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The refractive indexes, material attenuation and damage fractions of a multi-step ion implanted Lithium Niobate (LiNbO3) waveguide were analyzed as functions of the annealing temperatures. An almost flat damage depth profile was designed to reduce the uncertainties related to the indexes profile shape, thus providing a better test-case for the characterizations. The measurements performed on the fabricated optical waveguides confirmed the predicted step-index profiles showing that the light is confined inside the damaged layer. The low measured attenuation (less than 0.8 dB/cm @ 632.8 nm) makes the obtained waveguide attractive for device fabrication.

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INTRODUCTION: Aim of our study was to compare the results of the laparoscopic technique to those obtained by traditional open approach in patients with colon cancer. The advantages, disadvantages, and the contraindications (real and presumptive) of this mini-invasive approach are described, by comparing the data obtained from the international literature with our clinical experience. PATIENTS AND METHODS: From February 2000 to May 2006, we performed 73 laparoscopic colectomies for cancer in the Operative Unit of General and Laparoscopic Surgery, Department of Surgical Sciences of the University of Chieti, Italy. The data of these patients were compared with the data obtained from 141 other patients who underwent open procedure for the same pathology in the same period and in the same Unit. Factors such as obesity, previous major abdominal surgery, T4 cancers, perforation and obstruction of the colon, tumor located in the transverse colon or in the left flexure of the colon were considered contraindications to laparoscopic approach. RESULTS: The length of surgical specimens and the number of lymph nodes removed did not show significant differences in the two groups. Two patients in the open procedure group died in the postoperative period. No postoperative death was noted in the group of patients operated by laparoscopic method. Postoperative complications requiring re-operation were observed in 9 patients in the open group and in 3 patients of laparoscopic group. Postoperative complications not requiring re-operation were observed in 16 patients in the open group and in 4 patients in laparoscopic group. Hospital stay was shorter for laparoscopic right or left colectomy compared to corresponding open procedures. At the follow-up (a mean 30 months), the overall survival was 78% for open colectomies and 82.1% for laparoscopic colectomies. Disease-free survival, excluding patients with stage IV tumor and patients died in the postoperative period, was 77.6% for open colectomies and 82.5% for laparoscopic colectomies. In the group of laparoscopic patients, we observed 1 case of port-site recurrence. CONCLUSIONS: Our clinical experience, even if limited by the number of patients and by the duration of follow-up period, contributes in confirming the reliability of laparoscopic procedures in the treatment of tumours of the colon and the safety of oncological results.

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A case of cecal anisakiasis is presented. Symptoms were compatible with appendicitis. The patient was operated and a perforated ulcer of the cecum was found. Ileocolic resection was performed. The histologic result showed the presence of Anisakis simplex larva in the muscle of the cecum. The patient was discharged the fifth day without complications. At present he is asymptomatic. He had eaten uncooked anchovies some days before the onset of the disease.

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A case of perforated small bowel adenocarcinoma presenting as first symptom of Crohn's disease is reported in a 53 years old male patient with abdominal pain and alteration of bowel habits. Endoscopic bioptical sampling demonstrated a Crohn's disease in active stage. The patient underwent medical therapy with resolution of the complained symptomatology; 20 days after discharge the patients is rehospitalized for acute abdomen. A narrowing perforated neoplasia in terminal ileum was discovered at laparotomy. Diffuse peritonitis and metastatic peritoneal implantations were also revealed. An ileocolic resection is performed with ileo-transverse colon anastomosis. The patient dies 4 months later for advanced disease.

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We describe a case in which segmental resection of the third and fourth portion of the duodenum was performed for a very rare duodenal gastrointestinal tumor (GIST). A 58-year old man presented with melena. Capsule endoscopy revealed a pathological bleeding of the duodenum and oral contrast-CT enema confirmed a lesion of the duodenum inferior knee, measuring 3.5 cm in diameter. Such an image suggested a duodenal leiomyoma. Segmental resection of the third and fourth portion of the duodenum after intestinal derotation (Valdoni-Strong's procedure) was carried out and there were no post-operative complications. Pancreas sparing duodenal resection is at the present time indicated only in selected cases. The duodenal resection associated with bowel and right colon derotation has proved to be a safe and adequate procedure and could be preferred to other procedures.

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The Authors, after a short review of small bowel tumors, point out that recently a laparoscopic approach for these tumors has been suggested and some cases have been reported. The Authors present two cases of patients operated for small bowel tumor using a laparoscopic technique: the first case for a stromal tumor (GIST), the second case for an adenocarcinoma in advanced stage with multilobar lung metastases. The first patient is alive and disease free after one year, the second died after six months for tumor progression. The Authors believe that laparoscopic technique can be employed with satisfying results also in the treatment of small bowel tumors with moderate trauma and invasiveness.

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The chronobiological analysis by means of the cosinor method on the dynamic electrocardiographic tracings of 30 subjects aged over 65 years with no clinical or instrumental signs of heart disease revealed a significant circadian rhythm of heart rate with acrophase in the early afternoon. When compared with a group of 30 young adult subjects, the elderly exhibited only a non-significant reduction of the rhythm amplitude. Elderly patients with heart disease exhibited a similar chronobiological pattern of heart rate. Premature ventricular beats (PVBs) were present in all subjects and occurred mostly during the day. A significant circadian rhythm was present only in elderly heart patients with 30-150 PVBs/h. The circadian distribution of PVBs showed significant interindividual differences with nocturnal acrophase in about one third of the patients. The chronobiological analysis can represent the basis for a more appropriate therapeutic approach to the elderly with PVBs.

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A circadian rhythm for beta-endorphin was observed by means of the cosinor method in aged subjects. The rhythm mesor is a little lower but its amplitude is more extended than in young subjects. The confidence intervals of the acrophases of the two groups are superimposable with a timing in the morning.

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Peripheral blood mononuclear cells from three patients with multiple myelomas (M.M.), four patients with Essential Mixed Cryoglobulinaemia (E.M.C.) and four normal adults as controls were cultivated with or without poke weed mitogen (PWM); in vitro immunoglobulin (Ig) production was measured after seven days using the enzyme-linked immunosorbent assay method (ELISA). No significant differences in Ig production were noted between patients and controls: E.M.C. patients, on the other hand, displayed considerable spontaneous IgM production (without appreciable differences, however, between spontaneous and PWM-stimulated production). M.M. patients, on the other hand, displayed only scanty spontaneous IgM production and in two cases the PWM response was completely lacking. These results were then integrated and correlated with a parallel study of similar groups of patients and controls carried out with the aim of investigating modifications in the distribution of B and T lymphocyte subpopulations. Possible interpretations of the results are discussed.

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We analyzed a sample of 1,485 families with hemophilia A and B and with unknown diagnosis. The frequency of sporadic cases was estimated to be .166 and .078 for the two types of hemophilia, respectively. The sex ratio of mutation rates did not differ significantly from unity. The average age of maternal grandfathers of probands at birth of mothers with a single child, affected by hemophilia B, and of maternal grandfathers of probands at birth of mothers with more than one child affected by hemophilia B, was higher than the age in appropriate control groups.

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Studies on microcirculation in the elderly include observations in the small vessels of the bulbar conjunctiva and of the nailbed with respect to a classification of the findings according to a number of semeiologic criteria (diameter and shape alterations, terminal capillary network, intravascular red cell aggregation). In vascular diseases of the elderly there are typical alterations of the capillaroscopic findings in the bulbar conjunctiva and in the nailbed, particularly in cases of arteriosclerosis, arterial hypertension, diabetic microangiopathy, heart failure, ischemic myocardiopathies. During the treatment with some vasoactive drugs (nicotinic acid and its derivatives, buflomedil, CPD-choline) there are marked modifications of the small conjunctival vessels, with evident dilatations, appearance of collaterals, increased homogeneity of the blood flow, better evidence of the capillary network and reduction of intravascular red cell aggregation.

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In 8 young and 8 elderly subjects mean values of plasma beta-endorphin were nearly equal under basal conditions. In all subjects the cold pressor test provoked a marked increase of beta-endorphin, which was more evident in young subjects. Mean values of the areas of endorphin modifications were the same in both young and elderly subjects. These results may suggest that after a short-term stimulus, such as the cold pressor test, no marked differences in pituitary secretion between young and elderly subjects may be evidenced.

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After a review of the fundamental concepts on chronobiology, the importance of circadian rhythms in the aged was examined on the basis of the data obtained in animals and humans, including personal observations on over 40 blood constituents. During ageing there are significant modifications of circadian rhythms, with frequent diminution of amplitude and a shift of acrophase. The biological, clinical and therapeutic implications of these findings are discussed.

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Chronobiological modifications in advanced age were already observed for several biochemical parameters and biological functions. Within a review about the circadian rhythms of some blood constituents in the aged, personal results about blood picture, antithrombin III, serum iron and transferrin, immunoglobulins and some enzymes are reported. A circadian rhythm was evident for almost all parameters considered. Differences with respect to young persons were evidenced for IgA, IgG and antithrombin III. The circadian system in the aged is, in general, similar to that of the adult in the middle life.

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Among indications of cosmetic surgery in the aged, particularly face lifting, reductive and reconstructive mammoplasty (e.g. after mammectomy due to malignancies), and abdominoplasty were particularly mentioned. Among the operations of reconstructive surgery, above all reparation after removal of benign (e.g. rhinophyma) and malignant tumors and for pressure sores and ulcers due to burns and radiodermatitis was emphasized.

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