[Early colorectal reoperation: risk factors]. / Reinterventi precoci in chirurgia colorettale: fattori di rischio.

The aim of the study was to analyse the risk factors in colorectal reoperation. Over the period from January 1987 to December 1999, 371 patients (191 male and 180 female, aged from 16 to 88 years) underwent colorectal surgery. Eighteen reoperations (12 male, 6 female, aged from 20 to 74 years; median age: 52.6 years) were performed. These included reoperations performed within 30 days of the first operation (or patient admission). The overall incidence of reoperation after colorectal surgery was 4.8% (18/371). In 14 of 18 patients (77%) anastomotic dehiscence was the indication for reoperation. In our experience, the mortality rate was 16.6% (3/18), in agreement with other reports in the literature. Analysis of risk factors in colorectal reoperation poses several methodological problems because we have no randomized multicentre studies that analyse risk factors in colorectal reoperation and the related surgical mortality.

[Hemorrhagic emergency due to esophagogastric varices in the portal hypertension patient]. / L'urgenza emorragica da varici esofagogastriche nel paziente iperteso portale.

High gastrointestinal hemorrhage represents the more frequent (12-71.1%) and heavy complication of hepatic cirrhosis and correlates to portal hypertension; it is weighed by global mortality which sways from 30 to 50%. High gastrointestinal hemorrhage gives, therefore, a serious of diagnostic and therapeutic problems not easy to guide for at least 3 reasons: numerous causes of bleeding; hepatic failure; the marigold possible therapies. Aim of this work is to clarify some diagnostic and therapeutic features about high gastrointestinal hemorrhage in cirrhotic patient, because such eventuality often presents dramatic aspects, which endangers the patient's life. Our experience shows a casuistry referred to the period of time which goes from 1987 to 1998 and that comprehend 143 examined patients: 91 of them have been submitted to medical treatment (endoscopic sclerotherapy, glupressin e/o somatostatin); in 52 cases it has been possible to realize a surgical treatment, different from the elective therapy (33 pz) and emergency therapy. Immediate hemostatic effect obtained in both the conditions, has been satisfying with best results at a distance of three years and five years given by devascularization. As matter stands our preference of the devascularization surgical treatment, it seems appropriate to pay attention to the operation of mesocaval anastomosis which, either in our very brief experience (3 cases) or by international literature, seems to offer encouraging results.

[Emergencies in gastroesophageal varices hemorrhage in the patient with portal hypertension]. / L'urgenza emorragica da varici esofago-gastriche nel paziente iperteso portale.

High gastrointestinal hemorrhage represents the more frequent (12-71.1%) and heavy complication of hepatic cirrhosis and correlates to portal hypertension; it is weighed by global mortality which sways from 30 to 50%. High gastrointestinal hemorrhage gives, therefore, a serious of diagnostic and therapeutic problems not easy to guide for at least 3 reasons: numerous causes of bleeding; hepatic failure; the marigold possible therapies. Aim of this work is to clarify some diagnostic and therapeutic features about high gastrointestinal hemorrhage in cirrhotic patient, because such eventuality often presents dramatic aspects, which endangers the patient's life. Our experience shows a casuistry referred to the period of time which goes from 1987 to 1998 and that comprehend 143 examined patients: 91 of theme have been submitted to medical treatment (endoscopic sclerotherapy, glupressin e/o somatostatin); in 52 cases it has been possible to realize a surgical treatment, different from the elective therapy (33 pz) and emergency therapy. Immediate hemostatic effect obtained in both the conditions, has been satisfying with best results at a distance of three years and five years given by devascularization. As matter stands our preference of the devascularization surgical treatment, it seems appropriate to pay attention to the operation of mesocaval anastomosis which, either in Our very brief experience (3 cases) or by international literature, seems to offer encouraging results.

[Skin reactivity to hydrolyzed milk in protein intolerance to cow's milk]. / Reattività cutanea ai latti idrolizzati nelle intolleranze alle proteine del latte vaccino.

Thirty children with cow's milk protein intolerance were submitted to skin tests with either alpha-lactalbumin and casein commercial products or substitutes commonly used for infant feeding. This method showed helpful in choosing the proper milk substitute for affected children.

A case control study of dermatophagoides immunotherapy in children below 5 years of age.

BACKGROUND: In this study we investigate the effects of parenteral immunotherapy on children below 5 years of age in order to prove the safety and clinical efficacy of dust mite specific immunotherapy (SIT) in such young patients. In young children, allergy is often due to dermatophagoides and causes a persistent inflammation that leads to recurrent respiratory infections. This condition impairs the normal development of airways by inducing remodelling. Although many paediatric allergists are used to treating young allergic children with SIT, this method is still subject to discussion. The benefits versus risks of SIT must also be defined. METHODS: In a case control study, 28 patients with dermatophagoides induced asthma and rhinitis treated with subcutaneous immunotherapy were assessed alongside a comparable control group. Symptom and drugs scores were collected from diary cards. RESULTS AND DISCUSSION: Scores proved to be significantly lower in the immunotherapy group in respect to the control group (p = 0.001). In particular, asthma attacks in the case group decreased significantly during the first year of treatment (p = 0.001). SIT was well tolerated and compliance was good. CONCLUSIONS: Our results confirm the safety and the efficacy of SIT in children below 5 years of age and above all, they confirm that SIT can begin at a very early age.

[Allergy caused by Alternaria in children]. / L'allergia da Alternaria nel bambino.

For many years molds have considered to be important causes of rhinitis and asthma but since they have been poorly studied many questions remain unanswered. Allergological and epidemiological considerations have been made by the authors concerning the role of the Alternaria tenuis in respiratory diseases in children. 253 subjects were skin tested, 9.48 percent had an immediate reaction, 3.55 were also positive to the fungus only. Good correlation was observed between positive skin tests and RAST (66%). This study confirmed that probably Alternaria tenuis has an important role as immunopathogen for rhinitis and asthma in children. The authors discuss epidemiological considerations and related problems.

[Cross-reactivity of milk proteins: statistical analysis of RAST results]. / Reattività crociata fra le proteine del latte con l'analisi statistica dei risultati del RAST.

RIA dosages of specific IgE antibodies to cow milk, alpha-lactalbumin, beta-lactoglobulin, casein, cheddar and mould cheese were determined in 440 patients. Statistic analysis has been carried out with: 1) the linear regression and correlation coefficient r2: 2) U test of Mann-Whitney and then S test of Kendall Results show that casein has low allergenicity in comparison to other cow's milk proteins. It could be unnecessary to quantify specific IgE to cow milk and cheeses. From the observed data we could suppose that the formulas with casein/blood protein ratio similar to maternal milk may be more allergenic than casein based ones.

[Vojta's seven postural reactions in the detection of neuromotor disorders in infants. Experience with 2382 subjects]. / Le sette reazioni posturali di Vojta come depistage delle alterazioni neuromotorie del lattante. Esperienza su 2.382 soggetti.

The Authors examined 2.382 babies who were between 4 and 6 weeks old using the seven postural reactions proposed by Vojta for neuromotor screening. They followed the progress of 2.295 (96,35%) babies up to the age of 1 year. 100% of the babies judged to be normal after the first visit were normal after a year. The Authors describe the evolution of the babies who were abnormal at the first visit, and clarify the results obtained with early physiotherapeutic treatment.

[Measures to prevent injuries related to bicycle seats]. / Strumenti di prevenzione per i traumi correlati all'uso dei seggiolini per bicicletta.

Injuries related to the use of bicycle seats are increasing due to the more frequent use of bicycles, mostly in metropolis. Several cases of children who suffered lesions to the lower limbs are reported from which we may summarize the most frequent clinical features, characterized by a foot swelling caused by the crushing between the wheel spokes, with different degrees of skin injuries. Fractures of the lower part of the leg bones are frequent as well. A greater number of cases was reported in summertime and, in all the bicycles, there was no spoke cover and the seats did not provide any protection to the feet. So far no precise rules for the marketing approval of bicycle seats have been fixed by UE, contrary to what has been already set for cars. Therefore, we suggest that such rules should soon be enforced. We also recommend the compulsory use of the helmet, as in other countries. We underline the usefulness of a more detailed epidemiological monitoring to better understand the dynamic of such traumatic events and, consequently, achieve some further improvements in the seats design, for an increased safety. The critical factor in prevention, however, will always remain a proper sanitary education. In the general chapter of accidents prevention, pediatrics should provide the parents with all the indications and cautions concerned with bicycle seat safety.

Allergy to house dust and storage mites in children: epidemiologic observations.

One hundred and fifty-two children affected by respiratory syndromes, probably due to allergy, underwent skin testing to a range of extracts including several different species of mites. The incidence of positive reactions to different allergens was studied in two groups: below and over 4 years, each including both outpatients and inpatients. The aetiologic role of mites has been evaluated considering positive skin tests to single species between and within families.

Dermatophagoides and storage mites: statistical analysis of RAST results.

R.I.A. dosages of specific IgE antibodies to Dermatophagoides pteronyssinus, Dermatophagoides farinae (house dust mites), Acarus siro, Lepidoglyphus destructor, and Tyrophagus putrescentiae (storage mites) in 467 unselected patients were statistically analyzed. A significant noncorrelation between specific IgE antibodies to storage mites and those to house dust mites has been found, suggesting that storage mites have their own allergenic specificity.