First operation in SPIDER and the path to complete MITICA

The requirements of ITER neutral beam injectors (1 MeV, 40 A negative deuterium ion current for 1 h) have never been simultaneously attained; therefore, a dedicated Neutral Beam Test Facility (NBTF) was set up at Consorzio RFX (Padova, Italy). The NBTF includes two experiments: SPIDER (Source for the Production of Ions of Deuterium Extracted from Rf plasma), the full-scale prototype of the source of ITER injectors, with a 100 keV accelerator, to investigate and optimize the properties of the ion source; and MITICA, the full-scale prototype of the entire injector, devoted to the issues related to the accelerator, including voltage holding at low gas pressure. The present paper gives an account of the status of the procurements, of the timeline, and of the voltage holding tests and experiments for MITICA. As for SPIDER, the first year of operation is described, regarding the solution of some issues connected with the radiofrequency power, the source operation, and the characterization of the first negative ion beam.

Steady state magnetic sensors for ITER and beyond: Development and final design (invited)

The measurements of the magnetic field in tokamaks such as ITER and DEMO will be challenging due to the long pulse duration, high neutron flux, and elevated temperatures. The long duration of the plasma pulse makes standard techniques, such as inductive coils, prone to errors. At the same time, the hostile environment, with repairs possible only on blanket exchange, if at all, requires a robust magnetic sensor. This contribution presents the final design of novel, steady-state, magnetic sensors for ITER. A poloidal array of 60 sensors mounted on the vacuum vessel outer shell contributes to the measurement of the plasma current, plasma-wall clearance, low-frequency MHD modes and will allow for crosscheck with the outer-vessel inductive coils. Each sensor hosts a pair of bismuth Hall probes, themselves an outcome of extensive R&D, including neutron irradiations (to 10²³ n/m²), temperature cycling tests (73-473 K) and tests at high magnetic field (to 12 T). A significant effort has been devoted to optimize the sensor housing by design and prototyping. The production version features an indium-filled cell for in situ recalibration of the onboard thermocouple, vital for the interpretation of the Hall sensor measurement.

Final design of the beam source for the MITICA injector

The megavolt ITER injector and concept advancement experiment is the prototype and the test bed of the ITER heating and current drive neutral beam injectors, currently in the final design phase, in view of the installation in Padova Research on Injector Megavolt Accelerated facility in Padova, Italy. The beam source is the key component of the system, as its goal is the generation of the 1 MeV accelerated beam of deuterium or hydrogen negative ions. This paper presents the highlights of the latest developments for the finalization of the MITICA beam source design, together with a description of the most recent analyses and R&D activities carried out in support of the design.

[Gastrointestinal stromal tumors: case reports and review of the literature]

The Authors describe four cases of gastrointestinal stromal tumours (GIST) two of them were localized in the stomach, the others in the ileum. GIST are neoplasms of mesenchymal origin which develop inside the wall of the digestive tract. The most frequent site is the stomach, followed by the small bowel; less commonly these tumors can affect the oesophagus, the colon and the rectum. GIST originate from precursors of the interstitial cells of Cajal, which are localized in the gastro-intestinal wall and are involved in the regulation of the peristalsis. The treatment is surgical resection. For advanced disease there is a new interesting treatment based on the imatinib, a tyrosine kinase inhibitor.

[Day Surgery. Five years of experience and activity]

BACKGROUND

The aim of this paper is to evaluate the management of an integrated unit of Day Surgery in a General Surgery Department.

METHODS

An outline of the first 5 years of activity is presented. Setting of investigation: little provincial hospital. Patients have been selected on a basis of Day Surgery specific features: a total of 1,294 patients. Pathologies treated: inguinal hernias, phlebectasias, phimosis, borsitis, arthritic cysts, tendon cysts, carpal tunnel, Dupuytren's disease ("crispatura tendinum"), lymphadenitis, mammary nodules, hemorrhoids, hydroceles, varicoceles, adipomas. Patients' selection parameters, surgical operation type and modalities, postoperative course, protected discharges from hospital, follow-up and complications have all been carefully recorded.

RESULTS

The most numerous operations were related to hernial pathology (54.32%) and to adipomas (10.81%). The form of anesthesia was mainly loco-regional. Only 4 cases (0.3%) had to be hospitalized for the night after operation.

COMPLICATIONS

1 serious wound infection, needing removal of the hernial prosthesis; 1 painful "tumefaction" on the inguinal wound for hernioplastic operation; 3 "seromas" in inguinal hernioplastics.

CONCLUSIONS

Advantages of Day-Surgery: cut in health costs due to the reduction of admissions to hospital; reduction in hospital infections and in surgical wounds; reduction in drug use; thinning of waiting lists; increase of available beds for other pathologies; reduction of disability days; high appreciation index.

[Jeiuno-ileal diverticula complicated by perforation. Clinical case]

The diverticular disease is rarely located in the small intestine (0.1-1.4%). The most important feature is due to the lack of a typical symptomatology which may appear only on the occasion of the complications it may incur (perforation, haemorrhage and so on). It isn't also infrequent that the surgeon may observe intestinal diverticula accidentally, on the occasion of laparotomies carried out in emergency or for other pathologies. The literature on intestinal diverticula is reviewed and personal experience in a clinical case presenting as acute abdomen is described.

The ASGE guidelines for the appropriate use of upper gastrointestinal endoscopy in an open access system

AIMS

This multicenter and prospective study was aimed at examining the appropriate use of upper gastrointestinal endoscopy in an open access system (primary endoscopy) using the American Society for Gastrointestinal Endoscopy (ASGE) guidelines. We also wished to see whether these guidelines can be easily used in clinical practice.

MATERIALS AND METHODS

Three thousand four hundred fourteen upper gastrointestinal endoscopies performed in seven endoscopy units of different size were studied prospectively. The real indication, to be with the guidelines, was determined by the endoscopist before performing the examination, based on a patient's history.

RESULTS

Seven hundred eighty-one (23%) endoscopies were "generally not indicated," according to ASGE guidelines, and were distributed as follows: follow-up of duodenal ulcer healing (33%), follow-up of other healed benign diseases (24%), surveillance of gastric atrophy, pernicious anemia, metaplasia, treated achalasia, and prior gastric intervention (14%), diagnosis of dyspepsia considered functional in origin (13%), and uncomplicated heartburn responding to medical therapy (7%). Endoscopies "generally not indicated" accounted for 23% in the bigger endoscopy units, 24% in the average sized units, and 22% in the smaller ones. They accounted for 32% when the examination was prescribed by family doctors, 17% when prescribed by internists, 19% by surgeons, and 14% by gastroenterologists (p < 0.001). Eighty-six (2.5%) endoscopies were done for indications not provided in the guidelines.

CONCLUSIONS

This study shows that ASGE guidelines are complete and easy to use and that the rate of inappropriate indications in an open access system can be considerable. They occurred mainly in the follow-up of healed benign disease and were more frequent when the examination was prescribed by the family doctor.

[Palliative biliary-digestive bypass with a Kehr tube for neoplastic surgical cholestatic jaundice]

The authors, in some rare cases of surgical neoplastic icterus operation, had to adopt a technique of biliary-digestive bypass with prosthesis on account of the technical-anatomical and general conditions of the patients. That prosthesis has been made out of the typical Keher's duct which can be generally found in every general surgery. The above mentioned authors describe the operations they have carried out, their directions and the results of six cases which have been treated with a technique similar to Kron's.