Laparoscopic Appendectomy in Italy: An Appraisal of 26,863 Cases

Objective: To evaluate the practice of laparoscopic appendectomy (LA) in Italy. Methods: On behalf of the Italian Society of Young Surgeons (SPIGC), an audit of LA was carried out through a written questionnaire sent to 800 institutions in Italy. The questions concerned the diffusion of laparoscopic surgery and LA over the period 1990 through 2001, surgery-related morbidity and mortality rates, indications for LA, the diagnostic algorithm adopted prior to surgery, and use of LA among young surgeons (<40 years). Results: A total of 182 institutions (22.7%) participated in the current audit, and accounted for a total number of 26863 LA. Laparoscopic surgery is performed in 173 (95%) institutions, with 144 (83.2%) routinely performing LA. The mean interval from introduction of laparoscopic surgery to inception of LA was 3.4 ± 2.5 years. There was an emergent basis for 8809 (32.8%) LA procedures (<6 hours of admission); 10314 (38.4%) procedures were performed on an urgent basis (<24 hours of admission); while 7740 (28.8%) procedures were elective. The conversion rate was 2.1% (561 cases) and was due to intraoperative complications in 197 cases (35.1%). Intraoperative complications ranged as high as 0.32%, while postoperative complications were reported in 1.2% of successfully completed LA. The mean hospital stay for successfully completed LA was 2.5 ± 1.05 days. The highest rate of intraoperative complications was reported as occurring during the learning curve phase of their experience (in their first 10 procedures) by 39.7% of the surgeons. LA was indicated for every case of suspected acute appendiceal disease by 51.8% of surgeons, and 44.8% order abdominal ultrasound (US) prior to surgery. A gynecologic counseling is deemed necessary only by 34.5% surgeons, while an abdominal CT scan is required only by 1.5%. The procedure is completed laparoscopically in the absence of gross appendiceal inflammation by 83%; 79.8% try to complete the procedure laparoscopically in the presence of concomitant disease; while 10.4% convert to open surgery in cases of suspected malignancy. Of responding surgeons aged under 40, 76.3% can perform LA, compared to 47.3% surgeons of all age categories. Conclusions: The low response rate of the present survey does not allow us to assess the diffusion of LA in Italy, but rather to appraise its practice in centers routinely performing laparoscopic surgery. In the hands of experienced surgeons, LA has morbidity rates comparable to those of international series. The higher diagnostic yield of laparoscopy makes it an invaluable tool in the management algorithm of women of childbearing age; its advantages in the presence of severe peritonitis are less clear-cut. Surgeons remain the main limiting factor preventing a wider diffusion of LA in our country, since only 47.3% of surgeons from the audited institutions can perform LA on a routine basis.

Imátgenes 25, 26, 27 y última imatgen

Su mirada recorrió los lomos del estante inferior y se detuvo en un título que le llamó la atención. Lo liberó de la hilera que lo aprisionaba y lo abrió al azar. Al menos eso era lo que pretendía, aunque el libro se abrió por una página señalada con un pliegue en la esquina superior. Quien lo practicó quería señalar un punto con una indicación perenne. Seguro que era cosa de su abuelo, fallecido hacía ya unos cuantos años. Fue precisamente el recuerdo de su muerte lo que le animó a entrar en la biblioteca. No sabía porqué, pero de repente le había venido a la mente la imagen del anciano leyendo ensimismado en aquel sillón antiguo, rodeado de incontables volúmenes, páginas, frases, palabras, letras.

Annual westward propagating anomalies near 26 degrees N and eddy generation south of the Canary Islands: remote sensing (altimeter/SeaWIFS) and in situ measurement

Seasonal changes in altimeter data are derived for the North Atlantic Ocean. Altimeter data are then used to examine annually propagating structure along 26 degree N. By averaging the altimeter data into monthly values or by Fourier analysis, a positive anomaly can be followed from 17 degree W to similar to 50 degree W along similar to 26 degree N. The methods give a westward travel speed of 1 degree of longitude a month and a half-life of one year for the average decaying structure. At similar to 50 degree W 26 degree N, the average structure is about 2.8 years old with an elevation signal of similar to 1 cm, having gravelled similar to 3300 km westward. The mean positive anomaly results from the formation of anticyclonic eddies which are generally formed annually south of the Canary Islands by late summer and which then travel westward near 26 degree N. Individual eddy structure along 26 degree N is examined and related to in situ measurements and anomalies in the annual seasonal concentration cycle of SeaWiFS chlorophyll-a.

Marine Zooplankton of Southern Britain - Part 2: Arachnida, Pycnogonida, Cladocera, Facetotecta, Cirripedia and Copepoda. Occasional Publication of the Marine Biological Association 26

This series of three guides (of which this is Part 2) collates taxonomic identification information for the zooplankton groups recorded off south-west Britain , primarily for local identification and training purposes. However, because prevailing currents also bring oceanic zooplankton into the English Channel , the range of species sampled off Plymouth covers the majority found over the shallower parts of northern European continental shelf (excluding the Mediterranean Sea ), so the guides should be more widely useful and hopefully make tackling zooplankton identification easier for a wider audience. The commonest truly planktonic species and the most widely studied groups are covered in most detail, but some information is also included on benthic, epibenthic and parasitic species that are sampled occasionally. For all groups there is at least information on their morphology, guidance on their identification and bibliographies giving identification resources.