Neuropsychological and behavioural profiles of students with intellectual development disorder on parents and teachers' perceptions.

BACKGROUND: Children with intellectual development disorder (IDD) have high rates of comorbid neuropsychological and behavioural problems. However, there are not many studies on this population in middle-income and low-income countries. Therefore, we aimed to investigate the prevalence of neuropsychological and behavioural problems in students with and without IDD and to assess the correlation between the responses from informants (parents and teachers) and the clinical diagnoses in Brazil. METHODS: After clinical diagnosis, 78 male and female students (7-15 years old) were divided into two groups: children with IDD (n = 39) and children without IDD (n = 39). The Child Behaviour Checklist (CBCL) and Teacher's Report Form (TRF) scales were used to track neuropsychological and behavioural problems. Calculations of prevalence ratios were performed using Poisson regression with Wald tests. The CBCL and TRF results were compared between groups with Mann-Whitney U-tests and receiver operating characteristic (ROC) analyses. The agreement between scales was assessed using the Spearman correlation test. RESULTS: Neuropsychological and behavioural problems were significantly more prevalent in students with IDD. The average amount of CBCL problems was significantly higher than that of TRF in the dimensions of thought, attention, somatic, attention deficit/hyperactivity, opposition defiant and total problems. Low-to-moderate correlations between CBCL and TRF dimensions in the IDD group were observed. ROC analyses revealed that the dimensions of internalising problems and total scores reflecting CBCL and TRF problems were the most important factors for identifying neuropsychological and behavioural problems in the IDD group. CONCLUSIONS: Students with IDD require early identification of behavioural and emotional symptoms to avoid the underdiagnoses of various mental health problems, especially those with internalising characteristics. The CBCL and TRF may assist in the early screening of these comorbidities.

Feasibility and relevance of an immersive virtual reality cancellation task assessing far space in unilateral spatial neglect.

Unilateral spatial neglect (USN) is a highly prevalent neuropsychological syndrome. However, its assessment in clinical practice, mainly based on paper-and-pencil tests, encounters limits as only near space, called peripersonal, is assessed. However, USN is a multicomponent syndrome that can also affect far space, called extrapersonal. This space is not assessed in current clinical assessment although it can be more impacted than peripersonal space. Immersive virtual reality (VR) allows developing tasks in far space to assess this heterogeneity. This study aimed to test the feasibility and the relevance of an immersive VR task to assess far space. A cancellation task, the Bells test, was used in its original paper-and-pencil version and was also adapted into a far immersive VR version. Ten patients with left USN and sixteen age-matched healthy participants were included. A single-case method was performed to investigate the performance of each patient. Although five patients showed very similar results between both versions, the five others exhibited a dissociation with a more severe impairment in the VR version. Three of these five patients significantly differed from the healthy participants only on the VR version. As USN in far space is not brought to light by paper-and-pencil tests, immersive VR appears as a promising tool to detect USN affecting this space.

Polycystic liver disease with complications: fenestration by laparoscopic approach.

AIM: Isolated polycystic liver disease is a rare congenital cystic liver disease with autosomal dominant transmission. Its main feature is the presence of a large number of cysts of different sizes in the hepatic parenchyma, which have a benign evolution. METHOD: We present the case of an 80 years old male patient with massive polycystic liver disease, diagnosed three years ago by ultrasound examination and abdominal computed tomography scan. The evolution of the disease had been complicated by compressive symptoms, caused by the large dimensions of the cysts. The patient presented with abdominal pain, nausea, vomiting and lost weight. Cyst fenestration through laparoscopic approach resolved the symptoms. RESULTS: The patient was mobilized on the day of the surgery, and was discharged on the 9th postoperative day, after drainage tube removal. CONCLUSIONS: Isolated polycystic liver disease is rare. Surgical treatment is indicated only if complications occur. The laparoscopic approach is an alternate treatment method, if needed. The patients benefit from the advantages of minimally invasive surgery.

[Sentinel lymph node mapping in colorectal cancer]. / Determinarea ganglionului santinela în cancerul colorectal.

UNLABELLED: Colorectal cancer is the most common malignant tumor of digestive tract with high mortality due to local reccurences and metastases. These are due to micrometastases undetected by classical microscopic examination of regional lymph nodes. Sentinel lymph node SLN technique in colorectal cancer may lead to identification of micrometastases using immunohistochemistry. METHODS: We present our experience in SLN mapping in colorectal cancer using a limphofil dye, on 52 patients. We present the patients selection criteria in the study, the technique of SLN detection. RESULTS: Identification of SLN was performed in 48 cases, it failed in 4 cases. In 27 cases, 1 SLN was identified, in 21 cases 2 SLN were found. In 4 cases the SLN were false negative. In 30 cases SLN were negative on histopathology and immunohistochemistry. In 14 cases, SLN were positive, 4 cases presented micrometastases confirmed only by immunohistochemical methods. CONCLUSION: SLN technique in colorectal cancer: - doesn't change the surgical approach regarding the regional lymphadenectomy; - can modify the tumor stadialization by detecting lymph nodes micrometastases; - increase the number of patients who can benefit from the adjuvant chemotherapy and therefore, it may improve the prognosis.

Retromuscular mesh and hernial sac technique in the reconstruction of 139 cases of large median incisional hernias: one institution's experience.

PURPOSE: Incisional hernia is the most common complication of laparotomy. Postoperative parietal defects tend to relapse, even after the most optimal surgical methods. The aim of this study was to present the effectiveness of an adapted retromuscular technique with prolene mesh and a hernial sac, in patients with large incisional median hernias. The reported results were obtained by our team after more than 15 years of experience. METHODS: This retrospective study included 139 consecutive cases of large median incisional hernias operated on using a retromuscular mesh and hernial sac technique. The cross-sectional diameter of incisional hernias was larger than 10 cm, being classified in the W3 group, according to the European Hernia Society classification. RESULTS: The study included 83 females (59.71%) and 56 males (40.29%) with a median age of 62.4 ± 16.6 years and an average body mass index of 32.4 ± 7.6 kg. The hernia was supraumbilically located in 54 cases, subumbilically in 61 cases, and supra- and subumbilically in 24 cases. Postoperative complications were recorded in eight cases (5.75%): one case with a hematoma in the right abdominal muscle sheath; five cases with supra-aponeurotic seromas; two cases with skin necrosis and one with a mesh infection. Recurrence occurred in seven cases (5.03%): four cases in the first 2 years postoperatively and three cases in the third year after surgery. CONCLUSIONS: The retromuscular technique with prolene mesh and a hernial sac is an effective method of restoring the integrity of the abdominal wall in large median incisional hernias with low rates of morbidity and recurrence.

[Gastric stromal tumor with liver and subcutaneus metastasis. Case report]. / Tumora stromala gastrica cu metastaze hepatice si subcutanate. Prezentare de caz.

UNLABELLED: The gastrointestinal stromal tumours expand from the undefine mezenchimal cells of the intestinal wall and the origin is in the Cajal interstitial cells. The agresivity of GIST is difficult to be evaluate. Very importants factors for grading are the tumour localisation, the invasion of serosa or mucosa, the dimensions of tumour and the number of mytosis. We present a case with haemoragic gastric stromal tumour, with small dimensions, which was initially diagnosed as a "benign" tumour. Seven years after the operation, the patient presented voluminous liver metastases. After right hepathectomy and medical treatment with Glivec we followed up the case. Eleven years after the first operation she presented a subcutaneus metastasis in parietal region, which was confirmed with imunohistochemical exam. The patient is still under observation with higher doses of Glivec. CONCLUSIONS: The gastrointestinals stromal tumours represent a very rare group of digestive tract tumors, with malignant potentially evolution; the first choice of treatment is surgery, with complete ablation of the tumour. The medical treatment with Glivec is necessary in case of reccurence or metastases; the stromal tumours present a strange evolution, for this reason all the patients must be under medical observation, for the rest of their life.

[Long-term follow up after surgery for intractable ascites]. / Rezultate tardive ale tratamentului chirurgical pentru ascita netratabila.

The aim of the study is to evaluate the outcome of a selected group of 24 patients who underwent surgery for refractory ascites, in a 10 years period, 1995-2005. CLINICAL DIAGNOSIS: Alcoholic cirrhosis (n=18), inferior cava thrombosis (n=2), splenic vein thrombosis (n=1), cryptogenic cirrhosis (n=3), with association of variceal bleeding and refractory ascites. The surgical procedures consisted of porto-sistemic shunts (n=12), peritoneo-saphene shunts (n=10), mesenterico-caval shunt (n=1), mesenterico-right atrium shunt (n=1). Early results were very good: no postoperative mortality, no general haemo-dinamic failure, no renal fonctional failure, no encephalopathy. 7 of 10 peritoneo-saphene shunts had an excelent evolution, but in three cases the results were unsatisfactory, the patients continuing the medical treatment. Except one patient who died after 2 years, for B virus and alcoholic abuse, all the patients survived 5 or more years. There was not evidence of digestive hemorrhage or uncontrolable encephalopathy and thrombocytopenia. The grade of esophageal varices was mantained lower than II, ascites remained minimum or absent, and biological parameters were normal or slightly elevated. CONCLUSIONS: In the absence of the technical and economical possibilities of TIPS and liver transplantation, surgery for intractable ascites is a good option in selected patients, especially in the absence of viruses and alcohol consumption, and can improve complications in the natural evolution of the disease.

[Local recurrence after the sphincter-saving operations and abdominal perineal resection in rectal cancer]. / Recidiva tumorala locala dupa chirurgia conservatoare si rezectia abdominoperineala în cancerul rectal.

By local recurrence we define the appearance of the same anatomopathological type of cancer like the one initially described in the primary tumor, limited at the rectum or pelvis.The study is based on the analysis of all the cases with rectal cancer who undergone surgical procedures in Surgical Clinic No.2 Tg. Mures in the last 5 years. Using the most important parameters for each patient we identified some risk factors for the recurrence of the rectal cancer: surgical procedures--there were no major variations in the local recurrence between the sphincter-saving operations and abdominal perineal resections. The most frequent recurrence tumors appeared after Hartmann I operation; the moderate aggressive adenocarcinomas at the old patients and high aggressive adenocarcinomas in young patients, T3, T4 stages. The recurrent rectal cancer is more frequent in aged patients with high aggressive adenocarcinomas. There were no major differences in recurrence rate between the sphincter-saving operations and abdominal perineal procedures.

Two-step hepatectomy with right portal branch ligature for a right lobe metastasis.

Hepatic resection is the only treatment with possible curative effect both for primary and secondary tumors. An increase of the rate of resectability for tumors considered inoperable at first, and a decrease of the postoperative morbidity and mortality can be realized by right portal branch ligature and two-step hepatectomy. We would like to present the case of a patient with left bowel cancer with a hepatic metastasis. Right portal branch ligature was performed which was followed by systemic postoperative chemotherapy. The right portal branch occlusion was followed by right lobe atrophy and left lobe hypertrophy, confirmed by CT scanning. Three months after the portal occlusion the patient underwent a right lobe hepatectomy. The postoperative evolution was favorable, eight days of hospitalization were necessary. The portal branch ligature can be made in several cases of hepatic tumors to increase the resectability rate.

Two-step hepatectomy with right portal branch ligature for a right lobe metastasis.

AIMS/BACKGROUND: Hepatic resection is the only treatment with possible curative effect both for primary and secondary tumors. An increase of the rate of resectability for tumors considered inoperable at first and a decrease of the postoperative morbidity and mortality can be realized by right portal branch ligature and two-step hepatectomy. METHODOLOGY: This paper presents the case of a patient with left bowel cancer with a hepatic metastasis. A right portal branch ligature was performed followed by systemic postoperative chemotherapy. RESULTS: The right portal branch occlusion was followed by right lobe atrophy and left lobe hypertrophy, confirmed by CT scan. Three months after the portal occlusion a right lobe hepatectomy was performed. The postoperative evolution was favorable; eight days of hospitalization were necessary. CONCLUSIONS: Portal branch ligature can be performed in certain cases of hepatic tumors to increase the resectability rate.

[Telescopic anastomosis in colorectal surgery]. / Anastomoza prin telescopare in chirurgia colonului.

UNLABELLED: The most frequent postoperative morbidity and mortality in the colorectal surgery is caused by the failure of the anastomosis. On the base of the statistics the postoperative mortality caused by the failure of the anastomosis can rise up to 20%. In the last decade a lot of types of anastomoses was initiated, for example: telescopic anastomosis, mechanical anastomosis with stapler, anastomosis with a bio-fragmentary ring. In the technique of the telescopic anastomosis, introduced from the beginning of 20th century, many changes had made. The experimental and the operative results shown that the telescopic anastomosis is a secure, fast and cheap procedure in the surgery of the colon. CONCLUSIONS: the telescopic anastomosis is applicable also in emergency, with a short septic time , easy procedure and doesn't need special instruments.

[Cervical anastomotic fistula in surgery of the esophagus]. / Fistulele anastomozelor cervicale din chirurgia esofagului.

Cervical anastomotic fistula are reported in the surgical literature in 10-30% of the patients, providing a much longer hospitalisation, a higher morbidity and in some cases even mortality. Between 1997-2003, 91 patients underwent surgical treatment for esophageal cancers and 14 patients for chemical burns. In the cancer group the rate of resection was 67,03% (61 patients). In 8 patients with non-resection tumours a retrosternal esophageal by-pass with stomach was carried out. Cervical anastomosis were performed in 68 patients, by hand sutures. Anastomotic fistula were noted in 9 patients (13,24%). In 6 cases temporarily fistula occurred, with spontaneous healing by local treatment, in 8-28 days. 2 patients required reoperation and one patient a definitive feeding jejunostomy. Most common causes of fistula are technical problems, ischemic gastric or colonic tube, postoperative respiratory failure, with prolonged hypoxia. An anastomosis in the neck results in less postoperative complications than one of the lower level.

[Endosalpingiosis of the axillary lymph nodes--primary or metastatic tumour?]. / Endosalpingioza limfonodulilor axilari--leziune primara sau metastastica?

The involvement of extra-abdominal sites by serous ovarian tumours of low malignant potential is extremely rare. In this paper we present the case of a 33 years old woman, diagnosed with atypical endosalpingiosis in the axillary lymph nodes before the diagnosis of a bilaterally ovarian serous tumour of low malignant potential. The occurrence of axillary lymph nodes involvement associated with serous tumours of the ovary could be explained by the presence of circulating serous cells that remained dormant for a period of time or by the development of an independent primary tumour from glandular inclusions in axillary lymph nodes. The recognition of the occurrence of axillary atypical endosalpingiosis in association with serous tumours of the ovary is important to avoid misdiagnosis. It is better to define these lesions as secondary serous papillary involvement.

[Peritoneo-saphenous shunt for the treatment of ascites]. / Suntul peritoneosafen în tratamentul ascitei.

UNLABELLED: The life quality of the patient suffering from hepatic cirrhosis is affected by ascites refractory to drugs treatment. In the last 30 years, in the ascites treatment there were performed peritoneo-jugular shunts through synthetic prosthesis with unidirectional valve-LeVeen, Denver. The siliconated prostheses are expensive and in the process of time complications are registered consisting of clogged valve or obstruction, requiring thus their replacement. The unidirectional drainage of the ascites can also be performed through peritoneo-saphenous shunt. In our clinic, the peritoneo-saphenous shunt was applied for the first time in 2004, in three patients with hepatic cirrhosis with ascites refractory to drugs treatment. The postsurgical evolution was favourable, a gradual increase of diuresis and reduction of abdominal diameter being registered in all the three cases. CONCLUSIONS: the peritoneo-saphenous shunt is a simple procedure, it does not require special devices and it can be applied with success in the treatment of refractory ascites.

[Longitudinal Wirsung gastrostomy in the surgical management of chronic pancreatitis]. / Wirsungo-Gastrostomia longitudinala în tratamentul chirurgical al pancreatitei cronice.

UNLABELLED: The longitudinal pancreatico-jejunostomy is a commonly used procedure in the management of the chronic pancreatitis with dilated pancreatic duct (Wirsung), however the drainage of the dilated pancreatic duct is realizable with longitudinal Wirsungo-gastrostomy to. We present one clinical case of chronic pancreatitis with dilated pancreatic duct, where the pancreatic drainage was realized with an anastomosis between the dilated Wirsung duct and the posterior wall of the stomach (longitudinal Wirsungo-gastrostomy). RESULTS: One year after Wirsungo-gastrostomy (postoperative reevaluation of the patient) a general well condition without subjective accuses, ponderal increase and stabile glucidic metabolism was found. CONCLUSION: The Wirsungo-gastrostomy could represent an alternative procedure in the management of the chronic pancreatitis with dilated pancreatic duct.

[Duodenum preserving cephalic pancreatectomy and pancreatico-gastrostomy in the surgical treatment of the chronic pancreatitis]. / Pancreatectomie cefalica cu pastrarea duodenului si pancreatico-gastrectomie în tratamentul chirurgical al pancreatitei cronice.

UNLABELLED: Cephalic pancreaticoduodenectomy had been introduced in surgery practice by O. Whipple, for the treatment for the cancer of ampulla of Vater, later this indication has also been extended to other pancreatic disorders including the cases of chronic pancreatitis. Cephalic pancreatectomy with the remaining of the duodenum used lately in the treatment of chronic pancreatic eliminates the disadvantages of the operation Whipple. Further on, we present a case of chronic pancreatitis where a cephalo-pancreatic resection has been done with the remaining of the duodenum, the pancreatic blunt being anastomosed with the stomach by pancreatico-gastrostomy, terminal-lateral, a cystoduodenostomy had being done to this patient. Ten months after the surgery, the patient is in a good general state, without subjective pain, putting weight, and a glucose metabolism without changes. CONCLUSIONS: Pancreatico-gastrostomy may represent a modality of solving the pancreatic blunt after the cephalic pancreatectomy with the remaining of the duodenum.

[The surgical treatment of the parastomal hernia using prolene mesh]. / Tratamentul chirurgical a eventratiilor parastomale cu plasa prolen.

UNLABELLED: Parastomal herniation is a frequent complication in enterostomy. The therapeutic strategy consists in three approaches: local fascial repair, relocation of the stoma, local repair of the parietal defect using nonabsorbable meshes. In our clinic between 1997-2002 we used monofilament meshes placed in sublay position at four patients with parastomal herniation. At three patients we used midline laparotomy placing the mesh round the colostomy on preperitoneal space, after preparing the hernia sack. The size of the mesh goes beyond the parastomal parietal defect with 3-5 cm. At the fourth patient we placed the mesh round the preperitoneal segment of the colon using a combined intraperitoneal and parastomal procedure, the size of the mesh going beyond parastomal parietal defect in this case too with 3-5 cm. The immediately and delayed results was favorable. CONCLUSIONS: The parastomal herniation's surgical repair applying prolen mesh can be a therapeutic alternative with good results.

[Multivisceral operations for carcinoma of the upper stomach and cardia]. / Operatii multiviscerale pentru cancerul gastric al polului superior si al cardiei.

In this study are noted technical problems regarding "en bloc" multiple organ resections and the anatomic and functional reconstruction for carcinoma of the upper stomach and cardia. From 1997 to 2002, a total of 264 patients with cancers of the stomach were operated in the service. 75 patients presented cancers localized at the proximal stomach and cardia (97.33% adenocc.). The rate of resectability was 27.77% (27 pt.). Types of operations in this series were: standard esophagogastrectomy in 7 patients; total gastrectomy with regional lymphadenectomy in 9 patients; 11 patients underwent "en bloc" multiple organ resection, with the removal of the stomach, partial or total esophagectomy and, occasionally, ablation of the spleen, pancreas, left hepatectomy, resection of the diaphragm and an extensive lymphadenectomy. Surgical mortality for the complex multivisceral resections was noted in 3 patients (8.88%). The global 5 years survival in the service is poor: 15.9%.

The application of shock waves in the treatment of delayed bone union and pseudoarthrosis in long bones.

Lithotripsis using shock waves generated extracorporeally was administered to 46 patients with pseudarthrosis or delayed union of long bone fractures. From 1500 to 3000 high energy shock waves were administered one time only on an outpatient basis. Anesthesia was not required. No complications were observed. Complete recovery was obtained in all 25 patients with delayed union, and in 12 of the 21 patients with pseudoarthrosis (57%). The initiation of callus formation was observed 6-12 weeks after treatment. These results confirm that bone union can be stimulated by shock waves. The treatment procedure, advantages, contraindications and reasons for failures are discussed. This method appears to be a valuable supplement to the treatment of bone union disturbances.

Synchronous intestinal tumors: aggressive jejunal carcinoid and sigmoid malignant polyp.

Association of aggressive jejunal carcinoid tumors and other primary gastrointestinal neoplasms are rarely observed. We describe the case of a synchronous jejunal carcinoid tumor and two colorectal polyps in a 78-year old woman. Surgical intervention was performed for the colorectal tumors and the carcinoid was incidentally found. It was well differentiated but was accompanied by lymph node metastasis and peritoneal carcinomatosis. In this case, the prognosis was not depending by the colorectal tumors but the aggressive feature of jejunal carcinoid lead to patient's death.