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.

Na 50 Nachlass Arthur Schopenhauer - 'Schopenhauer-Archiv', 863 - Einladung nach Berlin

abgedruckt in: Schopenhauer-Jahrbuch 30 (1943), S. 210; Unterstreichungen Schopenhauers

Libia Castillo, Silvia (directora) (2007), Escuelas ruralizadas y desarrollo regional. Lecturas pedagógicas, Universidad Nacional de La Pampa - Miño y Dávlla, Santa Rosa, ISBN 978-950-863-092-6, 135p.

Fil: López, María Canela.

Povijest i pravo Slovenštine u crkvenom bogoslužju, sa osobitim obzirom na Hrvatsku. 1.sv. Od 863-1248.

No more published.

Operator's organizational, DS, GS, and depot maintenance manual including repair parts and special tools list for dehumidifier, desiccant, electric HS-863/G and air distribution manifolds, 3291-2 outlets, 3292-4 outlets, 3291-6 outlets, and 3479/3291-12 outlets.

Includes indexes.

Water rights settlement act. Hearings, Eighty-fourth Congress, second session on S. 863.

pt.1 March 19-23, 29, 1956. 417 p.--pt.2. June 22, 25, 1956. pp. 419-622.

Manufacturing management programs : are developing economies bridging the strategic gap?

Over the past decade there have been a large number of significant innovations in manufacturing which have resulted in more flexible and cost efficient methods and higher quality products, as manufacturers have set about upgrading their processes, systems and performance. This study compares the use of technologies and improvement programs between OECD and Non-OECD countries, and also between small and large firms, and examines differences in the use and outcomes across the economies and different sized firms. The empirical analysis provides an opportunity to test whether the ‘capabilities’ or strengths of a firm can be linked to these activities and examines if developing economies are using technology or management programs such as quality management and business process re-engineering to catch up to manufacturers in developed economies. The analysis utilises data from the second International Manufacturing Strategy Survey (IMSS), which encompasses 703 firms in 23 countries.

Synthesis and thermal analysis of Indium based hydrotalcites of formula Mg6In2(CO3)(OH)16•4H2O

Insight into the unique structure of layered double hydroxides has been obtained using a combination of X-ray diffraction and thermal analysis. Indium containing hydrotalcites of formula Mg4In2(CO3)(OH)12•4H2O (2:1 In-LDH) through to Mg8In2(CO3)(OH)18•4H2O (4:1 In-LDH) with variation in the Mg:In ratio have been successfully synthesised. The d(003) spacing varied from 7.83 Å for the 2:1 LDH to 8.15 Å for the 3:1 indium containing layered double hydroxide. Distinct mass loss steps attributed to dehydration, dehydroxylation and decarbonation are observed for the indium containing hydrotalcite. Dehydration occurs over the temperature range ambient to 205 °C. Dehydroxylation takes place in a series of steps over the 238 to 277 °C temperature range. Decarbonation occurs between 763 and 795 °C. The dehydroxylation and decarbonation steps depend upon the Mg:In ratio. The formation of indium containing hydrotalcites and their thermal activation provides a method for the synthesis of indium oxide based catalysts.