The Spanish flu and the fiction literature.

This review focuses on the fictional literature in which the Spanish flu is represented either as an anecdotal or as a historical aspect and the effect on the author or fictional character. We examine this sociocultural period in the press and mainly in Anglo-Saxon literary works and from other countries, including Spanish and Latin American literature that is not very represented in some international reviews on the subject. Also, we include books about the previous and subsequent influenza pandemics to the Spanish flu.

John Donne, Spanish Doctors and the epidemic typhus: fleas or lice?

We describe the infections that appeared in the life and work of John Donne (1572-1631), the English metaphysical poet, mainly the exanthematic typhus that suffered and gave arise to his work Devotions upon emergent occasions, and several steps in my sickness. We discuss the vector of transmission of this disease, in comparison of other infections in that period, that Donne´s scholars have related to the flea without mentioning the body louse, the true vector of the exanthematic typhus. Likewise, we mention the exanthematic typhus´s symptoms in his Devotions in comparison with the Luis de Toro´s or Alfonso López de Corella´s works, Spanish doctors in those times and the first doctors in write books about the disease, and the singular treatment of pigeon carcasses on the soles of the feet in English Doctors but not in Spanish Doctors.

[An historical, sociocultural view and in the fiction literature of Bacillus anthracis cases by shaving brushes]. / Una visión histórica, socio-cultural y literaria de casos de Bacillus anthracis por brochas de afeitar.

In the period from 1915 to 1924 anthrax outbreaks were described by Bacillus anthracis due to the contamination of razor brushes that reached Europe and the United States from areas such as Japan, China or Russia. The brushes were made with badger hair, and then, to reduce the cost with horse hair and other animals. World War I supoosed that the traffics of these brushes, that passed through Europe, changed and the processes of sterilization of the same were deficient giving rise to these outbreaks, that in a percentage of 20% produced the death of the users. The impact of the fashion of wearing a beard, the presence of these cases in the press, in the society of that period, and literature are studied through the work of Agatha Christie who wrote, in 1936, the Hercules Poirot´s novel Cards on the table, and where she describes the murder of one of the characters with the shaving brush contaminated with Bacillus anthracis spores.

[Budd-Chiari syndrome and splanchnic vein thrombosis: masked myeloproliferative neoplasms and JAK2V617F]. / Sindrome di Budd-Chiari e trombosi delle vene splancniche: neoplasie mieloproliferative mascherate e mutazione di JAK2V617F.

The Budd-Chiari Syndrome (BCS) and the splanchnic vein thrombosis are characterized by hepatic venous outflow obstruction, generally due to venous thrombosis. These rare diseases are usually caused by multiple concurrent factors, including acquired and inherited thrombophilias. Since the diagnosis of myeloproliferative neoplasms (MPNs) is often difficult in patients with BCS and splanchnic vein thrombosis because of spleen enlargement, secondary pancytopenia and bleeding disorders, recent observations have included in the diagnostic work-up the analysis of the JAK2 mutation. The revision of several recent reports clarify the importance of the JAK2V617F detection in the diagnostic work-up of the BCS and splanchnic vein thrombosis, allowing the demonstration of masked MPNs among these cases that may benefit, in the near future, of target molecular therapies directed toward the JAK2 mutation.

[Enema-induced intestinal perforation. A case report]. / Perforazione intestinale da clisma di pulizia. Descrizione di un caso clinico.

Constipation is a frequent clinical condition in pediatric age, with a low frequency of evacuation and emission of voluminous and hardened stools. In the most serious cases enemas became necessary, and are usually carried out without trouble. Nevertheless, traumatic events of great importance can take place, leading the patient to urgent surgical observation. The clinical case of a girl suffering from birth from chronic constipation is reported. The girl underwent a colostomy according to Mikulitz's technique on the descending colon, due to a rectal perforation induced during an enema. After the re-canalisation and the contemporaneous resection of 18 cm of the dolicho-sigmoid colon (which was most likely the cause of chronic constipation) the girl presented a normal defecatory rhythm.

Ectodermal dysplasias: a new clinical-genetic classification.

The ectodermal dysplasias (EDs) are a large and complex nosological group of diseases, first described by Thurnam in 1848. In the last 10 years more than 170 different pathological clinical conditions have been recognised and defined as EDs, all sharing in common anomalies of the hair, teeth, nails, and sweat glands. Many are associated with anomalies in other organs and systems and, in some conditions, with mental retardation.The anomalies affecting the epidermis and epidermal appendages are extremely variable and clinical overlap is present among the majority of EDs. Most EDs are defined by particular clinical signs (for example, eyelid adhesion in AEC syndrome, ectrodactyly in EEC). To date, few causative genes have been identified for these diseases. We recently reviewed genes known to be responsible for EDs in light of their molecular and biological function and proposed a new approach to EDs, integrating both molecular-genetic data and corresponding clinical findings. Based on our previous report, we now propose a clinical-genetic classification of EDs, expand it to other entities in which no causative genes have been identified based on the phenotype, and speculate on possible candidate genes suggested by associated "non-ectodermal" features.

[Idiopathic constipation in children: 10-year experience]. / La stipsi idiopatica in età pediatrica: 10 anni di esperienza.

Constipation is a frequent clinical disorder in pediatric age and it is often difficult to resolve without a suitable diagnostic and therapeutic approach. Parents and pediatrician often underestimate this pathology, reaching the specialist only when it has already shown its complications. In the Department of Pediatric Surgery of Siena, in the last 10 years, we have activated a study centre on constipation in the pediatric age and we have developed a diagnostic and therapeutic protocol to give indications on the type of constipation and the consequent therapy. The Authors report their experience on 174 children with chronic constipation. The patients underwent a scintigraphic colonic transit time evaluation by radionuclides, an enema and an anorectal manometry. Such examinations were able to divide patients into two groups: with colonic and rectal constipation. The management consisted in common dietetic, behavioural and pharmacological treatment at first and then of specific treatment (biofeedback, prokinetic, emicolectomy), according to the type. The follow up showed recovery or improvement in 83.53% cases, unchanged clinical condition in 8.57%, aggravation in 1.9%. The Authors conclude emphasising the importance of diagnostic techniques that allow to frame correctly the pediatric patient affected by constipation. Particularly the anorectal manometry can be considered a first level examination, able to identify rectal constipation; together with scintigraphic colonic transit time that individualizes colonic constipation. The right diagnosis will be able to give a suitable therapeutic treatment.

Acid exposure of proximal esophagus in healthy subjects.

BACKGROUND: An association between gastroesophageal reflux (GER) and pulmonary or laryngeal diseases has been recognized, and dual pH monitoring of both distal and proximal esophagus has been proposed to investigate chronic respiratory symptoms of unexplained etiology. However, the degree of acid reflux in the upper esophagus is still uncertain, making it difficult to discriminate between physiological and abnormal GER. AIM: To define normal values for proximal esophageal acid exposure. METHODS: Two-level esophageal pH monitoring was performed in 22 healthy subjects and 26 reflux patients. A dual pH sensor with electrodes spaced 15 cm that were positioned 5 and 20 cm above cardias was used. Two different thresholds of pH 4 and 5 were used to evaluate GER at proximal level. RESULTS: In healthy subjects, at proximal level, the acid exposure time (% time pH < 4) was 0.4%, 0.7% and 0.1% for 24-hrs, upright and recumbent periods, respectively. Using pH 5 as threshold, acid exposure time (% time pH < 5) was 1.5%, 2.3% and 0.3% for 24-hrs, upright and recumbent periods, respectively. Twenty cm above cardias, acid exposure was greater in reflux patients in comparison to controls; however, all reflux values were significantly different between the two groups only when pH 5 was used as threshold. The percentage of distal reflux reaching the proximal site (16.0%, 27.9% and 7.1% in controls for 24-hrs, upright and recumbent periods, respectively) was similar in the two groups. CONCLUSIONS: Acid reflux, to a limited extent, is physiologic in proximal esophagus. The technique of pH recording 20 cm above cardias might be useful in documenting the cephalic extend of GER, allowing to investigate patients with atypical presentations of GER disease. It may be best to use both thresholds 4 and 5 for evaluating proximal acid exposure.