No abstract

The aim of the study was to compare the early results in 52 patients randomly allocated to undergo either stapled or open hemorrhoidectomy. Seventy‐four patients with grade III and IV hemorrhoids were randomly allocated to undergo either stapled (37 patients) or open (37 patients) hemorrhoidectomy. Stapled hemorrhoidectomy was performed with the use of a circular stapling device. Open hemorrhoidectomy was accomplished according to the Milligan‐Morgan technique. Postoperative pain was assessed by means of a visual analogue scale (V.A.S.). Recovery evaluation included return to pain‐free defecation and normal activities. A 6‐month clinical follow‐up and a 17.5 (10 to 27)‐month median telephone follow‐up was obtained in all patients. Operation time for stapled hemorrhoidectomy was shorter (median 25 [range 15 to 49] minutes versus 30 [range 20 to 44] minutes, p = 0.041). Median (range) V.A.S. scores in the stapled group were significantly lower (V.A.S. score after 4 hours: 4 [2 to 6] versus 5 [2 to 8], p = 0.001; V.A.S. score after 24 hours: 3 [1 to 6] versus 5 [3 to 7], p = 0.000; V.A.S. score after first defecation: 5 [3 to 8] versus 7 [3 to 9], p = 0.000). Resumption of pain‐free defecation was significantly faster in the stapled group (10 [6 to 14] days vs 12 [9 to 19] days, p = 0.001). At follow‐up 4 weeks and 6 months postoperatively the median (range) symptom severity score was similar in both groups (1 [0 to 2] versus 0 [0 to 3], p = 0.150 and 0 [0 to 2] versus 0 [0 to 2], p = 0.731). At long‐term follow‐up occasional pain was present in 6/37 (16.2) patients in the stapled group and 7/37 (18.9%) in the Milligan‐Morgan group (p = 1.000); episodes of bleeding were reported by 8/37 (21.6%) patients in the stapled group and 5/37 (13.5%) patients in the Milligan‐Morgan group (p = 0.542). No problems related to continence and defecation were reported in either group. Patients were satisfied with the operation in 33/37 (89.2%) cases in the stapled group and 31/37 (83.8%) cases in the Milligan‐Morgan group (p = 0.735). Hemorrhoidectomy with a circular staple device is easy to perform and achieves better results than the Milligan‐Morgan technique in terms of postoperative pain and recovery. Comparable results are obtained at long‐term follow‐up.

OBJECTIVE: It has been reported that an increased availability of free fatty acids (NEFA) not only interferes with glucose utilization in insulin-dependent tissues, but may also result in an uncoupling effect of heart metabolism. We aimed therefore to investigate the effect of an increased availability of NEFA on gene expression of proteins involved in transmembrane fatty acid (FAT=CD36) and glucose (GLUT4) transport and of the uncoupling proteins UCP2 and 3 at the heart and skeletal muscle level. STUDY DESIGN: Euglycemic hyperinsulinemic clamp was performed after 24 h Intralipid 1 plus heparin or saline infusion in lean Zucker rats. Skeletal and heart muscle glucose utilization was calculated by 2-deoxy-[1-3 H]-D-glucose technique. Quantification of FAT=CD36, GLUT4, UCP2 and UCP3 mRNAs was obtained by Northern blot analysis or RT-PCR. RESULTS: In Intralipid 1 plus heparin infused animals a significant decrease in insulin-mediated glucose uptake was observed both in the heart (22.62 AE 2.04 vs 10.37 AE 2.33 ng=mg=min; P < 0.01) and in soleus muscle (13.46 AE 1.53 vs 6.84 AE 2.58 ng=mg=min; P < 0.05). FAT=CD36 mRNA was significantly increased in skeletal muscle tissue ( þ 117.4 AE 16.3%, P < 0.05), while no differences were found at the heart level in respect to saline infused rats. A clear decrease of GLUT4 mRNA was observed in both tissues. The 24 h infusion of fat emulsion resulted in a clear enhancement of UCP2 and UCP3 mRNA levels in the heart (99.5 AE 15.3 and 80 AE 4%) and in the skeletal muscle (291.5 AE 24.7 and 146.9 AE 12.7%). CONCLUSIONS: As a result of the increased availability of NEFA, FAT=CD36 gene expression increases in skeletal muscle, but not at the heart level. The augmented lipid fuel supply is responsible for the depression of insulin-mediated glucose transport and for the increase of UCP2 and 3 gene expression in both skeletal and heart muscle.

The aim of the study was prospectively to compare the early results and outcome in 105 patients randomly allocated to undergo tension-free laparoscopic hernia repair (LHR) with transabdominal preperitoneal technique (53 patients) or open hernia repair (OHR) with mesh apposition (52 patients). The mean (SD) operation time was longer in the LHR group than in the OHR group: 49.6 (5.4) versus 33. 9 (6.2) minutes; p < 0.001. One laparoscopic case was converted to open repair to deal with a hemorrhage from an aberrant obturatory artery at the level of Cooper's ligament. Groin discomfort or pain was the most common complication after both procedures. The patients requiring none, one, two, or more than two doses of intramuscular diclofenac were, respectively, 40.4%, 40.4%, 15.4%, and 3.8% after LHR and 50.0%, 30.8%, 17.3%, and 1.9% after OHR (p = 0.69; NS). The mean +/- SEM (range) postoperative visual analog scale score, ranging from 0 (no pain) to 10 (worst pain imaginable), was 3.1 +/- 0.2 (1-7) in the LHR subset and 2.7 +/- 0.2 (1-5) in the OHR group (p = 0.14; NS); on the second postoperative day the score was 2.3 +/- 0.2 (1-6) and 1.8 +/- 0.1 (1-4), respectively (p < 0.03). The time +/- SEM (range) of resumption of pain-free normal activities and work was faster in OHR group: 6.1 +/- 0.2 (4-8) weeks versus 6.5 +/- 0.1 (4-8) weeks; p < 0.03. Our results showed that tension-free open hernia repair is superior to LHR in terms of postoperative pain with no important differences in recovery.

Epidemiological data on Becker muscular dystrophy (BMD) and Duchenne muscular dystrophy (DMD) from a large sample of the Italian population are reported. For BMD the incidence rate was found to be 5.5 X 10(-5) live-born males (lbm) and the prevalence rate, 13.1 X 10(-6); the mutation rate was estimated to be about 6.0 X 10(-6). For DMD the incidence and prevalence rates were found to be respectively 26 X 10(-5) lbm and 31.6 X 10(-6). The DMD mutation rate obtained by the Haldane formula was 86.6 X 10(-6) and by the semi-direct method, 65.6 X 10(-6). The results are discussed in the light of possible allelism of BMD and DMD.

The outcome of various surgical procedures carried out in patients with severe (homozygote) factor XII deficiency were investigated for the appearance of blood coagulation-related complications with particular emphasis on thrombotic complications. The surgical procedures were total mastectomy, tonsillectomy and adenoidectomy, placement of a hip prosthesis, and double hernia repair. None of the patients slowed any complication. Several other reported cases of surgical procedures carried out in several patients ware found in the literature. Bleeding or thrombotic complications were noted in none of these cases. The surgical procedures in some cases were minor such as adenoidectomy, tonsillectomy, or nasal polyp removal. However several major surgical procedures were carried out in some patients (cholecystectomy, gastrectomy, repair of atrial septal defect, coronary bypass). All patients remained asymptomatic. In some cases whole blood and/or plasma were used as requested by the caring surgeons. In a few patients, the plasma was given prophylactically because of the long partial thromboplastin time. Finally, three patients (two for cardiac surgery and one after hip replacement) received heparin prophylaxis as foreseen by accepted procedures without the undue sequels. These data supply further evidence that factor XII deficiency does not only show any bleeding tendency but also can withstand even major surgical procedures without thrombotic complications.

The reagents most frequently used for FVII activity assay are obtained by rabbit brain or human placenta. In recent years, human recombinant thromboplastins have received great attention. FVII activity in FVII deficiency is usually low, regardless of the thromboplastin used. There are a few exceptions to this rule. These are represented by FVII Padua (Arg304Gln), FVII Nagoya (Arg304Trp), and FVII (Arg79Gln). In these three instances, clear discrepancies were noted in the FVII activity depending on the thromboplastin used. This indicates that at least two areas of FVII are involved in tissue binding, namely an epidermal growth factor domain of the light chain (Arg79Gln) and the catalytic domain (Arg304), controlled by exons 4 and 8, respectively. Since these three variants are cross reactive material positive, namely they are Type 2 defects, all other variants with normal antigen should be investigated by a panel of at least three tissue thromboplastins (rabbit brain, human tissue or human recombinant, and ox brain derived) in order to obtain a satisfactory classification.

Abstract. The weather forecasts for precipitation have considerably improved in recent years thanks to the increase of computational power. This allows for the use of both a higher spatial resolution and the parameterization schemes specifically developed for representing sub-grid scale physical processes at high resolution. However, precipitation estimation is still affected by errors that can impact the response of hydrological models. To the aim of improving the hydrological forecast and the characterization of related uncertainties, a regional-scale meteorological–hydrological ensemble is presented. The uncertainties in the precipitation forecast and how they propagate in the hydrological model are also investigated. A meteorological–hydrological offline coupled ensemble is built to forecast events in a complex-orography terrain where catchments of different sizes are present. The Best Discharge-based Drainage (BDD; both deterministic and probabilistic) index, is defined with the aim of forecasting hydrological-stress conditions and related uncertainty. In this context, the meteorological–hydrological ensemble forecast is implemented and tested for a severe hydrological event which occurred over Central Italy on 15 November 2017, when a flood hit the Abruzzo region with precipitation reaching 200 mm (24 h)−1 and producing damages with a high impact on social and economic activities. The newly developed meteorological–hydrological ensemble is compared with a high-resolution deterministic forecast and with the observations (rain gauges and radar data) over the same area. The receiver operating characteristic (ROC) statistical indicator shows how skilful the ensemble precipitation forecast is with respect to both rain-gauge- and radar-retrieved precipitation. Moreover, both the deterministic and probabilistic configurations of the BDD index are compared with the alert map issued by Civil Protection Department for the event showing a very good agreement. Finally, the meteorological–hydrological ensemble allows for an estimation of both the predictability of the event a few days in advance and the uncertainty of the flood. Although the modelling framework is implemented on the basins of the Abruzzo region, it is portable and applicable to other areas.