Measuring the level and content of consciousness during epileptic seizures: the Ictal Consciousness Inventory.

Ictal alterations of the level of general awareness and subjective content of consciousness play a pivotal role in the clinical phenomenology of epilepsy, and reflect the pathological involvement of different neurobiological substrates. However, no self-reported measures have been proposed for patients experiencing altered conscious states during seizures. This study describes the development and validation of a new scale for the quantitative assessment of the level and content of ictal consciousness, the Ictal Consciousness Inventory (ICI). The ICI is a 20-item questionnaire generated on the basis of interviews with patients, literature review, and consultation with experts. It was tested on a sample of 110 patients attending three different epilepsy clinics in Northern Italy, who also completed standardized clinical scales. Standard psychometric methods were used to demonstrate that this scale satisfies criteria for acceptability, reliability, and validity. The ICI is proposed as a user-friendly and clinically sound instrument for the measurement of ictal alterations of consciousness in patients with epilepsy.

Intrauterine volvulus without malrotation in a very low-birth-weight preterm infant.

Midgut volvulus without abnormalities of intestinal rotation/fixation is an extremely rare cause of acute intestinal obstruction in the neonatal period with a high morbidity and mortality. The authors describe an intrauterine volvulus without malrotation in a 970g preterm girl born at 27 weeks' gestation. The discrepancy between minimally evocatory clinical manifestations and severity of intestinal pathology is underscored. Resection of the necrotic bowel and primary end-to-end anastomosis within 30 hours of birth was followed by a favorable outcome. A literature review indicates a significant relation of intrauterine midgut volvulus without malrotation to preterm birth with low-birth-weight, immediate postnatal presentation and favorable prognosis.

[A case of surgical ligature of the sacro-iliac joint from Renaissance Central Italy]. / Un caso di legatura chirurgica sacro-iliaca di epoca rinascimentale dall'Italia Centrale.

The paper reports a case of interbone ligature between the sacrum and right ileum using copper wire in an adult woman whose skeleton, dating from approximately 1600-1700 A.D., was exhumed from the Church of Sant'Egidio in Borrello (Chieti). Having described the ligature and the techniques used, the Authors discuss the reasons for the operation. In conclusion, it is suggested that the most plausible hypothesis is that it represent an interbone ligature during the course of autopsy to allow the recomposition of a corpse with a sacro-ileal dislocation. The absence of signs of sacro-ileal dislocation caused by mechanical levers during the course of autopsy leads the Authors to suppose the sacro-ileal rupture occurred while the subject was still alive. The Authors therefore hypothesise that the woman died while giving birth following the laceration of the pubic symphysis and rupture of the right sacro-ileal joint. The hypothesis of a corpse restoration is also suggested.

[A paleopathological case of Stafne's defect of the mandible (the Rutigliano necropolis, Bari, 6th-4th century B.C.)]. / Un caso paleopatologico di difetto di Stafne della mandibola (necropoli di Rutigliano, Bari, VI-IV secolo a.C.)

Authors describes a paleopathological case of regional osseous atrophy of a human jaw dated from the Roman time and coming from Rutigliano (Bari). The atrophy was probably related to the compressive action of the lateral part of the submandibular salivary gland, such as the Stafne's defect. Authors discussed the differential diagnosis of this case and remarked the extreme rarity of this jaw pathology, especially in ancient times.

[The congenital absence of the permanent upper lateral incisors with the persistence of the deciduous canines in a subject of the Iron Age from the Sulmona (AQ) necropolis]. / Assenza congenita degli incisivi laterali superiori permanenti con persistenza dei canini decidui in un soggetto dell'età del Ferro della necropoli di Sulmona (AQ).

The paper reports a case of bilateral agenesia of the permanent upper lateral incisors associated with the persistence of the deciduous eye teeth placed between the first premolars and the permanent canine teeth which, in turn, had emerged in place of the agenetic lateral incisors (situs dentis inversus) in a adult male from the Iron Age whose skeletal remains were exhumed from tomb no. 58 of the Sulmona necropolis (AQ). The authors place the case in the context of agenesia as found both in today's population and in ancient times.

[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.

[Epididymitis in children: cause of acute scrotum]. / Epididimite in età pediatrica: una causa di scroto acuto.

The acute epididymitis in children is an uncommon disease which occurs mainly in adolescents. The pediatric surgeon must remember this illness whenever he observes a child with acute scrotum. The aim of this study is to review our experience at the Pediatric Surgery Department in Siena with 17 children (mean age: 7.53 years) underwent to surgery for acute scrotum and affected by primitive acute epididymitis without any other local or systemic associated disease. Our study shows that in children the acute epididymitis is more common than testicular torsion. It is often quite difficult to find the origin of epididymitis in children with no genito-urinary anomalies; so the acute scrotum and in particular the epididymitis require a standardized diagnostic and therapeutic approach based on an accurate physical exam, quickly feasible diagnostic procedures and a prompt surgical exploration of the scrotum.

[Prognostic aspects of esophageal ph-metry in infants with reflux]. / Aspetti prognostici nella pHmetria esofagea del lattante reflussore.

Gastroesophageal reflux (g.e.r.) is a very common event in children particularly in infants. Twenty-four-hour continuous esophageal pH monitoring has become the preferred test to quantify acid gastroesophageal reflux. It has a large sensitivity and specificity, but it does not allow a good prediction of esophagitis. The Authors show a computerized method to determine the area under the curve (a.u.c.) and the percentage of time at different pH levels. These parameters have shown the same sensitivity and specificity as DeMeester-Boix-Ochoa score. They directly relate the time of exposure and pH level in every reflux under pH 4 and so they suggest a better prognostic index. To improve this approach to g.e.r. we will need other studies with this method.

[Hypertrophic stenosis of the pyloric canal: genetic and familial incidence]. / Stenosi ipertrofica del canale pilorico: incidenza genetica e familiare.

The Authors hereby review the literature concerning hypertrophic pyloric stenosis, with particular reference to the genetic and familial influence. They present their cases of 49 children; out of these 3 pairs of biovular twins out of which only one of the twin babies was affected and 2 similar twins both of which were affected. In conclusion they are confirming the importance of a genetic component, influenced by environmental factors, on the origin of hypertrophic pyloric stenosis.

[Use of radionuclides in the evaluation of intestinal transit time in children with idiopathic constipation]. / Impiego dei radionuclidi nella valutazione dei tempi di transito intestinale in bambini affetti da stipsi idiopatica.

Colonic transit times, in patients with chronic idiopathic constipation, in the past were estimated using radiopaque markers. Currently they are evaluated with colonic scintigraphy, which employs 111In DTPA orally, added to the usual children's breakfast in a 0.05 mCi dose. Anterior views of the abdomen are obtained at 6th, 24th, 30th, 48th, 54th, 72nd hour using a gamma camera on a 128 x 128 matrix and stored on hard disk. These images are processed in successive times, and the colon is divided in three main segments: right-, left- and recto-sigmoid-colon. Total and segmental percentage retentions are evaluated in each interval time. 58 children (35 males and 23 females), aged 1-12 years (mean 8.13), referred for chronic idiopathic constipation at Pediatric Surgery Department of Siena, were studied between January 1990 and September 1996. This group was compared with a control group formed by 15 patients (9 males and 6 females) aged 3-14 years (mean 8.53). Cutoff values, obtained in this control group, allowed us to distinguish, among the 58 children with idiopathic constipation, 6 symptomatic patients with normal colonic transit times and 52 symptomatic patients with pathologic ones. In this last group the evaluation of segmentary colonic transit times allowed us to identify 13 patients (25%) with increased right colonic transit time, 19 (36.5%) with increased left colonic transit time and 20 (38.5%) with increased recto-sigmoidal colonic transit time. Statistical survey allowed to distinguish significantly pathological subjects from control group ones.

[Varicocelectomy by an inguinal approach. Our experience]. / Varicocelectomia per via inguinale. Nostra esperienza.

Varicocele is a dilatation of the spermatic plexus due to a pathologic venous reflux in the testes. It affects about 15-18% of adolescents. The modern diagnostic tools allow an early identification and a thorough staging. Surgical treatment in this phase seems to be useful for the preservation of gonad integrity. Recently, the interest in varicocele in pediatric surgery has increased because of the close relationship of this disease to male infertility. We performed a diagnostic-therapeutic protocol with a follow-up to evaluate the trophism and functional state of testes and to identify early recurrence of venous reflux. In our Institute, the surgical treatment usually performed is resection of spermatic plexus through an inguinal approach. This technique is simple, yields good outcome and has no morbidity.

[Infant and childhood mortality in some ancient populations from Abruzzo: paleodemographic and paleopathological implications]. / La mortalità nella prima e nella seconda infanzia in alcune popolazioni Abruzzesi antiche: implicazioni paleodemografiche e paleopathologiche.

The paleopathologic and paleodemographic study of skeletal samples of ancient populations from Abruzzo, Central Italy, yields data on the trends of infant mortality through the ages from the 7th century B.C. to the modern age. These data integrate the informations deriving from historic sources.

Total and segmental colon transit time in constipated children assessed by scintigraphy with 111In-DTPA given orally.

Serial colon scintigraphy using 111In-DTPA (2 MBq) given orally was performed in 39 children referred for constipation, and the total and segmental colon transit times were measured. The bowel movements during the study were recorded and the intervals between defecations (ID) were calculated. This method proved able to identify children with normal colon morphology (no. = 32) and those with dolichocolon (no. = 7). Normal children were not included for ethical reasons and we used the normal range determined by others using x-ray methods (29 +/- 4 hours). Total and segmental colon transit times were found to be prolonged in all children with dolichocolon (TC: 113.55 +/- 41.20 hours; RC: 39.85 +/- 26.39 hours; LC: 43.05 +/- 18.30 hours; RS: 30.66 +/- 26.89 hours). In the group of children with a normal colon shape, 13 presented total and segmental colon transit times within the referred normal value (TC: 27.79 +/- 4.10 hours; RC: 9.11 +/- 2.53 hours; LC: 9.80 +/- 3.50 hours; RS: 8.88 +/- 4.09 hours) and normal bowel function (ID: 23.37 +/- 5.93 hours). In the remaining children, 5 presented prolonged retention in the rectum (RS: 53.36 +/- 29.66 hours), and 14 a prolonged transit time in all segments. A good correlation was found between the transit time and bowel function. From the point of view of radiation dosimetry, the most heavily irradiated organs were the lower large intestine and the ovaries, and the level of radiation burden depended on the colon transit time. We can conclude that the described method results safe, accurate and fully diagnostic.

Testicular microliths: their origin and structure.

Light and electron microscopic studies were done on microliths in unilateral undescended testes to determine the origin and structure. The microliths seem to originate from degenerating intratubular cells and consist of a central calcified core surrounded by concentric layers of connective fibers.

Hypoplastic or absent mandibular frenulum: a new predictive sign of infantile hypertrophic pyloric stenosis.

Among 25 patients with hypertrophic pyloric stenosis, a hypoplastic or absent mandibular frenulum was noted in 92%, compared with 1.6% of 319 control infants (P <.001). This previously unrecognized sign may prove helpful in identifying newborns at risk of developing the disorder.

Congenital cystic adenomatoid malformation of the lung associated with esophageal atresia and tracheoesophageal fistula.

Bronchopulmonary malformations associated with esophageal atresia (EA) and tracheoesophageal fistula (TEF) are extremely rare. The authors describe a case of type II congenital cystic adenomatoid malformation (CCAM) of the right lower lobe associated with EA and TEF (Vogt-Gross type C) in a full-term female infant. The CCAM presented as an incidental radiologic finding, and a contralateral tension pneumothorax developed shortly after surgical repair of the EA. Early recognition of this rare association is essential for correct operative management.