Esophagopericardial fistula attributed to a barogenic rupture of the esophagus. Report of a case and review of the literature.

In this case we describe a fatal condition of esophagopericardial fistula secondary to barogenic rupture of the esophagus. The review of the literature disclosed only one fatal case (reported in 1968) of esophagopericardial fistula attributed to barogenic rupture of the esophagus. Early diagnosis and adequate treatment including pericardiocentesis along with intermittent drainage of the pericardium, full-course antibiotic therapy and a timely, well-planned surgical intervention will substantially improve the prognosis in this type of pathology. Patients similar to our case should be treated with either surgical bipolar esophageal exclusion (conservative disconnection) or esophagectomy combined with large drainage of the pericardial and mediastinal spaces. This case report reinforces the complexity of the diagnosis, and perhaps the need for clinical awareness and the inclusion of this entity in a differential diagnosis.

Determining the optimal time for consolidation after distraction osteogenesis.

The consolidation period, one of the biological factors participating in the distraction osteogenesis phenomenon, has not been elucidated. Parameters to assess new bone formation and consolidation in craniofacial distraction have been borrowed from the orthopedic experience. Up until now, the decision to discontinue distraction has been based more on personal experience than on objective data. By using Scintigraphy with Tc99 DP a method has been developed to accurately assess the termination of the consolidation phase. Scintigraphic evidence of consolidation was seen between the fourth and the fifth week after terminating distraction in infants (younger than 12 months). Not before the 10th week in children and between the 10th and the 14th week in adolescents and adults. The data roughly correlates with previous reports. It is believed that the consolidation period should be addressed in biologic terms and not in radiologic terms as done up until now. A method is proposed that offers objective qualitative and quantitative data for the noninvasive evaluation of bone consolidation which could have further applications in distraction of the craniofacial skeleton.

Serum Insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) in growing preterm infants on enteral nutrition.

We analyzed the range of serum concentrations of insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) and their inter-relationships with age and some parameters of nutritional and hormonal status in 46 growing preterm infants on enteral nutrition. 72 nutritional balances were performed, with a cross-sectional study design, at a mean age of 35.3 +/- 17.2 days, equivalent to a mean corrected age (gestational + postnatal age) of 36 +/- 2.3 weeks. Serum concentrations of IGF-I (mean 64 +/- 36 ng/ml) and IGFBP-3 (mean 1.15 +/- 0.53 mg/l) correlated significantly with each other (r = 0.46) and both correlated with body weight (r = 0.43 and 0.34), body length (r = 0.44 and 0.36) and serum concentrations of prealbumin, apolipoprotein A and cholesterol. IGF-I also correlated with urinary excretion of C-peptide (r = 0.32). There was a weak correlation between IGFBP-3 and postnatal age (r = 0.36) but no correlation between IGF-I and IGFBP-3 and correlated age or urinary excretion of growth hormone. In growing preterm infants, at least until 40 weeks of corrected age, serum concentrations of IGF-I and IGFBP-3 seem to be related principally to body weight, body length and nutritional factors, but not to growth hormone.

[Metabolic, hormonal and nutritional effects of long-term theophylline therapy in preterm infants: a case-control study]. / Effetti metabolici, ormonali e nutrizionali della terapia prolungata con teofillina nei nati pretermine: uno studio caso-controllo.

Theophylline is widely used in preterm newborns for the prevention of idiopathic apnoeas, but few controlled studies have evaluated its effects on the nutritional and hormonal status of the infant. For this reason we have studied the effect of long term theophylline administration on 16 laboratory parameters concerning the metabolism of proteins, glucose, lipids, hormones and the glomerular function (blood: hemoglobin, glucose, albumin, prealbumin, urea nitrogen, creatinine, cholesterol, triglycerides, apolipoproteins A-I and B-100, IGF-I, IGFBP-3; urine: urea nitrogen, creatinine, C-peptide, GH). A case-control study was performed on 18 healthy preterm infants who were receiving oral theophylline for the prevention of idiopathic apnoeas. The mean duration of therapy at the moment of the balance study was 31 days (SD 12, range 12-51), the mean daily dose was 4.2 mg/kg (SD 1.0), the plasma range of theophylline concentration was 5 to 15 mg/l. As controls, 18 healthy preterm infants of comparable post-conceptional age, body weight and calories/protein intake at the moment of the study, were selected if they had been never treated with theophylline. No statistically significant differences were found between the two groups for the growth velocity or any of the parameters studied. The only notable exception was hemoglobin, which was significantly lower in theophylline treated infants (mean values 10.5 vs 12.7 g/dl, p 0.005 at t test). In synthesis, long term theophylline treatment in preterm infants seems to be safe from the point of view of growth, glucose, protein and lipid metabolism, hormones and glomerular function, but further studies are needed on the effects of theophylline on neonatal erythropoiesis.

[Comparison of high-dose immunoglobulin and cyclosporine in newly diagnosed diabetic children]. / Confronto fra immunoglobuline ad alte dosi e ciclosporina in bambini diabetici all'esordio.

A controlled trial was carried out on type I diabetic children to evaluate and to compare the clinical effects of two different kinds of immunotherapy: high doses intravenous gammaglobulin (IVIgG) and cyclosporine A (CyA). 30 newly diagnosed patients were admitted to the trial, 10 of whom served as controls (group A), 10 received 400 mg/kg b.w. of IVIgG on 5 consecutive alternate days and subsequently after 15 days and monthly thereafter for up to six months (group B), 10 patients received CyA 5-10/kg b.w. by mouth in two daily doses for a period comprised between 6 and 18 months (group C). Serum post-prandial C-peptide level was significantly higher after 6 months in group B and C than in group A; after 12 months, only group C showed significantly higher values. This difference was no longer significative at 18 and 24 months. Insulin requirement in the treated groups was significantly lower than in control group at 6 months, this difference was no longer significative at 12 months. We didn't find any difference concerning insulin requirement during the study comparing the two groups treated with the two different immunosuppressive therapies. In 3 patients in group B and in 3 patients in group C we didn't observe any appreciable response to immunosuppressive therapy (defined as insulin requirement greater than 0.5 UI/kg b.w. at 6 months and/or greater than 0.8 UI/kg b.w. at 12 months). We couldn't find any significant difference between responders and not responders to the immunosuppressive therapies regarding age, symptoms lasting before the diagnosis, weight loss, ketoacidosis intensity and serum post-prandial C-peptide level at the onset.(ABSTRACT TRUNCATED AT 250 WORDS)

Tumoral markers (CA 125--CEA) in the screening of ovarian cancer.

Ovarian cancer has high rate of mortality among malignant gynecologic tumors. Because of its aggressiveness and low rate of 5 year survival of patients treated, it is important to realise a screening program for its early diagnosis. Today, immunologic research is directed to the study of tumoral markers that allow us to detect the presence of still clinically silent ovarian neoplasms. Some tumoral markers such as CEA and CA 125 are available for post-surgical monitoring of patients treated for ovarian cancer. The Authors have carried out a study to evaluate the possibility of their use in the depistage of ovarian neoplastic pathology. A blood sample was taken for the evaluation of serum CEA and CA 125 in a series of 520 patients older than 45 years, who did not complain signs or symptoms of pelvic pathology. A pathologic value for CEA was considered higher than 7.3 ng/ml and for CA 125 greater than 37 U/ml. For CEA 2.5% (13 cases) presented pathologic values compared to 2.88% (15 cases) for CA 125. One third of cases (0.5%) with high levels of CEA had repeated blood samples. 3 of them had confirmed high levels of CEA but echotomography performed in these patients was negative for pathologic ovarian masses. 15 patients had CA 125 high levels. 3 out of 15 cases repeated the blood sample that resulted normal. On 11 of these cases an echotomography was also performed that diagnosed a uterine myomatosis in 4 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[The laboratory in monitoring high-risk pregnancy]. / Il laboratorio nel monitoraggio della gravidanza a rischio.

108 cases of high-risk pregnancy are object of our investigation (gestosis, feto-placental insufficiency, chronic nephropathy, rhesus immunization). HCG, plasma estriol, HPL and beta1-SP1-glycoprotein have been studied. The simultaneous determination of the four hormones makes it possible to establish the degree of the pregnancy risk, eventual fetal suffering and the hormonal course of pregnancy.

[Esophageal and tracheal compression caused by vascular ring]. / Compresión traqueal y esofágica por anillo vascular.

Eight infants with anomalous vessels of the aortic arch were submitted to surgical operation of the structures interfering with tracheal and esophageal function. Four patients had an aberrant right subclavian artery; three had a double aortic arch with a left ligamentum arteriosum. None had congenital heart disease. One had a tracheoesophageal fistula and a short esophagus. Esophagograms and aortograms were performed in all. Tracheal and esophageal compression was relieved in the four boys and the four girls. All are alive and in good condition.

Diagnosis and treatment of pericarditis by the subxiphoid approach.

The subxiphoid approach for the diagnosis and treatment of pericarditis was used in 49 patients. Various diagnoses were established in 43 cases, and drainage was accomplished in 46. One patient died as a direct consequence of the procedure. Accidental right pneumothorax occurred in three cases. Total evacuation of the pericardial contents, direct inspection and palpation of structures, correction of unsuspected pathology and simultaneous biopsy of the pericardium and other tissues can be achieved, while avoiding the need for repeated pericardiocentesis. The procedure can be done safely under local anesthesia, providing prompt relief of abnormal hemodynamics and a sample for tissue diagnosis.