Modified patch repair of femoral hernia after inguinal herniorrhaphy

Background and aim. It has been reported that femoral hernias are rather common after a previous repair of inguinal hernia. We herein present a modified patch repair technique for large femoral hernias that develop after a Lichtenstein operation for ipsilateral inguinal hernia. Patients and methods. The modified technique for femoral hernia was applied to three patients who had a Lichtenstein repair for inguinal hernia. All patients were male. Hernia sac is dissected completely and sent back into to the preperitoneal space. Special attention should be given to the prevascular component of the sac. It is dissected as deep as possible into the preperitoneal space over the femoral vein. The defect is quite wide in this particular type of femoral hernia following Lichtenstein repair. A prosthetic patch that matches the defect is prepared. The medial edge of the mesh is configured to correspond to the pubic corner and lacunar ligament. The lateral margin of the patch is cut to create several petals for inverting the mesh above and medial to the femoral vein to prevent prevascular herniation. The mesh is secured to inguinal ligament, ilioinguinal tract, lacunar ligament, and Cooper ligament. Few sutures are put on the pubic corner and lacunar ligament. Results. One patient was discharged after two hours, other two stayed overnight. Readmission because of seroma development was recorded in two cases where standard polypropylene meshes were used. No complication was observed in the other patient who received lightweight meshes. No early recurrences were recorded after 4, 9, and 30 months. Conclusion. Femoral recurrence after previous inguinal hernia repair seems to be a specific entity. It has a prevascular component and the hernia defect can be much larger than that of a primary femoral hernia. A patch repair with infra-inguinal approach can be a valuable alternative with low complication rate.

Aortic valve replacement through the upper ministernotomy. Preliminary experience with modified technique

Minimally invasive approach for aortic valve surgery has been developed since 1995, reducing the complications related to the full sternotomy. We have introduced a new method for central cannulation that reduces the length of surgical incision for the aortic valve replacement through upper mini-sternotomy. To improve the surgical view without enlargement of the incision, two small additional incisions are performed for both arterial and atrial cannulation. We have used the modified technique in 60 patients without sternal infection or other surgical complications and with good cosmetic results. Cardiac surgery - Aortic valve replacement - Minimally invasive approach.

MSW: from pollution/degradation source to resource

Municipal Solid Waste is one of the biggest challenges that cities are facing: MSW is considered of the main sources of energy consumption, urban degradation and pollution. This paper defines the major negative effects of MSW on cities and proposes new solutions to guide waste policies. Most contemporary waste management efforts are focused at regional government level and based on high tech waste disposal by methods such as landfill and incineration. However, these methods are becoming increasingly expensive, energy inefficient and pollutant: waste disposal is not sustainable and will have negative implications for future generations. In this paper are proposed all the principle solutions that could be undertaken. New policy instruments are presented updating and adapting policies and encouraging innovation for less wasteful systems. Waste management plans are fundamental to increase the ability of urban areas effectively to adapt to waste challenges. These plans have to give an outline of waste streams and treatment options and provide a scenario for the following years that significantly reduce landfills and incinerators in favor of prevention, reuse and recycling. The key aim of an urban waste management plan is to set out the work towards a zero waste economy as part of the transition to a sustainable economy. Other questions remain still opened: How to change people’s behavior? What is the role of environmental education and risk perception? It is sure that the involvement of the various stakeholders and the wider public in the planning process should aim at ensuring acceptance of the waste policy.

Review Pages: Planning for Livable and Safe Cities: Energy, Pollution and the Degradation of the Urban Environment

Starting from the relationship between urban planning and mobility management, TeMA has gradually expanded the view of the covered topics, always remaining in the groove of rigorous scientific in-depth analysis. During the last two years a particular attention has been paid on the Smart Cities theme and on the different meanings that come with it. The last section of the journal is formed by the Review Pages. They have different aims: to inform on the problems, trends and evolutionary processes; to investigate on the paths by highlighting the advanced relationships among apparently distant disciplinary fields; to explore the interaction’s areas, experiences and potential applications; to underline interactions, disciplinary developments but also, if present, defeats and setbacks. Inside the journal the Review Pages have the task of stimulating as much as possible the circulation of ideas and the discovery of new points of view. For this reason the section is founded on a series of basic’s references, required for the identification of new and more advanced interactions. These references are the research, the planning acts, the actions and the applications, analysed and investigated both for their ability to give a systematic response to questions concerning the urban and territorial planning, and for their attention to aspects such as the environmental sustainability and the innovation in the practices. For this purpose the Review Pages are formed by five sections (Web Resources; Books; Laws; Urban Practices; News and Events), each of which examines a specific aspect of the broader information storage of interest for TeMA.