An unexpected highly stereoselective bisaziridination of (E,E)-1,4-dialkyl-2,3-dinitrobutadienes followed by a nitro group driven ring enlargement.

(+/-)-2,2'-Dinitro-2,2'-biaziridines were obtained by a direct aza-MIRC (Michael initiated ring closure) reaction on (E,E)-1,4-dialkyl-2,3-dinitro-l,3-butadienes under very mild conditions. The reactions occur with high stereoselectivity as shown by the enantioselective HPLC analyses performed on the crude mixtures. Ring enlargement to 3,3'-bi(1,2,4-oxadiazole) derivatives was easily obtained by a simple treatment with sodium iodide in DMSO, with an unforeseen regioselective aziridine C-C cleavage.

[Rectus sheath haematoma as an early complication of laparoscopic hemicolectomy: a case report and review of the literature].

We report a case of rectus sheath haematoma (RSH) in a patient undergoing laparoscopic right hemicolectomy and anticoagulant prophylaxis of a pulmonary thromboembolism (PTE) with low molecular weight heparin. This pathological condition is rare and could be a cause of misdiagnosis in patients with acute abdominal pain. It can be a serious complication in the course of anticoagulant therapy.

[Emergency laparoscopic cholecystectomy in the treatment of acute cholecystitis: when and how?].

Optimal surgical timing and operative technique in the treatment of acute cholecystitis are of major importance and are still debatable issues. We report the results of our study on the timing of surgery in a consecutive series of 163 patients treated in the emergency setting for acute cholecystitis over the period from 1998 to 2008. Early surgery and the partially downwards laparoscopic cholecystectomy technique provide a safe and effective way of treating these patients and preventing major complications.

[Understanding the different functions of vitamin D].

Exposure of the skin to sunlight is now considered the most important source of vitamin D in Western countries. It is presumed to contribute approximately two thirds of the total requirement, leaving the remaining one third to the few foods naturally rich in this vitamin. In the skin, vitamin D is synthesized as a cholesterol chain which undergoes structural modifications following exposure to UVB rays.

[The difficult start of nephrology in Rome].

Nephrology in Rome began in the 1960s with the arrival of Ernico Fiaschi in the wake of Cataldo Cassano at the Institute of Medical Pathology (later on Clinica Medica II). A group of doctors interested in nephrology was set up, with among them Giulio A. Cinotti, who was to become full professor of nephrology at the University of Rome ''La Sapienza'' in 1980.

[Continuous renal replacement therapies (CRRT) will remain the most widely adopted dialysis modality in the critically ill].

In the last 10-15 years, user-friendly continuous renal replacement therapy (CRRT) machines have played a major role in increasing the popularity of these techniques in intensive care settings. At present it is not clear which modality of renal replacement therapy (RRT) is optimal for critically ill patients with acute kidney injury (AKI). The choice between different modalities should therefore not be based on unproven ''outcome'' advantages but on evaluation of the clinical picture and logistical circumstances.

Genetic polymorphism of Angiotensin-Converting Enzyme is not associated with the development of Parkinson's disease and of L-dopa-induced adverse effects.

Sporadic Parkinson's disease (PD) is a frequent neurodegenerative movement disorder. Both environmental and genetic factors have been studied in the etiology of PD. Among genetic factors, increasing evidences suggest that deletion/insertion (D/I) gene polymorphism of the angiotensin I-converting enzyme (ACE) may be involved in the pathogenesis of PD and in the occurrence of the adverse effects of chronic L-dopa therapy.

[The non-invasive catheterization laboratory].

The objective of this review was to explore the clinical relevance of Doppler echocardiographic techniques in the evaluation of right and left ventricular function. It is well known that echocardiographic and Doppler analysis are able to provide information about several hemodynamic parameters, such as cardiac output, diastolic filling pressure, vascular resistances and pulmonary arterial pressures. This integrated approach, completely reliable and non-invasive, could allow to obtain useful information not only from a diagnostic and prognostic point of view but also for a potential therapeutic management, either pharmacological or surgical.

[Quadrantectomy and removal of the sentinel lymph node under local anaesthesia in the day hospital setting].

In recent years, breast carcinoma diagnostics and therapy have evolved very considerably, allowing conservative surgery in most cases. These kinds of major operations have been greatly simplified since the introduction of the sentinel lymph node approach, with the possibility of a day surgery operation under local anaesthesia. The aim of this study, after thorough analysis of the axillary lymph nodes with ultrasound and cytological examinations, was to assess whether it would be possible to distinguish between negative and metastatic lymph nodes and whether the operation could be performed under local anaesthesia without hospitalisation.

[Severe postoperative complications in colorectal surgery for cancer. Incidence related to the techniques employed: open versus laparoscopic colectomy].

In this preliminary retrospective study, severe postoperative complications following surgery for colorectal cancer were analysed, comparing the results obtained with open versus laparoscopic colectomy. Over the period 2005-2007, 50 patients (29 female, 21 male; age range: 32-85 years) underwent surgical treatment for colorectal-anal cancer. Twenty-nine (58%) were submitted to the traditional open technique and 21 (42%) to the laparoscopic technique.

[Acute pulmonary oedema associated with laryngospasm after thyroidectomy: a case report].

In this paper, a case report of acute pulmonary oedema following thyroidectomy in a 51-year-old male patient is reported. The aetiological factor was vigorous inspiratory effort against an obstruction of the upper airway occurring immediately after extubation. The patient was transferred to intensive care unit and treated with CPAP ventilation.

[Should surgical thread influence the outcome of haemorrhoidectomy with the transfixed stitch technique?].

The technique of haemorrhoidectomy with the transfixed stitch technique (TST) is a surgical treatment modality for haemorrhoids that is available to the surgeon. The authors, through a personal interpretation of haemorrhoids based on the PATE 2006 classification, report the results of a comparative trial, using TST with two different surgical threads, Assufil and Monofil. The aim of this prospective randomised trial was to compare the results with the use of each surgical thread, analysing early postoperative side effects (bleeding, urinary retention, pain), late postoperative side effects (pain, bleeding, stricture, anal secretion, tenesmus and faecal incontinence), return to active life and quality of life.

Baroreflex sensitivity in the elderly with silent myocardial ischemia.

In order to assess high-pressure baroceptor sensitivity and parasympathetic function in elderly patients with silent myocardial ischemia, we selected 45 inpatients in our geriatric unit for a prospective cohort study of patients with coronary heart disease. All patients were over 65 years of age (37 men and 8 women) and had coronary heart disease, documented by an angiographic study and electrocardiographic evidence of myocardial ischemia during exercise stress testing, performed according to the Bruce protocol. The subjects were divided in three subgroups: group 1 (22 patients) with electrocardiographic and echocardiographic history of myocardial infarction but no angina chest pain during exercise testing; group 2 (13 patients) with no exercise induced chest pain; and group 3 (10 patients) with exercise-induced chest pain.

Splenic infarction, rare cause of acute abdomen, only seldom requires splenectomy. Case report and literature review.

Splenic infarction is a rare disorder, commonly without a characteristic symptomatology, that rarely requires surgical procedure; in fact it has the peculiar feature of an high tendency for complete healing after the only medical approach. Furthermore in order to prevent OPSI, only in case of clear, persistent symptoms or complications it may be necessary surgical laparoscopic or open approach. The Authors report on a recent case observed in emergency of splenic infarction with infectious complications that made the surgical procedure mandatory.

N-propargylic beta-enaminones: common intermediates for the synthesis of polysubstituted pyrroles and pyridines.

N-Propargylic beta-enaminones have been used as common intermediates for the synthesis of polysubstituted pyrroles and pyridines. Best results have been obtained using DMSO as solvent. In the presence of Cs(2)CO(3) N-propargylic beta-enaminones are cyclized to pyrroles in good to high yields, whereas omitting bases and using CuBr leads to the selective formation of pyridines.

[Assessment of the risk of arm repetitive movements among workers in the motor vehicle glass finishing industry].

The aim of the study was to evaluate risk associated with biomechanical overload of the upper limbs in workers exposed to repetitive movements, employed to the finishing of glasses for motor vehicles. The risk assessment was performed using the OCRA method (OCRA index for every worker and Check-List OCRA for every workstation) and the results have been distributed for exposure levels. Altogether the results suggested the existence of risk associated with repetitive movements of the upper limbs and different risk classes (high, medium, light, very light).

Anatomic relationship between trigeminal nerve and temporomandibular joint.

Temporomandibular joint disorders (TMD) is a collective term used to describe pathologic conditions involving temporomandibular joint (TMJ), masticatory muscles and associated structures. Common related complaints include local pain, limited mouth opening and TMJ noises whereas symptoms often associated to TMD with debated pathogenesis enclose earache, headaches, tinnitus and trigeminal-like symptoms such as atypical orofacial pain. In particular, TMD trigeminal associated symptoms are intricate, difficult to treat and exert a great impact on everyday life of the patients thus invoking a complex multidisciplinary treatment.

[A new accessory for the isostatic anal retractor].

The authors present the characteristics and the advantages deriving from the use of a new accessory to be fitted on the isostatic anal retractor in order to further improve visualisation of the operative field during the treatment of pelvic and anal pathologies. The isostatic anal retractor consists of a system of rotating rings and valves which are positioned with surgical stitches on the patient's buttocks. The new accessory is characterised by one or more elastic systems that can be fixed to the retractor metal ring and attached by means of curved needles to flaps of anal mucosa, affording enhanced visibility of the operative field.

[Postoperative metabolic acidosis: use of three different fluid therapy models].

Intraoperative fluid administration is considered an important factor in the management of metabolic acidosis following surgical procedures. The aim of this study was to compare three types of intraoperative infusional models in order to evaluate their effect on acid-base changes in the immediate postoperative period as calculated by both the Henderson-Hasselbach equation and the Stewart approach. Forty-seven patients undergoing left hemicolectomy were enrolled in the study and assigned randomly to receiving 0.

[Minimally invasive adrenalectomy: transperitoneal vs. retroperitoneal approach].

Laparoscopic adrenalectomy is now regarded as the procedure of choice for most adrenal glands presenting surgical pathology. The primary adrenal-specific contraindication to laparoscopic adrenalectomy today is the presence of a large adrenal mass with evidence of local infiltration or venous invasion. We used our multicentre experience to compare the transperitoneal (TLA) and retroperitoneal (RLA) minimally invasive approaches.

Solution-phase synthesis of 2-cyano and 2-amido aziridinyl peptides.

Starting from a library of 2-l-α-amino acyl ()-acrylonitriles, different short 2-cyano and 2-amido aziridinyl peptides, potential protease inhibitors, were obtained under parallel solution-phase conditions. The transformations include careful selection of conditions for aziridine deprotection and cyano group partial hydrolysis.