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Background Efficacy and safety of OAGB/MGB (one anastomosis/mini gastric bypass) have been well documented both as primary and as revisional procedures. However, even after OAGB/MGB, revisional surgery is unavoidable in patients with surgical complications or insufficient weight loss. Methods A questionnaire asking for the total number and demographics of primary and revisional OAGB/MGBs performed between January 2006 and July 2020 was e-mailed to all S.I.C. OB centres of excellence (annual caseload > 100; 5-year follow-up > 50%). Each bariatric centre was asked to provide gender, age, preoperative body mass index (BMI) and obesity-related comorbidities, previous history of abdominal or bariatric surgery, indication for surgical revision of OAGB/MGB, type of revisional procedure, pre- and post-revisional BMI, peri- and post-operative complications, last follow-up (FU). Results Twenty-three bariatric centres (54.8%) responded to our survey reporting a total number of 8676 primary OAGB/MGBS and a follow-up of 62.42 ± 52.22 months. A total of 181 (2.08%) patients underwent revisional surgery: 82 (0.94%) were suffering from intractable DGER (duodeno-gastric-esophageal reflux), 42 (0.48%) were reoperated for weight regain, 16 (0.18%) had excessive weight loss and malnutrition, 12 (0.13%) had a marginal ulcer perforation, 10 (0.11%) had a gastro-gastric fistula, 20 (0.23%) had other causes of revision. Roux-en-Y gastric bypass (RYGB) was the most performed revisional procedure (109; 54%), followed by bilio-pancreatic limb elongation (19; 9.4%) and normal anatomy restoration (19; 9.4%). Conclusions Our findings demonstrate that there is acceptable revisional rate after OAGB/MGB and conversion to RYGB represents the most frequent choice. Graphical abstract

La presente relazione riporta l'attività di caratterizzazione morfologica, chimica e funzionale di n.2 catalizzatori commerciali per il trattamento DeNOx (SCR) dei gas di scarico di motori diesel di truck/bus commissionata dalla società Green Energy con sede in Napoli attiva nella realizzazione "aftermarket" di sistemi di abbattimento delle emissioni nel settore "automotive". I campioni da analizzare sono stati consegnati a cura del committente presso i laboratori dell'Istituto di Ricerca sulla Combustione. L'attività di caratterizzazione mira alla verifica delle proprietà catalitiche di abbattimento degli ossidi di azoto attraverso la reazione di riduzione selettiva con ammoniaca (SCR), ed è finalizzata a supportare il committente nella selezione di sistemi catalitici commerciali più performanti.

La presente relazione riporta l'attività di caratterizzazione morfologica, chimica e funzionale di n.2 catalizzatori commerciali per il trattamento DeNOx (SCR) dei gas di scarico di motori diesel di truck/bus commissionata dalla società Green Energy con sede in Napoli attiva nella realizzazione "aftermarket" di sistemi di abbattimento delle emissioni nel settore "automotive". I campioni da analizzare sono stati consegnati a cura del committente presso i laboratori dell'Istituto di Ricerca sulla Combustione. L'attività di caratterizzazione mira alla verifica delle proprietà catalitiche di abbattimento degli ossidi di azoto attraverso la reazione di riduzione selettiva con ammoniaca (SCR), ed è finalizzata a supportare il committente nella selezione di sistemi catalitici commerciali più performanti.

La presente relazione riporta l'attività di caratterizzazione morfologica, chimica e funzionale di n.2 catalizzatori commerciali per il trattamento DeNOx (SCR) dei gas di scarico di motori diesel di truck/bus commissionata dalla società Green Energy con sede in Napoli attiva nella realizzazione "aftermarket" di sistemi di abbattimento delle emissioni nel settore "automotive". I campioni da analizzare sono stati consegnati a cura del committente presso i laboratori dell'Istituto di Ricerca sulla Combustione nel mese di Ottobre 2018. L'attività di caratterizzazione mira alla verifica delle proprietà catalitiche di abbattimento degli ossidi di azoto attraverso la reazione di riduzione selettiva con ammoniaca (SCR), ed è finalizzata a supportare il committente nella selezione di sistemi catalitici commerciali più performanti.

Phytoremediation technique is of growing interest in the restoration of trace elements contaminated soils. An integrated approach, combining land restoration and biomass post-processing, using a pyrolysis process for material and/or energy recovery, could allow for effective realization of such a process. The dependence of yields, chemical and structural characteristics of char on the biomass feedstock and pyrolysis thermal conditions are important features to be evaluated to explore the possible applications of such a product. In this framework, a comparative study of steam assisted slow pyrolysis of five biomasses has been carried at 873 K. Results demonstrate that for applications requiring high specific surface area Populus Nigra. On the contrary, if the goal is the maximization of the energy recovery in the char, Eucalyptus represents the best choice.

BACKGROUND/AIMS: Laparoscopic cholecystectomy is characterized by a higher incidence of iatrogenic biliary lesions. The Authors evaluate the role of hepaticojejunostomy in the treatment of iatrogenic biliary lesions following laparoscopic cholecystectomy in 51 patients observed in the Campania region, Italy from 1991 to 2003. METHODOLOGY: The Authors report the data of a retrospective multicentric study of 51 patients -39 women (76.47%), 12 men (13.53%)-reoperated on for major biliary lesions following laparoscopic cholecystectomy. Hepaticojejunostomy in 20 cases (39.21%) and T-Tube plasty in 20 cases (39.21%) were performed. RESULTS: The mean follow-up was 25.01 months. The mean hospital stay was 25.7 days. 1/51 patients (1.9%) died from intraoperative incontrollable hemorrhage while cumulative postoperative mortality was 9.8% (5/51 patients). Therapeutic success rate of hepaticojejunostomy was 70% with a T-Tube plasty success rate of 65%. 9/51 patients (17.64%) were reoperated while in 4/51 (7.84%) a biliary stent was positioned. In 1/51 patients (1.9%) a biliary cirrhosis and in 3/51 (5.7%) a bioumoral cholestasis was observed. CONCLUSIONS: Laparoscopic cholecystectomy causes a higher incidence of iatrogenic biliary lesions. Hepaticojejunostomy gives better long-term results and lower morbidity compared to T-Tube plasty. Management of septic complications in patients with iatrogenic biliary lesions represents the first therapeutic step.

Splenic abscess is an uncommon but potentially life-threatening disease that generally occurs in patients with neoplasia, immunodeficiency, hemoglobinopathies, trauma, metastatic infection, splenic infarction and diabetes. Splenic abscess should be considered in a patient with fever, left upper abdominal pain, and leukocytosis. Splenectomy has been the gold standard treatment for splenic abscess, however, burdened by high morbidity rate related clinical conditions of the patient. With the recent development of minimally invasive techniques and percutaneous US- or CT-guided procedures, the placement of a drainage has achieved excellent results with resolution of the disease in a high percentage of cases with low morbidity and negligible mortality. Percutaneous drainage is indicated for uniloculated or biloculated abscesses and for high risk surgical patients. It is a reliable technique with a high rate of therapeutical success and low costs compared to surgery. Other advantages include avoiding risks of intra-abdominal spillage and perioperative complications and saving time, along with a better patient compliance and an easier nursing care. The authors describe a case of splenic abscess treated by percutaneous US-guided drainage. Our results suggest that ultrasound-guided percutaneous drainage is a safe and feasible alternative to surgery in the treatment of splenic abscesses. In addition, it allows spleen preservation.

"\"Abstract. INTRODUCTION:. The Authors present their experience with laparoscopic total or subtotal colectomy (TC or SC) in three patients operated for intractable chronic slow transit constipation (STC), together with a review of literature.. MATERIAL AND METHODS:. From July 2005 to July 2009 three young patients affected by STC, after meticulous preoperative instrumental work-up and after failure of medical treatment, were submitted to laparoscopic TC and ideo rectal anastomosis (IRA) in two cases and to laparo assisted SC followed by Ceco Rectal Anastomosis (CRA) in one case. Number of daily bowel motions, urgency soiling, incontinence, abdominal pain, bloating with special regard to patient's quality of life, were analyzed.. RESULTS:. All the interventions were completed via laparoscopic approach. No postoperative morbidity or mortality were observed. After twelve months, the patients referred two-three daily evacuation of soft stool, with a good continence and disappearance of abdominal pain and other relatives symptoms. They reported excellent satisfaction with the surgical results and a significant improvement of their quality of life.. DISCUSSION:. TC with IRA and CRA after SC represent the most effective and widely used surgical operations in the treatment of STC, in well selected patients, after failure of conservative treatment. According to Literature data, and in our experience, no significant differences in terms of postoperative morbidity or mortality neither in quality of life were observed between the two operations. It is well demonstrated the feasibility of the laparoscopic approach in treatment of colorectal pathologies with typically advantages of less invasive surgery, respect of parietal integrity, less postoperative pain and ileus, fewer postoperative adhesions, a reduced hospitalisation and finally a better cosmesis.. CONCLUSIONS:. Laparoscopic TC and IRA and CRA after laparo assisted SC represent efficacious operations in the treatment of STC offering a good postoperative quality of life and reduced morbidity compared to open surgery.\""

Background. Subtotal parathyroidectomy (SP) and total parathyroidectomy (TP) with autotransplantation (TPai) are the most commonly adopted operations for the treatment of secondary hyperparathyroidism (2HPT). TP without autotransplantation had previously been confined to patients with advanced dialytic vintage, not eligible for kidney transplantation. Over the years, the procedure has gained more widespread use, but there is no precise knowledge on the immediate and long-term effects. Methods. The Authors analysed the immediate and long-term results of TP without autotransplantation, that is after the systematic removal of at least four glands in 20 patients operated for 2HPT, which were compared with results from TPai in an equal number of cases. Results. An improvement of the typical clinical symptoms was found in every patient undergoing surgery, and a significant reduction in intact parathyroid hormone (iPTH) serum levels was achieved. Immediate normalisation of iPTH level was observed in 11/20 TP cases, hypoparathyroidism in 4/20 and persistent HPT in five cases. One year of follow-up showed a slight increase in hypoparathyroidism, with 1/20 (5 %) recurrence of the disease. One year TPai results showed a similar percentage of euparathyroidism, as well as a higher long-term recurrence rate (4/20, 20 %), although values do not reach statistical significance. Conclusions. TP may still be considered the operation of choice in patients with aggressive forms of 2HPT or of advanced dialytic vintage, with no access to renal transplantation, because of its low recurrence rate (5%). Postoperative aparathyroidism is rare, while hypoparathyroidism and hypocalcaemia can be well controlled by medical treatment. Background: Subtotal parathyroidectomy (SP) and total parathyroidectomy (TP) with autotransplantation (TPai) are the most commonly adopted operations for the treatment of secondary hyperparathyroidism (2HPT). TP without autotransplantation had previously been confined to patients with advanced dialytic vintage, not eligible for kidney transplantation. Over the years, the procedure has gained more widespread use, but there is no precise knowledge on the immediate and long-term effects. Methods: The authors analyzed the immediate and long-term results of TP without autotransplantation, that is after the systematic removal of at least four glands in 20 patients operated for 2HPT, which were compared with results from TPai in an equal number of cases. Results: An improvement of the typical clinical symptoms was found in every patient undergoing surgery, and a significant reduction in intact PTH (iPTH) serum levels was achieved. Immediate normalization of iPTH level was observed in 11/20 TP cases, hypoparathyroidism in 4/20 and persistent HPT in 5/20 cases. One year of follow-up showed a slight increase in hypoparathyroidism, with 1/20 (5%) recurrence of the disease. One-year TPai results showed a similar percentage of euparathyroidism, as well as a higher longterm recurrence rate (4/20, 20%), although values do not reach statistical significance. Conclusions: TP may still be considered the operation of choice in patients with aggressive forms of 2HPT or of advanced dialytic vintage, with no access to renal transplantation, because of its low recurrence rate (5%). Post-operative aparathyroidism is rare, while hypoparathyroidism and hypocalcemia can be well controled by medical treatment. ©2012, Editrice Kurtis.

To date surgical treatment of secondary hyperparathyroidism (HPTs) is still controversial. Subtotal parathyroidectomy with sparing of a part of not-nodular gland and total parathyroidectomy with autotransplantation (subcutaneous or muscular) represent the most common procedures with the aim to warrant a condition of euparathyroidism. Total parathyroidectomy (or so presumed) represent an unusual therapeutic option as the risks arising from aparathyroidism and from the need of a substitutive therapy are largely known. The authors evaluate the surgical results collected from 47 consecutive patients affected by HPTs and Chronic Renal Failure (CRF) and operated on between January 1999 and January 2006. Probably, a proper indication to the type of surgical procedure could be based on the severity of the disease, on the age of the patient and on the expectation of transplant. The significant incidence of recurrence and persistent disease is due to autoimplantation or residual gland hypertrophy after subtotal parathyroidectomy, to the presence of supernumerary or ectopic glands, to cervico-mediastinic hypertrophy of cellular foci. The identification and removal of supernumerary glands, which may cause persisting hyperparathyroidism, is mandatory.

Mechanical cecorectal anastomosis after subtotal colectomy, in the treatment of slow transit constipation, probably represents the most attractive surgical alternative to total colectomy and ileorectal anastomosis. In fact the operation allows better results in terms of postoperative diarrhoea, fecal incontinence and postoperative adherential syndrome. Literature data have demonstrated the feasibility of the laparoscopic approach with tipically advantages of less invasive surgery respect of parietal integrity,less postoperative pain and ileus, fewer postoperative adhesions, a reduced hospitalitation and finally, a better cosmesis. The Authors report a case of mechanical end to end cecorectal anastomosis after laparo-assisted subtotal colectomy (by four trocars) preserving superior rectal and ilecolic vessels, for the treatment of slow transit constipation in a 20 years old male patient .The reported operative approach which links tipical laparoscopic advantages to a more "safety" and "accurate" extracorporeal mechanical anastomosis.

AIM: The Authors analyze the short and long-term results of surgical treatment in 70 consecutive patients operated on from for secondary Hyperparathyroidism (2HPT) of chronic kidney disease (CKD). MATERIAL OF STUDY: Seventy patients affected by 2HPT of CKD, in hemodialytic treatment, were observed from January 1999 to January 2009. Twentyseven patients were submitted to total parathyroidectomy (TP), 36 pts were submitted to total parathyroidectomy plus subcutaneous autoimplantation (TP ai), 7 pts were submitted to subtotal parathyroidectomy (SP). RESULTS: An improvement of the typical clinical symptoms was found in every patient undergoing surgery, and a significant reduction in intact parathyroid hormone (iPTH) serum levels was achieved. TP determined a lower incidence of one year relapse. After TPai 9/36 pts successfully underwent renal transplantation. DISCUSSION: To date surgical treatment of 2HPT is still controversial. SP and TPai are the most commonly adopted surgical interventions while TP had been previously been confined to patients with advanced dialytic vintage or for the treatment of recurrence, for the risks arising from aparathyroidism. TP allows a lower long-term relapse incidence and managing the resulting hypoparathyroidism appears straightforward with medical treatment. CONCLUSIONS: The Authors are in favour of early surgical intervention to prevent cardiovascular complications. TPai may be the operation of choice in patients eligible for kidney transplantation while TP, carachterized by a lower incidence of long term relapse, is reserved to patients not eligible for transplantation and affected by a more "aggressive" forms of 2HPT.

Background Pheochromocytoma is a rare neuroendocrine tumor which mostly involves the adrenal glands and in only 10% of cases originates in extra-adrenal chromaffin tissue. Laparoscopic adrenalectomy (LA) is the gold standard for surgical treatment of tumors up to 6 cm in diameter and weighing less than 100 g. However, the role of laparoscopy in the treatment of lesions over 6 cm in diameter is still controversial, especially as regards pheochromocytomas. Purpose The aim of this study is to report the results of a polycentric retrospective study of 44 patients with pheochromocytoma conducted between January 1998 and June 2009. Methods Between January 1998 and June 2009, 44 patients, 29 women and 15 men, with an average age of 45 years (range: 21-77), who suffered from pheochromocytoma, underwent LA after preoperative preparation with an alpha adrenergic receptor blocker, for at least 2 weeks. All procedures were performed under general anesthesia and the patients underwent intra-arterial pressure monitoring. Results The average operative time was 177 minutes (range: 90-300). In 2 cases (4.5%) conversion to open was necessary; in one due to the presence of adherential syndrome, and in the other due to suspected invasion of the renal vessels, which was not confirmed on the definitive histological exam. There was no mortality. Four patients (9%) had complications. There was one case of hemorrhage, which resolved intraoperatively, one case of delayed wound healing in a diabetic patient, one case of serosanguineous fluid collection in the periadrenal space and high fever, treated with ultrasound- guided percutaneous drainage, and one case of pneumothorax, cured by pleural drainage. Sixteen patients (36.4%) had hypertensive crises, and 4 (9%) had hypotensive crises, which resolved after medical therapy. The average length of hospital stay was 4.5 days (range: 3-8). Follow-up involved arterial blood pressure monitoring, measurement of urinary metanephrines every 6 months, and imaging studies only in patients with hypertension and/or elevated levels of metanephrines. One patient had to be reoperated on because of disease persistence and underwent open surgery via a posterior approach. There were no significant long-term complications. Conclusions For patients with pheochromocytoma LA is effective, safe, and chartacterized by low morbidity. Adequate preoperative treatment with an alpha adrenergic receptor blocker does not prevent hypertensive rises but facilitates management of cardiovascular instability. However, minimally invasive surgery for pheochromocytoma is a complex procedure and should therefore be performed by dedicated and experienced multidisciplinary teams in specialized centers.

The RET gene codes for a tyrosine kinase receptor, expressed in neural crest derived cells playing a central role during embryogenesis. The RET proto-oncogene is responsible for medullary thyroid cancer and multiple endocrine neoplasia type 2. To date, more than 50 germline point mutations have been described. A specific correlation between genotype and phenotype is well recognized. Genetic testing is predictive of cancer onset, age at onset and biological aggressiveness. In recent years, the concept of codon-oriented prophylactic surgery has been introduced and three levels of risk have been identified on the basis of specific mutations. A review of the literature shows the excellent results of laboratory, genetic and clinical research that have made it possible to reduce medullary thyroid cancer-related mortality.

Papillary and follicular thyroid carcinoma are still characterised by unclear biological and clinical behaviour with an autoptic incidence higher than the clinical incidence. Lymph-node involvement represents a prognostic factor that may increase the rate of local relapse, reducing long-term survival only in high risk patients--age > 45 years, M+, T > 3 cm, extra thyroidal extension, follicular histotype. The authors analyse the role of lymph-node cervical dissection. Routine or selective, extended or conservative lymphectomy are described in the literature. Prognostic factors are useful to determine the most appropriate surgical procedure. An elective cervical central dissection may be indicated in patients at high risk, while in cases of monolateral lymph-node metastases, in patients at low risk, a selective lymph node dissection of levels VI-III-IV is associated with lower morbidity. Modified radical neck dissection is reserved for patients at high risk or in cases of multiple lymph-node metastases (> 5) to reduce the incidence of local relapse. In the treatment of differentiated thyroid carcinoma an elective total thyroidectomy must be performed in combination with adjuvant radioiodine ablation.

An higher incidence rate of iatrogenic bile duct injuries is reported in cholecystectomy performed with the laparoscopy than with the laparotomy approach. The aim of this study was to provide a multicentre report on surgical treatment and the outcome of biliary complications during and following laparoscopic cholecystectomy. A questionnaire was mailed to all surgeons with experience in laparoscopic cholecystectomy in the Campania region. Data were collected from January 1991 to December 2003. Each patient was requested to indicate age, gender, associated diseases, site and type of lesion, surgical experience, diagnosis, treatment and complications. Twenty-six surgeons answered the questionnaire. Fifty-one patients (36 F/15 M; mean age: 42.5 +/- 11.9, range 13-91 years) with bile duct injuries following laparoscopic cholecystectomy were reported. The most frequent lesions were main bile duct partial or total transection. The intraoperative mortality rate was 1/51 (1.9%) due to a complex biliary and vascular injury. The postoperative mortality rate of revision surgery was 5/50 (10%). T-tube positioning (n = 20) and Roux-en-Y hepato-jejunostomy (n = 20) were the procedures most frequently performed. The complication rate in patients treated with the T-tube was significantly higher than in those treated with hepatico-jejunostomy. Surgical treatment of biliary injuries following laparoscopic cholecystectomy was characterized by unusually high mortality and morbidity for a non-neoplastic disease. Roux-en-Y hepato-jejunostomy remains the procedure of choice for these injuries.

An higher incidence rate of iatrogenic bile duct injuries is reported in cholecystectomy performed with the laparoscopy than with the laparotomy approach. The aim of this study was to provide a multicentre report on surgical treatment and the outcome of biliary complications during and following laparoscopic cholecystectomy. A questionnaire was mailed to all surgeons with experience in laparoscopic cholecystectomy in the Campania region. Data were collected from January 1991 to December 2003. Each patient was requested to indicate age, gender, associated diseases, site and type of lesion, surgical experience, diagnosis, treatment and complications. Twenty-six surgeons answered the questionnaire. Fifty-one patients (36 F/15 M; mean age: 42.5 +/- 11.9, range 13-91 years) with bile duct injuries following laparoscopic cholecystectomy were reported. The most frequent lesions were main bile duct partial or total transection. The intraoperative mortality rate was 1/51 (1.9%) due to a complex biliary and vascular injury. The postoperative mortality rate of revision surgery was 5/50 (10%). T-tube positioning (n = 20) and Roux-en-Y hepato-jejunostomy (n = 20) were the procedures most frequently performed. The complication rate in patients treated with the T-tube was significantly higher than in those treated with hepatico-jejunostomy. Surgical treatment of biliary injuries following laparoscopic cholecystectomy was characterized by unusually high mortality and morbidity for a non-neoplastic disease. Roux-en-Y hepato-jejunostomy remains the procedure of choice for these injuries.

The adverse health effects of aerosol combustion-formed carbon pollutants, ranging from polycyclic aromatic hydrocarbons (PAH) to solid soot (Ciajolo et al., 2009), are due both to particle size (the health impact could becomes even more important going down to the nanometric size range, (Kennedy, 2007, Kumfer et al. 2009) and to the aromatic species (polymer-like species and PAH) often strongly adsorbed on soot particles (Mathieu et al., 2007, Alfè et al., 2008). The complex chemical nature of nanometric particles is currently under study representing a fundamental step to understand their role in health impact and in soot formation process. In this work a novel analytical approach was used to characterize in detail the species adsorbed fraction on combustion-formed particulate by means of extraction with diverse solvents and further mass spectrometric and FT-IR spectroscopy analysis of the chemical functionalities of both soot and soot extract. Copyright © 2010 AIDIC servizi S.r.l.

Combustion-derived soot is a polydispersion of carbon-based molecules/particles ranging from a molecular scale length to a particle scale length (1-100 nm). It is considered responsible of respiratory and heart disease (Kumfer et al., 2009), and its mechanisms of action is related to the composition and structure, in turn mainly depending on the fuel and temperature environment in which soot is generated. Soot particles present a structural variability at a mesoscopic scale (size, geometry, nanostructure, primary particle diameter) that can be responsible of a different lung deposition degree and particle translocation behaviour. The toxic effects of inhaled dusts are believed to be mainly driven by oxidative stress which is the result of reactive oxygen species (ROS) (i.e. hydrogen peroxide, superoxide anion, hydroxyl radical) either generated directly by the particles/molecules or by cells in response to the particle exposure (Donaldson et al., 2005). This work aims to gain insights about the radical activity measured by electron spin resonance of soot generated from different fuels, namely benzene and ethylene, in relation to the specific local chemistry and nanostructural features as inferred by FT-IR and Raman spectroscopy. This study was performed on soot washed by solvent in order to eliminate light PAH (< 300u) adsorbed on soot surface with the aim to study the specific soot activity independently from the well known role of PAH. Copyright © 2010 AIDIC servizi S.r.l.

Optical Properties of Particulates Collected in Rich Premixed Benzene Flames at Different Temperatures