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Laparoscopic cholecystectomy (LC) is the gold standard for the treatment of symptomatic gallbladder diseases such as cholecystitis and cholelithiasis and it is the most performed procedure in general surgery with more than 1.5 million cholecystectomies performed annually in the United States. The reasons behind the increasing number of laparoscopic surgeries are improved postoperative pain and improved healing time as compared to open cholecystectomy resulting in earlier recovery and discharge from the hospitals. However, even if it is considered a minimally invasive technique, the intensity of pain on the first postoperative day is significant. Appropriate pain control is essential for optimizing the clinical outcomes and to ensure the patient can walk as early as possible after surgery. 


Corruption affects healthcare effectiveness and efficiency and limits equity in access to health services. Aim of the survey was to document knowledge and viewpoints on the impact of corruption on healthcare system in a sample of students attending pre-lauream healthcare professional courses at Palermo University Medical school and to evaluate any improvement in their awareness on this topic after a dedicated multidisciplinary educational intervention. An anonymous questionnaire was administered to students before and after the intervention. Absolute and relative frequency of correct and incorrect answers was computed. Chi-squared test was used to compare answers given before and after the educational intervention. Approximately less than a quarter of the respondents were able to correctly estimate impact of corruption, inappropriateness and waste in healthcare on NHS. The study documented how improving students’ knowledge of the impact of corruption in the healthcare system could represent a possible strategy to prevent corruption in healthcare.

Pleomorphic adenoma is the most common benign tumor of the salivary glands. It arises mainly from the parotid, less frequently from the minor salivary glands of the oral cavity and, exceptionally, from the accessory glands widespread in the upper aero-digestive tract. Intranasal localization is rare and mainly affects the glands sited in the nasal septal mucosa. There are isolated case reports in literature regarding adult patients. We report a rare case of a young 14-year-old girl with pleomorphic adenoma arising from the nasal septum.

Coffee contains a wide variety of bioactive compounds including polyphenols, melanoidins, and diterpenes. Coffee consumption may have either neutral or beneficial effects toward human health. In this review, we summarize current evidence regarding the association between coffee consumption and breast, endometrial and ovarian cancer, as well as molecular mechanisms underlying the beneficial effects of coffee. The epidemiological evidence suggests a protective effect of coffee towards postmenopausal breast and endometrial cancer. However, no statistical association was found between coffee and ovarian cancer. The chemo-preventive effects of coffee phytochemicals may include activation of anti-oxidative and anti-inflammatory response. Finally, coffee bioactive components where shown to inhibit cancer cell proliferation and metastasis, as well as modulation of impaired angiogenesis.

We present our experience in the treatment of fractures of the tibial plateau with arthroscopic assistance. Between January 1997 and September 2001, we evaluated 23 patients with fractures of the tibial plateau. After their clinical and radiological evaluation, we included 17 patients in this study. Fractures were classified using the Schatzker classification. 14 patients were treated with arthroscopic reduction and percutaneous fixation, while 3patients underwent open reduction and osteosynthesis with platelets under arthroscopic control. The arthroscopic technique allows for a better articular visualization, decreases dissection of the tissues, and allows for an adequate diagnosis and treatment of the associated lesions. Arthroscopic reduction and percutaneous fixation can be considered the treatment of choice in a select group of fractures of the tibial plateau (Schatzker I and III).

Currently, surgical training of physicians in Italy has limited possibilities.Surgical training can be performed on dissection of human bodies as well as in animal laboratories, but experience is very poor. We conducted a survey through an anonymous questionnaire in order to evaluate the opinions of post-graduate physicians on their need for experience training on both human and animal bodies during their medical studies. A total of 165 young Sicilian physicians responded to the survey. Only 14 of them (8.5%) declared they had specific training on a live animal, while 46 (27.9%) reported they already attended cadaver labs. Over 70% assigned the maximum score to the utility of such courses as integration of medical academic offer. Our results showed that the majority of the subjects interviewed expressed a need for training using these practices and that it might be necessary to investigate patterns to promote the opportunity for direct practice on human and animal bodies.

Little is known about the relationship between laryngopharyngeal reflux (LPR) and periodontal or dental lesions. This study investigates the association of dental and periodontal involvement in patients with LPR compared to a control group. A prospective study was carried out on 102 patients complaining of LPR symptoms. The authors used the Reflux Symptom Index (RFS), Reflux Findings Score (RSI) and 24-h ambulatory pH monitoring to diagnose LPR disease. Two study groups were established, the LPR group included patients with LPR diagnosis and a control group selected from excluded patients. All patients underwent an oral examination for the evaluation of dental and periodontal status. Plaque index, gingival index and hemorrhage index were collected too. LPR was revealed to be associated with both an increased incidence of chronic periodontitis with significantly higher values of plaque index (p=0.018), hemorrhage index (p=0.048) , gingival recession (p=0.039) and higher tooth wear scores when compared to those of  the control group. We support the view that laryngopharyngeal reflux might play a considerable role in the manifestation of periodontal and dental lesions.


This paper is a retrospective study examining 328 cadavers deceased from traffic accidents (252 drivers and 76 front seat passengers). Specifically, the skeletal injuries of the cranial, spine, chest, upper and lower limbs were examined. The purpose of the study is to ascertain whether it is possible to identify, through the skeletal injury patterns, who was driving at the time of the traffic accident. A statistical analysis was used to detect injuries that could differentiate between driver and front passenger. Drivers more frequently reported chest injuries, especially sternal injuries, due to the collision with the steering wheel. On the other hand, front passengers more frequently reported skull and spinal injuries. Furthermore, a greater incidence of pelvis fractures in front passengers was observed compared to drivers. The chest injury pattern resulted to be the most effective for distinguishing the driver from the front passenger.

Being a serious threat to physical and emotional health of children and adolescents all over the world, bullying in school represents an important public health issue. Since 2007, in Italy, the Ministry of Education (MIUR) has promoted activities to face and prevent bullying in schools of all levels while at the same time national and local Health Authorities have implemented effective social-health strategies. To date, the lack of consistent data needed to properly describe the concerning increase of this Public Health phenomenon prevents both the ability to systematically survey and measure the effectiveness of the public health strategies against bullying. The Bullying In Sicilian Schools (BIAS) pilot study’s aims: i) to estimate the prevalence of bullying in a sample of secondary first-grade schools of Palermo, the largest city in Sicily, investigating its characteristics, and  ii) to assess the feasibility of alternative methods for the detection of the prevalence of bullying in schools.  Here we present the research protocol and the questionnaires that will be used.



Humeral reconstruction post tumor resection is a challenging quest. Reconstruction strategies depend first of all on age and general conditions of the patient, tumor dimensions, local invasion and bone quality. Many kinds of surgery are described in literature, mostly megaprosthesis, hemiartoplasty or alloprosthetic composite (APC) implants or allograft, allograft arthrodesis, clavicola pro-humeri or vascolarized fibula reconstructions. One of the most important goals of this surgery is to achieve implant stability. Surgical planning varies according to deltoid muscle, rotator cuff and axillary nerve conditions. When all these structures are conserved, an allograft or composite (anatomic or reverse arthroprosthesis) reconstruction could be a more suitable option for younger patients. When deltoid muscle function is impaired due to tumoral resection or axillary nerve disfunction, especially in elderly patients, surgeons prefer to implant endoprosthesis. The purpose of this paper is to describe the surgical technique to implant humeral megaprosthesis associated with tendon transfers and tips on how to achieve implant stability.

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