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Toxic trace elements from both, natural and anthropogenic origin, pose a threat to aquatic environments and marine wildlife due to their long-range transport, bioaccumulative nature, and biomagnification through the food chain. Being long-lived and migratory animals, sea turtles can be exposed to elevated levels of toxic elements, and are therefore considered sentinel species for chemical pollution. In this study, concentrations of trace elements (arsenic, cadmium, lead, mercury) were determined in tissues of 46 loggerhead sea turtles (Caretta caretta) stranded along Tyrrhenian and Ionian coasts of Calabria, in Southern Italy, between 2014 and 2020. Curved carapace length (CCL), curved carapace width (CCW), body mass (BM), and sex were determined and the correlations of these parameters with toxic elements concentrations were investigated. During necropsy, kidney, liver, and muscle tissues were collected and the concentration and distribution of metals determined. Muscle tissues showed the lowest toxic element burdens, except for As that showed the highest mean concentrations in this tissue. The kidney was the main accumulation organ for Cd, while similar levels of Hg and Pb were measured in kidney, liver, and muscle tissues. The risk assessment performed for Cd, Hg, and Pb in sea turtles' liver highlighted possible negative effects on sea turtles' health and the need for marine turtle toxicology researches. This is the first study reporting levels and distribution of toxic elements in tissues of Caretta caretta turtles from the Tyrrhenian and Ionian coasts of Calabria.

Malignant tumors of the large bowel develop colonic obstruction in 10-30% cases. Recently many authors have employed self-expandable stents to resolve the colonic obstruction. During 2002, seven patients affected by neoplastic malignant stenosis of the left colon underwent endoscopic placement of self-expandable enteral stent. The technique succeeded in relieving the obstruction in 6 patients, while in a woman affected by malignant tumor of the splenic flexure, colonic stenting was unsuccessful. The Authors didn't observe any procedure related complications; sign and symptoms of intestinal obstruction resolved within 24-72 hours from placement. Four patients needed hydro-electrolitemic correction, intestinal cleaning and R0 resection with one stage anastomosis within 5 and 9 days. Bowel decompression of the neoplastic stenosis relieved by self expandable metallic stents is useful to avoid emergency surgery and provide time for a complete preoperative staging, a metabolic correction and a mechanical bowel preparation. Complications of stent placement are common in many reports and include minor rectal bleeding (2%) and perforations (4%). Stenting is contraindicated in cases of enlarged colon with diameter superior to 8 cm or in flogistic lesions.

Malignant tumors of the large bowel become often clinically evident as an obstruction in 8-29% cases, specially the neoplasms at the splenic flexure (50%) or descending colon (25%). Different factors (urgency, age, colonic distension and lack of adequate bowel preparation) influence therapeutic choice, specially about the bowel resection and one stage anastomosis. Twenty-six patient with neoplastic stenosis of the large bowel (8 of ascending colon and proximal transverse, 5 of splenic flexure or descending colon, 12 of the sigma, 1 of the rectum) have been surgically treated. 4 patient have been subjected to right emicolectomy and ileo-transverse anastomosis; 2 to Hartman's operation; 1 to anterior resection of the rectum; 3 to left hemicolectomy and 2 to resection of the sigma with colic on table irrigation and one-stage anastomosis; 13 to colostomy; 1 to palliative ileo-colic bypass. Two patients (7.5%) died in post-operative period. In patients subjected to one-stage procedures for left colic stenosis, the Authors haven't observed major complications, but one patient developed an anastomic leakage (4%), conservative treated. In stenosis localized to ascending colon or hepatic flexure standard surgical operation is right emicolectomy. In patients affected by cancer of descending colon, the Hartmann's operation is considered the more rational procedure, even if 50% of the patients aren't reoperated on for reconstruction. The one-stage anastomosis is indicated only in selected cases, specially subjected to TPN before surgery or balancing of the metabolic parameters and to antibiotic prophylaxis. The subtotal or total colectomy is indicated when signs of colic perforation are found or when the colon is massively dilatated or there are signs of colonic necrosis or in case of other lesions of the large bowel preoperatively known.

Consensus doesn't exist about the intraoperative cholangiography specially if is need in every one laparoscopic cholecystectomy either exclusively in case of anatomical doubts or suspect of injures or stones of the common duct. We have considered 450 patient subjected to laparoscopic cholecystectomy during 1992-2000. Patients suspicious to be affected by common duct lithiasis (28 cases) are subjected to ERCP with cleaning of the biliary tree. In 18 patients (4%) it has been necessary the laparotomic conversion; 176 patients (39%) have been subjected to intraoperative cholangiography, selected on anatomical regional disposition or anamnesis and biochemical and instrumental results (history of jaundice or gallstones pancreatitis, abnormal serum level of the biliary stasis biochemistry, common bile duct major of 8 mm, michrolitiasis of the gallbladder). In 7 cases (4%) we have discovered common bile duct stones. We don't attempt intraoperative cholangiography in every one laparoscopic cholecystectomy, but only in cases where we suspect presence of common bile duct stones either iatrogenic injuries or when we retain it necessary to clarify the regional anatomy. Unlikely just in patients where would be more useful, causes major risk of intra- and post-operative complications, it is very difficult, often impossible, to attempt the intraoperative cholangiography. Routinary employing of the intraoperative cholangiography could be useful just for a little number of patients, while selective employing reduce 60% the X-ray. Collaboration with the radiologist is able to reduce the mistaken on the interpretation of the radiograms.

Background: Limbs phlebostatic ulcers are in many cases associated with perforator reflux veins often caused by post-thromboflebitis syndrome. The origin operation consisting in perforating vein interruption, described by Linton in 1938, allowed high quality exposition of these vessels and gave successful therapeutic results only affected by complications which prolonged hospitalisation. The most unfavorable prognostic factor was the need of performing an incision in skin sites affected by dermo-hypodermic degeneration induced by phlebopathy which inhibits post-surgery cicatrization. The therapeutic importance of reflux perforator vein interruption induced vascular surgeons to improve various procedures not affected by post-surgery complications and able to excise as much incontinent vessels as possible., Methods: By video-surgery and new surgery tools nowadays available, the Subfascial Endoscopic Perforating Veins Surgery (SEPS) was established as a feasible and valuable method. At present, there are many surgical techniques differing from each other for the tools and the subneurotic compartement from which the perforating veins start. The results obtained from 45 SEPS procedures performed on 45 patients presenting lymphodermatosclerosis or venous ulcers caused by chronic venous insufficiency have been retrospectively evaluated., Results: Thirty-six patients reached ulcer healing within 4 weeks after the operation; 7 ulcers healed over a 2 month time, while for 2 patients no clinical improvement has been recorded yet., Conclusions: SEPS is a valid alternative to the Linton procedure and provides remarkable advantages both in economic and clinical terms since it yields a more rapid lesions healing of small incisions which makes it one of the most minimally invasive surgical technique.

The purpose of this study was to determine the effect of increasing heel height on peak forefoot pressure. Thirty-five women were examined while wearing sneakers and shoes with 2-inch and 3-inch heels. An in-shoe pressure-measurement system was used to document the magnitude and location of plantar peak pressures. Pressure under the forefoot was found to increase significantly with increasing heel height. As the heel height increased, the peak pressure shifted toward the first metatarsal and the hallux. The reproducibility of data obtained with the in-shoe pressure-measurement system was tested in five subjects; the data were found to be reproducible to within approximately 3% of measured pressures.