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Objective: Arterial stiffness is mainly characterized by its Peterson's Modulus (EP). Increased values of EP are associated with a reduced heart function and an increased arterial blood pressure. Assessment of EP requires simultaneous measurements of arterial diameter and pressure signals. However, instantaneous determination of arterial diameter signals implies optical and ultrasonic techniques and neither of them are portables. Aims: To evaluate a novel method for estimating the Ep spectral variability of arterial stiffness, without arterial diameter signals. Design and method: Arterial pressure (Konigsberg micro-transducer) was measured in 10 sheeps (25–35 kg) during 24 hours. Instantaneous cardiac cycle of pressure signals were determined using five–level multi-resolution wavelet analysis and decomposition. A state machine processed and analysed different linear combinations of details d3, d4 and d5 of mother wavelet Symlet11. EP spectral estimation assessment involved the study of various temporal locations of the fiducial elasticity starting point within each beat. Moreover, discard criteria were added from the heart rate variability studio and coherence index between systolic pressure and beat to beat intervals around 0.1 Hz. Agreement between the actual direct measurement of EP and the proposed method of spectral stiffness estimation was analyzed according to the Bland–Altman approach. Results: Results showed a high coherence (more than 70%) between the actual and proposed method for a wide frequency range (0 to 0.5 Hz). Bland & Altman test showed a standard deviation of the mean less of 10% between the proposed methodology and the direct assessment of EP. Conclusions: The methodology presented in this work evidenced high levels of spectral coherence in EP variability studios and no significantly difference between the actual and the proposed estimation method. So, this novel method is able to estimate the Peterson's modulus spectral variability by solely using the arterial blood pressure signal.

Medullary thyroid carcinoma (MTC) is a rare disease which accounts for approximately 5-9% of all thyroid cancers and originates from the calcitonin-screening parafollicular C cells. MTC can be divided into two subgroups: sporadic (75%) or inherited (25%). The majority of patients with invasive MTC have metastasis to regional lymph nodes at the time of diagnosis, as evidenced by the frequent finding of persistently elevated calcitonin levels after thyroidectomy and the high rates of recurrence in the cervical lymph nodes reported in retrospective studies.The purpose of the study is to review our single institution's experience with MTC since 1998 and to evaluate surgical strategy, patterns of lymph node metastases and calcitonin response to compartment-oriented lymphadenectomy in patients with primary or recurrent sporadic medullary thyroid carcinoma.A retrospective review of 26 patients treated for MTC at the "Antonio Cardarelli" Hospital referral center, in Naples, between 1998 and 2012. There were 18 female and 8 male patients, median age at presentation was 55 years, and median follow-up for survivors was 5 years. Total thyroidectomy was performed in all 26 patients; central compartment (CC) node dissection (level VI) in 12 (46%) patients; central plus lateral compartment (LC) node dissection (levels II, III, and IV) in 7 (27%) patients. 4 patients (15%) underwent reoperation for loco-regional recurrent/persistent MTC. Results. After a median post-surgical follow-up of 5 years (range 1-10 years), 63 % of patients were living disease-free, 15% were living with disease and/or persistently elevated calcitonin levels after surgery, 11% were deceased due to MTC and 11 % were lost to follow-up.We agree with most authors advocating for a total thyroidectomy and prophylactic central neck dissection in the setting of clinically detected MTC. Lateral neck dissection may be best reserved for patients with positive preoperative imaging. Nevertheless MTC has a high rate of lymph node metastases that are sub optimally detected preoperatively in the central compartment by neck ultrasound or intra-operatively by the surgeon, and reoperation is associated with a higher rate of surgical complications. In our limited experience, patients with thyroid confined nodular pathology, without nodal disease and unknown preoperative diagnosis of MTC, underwent only total thyroidectomy with a good prognosis.

Molti studi hanno dimostrato la affidabilità della tecnica del linfonodo sentinella (SN) nella valutazione del parametro N nel cancro mammario tanto da indurre a limitare la dissezione ascellare alla biopsia del solo SN (SNB) in caso questo sia negativo. Dopo un periodo di messa a punto della tecnica di identificazione, biopsia ed esame istologico del SN (ottobre 97- gennaio 98) sempre seguita dalla dissezione completa dei tre livelli dell’ascella (ALND), abbiamo intrapreso uno studio per valutare la affidabilità di una dissezione limitata al solo I livello dell’ascella (FLND) in donne con T

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.

Chronic venous insufficiency is a recurrent pathology, but affected patients often undergo clinical observation at a most severe and clearly symptomatic stage of the disease. In this late stage, therapy can only relieve symptoms of the disease which often lead to disability. In the clinical course of chronic venous insufficiency, phlebostatic ulceration constitutes a recurrent finding and it is responsible of compromising patients quality of life. The role of perforating veins, made refluxive by various pathogenic noxa, in the genesis of ulcerative lesions has been known since long time. For many years the interest in perforating veins surgery has been limited because of the several negative consequences of the operations. The possibility of modifying the hemodynamics of perforating veins compartment without causing post-operation complications by video-supported surgery, led to the debate on the role of these vessels in the chronic venous insufficiency. The phlebostasis non-invasive diagnosis uses imaging techniques consisting in tests which mostly are cheap, simple and easy to perform, thus representing the best early approach to the patient. It is widely thought that even though complex examinations are available, most precious information can be obtained by only two examinations: color-Doppler ultrasonography and, limitedly, plethysmography. By these diagnostic directions it is possible to better identify the site and the hemodynamic origin of the venous insufficiency.