No abstract

Introduction. Aim of the present work is to review the literature to point out the role of laparoscopic reversal of Hartmann procedure. Material and Methods. Number of patients, age, sex, etiology, Hinchey classification, interval between procedure and reversal, position of the first trocars, mean operative time (min), number and causes of conversion, length of stay, mortality, complications, and quality of life were considered. Results. 238 males (52.4%) and 216 females (47.6%) between 38 and 67 years were analyzed. The etiology was diverticulitis in 292 patients (72.1%), carcinoma in 43 patients (10.6%), and other in 70 patients (17.3%). Only 7 articles (22.6%) reported Hinchey classification. The interval between initial procedure and reversal was between 50 and 330 days. The initial trocar was open positioned in 182 patients (43.2%) through umbilical incision, in 177 patients (41.9%) in right upper quadrant, and in 63 patients (14.9%) in colostomy site. The operative time was between 69 and 285 minutes. A total of 83 patients (12.1%) were converted and the causes were reported in 67.4%. The length of stay was between 3 and 12 days. 5 patients (0.7%) died. The complications concern 112 cases (16.4%). Conclusion. The laparoscopic Hartmann's reversal is safer and achieves faster positive results.

The present paper reports on the study of deterministic instabilities in the atomic cloud of a magneto-optical trap. Giant periodic and erratic self-oscillations are experimentally observed and analyzed through a simple original model taking into account the shadow effect and the spatial distribution of the atoms in the cloud. We show that giant oscillations are induced by a homoclinic orbit merging in the neighborhood of a Hopf bifurcation.

We present experimental and numerical studies of the atomic motion in an optical lattice displaying a fivefold rotational symmetry. The atomic transport has been investigated by measuring the time evolution of the size of the atomic cloud. The experimental results are compared to those of a semiclassical Monte Carlo simulation of the atomic motion in a three-dimensional optical quasicrystal. A good agreement has been obtained on the anisotropy of the diffusive expansion of the cloud. ͓S1050-2947͑99͒50312-0͔PACS number͑s͒: 32.80.Pj, 61.44.Br RAPID COMMUNICATIONS R4234PRA 60 GUIDONI, DÉ PRET, DI STEFANO, AND VERKERK RAPID COMMUNICATIONS R4236PRA 60 GUIDONI, DÉ PRET, DI STEFANO, AND VERKERK

Laparoscopic entry is a blind procedure and it often represents a problem for all the related complications. In the last three decades, rapid advances in laparoscopic surgery have made it an invaluable part of general surgery, but there remains no clear consensus on an optimal method of entry into the peritoneal cavity. The aim of this paper is to focus on the evolution of two used methods of entry into the peritoneal cavity in laparoscopic surgery.

The cloud of cold atoms obtained from a magneto-optical trap is known to exhibit two types of instabilities in the regime of high atomic densities: stochastic instabilities and deterministic instabilities. In the present paper, the experimentally observed deterministic dynamics is described extensively. Three different behaviors are distinguished. All are cyclic, but not necessarily periodic. Indeed, some instabilities exhibit a cyclic behavior with an erratic return time. A one-dimensional stochastic model taking into account the shadow effect is shown to be able to reproduce the experimental behavior, linking the instabilities to a several bifurcations. Erraticity of some of the regimes is shown to be induced by noise. PACS. 32.80.Pj Optical cooling of atoms; trapping -05.45.-a Nonlinear dynamics and nonlinear dynamical systems -05.40.Ca NoiseRecent studies have shown that the collective behavior of the atomic cloud produced by a MOT exhibit both stochastic instabilities [7,9] and deterministic instabilities [8]. The former has been extensively described in [9]. A model demonstrates that the different stochastic behaviors observed in the experiments are well explained if the absorption of light by the atoms is taken into account, through the so-called shadow effect [12]. It is also shown that these stochastic instabilities are not "instabilities" in the usual meaning, as they result from an amplification of noise, due, from a dynamical point of view, to the folded structure of the stationary solutions. The same model was also predicting, for slighly different values of the parameters,

AIM:To investigate our clinical experience with combined laparo-endoscopic Rendezvous (RV) for the treatment of patients affected by gallstones and common bile duct (CBD) stones and especially to study the never evaluated opinion of the endoscopist concerning the difficulty of the intraoperative endoscopic procedure during the RV in comparison with standard endoscopic retrograde cholangio-pancreatography (ERCP). METHODS:Eighty consecutive patients affected by cholecystolithiasis and diagnosed or suspected CBD stones were treated with a standardized "tailored" RV. The relevant technical features, the feasibility, the effectiveness in stone clearance, the safety but also the simple evaluation of difficulty and agreement of the endoscopist were analyzed with a questionnaire. R E S U LT S :T h e f e a s i b i l i t y w a s 9 7. 5 % a n d t h e effectiveness 100% concerning CBD clearance and solution of coexisting problems at the papilla. Minor morbidity was 3.3%, the operating time was prolonged by a mean of 14 min, the mean hospital stay was 3.8 d and only one stone's recurrence occurred. The endoscopist evaluated the procedure to be simpler than standard ERCP-ES in 81.2% of the cases. C O N C L U S I O N :S i m u l t a n e o u s R V c a r r i e s h i g h effectiveness and safety at least comparable to those reported for other options. The endoscopist is very often satisfied with this approach because of the minimization of some steps of the endoscopic procedure and avoidance of relevant iatrogenic risk factors. If the mandatory collaboration between surgeons and endoscopists is guaranteed, this approach can often be preferable for the patient, the surgeon, the endoscopist and the hospital.

Background: There is a lack of studies that explore the possible association between body weight, psychological symptoms, and migraine severity in pediatric populations. The purpose of the study was to explore: (1) the association between body weight and the frequency of migraine attacks, (2) the possible differences in anxiety and depression symptoms according to the frequency of attacks and body weight, and (3) the possible mediating role of anxiety and/or depression in the association between body weight and frequency of migraine attacks in children. Methods: One hundred and eleven children/adolescents with migraine were included (47 boys and 64 girls; mean age 11.7; ±2.4 years). The patients were classified as: (1) high frequency patients, reporting from weekly to daily episodes and (2) low frequency patients, with ≤3 episodes per month. According to their body mass index percentiles, the patients were divided in "Normal weight" (from ≥5 to <85 percentile), "Overweight" (from ≥85 to <95 percentile), and "Obese" (≥95 percentile). Given the low number of obese patients, the overweight and obese groups were considered together in the "Overweight" group. Anxiety and depression symptoms were assessed by the Self-Administered Psychiatric Scales for Children and Adolescents (SAFA). Results: Fifty-four patients were normal in weight (49.6%), while 56 patients (50.4%) were overweight. The overweight patients showed a higher frequency of migraine attacks (64.7%; p < 0.05). Patients with a high frequency of attacks reported higher scores in all SAFA-Anxiety subscales (SAFA-A Tot: F = 15.107; p = 0.000). Overweight patients showed a significantly higher score in the "Separation anxiety" subscale (F = 7.855; p = 0.006). We found a mediating role between the overweight and high frequency for total anxiety (z = 2.11 ± 0.03; p < 0.05) and social anxiety (z = 2.04 ± 0.03; p < 0.05). Conclusions: Our results suggest that, among the children suffering from migraine, the overweight status is associated with a higher frequency of attacks and separation anxiety symptoms. In particular, our study provides the first evidence of the role of anxiety in linking overweight and the frequency of migraine attacks in children and adolescents.