[Gastric atresia, diaphragmatic hernia, and gastroesophageal reflux: a rare malformation requiring a multiple approach]. / Atresia del corpo gastrico, ernia diaframmatica laterale sinistra, reflusso gastro-esofageo. Malformazione rara e complessa trattata in più stadi con tecnica mista.

The first cases of atresia or web in the pyloric and prepyloric regions were described in the literature since 1937. To date, only one case of atresia at the junction between the fundus and the body of the stomach has been reported. We want to describe a complex case with incomplete atresia between fundus and gastric body, with left lateral diaphragmatic hernia, treated in several stages by endoscopic, open surgery and minimally invasive surgery

Polypoid lesion of the gallbladder in childhood: case report and literature review.

Gallbladder polypoid lesions are rare in the pediatric patient and sometimes represent an incidental finding. A 13 year old male was referred to the Padua Hospital Pediatric Department for an obesity. A routine abdominal ultrasound (US) detected a gallbladder polypoid lesion 6 mm in diameter, initially considered a gallbladder adenoma. Investigation did not detect any other biliary tract abnormality. After seven months, the asymptomatic patient underwent a follow-up US which revealed the disappearance of the polypoid mass. The following concerns are raised: what is the size of the polypoid mass that should be considered for surgery? How does the presence of symptoms worsen the diagnosis and lead to preferring a surgical approach (cholecystectomy) over an echographic follow-up?

[Serious dog bite lesions in childhood: presentation of 3 cases and literature review]. / Lesioni gravi da morso di cane in età pediatrica: descrizione di 3 casi e revisione della letteratura.

Animal bite lesions in the pediatric patient are mainly accounted for by dog bites in 80% to 90% of the cases. They often present a favorable prognosis but serious lesions do account for 5% to 20% of the total incidence. We will present three particular clinical cases which required urgent surgical treatment as well as a review of the current literature to include both medical and surgical treatment methods for this kind of lesion.

Phosphate deficiency promotes modification of iron distribution in Arabidopsis plants.

Phosphate (Pi) is an essential element for plant development and metabolism. Due to its low availability and mobility in soils, it is often a limiting nutrient for their growth. This phenomenon is reinforced by the formation of insoluble complexes in the environment with many cations, affecting the solubility of both phosphate and associated ions. This interaction is investigated here for iron, a strong phosphate chelator. Depleting the medium in phosphate clearly resulted in an increase of iron content in Arabidopsis. These modifications triggered molecular responses linked with iron status (transport, homeostasis and accumulation). Interestingly, physiological modifications affecting iron storage were also observed. The accumulation of phosphate/iron complexes in the vacuoles of plants grown in Pi-rich medium disappeared in Pi-depleted medium in favor of accumulation of iron inside the chloroplasts, likely associated with ferritin.

[Surgical treatment of abdominal trauma in pediatric age]. / Traumi chirurgici addominali in età pediatrica.

AIM OF THE STUDY: to value the appropriateness and the efficacy of non-operative treatment in children with blunt abdominal trauma. PATIENTS AND METHODS: in this research 14 children with abdominal trauma, secondary mostly to road accidents, were studied; 9 of these had single organ injury while 5 had multiple organ injuries. Spleen has been the most injured organ (9 children), followed by liver (5 cases) and kidney (2 cases). Five children were admitted at emergency department in hypovolemic conditions, promptly corrected by resuscitative measures. All patients underwent abdominal ultrasound and/or C.T. scans in order to detect any intraperitoneal free fluid or organic injuries. Six children (43%) were followed by non-operative treatment, while other eight underwent surgery. RESULTS: all children, those treated conservatively as well as those operated, were cured, without any important complication. DISCUSSION AND CONCLUSIONS: nowadays, with the great help of ultrasound and C.T. scans, is possible to treat 40-50% of children affected by abdominal trauma with non-operative measures, with return to normal functions by the injured organs. The surgical approach is today accomplished only in presence of severe injuries or haemodynamic instability resistant to resuscitative treatment. The majority of Authors in the literature agree on the usefulness of non-operative treatment, especially for children. Regarding surgical treatment, in the near future probably we'll see a larger application of laparoscopic techniques also in the field of abdominal traumatology.

Ischemic stroke and fibrinogen in the elderly.

Senescence is accompanied by an important increase in prevalence and incidence of ischemic stroke. The plasma level of fibrinogen tends to increase with age in the elderly similarly to the prevalence of stroke. The aim of our study was to evaluate the age-related increase in fibrinogen plasma level in the elderly and to assess the presence of eventual differences between normal subjects and patients with previous ischemic stroke associated with precerebral atherosclerosis. Eighty inpatients (41 males and 39 females), consecutively admitted to our Geriatric Unit, were included to this study. The patient group was formed 32 subjects (20 males and 12 females) aged 50-79 years, suffering from cerebrovascular disease with one or several previous ischemic stroke episodes, having occurred at least 1 year earlier. The control group consisted of 48 normal subjects (21 males and 27 females) aged 50-79 years. Both control and patient groups were subdivided into three subgroups, according to their age: Group 1 (50-59 years), Group 2 (60-69 years)and Group 3 (70-79 years). The statistical comparison was carried out by means of the Mann-Whithney nonparametric test. In normal controls, a mild age effect is evident because only Group 3 shows fibrinogen levels significantly higher than those of Group 1. On the contrary, in patients with ischemic stroke, an age effect is already evident between Group 2 and Group 1; of course, also the comparison between patient Group 3 and Group I shows a statistically significant difference. Moreover, the levels of fibrinogen were significantly increased in patient Group 2 and 3 when compared to those of their respective age-matched controls. Our data are in agreement with those already available in the literature and demonstrate that fibrinogen in normal aging changes with age and shows a 19 %increase between age Group 1 and Group 3. Patients with ischemic stroke show an earlier and more evident age-related increase in fibrinogen than normal controls. Even if it is not possible to know, if the increase in fibrinogen is a consequence or not of the ischemic stroke, we can affirm that certainly the increased levels of fibrinogen should be considered as an important risk factor in the elderly for cerebrovascular disease and deserve treatment.

[Peritonitis secondary to gastrointestinal perforations]. / Le peritoniti da perforazioni gastro-intestinali.

BACKGROUND: The study was designed to check the etiopathogenesis of gastrointestinal perforations and to indicate possible factors determining better results in terms of mortality and morbidity. METHODS: A retrospective study was carried out on 128 patients operated during the last 10 years for gastrointestinal perforation at our Department of Emergency Surgery, where about 600 abdominal surgical operations are performed every year. In this study patients with perforated acute appendicitis and patients with postoperative anastomotic leakage were excluded. Surgical techniques were essentially of three types: drainage of the collection, suture of the perforation (with or without proximal stoma), resection with or without immediate anastomosis. RESULTS: 89% of the patients had an uneventful recovery, 9 patients (7%) died, and 5 (4%) had local infective complications cured by conservative measures (antibiotics, percutaneous drainage). CONCLUSIONS: Better results have been observed during the last years in patients operated for gastrointestinal perforation probably because of the more frequent use of sophisticated diagnostic examinations (especially ultrasound and CT scan) and also because of better timing and technique of surgery (more frequent use of Hartmann procedure as well as mechanical staplers).

[Pancreatic pseudocysts. Clinical contribution]. / Le pseudocisti del pancreas. Contributo clinico.

Aim of this study was to compare, taking into consideration data from the literature, the various diagnostic examinations and therapeutic modalities nowadays available to manage patients affected by pancreatic pseudocysts. Personal experience regarding three patients with post-necrotic pancreatic pseudocysts is reported; these patients complained of epigastric pain with nausea and tenderness in the upper abdominal quadrants. Diagnosis was made by CT. In one case a progressive decrease of the pseudocyst was observed; the second patient was treated by a pseudocyst-jejunostomy; the last patient initially underwent a trans-gastric percutaneous drainage for infection of the pseudocyst and afterwards an open pseudocyst-gastrostomy. All patients were cured, even if the second patient during the postoperative course developed a pleuric effusion, which was treated by thoracentesis. Pancreatic pseudocysts in 20% of cases resolve spontaneously, as observed in one of our patients. In other cases, a surgical operation is needed, now feasible through an endoscopic, percutaneous, laparotomic or laparoscopic approach. The endoscopic and percutaneous approach are indicated only in selected cases, so that the "gold standard" treatment is still the laparotomic one, especially by a pseudocyst-jejunostomy, which also in our experience has given the best result. Very promising also, according to the latest data from the literature, seems the laparoscopic approach, by which a wide communication between the stomach and the pseudocyst is obtained.

[Non-invasive urodynamic approach to the diagnosis, treatment and follow-up of voiding disorders in pediatric patients]. / Approccio urodinamico non invasivo nella diagnosi, trattamento e follow-up dei disturbi minzionali in età pediatrica.

The authors reports their experience on 248 patients affected by minctional disorders isolated or related to UTI (upper tract infections) and VUR (vesico-ureteral reflux). All the patients were assessed throught a predominantly non invasive diagnostic approach which included: pediatric urologic examination with aimed anamnestic and clinical freaming, functional examination of the lower urinary tract using uroflowmetry + EMG of the perineal plane muscles (UR + EMG), kidney and bladder ultrasound. This methodology has permitted a widening of the indications in the study of vesical function as well as limiting the selected cases (hight UTI, uncertain diagnosis) of mini-invasive examination, such as flow pressure study, minctional cystourethrogram (MC) and or renal scintigraphy. An MNR of the lumbo-sacral medulla (cord) and a neurological and/or neurosurgery evaluation were only carried out were there was a suspected occult neurological pathology. The clinical sintomatogy was as follows: approximately 70% of the patients suffered from partial diurnal incontinence, 42% were affected by secondary nocturnal enuresis while 58.6% suffered from recurrent UTI. In those patients with UTI, 11% (16 patients, 24 ureteral units) suffered from associated VUR while 3.5% suffered from either congenital or acquired urethral stenosis. From the urodynamic examination, we determined the presence of detrusorial instability in 158 patients (64%) and lazy bladder or vescical hypotonia in 84 patients (34%). The suggested therapy foresees the use of: hospital home-based uroriabilitation (minctional biofeedback), endoscopic therapy (sub-ureteral bulking, urethral dilatation) and corrective VUR surgery (only in those cases that did not respond to medical treatment). The percentage of total recovery in patients with detrusorial instability was 80%, the minctional biofeedback both associated and unassociated with drug therapy lead to complete recovery in 66% of patients with lazy and uncordinated bladder, wile 26% showed improvement and 7 patients (8.4%) did not respond. All the patients with VUR (24 reflux units) recovered; and endoscopic therapy and or surgery (12 reflux units) was carried out in some of this patients.

Endodermal sinus (yolk sac) tumor of the urachus.

A rare case of endodermal sinus (yolk sac) tumor of urachal remnants in a two-year-old infant is described. The tumor was located in the upper part of the bladder and appeared to arise from urachal remnants. The tumor could be entirely removed. The patient is free of tumor after three years and eight months follow-up.

[Varicose disease of the lower limbs: analysis of the most common predisposing factors in a sample of 589 patients from eastern Sicily. A retrospective study]. / Enfermedad varicosa de los miembros inferiores: análisis de los más habituales factores predisponentes bajo una muestra de 589 pacientes de Sicilia oriental. Estudio retrospectivo.

Authors analyze, retrospectively, the principal predisposing factors to varicose illness: age, sex, pregnancy, oral contraceptives, and labour activity, in 589 patients. They consider the correlation between subjective symptomatology and the time of varicose appearance, in order to individualize a pre-clinical status.

Age-related rather than ulcer-related impairment of venous function tests in patients with venous ulceration.

Various noninvasive tests of venous function and skin oxygenation were studied in 12 patients with unilateral venous ulcer and in 24 control subjects. In the ulcer patients, there was no difference between the leg with and the leg without ulcer regarding all the tests studied. Except for the maximal venous outflow, the patients and their age- and sex-matched controls did not differ with regard to all parameters studied. In contrast to these findings, ageing was associated with a reduction in maximum venous outflow, a shortening in venous filling time, an increase in venous pressure in the posterior tibial vein and a diminution of transcutaneous partial oxygen pressure.

[The course of varicose disease. Parallel retrospective study of 2 ethnic groups (Catania-Basel)]. / Curso de la enfermedad varicosa. Estudio retrospectivo en paralelo entre dos diferentes grupos étnicos (Catania-Basilea).

Authors presents a retrospective study with two different ethnic groups, one of them from Catania and the other from Basilea, with varicose veins and subjected to a saphenectomy. They studies the following parameters: age at the entrance, and when varicose veins appeared; correlation between varix appearance date and subjective symptomatology; and rapport between varix complications and its duration. The possible incidence of "ambiental factor" and contrasts between the two groups are considered.

[Headache as a postoperative symptom of patients subjected to saphenectomy using subarachnoid analgesia]. / La céphalée vue comme symptôme post-opératoire chez des patients opérés de saphénectomie en analgésie subarachnoïdienne.

Having confirmed the development of cephalea in a large number of patients undergoing saphenectomy under subarachnoidal anasthetic, the authors wanted to research its probable causes. With this in mind, they observed a group of patients who had varices of the lower limbs which they had operated. They present their study methodology, and then examine and discuss the results. The conclude that many factors are responsible for the aetiology of the symptoms of cephalea. The sex, age, and conditions of venous hypertension in the posterior tibial vein are particularly determining factors.