of all pro-inflammatory mediators was higher in the MU group, whereas the anti-inflammatory cytokine (IL-10, IL-1ra) production was higher in MO patients. Our results indicate that polypropylene multifilament mesh allows a higher intense acute inflammatory response as compared to monofilament mesh implantation.

A case of bilateral testicular lymphoma with involvement of skin and oropharynx was described. After a review of literature, the Authors underline the clinical features focusing the diagnostic approaches and the therapeutics options.

The role of innate immune response mediated by Toll-like receptors in HCV infection, is not yet well understood and there is a lack of data regarding liver tissue expression of these molecules in chronic hepatitis C (CHC). Our study is aimed to investigate ex vivo, liver expression of TLR2, TLR3 and TLR7, which are more involved in the immune-pathogenesis of CHC, and to explore possible correlations with features of disease. We obtained liver biopsies and collected peripheral blood mononuclear cells (PBMC) from 23 consecutive patients with CHC and from 6 patients of control, without liver disease, undergoing surgery for cholecystectomy. The levels of TLRs mRNA in the samples were determined using a real-time reverse transcription quantitative PCR (RT-qPCR). We found a significant high expression of TLR3 in the liver of CHC patients respect to controls (also higher than expression in the PBMC). Conversely no differences emerged in the TLR2 and TLR7 levels between cases and controls. Also we found a correlation of TLR2 and TLR7 levels with the grade of necro-inflammation in the liver. Furthermore TLR7 hepatic levels resulted related to a more advanced stage of liver fibrosis. Ours is the first study to provide data on tissue expression of TLRs during chronic hepatitis C and we believe that it could lead to a better understanding of the role of these molecules in the HCV-mediated liver damage.

The fabrication of composites is still based mainly on a trial and error procedure, because numerical simulation has not yet been applied to the development of control systems, which can correlate the main parameter values of the processes with the processing behavior and the final properties of the component. Understanding of this processing- structure- properties relationship and its implementation in industrial manufacturing procedures is the starting point to guarantee the high quality and reliability required for mass production. The aim of this work is to present some recent developments of the mathematical models that allow us to simulate the most important phenomena occurring during composites processing such as filament winding and RTM. In fact a real flexibility of production can be achieved by means of analytical models and correlated simulation software packages. This approach enables us to diversify the composite products economically and in a short time. Modelling a technological pr...

BACKGROUND: In patients affected by anterior chronic anal fissure (CAAF) with hypertonia of the internal anal sphincter (IAS), the role of IAS hypertonia remains unclear. The aim of this study was to evaluate the efficacy of fissurectomy combined with advancement flap and IAS injection of botulinum toxin in healing the CAAF with hypertonia of IAS resistant to medical therapy. METHODS: Ten consecutive patients were enrolled. Anorectal manometry was performed preoperatively and at 6 months. CAAF with hypertonia was defined as those associated with maximum resting pressure (MRP) values higher than 85 mmHg. All patients underwent fissurectomy and anoplasty with advancement skin flap combined with the intrasphincter injection of 30 UI of botulinum toxin. Complete healing, MRP changes, relief of symptoms and immediate and long-term complications were recorded. RESULTS: Complete healing was observed in all patients within 30 days of the operation. The intensity and duration of pain post-defecation was reduced significantly starting from the first defecation. In all subjects, the preoperative MRP values were significantly reduced at 6 months. One month after surgery, three patients reported anal incontinence, two of them had complained preoperatively. The only postoperative complications were minor. CONCLUSIONS: Fissurectomy combined with advancement flap and intrasphincter injection of botulinum toxin results in complete healing, significant MRP reduction and full relief of symptom in all patients, thus it represents a valid procedure in preventing the occurrence of anal incontinence.

An organized network of mullite anisotropic crystals embedded in a silico-aluminate matrix material is obtained at interfaces of sintered alternate layers of muscovite and kaolinite minerals. The nucleation and growth of mullite anisotropic crystals occur preferentially along the muscovite basal planes through topotactic reaction with the high temperature form of muscovite. Simultaneously to structural transformations, dehydroxylation of muscovite induces an exfoliation process, which is temperature and time dependent. The kinetics of this process was controlled using an appropriate thermal cycle and uniaxial load. During sintering, the control of mullite size mainly depends in temperature and the addition of a small quantity of low-temperature liquid phase also favors the growth of mullite. But liquid induces the weakening of the organization degree of the mullite network. Quantitative texture analysis (QTA) and SEM were used to characterize microstructural characteristics. Flexural strength, Young modulus and fracture toughness are closely related to size and organization degree of the mullite network. In general, mullite length favors the increase of strength and fracture toughness. But a high organization degree of the mullite network favors the occurrence of interconnected crystals and increases mechanical properties.

The technique of particle tracking with scintillating fibres is described and its application to the study of short-lived particles is illustrated using results obtained in the WA84 experiment at CERN.

Pilonidal sinus (PS) disease of the sacrococcigeal region is an acquired condition resulting from penetration of shed hair shafts through the skin. Different types of operations have been described in the letterature. More recently fibrin glue has been used with succesfull. Aim of this study was to assess the effectiveness of fibrin glue for the treatment of pilonidal sinus.Eight patients age ranged 21,8 +/- 6,5 affected by PS disease of sacrococcigeal region were included in this study. All patients undergoing surgical operation under local anaesthesia. Following administration of 1% methylene blue through the main opening, a small vertical elliptical incision is maked including the entire sinus opening and an excision of PS was performed without entering the sinus cavity, removing a minimal amount of subcutaneous tissue. Afterwards the highly concentrated fibrin glue, containing 1,000 U/ml of thrombin was applied to cover the wound. Post-operative pain, analgesic consumption, duration of hospital stay, failure healing, the rate and time of recurrence, time to healing, time to return to work and post-operative complications were recordered.All patients expressed satisfaction with the procedure. Mean hospital stay was 5.4 +/- 2.1 hours. Healing was achieved after 25.8 +/- 13.2 days. The post-operative pain mean score was 3.8 +/- 2.1 in first day, 2,9 +/- 1,8 in third day and 1,3 +/- 0,8 in the seventh day. The mean analgesic consumption per week was 5,6 +/- 3,2 medications. Mean time to return to work was 5,3 +/- 2,1 days.The minimal excision of PS and application of fibrin glue is a non-invasive effective treatment, easy and simple to performe and not associated to recurrences. For these reasons this procedure in our opinion as the first line treatment for pilonidal sinus disease.

Cytokines are part of a family of molecules involved in the initiation, control and termination of the events that occurs in wound healing process. Aim of this study was to evaluate the production of some cytokines [interleukin (IL)-6, IL-10, IL-1alpha, IL-1ra, interferon (IFN)-gamma] in the drainage wound fluid from patients undergoing incisional hernia repair.Ten female patients with abdominal midline incisional hernia undergoing to surgical repair were included in this study. In all cases a closed suction drain was placed in the wound below the fascia and it was removed on the 4th postoperative day. Wound fluid was collected on the 1st, 2nd, 3rd and 4th day and its amount in each time was recorded. The production of IL-6, IL-10, IL-1alpha, IL-1ra and IFN-gamma were evaluated as quantity produced in 24 hour.In all patients the amount of drain fluid from surgical wound was highest on the 1st day after surgery, afterwards there is a significant reduction. The production of all cytokines evaluated was highest on the 1st day decreasing on the 2nd day except for IL-1alpha that not show any modification. The produciton of IL-1ra, IL-6, IL-1alpha and IL-10 was significantly reduced on the 3rd and 4th postoperative day in comparison with the respectively values recorded on the 1st day, whereas IFN-gamma levels were similar.The dosage of cytokines in the drain fluid led us to better evaluated the events that follow surgical wound and their analysis offers further information in the role of cytokines in healing process, with the goal to get supportive treatments to promote the best evolution.

Postoperative pain associated with Milligan Morgan haemorrhoidectomy (MMH) remains problematic. Most patients complaint a severe pain on defecation and in the 1st postoperative week because of secondary infection and sphincter spasm. We studied the effect of metronidazole, lactulose and glyceryl-trinitrate on pain after MMH.Thirty patients were randomly assigned to two groups. The 1st received a treatment with oral laxative (lactulose 66.7%) metronidazole and a topical glyceryl-trinitrate ointment at 0.2% both pre and postoperative; the 2nd received a placebo at the same dosage. The amount of pain in the 1st week and at the time of two defecation, postoperative analgesic requirement and time to return to normal activities were documented.A significant differences in the score pain on 2nd and 3rd day and on the 1st two defecation were observed among group. Analgesic consumption was highest in the placebo group.The treatment with lactulose, metronidazole and topic glyceryl-trinitrate in patients undergoing MMH, seems to reduce secondary pain and increase patients satisfaction and earlier return to work with improvement of cost and benefit.

Abdominal cystic lymphangiomas are a rare pathology that are related to abnormal development of the lymphatic system. They predominate in a children and are very uncommon in adults. Here the authors report a case of a cystic intra-abdominal lymphangioma in a 64-years old woman in which the cyst was situated in the mesentery of the jejuneum, with rapid growth. Ultrasonography, computed tomography and magnetic resonance imaging led us to evaluate a cystic characterizations and his site. Surgical excision remain the treatment of choice because we can establish an histologic diagnosis. Complete surgical excision of cyst, although it can be difficult, consent a definitive healing.

Free perforation in abdominal cavity in patients with Crohn's disease is a rare entity as attested from the data reported in the literature. It is a very dangerous event and requires a surgical urgency management. The Authors reported two cases of free perforation, in patients with Crohn' disease, undergoing surgical operation in urgency. Analyzing pathogenesis, difficulty in diagnosis making and therapeutic choices, they underline that CT is very useful in the diagnosis, while resection of the perforated intestinal tract represent the best surgical treatment.

Internal abdominal hernias are a rare entity and may cause unexplained abdominal pain. This report concerns a 46 year old male patient, with a four year history of episodic colicky peristaltic abdominal pains, in whom a left paraduodenal hernia was found at surgical exploration after a negative diagnostic screening by ultrasound, CT and small bowel enema. Upon laparotomy the Authors found a left-sided paraduodenal hernia with an empty herniated sack. Repair of the hernial defect resulted in the complete and stable resolution of abdominal symptoms. The importance of considering paraduodenal hernias in the differential diagnosis of unexplained intermittent abdominal pain is discussed.

Milligan-Morgan haemorrhoidectomy is considered the best treatment for hemorrhoidal disease. Although this, many patients complaint post-operative pain that remain the worse complication. For this reason different are the trials performed in order to reduce his intensity. In this report we want to evaluate if the use of ultrasonic scalpel to perform Milligan-Morgan hemorrhoidectomy, compared with conventional surgery, could reduce post-operative pain.30 patients with III and IV degree of haemorrhoids were included in this study and divided in two groups. In the first group Milligan-Morgan haemorrhoidectomy was performed with conventional instruments, while in the second group the some procedure was performed with ultrasonic scalpel. The duration of intervention, time hospitalization, the time to open alvus to stools, the time to return to normal activity, the complications, pain and the amount of analgesic consumption were evaluated.In the II group's patients, it was observed a reduced time to healing with reduced spread of necrosis and inflammatory pattern, associated with reduced post-operative pain and the lower analgesic consumption.The use of ultrasonic scalpel to perform Milligan-Morgan haemorrhoidectomy, compared with conventional instruments, reduce post-operative pain making a more short time to healing and a precocious time to return to normal activity. For this reason we believe that the use of ultrasonic scalpel, although a more elevated costs, seems to be advantageous.

A case of 28 years woman with nipple's leiomyoma we report. Only 38 cases are reported in the literature. This neoplasm presents a difficult differential diagnosis with the remaining flogistic and neoplasm breast and nipple disease.

The modifications of IL-6. CRP, ceruloplasmin, alpha 1 antitrypsin, fibrinogen, transferrin, albumin and leukocytes counts have been evaluated after traditional open cholecystectomy (OC) or laparoscopic cholecystectomy (LC). Forty-two patients were included in this study, 20 underwent to OC and 22 underwent to LC. Serum samples were performed before surgery and at distance of 6, 24, 48 and 168 hours. The results show a more significant increase in acute phase inflammatory response after OC compared with LC as attested by highest values of leukocytosis, IL-6, CRP, fibrinogen and alpha 1 antitrypsin and lower levels of albumin. In conclusion, after LC, the phase acute response is attenuate and it can explain the reduced period of convalescence of patients treated with LC.

The advantages of laparoscopic (LC versus, open cholecystectomy (OC) seems to be related to minimal invasive procedure and to the moderate inflammatory response. The aim of this study is to define the involvement of Th1 (IFN-gamma) and Th2 (IL-4, IL-6, IL-10, IL-13) cytokines production in vivo and in vitro in patients undergoing OC or LC. In 42 patients undergoing LC (n = 22) and OC (n = 20) Th1-like and Th2-like was evaluated before operation and at 6, 24 and 48 hours after operation for white blood cell counting and cytokines (IL-4, IL-6, IL-10, IL-13, IFN-gamma, TNF-alpha) in the sera and in the supernatants from circulating mononuclear cells stimulated with phytohemagglutinin or lipopolysaccharide. The acute phase response cytokine, IL-6, appeared significantly increased following OC than after LC. All other cytokines did not very significantly. In vitro data shows a reduction of IFN-gamma and increase in Th2-like cytokines in OC patients compared with the basal value. In LC subjects we observed an high production of IFN-gamma associated to an increase of Th2-like cytokines, like IL-10 and IL-13, even though IL-4 and IL-6 were unmodified. In contrast to OC, LC did not significantly affect immunocompetence, maintaining a moderate inflammatory response and an adequate balance between Th1 and Th2 cytokine. Furthermore, the strong activation of cells producing Th1-like cytokines in LC patients following mitogen activation indicated a consistent anti-microbial activity, that was not detectable in OC patients, that showed after activation only a Th2 response.

The authors report their experience about the endoscopic treatment of upper gastrointestinal bleeding from Dieulatoy's ulcer (non variceal bleeding).Report of 5 cases; evaluation of mortality and effectiveness of the treatment.Operative Unit of General and Thoracic Surgery, Department of Surgical, Anatomical and Oncological Disciplines. Policlinico, University of Palermo.EGDS + sclerotherapy (emergency room) in all 5 patients.80% successful (stop bleeding).Endoscopic sclerotherapy is choice treatment of upper gastrointestinal bleeding from Dieulafoy's ulcer, only in well experienced teams and rapidly.

Some cases of Ménétrier's disease associated with Helicobacter pylori (HP) have recently been reported in the literature. We report here the case of a 51-year-old man with a diagnosis of Ménétrier's disease who had previously been unsuccessfully treated with H(2) antagonists. A subsequent demonstration of HP infection led us to treat the patient with an eradicating therapy which prompted complete regression of clinical symptoms, resolution of the gastric endoscopic picture, and absence of HP on gastric histology. This result, in accordance with others in the literature, indicates an eventual association of HP infection with Ménétrier's disease and that consequent therapy is mandatory.

Inflammatory pseudotumor is rare benign lesion ad uncommon is a multiple localization of the liver and spleen. We report a case of inflammatory pseudotumor of the liver associated with an other lesion in the spleen, a 53-years-old ma in which we observed the evolution of clinical picture. Making the diagnosis is often difficult, despite the use of the modern imaging and laboratories techniques, and generally these masses often confuse with others lesions, such as primary or secondary neoplasm, because the clinical presentation and morphological appearance are often unspecific. The medical treatment seems to be more appropriate for patients when it is possible make a correct diagnosis with a biopsy of the lesion. In the other cases, the surgical procedure is the best treatment that must be supported by histologic examination.

Cell-mediated immunity (CMI) is temporarily decreased after major surgical procedures in relation to type of anaesthesia, length and severity of an intervention. In this study it has been evaluated CMI response in vivo, after laparoscopic (LC) and open cholecystectomy (OC). 5 healthy persons and 16 patients with symptomatic and uncomplicated gallstones were studied. They were subdivided in two groups: 8 were treated by OC, 8 by LC. A skin test system (Multitest, IMC-Institute Merieux, Lyon, France) consisting of a plastic disposable multiple-puncture device capable of simultaneous application of seven delayed-type hypersensitivity antigens and a glycerin and saline diluent (negative control) was used. The test was performed 48 hours before and 24 hours after the surgical procedure. A diameter of 2 mm or more of the induration was considered as a positive response. A score expressed, as the sum in millimeters of all the mean diameters (DM) of positive reactions and as numbers of antigens (NA) positive was calculated. Statistics was assessed by Student's t test for comparison of averages. There was no difference of age, sex, anesthesiologic risk, length of the operation between the two groups. We observed a significative reduction of DM (P0.05) and of NA (P0.05) in patients in which OC was performed while there were no significant in the group treated by LC. Results show a significant suppression of the CMI after OC, no particular changes after LC according to other studies in vitro.

Deep-vein thrombosis (DVT) and pulmonary embolism (PE) are the most important causes of morbility and mortality in patients submitted to surgical intervention: some peculiar factors of laparoscopic surgery can modify their risk. The aim of this study is to evaluate possible variations of the fibrinolytic system after cholecystectomy.Eighteen patients affected by symptomatic and non-complicated gallstones have been included in this study. They were divided into two groups of nine patients each: the first group was submitted to laparoscopic cholecystectomy (LC) and the second to open cholecystectomy (OC). Antitrombin III (ATIII), fibrinogen degradation products (FDP), tissue plasminogen activator (tPA), and plasminogen activator inhibitor (PAI) have been evaluated preoperatively and 6, 12, 24 and 48 hours after the operation.The levels of ATIII did not present significantly variations. The FDP in both groups were significantly increased 48 hours after open cholecystectomy. Levels of PAI instead were increased in comparison to the basal values at 6, 12, 24, 48 hours with p0.05; p0.01 and p0.05 respectively in patients submitted to OC, in the LC group no variations were observed; a comparison between the groups showed a significant modification (p0.05) only at the 12th hour.The early mobilization of patients in the postoperative course and the lower invasion of LC can oppose the prothrombotic effect in the lower limbs.

A 30 degrees reverse Trendelenburg position and the pneumoperitoneum performed in patients undergoing at Laparoscopic Cholecystectomy (LC) cause haemodynamic modifications in inferior cava vein and in femoral veins producing a venous stasis in lower limbs. So that activation of coagulation with hypercoagulability occurs. The aim of this study is to value the modification of the haemocoagulative and fibrinolytic factors during LC and OC. 18 patients with symptomatic and non complicated lithiasis were examined. They were divided in two groups, nine patients for each group. LC was performed in first group and OC in the other group. Prothrombin time (PT), plasma-activated partial thromboplastin time (PTT), Antithrombin III (AT III) fibrinogen degradation products (FDP) were valued before and at 6, 12, 24, 48 hours after operation. For the statistical analysis Student "t" for average comparison was used. There were no relevant alterations of PT, PTT and ATIII after operation in the two groups. FP was increased after surgery, especially at 24th-48th hours in the group in which OC (p0.05) was performed. FDP were increased in both groups but only at 24 and 48 hour after OC (p0.05) the result was significant. Earlier mobilization and reduced invasivity of laparoscopy could contrast thrombotic effects of the blood stasis in the lower limbs when 30 degrees-45 degrees reverse Trendelenburg and pneumoperitoneum are performed.

The authors report a case of agenesis of gallbladder associated with lithiasis of common bile duct. A review of the literature confirms the rarity of this congenital malformation. In 40-60% of cases it is associated with other gastrointestinal, skeletal, cardiovascular and genitourinary malformations. In 20-50% of cases it can be associated with common bile duct stones. Patients are asymptomatic in the majority of cases. A preoperative diagnosis is difficult despite of high accuracy of the modern diagnostic imaging techniques.

A case of intersigmoid hernia, personally observed is described, The various aspects of this pathology are examined and the imprecise clinical picture as well as the anatomical and diagnostic aspects and surgical techniques are underlined. The conclusion is drawn that a preoperative diagnosis is not easy and the importance of enteroclysma and TAC to prove the presence of hernia is underlined.

The authors have reported two laparocele cases in the place of insertion of the umbilical trocar, on 156 laparoscopic accesses made by them. Both cases took place at the beginning of their experience when the navel fascial breach had not yet been stitched. The authors made an extensive review of the medical literature and have found out that such complication is rare and to prevent it, it is right to stitch the navel fascial defect, being careful for not englobing the epiploon or an intestinal loop in the suture.

The Authors report 6 cases of Warthin's tumor of the parotid gland recently observed. In all cases the tumor was intraglandular, single, and no noteworthy disorders or symptoms except for a 2 to 5 cms tumefaction were present. At surgery all lesions appeared well-capsulated and the exeresis followed a cleavage plane easily identifiable which enabled the preservation of the residual glandular tissue as well as the surrounding nervous and vascular structures. All the patients, up to now, are free from relapse.

The aim of this study is to evaluate, after laparoscopic (CL) or open (CO) cholecystectomy, the incidence of pulmonary atelectasis and hypoxaemia which are strictly related to the onset of pulmonary complications. Two groups of 20 consecutive patients affected by symptomatic and not complicated gallstone disease were cholecystectomized either using CO or CL. Hypoxaemia was assessed preoperatively and after operation. Postoperative determination was performed at the 4th, 8th, 12th and 24th hour and then every 12 hours until discharge from hospital. A not informed radiologist evaluated atelectasis through two X-rays, preoperatively and postoperatively at the 3rd day. Atelectasis cases were divided in micro, focal, segmental, lobar and of the entire lung. Statistic analysis was performed using the "t" Student test. No mortality or intraoperative complications occurred. The two groups were similar for age, sex, smoker percentage, obesity, preexisting pulmonary dysfunctions and anaesthesiological risk (ASA). Operative time resulted in longer in CL compared to CO patients although in an insignificant way. PO2 value resulted significatively reduced (P0.05) at 4th, 8th, 12th and 24th postoperative hour after CO, while subsequent measurements did not show significant differences. There was no evidence of PO2 significative reduction after CL. After operation atelectasis was found in 11 patients (55%) of CL group (P0.05) and in 17 patients (85%) of CO group (P0.001). Atelectasis observed in the group of 11 CL patients was represented by 7 micro and 4 focal types, while in the CO group 7 micro, 8 focal and 2 segmental types were found. This study suggests that CL alters the pulmonary function less than CO.

The authors report their laparoscopic access technique. It has to be considered a variation of the classical closed technique, with the introduction of the Veress needle and the first trocar directly at the level of the fascia which is kept in traction by two Kochers.

The Authors analysed the complications observed during 156 laparoscopic accesses. In 38 cases following the classic closed technique, two pneumoderma, one pneumoscrotum, one pneumoepiploon and two laparoceles were observed in the umbilical area. In 30 patients the laparascopic access was performed according to the open technique, registering a significant loss of gas during the operation though not compromising it in 4 patients, and two infections of the umbilical incision. In 88 cases the modified closed technique was used and only one infection in the umbilical trocar insertion area was observed. After discussing the incidence, the etiopathogenesis, the diagnosis and the treatment of complications related to the laparoscopic access, the Authors emphasize the fact that in patients with surgical scars near the naval or patients who have already undergone laparascopy, or those with a positive history of affections causing abdominal adherence, the laparoscopic access must be performed using the open technique.

This work aims to develop a procedure for optimizing the generic filament wound structures that are readily adaptable to existing systems. Compromise between the structural and technological requirements is achieved by selecting the appropriate choice of fiber orientation. To this end, a finite element code in conjunction with that for numerical simulation was developed to obtain fiber stability on the mandrel when winding. Once the design variables are defined, the winding process is optimized in terms of percentage of waste material, machine time and others.

Thirty-five patients who had undergone gastric resection between two and five years earlier were included in the study. Digestive continuity had been achieved in 18 cases using the BII method, and in 17 using a Roux en Y loop. Vagotomy was not performed in any patient. All patients were assessed using endoscopy and multiple biopsies of the gastric mucous were taken. No postoperative peptic ulcers were observed. Mucous close to the stoma appeared to be hyperemic and edematous in 16 of the patients who underwent gastric resection using the BII method and in 5 of those in whom a Roux en Y loop was used. In BII patients, the histological analysis of endoscopic biopsies revealed mucous alterations in 94.4% of cases, and the most frequent finding was chronic atrophic gastritis; in the Roux en Y patients signs of inflammation were only observed in 58.8% of patients and in the majority of cases it was limited to superficial chronic gastritis.

Twenty-three patients who had undergone surgery for non-neoplastic pathologies of the terminal choledochus were studied using 99mTc Br-IDA. This method is used to study patients operated for PST of CDS because: 1) is not invasive and does not cause allergies; 2) it allows a physiological evaluation of biliary flow to be obtained; 3) it is not influenced by the patient's body structure, by the presence of intestinal gas or costo-chondral calcification; 4) the radiation dose absorbed by the patient is very low; 5) it does not require any special preparation of the patient. Papillosphincterotomy was performed in 16 patients and choledochoduodenostomy in 7 patients. Follow-up varied between a minimum of two and maximum of eight years. The morphology of the biliary tract remained normal in all cases or was only slightly dilated. Captation and excretion time remained within normal values. Marker activity in the duodenum appeared early in all cases. A duodenogastric reflux was only observed in one patient among those undergoing PST, whereas it was observed almost constantly following CDS.

The gastric emptying has been studied with 99Tc labelled in 35 patients followed for 2-8 years after duodenogastric resection. All patients had been undergone a gastric resection of 2/3 of stomach. In 18 had been performed a Billroth II (BII) and in 17 a gastrojejunostomy with a Roux-en-Y anastomosis. The jejunal loop had been carried out about 25-35 cm from the Treitz, the mesenteric margin isolated for 2-3 cm and the jejunojejunostomy performed about 50 cm from the gastrojejunostomy. Nobody complained symptoms from altered gastric emptying. In all patients with Roux-en-Y anastomosis there was an intense radioactivity in the new stoma till the 150th minute, and peristaltic activity was valid and coordinated. In patients with BII there was no radioactivity in the new stoma before the 150th minute, and peristaltic activity was always convulsive and uncoordinated.

Three cases of leiomyosarcomas of the small bowel, two localized in the jejunum and one in the ileum are reported. In the light of reported data, stress is laid on the anatomicopathological aspects and it is pointed out that the symptomatology is not specific and is comparable to that characterising the other neoplasms of the small bowel. The usefulness of the various diagnostic investigations are analysed and it is maintained that surgery plays a primary role in the treatment of such neoformations. It is maintained, finally, that further studies are needed to pinpoint the factors that may be correlated with the prognosis.

A careful survey of the literature on the relationships between pyoderma gangrenosum and Crohn disease is made. The pathogenetical and clinical aspects are analysed and a case, personally observed, is presented.

The role of aminophylline in the re-formation of peritoneal adhesions was considered in 23 rats. Since the adhesions were obtained, the animals were subsequently divided into three groups, the first one containing seven units, the others containing eight animals each. During the four days prior the surgery, allopurinol at the dose of 50 mg/kg/die was added to the regular ground laboratory chow in the animals of the second group; aminophylline at the dose of 40 mg/kg/die was administered four hours and immediately prior the surgery, to the animals of the third group. The adhesions that we observed, were graded and evaluated assigning them a score. At the moment of the lysis of adhesions, we observed the score of 2.71 +/- 1.11 in the first group, 3.12 +/- 1.13 in the second group, and 2.75 +/- 1.03 in the third one. Matching each group one another no statistically significant difference was found. At the end the experiment, we observed a score of 3.71 +/- 0.49 for the adhesions in the first group, 2 +/- 0.75 in the second group, and 3.87 +/- 0.35 in the third one. Matching these scores with those observed at the moment of their lysis, they appeared significantly higher in the animals of the first group (p less than 0.02) and of the third group (p less than 0.05), but they were lower in the second group (p less than 0.05). Such results indicate that the re-formation of peritoneal adhesions following their lysis is constant, that allopurinol decreases the intensity of the process, while aminophylline increases it.

The aim of this paper is to present our investigation on chemical and physical interaction between laser beam and tows of thermoplastic material for filament winding.

This paper gives a review of the physics aims of the fixed-target experiment WA84, currently being conducted at CERN, and of the methods used. The operation and performance of the scintillating-fibre microvertex detector are described.