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Hemorrhoids are the most common proctological disorder with a high incidence per test and prevalence up to 39% in general population. This condition often leads to disruption in an individuals's personnel and working life.

To evaluate the long-term clinical and echocardiographic performance of mitral valve repair with the edge-to-edge technique.In-hospital results, actuarial freedom from all-cause mortality, cumulative incidence of cardiovascular mortality, recurrent mitral regurgitation ≥3+ and reoperation on the mitral valve were assessed in 180 consecutive patients undergoing mitral repair with the edge-to-edge technique for degenerative or functional regurgitation. Exercise echocardiography was performed in 24 patients to assess valve hemodynamics in the long-term follow-up.The edge-to-edge repair was applied as a first strategy in 157 patients (87.2%) or as a bail-out procedure in 23 patients (12.8%). At discharge, mitral regurgitation grade was absent in 152 patients (84.4%) and trivial in 28 patients (15.6%). Mean gradient was 2.8 ± 0.6 mmHg and effective orifice area was 2.9 ± 0.4 cm2. After a median follow-up of 6.5 (interquartile range 3.5-10.2) years, 93.6% patients were in NYHA functional class I-II. Actuarial survival at 15 years was 89.2 ± 2.7%, whereas the cumulative incidence of cardiovascular mortality was 7.0%, of recurrent mitral regurgitation ≥3+ 12.6% and of reoperation on the mitral valve 3.2%. Exercise stress echocardiography revealed a significant increase of functional area (3.1 ± 0.3 vs 4.0 ± 0.6 cm2, p0.001) and mean gradients (2.7 ± 0.4 vs 4.6 ± 1.2 mmHg, p0.001).The edge-to-edge technique effectively corrects degenerative and functional mitral regurgitation and represents a valid bail-out procedure in case other approaches failed to achieve adequate intraoperative valve competence. Long-term results are sustained up to 15 years, with significant improvement in functional status. Despite an altered geometry, the occurrence of iatrogenic mitral stenosis is avoided even at high workload conditions.

Background and aim of the work: Bullying involves a significant percentage of school-age children. According to the latest available surveillance data, in Sicily, the estimated prevalence among 11-15 years old children is 14%. This study aimed to estimate a prevalence of the bullying phenomenon, observed by teachers, in a sample of secondary schools of Palermo, Sicily. Moreover, after the conduction of preventive interventions among teachers, aimed to evaluate any modification in bullying prevalence. Methods: A cluster sampling selection according to socio-economic level of the school neighborhood was carried out. Two anonymous online questionnaires, pre and post-intervention, were administered to the 63 teaching staff, belonging to second and third year classes of ten secondary schools enrolled. Preventive interventions were conducted among teachers by experienced researchers. Results: Prevalence of bullying reported decreased significantly from 44.4% to 19.0% (p-value 0.001), comparing pre and post-intervention questionnaires. A reduction in the prevalence of verbal and physical bullying and a concomitant slight increase of indirect bullying were also observed. All the characteristics, reported by the teaching staff, for describing bullies, victims and observers of bullying have been categorized under three different content domains (affective-relational discomfort, sociocultural context, and character/natural disposition). Conclusions: The present study estimated the prevalence and the characteristics of bullying phenomenon in a sample of secondary schools of Palermo, evaluating the reduction of bullying episodes among students, after a preventive interventions conducted among teaching staff. Data obtained confirmed the effectiveness of this approach and suggested an extension of the project at Regional Level.

Foreign bodies in the rectum are a true proctological emergency. The incidence of these cases is increasing in recent years mostly due to auto-erotic acts and behavior disordes and is mainly observed in young patients. Most patients with rectal foreign bodies present to the emergency room usually exhausted after efforts of removingothe object at home. Many endoscopic and surgical techniques to get such removal have been described in the literature and the reported variety of in foreign bodies is as large as the number of techniques used to remove them. Authors report a case of unusual foreign body in the rectum that required multiple attempts to be removed and an original solution. KEY WORDS: Emergency surgery, Rectal foreign body, Transanal Extraction.

BACKGROUND: The first choice technique for the resection of colorectal polyps is without doubt the Endoscopic polypectomy, which plays a significant role in the prevention of colorectal cancer. The purpose of this study was to evaluate the sedation of patients undergoing polypectomy in reducing pain and discomfort. METHODS: A 200 patients case-control study shows the role of analgesia and sedation in endoscopic procedures. Patients submitted to a colonoscopy to perform a polypectomy, were allocated in two different groups according to receive or not a sedation. A continuous vital signs checking has been applied, and a comparison of pain and discomfort felt by the two groups, shows a statistically minor presence of the two symptoms in analgesia group with a shorter caecum reaching time as well. RESULTS: Eighty-five percent of group A patients described the procedure as painful according to VAS pain scale (VAS>6) and the 90% reported moderate discomfort as well. Comparing the two groups is possible to observe with a statistical significativity that 38,8% of group B patients reported the procedure as painful, while the 85% of group A patients. CONCLUSIONS: The use of analgesia drugs such as short life benzodiazepine is the favorite particularly in well set outpatient according to our study outcomes, leading to a less discomfort related procedure and a better procedure performance.

The aim of the paper is to describe the results of the application of a methodology based both on the use of time series analyses and of geospatial analyses of monthly climatic data (rainfall, wet days, rainfall intensity, and temperature), annual maximum of short-duration rainfall (from 1 hour to 5 days), and historical modification of land use in order to characterise the effects of these variables on the occurrence of landslide events. The methodology was applied in the Subappennino Dauno area, located on the eastern margin of the Southern Apennines thrust belt (Southern Italy). Despite the decreasing trend of rainfall and rainfall intensity and the increasing trend of temperatures and wet days, there is an increasing trend of landslide occurrence, highlighting the negative effect of anthropogenic modifications and the mismanagement of landslide-prone areas. This hypothesis was confirmed by comparing the distribution of landslides with the land use variations data (especially urban areas and wooded areas) collected from 1930 to 2006.