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Summary: Background/Objective: In the late's 90' a new surgical treatment, the stapled trans-anal rectal resection (STARR) was born to treat obstructed defecation syndrome (ODS). In this study we retrospectively analyze a series of 450 cases that underwent STARR in 10 years. Methods: Between January 2001 to December 2011, 450 patients, diagnosed with ODS syndrome caused by rectocele or intussusception, underwent to STARR procedure. The presence of rectocele and/or intussusception was verified by dynamic defecography. The preoperative evaluation was completed with anorectal manometry and colonoscopy. Follow-up visits were scheduled 1 week, 1 month, 3 months, 1 years, 3 years and 5 years after surgery. Results: Mean operative time was 30,2 min. In 408 cases (90.7%) hospital discharge occurred 24 hours after surgery. Among postoperative complications urinary retention was observed in 35 patients (7.8%). Five (1.1%) patients presented an early rectal bleeding and 8 (1.8%) patients presented a late bleeding. In 5 (1.1%) patients a stable pelvic hematoma was found. Six (1.3%) patients presented pelvic sepsis due to subperitoneal perforation. An asymptomatic partial dehiscence of stapler row occurred in 19 patients (4.2%).125 patients (27.8%) reported defecation urgency that completely vanished at 3 months follow-up in 83 patients (66,4%) and in further 42 patients (33,6%) at 6-months. The average preoperative ODS score was 14.1; 3.1 at one year; 4.3 at 3 years and 6.4 after five years. Conclusions: In expert hands, with right indications, STARR procedure is safe with good results in terms of improvement of the ODS score. Keywords: Obstructed defecation, Urgency, Rectal mucosal prolapse, Rectocele, Trans-anal rectal resection

Stapling procedure for prolapsed hemorrhoids (PPh) is a widely accepted surgical procedure for third-degree hemorrhoids. intra-abdominal hemorrhage with retroperitoneal hematoma is an uncommon but possible complication. We report on the non-operative management of a case of intra-abdominal bleeding and retroperitoneal hematoma after PPh in a 56-year-old healthy woman presenting third-degree internal hemorrhoids. On the first postoperative day, the patient developed acute back pain, abdominal pain, abdominal distension with clinical signs of peritoneal irritation at left iliac fossa and hypogastrium and a drop in hemoglobin (hb 7.6 mg/dL). Computed tomography (CT) of the abdomen showed intra-abdominal free blood and an anterior intraparietal hematoma of the rectum. She was treated conservatively with intravenous fluids, antibiotics and analgesia. at the third postoperative day, the hematoma drained through surgical wound spontaneously. The patient was discharged 7 days after the operation with normal bowel movements. At 2 weeks after surgery a CT of control pointed out total resolution of perirectal hematoma. No evidence of clinical problems one month after surgery. The non-operative management of intra-abdominal hemorrhage with retroperitoneal hematoma can be successful in selected patients with hemodynamic stability and no evidence of arterial blushings or pneumoperitoneum at CT.

Summary: Background: Fistula-in-ano is one of the most commonly presenting anorectal diseases. Sphincter sparing treatment options should be considered in patients with complex fistulas. Salvecoll-E gel is a native collagen deantigenated and purified, non-cross-linked equine dermal extract, with an amino acid composition identical to human collagen. Methods: The multicentric trial study was a prospective, single-arm observational clinical study with the objective to assess the efficacy of Salvecoll-E gel for anal fistula repair in 70 patients. All patients had undergone preliminary surgical treatment consisting of positioning of a draining loosing seton that was maintained for a period of 4–6 weeks. After seton removal, a gentle debridement and washing of the fistula track was performed. The scar tissue was removed from the internal orifice. Internal opening was covered by a side-to side mucosal suture. Salvecoll-E was injected through the external opening into the fistula track, the external opening it has been opened. Results: Twelve months after surgery, 55 patients demonstrated a clinically healed fistula (78,5%), 15 patients have a recurrence (21,5%). Most of the recurrences were observed in the first 6 months of treatment (13/15, 86.6%). We don't observe any worsening in CCF score. The results obtained at 1 year certainly seem satisfactory and in line with the best results published in literature using mini-invasive techniques. Conclusion: Salvecoll-E gel is a promising non-invasive technique for conservative treatment of anal fistulas, it's well tolerated by the patients and, in case of recurrence, reinjection or all other known techniques are feasible. Keywords: Complex ano-rectal fistula, Non cutting technique, Mini-invasive treatment

Background: Perianal giant condyloma acuminatum (gCa) is a rare clinical condition related to low-risk human papillomavirus (hPV) characterized by a circumferential, exophytic, cauliflower-like mass. GCA is not a malignant lesion by histologic criteria but often shows a propensity to compress or infiltrate adjacent tissues and harbor tumor foci with high potential for malignant transformation (30-56%). Local extent of tumor invasion, not malignant histology, had the greatest impact on morbidity. Local full thickness surgical excision with 1 cm macroscopically negative margins is presently considered the most appropriate treatment for this type of lesion. Methods: This study reports successful treatment of 13 patients (11 males, 2 females, mean age 38.5 years old) with a new surgical approach. This technique consists in the removal of a mucocutaneous cylinder containing the entire lesion with 1 cm of disease-free margin both on the perianal skin and on the mucosa of the anal canal. Subsequently, the mucosa of the anal canal is sutured to the external margin of the internal sphincter with detached points in absorbable material. The anesthetic technique was spinal anesthesia. Results: The early postoperative period was uneventful in all 13 patients. Complete healing occurred in 40 days. Two months from surgery, no findings of anal stenosis were reported except for 2 patients (due to an incorrect postoperative management). No findings of mucosal ectropion two months after surgery. at the 1-year follow-up, there was no recurrence of condylomatosis in any patient. Conclusions: This procedure seems to combine technical simplicity, rapid discharge, low complication rates (no anal stenosis nor mucosal ectropion) and without recurrence of condylomatosis after 1-year follow-up. For all these reasons we think it might be a valid therapy for gCa.

INTRODUZIONE: La colpo-cisto entero defecografia rappresenta oggi il gold standard per l’identificazione e la stadiazione dei disordini morfologici e funzionali della regione retto-anale e del pavimento pelvico nelle sindromi da defecazione ostruita. MATERIALI E METODI: Tra Gennaio 2010 e Gennaio 2013 88 pazienti sono stati sottoposti a procedura di STARR per sindrome da defecazione ostruita (ODS) causata da rettocele e intussuscezione retto-anale. Abbiamo analizzato retrospettivamente i dati raccolti ed in particolare rivisto i risultati defecografici pre-operatori. RISULTATI: 30 pazienti (34%) alla colpo-cisto entero defecografia pre-operatoria, avevano un’apertura del canale anale compresa tra 0 e 5 secondi, 44 (50%) tra 6 e 10 secondi e 14 pazienti (16%) superiore ai 10 secondi. Le immagini hanno mostrato presenza di enterocele in 30 pazienti (34%). In 25 pazienti (28,4%) si trattava di enterocele dinamico, in 5 (5,6%) di enterocele stabile. 53 pazienti avevano un rettocele di II° (60,2%) e 35 pazienti un rettocele di III° (39,7%). I’ ODS score medio preoperatorio era 14. Il punteggio medio di ODS rivalutato a 1 anno è stato di 3,1, 4,3 a 3 anni e 6,4 dopo 5 anni. Il miglioramento del punteggio ODS era inferiore nel sottogruppo di pazienti che presentavano un’apertura lenta del canale anale (> 10 sec): 7,5 a un anno, 9,1 a 3 anni e 11 dopo 5 anni di follow-up. Anche nel sottogruppo di pazienti con enterocele stabile (5,6%) il miglioramento era meno evidente: 6,7 a 1 anno, 8 a 3 anni e 9,7 dopo 5 anni di follow-up. DISCUSSIONE E CONCLUSIONE: I dati ottenuti ci hanno dimostrato che la coesistenza di un lungo periodo di apertura del canale anale e / o la presenza di un enterocele stabile sono fattori che riducono significativamente l’efficacia della chirurgia riducendo il miglioramento dell’ODS score nel breve e lungo periodo. Consigliamo pertanto nel primo caso l’associazione di fisoterapia perineale mentre nel secondo una plastica del cavo del Douglas. INTRODUCTION: The conventional video colpo-cysto entero defecography describing the morpho- functional imaging features, physiological and pathological of the recto-anal region and pelvic floor . It represents the gold standard examination for the identification and staging of morphological and functional disorders of the recto-anal region and pelvic floor in evacuation dysfunctions. MATERIALS AND METHODS: Between January 2010 to January 2013 88 patients underwent STARR procedure for obstructed defecation syndrome (ODS) caused by single rectocele or internal rectal intussusception. We retrospectively analyzed the collected data,in particular we reviewed the defecography results before surgery. RESULTS: At defecography imaging , 30 patients (34 %) had an anal canal opening between 0 and 5 seconds, 44 (50 %) between 6 and 10 seconds and 14 patients (16 %) over 10 seconds at defecography imaging. The defecography showed an enterocele in 30 patients (34 %) The enterocele was functional in 25 (28,4 %) and stable in 5 (5,6 %) patients. 53 patients have a II° rectocele (60,2 %) and 35 patients a III° rectocele (39,7 %). The average preoperative ODS score was 14 . The average ODS score revaluated at 1 year was 3.1, 4.3 at 3 years an 6,4 after 5 years. The improvement of the ODS score was lower in the subgroup of patients presenting a slow opening of the anal canal (> 10 sec): 7.5 at one year, 9.1 at 3 years and 11 after 5 years follow-up. Also in the subgroup of patients with stable enterocele (5,6 %) the improvement was less evident: 6.7 at 1 year, 8 at 3 years and 9.7 after 5 years follow-up. DISCUSSION AND CONCLUSION: We have observed that a coexistence of a long opening time of the anal canal and / or the presence of a stable enterocele are factors that significantly reduce the effectiveness of the surgery leading over time to ODS score values close to those present before surgery. In the fisrt case we suggest a pre and post-operative perineal physiotherapy, in the second case a Dougla's platsy KEY WORDS: Defecography, Obstructed defecation syndrome, Rectocele, Recto-anal prolapse.

Since the 1970s, in the USA, we witnessed a progressive increase of one-day surgical procedures. This attitude soon gained ground in Europe as well. In proctology, this kind of clinical approach has always been limited by the acute sensitivity of the anal- perineal area and by difficulties in attaining a complete sphincter relaxation with local anesthesia. Posterior perineal block seems to be associated with both a good pain control and an effective sphincter relaxation.Between January 2017 and January 2018, we enrolled in our study 33 patients suffering from hemorrhoidal disease. They were all subjected to posterior perineal block. We measured anal resting pressure and squeeze pressure before and after anesthesia. Measurements where taken 5 minutes before and 15 minutes after the administration of local.We registered an average decrease of 39,2% of resting pressure and of 45,4% of squeeze pressure.We may state that perineal posterior block, while reducing striated muscle contractile activity, also causes a relevant reduction of anal basal tone. During surgical procedures done under regional anesthesia, we experienced a good sphincter relaxation, which was comparable, if not equal, to that induced by general anesthesia. In fact, 10 to 15 minutes after performing the block you could observe the elevation of the inferior margin of the exterior sphincter and the concomitant descent of the inferior margin of the internal sphincter (coaxial dislocation).Anorectal manometry, Anesthesia, Local-regional, Perineal block.A partire dagli anni 70 negli Stati Uniti si è assistito ad un progressivo aumento delle procedure chirurgiche in day surgery Questo processo si è diffuso anche nella maggior parte delle strutture sanitarie in Europa. In ambito proctologico le indicazioni sono sempre state limitate dalla particolare sensibilità della zona ano-perineale e da un difficile completo rilassamento dell’apparato sfinteriale dopo anestesia locale. Il blocco perineale posteriore sembra essere associato oltre che ad una buona analgesia ad un efficace rilassamento sfinterico.Da gennaio 2017 a gennaio 2018 sono stati arruolati 33 pazienti affetti da patologia emorroidaria. In tutti i pazienti è stato eseguito un blocco perineale posteriore. Sono state misurate la pressione basale del canale anale e la contrazione massima volontaria prima e dopo l’anestesia. Le due rilevazioni manometriche sono avvenute in posizione litotomica 5 minuti prima e 15 minuti dopo l’esecuzione dell’anestesia.La diminuzione media del tono basale dopo blocco perineale posteriore è stata pari al 39,2% e la riduzione media della contrazione massima è stata del 45,4%.Possiamo affermare che il blocco perineale posteriore determina oltre alla riduzione dell’attività contattile della muscolatura striata, anche un rilevante decremento del tono anale di base. Durante interventi proctologici eseguiti in anestesia locoregionale con il blocco perineale posteriore si è riscontrato notevole rilasciamento della parete sfinteriale dell’ano paragonabile, anche se non uguale, a quello che si verifica durante un’anestesia generale. Infatti dopo circa 10-15 minuti nella quasi totalità dei casi si osserva sia la risalita del margine inferiore dello sfintere esterno che la concomitante discesa del margine inferiore dello sfintere interno (dislocazione coassiale).

Direct inguinal blunt trauma is an uncommon but possible cause of bowel perforation in patients with groin hernia. in this case report we want to describe bowel perforation in a 67-year-old patient with bilateral groin hernia due to a directly inguinal blunt trauma managed with loop ileostomy with rod. This case reveals the importance of elective hernia repair and the value of clinical and instrumental evaluation of a patient with groin hernia after direct blunt trauma.

The incidence of full-thickness rectal prolapse is 1% in patients over 65 years of age. Risk factors are multiparity, previous pelvic surgery, and neurological or psychiatric disorders. IBS, constipation, and chronic straining are comorbidity factors. Symptoms and risk of complications are indications for surgical treatment. Among abdominal operations, ventral rectopexy recently seems to offer the best long-term results. Recurrence rate less than 3–4%, a net improvement of continence, is in up to 80–90% of cases; compared with traditional rectopexies, a greater improvement in constipation and a reduced risk of postoperative constipation are observed. Perineal procedures (Altemeier’s proctosigmoidectomy) are less demanding on the patients and are still the favorite technical choice in the elderly, mostly in high-risk patients. Morbidity and mortality are low and postoperative recovery is faster. If the technique is correctly performed, there seems to be no statistically significant difference in recurrence rate between abdominal and perineal procedures. However, in the last few years, there is a new emerging trend for a wider use of laparoscopic ventral rectopexy also in geriatric low-risk patients.

Summary: Background: We propose a new open mesh hernia repair procedure for the treatment of inguinal hernias in adults aiming to improve patients' comfort and to reduce the incidence of chronic neuralgia. Methods: From September 2012 to August 2015, 250 consecutive patients were treated with “all in-one” mesh hernioplasty procedure in our Institution. According to the devised technique, a new smaller prosthesis was placed on the floor of the inguinal canal in order to strengthen all areas of weakness from which hernias may originate. The mesh was enveloped by a fibro-cremasteric sheath avoiding contact with neural structures. Follow-up was carried out at 3, 6, 12, 18 and 24 months for evaluation of postoperative pain using Visual Analogue Scale score, need of medication, patients' comfort and short or long-term complications. Results: All patients were discharged within 24 h from surgery. Slight pain was reported by the majority of patients and 47.6% of them did not require pain medication at home. After the 1st postoperative week 96.8% reported no pain and no other symptoms. No relevant limitation of normal activities was reported. There has been no postoperative neuralgia. One recurrence was observed. Conclusions: This new hernioplasty technique respects the anatomy of the inguinal canal, uses a smaller mesh, and seems to avoid neuralgia with maximum comfort for the patients. Keywords: Inguinal hernioplasty, Tension free hernia repair, Hernioplasty technique, Mesh for groin hernia, Neuralgia post-hernioplasty

Key Clinical Message This clinical image shows the importance of the early diagnosis and treatment of any suspicious skin lesion.

Gastric adenocarcinoma is the third most common cancer and the second most common cause of death due to cancer worldwide. Surgery is still the major prognostic factor for gastric cancer. Patients who could not be resected have a poor prognosis with survival ranging from 3 to 11 months. There is evidence that surgical operations can cause a variety of immunological disturbances in man both in vivo and in vitro. The postoperative changes in the systemic immune response are proportional to the degree of surgical trauma leading to a generalized state of immunosuppression, which is implicated in the development of septic complications and provided a “fertile soil” for tumor cell metastasis. Immunotherapy may be a potentially promising alternative strategy for gastric cancer. In early clinical trials, systemic immunotherapy included both active vaccination directed against defined tumor-associated antigens expressed in gastric carcinoma cells and passive administration of IL-2 with some evidence of regression of metastatic gastric cancer. Other studies have applied immunotherapy in the adjuvant setting with equally promising results. For example, OK-432, a streptococcal preparation, demonstrated marginal improvement in survival for patients with stage III gastric cancer and a meta-analysis of centrally randomized controlled clinical trials indicated a significant survival benefit with combination OK-432 and chemotherapy compared to chemotherapy alone (p < 0.05). Additional data suggesting a biological and clinical benefit of subcutaneous, preoperative administration of low-dose IL-2 in colon cancer encouraged us to evaluate low-dose IL-2 therapy in the neoadjuvant setting for patients with gastric adenocarcinoma who undergo surgery and to evaluate its effects on systemic and tumor infiltrating lymphocyte numbers. We also sought to determine if neoadjuvant low-dose IL-2 could influence the clinical outcome for patients undergoing gastric resection for cancer. We report the biological, histological and clinical results with the full accrual of patients and a median follow-up of 51 months

Scopinaro's bilio-pancreatic diversion is considered as an acceptable malabsorptive surgical approach for the treatment of morbid obesity. We describe a case of acute recurrent gastro-intestinal bleeding in a patient with a previous Scopinaro's bilio-pancreatic diversion. At the first admission in our department, gastroscopy, colonoscopy, contrast-enhanced computerized tomography and angiography resulted negative for active bleeding. Hypovolemic shock indicated laparotomy and an intraoperative enteroscopy performed through a small enterotomy showed an ulcerative perforation sourced in an ischemic portion of a distended duodenal stump, with a bleeding branch of gastro-duodenal artery at the bottom. Hemorrhage was stopped with stitches. Two years later a new episode of duodenal bleeding associated with severe malnutrition occurred. A covered chronic ischemic perforation sustained by duodenal distension due to biliopancreatic limb sub-obstruction appeared to be the most probable etiology of the recurrent duodenal bleeding. The patient underwent again to laparotomy and adhesiolysis; hemorrhage was stopped by means of ligation of gastroduodenal artery and bilio-pancreatic diversion was converted into a standard Roux-en-Y gastroenterostomy with an entero-entero anastomosis 40 cm from the Treitz ligament in order to restore an anatomo-functional condition guaranteeing normal absorption and intestinal transit. After Scopinaro's bilio-pancreatic diversion duodenal bleeding can represent a rare serious presentation of biliopancreatic limb obstruction; because of the complex anatomical reconstruction performed during this intervention, the duodenum results unavailable during upper gastro-intestinal endoscopy, and if a duodenal bleeding is suspected laparotomy followed by enteroscopy represents an effective diagnostic approach.

Introduction Perianal giant condyloma acuminatum is a rare clinical condition related to human papillomavirus infection and characterized by a circumferential, exophytic, cauliflower-like mass with an irregular warty surface localized in the anal region. Technique A circular incision with a diathermocoagulator was performed on macroscopically healthy skin, 1 cm from the margin of the lesion. The dermis was divided from the subcutaneous tissue. This way, a mucocutaneous cylinder including the whole lesion was obtained. A median radial incision was carried out to open the cylinder at its front. A progressive circumferential section on healthy mucosa (≈1 cm above the margin of the lesion) by means of a radiofrequency dissector allowed for the complete removal of the mass. The healthy mucosa of the anal canal was pulled out by Allis forceps and was sutured to the external margin of the internal sphincter with single layer of Vicryl (polyglactin 910) 2-0 sutures. Results Two months after surgery, no findings of anal stenosis or mucosal ectropion were reported. At the 1-year follow-up there was no recurrence of condylomatosis in any of the 3 cases. Conclusions Our procedure seems simpler to perform when compared with other techniques and reduces hospital stay and complications such as anal stenosis and mucosal ectropion.

Purpose: Early laparoscopic cholecystectomy (ELC) is the treatment of choice for acute cholecystitis (AC), but the optimal surgical timing is controversial. The aim of this study was to retrospectively verify the outcome of patients with AC according to different timing of cholecystectomy. Methods: Patients undergoing cholecystectomy for AC from 2006 to 2012 were stratified into two groups: initial admission cholecystectomy (IAC) and delayed cholecystectomy (DC, after at least 4 weeks). Among IAC, a subgroup undergoing immediate cholecystectomy (IC, within 72 h of symptom onset) was further analyzed. Results: Three-hundred and sixteen consecutive patients were studied. IAC group included 262 patients (82.9 %) and DC group included 54 patients (17.1 %). The two groups were similar in conversion rate, operation length, and overall complication rate. The total length of hospitalization was longer in DC patients (p = 0.005). Among DC patients, 25.9 % required re-hospitalization while waiting an elective procedure. In the group undergoing IC (66 patients), conversion rate, length of operation, and postoperative morbidity were similar to that of the IAC group. Length of stay was shorter in IC group (p < 0.001). Multivariate analysis identified moderate-severe AC grading and ASA score ≥ 3 as predictors of postoperative complications. Conclusions: The timing of cholecystectomy for AC does not seem to affect conversion rate and postoperative morbidity. Therefore the 72-h period should not be considered a strict limit to perform LC, provided that the operation is carried out during the initial hospital admission. © 2013 Springer-Verlag Berlin Heidelberg.

Background: Leukocyte-depleted blood transfusions were introduced to reduce transfusion-Associated immunomodulation, but the clinical effects of different types of leukocyte depletion have been analyzed rarely. The aim of this survey was to analyze the clinical impact of pre-storage leukocyte-depleted blood transfusions (considered as pre-storage or bedside-filtered) on post-operative complications in patients undergoing elective or urgent colorectal resection. Methods: Data were collected retrospectively from the medical records of 437 consecutive patients who underwent colorectal resection from 2005 to 2010. All patients requiring transfusion received pre-storage or bedside-filtered leukocyte-depleted red blood cell concentrates according to availability at the blood bank. The outcomes were measured by the analysis of post-operative morbidity in patients receiving the different types of transfusions or having other potentially predictive risk factors. Results: The overall morbidity rate, infective morbidity rate, and non-infective morbidity rate were, respectively, 35.6%, 28.1%, and 21.0%. Two hundred five patients (46.9%) received peri-operative transfusions. On multivariable analysis, leukocyte-depleted transfusion (odds ratio [OR] 3.33; 95% confidence interval [CI] 2.14-5.20; p

Key Clinical Message A hard and bleeding anal and perianal mass stenotized the anus and required left-sided colostomy. Incisional biopsy showed a moderately differentiated spiniocellular carcinoma. Chemoradiotherapy treatment alone reduced significantly the mass.

Splenectomy has been performed for a heterogeneous group of hematologic diseases with a therapeutic or diagnostic purpose or as part of the staging process in Hodgkin's disease. Most patients undergoing therapeutic splenectomy are chronically ill with significant splenomegaly. This scenario can be associated with a high risk of postoperative morbidity and mortality due to the prolonged course of disease for patients with myelofibrosis; their susceptibility to infection, thrombosis, and hemorrhage; and the severe enlargement of their spleens. We have reviewed the main papers published about postoperative complications after splenectomy, analyzing the risk factors, prevention measures, and respective treatments. Great care must be taken in the management of patients presenting malignant diseases, splenomegaly, and hemostasis disorder. Moreover, despite the faster discharge that new surgical techniques now allow, close attention should be paid to symptoms reported by patients, in order to avoid potentially life-threatening complications such as portal vein thrombosis, pancreas injuries, and overwhelming postsplenectomy infection.

The purpose of this paper is to analyze the reasons underlying the development of new shipping systems and the realization of better board equipment and fittings. At first, the events which have led to the present technical solutions will be considered, the main characteristics of which being energy saving nd the use of alternative energy forms, without however impairing the efficiency of the services they are devised for. The second part of this study regards present-day trends in the shipbuilding industry, and hypotheses as to their future development, in the light of new transport- prospectives. Particular attention is given to the possibilities of developing new systems of barge-carrying ships, of “slurry” ships, “swath” systems and the recent integrated constructions consisting of barges and tug-boats, thereby also taking into account their use in river and sea systems. A survey follows, regarding recent laws and regulations relevant to the safeguard of human life at sea and regulations concerning the prevention of sea pollution, thereby briefly evaluating their probable effects on the shipbuilding industry; for a better comprehension of this aspect a further look at past effects of this kind may prove useful. This paper then examines in detail some technical solutions that are being studied and applied to improve the ship’s efficiency. These solutions regard: a) systems for the loading and unloading of acrgo on ships which have so far not been equipped with such systems; b) studies and applications concerning on hydrodynamics on the bottom and the propeller; c) recent studies and realizations concerning coal-fuelled ship-propulsion; d) studies and realizations of propulsive systems driven by alternative energy forms, such as wind; e) prospective use of new fuels in naval engines; f) Technical measures aiming at an optimum exploitation of propulsive equipments. These various uses may not only lead to a reduction in energy consumption and improve the efficiency of the equipment and the transport and the distribution of goods by sea, but also contribute to relaunching the shipbuilding industry.

The present situation of economic recession is negatively affected the development of maritime trades, causing a considerable slow down in the shipbuilding sector. I will first draw Your attention to some aspects of the situation, taking then into consideration some reactions arising among shipowners and shipbuilders and leading to the production of new, more complex and more flexible ships. These ships can meet the many different market requirements and can operate more profitably even in the most difficult economic situations. In the ‘60s and in ‘70s we saw the beginning and the development of container-ships, roll-on/roll-off, supertankers, bulk-carriers, etc..; such units were required by a fast growing market, which called for ships of great speed and capacity, suitable to carry specific cargo from areas of high output to zones of high consumption. A partial fall in demand does not deny the present, through diminished of those units. Nevertheless this drop leads shipowners to call for ships which can easily carry different cargoes. Therefore conbulk, condock, ro-ro/lo-lo of many different types, oil products/chemical carriers, etc.. are being built. Both new and more traditional ships are provided with equipment, engine and building innovations; I will touch upon them in the four following points, concerning : 1) cutting down operating costs; 2) increasing ship’s flexibility; 3) increasing shipping security; 4) promoting environmental protection. New forms of maritime transport, some of which more futurist, are being studied, while new systems of shipping propulsion and engineering are being carried out. I will now outline some projects which, in my view, are worth carrying out, at the same time providing their operational pros and cons.