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Die roboterassistierte hepatobiliare Chirurgie ist in den letzten Jahren stetig gewachsen. Sie stellt bei ausgewahlten Patienten eine Alternative zu den offenen und laparoskopischen Verfahren dar. Die Endowrist-Instrumente und die verbesserte Visualisierung bieten einen wichtigen Vorteil bezuglich Blutungskontrolle, Mikronahten und Dissektion. Cholezystektomien und kleinere Hepatektomien werden mit vergleichbaren Ergebnissen durchgefuhrt wie offene und laparoskopische Operationen. Auch komplexe Verfahren, wie z. B. schwere und erweiterte Hepatektomien zeigen exzellente Ergebnisse, sofern sie von Experten durchgefuhrt werden. Der zusatzlich verwendete fluoreszierende Farbstoff Indozyaningrun bietet einen weiteren Vorteil zur Erkennung der vaskularen und biliaren Anatomie. Zukunftige Innovationen werden es ermoglichen, die Anwendung und Indikationsgebiete fur dieses Verfahren zu erweitern. Die roboterassistierte Operation ist zu einem sehr wichtigen Teil der modernen minimal-invasiven Chirurgie geworden, und die Entwicklung neuer Robotertechnologien werden eine breitere Anwendung dieser Technik fordern.

The present-day Lesina area (Adriatic coast of southern Italy) preserves in the subsurface the stratigraphic signature of a recent sedimentary process regime change, which was responsible for the conversion of a former alluvial plain into a back-barrier tidal flat and, finally, into the modern barrier island. Facies-based analyses of the first 55 m of the upper Pleistocene–Holocene stratigraphic record, integrated with biostratigraphic sampling, radiocarbon data, and aerial observations of some diagnostic relict morphologies, allowed us to reconstruct the history of the last 20,000 years of this area. The succession investigated is adjacent to a salt dome, which uplifted in recent times, forming the easternmost boundary of the present-day Lesina lagoon. Three main stratigraphic intervals were detected in the subsurface: the lowermost unit is made up of conglomerates, sandstones, and mudstones of terrestrial origin, belonging to a complex system of alluvial plain filling a pre-existing Last Glacial Maximum (LGM) topography. The second interval consists of sands and muds, with subordinate conglomerates of brackish and marine origin, and lies on the previous one through a wide ravinement. Its composing lithofacies exhibit a strong tidal signature preserved in tidal rhythmites belonging to a net of tidal channels, associated with marshes, mud flat, and lagoonal deposits. These sediments record the emplacement of a back-barrier tidal flat, which developed under the strong influence of a tidal influx enhanced by the late post-LGM transgression. The third uppermost interval resulted from the deposition of coastal-marine sands and gravels accumulated during the ensuing modern normal regression, under the dominance of a wave-dominated coastal dynamics, which was responsible for the progradation of the present-day beach barrier and the closure of the Lesina lagoon. The paleogeography of the back-barrier tidal flat preceding the onset of the modern barrier island is thus reconstructed based on the results of our facies analysis, biostratigraphy, and AMS dating. Many of the elements composing this mid-Holocene tide-influenced system were also interpreted from the aerial-photograph observation of several relict morphologies, which are still preserved in many parts of the modern Lesina barrier island. We propose some new interpretation on the origin some of these elements, which possibly developed under sedimentary process regimes different from the modern ones, including some flood-tidal deltas, previously interpreted as tsunami-derived washover fans.

Robot-assisted hepatobiliary surgery has been steadily growing in recent years. It represents an alternative to the open and laparoscopic approaches in selected patients. Endowristed instruments and enhanced visualization provide important advantages in terms of selective bleeding control, microsuturing, and dissection. Cholecystectomies and minor hepatectomies are being performed with comparable results to open and laparoscopic surgery. Even complex procedures, such as major and extended hepatectomies, can have excellent outcomes, in expert hands. The addition of indocyanine green fluorescence provides an additional advantage for recognition of the vascular and biliary anatomy. Future innovations will allow for expanding its use and indications. Robotic surgery has become a very important component of modern minimally invasive surgery and the development of new robotic technology will facilitate a broader adoption of this technique.

Robot-assisted hepatobiliary surgery has been steadily growing in recent years. It represents an alternative to the open and laparoscopic approaches in selected patients. Endowristed instruments and enhanced visualization provide important advantages in terms of selective bleeding control, microsuturing, and dissection. Cholecystectomies and minor hepatectomies are being performed with comparable results to open and laparoscopic surgery. Even complex procedures, such as major and extended hepatectomies, can have excellent outcomes, in expert hands. The addition of indocyanine green fluorescence provides an additional advantage for recognition of the vascular and biliary anatomy. Future innovations will allow for expanding its use and indications. Robotic surgery has become a very important component of modern minimally invasive surgery and the development of new robotic technology will facilitate a broader adoption of this technique.

Hepatobiliary surgery is a challenging surgical subspecialty that requires highly specialized training and an adequate level of experience in order to be performed safely. As a result, minimally invasive hepatobiliary surgery has been met with slower acceptance as compared to other subspecialties, with many surgeons in the field still reluctant about the approach. On the other hand, gastric surgery is a very popular field of surgery with an extensive amount of literature especially regarding open and laparoscopic surgery but not much about the robotic approach especially for oncological disease. Recent development of the robotic platform has provided a tool able to overcome many of the limitations of conventional laparoscopic hepatobiliary surgery. Augmented dexterity enabled by the endowristed movements, software filtration of the surgeon's movements, and high-definition three-dimensional vision provided by the stereoscopic camera, allow for steady and careful dissection of the liver hilum structures, as well as prompt and precise endosuturing in cases of intraoperative bleeding. These advantages have fostered many centers to widen the indications for minimally invasive hepatobiliary and gastric surgery, with encouraging initial results. As one of the surgical groups that has performed the largest number of robot-assisted procedures worldwide, we provide a review of the state of the art in minimally invasive robot-assisted hepatobiliary and gastric surgery.The English full-text version of this article is available at SpringerLink (under supplemental).

Laparoscopy is not universally accepted as the best approach for pancreatic tumor disease. It is considered an élite surgical approach especially because of the technical difficulties involved; and the highly trained surgeons that are required to perform these operations. In addition, long operation times and lack of reduction in length of hospital stay press for the use of the laparotomic approach instead of a laparoscopic one. Four major areas of interest have been focused on: pancreaticoduodenectomy, pancreas resection and enucleation, the increasingly important areas of diagnostic laparoscopy for staging of pancreatic cancer and laparoscopic palliation of unresectable pancreatic cancer. A review of the literature about laparoscopic management of pancreatic tumors disease has been examined: 14 laparoscopic pancreaticoduodenectomies, 93 pancreatic resections, 41 enucleations, 4 left pancreatectomies and 2 hand assisted enucleations have been described since 1994. The laparoscopic distal pancreas resection and enucleation appear to be the best treatment option for lesions located in the body and tail of the gland; conversely laparoscopy may not be indicated for lesions located in the head of the gland. The laparoscopic approach today, does not present advantages in terms of post-operative outcome and operation times than the laparotomic approach. The hand assisted approach may be helpful in difficult cases to facilitate the operation; it permits an easier and safer dissection still conserving a minimally invasive approach. Moreover, laparoscopy is also becoming the best approach for tumor staging and palliation, and many surgeons use the laparoscopy to obtain the most information with the minimal damage in a situation already compromised by a weakening disease.

The gastrointestinal tract, particularly the oesophagus, is affected in about half of all patients with systemic sclerosis. Only a few studies so far have dealt with the anorectal tract. We studied the anal function using anorectal manometry in 12 patients with limited systemic sclerosis. We also studied the oesophageal function. For the oesophagus, we measured the difference between intragastric and oesophageal pressure, while for the anorectal tract we investigated the maximum resting pressure, the maximum voluntary squeeze effort and the rectoanal inhibitory reflex. Maximum resting pressure and maximum voluntary squeeze effort were found to be decreased in all patients. The rectoanal inhibitory reflex was abnormal in four patients. Statistical analysis showed a significant correlation between maximum resting pressure and maximum voluntary squeeze effort. No correlation was found between oesophageal and anorectal involvement. Anorectal dysfunction is common in patients with limited systemic sclerosis. We suggest that these patients should have an evaluation of their anorectal function including anorectal manometry.

Anomalous origin of the right coronary artery from the left sinus of Valsalva is a rare congenital anomaly classified as a "minor" anomaly of no clinical importance. Recently, manifestations of myocardial ischemia (angina pectoris, myocardial infarction, nonfatal ventricular fibrillation, sudden death) have been described in patients with this anomaly in the absence of atherosclerosis or other. Sudden death occurs frequently in symptomatic patients and rarely in asymptomatic patients (sudden unexpected death). In this study we report two cases of juvenile sudden death observed in asymptomatic patients with anomalous origin of the right coronary artery from the left sinus of Valsalva. In both cases the sudden death was exertion-related. In case 1 the coronary anomaly was the cause of death, since it was the only significant anatomic abnormality at necropsy; the microscopic findings revealed ischemic lesions only in the myocardium supplied by the anomalous right coronary artery. In case 2 the coronary anomaly was connected to other cardiac and non cardiac diseases (lymphocytic active myocarditis, chronic portitis, encephalitis, medullary adrenalitis). Since these morphologic lesions were extremely slight and there was no adrenal catecholamine damage in the myocardium, we consider negligible their possible role in determining death, which in this case was induced by the congenital coronary anomaly. The cardiac microscopic findings, also in this case, revealed ischemic lesions in the myocardium supplied by the anomalous right coronary artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Nitrobenzene and aniline react with Ru 3 (CO) 12 to yield the following trinuclear compounds: Ru 3 (CO) 10 NPh, Ru 3 (CO) 9 (NPh) 2 . HRu 3 (CO) 10 NHPh, and H 2 Ru 3 (CO) 9 NPh. Structural proposals for those products are made on the basis of instrumental analysis. Their properties are described and some comments on their reactivity are made.

Practice brochures are used by many dentists as a means of attracting patients to the office and providing them information. Creating an effective brochure requires careful selection of content, clear writing, and attractive format. Effective distribution is also essential if the brochure is to accomplish its purpose. A survey of practices using brochures revealed interesting findings on these various aspects of the practice brochure as a marketing tool.

The CT-v can therefore be considered an effective method as an aid in the autopsy evaluation of individuals who died for various causes; in particular, in the case of deaths due to accidental falls from high altitudes, is able to identify the primary cause of death and all the epiphenomena due to precipitation.

Buffalo milk samples differing significantly for cheese yield values were analysed by 2D electrophoresis in order to outline a protein profile, with specific regards to k-casein fractions. Four buffaloes, two of which showing high cheese yield and two with low cheese yield selected from a group of 135 subjects were chosen for the proteomic analyses. Six main spots in 2D gels were recognized as alpha s1-, alpha s2-, beta- and k-casein, alpha-lactoalbumin, beta-lactoglobulin. The main visible differences in the 2D gels between buffaloes with high vs. low cheese yield were found in the appearance of the four k-casein spots (spots numbers:20, 19, 16, 18) which differ in the number of phosphorilation and glycosilation. The area and the intensity of the four spots were calculated by using Melanie II (Bio-Rad) software. Samples with high cheese yield showed higher value of the by-products: area x intensity of spot 16, correspondent to k-casein with one phosphorilation site, and lower values of spots 19 and 20, of k-casein with more than one phosphorilation site and glycosilated.